Effectiveness of nonpharmacological and nonsurgical interventions for patients with rheumatoid arthritis: an overview of systematic reviews

Conclusions based on systematic reviews of randomized controlled trials are considered to provide the highest level of evidence about the effectiveness of an intervention. This overview summarizes the available evidence from systematic reviews on the effects of nonpharmacological and nonsurgical interventions for rheumatoid arthritis (RA). Systematic reviews of studies of patients with RA (aged >18 years) published between 2000 and 2007 were identified by comprehensive literature searches. Methodological quality was independently assessed by 2 authors, and the quality of evidence was summarized by explicit methods. Pain, function, and patient global assessment were considered primary outcomes of interest. Twenty-eight systematic reviews were included in this overview. High-quality evidence was found for beneficial effects of joint protection and patient education, moderate-quality evidence was found for beneficial effects of herbal therapy (gamma-linolenic acid) and low-level laser therapy, and low-quality evidence was found for the effectiveness of the other interventions. The quality of evidence for the effectiveness of most nonpharmacological and nonsurgical interventions in RA is moderate to low.     

Scaling up an Empirically Supported Intervention with Long-Term Outcomes: the Nationwide Implementation of GenerationPMTO in Norway

Prevention Science - Effective implementation outcomes are necessary preconditions for effective service and positive treatment outcomes for children with behavioral problems. The aim of this study...     

Sleep Apnea Is Associated with Cardiovascular Risk Factors among Kidney Transplant Patients

Background and objectives: We assessed the prevalence of obstructive sleep apnea (OSA) and its clinical correlates in a large sample of patients who received a kidney transplant (Tx). We also compared the prevalence of the disorder between dialysis patients who were on the waiting list for a Tx (WL) and Tx patients.Design, setting, participants, & measurements: This was a cross-sectional study of 100 Tx and 50 WL patients who underwent one-night polysomnography (SLeep disorders Evaluation in Patients after kidney Transplantation [SLEPT] Study). Sociodemographic information and data about medication, comorbidity, and laboratory parameters were collected.Results: The prevalence of mild (apnea-hypopnea index [AHI] ≥5/h and <15/h), moderate (AHI ≥15/h and <30/h), and severe OSA (AHI ≥30/h) was 18, 11, and 14% in the Tx group and 28, 16, and 10% in the WL group, respectively. The AHI was significantly correlated with age (ρ = 0.34), body mass index (ρ = 0.45), neck circumference (ρ = 0.4), abdominal circumference (ρ = 0.51), and hemoglobin (ρ = 0.24) in the Tx group. The proportion of Tx patients who were treated with three or more antihypertensive drugs was significantly higher in the OSA group (56 versus 31%; P = 0.022). Despite taking significantly more antihypertensive drugs, the average systolic BP was still higher in patients with versus without OSA (147 ± 21 versus 139 ± 18 mmHg; P = 0.059).Conclusions: The prevalence of OSA is similar in Tx and WL patients and it may contribute to presence of hypertension in patients who receive a Tx.Obstructive sleep apnea (OSA) is the most clinically important form of sleep-related breathing disorders. The severity of OSA is generally characterized by the apnea-hypopnea index (AHI), which is the number of apneic and hypopneic events per hour of sleep.The prevalence of moderate and severe OSA syndrome (OSAS; AHI ≥15 and the presence of daytime symptoms of OSA) is 2 to 4% in the general population (1) and is associated with increased cardiovascular morbidity and mortality (2,3). OSAS is reportedly associated with higher risk for stroke, hypertension, diabetes, congestive hearth failure, arrhythmias, and the metabolic syndrome and also with fatal and nonfatal cardiovascular events (4–7)Previous studies have shown high prevalence of OSA (16 to 54%) in patients with chronic kidney disease (CKD) (8,9). Unruh et al. (10) showed that OSA is more common in hemodialysis patients than in general population.Although OSA may contribute to the increased cardiovascular risk seen in Tx patients, consistent information about OSA in patients who have received a kidney transplant (Tx) is scarce. Previously, we found that the prevalence of high risk for OSAS is approximately 30% in both WL and Tx patients (11). A case series indicated that AHI did not change after transplantation in 73% of the patients (12). Conversely, Mallamaci et al. (13) recently reported that 22% of renal Tx recipients had a respiratory disturbance index >5, which was similar to results seen in the general population.We designed this cross-sectional study to determine the prevalence and clinical correlates of OSA in a large, randomly selected sample of Tx patients using polysomnography. On the basis of our previous findings, we hypothesized that the prevalence of OSA would be similarly high in Tx and WL patients. Finally, we expected to find an increased cardio- and cerebrovascular risk in patients with versus without OSA in the Tx population.     

Double- and monofunctional CD4⁺ and CD8⁺ T-cell responses to Mycobacterium tuberculosis DosR antigens and peptides in long-term latently infected individuals

More than 2 billion individuals are latently infected with Mycobacterium tuberculosis (Mtb). Knowledge of the key Mtb antigens and responding T-cell subsets mediating protection against Mtb is critical for developing improved tuberculosis (TB) vaccines. We previously reported that Mtb DosR-regulon-encoded antigens are recognized well by human T cells in association with control of Mtb infection. The characteristics of the responding T-cell subsets, however, remained unidentified. We have therefore studied the cytokine production and memory phenotypes of Mtb DosR-regulon-encoded antigen-specific T cells from individuals who had been infected with Mtb decades ago, yet never developed TB (long-term latent Mtb-infected individuals). Using multi-parameter flow cytometry and intracellular cytokine staining for IFN-γ, TNF-α and IL-2, we found double and single cytokine-producing CD4(+) as well as CD8(+) T cells to be the most prominent subsets, particularly IFN-γ(+) TNF-α(+) CD8(+) T cells. The majority of these T cells comprised effector memory and effector T cells. Furthermore, CFSE labeling revealed strong CD4(+) and CD8(+) T-cell proliferative responses induced by several "immunodominant" Mtb DosR antigens and their specific peptide epitopes. These findings demonstrate the prominent presence of double- and monofunctional CD4(+) and CD8(+) T-cell responses in naturally protected individuals and support the possibility of designing Mtb DosR antigen-based TB vaccines.     

Neural basis of interpersonal traits in neurodegenerative diseases

Several functional and structural imaging studies have investigated the neural basis of personality in healthy adults, but human lesions studies are scarce. Personality changes are a common symptom in patients with neurodegenerative diseases like frontotemporal dementia (FTD) and semantic dementia (SD), allowing a unique window into the neural basis of personality. In this study, we used the Interpersonal Adjective Scales to investigate the structural basis of eight interpersonal traits (dominance, arrogance, coldness, introversion, submissiveness, ingenuousness, warmth, and extraversion) in 257 subjects: 214 patients with neurodegenerative diseases such as FTD, SD, progressive nonfluent aphasia, Alzheimer's disease, amnestic mild cognitive impairment, corticobasal degeneration, and progressive supranuclear palsy and 43 healthy elderly people. Measures of interpersonal traits were correlated with regional atrophy pattern using voxel-based morphometry (VBM) analysis of structural MR images. Interpersonal traits mapped onto distinct brain regions depending on the degree to which they involved agency and affiliation. Interpersonal traits high in agency related to left dorsolateral prefrontal and left lateral frontopolar regions, whereas interpersonal traits high in affiliation related to right ventromedial prefrontal and right anteromedial temporal regions. Consistent with the existing literature on neural networks underlying social cognition, these results indicate that brain regions related to externally focused, executive control-related processes underlie agentic interpersonal traits such as dominance, whereas brain regions related to internally focused, emotion- and reward-related processes underlie affiliative interpersonal traits such as warmth. In addition, these findings indicate that interpersonal traits are subserved by complex neural networks rather than discrete anatomic areas.