Immediate and lasting improvements in weight distribution seen in baropodometry following a high-velocity, low-amplitude thrust manipulation of the sacroiliac joint

The biomechanics of the sacroiliac joint makes the pelvic segment responsible for proper weight distribution between lower extremities; however, it is known to be susceptible to altered mobility. The objective of this study was to analyze baropodometric responses following thrust manipulation on subjects with sacroiliac joint restrictions. Twenty asymptomatic subjects were submitted to computerized baropodometric analysis before, after, and seven days following sacroiliac manipulation. The variables peak pressure and contact area were obtained at each of these periods as the average of absolute values of the difference between the right and left foot based on three trials. Data revealed significant reduction only in peak pressure immediately after manipulation and at follow-up when compared to pre-manipulative values (p < 0.05). Strong correlation was found between the dominant foot and the foot with greater contact area (r = 0.978), as well as between the side of joint restriction and the foot with greater contact area (r = 0.884). Weak correlation was observed between the dominant foot and the foot with greater peak pressure (r = 0.501), as well as between the side of joint restriction and the foot with greater peak pressure (r = 0.694). The results suggest that sacroiliac joint manipulation can influence peak pressure distribution between feet, but contact area does not seem to be related to the biomechanical aspects addressed in this study.     

Placental Transfer of Darunavir in an Ex Vivo Human Cotyledon Perfusion Model

Placental transfer of the HIV protease inhibitor darunavir was investigated in 5 term human cotyledons perfused with darunavir (1,000 ng/ml) in the maternal to fetal direction. The mean (± the standard deviation [SD]) fetal transfer rate (FTR) (fetal/maternal concentration at steady state from 30 to 90 min) was 15.0% ± 2.1%, and the mean (±SD) clearance index (darunavir FTR/antipyrine FTR) was 40.3% ± 5.8%. This shows that darunavir crosses the placenta at a relatively low rate, resulting in fetal exposure.     

A Decision Support Tool Facilitating Medicine Design for Optimal Acceptability in The Older Population

Purpose

Medicine acceptability, which is of the utmost importance for vulnerable patients’ adherence, is driven by both user and product characteristics. Herein, a novel multivariate approach integrating the many aspects of acceptability is used to discriminate positively and negatively accepted medicines in the older population.

Methods

An observational study was carried out in eight hospitals and eight nursing homes to collect a large set of real-life data on medicines uses in older patients (≥65 years). Mapping and clustering explored these multiple observational measures and summarised the main information into an intelligible reference framework. Resampling statistics were used to validate the model’s reliability.

Results

A three-dimensional map and two clusters defining acceptability profiles, as positive or negative, emerged from the 1079 evaluations. Factors of interest (medicines, user features…) were positioned on the map at the barycentre of their evaluations and assigned to an acceptability profile. Focusing on patients’ ability to swallow, we have highlighted the tool’s efficacy in demonstrating the impact of user features on medicine acceptability.

Conclusions

This multivariate approach provides a relevant judgement criterion for this multi-dimensional concept. Facilitating the choice of the most appropriate dosage form to achieve optimal acceptability in a targeted population, this tool is of real potential to improve clinical decisions.

     

Gender as a moderator in the relationship between anxiety and carotid intima-media thickness: The PREVENCION study

BackgroundPrevious studies regarding the association of atherosclerotic risk and anxiety have yielded conflicting results. Carotid intima–media thickness (cIMT) is an early marker of subclinical atherosclerosis and an independent predictor of cardiovascular risk. We aimed to determine the relationship between anxiety and cIMT in Andean Hispanics and examine the moderating effects of gender in this relationship.MethodsWe studied 496 adults enrolled in a population-based study in Peru. cIMT was measured with high-resolution ultrasonography. Anxiety levels were assessed with the HADS anxiety score.ResultsMedian anxiety scores were 6 (IQR = 4–8) in men and 8 (IQR = 5–11) in women. We found a significant moderating effect of gender on the association between the HADS anxiety score and cIMT. Among men, the HADS anxiety score was significantly associated with cIMT (β = 0.15; P = 0.004) after adjusting for age, education, employment status, SBP, DBP, fasting glucose, diabetes mellitus, smoking and LDL cholesterol. Other significant predictors of cIMT in men were age (β = 0.60; P < 0.001), SBP (β = 0.16; P = 0.023) and diabetes mellitus (β = 0.12; P = 0.033). The model explained 54% of the population variability in cIMT. The HADS anxiety score was not associated with cIMT in women.ConclusionsWe found an important moderating effect of gender in the relationship between anxiety and subclinical atherosclerosis. Anxiety was independently associated with subclinical atherosclerosis among Andean Hispanic men, whereas no relationship was found among women. Further studies are required to assess the mechanistic determinants of this association and assess whether interventions to decrease anxiety levels retard the progression of early, subclinical atherosclerosis.