Enhancing individual and community disaster preparedness: Individuals with disabilities and others with access and functional needs

Preparedness planning is essential to minimizing the impact of disasters on communities and individuals. Attention to the needs of people with disabilities is vital as they have additional needs before, during and after a disaster that are specific to the disabling condition. In this Commentary, we emphasize national guidelines on disability inclusion in emergency preparedness. We examine some potential areas of planning and response that need attention as suggested by preparedness data for people with self-reported disabilities (also referred to as access and functional needs) and highlight selected resources (e.g., tools, trainings, and online webinars) to enhance whole community preparedness and disability inclusion efforts. This Commentary intends to bridge the gap between those various facets of preparedness, at all levels of government and among individuals, with the aim of ensuring that the whole community is prepared to adapt, withstand and rapidly recover from disruptions due to disasters.     

类风湿关节炎患者健康管理服务研究进展

类风湿关节炎(rheumatoid arthritis, RA)是一种常见的以关节破坏为特征的慢性炎症性自身免疫病,但在临床实践中,RA患者因缺乏就医条件及合适的健康管理服务,导致治疗达标率低。健康管理是对个体或群体的健康实现全面、全过程的健康保健服务。其中,慢性病健康管理能有效改善慢性病的治疗效果。而整合型卫生服务通过调整服务方式和协同机制,能在不增加或少增加卫生总投入的前提下,有效提高整体的卫生服务效率和服务质量。此文系统梳理国内外RA健康管理服务进展及慢性病整合型卫生服务经验,有望为开展RA患者健康管理提供思路。     

Implications of long-term conditions for both mental and physical health: comparison of rheumatoid arthritis and schizophrenia

Purpose  To investigate whether people with long term conditions, whatever their specific nature, need to be assessed and treated for the full range of mental, physical and social problems. Main question investigated: that rheumatoid arthritis and schizophrenia will be associated with significantly greater impairment across the subscores of the SF36 scale than in reference general population samples. Specific hypothesis tested: while rheumatoid arthritis and schizophrenia will impair both physical and mental functioning, when comparing the two groups there will be a greater difference between the physical component scores than there will be between the mental/emotional component scores of the short form health survey (SF-36). Methods  Cross sectional comparison of SF-36 subscore profiles of cohorts of: (1) people with rheumatoid arthritis attending specialist Rheumatology outpatient clinics in five London hospitals (n = 446), and (2) people with schizophrenia treated by community psychiatric teams in four sites in Europe (n = 409). Results  Both groups had greater impairments across the whole spectrum of mental and physical problems assessed by the SF-36 than age specific normative data for the general population. The results also support our hypothesis that, comparing the people with rheumatoid arthritis and schizophrenia, we did find that there is a greater discrepancy between the physical scales than there is between the mental/emotional scales of the SF-36. Conclusions  These findings show that whether the primary long-term condition is presenting as physical or as mental disorder, the practitioner should ensure that the full range of physical, mental and social problems is assessed and treated. Contributorships  All authors contributed to the writing of this paper, and in addition, HK, GT, ML, BK, DS and MT contributed to the design of the studies, while NF, AL and MS contributed to the data analyses and interpretation. ML had full access to all of the data in the study and takes responsibility for the accuracy of the data analysis. The sponsors played no part in the analysis or interpretation of data, in the writing of the article, or in the decision to submit it for publication. The researchers are independent from funders and sponsors, and had full access to all the data.     

抗环瓜氨酸肽(CCP)抗体与类风湿关节炎病情活动度及关节损害的关系探讨

目的:分析抗环瓜氨酸肽(CCP)抗体对类风湿关节炎(RA)的诊断和评估意义,探讨抗CCP抗体与RA的病情活动度、关节侵蚀的关系。方法:用ELISA检测32例RA患者血清和关节液中的抗CCP抗体,并测定类湿因子(RF),记录RA患者的一些临床参数。对检测结果及临床参数进行统计分析。结果:抗CCP抗体阳性组与阴性组相比,年龄、关节肿胀个数、关节疼痛个数、DAS28、血沉及CRP等没有显著性差异(P0.05);类风湿因子的阳性率在两组间的差异有统计学意义(P0.05)。抗CCP抗体与年龄、关节肿胀个数、关节疼痛个数、DAS28、ESR和CRP等相关无显著性差异;抗CCP抗体与RF因子呈明显相关(r=0.639,P=0.001)。DAS28评分与关节肿胀个数、关节疼痛个数、DAS28、ESR和CRP显著相关,与年龄因素呈正相关,与类风湿因子的相关无统计学意义。结论:抗CCP抗体对RA的预后有一定的评估作用。     

抗环瓜氨酸肽抗体和类风湿因子联合检测对类风湿关节炎合并间质性肺疾病的临床意义

目的探讨类风湿关节炎合并间质性肺疾病(RA-ILD)的临床特点,为早期发现并诊断RA-ILD提供依据。方法选取2017年7月-2018年6月本院收治的类风湿关节炎患者共61例。根据RA患者是否合并间质性肺疾病,分为观察组RA-ILD和对照组RA,分析比较2组临床资料是否有统计学差异,包括发病年龄、病程、类风湿因子(RF)、抗环瓜氨酸肽抗体(CCP)、C-反应蛋白(CRP)、红细胞沉降率(ESR)、免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、免疫球蛋白A(IgA)、血小板(Plt)、血红蛋白(Hb)。结果RA-ILD组的发病年龄比RA组早,CCP、CRP、ESR、IgG均比RA组水平高(P<0.05),而2组在性别、病程长短、RF、IgM、IgA、Plt、Hb水平的差异无统计学意义(P>0.05)。结论RA患者中发病年龄早及CCP、CRP、ESR、IgG水平高的患者,易并发肺间质疾病。     

河北省某山区建档立卡贫困人口健康相关慢性病/伤残调查

目的 探讨河北省某山区建档立卡贫困居民慢性病或伤残检出率分布状况,为该地区慢性病或伤残防治提供策略依据。方法 随机整群抽取某乡建档立卡贫困人口5 259人,对研究人群进行不同性别常见慢性病或伤残检出率比较、不同年龄层检出率趋势分析、共病情况分析。结果 研究人群慢性病或伤残检出率26.30%(男:28.27%,女:23.07%);肥胖、高血压、糖尿病、血脂异常和伤残的检出率分别为10.02%、7.57%、2.97%、22.21%和4.43%;男性和女性的慢性病或伤残检出率随着年龄的增大而升高(男:χ2=740.546,P＜0.001;女:χ2=538.738,P＜0.001);男性与女性慢性病或伤残检出率随着共病数量的增加呈降低趋势(男:χ2=399.302,P＜0.001,女:χ2=274.733,P＜0.001)。结论 河北省山区建档立卡贫困人口慢性病或伤残检出率较高,提升基层卫生服务能力仍需要加强、助推利贫政策发挥实效。     

来氟米特与甲氨蝶呤治疗类风湿性关节炎的Meta分析

目的评价来氟米特与甲氨蝶呤治疗类风湿性关节炎有效性和安全性。方法检索来氟米特与甲氨蝶呤治疗类风湿性关节炎的临床实验。Jadad量表评价临床实验。计算治疗后两组达到ACR20%标准的相对危险度和相关指标的加权均值差,两组患者全部和常见不良事件发生率的相对危险度。结果治疗后两组达到ACR20%标准的百分率差异无统计学意义,RR0.99(95%CI0.80～1.22),P=0.91。两组患者全部不良事件的发生率差异无统计学意义,RR1.32(95%CI0.74～2.36),P=0.35。来氟米特组腹泻、高血压、脱发、皮疹和瘙痒的发生率多于甲氨蝶呤组,仅口腔溃疡的发生率少于甲氨蝶呤组。结论来氟米特治疗类风湿关节炎的有效性与甲氨蝶呤相当,但安全性略逊于甲氨蝶呤。     

Probiotic supplementation improves inflammatory status in patients with rheumatoid arthritis

ObjectivesRheumatoid arthritis (RA) is an inflammatory autoimmune disease in which the gut microbiota is altered. Probiotics are microorganisms that can normalize gut microbiota; thus, they may help to alleviate RA symptoms. The objective of the present clinical trial was to assess the effects of probiotic supplementation on disease activity and inflammatory cytokines in patients with RA.MethodsForty-six patients with RA were assigned into two groups in this randomized, double-blind, placebo-controlled clinical trial. The patients in the probiotic group received a daily capsule that contained a minimum of 10⁸ colony-forming units of Lactobacillus casei 01 for 8 wk. The placebo group took capsules filled with maltodextrin for the same time period. Questionnaires, anthropometric measurements, and fasting blood samples were collected, and the participants were assessed by a rheumatologist at baseline and at the end of the trial.ResultsDisease activity score was significantly decreased by the intervention, and there was a significant difference between the two groups at the end of the study (P < 0.01). Three of the assessed serum proinflammatory cytokines (tumor necrosis factor-α, interleukin-6, and interleukin-12) significantly decreased in the probiotic group (P < 0.05); however, serum levels of interleukin-1 β were not significantly affected by the probiotic (P = 0.22). The serum level of regulatory cytokine (interleukin-10) was increased by the supplementation (P < 0.05). The proportion of interleukin-10 to interleukin-12 was significantly increased in the probiotic group as well.ConclusionsL. casei 01 supplementation improved the disease activity and inflammatory status of patients with RA. Further studies are warranted to confirm these results, and such confirmation may lead to the introduction of probiotics as adjunctive therapy for this population.     

类风湿关节炎患者血清趋化因子配体20与疾病严重程度的相关性研究

目的:探讨类风湿性关节炎患者（RA）血清趋化因子配体20（CCL20）水平与疾病严重程度的相关性。方法:采用横断面研究,选取2018年7月至2019年7月南方医科大学第三附属医院风湿免疫科门诊及住院诊断的RA患者105 例,对照组是同期年龄、性别相匹配的在同院进行体检的健康人90名。根据Steinbrocker分级,将...     

Higher mortality rates associated with rheumatoid arthritis in Saskatchewan,Canada, 2001–2019

ObjectivesTo estimate provincial all-cause mortality rates of Saskatchewan people with rheumatoid arthritis (RA) for comparison with the general population over time and between different geographic regions.MethodsSaskatchewan provincial administrative health databases (2001–2019) were utilized as data sources. Two RA case definitions were employed: (1) ≥ 3 physician billing diagnoses, at least 1 from a specialist (rheumatologist, general internist or orthopaedic surgeon) within 2 years; (2) ≥ 1 hospitalization diagnosis (ICD-9 code 714, and ICD-10-CA codes M05, M06). Data from these definitions were combined to create an administrative data RA cohort. All-cause mortality rates across geographic regions, between rural/urban residences and between sexes were examined.ResultsOver an 18-year span, between fiscal-year 2001–2002 and fiscal-year 2018–2019, age- and sex-adjusted mortality rates ranged from 17.10 to 21.04 (95% CI 14.77, 19.44; 18.03, 24.05)/1000 RA person-years, compared with mortality rates for the general Saskatchewan population without RA, which ranged from 9.37 to 10.88 (95% CI 9.23, 9.51; 10.72, 11.05)/1000 person-years. Fiscal-year mortality rate ratios ranged from 1.82 to 2.13 (95% CI 1.56, 2.13; 1.83, 2.46). Provincial mortality rates were higher in men than in women for both general and RA populations. Northern Saskatchewan mortality rates were significantly higher in the general population but did not achieve significance compared with other provincial regions for the RA population. Regression analysis identified age, male sex, RA and geographic region as factors contributing to increased mortality. A trend towards lower mortality rates over time was observed.ConclusionHigher mortality rates were observed in the RA population overall. Men had higher mortality rates, as did residents of Northern Saskatchewan compared with residents of other regions for the general population.     

类风湿关节炎继发糖尿病患者肺部感染的临床治疗效果观察

目的探讨胰岛素联合抗菌药物治疗类风湿关节炎继发糖尿病患者肺部感染的临床效果,为临床治疗提供参考依据。方法选择2007年3月-2012年12月医院收治的80例类风湿关节炎继发糖尿病患者发生肺感染的临床资料,将其分为观察组和对照组,每组各40例,观察组患者采用胰岛素联合抗菌药物进行治疗,对照组患者使用口服降糖药联合抗菌药物进行治疗,比较两组患者的治疗效果,数据采用SPSS 17.0统计软件进行分析。结果观察组患者的血糖达标时间及住院时间分别为(4.3±0.5)d、(8.0±2.1)d,均明显优于对照组患者,且差异有统计学意义(P<0.05),而且观察组患者的总有效率为100.0%,明显高于对照组患者的85.0%,差异有统计学意义(P<0.05)。结论胰岛素联合抗菌药物治疗类风湿关节炎继发糖尿病并发肺感染患者疗效显著,有效缩短住院时间节省费用,值得临床广泛应用。     

Employment and disability for work in patients with COPD: a cross-sectional study among Dutch patients

Objectives: The aim was to gain insight into work experiences and problems of subjects with chronic obstructive pulmonary disease (COPD) to develop more effective guidelines for preventing work disability and work loss. Methods: A total of 617 patients aged 45–60, recruited from pulmonary outpatient clinics and general practices, completed a questionnaire on (respiratory) health and work history. Results: Of the patients 43% were female, 52% were employed and more than half were less educated. Comorbidity was present in 52% of the study group. Of those who stopped working (N=260), 36% stopped before the onset of COPD, 39% stopped because of COPD and 25%, although having COPD, had other reasons to stop. Of the patients with a work history 39% had an invalidity benefit: 21% of the working and 60% of the non-working patients. For one-third of these patients COPD was not the reason for having an invalidity benefit. For 56% of those who had a benefit because of COPD, comorbidity contributed to work disability. No difference in current smoking habit was seen between working patients and non-working patients. Yet, non-working patients were more often smokers at the moment they stopped working. Furthermore, former smokers who still worked stopped smoking at a younger age than former smokers who stopped working. Compared with workers and independent of smoking habit, former workers were more exposed to dust/irritants, had their work(place) less frequently modified and had more unfavourable (social) work experiences. Conclusion: For employees with COPD, work loss is often multi-factorial. Comorbidity is often present and an important cause for work loss. Therefore occupational health guidance has to take other interfering (health) factors than COPD into consideration as well. In preventing work disability, work(place) adjustment merits more attention.     

General practitioners' knowledge of functional and social factors in patients with rheumatoid arthritis

The care of people with chronic physical disease is an important part of the work of general practitioners (GPs). Knowledge of social and functional factors, and good teamwork with other health and social care professionals, are necessary to provide high quality general practice care. This study investigated functional disability, social situation and the involvement of health and social care professionals in patients with rheumatoid arthritis, and their GPs' knowledge of these factors. Questionnaires were sent to all patients aged 15-74 with rheumatoid arthritis in two general practices, and similar questionnaires were given to their GPs. Functional disability was assessed using the health assessment questionnaire (HAQ), on a scale of 0-3. The GP consultation rate for patients with rheumatoid arthritis in the previous year was 6.9 compared to 3.7 for all patients in the practices, and increased with increasing disability. Sixty-five per cent of patients had a moderate (HAQ > 1 but 2) disabiltiy. There was an average difference between patient and GP scores for functional disability on the HAQ of 0.49 (95% confidence interval 0.36-0.62), with GPs scoring lower than patients and the difference increased with increasing disability. Seventy-one per cent of patients had seen a rheumatologist or orthopaedic surgeon in the previous year, but there was little involvement by other members of the primary health care team (PHCT). General practitioners had good levels of knowledge of their patients' employment status and who they lived with, but poor knowledge of most of the welfare benefits they were receiving, and of other health and social care professionals involved. It is concluded that GPs see their patients with rheumatoid arthritis frequently, but are often lacking the knowledge about their patients to provide high quality care. They often only know about aspects of their patients' care in which they are directly involved. Ways are suggested for how this situation could be improved.     

The cellular immune response to influenza vaccination is preserved in rheumatoid arthritis patients treated with rituximab

Objectives

Yearly vaccination against influenza is currently recommended to patients with rheumatoid Arthritis (RA). Antibody and cell-mediated responses are both involved in the defense against influenza. Humoral responses to influenza vaccine are impaired in RA patients treated with rituximab (RTX). The objectives of this study were to comparatively assess cell mediated and humoral responses to influenza vaccination in RA patients with or without RTX-induced CD20 B-cell depletion.

Methods

Trivalent influenza subunit vaccine was administered to 46 RA patients and to 16 healthy controls. The RA group included 29 patients treated by RTX and 17 on conventional disease-modifying anti-rheumatic drugs (DMARDs), mostly methotrexate. Peripheral blood mononuclear cells and sera were obtained immediately before and 4-6 weeks after vaccination. Cell-mediated response to influenza antigens was evaluated by flow cytometry for activated CD4 T-cells. Humoral response was evaluated by haemagglutination inhibition assay.

Results

Cellular response: Cell-mediated responses were comparable in RTX-treated vs. DMARDs-treated patients. The recall postvaccination CD4+ cellular response was similar in RA patients and healthy controls. A positive correlation was found between CD19+ cell count on the day of vaccination and cellular response in RTX-treated RA patients. Humoral response: The antibody response rate was significantly impaired in the RTX group: being 26.4%, 68.4% and 47.1% in RTX-treated, DMARDs-treated and controls, respectively.

Conclusion

Cellular immunity to influenza vaccination in RTX-treated patients was similar to DMARDs-treated patients and healthy controls, while humoral immunity was severely impaired. The preservation of cellular immunity may explain the relatively low rate of infection among B-cell depleted patients.     

The health-related quality of life of patients with epilepsy compared with angina pectoris, rheumatoid arthritis, asthma and chronic obstructive pulmonary disease

The objective of this study was to compare the health-related quality of life (HRQL) of patients with epilepsy with populations suffering from different chronic diseases, using the short form 36 (SF-36) health profile measure. The populations to be compared were adult patients drawn from hospital based registers, with confirmed epilepsy (n = 397), angina pectoris (n = 785), rheumatoid arthritis (n = 1030), asthma (n = 117) and chronic obstructive pulmonary disease (COPD) (n = 221). Health-related quality of life scores were compared using analysis of covariance (ANCOVA) for predicting mean scores adjusted for age, gender, education and comorbidity. Patients with epilepsy on average scored highest on all scales, reflecting that in our sample the majority had well-controlled epilepsy. Our results indicate that the HRQL of a representative sample of patients with epilepsy is good, when compared with other chronic disorders, although reduced in several dimensions compared with a general reference population. Patients with rheumatoid arthritis (RA) and COPD scored lowest on the physical function scales, while rheumatoid arthritis patients reported most pain. This revised version was published online in June 2006 with corrections to the Cover Date.     

Tick-borne encephalitis (TBE) vaccine to medically immunosuppressed patients with rheumatoid arthritis: A prospective,open-label,multi-centre study

BackgroundTick-borne Encephalitis (TBE) is endemic in south-eastern Sweden as well as in the Baltic regions, Central Europe and Russia. Ageing and immunosuppressed individuals are more prone to severe disease and neurological complications. We assessed the immunogenicity of TBE-vaccine in rheumatoid arthritis (RA) patients treated with tumor necrosis factor-inhibitors (TNFi) and/or methotrexate (MTX).MethodsTBE vaccine, FSME-Immune^® or Encepur^®, was administered to non-immune RA patients as well as age and gender matched healthy controls. Individuals <60 years of age were given three doses at month 0, 1, 12. Individuals ≥60 years old were given an additional priming dose at month 3, i.e. a total of four doses. Tick-borne encephalitis neutralizing antibodies were assessed by a rapid fluorescent focus inhibition test.ResultsThe study population consisted of 66 patients and 56 age and gender matched healthy controls. Median age was 58.5 years. The patients were either treated with TNFi (n = 16), TNFi + MTX (n = 36) or MTX (n = 14). After the last TBE-vaccine dose, given one year after the first, 39% of the patients compared to 79% of the healthy controls had seroprotective levels (p = <0.05).ConclusionsStandard TBE-vaccine schedule does not confer enough immunogenicity in this group of immunosuppressed patients, who should be carefully informed about a higher risk for vaccination failure and risk of infection when exposed in high-endemic areas.     

Single-factor scoring validation for the Health Assessment Questionnaire-Disability Index (HAQ-DI) in patients with systemic sclerosis and comparison with early rheumatoid arthritis patients

Objective Structural validity for the Health Assessment Questionnaire-Disability Index (HAQ-DI) has recently been provided for patients with rheumatoid arthritis (RA). The goal of the current study was to examine the structural validity of the HAQ-DI in patients with systemic sclerosis (SSc, scleroderma) and to compare its performance with that in patients with RA.Methods The HAQ-DI structural validity was first assessed in a sample of 100 scleroderma patients using confirmatory factor analysis. Second, the similarity of factor structures between SSc patients (n = 291) and RA patients (n = 278) was tested using a multigroup structural validity model to assure that comparison of scores between these two diagnostic groups is appropriate.Results Results yielded a single-factor HAQ-DI score which favored the current scoring system of the HAQ-DI (model fit was CFI = 0.99 and RMSEA = 0.04). Moreover, even the most stringent model of multigroup structural validity affirmed the similarity between SSc and RA patients on the HAQ-DI (model fit was CFI = 0.99 and RMSEA = 0.04) nor was it different from a model without any demands on group similarity: CFI difference = 0.007; χ² = 4.29, df = 26, p=0.99.Conclusion The current results indicate that a single-factor HAQ-DI is appropriate for future clinical trials in scleroderma and, in addition, HAQ-DI scores among patients with SSc and early RA can be compared legitimately with one another.     

类风湿关节炎尿脱氧吡啶啉测定的临床意义

目的:通过对类风湿关节炎(RA)患者的尿脱氧吡啶啉(D-Pyd)测定,观察其变化是否与RA病情活动的相关性,以便寻找一种比较客观又能及早评价RA药物治疗时的重要转归指标。方法:该研究的对象共526例,其中活动期RA患者224例(即RA尚未达到ACR临床缓解标准)和非活动期RA患者184例(即RA达到ACR临床缓解标准),以及118例健康体检者作为对照组。分别检测尿液脱氧吡啶啉骨吸收标记物水平。另外还对其中40例RA患者使用慢作用抗风湿药(DMARD)治疗并随访9个月。观察其尿液脱氧吡啶啉骨吸收标记物水平的变化。结果:RA活动组和非活动组的患者,其尿液D-Pyd浓度均较健康对照组升高(P<0.001),RA活动组的患者尿液D-Pyd浓度较非活动组升高(P<0.001)。40例RA患者使用慢作用抗风湿药(DMARD)治疗9个月后,其尿液D-Pyd浓度水平均较起始时下降(P<0.001)。结论:RA可致骨丢失,并且其骨质丢失随着病程的增加,疾病的活动和病情严重程度的增加而增加;通过积极抗风湿治疗,控制RA疾病活动性,使炎症受到抑制后,骨丢失也可受到抑制。RA尿液D-Pyd测定可以作为一种有助于及早评价RA药物治疗的一种客观指标。