Absence Of Significant Improvement Research Articles

Training Health Professionals to Support Patients with Appearance-Affecting Conditions

Multidisciplinary health professionals (HPs) are involved in supporting patients who have conditions that affect their appearance. With appearance-associated distress common in this group, acceptance and commitment therapy (ACT) and enhanced communication skills both show effectiveness in helping patients adjust to their conditions. Multidisciplinary HPs are perfectly placed to provide low-level psychological support as paraprofessionals. We present the real-world evaluation of a training programme, ACT Now, which was delivered via the train-the-trainer model to 149 multidisciplinary HPs in six European countries. Trainees completed a 16-item knowledge, attitude and practice survey covering psychoeducation on appearance concerns, ACT applied to the patient group and communication skills, at pre-training, post-training and at 3-or-6-month follow-up. Findings show that trainees’ confidence consistently improved in understanding specific facets of appearance concerns and ACT processes, with largely positive changes in other facets, skewed towards delivery nations in which psychologists delivered the training. Patient communication skills generally improved, though again these were more pronounced in psychologist-led countries. However, an absence of significant improvements in ACT comprehension suggests a challenge in transmitting the ACT model to HPs. Providing more initial training to non-psychologist trainers and embedding post-training skills practice for trainees may help reinforce the ACT component of the training.

SANOGENESIS OF PAIN SYNDROMES CAUSED BY DEGENERATIVE-DYSTROPHIC SPINE DAMAGE

Aim. Explore different treatment approaches for degenerative-dystrophic damage of the spine and formulate the most effective treatment methods, their stage from accounting pathogenetic basis of pain syndromes.
 Research methods – bibliosemantic, comparative, systemic.
 Results. Diverse treatments for degenerative-dystrophic damage of the spine does not facilitate but even complicates general practitioner’s work due to the fact that information on clinical benefits of various drugs and techniques as well as various types of surgery is too contradictory; there is no single method of consistent, combination therapy for vertebrogenic pain. There is no universal therapy or surgery that would provide sustainable relief of symptoms of nonspecific back pain and/or radicular syndrome. The pathogenesis of development of specific clinical manifestations of the disease and the ratio of clinical manifestations and pathomorphological changes are crucial in choosing the treatment. The general principles of treatment are unchanged: rest, analgesics and movement should be combined in appropriate sanogenic proportions in each case. Reduction of oedema and swelling of the intervertebral disc and the spinal nerve root, nerve endings are crucial in regression of pain syndrome. There is no doubt that nonsteroidal anti-inflammatory drugs (NSAIDs) are the most effective in relieving lumbar and radicular pain at the beginning of treatment. In the absence of significant improvement after the use of NSAIDs and the necessary sanogenic motor loads, a more dynamic treatment should be used. First of all, different methods of local administration of pharmacological drugs: starting with the banal subcutaneous injection of painful areas and finishing with ultrasound and MRI-controlled injections directly into the area around the damaged nerve root, the epidural space, or the facet joint. In most cases, epidural injections can reach areas of disc-radicular conflict – after the drug is injected into the epidural space, favourable conditions are created for diffusion of glucocorticoids (or other pharmacological agents) into surrounding tissues, as well as the nerve root, regardless of its compression or irritation.
 Conclusions. And only after the ineffectiveness of NSAIDs and puncture treatments, as well as epidural injection and in the case of persistent mechanical compression of nerve roots in comparison with clinical manifestations, appropriate surgical treatments, both minimally invasive and open, are necessary.

Environmental and Energy Implications of Meat Consumption Pathways in Sub-Saharan Africa

In sub-Saharan Africa (SSA), diets are largely based on cereal or root staple crops. Together with socio-cultural change, economic and demographic growth could boost the demand for meat, with significant environmental repercussions. We model meat consumption pathways to 2050 for SSA based on several scenarios calibrated on historical demand drivers. To assess the consequent environmental impact, we adopt an environmentally-extended input-output (EEIO) framework and apply it on the EXIOBASE 3.3 hybrid tables. We find that, depending on the interplay of resources efficiency and demand growth, by 2050 the growth in meat consumption in SSA could cause a growth in greenhouse gases emissions of 1.4 [0.9–1.9] Gt CO2e/yr (~175% of current regional agriculture-related emissions), which is an extension of cropping and grazing-related land of 15 [12.5–21] · 106 km2 (one quarter of today’s global agricultural land), the consumption of an additional 36 [29–47] Gm3/yr of blue water (nearly doubling the current regional agricultural consumption), an eutrophication potential growth of 7.6 [4.9–9.5] t PO4e/yr, and the consumption of additional 0.9 [0.5–1.4] EJ/yr of fossil fuels and 49 [32–73] TWh/yr of electricity. These results suggest that—in the absence of significant improvements in the regional sectoral resource efficiency—meat demand growth in SSA is bound to become a major global sustainability challenge. In addition, we show that a partial substitution of the protein intake from the expected growth in meat consumption with plant-based alternatives carries additional significant potential for mitigating environmental impacts. The policies affecting both farming practices and dietary choices will thus have a significant impact on the SSA and global environmental flows.

Liver fibrosis assessment by transient elastography in patients with liver cirrhosis after hepatitis C virus eradication

Direct-acting antivirals (DAAs) therapy is associated with fibrosis regression in patients with hepatitis C virus liver cirrhosis.Aim. To study the dynamic of liver fibrosis in cirrhotic patients with a DAAs-induced sustained virological response (SVR).Materials and methods. The retrospective cohort study included 80 cirrhotic patients (male — 43%, median age 54 years). Liver stiffness (LS) was measured by transient elastography before treatment and after SVR. Patients with LS improvement ≥30% were included in group 1, other patients — in group 2. Clinical, laboratory and instrumental parameters were assessed. Independent risk factors for the absence of LS improvement ≥30% were determined by binary logistic regression with the definition of odds ration (OR) and 95% confidence interval (CI).Results. LS reduced from 21.35 (15.2; 27.7) to 13.5 [10.1; 20.0] kPa (p < 0.001), the median reduction was 5.1 [2.6; 11.0] kPa. Regression of fibrosis from F4 to F2 and F3 stages was observed in 16 (20%) and 19 (24%) of cases, respectively. Overall, 36 patients were included in group 1, 44 patients — in group 2. Platelet counts increased in group 1 compared to group 2 by 24.5% vs 5.2% (p = 0.014), a disappearance or reducing the size of esophageal varices were observed in 72% vs. 35% of cases (p = 0.035). Significant differences in ALT, AST, albumin, prothrombin time dynamics were not observed. Baseline albumin level ≤35 g/l is an independent risk factor for the absence of significant improvement of LS: OR 6.7 (95% CI 1.7–25.9, p = 0.006).Conclusion. SVR leads to fibrosis regression to F2-F3 stages in 44% of patients. Baseline albumin level ≤35 g/l is an independent risk factor for the absence of significant improvement of LS.

Impact of aerobic water running training on peripheral immune-endocrine markers of overweight-obese women

Summary Objective The purpose of this study was to evaluate the effect of water running training on immune-endocrine parameters evaluated in peripheral blood of overweight-obese women. Methods Eleven sedentary overweight-obese women (age 48.81 ± 12.87 years; body mass index 34.56 ± 4.08 kg/m 2 ) participated of 12-week of aerobic water running training in a heated swimming pool (70 minutes/session; 3×/week). In addition, nine women matched to age and body mass index were recruited to sedentary control group (age 49.9 ± 10.5 years; body mass index 33.05 ± 3.45 kg/m 2 ). Serum levels of interleukin-6 (IL-6), interleukin-10 (IL-10), interleukin-17a (IL-17a), interferon-gamma (INF-γ), tumor necrosis factor-alpha (TNF-α), salivary cortisol, and the peripheral frequency of CD3+CD4+ and CD3+CD8+ T cells were evaluated before and after 12 weeks in exercised individuals and after 12 weeks in control subjects. In addition, anthropometric measurements (body mass, % of body fat and trunk circumferences) and functional capacity (VO 2Peak and time to exhaustion) were also evaluated. Results After 12 weeks of exercise training, serum adiponectin ( P = 0.030), IL-10 ( P = 0.01) and TNF-α ( P = 0.004), and CD8+ T cells frequency ( P = 0.03) increased significantly, while salivary cortisol reduced ( P = 0.003) in exercised women. After 12 weeks of training, exercised individuals had higher TNF-α levels ( P = 0.02), CD4+ ( P = 0.03) and CD8+ ( P = 0.04) T cells than control group. In addition, exercised women reduced the waist circumference ( P = 0.030) and improved the time to exhaustion ( P = 0.003). Conclusion In conclusion, deep water running was able to modulate immune-endocrine parameters in absence of significant improvements in body composition or VO 2Peak in overweight-obesity women. This training could be an interesting tool to control the obesity-related chronic low-grade inflammation.

Treatment of hidradenitis suppurativa with biologic medications

Given the absence of significant improvement in the treatment of hidradenitis suppurativa (HS) with traditional medical and surgical therapies, biologics have piqued the interest of research investigators. The efficacy of biologics in the treatment of inflammatory conditions like psoriasis and rheumatoid arthritis is well-documented. More recently, success with biologics has been demonstrated in atopic dermatitis, another dermatological condition associated with inflammatory states. Researchers have begun to probe the utility of biologic agents in less prevalent conditions that feature inflammation as a key characteristic, namely, hidradenitis suppurativa. Five agents in particular adalimumab, anakinra, etanercept, infliximab, and ustekinumab, have been explored in the setting of HS. Results to date put forward adalimumab and infliximab as biologic treatments that can safely be initiated with some expectant efficacy. Other biologic agents require more rigorous examination before they are worthy of addition to the treatment armamentarium.

Public procurement as a means to achieving social gains – progress and challenges in European legislation and standards for accessible information and communication technology

This article explores the European Commission goal of improving the quality and level of accessibility in mainstream information and communication technology (ICT) goods and services available in Member States through the use of public procurement legislation and performance standards. Over the past two decades, the Commission has encouraged Member States to adopt common requirements for accessibility and to strengthen efforts to use these requirements in public procurement. In the absence of significant improvements in the level of accessibility over this time, the Commission has more recently committed to bringing forward legislative proposals to harmonize the accessibility requirements used by Member States. A new procurement directive package contains stronger obligations on public bodies to include accessibility as mandatory requirements in Technical Specifications. In parallel to this, a standardization mandate by the Commission to the European Standards Organizations (ESOs) concluded in March 2014 with the publication of the first European standard on ICT accessibility. In light of these developments, this article analyses the trajectory of European policy in the field of accessibility over the last two decades, and the interplay between European public procurement, standardization and law. It examines how far these developments have succeeded in bringing into being a public procurement eco-system that will nudge the market in Europe to producing affordable and accessible ICT products and services for persons with disabilities.

The pathogenetic substantiation of the use of angiotensin-converting enzyme for the treatment of diabetic retinopathy

The objective of the present work was to study visual functions, as well as changes in the systemic and local renin-angiotensin system before and after intake of the ACE inhibitor perindopril in 65 patients (130 eyes) presenting with diabetic retinopathy. The treatment caused the most pronounced changes in the patients with preproliferative diabetic retinopathy including the two-fold (p<0.05) decrease of ACE activity in the blood and its 7.5-fold (p<0.05) increase in the tears. These effects appear to be attributable to the action of perindopril on the levels of the proangiogenic factors known to be elevated in the patients with severe retinal ischemia. The treatment of patients with diabetic macular oedema with perindopril resulted in the decrease of the retinal thickness from 392.5±46.7 to 347.2±39.6 mcm in the absence of significant improvement in the acuteness of vision. All the patients experienced a significant reduction in the level of glycosylated hemoglobin.

Peer supporters for cardiac patients with diabetes: a randomized controlled trial

To determine whether incorporation of patient peer supporters in a Cardiac-Diabetes Self-Management Program (Peer-CDSMP) led to greater improvement in self-efficacy, knowledge and self-management behaviour in the intervention group compared to a control group. Promoting improved self-management for those with diabetes and a cardiac condition is enhanced by raising motivation and providing a model. Peer support from former patients who are able to successfully manage similar conditions could enhance patient motivation to achieve better health outcomes and provide a model of how such management can be achieved. While studies on peer support have demonstrated the potential of peers in promoting self-management, none have examined the impact on patients with two co-morbidities. A randomized controlled trial was used to develop and evaluate the effectiveness of the Peer-CDSMP from August 2009 to December 2010. Thirty cardiac patients with type 2 diabetes were recruited. The study commenced in an acute hospital, follow-up at participants' homes in Brisbane, Australia. While both the control and intervention groups had improved self-care behaviour, self-efficacy and knowledge, the improvement in knowledge was significantly greater for the intervention group. Significant improvement in knowledge was achieved for the intervention group. Absence of significant improvements in self-efficacy and self-care behaviour represents an inconclusive effect; further studies with larger sample sizes are recommended.

Revisiting the Gathering Storm

Five years after the release of the National Academies’ report Gathering Storm, its authors conclude in an update that the United States has yet to shore up its lagging competitive posture. In the absence of significant improvements to the nation’s research and education capabilities, the United States will cede its leadership in science and technology to other nations, the authors warn, causing “dire consequences” for the country overall as well as for its citizens.

No-Reflow: A Heterogeneous Clinical Phenomenon with Multiple Therapeutic Strategies

Previously defined as the failure to achieve uniform intramyocardial reperfusion after prolonged but reversible coronary occlusion, only recently has no-reflow phenomenon been characterized as a heterogeneous clinical condition. In fact, in about half of post-infarct patients that show no-reflow after 24 hours from coronary recanalization by either thrombolysis or PTCA, no-reflow phenomenon is spontaneously reversible. Reversible no-reflow is associated with favorable left ventricular remodeling even in the absence of significant improvement in regional contractile function. Thus, it may be a clinical marker of yet unknown mechanisms, which may favorably affect myocardial response to necrosis. Based on the pathogenesis and on the time-course of no-reflow, the phenomenon may be associated with lack of patency or with loss of anatomic integrity of microvessels, with the former being potentially reversible while the latter associated with definitive tissue damage. As a consequence, possible therapeutic strategies of no-reflow have to be designed according to not only the main target [microvessel patency or integrity], but also taking into account the timing of development of the damage. This "mini review" is focused on recent advances on the pathogenesis and clinical presentation on no-reflow. These data will give the opportunity to formulate novel interpretation and classification of the phenomenon and consequently, to propose adequate therapeutic strategies.

Moderate prenatal carbon monoxide exposure produces persistent, and apparently permanent, memory deficits in rats

The effects of moderate (150 +/- 2 ppm) prenatal carbon monoxide (CO) exposure (maternal HbCO concentrations of 15.6 +/- 1.1%) on learning and memory were assessed in young and aged adult rats using a two-way active avoidance paradigm. In experiment 1, the prenatal CO-exposed rats at 120 days of age acquired a conditioned avoidance response equally well as control animals in a 100-trial session. However, following a 24-hr interval the CO-exposed rats failed to demonstrate significant retention of the task as indicated by the absence of significant improvement in performance over the indicated by the absence of significant improvement in performance over the previous day; control subjects did show significant retention. In experiment 2, in which 120-day-old animals received 50 training trials per day until a criterion of ten consecutive avoidance responses was met, the prenatal CO-exposed subjects again acquired the task as well as control animals. When tested for retention 28 days later, a significant memory impairment was again observed in terms of trials required to reattain the avoidance criterion as well as in total percent avoidance responding. In neither experiment did an analysis of initial or average latency to escape the footshock stimulus reveal any significant alterations. These latter results suggest that the observed performance impairment reflected a memory deficit and not a disruption of sensory, motor, or motivational factors. In experiment 3, prenatal CO-exposed rats approximately 1 year of age (300-360 days of age) showed impairment relative to air-exposed controls in both the original learning and retention of the two-way avoidance response. Again, however, there was no evidence for alterations in performance factors per se. Collectively these data indicate that while young adult rats prenatally exposed to 150 ppm CO demonstrate an associative deficit restricted to memory impairment, aged adults similarly exposed during the prenatal period display a more pronounced deficit similar to that recently reported for animals tested as juveniles. The importance of parametric manipulations in uncovering long-term toxicity is also discussed.

Factors responsible for weight loss in tropical sprue

The respective roles of reduced dietary intake and malabsorption in the pathogenesis of weight loss in persons with chronic tropical sprue have been evaluated . Dietary intake was found to be significantly (P less than 0.001) less in a group of 45 patients with tropical sprue, all of whom had anorexia due to deficiency of folate and/or vitamin B12, than in a group of 51 healthy Puerto Ricans. Weight loss was equally prominent in those patients with tropical sprue who had normal absorption of fat and protein as in those who had excessive fecal loss and reduced absorption of these nutrients. Treatment of five sprue patients with folic acid or vitamin B12 for 2 weeks resulted in improved appetite and increased in dietary intake with weight gain in the absence of significant improvement in intestinal absorption. Treatment with oral tetracycline for a similar period of time in five other patients was not associated with vitamin repletion, return of appetite or weight gain. These observations indicate that reduced dietary intake resulting from anorexia caused by vitamin deficiency is a significant, and sometimes the most important, factor in the pathogenesis of weight loss in persons with chronic tropical sprue.