Using self-regulation assessment to explore associations between self-regulation, participation and health-related quality of life in a rehabilitation population

Objective: Self-regulation, participation and health-related quality of life are important rehabilitation outcomes. The aim of this study was to explore associations between these outcomes in a multi-diagnostic and heterogenic group of former rehabilitation patients.Methods: This cross-sectional survey used the Self-Regulation Assessment (SeRA), Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation) and the Patient-Reported-Outcome-Measurement-System (PROMIS) ability and PROMIS satisfaction with participation in social roles, and the EuroQol-5L-5D and PROMIS-10 Global Health. Regression analyses, controlling for demographic and condition-related factors, were performed.Results: Respondents (n=563) had a mean age of 56.5 (standard deviation (SD) 12.7) years. The largest diagnostic groups were chronic pain disorder and brain injury. In addition to demographic and condition-related factors, self-regulation subscales explained 0–15% of the variance in participation outcome scores, and 0–22% of the variance in HRQoL outcome scores. Self-regulation subscales explained up to 22% of the variance in satisfaction subscales of participation (USER-Participation and PROMIS) and the mental health subscale of the PROMIS-10. Self-regulation subscales explained up to 11% of the restriction and frequency subscales of participation (USER-Participation) and the physical health subscale of the PROMIS-10.Conclusion: Self-regulation is more strongly associated with outcomes such as satisfaction with participation and mental health compared with outcomes such as restrictions in participation and physical health.</p

Healthcare utilization patterns for knee and hip osteoarthritis before and after changes in national health insurance coverage:A data linkage study from the Netherlands

Introduction: Medical guidelines aim to stimulate stepped care for knee and hip osteoarthritis, redirecting treatments from hospitals to primary care. In the Netherlands, this development was supported by changing health insurance coverage for physio/exercise therapy. The aim of this study was to evaluate healthcare utilization patterns before and after health changes in health insurance coverage. Method: We analyzed electronic health records and claims data from patients with osteoarthritis in the knee (N =32,091) and hip (N = 16,313). Changes between 2013 and 2019 in the proportion of patients treated by the general practitioner, physio/exercise therapist or orthopedic surgeon within 6 months after onset were assessed. Results: Joint replacement surgeries decreased for knee (OR 0.47 [0.41–0.54]) and hip (OR 0.81 [0.71–0.93]) osteoarthritis between 2013–2019. The use of physio/exercise therapy increased (knee: OR 1.38 [1.24–1.53], hip: OR 1.26 [1.08–1.47]). However, the proportion treated by a physio/exercise therapist decreased for patients that had not depleted their annual deductibles (knee: OR 0.86 [0.79 – 0.94], hip: OR 0.90 [0.79 – 1.02]). This might be affected by the inclusion of physio/exercise therapy in basic health insurance in 2018. Conclusion:We have found a shift from hospitals to primary care in knee and hip osteoarthritis care. However, the use of physio/exercise therapy declined after changes in insurance coverage for patients that had not depleted their deductibles

Challenging the challenge hypothesis on testosterone in fathers: Limited meta-analytic support

In fathers testosterone levels are suggested to decrease in the context of caregiving, but results seem inconsistent. In a meta-analysis including 50 study outcomes with N = 7,080 male participants we distinguished three domains of research, relating testosterone levels to parental status (Hedges’ g = 0.22, 95% CI: 0.09 to 0.35; N = 4,150), parenting quality (Hedges’ g = 0.14, 95% CI: 0.03 to 0.24; N = 2,164), and reactivity after exposure to child stimuli (Hedges’ g = 0.19, 95% CI: -0.03 to 0.42; N = 766). The sets of study outcomes on reactivity and on parenting quality were both homogeneous. Parental status and (higher) parenting quality were related to lower levels of testosterone, but according to conventional criteria combined effect sizes were small. Moderators did not significantly modify combined effect sizes. Results suggest that publication bias might have inflated the meta-analytic results, and the large effects of pioneering but small and underpowered studies in the domains of males’ parental status and parenting quality have not been consistently replicated. Large studies with sufficient statistical power to detect small testosterone effects and, in particular, the moderating effects of the interplay with other endocrine systems and with contextual determinants are required

Nocebo Hyperalgesia in Patients With Fibromyalgia and Healthy Controls:An Experimental Investigation of Conditioning and Extinction Processes at Baseline and 1-Month Follow-up

Nocebo effects are adverse treatment outcomes that are not ascribed to active treatment components. Potentially, their magnitude might be higher in patients with chronic pain compared to healthy controls since patients likely experience treatment failure more frequently. The current study investigated group differences in the induction and extinction of nocebo effects on pressure pain at baseline (N = 69) and 1-month follow-up (N = 56) in female patients with fibromyalgia and matched healthy controls. Nocebo effects were first experimentally induced via classical conditioning combined with instructions on the pain-increasing function of a sham transcutaneous electrical nerve stimulation device, then decreased via extinction. One month later, the same procedures were repeated to explore their stability. Results suggest that nocebo effects were induced in the healthy control group during baseline and follow-up. In the patient group, nocebo effects were only induced during follow-up, without clear group differences. Extinction was only observed during baseline in the healthy control group. Further comparisons of nocebo effects and extinction indicated no significant changes across sessions, possibly suggesting their overall magnitudes were stable over time and across groups. In conclusion, contrary to our expectations, patients with fibromyalgia did not have stronger nocebo hyperalgesia; instead, they might be less responsive to nocebo manipulations than healthy controls. Perspective: The current study is the first to investigate group differences in experimentally manipulated nocebo hyperalgesia between chronic pain and healthy populations at baseline and 1-month follow-up. Since nocebo effects are common in clinical settings, their investigation in different populations is essential to explain and minimize their adverse effects during treatment.</p

The rat androgen receptor gene promoter

The androgen receptor (AR) is activated upon binding of testosterone or dihydrotestosterone and exerts regulatory effects on gene expression in androgen target cells. To study transcriptional regulation of the rat AR gene itself, the 5' genomic region of this gene was cloned from a genomic library and the promoter was identified. S1-nuclease protection analysis showed two major transcription start sites, located between 1010 and 1023 bp upstream from the translation initiation codon. The area surrounding these start sites was cloned in both orientations in a CAT reporter plasmid. Upon transfection of the constructs into COS cells, part of the promoter stimulated transcription in an orientation-independent manner, but the full promoter showed a higher and unidirectional activity. In the promoter/reporter gene constructs, transcription initiated from the same positions as in the native gene. Sequence analysis showed that the promoter of the rat AR gene lacks typical TATA and CCAAT box elements, but one SP1 site is located at about 60 bp upstream from the major start site of transcription. Other possible promoter elements are TGTYCT sequences at positions -174 to -179, -434 to -439., -466 to -471, and -500 to -505, resembling half-sites of the glucocorticoid-responsive element (GRE). Furthermore, a homopurine stretch containing a total of 8 GGGGA elements and similar to sequences that are present in several other GC-rich promoters, is located between -89 and -146 bp upstream from the major start site of transcriptio

Effects of vasopressin on neural processing of infant crying in expectant fathers

Multivariate analysis of psychological dat