Transforming rural education in Colombia through family participation: The case of school as a learning community

Purpose: This article studies the impact of the implementation of learning communities in a rural context of Colombia, specifically concerning the improvements related to learning and social cohesion. Design/methodology/approach: This longitudinal case study analyses the process and the impacts of the transformation of a school in 2015 and the subsequent years of 2016 and 2017. The data analysed include standardized external tests, a documentary analysis of the school and interviews with students, family members and the schoolteacher. Findings: The results obtained indicate academic improvement within the school with results that exceed the national average of Colombia. The results also report how violence has been reduced by 80%. All of these outcomes were motivated by the participation of the community in the school. Practical implications: The conclusions drawn are relevant as they show a success case that overcame the difficulties related to the lack of accessibility and quality of rural education in Colombia

A research synthesis of the impacts of successful educational actions on student outcomes

Successful Educational Actions (SEAs) are school-based initiatives oriented to provide high-quality education for all students. Identified by the INCLUD-ED research project, SEAs have been implemented in schools in different countries and researchers have studied their implementation and the impacts achieved. We undertook a review and synthesis of research findings on the implementation of SEAs with three aims. First, identify different types of impacts on students (3-12 years), second, offer a unified and comprehensive framework, and thirdly, provide suggestions for further research. We identified 63 studies that met our inclusion criteria and were coded descriptively. The findings documented in our reviewed studies accounted for impacts on the individual level, comprising (1) students' instrumental learning and 2) self-esteem and motivation; on the group level, involving (3) enhancement of interpersonal relationships and (4) cohesion and conflict reduction; and on the community level, comprising (5) family involvement and change towards school and (6) absenteeism reduction. The synthesis concludes with a discussion of the implications of those findings and further research suggestions

Withdrawal of infliximab therapy in ankylosing spondylitis in persistent clinical remission, results from the REMINEA study

BackgroundRecent data suggest that anti-TNF doses can be reduced in ankylosing spondylitis (AS) patients. Some authors even propose withdrawing treatment in patients in clinical remission; however, at present there is no evidence to support this.ObjectiveTo assess how long AS patients with persistent clinical remission remained free of flares after anti-TNF withdrawal and to evaluate the effects of treatment reintroduction. We also analyze the characteristics of patients who did not present clinical relapse.MethodsMulticenter, prospective, observational study of a cohort of patients with active AS who had received infliximab as a first anti-TNF treatment and who presented persistent remission (more than 6months). We recorded at baseline and every 6-8weeks over the 12-month period the age, gender, disease duration, peripheral arthritis or enthesitis, HLA-B27 status, BASDAI, CRP, ESR, BASFI, and three visual analogue scales, spine global pain, spinal night time pain, and patient's global assessment.ResultsThirty-six out of 107 patients (34%) presented persistent remission and were included in our study. After treatment withdrawal, 21 of these 36 patients (58%) presented clinical relapse during follow-up. Infliximab therapy was reintroduced and only 52% achieved clinical remission, as they had before the discontinuation of infliximab; in an additional 10%, reintroduction of infliximab was ineffective, obliging us to change the anti-TNF therapy. No clinical or biological factors were associated with the occurrence of relapse during the follow-up.ConclusionsTwo thirds of patients in clinical remission presented clinical relapse shortly after infliximab withdrawal. Although the reintroduction of infliximab treatment was safe, half of the patients did not present the same clinical response that they had achieved prior to treatment withdrawal

Correlation of fatigue with other disease related and psychosocial factors in patients with rheumatoid arthritis treated with tocilizumab: ACT-AXIS study

To assess the hypothesis if tocilizumab (TCZ) is effective on disease activity, and also its effect in fatigue and other clinical and psychological disease-related factors in patients with rheumatoid arthritis (RA) treated with TCZ.A 24-week, multicenter, prospective, observational study in patients with moderate to severe RA receiving TCZ after failure or intolerance to disease-modifying antirheumatic drugs or tumor necrosis factor-alpha was conducted.Of the 122 patients included, 85 were evaluable for effectiveness (85% female, 51.9 ± 12.5 years, disease duration 8.7 ± 7.4 years). Mean change in C-reactive protein level from baseline to week 12 was -11.2 ± 4.0 (P < .001). Mean Disease Activity Index score (DAS28) decreased from 5.5 ± 1.0 at baseline to 2.7 ± 1.3 (P < .001) at week 24. Mean change in Functional Assessment of Chronic Illness Therapy score was -5.4 ± 11.2 points at week 24. Multiple regression analysis showed that the improvement in DAS28, sleep, and depression explained 56% and 47% of fatigue variance at week 12 and 24, respectively.Tocilizumab is effective in reducing disease activity and results in a clinically significant improvement in fatigue, pain, swollen joint count, morning stiffness, sleepiness, depression, and DAS28; the last 3 were specifically identified as factors explaining fatigue variance with the use of TCZ in RA patients

Cambios psicológicos en pacientes con espondiloartritis axial tratados con infliximab

Es conocido que los pacientes con enfermedades reumáticas presentan alteraciones psicológicas relacionadas con su enfermedad articular crónica. Algunos estudios reportan el beneficio de las terapias biológicas en las espondiloartritis (EsP), pero son pocos los datos acerca del impacto de los fármacos biológicos en los síntomas psicológicos. El objetivo del estudio fue el de analizar la influencia del tratamiento con un fármaco biológico anti-TNFα, infliximab (IFX), en los síntomas de ansiedad y depresión valorados mediante test psicológicos en pacientes con espondiloartritis y la relación con otros parámetros de actividad. Se analizaron 62 pacientes con EsP axial, 48 de ellos cumplieron criterios de Nueva York modificados para Espondilitis anquilosante (EA) y los 14 restantes, criterios de espondiloartritis indiferenciada de predominio axial (EsP Ind ax) del Grupo Europeo de Estudio de Espondiloartritis. Se reclutaron pacientes de 12 centros hospitalarios distribuidos por la geografía de Cataluña. Los pacientes recibieron IFX a dosis de 5mg/kg en infusión e.v. en la semana 0, 2, 6 y cada 8 semanas posteriormente. Se recogieron a nivel basal y a las 22 semanas, los siguientes datos: analíticos (VSG, PCR), de exploración física con número de articulaciones tumefactas (NAT), de actividad de la enfermedad (BASDAI), de dolor (EPN para dolor nocturno y global), de evaluación global de la enfermedad por el paciente (EGP), de función física (BASFI), metrológicos (prueba de Schöber modificada y prueba dedo-suelo). Durante la infusión en Hospital de Día, los pacientes cumplimentaron los tests psicológicos, para ansiedad (STAI-E/R, con punto de corte > 7) y ansiedad y depresión (HADS, con punto de corte > 11, con subescalas HADD con punto de corte de 7 y HADA con punto de corte 10). El estudio estadístico comparativo de las variables continuas basales y a las 22 semanas y entre subgrupos (EA y EsP Indif ax) se realizó mediante test de t de Student y de Wilcoxon, y las variables categóricas se compararon con los tests de McNemar´s y de Wilcoxon. El análisis multivariado de regresión logística binaria se realizó considerando HADS > 3 como variable dependiente. Los resultados mostraron una disminución significativa de los valores de HADS a las 22 semanas, con media de 16.78 (DE: 7.90) que pasó a 12.12 (DE: 7.1), con p<0.001. Las escalas de HADD decreció de una mediana de 8 (RIC: 5-12) a una de 4 (RIC: 1-8), p<0.001 y en HADA la mediana basal fue de 8 (RIC: 5-12) que pasó a 6(RIC: 3-10). También se observó una reducción significativa en la proporción de pacientes con alteración psicológica, de 74.2% a 41.9% y en el estudio por separado, de depresión (HADD) de un 59.7% a un 41.6%. Otros parámetros como también mostraron mejoría significativa: VSG, PCR, NAT, dolor noche y global, EGP, índices de BASDAI y BASFI. En el estudio multivariado, sólo la VSG (OR: 0.98-0.99) y el BASFI basal (OR:0.42-0.99) mostraron ser las dos variables independientes de la mejoría de HADS. Por tanto, los pacientes con alta actividad y disfunción física basal fueron los que mostraron una alta probabilidad de mejoría psicológica con infliximab a las 22 semanas de inicio del tratamiento.Patients with chronic inflammatory rheumatic disease are known to present frequently associated psychological disorders. Several studies have reported the benefit of biological therapies in spondyloarthritis (SpA), but there are few data regarding its impact on psychological symptoms and well-being. The purpose of this study was to analyze the influence of infliximab as an anti-TNFα therapy on self-reported indices of anxiety and depression in patients with axial chronic SpA and their relation to the main disease activity parameters. We analized 62 patients with SpA, according to the New York modified criteria for 48 Ankylosing Spondilytis and to the European Spondyloarthropathy Study Group for 14 undifferentiated axial SpA, fulfilling Spanish Rheumatology Society criteria for biological therapy. They were enrolled in a prospective multicentric observational study participating 12 hospitals from Catalonia. They received 5 mg/Kg infliximab iv infusion at 0, 2, 6 and every 8 weeks thereafter. At baseline and at 22 weeks patients were assessed for demographic variables, number of swollen joints (NSJ), analytical parameters (ESR and CRP), mobility indices (Schöber modified test and fingertip-to-Floor distance), BASDAI (disease activity) and BASFI (functional status) questionnaires, numerical rate scale (NRS) for pain at night and at total day, and also for self-reported global patient assessment (GPA) of disease activity. Patients were also assessed for self-reported anxiety (STAI-R and STAI-S questionnaires) and psychological disorder (HADS, with cutpoint at >11 points) and its subscales for anxiety (HADA, from 10 points) and depression (HADD, from 7 points). Continuous variables at baseline and at 22 weeks were compared with Student t or Wilcoxon tests, while categorical variables were compared with McNemar’s or Wilcoxon’s tests. A multivariate Binary Logistic Regression analysis was performed taking a > 3 points decrease in the HADS score as the dependent variable. The results showed that HADS score decreased significantly at 22 weeks. The median were from 16,78 (SD:7.90) at baseline to 12,12 (SD:7.09), p 11), from 74.2% to 41.9%, p=0,029, and with definite depression (HADD score > 7) from 59,7,2% to 41.6%, p=0.01. Other parameters improved significantly as expected, including NSJ, Schöber modified test, ESR, CRP, NRS for pain (at night, total), GPA of disease activity, BASDAI and BASFI indices. In the multivariate analysis, only ESR (OR: 0.908 – 0.996) and BASFI (OR: 0,422 - 0,990) were found to contribute significantly to the improving of HADS. In conclusion, patients with axial spondyloarthritis who received infliximab presented a high incidence of psychological disorders that improve after 22 weeks of therapy assessed by the HADS validated self-reported test. High values of VSG and BASFI were significant predictors of such improvement

Cambios psicológicos en pacientes con espondiloartritis axial tratados con infliximab

Es conocido que los pacientes con enfermedades reumáticas presentan alteraciones psicológicas relacionadas con su enfermedad articular crónica. Algunos estudios reportan el beneficio de las terapias biológicas en las espondiloartritis (EsP), pero son pocos los datos acerca del impacto de los fármacos biológicos en los síntomas psicológicos. El objetivo del estudio fue el de analizar la influencia del tratamiento con un fármaco biológico anti-TNFα, infliximab (IFX), en los síntomas de ansiedad y depresión valorados mediante test psicológicos en pacientes con espondiloartritis y la relación con otros parámetros de actividad. Se analizaron 62 pacientes con EsP axial, 48 de ellos cumplieron criterios de Nueva York modificados para Espondilitis anquilosante (EA) y los 14 restantes, criterios de espondiloartritis indiferenciada de predominio axial (EsP Ind ax) del Grupo Europeo de Estudio de Espondiloartritis. Se reclutaron pacientes de 12 centros hospitalarios distribuidos por la geografía de Cataluña. Los pacientes recibieron IFX a dosis de 5mg/kg en infusión e.v. en la semana 0, 2, 6 y cada 8 semanas posteriormente. Se recogieron a nivel basal y a las 22 semanas, los siguientes datos: analíticos (VSG, PCR), de exploración física con número de articulaciones tumefactas (NAT), de actividad de la enfermedad (BASDAI), de dolor (EPN para dolor nocturno y global), de evaluación global de la enfermedad por el paciente (EGP), de función física (BASFI), metrológicos (prueba de Schöber modificada y prueba dedo-suelo). Durante la infusión en Hospital de Día, los pacientes cumplimentaron los tests psicológicos, para ansiedad (STAI-E/R, con punto de corte > 7) y ansiedad y depresión (HADS, con punto de corte > 11, con subescalas HA01 con punto de corte de 7 y HADA con punto de corte 10). El estudio estadístico comparativo de las variables continuas basales y a las 22 semanas y entre subgrupos (EA y EsP Indif ax) se realizó mediante test de t de Student y de Wilcoxon, y las variables categóricas se compararon con los tests de McNemaŕs y de Wilcoxon. El análisis multivariado de regresión logística binaria se realizó considerando HADS > 3 como variable dependiente. Los resultados mostraron una disminución significativa de los valores de HADS a las 22 semanas, con media de 16.78 (DE: 7.90) que pasó a 12.12 (DE: 7.1), con p 0.001. Las escalas de HA01 decreció de una mediana de 8 (RIC: 5-12) a una de 4 (RIC: 1-8), p 0.001 y en HADA la mediana basal fue de 8 (RIC: 5-12) que pasó a 6(RIC: 3-10). También se observó una reducción significativa en la proporción de pacientes con alteración psicológica, de 74.2% a 41.9% y en el estudio por separado, de depresión (HA01) de un 59.7% a un 41.6%. Otros parámetros como también mostraron mejoría significativa: VSG, PCR, NAT, dolor noche y global, EGP, índices de BASDAI y BASFI. En el estudio multivariado, sólo la VSG (OR: 0.98-0.99) y el BASFI basal (OR:0.42-0.99) mostraron ser las dos variables independientes de la mejoría de HADS. Por tanto, los pacientes con alta actividad y disfunción física basal fueron los que mostraron una alta probabilidad de mejoría psicológica con infliximab a las 22 semanas de inicio del tratamientoPatients with chronic inflammatory rheumatic disease are known to present frequently associated psychological disorders. Several studies have reported the benefit of biological therapies in spondyloarthritis (SpA), but there are few data regarding its impact on psychological symptoms and well-being. The purpose of this study was to analyze the influence of infliximab as an anti-TNFα therapy on self-reported indices of anxiety and depression in patients with axial chronic SpA and their relation to the main disease activity parameters. We analized 62 patients with SpA, according to the New York modified criteria for 48 Ankylosing Spondilytis and to the European Spondyloarthropathy Study Group for 14 undifferentiated axial SpA, fulfilling Spanish Rheumatology Society criteria for biological therapy. They were enrolled in a prospective multicentric observational study participating 12 hospitals from Catalonia. They received 5 mg/Kg infliximab iv infusion at 0, 2, 6 and every 8 weeks thereafter. At baseline and at 22 weeks patients were assessed for demographic variables, number of swollen joints (NSJ), analytical parameters (ESR and CRP), mobility indices (Schöber modified test and fingertip-to-Floor distance), BASDAI (disease activity) and BASFI (functional status) questionnaires, numerical rate scale (NRS) for pain at night and at total day, and also for self-reported global patient assessment (GPA) of disease activity. Patients were also assessed for self-reported anxiety (STAI-R and STAI-S questionnaires) and psychological disorder (HADS, with cutpoint at >11 points) and its subscales for anxiety (HADA, from 10 points) and depression (HADD, from 7 points). Continuous variables at baseline and at 22 weeks were compared with Student t or Wilcoxon tests, while categorical variables were compared with McNemar's or Wilcoxon's tests. A multivariate Binary Logistic Regression analysis was performed taking a > 3 points decrease in the HADS score as the dependent variable. The results showed that HADS score decreased significantly at 22 weeks. The median were from 16,78 (SD:7.90) at baseline to 12,12 (SD:7.09), p 0.001. Also a reduction was observed in the proportion of patients with psychological disorder (HADS > 11), from 74.2% to 41.9%, p=0,029, and with definite depression (HADD score > 7) from 59,7,2% to 41.6%, p=0.01. Other parameters improved significantly as expected, including NSJ, Schöber modified test, ESR, CRP, NRS for pain (at night, total), GPA of disease activity, BASDAI and BASFI indices. In the multivariate analysis, only ESR (OR: 0.908 - 0.996) and BASFI (OR: 0,422 - 0,990) were found to contribute significantly to the improving of HADS. In conclusion, patients with axial spondyloarthritis who received infliximab presented a high incidence of psychological disorders that improve after 22 weeks of therapy assessed by the HADS validated self-reported test. High values of VSG and BASFI were significant predictors of such improvement

Palindromic Rheumatism: Just a Pre-rheumatoid Stage or Something Else?

Palindromic rheumatism (PR), a unique clinical entity, has a characteristic clinical presentation with a relapsing/remitting course. It is established that most patients with PR evolve to chronic disease, of which rheumatoid arthritis (RA) is by far the most common. The relationship between PR and RA is unclear, with similarities and differences between the two, and not all patients evolve to RA in the long-term. Therefore, PR is clearly a pre-RA stage for most, but not all, patients. Autoimmunity plays a substantial role in PR, with the same characteristic autoantibody profile observed in RA, although with some differences in the immune response repertoire. Autoinflammation may also be relevant in some cases of PR. Prognostic factors for RA progression are identified but their exact predictive value is not clear. There are several unmet needs in PR, such as the diagnostic criteria and clinical case definition, the pathogenic mechanisms involved in the unusual clinical course, and the evolution to RA, and our understanding of the therapeutic strategy that could best avoid progression to persistent and potentially destructive arthritis.Peer reviewe

sj-docx-1-tab-10.1177_1759720X221114105 – Supplemental material for Plasma calprotectin as a biomarker of ultrasound synovitis in rheumatoid arthritis patients receiving IL-6 antagonists or JAK inhibitors

Supplemental material, sj-docx-1-tab-10.1177_1759720X221114105 for Plasma calprotectin as a biomarker of ultrasound synovitis in rheumatoid arthritis patients receiving IL-6 antagonists or JAK inhibitors by Beatriz Frade-Sosa, Andrés Ponce, José Inciarte-Mundo, Rosa Morlà, Viginia Ruiz-Esquide, Laura Macías, Ana Belen Azuaga, Julio Ramirez, Juan D. Cañete, Jordi Yague, Josep M. Auge, José A. Gomez-Puerta and Raimon Sanmarti in Therapeutic Advances in Musculoskeletal Disease</p