Are the benefits of a high‐intensity progressive resistance training program sustained in rheumatoid arthritis patients? A 3‐year followup study

Objective

Rheumatoid arthritis (RA) patients were reassessed for body composition and physical function mean ± SD 39 ± 6 months after commencing a randomized controlled trial involving 24 weeks of either high‐intensity progressive resistance training (PRT) or low‐intensity range of movement exercise (control) to determine whether the benefits of PRT (i.e., reduced fat mass [FM], increased lean mass [LM], and improved function) were retained.

Methods

Nine PRT and 9 control subjects were reassessed for body composition (dual x‐ray absorptiometry) and function (knee extensor strength, chair test, arm curl test, 50‐foot walk) approximately 3 years after resuming normal activity following the exercise intervention.

Results

At followup, PRT subjects remained significantly leaner than control subjects (P = 0.03), who conversely had accumulated considerable FM during the study period (approximately ?1.0 kg versus +2.4 kg, PRT versus controls). PRT subjects also retained most of the improvement in walking speed gained from training (P = 0.03 versus controls at followup). In contrast, the PRT‐induced gains in LM and strength‐related function were completely lost. Data from the controls suggest that established and stable RA patients have similar rates of LM loss but elevated rates of FM accretion relative to age‐matched sedentary non‐RA controls.

Conclusion

We found that long‐term resumption of normal activity resulted in loss of PRT‐induced improvements in LM and strength‐related function, but substantial retention of the benefits in FM reduction and walking ability. The relatively long‐term benefit of reduced adiposity, in particular, is likely to be clinically significant, as obesity is very prevalent among RA patients and is associated with their disability and exacerbated cardiovascular disease risk.

     

Who should have genetic testing for maturity‐onset diabetes of the young?

Maturity-onset diabetes of the young (MODY) is a clinically heterogeneous group of monogenic disorders characterized by autosomal dominant inheritance of young-onset, non-insulin-dependent diabetes. The genes involved are important in beta cell development, function and regulation and lead to disorders in glucose sensing and insulin secretion. Heterozygous GCK mutations cause impaired glucokinase activity resulting in stable, mild hyperglycaemia that rarely requires treatment. HNF1A mutations cause a progressive insulin secretory defect that is sensitive to sulphonylureas, most often resulting in improved glycaemic control compared with other diabetes treatment. MODY owing to mutations in the HNF4A gene results in a similar phenotype, including sensitivity to sulphonylurea treatment. HNF1B mutations most frequently cause developmental renal disease (particularly renal cysts) but may also cause MODY in isolation or may cause the renal cysts and diabetes syndrome (RCAD syndrome). Mutations in NEUROD1, PDX1 (IPF1), CEL and INS are rare causes of MODY. MODY is often misdiagnosed as type 1 or type 2 diabetes. However, a correct genetic diagnosis impacts treatment and identifies at-risk family members. Thus, it is important to consider a diagnosis of MODY in appropriate individuals and to pursue genetic testing to establish a molecular diagnosis.     

Do parents' marital circumstances predict young adults' DSM‐IV cannabis use disorders? A prospective study

AIMS: To determine whether parental marital status and marital quality in adolescence are associated with cannabis use disorders in young adults. DESIGN: Prospective birth cohort study. SETTING: A 21-year follow-up of 4815 mothers and their children who participated at 14 years after the child's birth in Queensland, Australia. PARTICIPANTS: Cohort of 2303 young adults who completed the life-time version of the Composite International Diagnostic Interview-computerized version (CIDI-Auto) at the 21-year follow-up. MEASUREMENTS: Young adults' cannabis use disorders were assessed using the CIDI-Auto. Marital status and quality (marital circumstances) and potential confounding factors such as socio-economic status (SES), maternal mental health and maternal substance use were measured when the child was 14 years of age. FINDINGS: Marital circumstances of the mother when child was aged 14 years predicted risk of cannabis use disorders in their offspring. After adjustment for potential confounding factors, adolescents who grew up in step-father families were more likely to have cannabis use disorders in early adulthood and a moderate association was found for those children who experienced maternal marital disagreement [odds ratio (OR) = 1.7; 95% confidence interval (CI): 1.0, 2.9]. There was no significant increase in subsequent risk of cannabis use disorders for children whose mothers were unpartnered at 14 years. CONCLUSIONS: Maternal marital status and marital quality are associated with young adults' subsequent cannabis use disorders. This association is independent of suspected confounding factors measured at 14 years. However, at least part of the association is explained by changes in marital status before 14 years.     

Who needs ‘pukka1 anthropologists'? A study of the perceptions of the use of anthropology in tropical public health research

Over the past 50 years, there have been considerable changes both in how medical anthropologists view their relationship to tropical public health and in how tropical public health professionals view the role of anthropologists. In particular, in recent decades critical currents have emerged from an anthropology of medicine, calling for an examination of biomedicine and its conceptualisation of public health. There are parallel debates in public health about a narrow disease-focused or broader socio-cultural approach to improving population health. Based on a review of the literature and a qualitative study of the views of public health professionals and anthropologists working in tropical public health, the data presented in this paper suggest that public health professionals remain unaware of many of the contributions anthropology could make to tropical public health theory and practice. However, the objectives of a critical social science are not dissimilar to those of the broader concept of public health. We suggest that there are grounds for optimism. For those of us concerned not just with disease but also with inequities in health, the challenge is to work towards a critical tropical public health which draws as much from social science as from biomedicine, in theory and practice.     

“Are you better?” A qualitative study of the meaning of recovery

Purpose Research into the meaning of illness has often focused on an individual's transition into a state of being ill, for example the adoption of a sick role. The question “Are you better?” addresses the transition out of this state and is fundamental to the patient–clinician relationship, guiding decisions about treatment. However, the question assumes that all patients have the same meaning for “being better.” The purpose of this study was to explore the meaning of the concept of recovery (getting better) in a group of people with upper limb musculoskeletal disorders.

Methods

Qualitative (grounded theory) methods were used. Individual interviews were conducted with 24 workers with work‐related musculoskeletal disorders of the upper limb. The audiotaped interviews were transcribed and coded for content. Categories were linked, comparisons made, and a theory built about how people respond to the question “Are you better?”

Results

The perception of “being better” is highly contextualized in the experience of the individual. Being better is not only reflected in changes in the state of the disorder (resolution) but could be an adjustment of life to work around the disorder (readjustment) or an adaptation to living with the disorder (redefinition). The experience of the disorder can be influenced by factors such as the perceived legitimacy of the disorder, the comparators used to define health and illness, and coping styles, which in turn can influence being better.

Conclusion

Two patients could mean very different things when saying that they are better. Some may not actually have a change in disease state as measured by symptoms, impairments, or function.

     

Low‐grade systolic murmurs in healthy middle‐aged individuals: innocent or clinically significant? A 35‐year follow‐up study of 2014 Norwegian men

Abstract. Bodegard J, Skretteberg PT, Gjesdal K, Pyörälä K, Kjeldsen SE, Liestøl K, Erikssen G, Erikssen J (Oslo University Hospital, Oslo; University of Oslo, Oslo; University of Eastern Finland, Kuopio; University of Oslo, Oslo; Oslo University Hospital, Oslo). Low‐grade systolic murmurs in healthy middle‐aged individuals: innocent or clinically significant? A 35‐year follow‐up study of 2014 Norwegian men. J Intern Med 2012; 271 : 581–588. Objective. To determine whether a low‐grade systolic murmur, found at heart auscultation, in middle‐aged healthy men influences the long‐term risk of aortic valve replacement (AVR) and death from cardiovascular disease (CVD). Setting and subjects. During 1972–1975, 2014 apparently healthy men aged 40–59 years underwent an examination programme including case history, clinical examination, blood tests and a symptom‐limited exercise ECG test. Heart auscultation was performed under standardized conditions, and murmurs were graded on a scale from I to VI. No men were found to have grade V/VI murmurs. Participants were followed for up to 35 years. Results. A total of 1541 men had no systolic murmur; 441 had low‐grade murmurs (grade I/II) and 32 had moderate‐grade murmurs (grade III/IV). Men with low‐grade murmurs had a 4.7‐fold [95% confidence interval (CI) 2.1–11.1] increased age‐adjusted risk of AVR, but no increase in risk of CVD death. Men with moderate‐grade murmurs had an 89.3‐fold (95% CI 39.2–211.2) age‐adjusted risk of AVR and a 1.5‐fold (95% CI 0.8–2.5) age‐adjusted increased risk of CVD death. Conclusions. Low‐grade systolic murmur was detected at heart auscultation in 21.9% of apparently healthy middle‐aged men. Men with low‐grade murmur had an increased risk of AVR, but no increase in risk of CVD death. Only 1.6% of men had moderate‐grade murmur; these men had a very high risk of AVR and a 1.5‐fold albeit non‐significant increase in risk of CVD death.     

Electronic gaming machines: are they the ‘crack‐cocaine’ of gambling?

BACKGROUND: There is a general view that electronic gaming is the most 'addictive' form of gambling, in that it contributes more to causing problem gambling than any other gambling activity. As such, electronic gaming machines have been referred to as the 'crack-cocaine' of gambling. While this analogy has popular appeal, it is only recently that the scientific community has begun to investigate its validity. In line with the belief that electronic gambling has a higher 'addictive' potential than other forms of gambling, research has also begun to focus on identifying the characteristics of gaming machines that may be associated with problem gambling behaviour. AIMS AND METHODS: This paper will review the different types of modern electronic gaming machines, and will use the introduction of gaming machines to Australia to examine the association between electronic gaming and problem gambling, with particular reference to the characteristics of modern electronic gaming machines. FINDINGS AND CONCLUSIONS: Despite overwhelming acceptance that gaming machines are associated with the highest level of problem gambling, the empirical literature provides inconclusive evidence to support the analogy linking electronic gaming to 'crack-cocaine'. Rigorous and systematic evaluation is required to establish definitively the absolute 'addictive' potential of gaming machines and the degree to which machine characteristics influence the development and maintenance of problem gambling behaviour.     

Why would young people donate blood? A survey‐based questionnaire study

Background and Objectives   Different issues associated with blood donation among young donors were studied, towards building a large and consistent blood donor base.
Methods   Data were collected from 221/285 donors in drives conducted among military personnel (response rate of 78%), through a self-administered questionnaire tailored to review knowledge, beliefs, attitudes and habits regarding blood and general donations. Data were then further analysed using a multivariate model.
Results   The most significant factors related to blood donation were the donors' perception of approval from a superior (the commander's request to donate blood) and the participant's military rank or position ( P  < 0·0001 and P  = 0·0019, respectively). Experienced blood donors comprised 71·9% of all donors and more donations were noted among men ( P  = 0·0013).
Conclusions   The important role of a significant superior, and his or her personal involvement in the blood drive organization was elucidated. Various other factors, previously found to be related to readiness or reluctance to donate blood, were insignificant among the studied population. Our finding may assist blood centres in optimizing their efforts in recruiting and retention of young donors.     

A 5‐year follow up of patients discharged with non‐specific abdominal pain: out of sight,out of mind?

Background/Aim: Acute non‐specific abdominal pain (NSAP) is prevalent in 6–25% of the general population and is a common cause of admission to the emergency department (ED). Despite involvement of substantial financial and human resources, there are few data on long‐term outcome after initial diagnosis. The aim of this study was to evaluate long‐term outcome of patients initially admitted with NSAP to an ED. Methods: The study involves a 5‐year follow‐up analysis of prospectively collected data on 104 patients admitted to our ED in 2003 with NSAP. Primary end‐point was clinical outcome 5 years after initial ED admission. Predictive risk factors were assessed using a multivariate regression model. Results: 29 patients (28%) had recurring NSAP 5 years after initial ED admission, 76% of these patients received (multiple) diagnostic examinations and 13% eventually required diagnostic (or therapeutic) surgery. Although approximately half of patients with recurring NSAP eventually received a definite diagnosis, 30% still suffered from recurrent abdominal pain. Using regression analysis, no single factor in our dataset could be identified as a predictor for NSAP persistence. Conclusion: The long‐term impact for patients initially admitted to our ED with acute NSAP is significant – 28% of patients continue to suffer from recurring NSAP after 5 years. NSAP therefore remains, despite more advanced diagnostic tools, a true and, as yet, unsolved problem.     

Is hypertension a predictor for heart failure? A cross cultural comparison over a 10‐year period

This was a retrospective cohort study to assess the effect of hypertension (HTN) among Qatari and Asian patients admitted to the Hamad General Hospital in Qatar with heart failure (HF) and to identify risk factors that contribute to the development of HF in HTN patients in the State of Qatar. A total of 20,856 patients were treated during the 10-year period; 8446 were Qataris and 60% were male. Among the total Qatari patients admitted with HF (n=2342), 52.4% had HTN. The incidence of HTN was slightly higher in males than in females (50.4 vs. 49.6%; p<0.001). Significantly more HTN patients had diabetes mellitus (DM) (p<0.001) and hypercholesterolemia (p<0.001). There was also a significant difference between Qatari and Asian HTN patients in respect of their age (p<0.001) and gender (p<0.001). Qatari hypertensive patients were more likely to have DM (p<0.001). HTN and DM were the most common risk factors for HF.