The footwear experiences of people wth Gout- a qualitative study

Abstract Background: Footwear is an important concern for people with gout, who often describe difficulty finding suitable footwear. Previous studies have identified footwear as a major concern for people with gout. The aim of this study was to carry out an exploration of the footwear experiences of people with gout. Methods: A qualitative descriptive methodological approach was used for both data collection and analysis. A purposive sampling strategy was adopted with semi-structured interviews conducted, involving 11 participants with gout. Thematic analysis was employed to identify key meanings and patterns within the data. Results: Four key themes derived from interviews included; (1) comfort as a priority, (2) knowing what to buy, (3) knowing what to wear, and (4) challenges of different environments. Footwear comfort was of great importance and linked to characteristics of footwear, with uncomfortable footwear negatively influencing participation in daily activities. The balancing of comfort, appearance and cost, led to less options and reduced confidence when shoe shopping. Footwear use was further limited by the presence of foot tophi and flares, resulting in compromise of footwear choice. Environments such as formal settings and the workplace, led to different footwear requirements. Conclusion: People with gout experience problems with footwear which can impact many aspects of life. Health care professionals should consider these footwear-related issues to help facilitate those with gout in finding appropriate footwear. Keywords: Gout, Footwear, Qualitative researc

Footwear interventions for foot pain, function, impairment and disability for people with foot and ankle arthritis : a literature review

Objective: To conduct a literature review on the effectiveness of footwear on foot pain, function, impairment and disability for people with foot and ankle arthritis. Methods: A search of the electronic databases Scopus, Medline, CINAHL, SportDiscus and the Cochrane Library was undertaken in September 2017. The key inclusion criteria were studies reporting on findings of footwear interventions for people with arthritis with foot pain, function, impairment and/or disability. The Quality Index Tool was used to assess the methodological quality of studies included in the qualitative synthesis. The methodological variation of the included studies was assessed to determine the suitability of meta-analysis and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Between and within group effect sizes were calculated using Cohen’s d. Results: 1440 studies were identified for screening with 11 studies included in the review. Mean (range) quality scores were 67% (39%-96%). The majority of studies investigated rheumatoid arthritis (n=7), but also included gout (n=2), and 1st metatarsophalangeal joint osteoarthritis (n=2). Meta-analysis and GRADE assessment were not deemed appropriated based on methodological variation. Footwear interventions included off-the-shelf footwear, therapeutic footwear and therapeutic footwear with foot orthoses. Key footwear characteristics included cushioning and a wide toe box for rheumatoid arthritis; cushioning, midsole stability and a rocker-sole for gout; and a rocker-sole for 1st metatarsophalangeal joint osteoarthritis. Between group effect sizes for outcomes ranged from 0.01-1.26. Footwear interventions were associated with reductions in foot pain, impairment and disability for people with rheumatoid arthritis. Between group differences were more likely to be observed in studies with shorter follow-up periods in people with rheumatoid arthritis (12 weeks). Footwear interventions improved foot pain, function and disability in people with gout and foot pain and function in 1st metatarsophalangeal joint osteoarthritis. Footwear interventions were associated with changes to plantar pressure in people with rheumatoid arthritis, gout and 1st metatarsophalangeal joint osteoarthritis and walking velocity in people with rheumatoid arthritis and gout. Conclusion: Footwear interventions are associated with reductions in foot pain, impairment and disability in people with rheumatoid arthritis, improvements to foot pain, function and disability in people with gout and improvements to foot pain and function in people with 1st metatarsophalangeal joint osteoarthritis. Footwear interventions have been shown to reduce plantar pressure rheumatoid arthritis, gout and 1st metatarsophalangeal joint osteoarthritis and improve walking velocity in rheumatoid arthritis and gout

Foot Pain, Impairment and Disability in Patients With Acute Gout Flares; A Prospective Observational Study

Objectives: The aim of this study was to evaluate the impact of acute gout on foot pain, impairment and disability. Methods: This prospective observational study recruited 20 patients with acute gout flares. Patients were recruited from emergency departments, hospital wards and rheumatology outpatient clinics throughout Auckland, New Zealand. Patients were recruited at the time of the flare (baseline visit) and then reassessed at a follow-up visit once the acute flare had resolved 6-8 weeks after the initial assessment. Joint counts, C-reactive protein and serum urate were recorded at both visits. General and foot-specific outcome measures were also recorded at each visit including pain visual analogue scale, Health Assessment Questionnaire (HAQ)-II, Lower Limb Tasks Questionnaire, and the Leeds Foot Impact Scale. Results: The foot was affected by acute gout in 14 (70%) patients. Objective measures of joint inflammation including swollen and tender joint counts and C-reactive protein significantly improved at the follow-up visit, compared with the baseline visit. At baseline, high levels of foot pain, impairment and disability were reported. All patient-reported outcome measures of general and foot-specific musculoskeletal function improved at the follow-up visit compared with the baseline visit. However, pain, impairment and disability scores did not entirely normalise after resolution of the acute gout flare. Conclusions: Patients with acute gout flares experience severe foot pain, impairment and disability. These data provide further support for improved management of gout to prevent the consequences of poorly controlled disease

Feeding-associated gene expression in sheep scab mites (Psoroptes ovis)

The mite Psoroptes ovis is the causative agent of sheep scab. Although not usually fatal, the disease can spread rapidly and is a serious animal welfare concern. Vaccine development against ectoparasites has primarily focussed on two sources of candidate vaccine antigens – “exposed” antigens that are secreted in saliva during feeding on a host and “concealed” antigens that are usually expressed in the parasite gut and may be involved in digestion. Here, we sought to identify genes encoding proteins important for mite feeding and digestion by a subtractive suppressive hybridisation approach comparing mRNA transcript abundance in “fed” and “starved” mites. The study identified a variety of genes which are up-regulated by feeding mites. These included group 1, 5, 7 and 13 allergens including the previously described cysteine protease Pso o 1. In addition, numerous novel genes were identified here including some encoding potential salivary gland proteins and others encoding proteins which may facilitate feeding such as a serum opacity factor. An olfactory receptor-like protein was identified in the starved mite population which may help the mite to identify a host

Perfectionism and training distress in junior athletes: A longitudinal investigation

Perfectionistic athletes may train harder and for longer than non-perfectionistic athletes, leaving them susceptible to elevated levels of training distress. So far, however, no study has investigated the relationships between perfectionism and training distress, a key indicator of overtraining syndrome. Furthermore, no study has determined psychological predictors of overtraining syndrome. Using a two-wave design, the present study examined perfectionistic strivings, perfectionistic concerns, and training distress in 141 junior athletes (mean age 17.3 years, range 16-19 years) over 3 months of active training. Multiple regression analyses were employed to test cross-sectional and longitudinal relationships between perfectionism and training distress. In all analyses, perfectionism emerged as a significant predictor, but strivings and concerns showed differential relationships. When the cross-sectional relationships were regarded, perfectionistic concerns positively predicted training distress (p .05). The findings suggest that sports scientists who wish to identify athletes at risk of overtraining syndrome may monitor athletes’ perfectionistic concerns as a possible risk factor

Molecular characterization, expression and localization of a peroxiredoxin from the sheep scab mite, Psoroptes ovis

The sheep scab mite, Psoroptes ovis, induces an intensely pruritic exudative dermatitis which is responsible for restlessness, loss of appetite and weight loss. Within the first 24 h of infection, there is a rapid inflammatory influx of eosinophils and apoptosis of the keratinocytes at the site of infection. The former cell type is capable of a sustained respiratory burst, toxic products of which may directly damage the mite and also contribute to lesion formation. Analysis of a P. ovis expressed sequence tag (EST) database identified a number of antioxidant enzyme-encoding sequences, including peroxiredoxin (thioredoxin peroxidase EC 1.11.1.15), all of which may help the mite endure the potentially toxic skin environment. A full length sequence encoding Po-TPx, a protein of 206 amino acids which showed high homology to a peroxiredoxin from the salivary gland of the tick Ixodes scapularis, was amplified from P. ovis cDNA. Recombinant Po-TPx was expressed in bacteria and antiserum to this protein was used to localize native Po-TPx in mite sections. Peroxiredoxin was localized, amongst other sites, to a subpharyngeal region in mite sections. The recombinant protein was recognized by sera from sheep infested with the mite suggesting that it may be secreted or excreted by the mite and interact with the host immune response

Therapeutic Challenge with a CDK 4/6 Inhibitor Induces an RB-Dependent SMAC-Mediated Apoptotic Response in Non-Small Cell Lung Cancer.

Purpose: The retinoblastoma tumor suppressor (RB), a key regulator of cell-cycle progression and proliferation, is functionally suppressed in up to 50% of non-small cell lung cancer (NSCLC). RB function is exquisitely controlled by a series of proteins, including the CyclinD-CDK4/6 complex. In this study, we interrogated the capacity of a CDK4/6 inhibitor, palbociclib, to activate RB function. Experimental Design and Results: We employed multiple isogenic RB-proficient and -deficient NSCLC lines to interrogate the cytostatic and cytotoxic capacity of CDK 4/6 inhibition in vitro and in vivo We demonstrate that while short-term exposure to palbociclib induces cellular senescence, prolonged exposure results in inhibition of tumor growth. Mechanistically, CDK 4/6 inhibition induces a proapoptotic transcriptional program through suppression of IAPs FOXM1 and Survivin, while simultaneously augmenting expression of SMAC and caspase-3 in an RB-dependent manner. Conclusions: This study uncovers a novel function of RB activation to induce cellular apoptosis through therapeutic administration of a palbociclib and provides a rationale for the clinical evaluation of CDK 4/6 inhibitors in the treatment of patients with NSCLC