Validation of the italian version of the 5-item compliance questionnaire for rheumatology (i-cqr5) and a cross-sectional study on treatment adherence in rheumatoid arthritis patients

Background The 5-item Compliance Questionnaire for Rheumatology (CQR5) allows the identification of patients likely be high adherers (HA) to anti-rheumatic treatment (i.e. taking ≥80% of their medications correctly), or “low” adherers (LA). The objective of the entire study was to validate an Italian version of I-CQR5 in rheumatoid arthritis (RA) patients. Furthermore, a cross-sectional analysis was conducted to investigate what factors are associated with high treatment adherence. Methods RA patients (with disease duration >1 year, undergoing treatment with ≥1 self-administered biological disease-modifying anti-rheumatic drugs (bDMARDs) or conventional synthetic DMARDs (csDMARDs), willing and capable of completing the questionnaire unaided) were enrolled in the study. The cross-cultural adaptation into Italian and validation of I-CQR5 followed standardized guidelines. The I-CQR5 was completed by patients on one occasion. Data were subjected to Partial Credit model Parametrisation (PCM) to assess the construct validity and reliability of I-CQR5. Patients who gave consent to retrieve their clinical data were included in the analysis of factors associated with high adherence to anti-rheumatic treatment. Factors included were demographic and social characteristics of the patients, and clinical and treatment information. Factors achieving a p<0.10 in univariate analysis were included in a multivariate regression analysis. Separate models were conducted in the entire cohort and in the csDMARD only- and bDMARD- treated groups. Results Among 604 RA patients, 401 were eligible for the analysis: 274 patients were included in the validation analysis and 328 in the cross-sectional analysis. Median age of the patients was 57 years (48-134), most were females (232, 82%), median disease duration was 12 years (7-19); 64.3% (193/300) of patients was treated with bDMARDs and 54.6% (107/300) with csDMARD treatment; 90.3% (270/299) of the patients was in low disease activity or 1 remission. Issues regarding the adaptation of CQR5 were discussed and solved by an expert committee assessment. The I-CQR5 was well understood by patients. Factor analysis and PCM confirmed the construct validity, unidimensionality and internal consistency of the I- CQR5. HA were found to be 35.2% (109/310) of the patients: 40.2% (79/193) in patients treated with bDMARDs and 22.4% (24/107) with csDMARDs only. bDMARD treatment and employment were found to be independently associated with high adherence: OR 2.88 (1.36-6.1), p=0.006 and OR 2.36 (1.21-4.62), p=0.012 respectively. Older age, lower education level, higher prednisone daily dose, use of a csDMARD (particulary hydroxychloroquine and sulfasalazine) and higher patient-VAS were significantly more frequent in LA compared with HA but the association was not confirmed by the multivariate analysis. No independent predictors were found in the group of patients treated with csDMARDs only. Employment was also positively and significantly associated with high adherence considering patients treated with bDMARDs: OR 2.89 (1.3-6.44), p=0.009. Conclusions Only one third of Italian RA patients were found to be highly adherent to treatment according to the I-CQR5. Treatment with bDMARDs and employment status were the major determinants, increasing by almost 3-fold the likelihood of being adherent. Age, education level, PDN daily dose, and patient global assessment on a visual analogic scale, might contribute in explaining adherence in RA patients

Adherence in Rheumatoid Arthritis patients assessed with a validated Italian version of the 5-item compliance questionnaire for rheumatology

OBJECTIVES: The 5-item Compliance Questionnaire for Rheumatology (CQR5) proved reliability and validity in respect of identification of patients likely to be high adherers (HAs) to anti-rheumatic treatment, or low adherers (LAs), i.e. taking<80% of their medications correctly. The objective of the study was to validate an Italian version of CQR5 (I-CQR5) in rheumatoid arthritis (RA) patients and to investigate factors associated with high adherence. METHODS: RA patients, undergoing treatment with ≥1 self-administered conventional synthetic disease-modifying anti-rheumatic drug (csDMARD) or biological DMARD (bDMARD), were enrolled. The cross-cultural adaptation and validation of I-CQR5 followed standardised guidelines. I-CQR5 was completed by patients on one occasion. Data were subjected to factor analysis and Partial Credit model Parametrisation (PCM) to assess construct validity of I-CQR5. Analysis of factors associated with high adherence included demographic, social, clinical and treatment information. Factors achieving a p<0.10 in univariate analysis were included in multivariable analysis. RESULTS: Among 604 RA patients, 274 patients were included in the validation and 328 in the analysis of factors associated with adherence. Factor analysis and PCM confirmed the construct validity and consistency of I-CQR5. HAs were found to be 109 (35.2%) of the patients. bDMARD treatment and employment were found to be independently associated with high adherence: OR 2.88 (1.36-6.1), p=0.006 and OR 2.36 (1.21-4.62), p=0.012, respectively. CONCLUSIONS: Only one-third of RA patients were HAs according to I-CQR5. bDMARDs and employment status increased by almost 3-fold the likelihood of being highly adherent to the anti-rheumatic treatment.Peer reviewe

Validation of the Italian version of the educational needs assessment tool in rheumatoid arthritis patients and factors associated with educational needs

The educational needs assessment tool (ENAT) is a seven-domain questionnaire assessing the educational needs (EN) of patients with rheumatoid arthritis (RA). The aim of this study was to validate the Italian version of the ENAT and to identify factors associated with EN in people with RA. The original English ENAT version was translated into Italian according to Beaton's method and subjected to Rasch analysis for validity testing. Socio-demographic and clinical variables were tested for associations with the ENAT domain scores using a multivariable linear regression model. The ENAT translated well into Italian and retained its construct validity. Some adjustments were needed when pooling the Italian and English datasets. The overall score of the ENAT had a high median: 82.8 (interquartile range (IQR): 57.5 to 100) i.e., 72.4% of the maximum score. The highest score was observed in the domain "Arthritis process" and the lowest was in "Support systems". Only gender was independently associated with EN (females having higher EN than males). The Italian ENAT is feasible for the use in the clinical setting and may help the health care practitioners to tailor educational interventions for RA patients. The characteristics of the patients, particularly female gender, may be associated with higher EN

Viviparity and habitat restrictions may influence the evolution of male reproductive genes in tsetse fly (Glossina) species

11openInternationalInternational coauthor/editorBackground Glossina species (tsetse flies), the sole vectors of African trypanosomes, maintained along their long evolutionary history a unique reproductive strategy, adenotrophic viviparity. Viviparity reduces their reproductive rate and, as such, imposes strong selective pressures on males for reproductive success. These species live in sub-Saharan Africa, where the distributions of the main sub-genera Fusca, Morsitans, and Palpalis are restricted to forest, savannah, and riverine habitats, respectively. Here we aim at identifying the evolutionary patterns of the male reproductive genes of six species belonging to these three main sub-genera. We then interpreted the different patterns we found across the species in the light of viviparity and the specific habitat restrictions, which are known to shape reproductive behavior. Results We used a comparative genomic approach to build consensus evolutionary trees that portray the selective pressure acting on the male reproductive genes in these lineages. Such trees reflect the long and divergent demographic history that led to an allopatric distribution of the Fusca, Morsitans, and Palpalis species groups. A dataset of over 1700 male reproductive genes remained conserved over the long evolutionary time scale (estimated at 26.7 million years) across the genomes of the six species. We suggest that this conservation may result from strong functional selective pressure on the male imposed by viviparity. It is noteworthy that more than half of these conserved genes are novel sequences that are unique to the Glossina genus and are candidates for selection in the different lineages. Conclusions Tsetse flies represent a model to interpret the evolution and differentiation of male reproductive biology under different, but complementary, perspectives. In the light of viviparity, we must take into account that these genes are constrained by a post-fertilization arena for genomic conflicts created by viviparity and absent in ovipositing species. This constraint implies a continuous antagonistic co-evolution between the parental genomes, thus accelerating inter-population post-zygotic isolation and, ultimately, favoring speciation. Ecological restrictions that affect reproductive behavior may further shape such antagonistic co-evolution.openSavini, Grazia; Scolari, Francesca; Ometto, Lino; Rota-Stabelli, Omar; Carraretto, Davide; Gomulski, Ludvik M.; Gasperi, Giuliano; Abd-Alla, Adly M. M.; Aksoy, Serap; Attardo, Geoffrey M.; Malacrida, Anna R.Savini, G.; Scolari, F.; Ometto, L.; Rota-Stabelli, O.; Carraretto, D.; Gomulski, L.M.; Gasperi, G.; Abd-Alla, A.M.M.; Aksoy, S.; Attardo, G.M.; Malacrida, A.R

An umbrella review of systematic reviews with meta-analyses evaluating positive and negative outcomes of hydroxychloroquine and chloroquine therapy

Background & aims: Hydroxychloroquine (HCQ) and chloroquine (CQ) are anti-malarial drugs frequently used in the rheumatologic field. Recently they were identified as possible therapeutic options against Coronavirus Disease (COVID-19). Therefore, the present study aimed to map and grade the diverse health outcomes associated with HCQ/CQ using an umbrella review approach. Methods: Umbrella review of systematic reviews of observational and intervention studies. For observational studies, random-effects summary effect size, 95% confidence interval, and 95% prediction interval were estimated. We also assessed heterogeneity, evidence for small-study effect and evidence for excess significance bias. The quality of evidence was then graded using validated criteria from highly convincing to weak. The evidence from randomized-controlled trials (RCTs) was graded using the GRADE tool. Results: From 313 articles returned, 6 meta-analyses were included (n = 25 outcomes). Among meta-analyses of observational studies, HCQ/CQ is weakly associated with a reduced risk for cardiovascular events and diabetes when used for autoimmune diseases; it is also associated with higher risk of death when used for COVID-19 and with spontaneous abortion. Among meta-analyses of RCTs, HCQ/CQ is associated with an improvement of articular manifestations of the rheumatic diseases. Conclusions: There is high evidence of the efficacy of HCQ/CQ in the rheumatologic field. The lack of evidence for efficacy and risk of death associated with the use of HCQ/CQ for COVID-19, indicate the inappropriateness of its inclusion in recent COVID-19 therapy guidelines and urgent need for Randomised Controlled Trials to determine their eventual appropriateness as a therapy in that circumstance

Woody aboveground biomass mapping of the brazilian savanna with a multi-sensor and machine learning approach

The tropical savanna in Brazil known as the Cerrado covers circa 23% of the Brazilian territory, but only 3% of this area is protected. High rates of deforestation and degradation in the woodland and forest areas have made the Cerrado the second-largest source of carbon emissions in Brazil. However, data on these emissions are highly uncertain because of the spatial and temporal variability of the aboveground biomass (AGB) in this biome. Remote-sensing data combined with local vegetation inventories provide the means to quantify the AGB at large scales. Here, we quantify the spatial distribution of woody AGB in the Rio Vermelho watershed, located in the centre of the Cerrado, at a high spatial resolution of 30 metres, with a random forest (RF) machine-learning approach. We produced the first high-resolution map of the AGB for a region in the Brazilian Cerrado using a combination of vegetation inventory plots, airborne light detection and ranging (LiDAR) data, and multispectral and radar satellite images (Landsat 8 and ALOS-2/PALSAR-2). A combination of random forest (RF) models and jackknife analyses enabled us to select the best remote-sensing variables to quantify the AGB on a large scale. Overall, the relationship between the ground data from vegetation inventories and remote-sensing variables was strong (R2 = 0.89), with a root-mean-square error (RMSE) of 7.58 Mg ha−1 and a bias of 0.43 Mg ha−1

Comparative Genomic Analysis of six Glossina Genomes, Vectors of African Trypanosomes

Background: Tsetse flies (Glossina sp.) are the vectors of human and animal trypanosomiasis throughout subSaharan Africa. Tsetse flies are distinguished from other Diptera by unique adaptations, including lactation and the birthing of live young (obligate viviparity), a vertebrate blood-specific diet by both sexes, and obligate bacterial symbiosis. This work describes the comparative analysis of six Glossina genomes representing three sub-genera: Morsitans (G. morsitans morsitans, G. pallidipes, G. austeni), Palpalis (G. palpalis, G. fuscipes), and Fusca (G. brevipalpis) which represent different habitats, host preferences, and vectorial capacity. Results: Genomic analyses validate established evolutionary relationships and sub-genera. Syntenic analysis of Glossina relative to Drosophila melanogaster shows reduced structural conservation across the sex-linked X chromosome. Sex-linked scaffolds show increased rates of female-specific gene expression and lower evolutionary rates relative to autosome associated genes. Tsetse-specific genes are enriched in protease, odorant-binding, and helicase activities. Lactation-associated genes are conserved across all Glossina species while male seminal proteins are rapidly evolving. Olfactory and gustatory genes are reduced across the genus relative to other insects. Visionassociated Rhodopsin genes show conservation of motion detection/tracking functions and variance in the Rhodopsin detecting colors in the blue wavelength ranges. Conclusions: Expanded genomic discoveries reveal the genetics underlying Glossina biology and provide a rich body of knowledge for basic science and disease control. They also provide insight into the evolutionary biology underlying novel adaptations and are relevant to applied aspects of vector control such as trap design and discovery of novel pest and disease control strategies

Comparative genomic analysis of six Glossina genomes, vectors of African trypanosomes.

BACKGROUND Tsetse flies (Glossina sp.) are the vectors of human and animal trypanosomiasis throughout sub-Saharan Africa. Tsetse flies are distinguished from other Diptera by unique adaptations, including lactation and the birthing of live young (obligate viviparity), a vertebrate blood-specific diet by both sexes, and obligate bacterial symbiosis. This work describes the comparative analysis of six Glossina genomes representing three sub-genera: Morsitans (G. morsitans morsitans, G. pallidipes, G. austeni), Palpalis (G. palpalis, G. fuscipes), and Fusca (G. brevipalpis) which represent different habitats, host preferences, and vectorial capacity. RESULTS Genomic analyses validate established evolutionary relationships and sub-genera. Syntenic analysis of Glossina relative to Drosophila melanogaster shows reduced structural conservation across the sex-linked X chromosome. Sex-linked scaffolds show increased rates of female-specific gene expression and lower evolutionary rates relative to autosome associated genes. Tsetse-specific genes are enriched in protease, odorant-binding, and helicase activities. Lactation-associated genes are conserved across all Glossina species while male seminal proteins are rapidly evolving. Olfactory and gustatory genes are reduced across the genus relative to other insects. Vision-associated Rhodopsin genes show conservation of motion detection/tracking functions and variance in the Rhodopsin detecting colors in the blue wavelength ranges. CONCLUSIONS Expanded genomic discoveries reveal the genetics underlying Glossina biology and provide a rich body of knowledge for basic science and disease control. They also provide insight into the evolutionary biology underlying novel adaptations and are relevant to applied aspects of vector control such as trap design and discovery of novel pest and disease control strategies