HIV and employment among Black men who have sex with men in Baltimore

ABSTRACT

Employment status is a key social determinant of health, and many populations in the United States that are impacted by HIV have unequal access to education and employment opportunities which contributes to HIV-related disparities. Black men who have sex with men (BMSM) are one of the groups most heavily burdened by HIV. With improved health outcomes associated with advancements in HIV treatment, research suggests that more people living with HIV want to work. This study describes employment among BMSM living in Baltimore, assesses differences in employment by HIV status and assesses predictors of full-time employment among BMSM. The study found that BMSM have limited access to full-time employment and that this disparity is even more pronounced among BMSM living with HIV. Men living with HIV were less likely to be employed full-time compared to men not living with HIV controlling for education and social contextual factors (OR 0.40 95% CI (0.22–0.73)). HIV will most likely have important implications for employment patterns and trajectories of BMSM over the life course. Additional research is needed among BMSM living with HIV to understand work histories and experiences, facilitating factors, and the impact of various work experiences on the health and wellbeing.     

Employment status and impact on mental wellbeing in the UK working age population: a cross-sectional analysis

BackgroundGlobal evidence suggests that exposure to non-permanent or precarious employment can have negative effects on mental wellbeing, but research from the UK is sparse. This study explored whether these findings were applicable to the UK working population. As the employment market is evolving with more precarious working opportunities, we also ascertained whether any type of employment contract arrangement was more beneficial to mental wellbeing than being unemployed.MethodsWe retrospectively analysed the Understanding Society Wave 7 dataset (anonymous pan-UK dataset from 2015). In this study, we only included respondents aged 18–64 years, in paid employment or unemployed (n=18 525, 8473 men, 10 052 women). We used the seven components of, and the overall, Short Warwick Edinburgh Mental Wellbeing Score. A score lower than 18·82 determined low mental wellbeing. Part-time contracts were defined as working 30 h or less per week. To examine the associations between the respective employment statuses (contract types, in or out of employment) and mental wellbeing, we did a χ² analysis and calculated odds ratios (adjusted for age group and gender).FindingsThe prevalence of low mental wellbeing was highest in those unemployed (30·1%, n=438/1457), followed by those in non-permanent (14·3%, n=135/945) and permanent (12·1%, n=1943/16 123) employment arrangements. Compared with individuals employed on permanent contracts, those in non-permanent arrangements were more likely to report struggling to deal with problems (odds ratio 1·26, 95% CI 1·01–1·58, p=0·042), being unable to make up their mind (1·57, 1·20–2·06, p=0·001) or think clearly (1·35, 1·06–1·72, p=0·014), and report not feeling close to others (1·48, 1·21–1·81, p<0·0001). The association between contract types (permanent vs non-permanent) and low mental wellbeing was not significant (1·16, 0·96–1·40, p=0·13) as were the associations between contract types and future optimism, feeling useful, or feeling relaxed. Unemployed individuals were more likely to report low mental wellbeing than permanent (3·07, 2·72–3·47, p<0·0001), non-permanent (2·59, 2·09–3·21, p<0·0001), full-time (3·16, 2·79–3·58, p<0·0001), or part-time (2·60, 2·25–3·01, p<0·0001) workers.InterpretationPrecarious employment is associated with components of poorer mental wellbeing. However, the strongest associations for low mental wellbeing are observed in currently unemployed people. To understand and explore these complex relationships in greater detail, longitudinal research is required.FundingNone.     

Healthy but unhappy? Cross-national comparative analysis of depressive symptoms in Japanese vs. Korean elders

BackgroundJapan and South Korea, two neighbouring countries in East Asia, enjoy the highest life expectancies in the world, yet suffer paradoxically from high suicide rates.AimWe sought to conduct a cross-national comparative analysis of depressive symptoms among older adults in Japan vs. Korea, focusing particularly on poverty and physical health status.MethodsWe used nationally representative samples aged 65 and over from the Comprehensive Survey of Living Conditions in Japan and the Korean Community Health Survey in South Korea. Multivariate logistic regression models were conducted to examine if equivalized household income, poor self-rated health, disability and comorbidity (number of diseases) were associated with depressive symptoms, adjusting for age, education, marital status, alcohol use, smoking and living alone.ResultsOlder Japanese adults with poor self-rated health and disability were more likely to report depressive symptoms, but income level was not significantly associated with mental distress. By contrast, among older Korean people, depressive symptoms were strongly patterned by household income level, as well as poor self-rated health, disability, and comorbidity.ConclusionPoor physical health status was correlated with depressive symptoms among both Japanese and Korean seniors. However, income level was associated with depressive symptoms among only Korean elders, but not Japanese. Thus, the current generation of older Japanese adults appears to enjoy (relative) financial security, longevity, and mental wellbeing. By contrast, older Koreans experience high levels of mental distress, especially if they are financially insecure.     

Associations between soundscape experience and self-reported wellbeing in open public urban spaces: a field study

BackgroundPrevious studies, mainly conducted in laboratory experiments, showed there are associations between the perception of acoustic environments (ie, soundscapes, as per the International Organization for Standardization [ISO] 12913-1:2014 definition) and measures of individual health and wellbeing. The aim of this study was to confirm these findings in more ecologically realistic settings, by exploring associations between soundscapes and wellbeing via a questionnaire campaign.MethodsStudy design We performed a socioacoustic field survey with adult volunteers from members of the public who we approached across seven public spaces in London (UK), two in Venice (Italy), and two in Granada (Spain), including parks, urban squares, and commercial streets. Questionnaires gathered individual data about self-reported soundscape experience and wellbeing. Analysis The soundscape assessment protocol relied on the ISO/TS 12913-2:2018, whereas wellbeing measures were based on the WHO-five well-being index (WHO-5). A k-means cluster analysis was performed on the scores of the 15-item soundscape questionnaires, resulting in a two-group stratification of the sample into positive and negative soundscape experiences. The primary outcomes were WHO-5 scores and soundscape experience cluster membership.FindingsWHO-5 scores were computed for 825 (97%) of 849 surveyed participants following WHO instructions. An independent-samples t test showed statistically significant differences in WHO-5 scores between the groups who had a positive (n=445) or negative (n=380) soundscape experience; t(823)=–3·578; p<0·001. The positive group had higher WHO-5 scores (mean 63·5 [SD19·1]) than the negative group (mean 58·7 [18·9]).InterpretationTo the best of our knowledge, this is the first field study to explore associations between (perceived) soundscapes and self-reported measures of wellbeing. Although no causal effects can be established at this stage, results suggest that people with higher levels of wellbeing are more likely to report positive soundscapes, whereas people with lower levels of wellbeing might have a more negative attitude towards the acoustic environments. Self-reported data should be interpreted with caution: to contain any consequent bias, future studies might consider non-participatory methods of investigation and look at temporal effects in longitudinal designs. Overall, these findings highlight the importance of taking into account personal traits when characterising the quality of urban soundscapes and complementing conventional assessments by decibel-related metrics.FundingEuropean Research Council Advanced Grant (no 740696) on Soundscape Indices.     

Interventions that enhance health-professional contact with parents and infants to improve child development and social and emotional wellbeing in the early years in high-income countries: a systematic review

BackgroundExperiences in the first 1000 days of life have a crucial influence on child development and health. Universal health services provide support for families during this time, but new unassessed components are often added. We systematically reviewed the evidence for interventions in high-income countries designed to improve child development by enhancing health professional contact with parents in the very early years.MethodsWe searched Cochrane Central Register of Controlled Trials, Medline, Embase, CINAHL, PsycINFO, Web of Science, Scopus, ASSIA, LiLACS, Sociological Abstracts, Social Services Abstract, OpenGrey, ClinicalTrials.gov, UK Clinical Trials Gateway, and the WHO International Clinical Trials Registry Platform for studies published in any language between Jan 1, 1996, and Dec 17, 2014, using subject headings and key words with the following search structure: [health OR parenting professionals OR known programme names] AND [child development OR emotional/behavioural OR language OR cognitive outcomes]. We hand searched eight journals and 47 programme or organisation websites. We included randomised controlled trials (RCTs) that examined professional interventions designed to augment existing universal health-care provision from the antenatal period to 2 years post partum. Primary outcomes were motor, cognitive, and language development, and social and emotional wellbeing, measured to 3 years of age. Results were reported by narrative synthesis, because of heterogeneity in intervention design and outcome measurement.FindingsOf 12 473 studies identified, 21 RCTs met eligibility criteria. 15 had a high or unclear risk of bias as judged by Cochrane criteria. There was limited evidence for intervention effectiveness: some positive effects were seen in one of five studies for motor development, four of ten for language development, four of seven for cognitive development, and five of 18 for social and emotional wellbeing. However, most positive effects were in studies at high or unclear risk of bias, within-study effects were inconsistent, and negative effects were also seen. Intervention content and intensity varied greatly, but this was not associated with effectiveness. The quality of evidence overall was low as judged by GRADE criteria.InterpretationEvidence that interventions to enhance universal health services up to 2 years postpartum are effective for improving child development is weak. There is an urgent need for more robust assessment of existing interventions, and to develop and evaluate novel interventions to enhance the universal offer.FundingPublic Health Wales.     

Poverty,food insecurity,and health of Palestinian refugees in Lebanon and recently displaced from Syria to Lebanon: findings from the 2015 socioeconomic household survey

Background

The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) provides health, education, and housing services to Palestinian refugees in Lebanon (PRL), and food assistance and welfare support to the most vulnerable refugees. Palestinian refugees recently displaced from Syria (PRS) to Lebanon have placed additional pressures on health and education services, and employment rights of Palestinians remain limited. The objective of this study was to provide an updated profile of the socioeconomic and health status of PRL and PRS after their influx into Lebanon.

Role clarity and role conflict among Swedish diabetes specialist nurses

AimTo explore diabetes specialist nurses (DSNs)’ perceptions of their role in terms of clarity, conflict and other psychosocial work aspects.MethodsA cross-sectional study was conducted among DSNs in a county in northern Sweden. The DSNs answered the Nordic Questionnaire of Psychological and Social Factors at Work (QPS Nordic) about psychosocial aspects of their work. Statistical analysis compared DSNs with a reference group of different health professionals. Correlations between role clarity, role conflict, and other variables were analysed.ResultsThe DSNs perceived more, and higher, job demands, including quantitative, decision-making and learning demands, but also more positive challenges at work compared with the reference group. Role clarity correlated with experiences of health promotion, perception of mastery, co-worker support, and empowering leadership, while role conflict correlated with quantitative and learning demands.ConclusionsThe DSNs perceived high demands but also positive challenges in their work. Their role expectations correlated with several psychosocial work aspects. It is important that DSNs should be presented with positive challenges as meaningful incentives for further role development and enhanced mastery of their work.     

The role of social support in moderating the relationship between HIV centrality,internalised stigma and psychological distress for people living with HIV

ABSTRACT

Research has documented the negative impact of stigma on health outcomes for people living with HIV (PLHIV). How central HIV is to the identity of the individual may increase the negative effects of stigma, including greater psychological distress, while having strong social supports may play a buffering role. This study aimed to establish whether internalised stigma mediates the relationship between the centrality of HIV identity and psychological distress, while also assessing the role of social support as a moderator. PLHIV (n?=?181) responded to a survey assessing experiences of living with HIV focussed on centrality of HIV identity, internalised stigma, and wellbeing. After controlling for age and education, findings from the mediation analysis show that the more central HIV is to an individual’s identity, the more stigma is internalised and the greater the negative impact on psychological wellbeing. However, this is only the case for people with low levels of social support. Regardless of how central HIV is to identity, social support appears to act as a buffer and promote positive wellbeing. For those working with PLHIV, promoting the importance of good social support systems may be one way to address some of the negative impacts of stigma.     

Impact of moving into poverty on maternal and child mental health: longitudinal analysis of the Millennium Cohort Study

BackgroundThe UK Government has recently questioned whether relative measures of income poverty effectively reflect children's life chances. Although relative poverty is associated with poor maternal and child mental health, few studies have assessed the impact of moving into poverty on mental health outcomes. To inform this debate, we explored the association between transitions into poverty and mental health among children and their mothers using a nationally representative sample of children in the UK followed up between 2000 and 2012.MethodsOur analysis of the UK Millennium Cohort Study was based on 5877 singletons who participated in sweeps of the study at ages 9 months to 11 years and were not in relative poverty nor had maternal and child mental health problems when these measures were first recorded at 3 years old. The main outcomes were maternal psychological distress (Kessler Psychological Distress scale, K6) and child socioemotional behavioural problems (Strengths and Difficulties Questionnaire) at ages 5, 7, and 11 years. The main exposure of interest was moving into relative poverty, defined as household equivalised income less than 60% of median household income, according to the Organisation for Economic Co-operation and Development equivalence scale. Using discrete time-hazard models, we estimated odds ratios for subsequent maternal and child mental health of new transitions into poverty, while adjusting for baseline confounding. We further assessed how maternal mental health mediated any impact on child mental health.FindingsOverall 904 families (15·4%) experienced a new transition into poverty. After adjustment for confounders, transition into relative poverty increased the odds of maternal psychological distress (odds ratio 1·86, 95% CI 1·51–2·29) and socioemotional behaviour problems in children (1·37, 1·02–1·85). Controlling for maternal psychological distress reduced the odds of socioemotional behavioural problems in children, and rendered the association non significant (adjusted odds ratio 1·26, 95% CI 0·92–1·72).InterpretationIn this UK cohort, transitions into relative poverty, by use of the currently contested income-based definition, were associated with an increase in the risk of child and maternal mental health problems. Maternal mental health appeared to mediate the association between poverty transitions and child mental health. Actions to address child poverty are needed to tackle the mental health crisis in children in the UK.FundingSW, BB, and DT-R are funded by the Wellcome Trust.     

The influence of childhood welfare participation on adulthood substance use: evidence from the National Longitudinal Study of Adolescent to Adult Health

Background: The associations between early life-socioeconomic status and health, specifically substance use, are well substantiated. The vulnerabilities associated with adversity in childhood, particularly poverty, can have a cumulative effect on an individual’s risk and resilience throughout the life course. While several studies substantiate the relationship between substance use and welfare participation, less known is the impact of and prevalence of behavioral health problems later in life among young adults who were welfare recipients before age 18. Objective: This article explores whether childhood welfare participation before the age of 18 years influences substance use until young adulthood (24–34 years). Methods: This study used Add Health data with sample sizes ranging from 12,042 to 12,324 respondents, and propensity score matching methods to balance the samples and account for selection bias. Matched data were then used to run a series of regression models. Results: Those who participated in welfare before the age of 18 years had a significant lower probability of remaining substance-free until young adulthood (marijuana-free by 30%, p < 0.001; and other illicit substances-free by 16%, p < 0.05). However, no significant between-group differences were found on any of the alcohol-related variables. Conclusions: Findings highlight long-term behavioral health risks, especially substance use, faced by young adults who participated in welfare before the age of 18 years. Acknowledging the vulnerabilities associated with welfare participation and living in poverty could help increase the effectiveness of program and treatment efforts. The prevention of long-term behavioral health disorders hinges on early diagnosis and intervention.     

Linked work lives: The interrelation of own and partner’s employment history and their relationship with mental health in older European couples

IntroductionThere is strong evidence for the importance of previous employment for mental health at older age but little is known about the role of partner’s employment history in this. Life course theory suggests that individual trajectories are linked and evidence from cross-sectional studies suggest that there are cross-over effects within couples. Therefore, the present study tests the interdependence of own and partner’s employment history and their relationship with depressive symptoms.MethodsAnalyses are based on retrospective data from the SHARE survey for 5664 long-term couples aged 50 or older, with employment information for each age between 30 and 50 (full-time, part-time, domestic work or non-employed). We use sequence analysis to group similar employment histories and relate own and partner’s employment histories with depressive symptoms (EURO-D) using regression models.ResultsResults show that own and partner’s employment history are interdependent and mainly follow traditional divisions of paid work, with the majority of men working full-time and women often working part-time or not working. We find increased depressive symptoms after longer episodes of non-employment for men but not for women, regardless of partner’s employment situation.ConclusionThe study shows that mental health later in life is related to own employment history and that this relationship is not moderated by partner’s employment history. The results need to be interpreted against cultural and gender role norms at the time.     

Offspring neurodevelopmental outcomes born to parents with chronic inflammatory arthritis using antirheumatic therapies: A scoping review

IntroductionMost women with rheumatic diseases discontinue antirheumatic therapies in anticipation of, or during pregnancy due to concerns around medication safety and fetal wellbeing.ObjectiveWe performed a scoping review of available evidence investigating the risks of adverse offspring neurodevelopmental outcomes amongst parents with chronic inflammatory arthritis, taking antirheumatic therapies during conception or pregnancy.MethodsWe designed a scoping review protocol and search strategy a priori in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We performed an exhaustive search in Cochrane Library, Embase, Google Scholar, Medline, and Web of Science for relevant literature in January 2023. Articles needed to include offspring neurodevelopmental outcomes born to parents with CIA who took antirheumatic therapies during conception or pregnancy. Independent reviewers extracted data from eligible articles using a standard abstraction tool and performed critical appraisal of study quality.ResultsSix studies were included for full data abstraction. Use of Nonsteroidal Anti-inflammatory Drugs, Tumor Necrosis Factor Alpha inhibitors, and exposure to methotrexate during early first trimester of pregnancy did not seem to increase risk for adverse offspring neurodevelopmental outcomes. Corticosteroid use during pregnancy seemed to pose an increased risk for attention deficit hyperactive disorders in offspring.ConclusionUse of some antirheumatic therapies during pregnancy may not be associated with adverse offspring neurodevelopmental outcomes. Further investigations are needed to elucidate if other confounding factors affect long term offspring health outcomes born to parents with chronic inflammatory arthritis.     

Associations of perceived poor societal treatment among the oldest-old

BackgroundPrevious studies of perceived ageism among older people have focused on younger age groups with the respondents’ mean age far below 80.ObjectiveTo explore the perceptions of poor societal treatment of older people among home-dwelling people aged 75–100+ and how their perceptions are associated with demographic characteristics, health, functioning, and wellbeing.MethodsIn the Helsinki Aging Study, a random sample of 2,917 home-dwelling people aged 75–104 received a postal questionnaire inquiring about their health, wellbeing and experiences. The response rate was 74%. We asked: ‘How in your opinion are older people treated in Finland?’ (well/moderately/poorly) and categorized the respondents according to their responses. A multivariable forward stepwise ordered logistic regression model was used to determine the independent associations of the variables on the ordinal level of perceptions of treatment.ResultsOf the participants, 1,653 responded to the index item. Of these, only 13% thought that older people are treated well in society, and 66% and 21% were of the opinion that older people are treated moderately or poorly in society, respectively. Perceived poor societal treatment was more common among women, the younger respondents, and those with lower incomes, as well as family caregivers and those with lower self-rated health and lower psychological wellbeing. Those who were able to walk outside unassisted and those with a regular hobby perceived poor societal treatment more often.ConclusionsSeveral demographic factors, self-rated health, psychological wellbeing and better functioning were associated with perceptions of poor treatment among the oldest-old.     

Twitter conversations about food poverty: an analysis supplemented with Google Trends analysis

BackgroundAlthough the UK has not routinely collected national data on household food insecurity, the United Nations estimates that 8·4 million people in the UK experience food insecurity, a point emphasised by UN Special Rapporteur Philip Alston. With the use of novel and mixed methods we explored current topics, communications, and characteristics of social media networks on food poverty posted on Twitter. Our research questions were: what discussions were taking place on Twitter related to food poverty within the specified time? What hashtags, words, and websites were the most mentioned related to food poverty? What word-pair groups emerged by social analysis?MethodsWe used NodeXL Pro software to collect tweets sent between Nov 28 and Nov 30, 2018, using the phrase food poverty. This temporal range controlled for variables associated with food poverty, notably school-aged children and holiday periods, as we used Twitter's free public application programming interface (API) limit of 18 000 tweets and search range of 9 days. We analysed and visualised our data using social and semantic analysis tools such as overall graph metrics, vertex degree, vertex betweenness and closeness centralities, words and word pairs, and Network top items graph metrics. We also explored the spatiotemporal trends associated with this phrase using Google Trends.FindingsWe identified 4843 Twitter users whose recent tweets contained the term food poverty. There was 6039 tweets and connections in our network including 376 unique tweets, 3576 retweets, 1625 mentions, and 462 replies. The users shared information related to the existence of food poverty in the UK. Conversations included the growing numbers of foodbanks, welfare reforms, and Universal Credit as the cause of this problem. Google Trends indicated the highest degree of interest for food poverty search queries was related to New Zealand, followed by the UK and USA. Philip Alston was also the highest search term trend in the UK during this time.InterpretationThis research provides a snapshot of conversations about food poverty on Twitter. The themes we obtained indicate a lack of acknowledgment of food poverty in terms of both social policy and public health in the UK. Capturing and analysing social communications using this approach has highlighted increasing public awareness of food poverty.FundingTeesside University.     

Experiences of married men with HIV during the early phase of diagnosis within the context of mandatory disclosure in Singapore: An interpretative phenomenological analysis study

ABSTRACT

This qualitative study explored heterosexual married men’s experiences surrounding the mandatory disclosure of their HIV-positive status to their spouse and their adjustment in moving on with their life. Four men and three health care professionals were recruited from a hospital and interviewed. Their experiences were analyzed using Interpretative Phenomenological Analysis (IPA). Five themes were identified: acceptance as a process, the way people look at us, wife needs to know, disclosure transforms family, and living with HIV. These results are useful to help health care professionals plan the emotional and social support needed for this group of individuals to work toward acceptance of their diagnosis while having to inform their spouse within the limited time frame imposed by mandatory disclosure.     

Employment-based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence: a randomized controlled trial

Context Due to the chronic nature of cocaine dependence, long‐term maintenance treatments may be required to sustain abstinence. Abstinence reinforcement is among the most effective means of initiating cocaine abstinence. Practical and effective means of maintaining abstinence reinforcement programs over time are needed. Objective To determine whether employment‐based abstinence reinforcement can be an effective long‐term maintenance intervention for cocaine dependence. Design Participants (n = 128) were enrolled in a 6‐month job skills training and abstinence initiation program. Participants who initiated abstinence, attended regularly and developed needed job skills during the first 6 months were hired as operators in a data entry business and assigned randomly to an employment‐only (control, n = 24) or abstinence‐contingent employment (n = 27) group. Setting A non‐profit data entry business. Participants Unemployed welfare recipients who used cocaine persistently while enrolled in methadone treatment in Baltimore. Intervention Abstinence‐contingent employment participants received 1 year of employment‐based contingency management, in which access to employment was contingent upon provision of drug‐free urine samples under routine and then random drug testing. If a participant provided drug‐positive urine or failed to provide a mandatory sample, then that participant received a temporary reduction in pay and could not work until urinalysis confirmed recent abstinence. Main outcome measure Cocaine‐negative urine samples at monthly assessments across 1 year of employment. Results During the 1 year of employment, abstinence‐contingent employment participants provided significantly more cocaine‐negative urine samples than employment‐only participants [79.3% and 50.7%, respectively; P = 0.004, odds ratio (OR) = 3.73, 95% confidence interval (CI) = 1.60–8.69]. Conclusions Employment‐based abstinence reinforcement that includes random drug testing is effective as a long‐term maintenance intervention, and is among the most promising treatments for drug dependence. Work‐places could serve as therapeutic agents in the treatment of drug dependence by arranging long‐term employment‐based contingency management programs.     

The ASAS-OMERACT core domain set for axial spondyloarthritis

BackgroundThe current core outcome set for ankylosing spondylitis (AS) has had only minor adaptations since its development 20 years ago. Considering the significant advances in this field during the preceding decades, an update of this core set is necessary.ObjectiveTo update the ASAS-OMERACT core outcome set for AS into the ASAS-OMERACT core outcome set for axial spondyloarthritis (axSpA).MethodsFollowing OMERACT and COMET guidelines, an international working group representing key stakeholders (patients, rheumatologists, health professionals, pharmaceutical industry and drug regulatory agency representatives) defined the core domain set for axSpA. The development process consisted of: i) Identifying candidate domains using a systematic literature review and qualitative studies; ii) Selection of the most relevant domains for different stakeholders through a 3-round Delphi survey involving axSpA patients and axSpA experts; iii) Consensus and voting by ASAS; iv) Endorsement by OMERACT. Two scenarios are considered based on the type of therapy investigated in the trial: symptom modifying therapies and disease modifying therapies.ResultsThe updated core outcome set for axSpA includes 7 mandatory domains for all trials (disease activity, pain, morning stiffness, fatigue, physical function, overall functioning and health, and adverse events including death). There are 3 additional domains (extra-musculoskeletal manifestations, peripheral manifestations and structural damage) that are mandatory for disease modifying therapies and important but optional for symptom modifying therapies. Finally, 3 other domains (spinal mobility, sleep, and work and employment) are defined as important but optional domains for all trials.ConclusionThe ASAS-OMERACT core domain set for AS has been updated into the ASAS-OMERACT core domain set for axSpA. The next step is the selection of instruments for each domain.     

Clinical features of ST-segment elevation myocardial infarction in patients receiving welfare public assistance in urban area of Japan

BackgroundAn increase in the rate of relative poverty and the number of welfare recipients is a serious social problem in Japan. A recent overseas survey demonstrated that lack of health insurance was associated with increased in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI). The aim of this study is to investigate the clinical features of STEMI patients who receive welfare public assistance in Japan.MethodsWe enrolled 525 STEMI patients who were hospitalized in our hospital from 2010 to 2019. We divided patients into groups of patients receiving welfare public assistance (WPA group, N = 67) and groups of patients not receiving welfare public assistance (non-WPA group, N = 458). Patient characteristics, clinical outcome, and cardiac function on transthoracic echocardiography were compared.ResultsWPA group were younger than non-WPA group (61.2 ± 10.9 years VS 64.5 ± 13.3 years, p = 0.03). The prevalence of smoking was higher in WPA group compared to non-WPA group (91.0% VS 81.1% p = 0.04) and high-density lipoprotein cholesterol value of WPA group was lower than in non-WPA group (43.2 ± 9.9 mg/dl vs 47.1 ± 12.8 mg/dl, p = 0.005).Ventricular arrhythmia on admission was significantly more frequent in WPA group (11.9% VS 4.8%, p = 0.02). In acute and chronic phase, left ventricular ejection fraction in WPA group was lower than non-WPA group (in acute phase 46.6 ± 10.7% vs 53.3 ± 8.6% p = 0.001, in chronic phase 48.7 ± 10.1% vs 55.3 ± 9.4%, p = 0.008).ConclusionSTEMI patients receiving welfare public assistance had poorer control of coronary risk, increased risk of fatal arrhythmia, and reduced systolic function than those not receiving welfare public assistance. It is necessary to have a system that can strengthen lifestyle management, such as diet and smoking cessation for the purpose of improving the prognosis of welfare recipients after AMI.