A pragmatic randomised controlled trial of hydrotherapy and land exercises on overall well being and quality of life in rheumatoid arthritis

Background \ud Hydrotherapy is highly valued by people with rheumatoid arthritis yet few studies have compared the benefits of exercises in heated water against exercises on land. In particular, data on quality of life is rarely reported. This is especially important because patients treated with hydrotherapy often report an enhanced sense of well-being. We report a randomised controlled trial in which we compared the effects of hydrotherapy with exercises on land on overall response to treatment, physical function and quality of life in patients with rheumatoid arthritis. \ud \ud Methods \ud One hundred and fifteen patients with RA were randomised to receive a weekly 30-minute session of hydrotherapy or similar exercises on land for 6 weeks. Our primary outcome was a self-rated global impression of change – a measure of treatment effect on a 7-point scale ranging from 1(very much worse) to 7 (very much better) assessed immediately on completion of treatment. Secondary outcomes including EuroQol health related quality of life, EuroQol health status valuation, HAQ, 10 metre walk time and pain scores were collected at baseline, after treatment and 3 months later. Binary outcomes were analysed by Fisher's exact test and continuous variables by Wilcoxon or Mann-Whitney tests. \ud \ud Results \ud Baseline characteristics of the two groups were comparable. Significantly more patients treated with hydrotherapy (40/46, 87%) were much better or very much better than the patients treated with land exercise (19/40, 47.5%), p < 0.001 Fisher's exact test. Eleven patients allocated land exercise failed to complete treatment compared with 4 patients allocated hydrotherapy (p = 0.09). Sensitivity analyses confirmed an advantage for hydrotherapy if we assumed non-completers would all not have responded (response rates 70% versus 38%; p < 0.001) or if we assumed that non-completers would have had the same response as completers (response rates 82% versus 55% p = 0.002). Ten metre walk time improved after treatment in both cases (median pre-treatment time for both groups combined 10.9 seconds, post-treatment 9.1 s, and 3 months later 9.6 s). There was however no difference between treatment groups. Similarly there were no significant differences between groups in terms of changes to HAQ, EQ-5D utility score, EQ VAS and pain VAS. \ud \ud Conclusion \ud Patients with RA treated with hydrotherapy are more likely to report feeling much better or very much better than those treated with land exercises immediately on completion of the treatment programme. This perceived benefit was not reflected by differences between groups in 10-metre walk times, functional scores, quality of life measures and pain scores

Children as Pawns of US Immigration Policy

The highly publicized imposition and retraction of the “family separation” border policy by the current U.S. Administration was not an anomaly in U.S. history. In this manuscript, we place these troubling recent events in the context of decades of U.S. immigration policies and politics. We then describe the consequences of family separation and other current immigration policies on child health. We end with a call to action: Pediatricians and other advocates for child health should demand a new direction in immigration policy that stops the use of children as pawns. Instead, the United States should adopt as a fundamental guiding principle support for children and families, both abroad and at home

Castes and polymorphisms in Neotropical Social Wasps

Neotropical social wasps have a set of chimeric characteristics that make them unique and difficult to fit into current theories on the evolution of social behavior (Noll and Wenzel, Biol J Linn Soc 93: 509-22, 2008). Among them, the presence of more than one functional queen (polygyny), absence of strong morphological differentiation, and flexibility between casts result in relaxation of ovarian control and breeding opportunity for workers (West-Eberhard, Science 200: 441-3, 1978; Noll, Sociobiology 60: 347-54, 2013). Adding to these particularities, the Polistinae wasps, especially those belonging to the Epiponini, reached a great radiation and evolutionary success in the Neotropical region due to the unique mode of social organization: colony foundation by a swarm (Jeanne, The swarm-founding Polistinae. In: Ross KG, Matthews RW (eds) The social biology of wasps. Cornell University Press, Ithaca, pp 191-231, 1991), where several or many reproductive females (queens) tolerate each other laying eggs. This chapter deals in general with aspects of the complex caste delimitation, the division of labor in the colony, the recruitment and foraging, and the lack of colony in social wasps, with emphasis on swarm founders.Universidade Estadual Paulista Júlio de Mesquita FilhoFaculdade de Filosofia Ciências e Letras de Ribeirão Preto-USPUniversidade Estadual Paulista Júlio de Mesquita Filh