Social Role Participation and the Life Course in Healthy Adults and Individuals with Osteoarthritis: Are We Overlooking the Impact on the Middle-Aged?

Research Highlights: •Individuals with OA report greater health care utilization and coping efforts than healthy adults •Middle-aged participants report greater stress and role conflict •Middle-aged adults with osteoarthritis report more role limitations and health care utilization •Role perceptions and age are important in understanding the relationship of OA to health outcomesLittle is known about life course differences in social role participation among those with chronic diseases. This study examined role salience (i.e., importance), role limitations, and role satisfaction among middle- and older-aged adults with and without osteoarthritis (OA) and its relationship to depression, stress, role conflict, health care utilization and coping behaviours. Participants were middle- and older-aged adults with OA (n = 177) or no chronic disabling conditions (n = 193), aged ≥40 years. Respondents were recruited through community advertising and clinics in Ontario, Canada (2009-2010). They completed a 45-50 minute telephone interview and 20 minute self-administered questionnaire assessing demographics (e.g., age, gender); health (e.g., pain, functional limitations, health care utilization); the Social Role Participation Questionnaire (SRPQ) (role salience, limitations, satisfaction in 12 domains), and psychological variables (e.g., depression, stress, role conflict, behavioural coping). Analyses included two-way ANOVAs, correlations, and linear regression. Results indicated that middle-aged adults (40-59 years) reported greater role salience than older-aged adults (60+ years). Middle-aged adults with OA reported significantly greater role limitations and more health care utilization than all other groups. Middle-aged adults and those with OA also reported greater depression, stress, role conflict, and behavioural coping efforts than older adults or healthy controls. Controlling for age and OA, those with higher role salience and greater role limitations reported more health care utilization. Those with greater role limitations and lower role satisfaction reported greater depression, stress, role conflict, and behavioural coping. This study has implications for research and interventions, highlighting the need to characterize role participation as multidimensional. It points to the importance of taking into account the meaning of roles at different ages among those with chronic diseases like OA when developing interventions to help understand the impact of roles on psychological well-being.Canadian Institutes of Health Research(CIHR

Perceived personal importance of exercise and fears of re-injury: a longitudinal study of psychological factors related to activity after anterior cruciate ligament reconstruction

Abstract Background Psychological perceptions are increasingly being recognized as important to recovery and rehabilitation post-surgery. This research longitudinally examined perceptions of the personal importance of exercise and fears of re-injury over a three-year period post anterior cruciate ligament (ACL) reconstruction. Stability and change in psychological perceptions was examined, as well as the association of perceptions with time spent in different types of physical activity, including walking, household activities, and lower and higher risk for knee injury activities. Methods Participants were athletes, 18–40 years old, who underwent ACL reconstruction for first-time ACL injuries. They were recruited from a tertiary care centre in Toronto, Canada. Participants completed interviewer-administered questionnaires pre-surgery and at years one, two and three, postoperatively. Questions assessed demographics, pain, functional limitations, perceived personal importance of exercise, fear of re-injury and physical activities (i.e., walking; household activities; lower risk for knee injury activities; higher risk for knee injury activities). Analyses included fixed-effect longitudinal modeling to examine the association of a fear of re-injury and perceived personal importance of exercise and changes in these perceptions with the total hours spent in the different categories of physical activities, controlling for other factors. Results Baseline participants were 77 men and 44 women (mean age = 27.6 years; SD = 6.2). At year three, 78.5% of participants remained in the study with complete data. Fears of re-injury decreased over time while personal importance of exercise remained relatively stable. Time spent in walking and household activities did not significantly change with ACL injury or surgery. Time spent in lower and higher risk of knee injury physical activity did not return to pre-injury levels at three years, post-surgery. Greater time spent in higher risk of knee injury activities was predicted by decreases in fears of re-injury and by greater personal importance of exercise. Conclusions This study highlights not only fears of re-injury, which has been documented in previous studies, but also the perceived personal importance of exercise in predicting activity levels following ACL reconstructive surgery. The findings can help in developing interventions to aid individuals make decisions about physical activities post knee injury and surgery

Airway microecology in rifampicin-resistant and rifampicin-sensitive pulmonary tuberculosis patients

Abstract Background Pulmonary tuberculosis is a chronic infectious disease of the respiratory system. It is still one of the leading causes of death from a single infectious disease, but it has been stuck in the study of a single pathogen. Recent studies have shown that many diseases are associated with disruption of the native microbiota. In this study we investigated the occurrence of tuberculosis and the correlation between drug resistance and respiratory flora. High-throughput 16 S rRNA gene sequencing was used to characterize the respiratory microbiota composition of 30 tuberculosis (TB) affected patients and compared with 30 healthy (H) controls. According to their Gene Xpert results, 30 pulmonary tuberculosis patients were divided into 12 persons in the drug-sensitive group (DS0) and 18 persons in the drug-resistant group (DR0). The microbial flora of the two were compared with the H group. Results The data generated by sequencing showed that Firmicutes, Proteus, Bacteroides, Actinomyces and Fusobacterium were the five main bacterial phyla detected, and they constituted more than 96% of the microbial community. The relative abundances of Fusobacterium, Haemophilus, Porphyromonas, Neisseria, TM7, Spirochetes, SR1, and Tenericutes in the TB group was lower than that of the H group, and Granulicatella was higher than the H group. The PcoA diagrams of the two groups had obvious clustering differences. The Alpha diversity of the TB group was lower than that of the H group, and the Beta diversity was higher than that of the H group (P < 0.05). The relative abundance of Streptococcus in the DS0 group was significantly higher than that in the DR0 group (P < 0.05). Conclusion Pulmonary tuberculosis can cause disorders of the respiratory tract microbial flora, in which the relative abundance of Streptococcus was significantly different between rifampicin-sensitive and rifampicin-resistant patients

Gene mutations as a non-invasive measure of adult cochlear implant performance: Variable outcomes in patients with select TMPRSS3 mutations.

BackgroundThe cochlear implant (CI) has proven to be a successful treatment for patients with severe-to-profound sensorineural hearing loss, however outcome variance exists. We sought to evaluate particular mutations discovered in previously established sensory and neural partition genes and compare post-operative CI outcomes.Materials and methodsUtilizing a prospective cohort study design, blood samples collected from adult patients with non-syndromic hearing loss undergoing CI were tested for 54 genes of interest with high-throughput sequencing. Patients were categorized as having a pathogenic variant in the sensory partition, pathogenic variant in the neural partition, pathogenic variant in both sensory and neural partition, or with no variant identified. Speech perception performance was assessed pre- and 12 months post-operatively. Performance measures were compared to genetic mutation and variant status utilizing a Wilcoxon rank sum test, with PResultsThirty-six cochlear implant patients underwent genetic testing and speech understanding measurements. Of the 54 genes that were interrogated, three patients (8.3%) demonstrated a pathogenic mutation in the neural partition (within TMPRSS3 genes), one patient (2.8%) demonstrated a pathogenic mutation in the sensory partition (within the POU4F3 genes). In addition, 3 patients (8.3%) had an isolated neural partition variance of unknown significance (VUS), 5 patients (13.9%) had an isolated sensory partition VUS, 1 patient (2.8%) had a variant in both neural and sensory partition, and 23 patients (63.9%) had no mutation or variant identified. There was no statistically significant difference in speech perception scores between patients with sensory or neural partition pathogenic mutations or VUS. Variable performance was found within patients with TMPRSS3 gene mutations.ConclusionThe impact of genetic mutations on post-operative outcomes in CI patients was heterogenous. Future research and dissemination of mutations and subsequent CI performance is warranted to elucidate exact mutations within target genes providing the best non-invasive prognostic capability