Low Activity Rates Research Articles

Comparison of the impact of Tripterygium wilfordii Hook F and Methotrexate treatment on radiological progression in active rheumatoid arthritis: 2-year follow\xa0up of a randomized, non-blinded, controlled study

BackgroundTripterygium wilfordii Hook F (TwHF) alone or in combination with methotrexate (MTX) has been shown to be more effective than MTX monotherapy in controlling the manifestations in subjects with disease-modifying antirheumatic drug (DMARD)-naïve active rheumatoid arthritis (RA) over a 6-month period. The long-term impact of these therapies on disease activity and radiographic progression in RA has not been examined.MethodsPatients with DMARD-naïve RA enrolled in the “Comparison of Tripterygium wilfordii Hook F with methotrexate in the Treatment of Active Rheumatoid Arthritis” (TRIFRA) study were randomly allocated into three arms with TwHF or MTX or the two in combination. Clinical indexes and radiographic data at baseline and year 2 was collected and compared using an intent-to-treat (ITT) and a per-protocol (PP) analysis. Two radiologists blinded to the treatment scored the images independently.ResultsOf 207 subjects 109 completed the 2-year follow up. The number of subjects withdrawing from the study and the number adhering to the initial regimens were similar among the three groups (p > = 0.05). In the ITT analysis, proportions of patients reaching American College of Rheumatology 50% (ACR50) response criteria were 46.4%, 58.0% and 50.7% in the MTX, TwHF and MTX + TwHF groups (TwHF vs MTX monotherapy, p = 0.004). Similar patterns were found in ACR20, ACR70, Clinical Disease Activity Index good responses, European League Against Rheumatism good response, remission rate and low disease activity rate at year 2. The results of the PP analysis agreed with those in the ITT analysis. The changes in total Sharp scores and joint erosion and joint space narrowing during the 2 years were associated with changes in disease activity measured by the 28-joint count Disease Activity Score and were comparable among the three groups (p > 0.05). Adverse events were similar in the three treatment groups.ConclusionsDuring the 2-year therapy period, TwHF monotherapy was not inferior to MTX monotherapy in controlling disease activity and retarding radiological progression in patients with active RA.Trial registrationThis is a follow-up study. Original trial registration: ClinicalTrials.gov, NCT01613079. Registered on 4 June 2012.

Promotion of Exercise in Multiple Sclerosis Through Health Care Providers.

Participation in exercise yields meaningful benefits among persons with multiple sclerosis (MS), yet this population engages in low rates of health-promoting physical activity. The disconnect between evidence of benefits and rates of participation requires consideration of new opportunities for changing this health behavior. The current article hypothesizes that the patient-provider interaction offers a fertile opportunity for promoting exercise behavior in MS.

Medieval European Traditions in Representation and State Capacity Today

Rich economies are characterized by the coincidence of, on the one hand, high state capacity and, on the other, well-functioning markets and the rule of law. They have states that are powerful and centralized and yet also limited. Furthermore, relatively low rates of shadow economic activity and tax evasion suggest that citizens perceive their states’ limitations to be credible. This suggests that a state’s ability to be credibly limited may facilitate its investments in state capacity. Consistent with this, we explore the potential link between historical traditions of representative governance institutions and state capacity today. We report that medieval and early modern representative assembly experiences positively correlate with higher tax revenues, smaller shadow economies, greater state control of violence and yet fewer state resources dedicated to violence. Relative to tax revenues, the evidence regarding shadow economies and violence is more robust to various controls and samples.

Brachytherapy of Intracranial Gliomas.

Interstitial implantation of radioactive materials (brachytherapy [BT]) has been designed to protractedly deliver a high radiation dose to a well-defined target volume, while minimizing irradiation of the adjacent normal tissues. Even though promising results have been reported over time, the role of this treatment modality in the management of brain tumors is still poorly defined, and only a few centers worldwide apply it in clinical practice. Nevertheless, temporary or permanent interstitial implantation of low activity (<20 mCi) and low dose rate (≤10 cGy/h) iodine-125 (125I) seeds as possible therapy of intracranial gliomas is currently undergoing a definite revival, and several indications for its use have been identified. Generally, 125I-BT may be considered a reasonable option in cases of unresectable, well-circumscribed, either newly diagnosed or recurrent tumors with a diameter of ≤4 cm, virtually in any location within the brain. Importantly, this treatment does not narrow down the spectrum of the possible subsequent salvage therapeutic options, since neither repeated interstitial nor additional external beam irradiation at the time of tumor progression after BT is associated with a significantly increased risk of radiogenic complications. Using correct patient selection criteria, appropriate surgical technique, and established treatment parameters, would make BT a truly minimally invasive procedure with a low risk of complications and reasonable efficacy.

Development of activity rates in fledgling songbirds: when do young birds begin to behave like adults?

Abstract Logistical and technological limitations have constrained the characterization of behavioural development in songbirds, particularly during the post-fledging period. Recently, advances in radio-telemetry technology — automated radio-telemetry systems (ARTS) capable of recording continuous, high-resolution spatial-temporal data on radio-tagged birds — have opened the door to more comprehensive examinations of fledgling behaviour. We examined development of activity rates (number of times a bird was determined to have moved per number of detections, per hour) in fledgling Dickcissels using ARTS established at two grassland sites in east-central Illinois, USA. Specifically, we described general patterns of fledgling activity rates and determined the age at which fledglings began exhibiting activity rates like adults. We found that juveniles decreased activity rates immediately following fledging, likely to avoid detection by snakes and other predators, but increased activity levels throughout the rest of the post-fledging period. Peak hours of fledgling activity occurred around 0700 and 1800 h for all ages, with consistently low activity rates at night. On average, fledglings began exhibiting adult-like activity rates approximately 22 days after fledging, around roughly the same time they stopped being fed by adults. While our study provides important insights into development of fledgling behaviour in the Dickcissel, it remains unclear how patterns of behavioural development vary within and among species.

Health App Use Among US Mobile Phone Users: Analysis of Trends by Chronic Disease Status.

BackgroundMobile apps hold promise for serving as a lifestyle intervention in public health to promote wellness and attenuate chronic conditions, yet little is known about how individuals with chronic illness use or perceive mobile apps.ObjectiveThe objective of this study was to explore behaviors and perceptions about mobile phone–based apps for health among individuals with chronic conditions.MethodsData were collected from a national cross-sectional survey of 1604 mobile phone users in the United States that assessed mHealth use, beliefs, and preferences. This study examined health app use, reason for download, and perceived efficacy by chronic condition.ResultsAmong participants, having between 1 and 5 apps was reported by 38.9% (314/807) of respondents without a condition and by 6.6% (24/364) of respondents with hypertension. Use of health apps was reported 2 times or more per day by 21.3% (172/807) of respondents without a condition, 2.7% (10/364) with hypertension, 13.1% (26/198) with obesity, 12.3% (20/163) with diabetes, 12.0% (32/267) with depression, and 16.6% (53/319) with high cholesterol. Results of the logistic regression did not indicate a significant difference in health app download between individuals with and without chronic conditions (P>.05). Compared with individuals with poor health, health app download was more likely among those with self-reported very good health (odds ratio [OR] 3.80, 95% CI 2.38-6.09, P<.001) and excellent health (OR 4.77, 95% CI 2.70-8.42, P<.001). Similarly, compared with individuals who report never or rarely engaging in physical activity, health app download was more likely among those who report exercise 1 day per week (OR 2.47, 95% CI 1.6-3.83, P<.001), 2 days per week (OR 4.77, 95% CI 3.27-6.94, P<.001), 3 to 4 days per week (OR 5.00, 95% CI 3.52-7.10, P<.001), and 5 to 7 days per week (OR 4.64, 95% CI 3.11-6.92, P<.001). All logistic regression results controlled for age, sex, and race or ethnicity.ConclusionsResults from this study suggest that individuals with poor self-reported health and low rates of physical activity, arguably those who stand to benefit most from health apps, were least likely to report download and use these health tools.

High resolution stratigraphy of initial stages of rifting, Sergipe-Alagoas Basin, Brazil

ABSTRACT: The present work aims to characterize the Neo-Jurassic to Neocomian succession of the Sergipe-Alagoas Basin, located in northeast region of Brazil, in order to discover the influence of tectonics on sedimentation in detailed scale and thus separating this sedimentary succession in tectono-stratigraphic units. Fieldwork observations and stratigraphic sections analysis allowed subdividing this rift succession into three depositional units that indicate different paleogeographic contexts. Unit I, equivalent to the top of Serraria Formation, is characterized by braided fluvial channel deposits, with paleocurrent direction to SE; unit II, corresponding to the base of Feliz Deserto Formation, is composed of anastomosed fluvial channel and floodplain facies associations; and unit III, equivalent to the major part of Feliz Deserto Formation, is characterized by delta deposits with polymodal paleocurrent pattern. The changes of depositional system, as well as paleocurrent direction, suggest that the previously described units were deposited in different evolutionary stages of rifting. Units I and II represent the record of a wide and shallow basin associated with the first stage of rifting. Unit I is characterized by incipient extensional stress generating a wide synclinal depression, associated to the low rate of accommodation and low tectonic activity. These two parameters progressively increase in unit II. The paleocurrent direction of unit I indicates that the depocenter of this wide basin was located at SE of the studied area. No conclusion could be done on paleocurrent from unit II because of the low amount of measurements. Unit III suggests a second stage marked by a deeper basin context, with a high rate of accommodation space associated with the lateral connection of faults and individualization of the half-graben. The scattering in the paleocurrent direction in this unit indicates sedimentary influx coming from several sectors of the half-graben. The boundary between these two stages is marked by a flooding surface that indicates an extremely fast transition and suggests a radical change in geometric characteristics of the basin due to the increase of tectonic activity.

Toward High Performance Thiophene‐Containing Conjugated Microporous Polymer Anodes for Lithium‐Ion Batteries through Structure Design

AbstractPoly(thiophene) as a kind of n‐doped conjugated polymer with reversible redox behavior can be employed as anode material for lithium‐ion batteries (LIBs). However, the low redox activity and poor rate performance for the poly(thiophene)‐based anodes limit its further development. Herein, a structure‐design strategy is reported for thiophene‐containing conjugated microporous polymers (CMPs) with extraordinary electrochemical performance as anode materials in LIBs. The comparative study on the electrochemical performance of the structure‐designed thiophene‐containing CMPs reveals that high redox‐active thiophene content, highly crosslinked porous structure, and improved surface area play significant roles for enhancing electrochemical performances of the resulting CMPs. The all‐thiophene‐based polymer of poly(3,3′‐bithiophene) with crosslinked structure and a high surface area of 696 m2 g−1 exhibits a discharge capacity of as high as 1215 mAh g−1 at 45 mA g−1, excellent rate capability, and outstanding cycling stability with a capacity retention of 663 mAh g−1 at 500 mA g−1 after 1000 cycles. The structure–performance relationships revealed in this work offer a fundamental understanding in the rational design of CMPs anode materials for high performance LIBs.

Radiate and Planar Multipolar Neurons of the Mouse Anteroventral Cochlear Nucleus: Intrinsic Excitability and Characterization of their Auditory Nerve Input.

Radiate and planar neurons are the two major types of multipolar neurons in the ventral cochlear nucleus (VCN). Both cell types receive monosynaptic excitatory synaptic inputs from the auditory nerve, but have different responses to sound and project to different target regions and cells. Although the intrinsic physiology and synaptic inputs to planar neurons have been previously characterized, the radiate neurons are less common and have not been as well studied. We studied both types of multipolar neurons and characterized their properties including intrinsic excitability, synaptic dynamics of their auditory nerve inputs, as well as their neural firing properties to auditory nerve stimulation. Radiate neurons had a faster member time constant and higher threshold current to fire spikes than planar neurons, but the maximal firing rate is the same for both cell types upon large current injections. Compared to planar neurons, radiate neurons showed spontaneous postsynaptic currents with smaller size, and slower but variable kinetics. Auditory nerve stimulation progressively recruited synaptic inputs that were smaller and slower in radiate neurons, over a broader range of stimulus strength. Synaptic inputs to radiate neurons showed less depression than planar neurons during low rates of repetitive activity, but the synaptic depression at higher rates was similar between two cell types. However, due to the slow kinetics of the synaptic inputs, synaptic transmission in radiate neurons showed prominent temporal summation that contributed to greater synaptic depolarization and a higher firing rate for repetitive auditory nerve stimulation at high rates. Taken together, these results show that radiate multipolar neurons integrate a large number of weak synaptic inputs over a broad dynamic range, and have intrinsic and synaptic properties that are distinct from planar multipolar neurons. These properties enable radiate neurons to generate powerful inhibitory inputs to target neurons during high levels of afferent activity. Such robust inhibition is expected to dynamically modulate the excitability of many cell types in the cochlear nuclear complex.

Extending Working Life: Which Competencies are Crucial in Near-Retirement Age?

Nowadays, one of the most important economic and social phenomena is population ageing. Due to the low activity rate of older people, one of the most important challenges is to take various actions involving active ageing, which is supposed to extending working life, and along with it—improve the competencies of older people. The aim of this paper is to evaluate the relevance of different competencies for extending working life, with limiting the analysis for Poland. The paper also assesses the competencies of mature Polish people (aged 50+, but still in working age). In the statistical analysis, I used logistic regression, as well as descriptive statistics and appropriate statistical tests. The results show that among the actions aimed at extending working life, the most important are those related to lifelong learning, targeted at improving the competencies of the older generation. The competencies (both soft and hard) of people aged 50+ are more important than their formal education.

Collective Efficacy, Physical Activity, and Health Outcomes Among Mothers.

Motherhood is associated with low rates of physical activity that increase disease risk. Most theory-based approaches to increasing physical activity focus on personal rather than social factors. The purpose of this study was to examine the associations among perceptions of community collective efficacy and objectively measured physical activity, self-efficacy, social support, and health. Mothers completed questionnaires and wore a pedometer for 7 days. There was a significant, positive association between physical activity and collective efficacy-social cohesion subscale. In the regression analysis, only age and social support were independent predictors of physical activity. Future studies should examine relationships among collective efficacy and social support and physical activity.

Promoting physical activity with Hard-to-Reach women: an iterative and participatory research study.

Approximately half of all UK women are insufficiently physically active, with the lowest activity rates among ‘Hard-to-Reach’ or unreached women. In this article, Kathryn Brook, Dr Andy Pringle FRSPH, Dr Jackie Hargreaves and Dr Nicky Kime of Leeds Beckett University outline their research into developing methods to assess and meet the needs of ‘Hard-to-Reach’ women in needs-led and person-centred interventions.

Proteasome activity regulates CD8+ T lymphocyte metabolism and fate specification.

During an immune response, CD8+ T lymphocytes can undergo asymmetric division, giving rise to daughter cells that exhibit distinct tendencies to adopt terminal effector and memory cell fates. Here we show that "pre-effector" and "pre-memory" cells resulting from the first CD8+ T cell division in vivo exhibited low and high rates of endogenous proteasome activity, respectively. Pharmacologic reduction of proteasome activity in CD8+ T cells early during differentiation resulted in acquisition of terminal effector cell characteristics, whereas enhancement of proteasome activity conferred attributes of memory lymphocytes. Transcriptomic and proteomic analyses revealed that modulating proteasome activity in CD8+ T cells affected cellular metabolism. These metabolic changes were mediated, in part, through differential expression of Myc, a transcription factor that controls glycolysis and metabolic reprogramming. Taken together, these results demonstrate that proteasome activity is an important regulator of CD8+ T cell fate and raise the possibility that increasing proteasome activity may be a useful therapeutic strategy to enhance the generation of memory lymphocytes.

Increasing physical activity for veterans in the Mental Health Intensive Case Management Program: A community-based intervention

Individuals with severe mental illness (SMI), experience increased mortality-20 years greater disparity for men and 15 years greater disparity for women-compared to the general population (Thornicroft G. Physical health disparities and mental illness: The scandal of premature mortality. Br J Psychiatr. 2011;199:441-442). Numerous factors contribute to premature mortality in persons with SMI, including suicide and accidental death (Richardson RC, Faulkner G, McDevitt J, Skrinar GS, Hutchinson D, Piette JD. Integrating physical activity into mental health services for persons with serious mental illness. Psychiatr Serv. 2005;56(3):324-331; Thornicroft G. Physical health disparities and mental illness: The scandal of premature mortality. Br J Psychiatr. 2011;199:441-442), but research has shown that adverse health behaviors-including smoking, low rate of physical activity, poor diet, and high alcohol consumption-also significantly contribute to premature deaths (Jones J. Life expectancy in mental illness. Psychiatry Services. 2010. Retrieved from http://psychcentral.com/news/2010/07/13/life-expectancy-in-mental-illness). This quality improvement (QI) project sought to improve health and wellness for veterans in the Mental Health Intensive Case Management Program (MHICM), which is a community-based intensive program for veterans with SMI at risk for decompensation and frequent hospitalizations. At the time of this QI project, the program had 69 veterans who were assessed and treated weekly in their homes. The project introduced a pedometer steps intervention adapted from the VA MOVE! Program-a physical activity and weight management program-with the addition of personalized assistance from trained mental health professionals in the veteran's home environment. Because a large percentage of the veterans in the MHICM program had high blood pressure and increased weight, these outcomes were the focus of this project. Through mental health case management involvement and the comfort of their familiar living environment, veterans were assisted to meet their physical and mental health goals with a program that could easily be integrated into their daily lives. Healthy People 2020 developed goals to improve levels of physical activity and has ranked physical activity as a leading health indicator (US DHHS. Office of Disease Prevention and Health Promotion. Physical activity topic overview. In Healthy People 2020. 2016. Retrieved from https://www.healthypeople.gov/2020/topics-objectives/topic/physical-activity). Individuals with SMI are significantly less active than the general population (Shor and Shalev, 2014). It is sometimes difficult for the average individual to obtain the recommended 10,000 steps and even more difficult for those with SMI. Lifestyle modifications, in particular diet and exercise, are recommended for improvement of chronic disease outcomes (US Preventive Services Counseling Task Force, 2016). The health benefits of physical activity for people with SMI are mixed (Pearsall R, Smith D, Pelosi A, Geddes J. Exercise therapy in adults with serious mental illness: A systematic review and meta-analysis. BMC Psychiatr. 2014;14:117). Some studies found significant physical health benefits, while others did not. However, according to a review by Soundy etal., physical exercise is shown to not only have physical benefits but also psychosocial benefits. One of the barriers that hinder participation in physical activities is accessibility (Shor and Shalev, 2014). Integrating a more personalized supported, and in-home pedometer program into mental healthcare should ensure better access to interventions that could possibly reverse the causes of premature death. The program was offered to 69 veterans in the MHICM. Forty-nine agreed to start the program and 20 declined. Twenty-five clients actually started the program with 17 veterans completing it. Preimplementation data included collecting blood pressure and weight measures for all veterans in the MHICM program. Additionally, a focus group was held with case managers to obtain a group perspective on motivating veterans to participate in this program. Further, a teaching session was held to review pedometers use, the client video, the client booklet, methods for getting veterans started, and the progression of the walking intervention. The pedometer physical activity intervention continued for 2 months. At the end of the 2 months, aggregate de-identified data on number of steps, blood pressure, and weight were collected. At the end of the program, the data were reviewed, synthesized, and analyzed, being careful to account for potentially intervening conditions and other chronic illnesses. The postimplementation data revealed that the mean weight decreased by 9 lbs. The percentage of controlled blood pressure increased from 60 to 84, while the percentage of uncontrolled blood pressure decreased from 40 to 16. Implementation of a multiple component personalized exercise intervention program for veterans with SMI contributed to reduction in weight and blood pressure.

Abstract 4219: An exergaming intervention to reduce breast cancer risk in Black women

Abstract Obesity and low physical activity rates contribute to high rates of postmenopausal breast cancer in Black women. Use of new and exciting strategies to increase physical activity should be tested in health disparity populations at high risk of cancer. We tested the effect of a six-month exercise intervention using the active videogaming systems (exergaming) on anthropometric markers, body composition, and cardiovascular fitness (VO2max) in overweight and obese Black women. We conducted a six-month, two-arm randomized clinical trial comparing an exergaming intervention group to a control group in 100 cancer-free, overweight/obese, sedentary Black women who were 40-59 years of age. Participants were randomized to a supervised facility-based exergaming group (n=50) or a usual care control group (n=50). Participants in the exergaming group followed an exercise program using the Nintendo Wii Fit and/or the X-Box Kinect gaming systems under supervision of a clinical exercise physiologist. Control group participants were asked to maintain their normal daily activities. Endpoints were assessed at baseline, 3 months, and 6 months. Assessments included measurements of demographic variables, medical history, physical activity, VO2max, anthropometric variables (height, weight, waist and hip circumferences), and body composition. Distribution of baseline characteristics between exergaming and control groups was comparable except for education status and BMI. Data on 3 month and 6-month follow-up were available for 66 participants. Follow-up rates were similar for exergaming and control groups. Compared to control group participants whose waist circumference on average remained unchanged, exergaming group participants had lower waist circumference at 3-months and 6- months compared to baseline (mean change: -2.54 cm, P=0.05). Exergaming participants also had small changes in weight (-1.4 lbs) at 6 months compared to control group in whom average weight remained unchanged but this finding was not statistically significant. Fat mass and lean mass as measured by DXA did not show any changes at 3-months or 6-months in either the exergaming or the control group. This pilot study of a short-term exergaming in overweight/obese Black women was associated with small changes in waist circumference in the intervention group. Given the challenges associated with traditional physical activity interventions to reduce cancer risk, new and non-traditional interventions like exergaming should be tested in larger studies in health disparity populations. Citation Format: Chiranjeev Dash, Jennifer Hicks, Vivian Watkins, Mary Mills, James Hagberg, Lucile L. Adams-Campbell. An exergaming intervention to reduce breast cancer risk in Black women [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4219. doi:10.1158/1538-7445.AM2017-4219

Hyperprolactinemia Induced by Antipsychotics: From Diagnosis to Treatment Approach.

Schizophrenia is one of the most severe psychiatric diseases with a significant impact on the psychosocial functioning of the patients. People with schizophrenia are at risk to die prematurely because of their illness with their poor lifestyle contributing to the excess morbidity and higher mortality rate. In particular, lifestyle (e.g. poor diet, low rates of physical activity and increased likelihood to smoke cigarettes) predisposes them to poor physical health and comorbid medical diseases. In addition, the treatment of schizophrenia usually involves the long-term administration of antipsychotic drugs and some of these medications are implicated in the increased risk of metabolic and cardiovascular effects. The antipsychotic-induced hyperprolactinemia was ascertained for the first time by Kleinberg in 1971 and was considered for this treatment. Antipsychotics are the most common pharmacological agents which cause hyperprolactinemia The aim of this review is to describe PRL physiology, PRL biological effects and pathway to the diagnosis, causes, consequences of HPRL focusing on the antipsychotic effects on the PRL. We conducted a review of studies published between 1974 and December 2014. The search was performed using the following PubMed search terms: "Hyperprolactinemia" and "antipsychotic" and 827 papers were detected. The articles were examined and the overlapping or insufficiently clear works were excluded. Finally we chose 104 titles. We added to the selected articles additional articles, including 28 articles regarding the latest international guidelines, the pathophysiology of hyperprolactinemia and the various therapeutic choices.

Diffusion Mechanism for Arsenic in Intrinsic and Extrinsic Conditions in HgCdTe

Due to its low diffusivity and high activation rate, arsenic has become the dopant of choice in p/n HgCdTe high operating temperature technology. Its diffusion mechanism, however, remains imprecise. In this work, arsenic diffusion was studied in molecular beam epitaxy HgCdTe structures consisting of alternatively As-doped and intrinsic layers grown on a CdZnTe substrate. The diffusion coefficient of As was extracted from secondary ion mass spectroscopy concentration profiles. Annealings were performed for different temperatures, mercury partial pressures (P Hg), annealing times and cadmium atomic fractions. Fermi-level effect on diffusion was observed, indicating extrinsic conditions for diffusion at high As concentration. Based on the variation of As diffusivity with P Hg and As concentration, we propose that As diffusion occurs on both II and VI sublattices. Our results are consistent with the fact that AsVI diffusion is assisted by the Te interstitial, introducing donor levels in the bandgap, while AsII diffusion is assisted by the cation vacancy.

The impact of anti-drug antibodies on drug concentrations and clinical outcomes in rheumatoid arthritis patients treated with adalimumab, etanercept, or infliximab: Results from a multinational, real-world clinical practice, non-interventional study.

ObjectiveTo assess the incidence of anti-drug antibodies (ADA) in patients with rheumatoid arthritis (RA) treated with the TNF inhibitors etanercept (ETN), adalimumab (ADL), or infliximab (IFX), and determine the potential relationship with trough drug concentration, efficacy, and patient-reported outcomes.MethodsThis multi-national, non-interventional, cross-sectional study (NCT01981473) enrolled adult patients with RA treated continuously for 6–24 months with ETN, ADL, or IFX. ADA and trough drug concentrations were measured by independent assays ≤2 days before the next scheduled dose. Efficacy measurements included Disease Activity Score 28-joint count (DAS28), low disease activity (LDA), remission, and erythrocyte sedimentation rate (ESR). Targeted medical histories of injection site/infusion reactions, serum sickness, and thromboembolic events were collected.ResultsBaseline demographics of the 595 patients (ETN: n = 200; ADL: n = 199; IFX: n = 196) were similar across groups. The mean duration of treatment was 14.6, 13.5, and 13.1 months for ETN, ADL, and IFX, respectively. All ETN-treated patients tested negative for ADA, whereas 31.2% and 17.4% patients treated with ADL and IFX, respectively, tested positive. In ADL- or IFX-treated patients, those with ADA had significantly lower trough drug concentrations. There were negative correlations between trough drug levels and both CRP and ESR in ADL- and IFX-treated patients. DAS28-ESR LDA and remission rates were higher in patients without ADA. The rate of targeted medical events reported was low.ConclusionADA were detected in ADL- and IFX-treated but not ETN-treated patients. Patients without ADA generally showed numerically better clinical outcomes than those with ADA.Trial registrationThis study was registered on www.ClinicalTrials.gov (NCT01981473).

Unhealthy habits persist: The ongoing presence of modifiable risk factors for disease in women.

ObjectivesVascular disease remains a leading cause of death. There are several vascular risk factors identified that can mitigate development of disease in ageing. We examine reported rates of modifiable risk factors in women responding to an online health questionnaire advertised by popular media.MethodsA sample of 26 620 women aged over 18 was examined in 2015 with a cross-sectional health questionnaire. The questionnaire included self-reported health, mood, lifestyle and vascular risk factors.ResultsThere remains high rates of modifiable risk factors present in women. The vast majority of women (80%) reported not eating enough fruit and vegetables. Compared to the guidelines for health, the majority did not perform enough weekly physical activity (70%) and more than half the participants were overweight (54%). Sufficient fruit, vegetables, fish, legumes and physical activity were reported in less than 30% of women!ConclusionsWomen continue to report low rates of physical activity, fruit and vegetable intake and higher BMI than recommended for good health, despite worldwide health promotion activities aimed at changing these lifestyle factors. Programs to support healthy living need to be reviewed and revised to reduce the burden of vascular disease and dementia in women. Previous guidelines are not having the important impact they should, particularly in women.

A reduced 12-joint ultrasound examination predicts lack of X-ray progression better than clinical remission criteria in patients with rheumatoid arthritis.

To study the predictive value of clinical remission definitions and ultrasound (US) examination on X-ray progression in rheumatoid arthritis (RA). This was an observational prospective multicenter 1-year follow-up cohort of RA patients with moderate disease activity (3.2<DAS28≤5.1) who started anti-TNF therapy. DAS28ESR, DAS28CRP, SDAI, CDAI, and ACR/EULAR remission criteria were applied and reduced 12-joint US examination was performed at baseline and at 6 and 12months. At baseline and month 12, radiographs of hands and feet were obtained in a subset of patients. A blind independent reader scored radiographs. X-ray progression was defined as Sharp van der Heijde change score>1 and no progression was defined as≤0. 319 of 357 patients completed the study; patients had a mean (SD) age of 53.5 (13.1) years, with a disease duration of 7.5 (7.1) years. Laboratory, clinical, and US values significantly improved at month 6, except CRP, with additional improvement at month 12. Remission and low disease activity rates increased at follow-up. In the subset of 115 patients with radiological studies, clinical remission by any definition was not significantly associated with X-ray progression. Patients without PD signal at baseline and month 6 were a lower risk of X-ray progression than patients with PD signal, OR 0.197 (95% CI 0.046-0.861) and 0.134 (95% CI 0.047-0.378), respectively. Absence of PD signal, but not clinical remission predicts lack of X-ray progression. A feasible 12-joint US examination may add relevant information to RA remission criteria.