Aiming for a healthier life: a qualitative content analysis of rehabilitation goals in patients with rheumatic diseases

Purpose: To explore and describe rehabilitation goals of patients with rheumatic diseases during rehabilitation stays, and examine whether goal content changed from admission to discharge.

Method: Fifty-two participants were recruited from six rehabilitation centers in Norway. Goals were formulated by the participants during semi-structured goal-setting conversations with health professionals trained in motivational interviewing. An inductive qualitative content analysis was conducted to classify and quantify the expressed goals. Changes in goal content from admission to discharge were calculated as percentage differences. Goal content was explored across demographic and contextual characteristics.

Results: A total of 779 rehabilitation goals were classified into 35 categories, within nine overarching dimensions. These goals varied and covered a wide range of topics. Most common at admission were goals concerning healthy lifestyle, followed by goals concerning symptoms, managing everyday life, adaptation, disease management, social life, and knowledge. At discharge, goals about knowledge and symptoms decreased considerably, and goals about healthy lifestyle and adaptation increased. The health profession involved and patient gender influenced goal content.

Conclusions: The rehabilitation goals of the patients with rheumatic diseases were found to be wide-ranging, with healthy lifestyle as the most prominent focus. Goal content changed between admission to, and discharge from, rehabilitation stays.

• Implications for rehabilitation

• Rehabilitation goals set by patients with rheumatic diseases most frequently concern healthy lifestyle changes, yet span a wide range of topics.

• Patient goals vary by gender and are influenced by the profession of the health care worker involved in the goal-setting process.

• To meet the diversity of patient needs, health professionals need to be aware of their potential influence on the actual goal-setting task, which may limit the range of topics patients present when they are asked to set rehabilitation goals.

• The proposed framework for classifying goal content has the capacity to detect changes in goals occurring during the rehabilitation process, and may be used as a clinical tool during goal-setting conversations for this patient group.

     

Physiopathology of dental rickets in vitamin D receptor-ablated mice

1α25(OH)(2)vitaminD(3) and its nuclear receptor, VDR, are essential for normal tooth development. However, the relative contributions of the direct vs. indirect effects of vitamin D action on odontogenesis are unclear. The aim of this study was to discriminate among the specific roles of 1α25(OH)(2) vitaminD(3), calcemia/phosphatemia, and the maternal environment in mouse VDR null mutants. Microradiographic, histological, and molecular analyses were conducted on adult mice under hypocalcemic/hypophosphatemic vs. normocalcemic/normophosphatemic conditions, and pups of first- (VDR-/- born to VDR+/- dams) vs. second-generation (VDR-/- born to VDR-/- dams) mice. In VDR-/- mice, crown morphogenesis was affected exclusively in second-generation pups. In first-generation adult VDR-/- mice, both enamel and dentin were affected, and pathologic features of root resorption in both apical and cervical regions were observed. Nutritional calcium and phosphate normalization completely rescued the root resorption and partially rescued the dentin and enamel phenotypes (altered cell differentiation and matrix protein expression). Analysis of these data illustrates the co-existence of different pathways of vitamin D action in tooth differentiation and biomineralization. These targeted and cumulative effects would generate the diverse and wide spectrum of dental rickets phenotypes.     

Prognostic merit of N-terminal-proBNP and N-terminal-proANP in mechanically ventilated critically ill patients

Background: Amino‐terminal fragments of type‐A and type‐B natriuretic peptide prohormones (NT‐proBNP, NT‐proANP) are powerful prognostic markers in patients with cardiac disease, and NT‐proBNP has been demonstrated to predict outcome in severe sepsis and septic shock. We assessed the prognostic value of NT‐proBNP and NT‐proANP in a consecutive series of mechanically ventilated intensive care patients and compared their prognostic merit. Methods: Seventy unselected patients admitted to the intensive care unit (ICU) were included in the study 48 h after start of controlled mechanical ventilation. Venous blood was obtained on inclusion and assayed for NT‐proBNP and NT‐pro ANP. Univariate and multivariate logistic regression analysis was used to assess the association of NT‐proBNP and NT‐proANP levels with 30‐day mortality. Established risk factors and possible confounders were used as covariates. Discrimination of different prognostic models was assessed calculating the area under the receiver‐operating characteristics curve (ROC‐AUC). Results: NT‐proBNP and NT‐proANP levels were higher in non‐survivors (n=25) than in 30‐day survivors (n=45). Log NT‐proBNP [odds ratio (OR) 2.34, 95% CI 1.17–4.66], and log NT‐proANP (OR 2.44, 95% CI 1.12–5.30) were independently predictive of increased mortality. A prior diagnosis of chronic obstructive lung disease was predictive of decreased mortality (OR 0.29, 95% CI 0.08–1.00). The relative prognostic values, evaluated by the ROC‐AUCs of NT‐proBNP (AUC 0.74, 95% CI 0.61–0.86) and NT‐proANP (AUC 0.73, 95% CI 0.61–0.86), were nearly identical. Conclusions: High NT‐proANP and NT‐proBNP levels associated with decreased short‐term survival in unselected, mechanically ventilated ICU patients. NT‐proANP performed equally well as a prognostic indicator as NT‐proBNP, and may represent a clinically useful alternative to NT‐proBNP.     

Opsonophagocytic activity and other serological indications of Bordetella pertussis infection in military recruits in Norway

Bordetella pertussis is the causative agent of pertussis (whooping cough). Despite high vaccination coverage, pertussis remains a significant disease in many countries. Besides vaccination, transient carriage of Bordetella spp. or other cross-reacting organisms adds to the immunity against pertussis. However, the various immunological mechanisms conferring protection remain largely unknown. In this study, paired serum samples from 464 healthy Norwegian military recruits were collected, the first at enrolment and the second about 8 months later. The prevalence of pertussis during military service was examined by comparing the paired serum samples for immunoglobulin G (IgG) antibodies against pertussis toxin (PT) by enzyme-linked immunosorbent assay (ELISA). Seventy-eight percent of the recruits had low levels of IgG antibodies against PT in both samples. Conversely, 8.4% of the recruits demonstrated high anti-PT IgG levels in the first sample, indicative of recent pertussis prior to enrolment. One recruit experienced seroconversion, indicating pertussis during service. A subset of 248 serum samples with low, medium, and high anti-PT IgG titers were analyzed by a different ELISA kit for IgG and IgA antibodies against PT and filamentous hemagglutinin (FHA) and for opsonophagocytic activity (OPA), for induction of C3b deposition products, and for IgG binding with live B. pertussis as the antigen. We observed high correlations between OPA and IgG against live bacteria (r = 0.83), between OPA and IgG anti-FHA (r = 0.79), between OPA and anti-PT IgG (r = 0.68), and between OPA and C3b binding (r = 0.70) (P < 0.0001 for all). Anti-PT IgA did not correlate closely with the other assays.     

Bupivacaine-induced cellular entry of QX-314 and its contribution to differential nerve block

Background and Purpose: Selective nociceptor fibre block is achieved by introducing the cell membrane impermeant sodium channel blocker lidocaine N-ethyl bromide (QX-314) through transient receptor potential V1 (TRPV1) channels into nociceptors. We screened local anaesthetics for their capacity to activate TRP channels, and characterized the nerve block obtained by combination with QX-314.Experimental Approach: We investigated TRP channel activation in dorsal root ganglion (DRG) neurons by calcium imaging and patch-clamp recordings, and cellular QX-314 uptake by MS. To characterize nerve block, compound action potential (CAP) recordings from isolated nerves and behavioural responses were analysed.Key Results: Of the 12 compounds tested, bupivacaine was the most potent activator of ruthenium red-sensitive calcium entry in DRG neurons and activated heterologously expressed TRPA1 channels. QX-314 permeated through TRPA1 channels and accumulated intracellularly after activation of these channels. Upon sciatic injections, QX-314 markedly prolonged bupivacaine''s nociceptive block and also extended (to a lesser degree) its motor block. Bupivacaine''s blockade of C-, but not A-fibre, CAPs in sciatic nerves was extended by co-application of QX-314. Surprisingly, however, this action was the same in wild-type, TRPA1-knockout and TRPV1/TRPA1-double knockout mice, suggesting a TRP-channel independent entry pathway. Consistent with this, high doses of bupivacaine promoted a non-selective, cellular uptake of QX-314.Conclusions and Implications: Bupivacaine, combined with QX-314, produced a long-lasting sensory nerve block. This did not require QX-314 permeation through TRPA1, although bupivacaine activated these channels. Regardless of entry pathway, the greatly extended duration of block produced by QX-314 and bupivacaine may be clinically useful.     

Bone formation in the context of growth retardation induced by hIGFBP-1 overexpression in transgenic mice

In humans, intrauterine growth retardation (hIUGR) is correlated with an overexpression of insulin-like growth factor binding protein 1 (IGFBP-1). The affected children also present a delay in bone mineralization. In this study, transgenic 12-day-old mutant mice overexpressing human IGFBP-1 hepatospecifically showed a severe growth retardation. Alcian blue and alizarin red S staining of the skeleton revealed mineralization defects at the posterior level of the skull (delayed suture closure) and in appendicular and axial skeleton. Furthermore, microradiographic analysis showed a reduced bone density in the same areas. Thus, overexpressing of hIGFBP-1 demonstrates early postnatal life growth retardation and a delay in mineralization in transgenic mutant mice. These data show the involvement of the IGF/IGFBP system and more particularly IGFBP-1 in the biomineralization process.