Exploring sedentary behavior during neo- or adjuvant treatment in patients with cancer: A phenomenological study.

PURPOSE: Increased sedentary behavior during cancer treatment is common, which may have negative long-term health effects. Understanding patients' experience of sedentary behavior during neo- or adjuvant cancer treatment may be crucial in developing effective support for patients to reduce sedentary behavior. Therefore, the present study aimed to explore sedentary behavior in patients undergoing neo- or adjuvant cancer treatment. METHODS: Eleven interviews were conducted with patients undergoing treatment for breast, prostate, and colorectal cancer. Participants were recruited from a university hospital in Sweden. Interviews were analyzed phenomenologically, and the results were presented as descriptions of the phenomenon sedentary behavior. RESULTS: The overarching theme of sedentary behavior during cancer treatment was that sedentary behavior is experienced through being physically active or not. Furthermore, experiences of sedentary behavior increased with side effects and varied depending on the type and phase of cancer treatment, meaning that sedentary behavior is an adjustment to side effects. Additionally, sedentary behavior was influenced by life circumstances and social interaction, such as work status and having social support. Finally, sedentary behavior is influenced by strategies and motivations, such as the perceived benefits of physical activity and self-image. CONCLUSIONS: Sedentary behavior is difficult for patients to discern, which is why health care personnel may need to help patients by increasing awareness of the negative impact of sedentary behavior in a way that does not stigmatize patients. Furthermore, developing support that targets periods with more side effects and helping patients reduce sedentary behavior throughout changing life circumstances may be helpful.

DNA metabarcoding reveals the dietary profiles of a benthic marine crustacean, Nephrops norvegicus.

Norwegian lobster, Nephrops norvegicus, are a generalist scavenger and predator capable of short foraging excursions but can also suspension feed. Existing knowledge about their diet relies on a combination of methods including morphology-based stomach content analysis and stable isotopes, which often lack the resolution to distinguish prey items to species level particularly in species that thoroughly masticate their prey. DNA metabarcoding overcomes many of the challenges associated with traditional methods and it is an attractive approach to study the dietary profiles of animals. Here, we present the diet of the commercially valuable Nephrops norvegicus using DNA metabarcoding of gut contents. Despite difficulties associated with host amplification, our cytochrome oxidase I (COI) molecular assay successfully achieves higher resolution information than traditional approaches. We detected taxa that were likely consumed during different feeding strategies. Dinoflagellata, Chlorophyta and Bacillariophyta accounted for almost 50% of the prey items consumed, and are associated with suspension feeding, while fish with high fisheries discard rates were detected which are linked to active foraging. In addition, we were able to characterise biodiversity patterns by considering Nephrops as natural samplers, as well as detecting parasitic dinoflagellates (e.g., Hematodinium sp.), which are known to influence burrow related behaviour in infected individuals in over 50% of the samples. The metabarcoding data presented here greatly enhances a better understanding of a species' ecological role and could be applied as a routine procedure in future studies for proper consideration in the management and decision-making of fisheries.

Do air-breathing fish suffer branchial oxygen loss in hypoxic water?

In hypoxia, air-breathing fish obtain O2 from the air but continue to excrete CO2 into the water. Consequently, it is believed that some O2 obtained by air-breathing is lost at the gills in hypoxic water. Pangasionodon hypophthalmus is an air-breathing catfish with very large gills from the Mekong River basin where it is cultured in hypoxic ponds. To understand how P. hypophthalmus can maintain high growth in hypoxia with the presumed O2 loss, we quantified respiratory gas exchange in air and water. In severe hypoxia (PO2: ≈ 1.5 mmHg), it lost a mere 4.9% of its aerial O2 uptake, while maintaining aquatic CO2 excretion at 91% of the total. Further, even small elevations in water PO2 rapidly reduced this minor loss. Charting the cardiovascular bauplan across the branchial basket showed four ventral aortas leaving the bulbus arteriosus, with the first and second gill arches draining into the dorsal aorta while the third and fourth gill arches drain into the coeliacomesenteric artery supplying the gut and the highly trabeculated respiratory swim-bladder. Substantial flow changes across these two arterial systems from normoxic to hypoxic water were not found. We conclude that the proposed branchial oxygen loss in air-breathing fish is likely only a minor inefficiency.

Psychometric evaluation of the subjective well-being measure GP-CORE in a group of older adults in Sweden.

BACKGROUND: The world's growing population of older adults is one population that needs to be focused more regarding subjective well-being. It is therefore important to evaluate self-report instruments that measures general well-being for this specific group - older adults. The aim of the present study was to investigate psychometric properties of the Swedish translation of the GP-CORE (general population - Clinical Outcomes in Routine Evaluation) in a group of older adults (> 65 years). METHODS: In this study, a psychometric evaluation of the GP-CORE is presented for 247 Swedish older adults (> 65 years), 184 women and 63 men who applied for home care assistance for the first time. RESULTS: The psychometric evaluation showed high acceptability; provided norm values in terms of means, standard deviations and quartiles; showed satisfactory reliability in terms of both internal consistency and stability; showed satisfactory validity in terms of convergent and discriminant validity; provided a very preliminary cut-off value and quite low sensibility and sensitivity and showed results which indicated that this scale is sensitive to changes. One gender difference was identified in that women without a cohabitant had a higher well-being than men without a cohabitant (as measured by GP-CORE). CONCLUSIONS: The GP-CORE showed satisfactory psychometric properties to be used to measure and monitor subjective well-being in older adults (> 65 years) in the general population of community dwelling. Future studies should establish a cut-off value in relation to another well-being measure relevant for mental health in older adults.

Does the Danish version of the Spinal Cord Lesion-related Coping Strategies Questionnaire measure what we think it measures? A triangulated mixed-methods validation approach.

STUDY DESIGN: Triangulated mixed-methods validation study. OBJECTIVES: To validate the Danish version of the Spinal Cord Lesion-related Coping Strategies Questionnaire (SCL-CSQ). SETTING: Community in Denmark. METHODS: Participants were invited via a patient organization and its specialized hospital. Eligibility criteria were having a spinal cord injury (SCI), being 18 years or older, and able to understand and respond in Danish. Quantitative data were collected to determine internal consistency and criterion validity of the three subscales of SCL-CSQ, i.e., acceptance, fighting spirit, and social reliance. The Three-Step Test-Interview approach was employed to determine whether items measured what they were intended to measure (i.e., construct validity based on response processes). RESULTS: The quantitative sample consisted of 107 participants, and the interview sample comprised 11 participants. The acceptance and fighting spirit subscales showed adequate internal consistency (Cronbach's alpha of 0.72 and 0.76 respectively) and satisfactory criterion validity (expected correlations with quality of life and depression). The social reliance subscale showed inadequate internal consistency (Cronbach's alpha of 0.58) and criterion validity. All fighting spirit items and all but one acceptance items were interpreted congruently by most participants. Conversely, two social reliance items were only interpreted congruently by 9 and 27%. CONCLUSION: The acceptance and fighting spirit subscales of the Danish version of the SCL-CSQ showed good psychometric properties, while the social reliance subscale showed serious issues and should be revised. Researchers and clinicians are urged to reflect on these findings when revising the SCL-CSQ or adapting it to other languages, cultural contexts, and rehabilitation settings.

Measurement properties of the Swedish clinical outcomes in routine evaluation outcome measures (CORE-OM): Rasch analysis and short version for depressed and anxious out-patients in a multicultural area.

INTRODUCTION: The Swedish version of the patient-reported Clinical Outcomes in Routine Evaluation Outcome Measures (CORE-OM) has demonstrated high reliability and acceptable convergent validity in explanatory factor analyses. However, the fundamental scale properties have not yet been validated according to item response theory. The aim of this study was to analyze the measurement properties of the Swedish CORE-OM in a cohort of psychiatric out-patients with depression and anxiety in a multicultural area and to explore combinations of items based on shorter versions of the scale (CORE-10, CORE-6D) to improve measurement properties. METHODS: Data from CORE-OM assessments of 337 patients were analyzed using Rasch analysis. The patients had a mean age of 30 ± 14 years, the majority were women (72%). Requirements for measurement properties were checked: overall model fit, item fit residuals, targeting, internal consistency, differential item functioning and thresholds. Sensitivity to change was also analyzed. RESULTS: The CORE-OM showed high internal consistency (person separation index = 0.947) and adequate targeting, but there was overall model misfit (item trait interaction χ2 = 917.53, p < 0.001), indication of local dependency, and differential item functioning in 9 items. The risk items showed problems with disordered thresholds. The emotional component of the shorter CORE-6D showed the best fit for our sample. Adding 3 items to include depressive and trauma-related content resulted in a unidimensional 8-item set with acceptable reliability, model fit, targeting and sensitivity to change. CONCLUSION: For out-patients with diagnosed depression or anxiety in a multicultural area, the Swedish CORE-OM showed high internal consistency, but also validity problems. Based on the shorter CORE-6D version, a unidimensional 8-item set could be an alternative brief measure of psychological distress for this population, but further validity studies are required. Qualitative studies exploring the CORE-OM items in non-native speakers are also warranted.

Arapaima gigas maintains gas exchange separation in severe aquatic hypoxia but does not suffer branchial oxygen loss.

One of the most air-reliant obligate air-breathing fish is the South American Arapaima gigas, with substantially reduced gills impeding gas diffusion, thought to be a result of recurring aquatic hypoxia in its habitat. In normoxic water, A. gigas is reported to satisfy 70-80% of its O2 requirement from the air while excreting 60-90% of its CO2 to the water. If this pattern of gas exchange were to continue in severely hypoxic water, O2 loss at the gills would be expected. We hypothesized therefore that partitioning of CO2 would shift to the air phase in severe aquatic hypoxia, eliminating the risk of branchial O2 loss. By adapting a respirometer designed to measure aquatic MO2/MCO2, we were able to run intermittent closed respirometry on both water and air phase for both of these gasses as well as sample water for N-waste measurements (ammonia-N, urea-N) so as to calculate metabolic fuel utilization. In contrast to our prediction, we found that partitioning of CO2 excretion changed little between normoxia and severe hypoxia (83% versus 77% aquatic excretion, respectively) and at the same time there was no evidence of branchial O2 loss in hypoxia. This indicates that A. gigas can utilize distinct transfer pathways for O2 and CO2. Routine and standard MO2, N-waste excretion and metabolic fuel utilization did not change with water oxygenation. Metabolism was fuelled mostly by protein oxidation (53%), while carbohydrates and lipids accounted for 27% and 20%, respectively.

Can a key boreal Calanus copepod species now complete its life-cycle in the Arctic? Evidence and implications for Arctic food-webs.

The changing Arctic environment is affecting zooplankton that support its abundant wildlife. We examined how these changes are influencing a key zooplankton species, Calanus finmarchicus, principally found in the North Atlantic but expatriated to the Arctic. Close to the ice-edge in the Fram Strait, we identified areas that, since the 1980s, are increasingly favourable to C. finmarchicus. Field-sampling revealed part of the population there to be capable of amassing enough reserves to overwinter. Early developmental stages were also present in early summer, suggesting successful local recruitment. This extension to suitable C. finmarchicus habitat is most likely facilitated by the long-term retreat of the ice-edge, allowing phytoplankton to bloom earlier and for longer and through higher temperatures increasing copepod developmental rates. The increased capacity for this species to complete its life-cycle and prosper in the Fram Strait can change community structure, with large consequences to regional food-webs.

Evaluation of a Web-Based Stress Management Program for Persons Experiencing Work-Related Stress in Sweden (My Stress Control): Randomized Controlled Trial.

BACKGROUND: Stress is one of the most common reasons for sick leave. Web-based interventions have the potential to reach an unlimited number of users at a low cost and have been shown to be effective in addressing several health-related problems. Handling stress on an individual level is related to behavior change. To support behavioral changes in stress management, My Stress Control (MSC) was developed. The development of MSC was based on several health psychology theories and models; however, central in the development were Social Cognitive Theory, Theory of Reasoned Action, Theory of Planned Behavior, Transactional Theory of Stress and Coping, and the Transtheoretical Model and Stages of Change. MSC is a fully automated program. The program is tailored to the user's specific needs for stress management and behavior change. OBJECTIVE: In this study, we aim to conduct a randomized controlled trial to evaluate the extent to which MSC affects perceived stress in persons experiencing work-related stress. METHODS: This was a randomized controlled trial with 2 arms. Study participants were recruited by visiting the worksites and workplace meetings. Participants were assigned to the intervention or wait-list group. Web-based questionnaires were used before and after the intervention to collect data. Perceived stress measured using the Perceived Stress Scale-14 was the primary outcome measurement. Analyses were conducted for both between-group and within-group changes. RESULTS: A total of 92 participants were included in this study: 48 (52%) in the intervention group and 44 (48%) in the wait-list group. Overall, 25% (12/48) of participants in the intervention group and 43% (19/44) of participants in the wait-list group completed the postintervention assessment. There were no significant effects on perceived stress between the intervention and wait-list groups or within the groups. A small effect size (Cohen d=0.25) was found when comparing mean change over time on the primary outcome measure between the intervention and wait-list groups. In addition, a small effect size was found between pre- and postintervention assessments within the intervention group (Cohen d=0.38) as well as within the wait-list group (Cohen d=0.25). CONCLUSIONS: The effect of MSC on perceived stress remains uncertain. As adherence was low in the intervention group, elements or features that facilitate adherence and engagement must be further developed before firmer conclusions regarding the effect of MSC can be made. TRIAL REGISTRATION: ClinicalTrials.gov NCT03077568; https://clinicaltrials.gov/ct2/show/NCT03077568.

Artificial spider silk supports and guides neurite extension in vitro.

Surgical intervention with the use of autografts is considered the gold standard to treat peripheral nerve injuries. However, a biomaterial that supports and guides nerve growth would be an attractive alternative to overcome problems with limited availability, morbidity at the site of harvest, and nerve mismatches related to autografts. Native spider silk is a promising material for construction of nerve guidance conduit (NGC), as it enables regeneration of cm-long nerve injuries in sheep, but regulatory requirements for medical devices demand synthetic materials. Here, we use a recombinant spider silk protein (NT2RepCT) and a functionalized variant carrying a peptide derived from vitronectin (VN-NT2RepCT) as substrates for nerve growth support and neurite extension, using a dorsal root ganglion cell line, ND7/23. Two-dimensional coatings were benchmarked against poly-d-lysine and recombinant laminins. Both spider silk coatings performed as the control substrates with regards to proliferation, survival, and neurite growth. Furthermore, NT2RepCT and VN-NT2RepCT spun into continuous fibers in a biomimetic spinning set-up support cell survival, neurite growth, and guidance to an even larger extent than native spider silk. Thus, artificial spider silk is a promising biomaterial for development of NGCs.

Production of functional human fetal hemoglobin in Nicotiana benthamiana for development of hemoglobin-based oxygen carriers.

Hemoglobin-based oxygen carriers have long been pursued to meet clinical needs by using native hemoglobin (Hb) from human or animal blood, or recombinantly produced Hb, but the development has been impeded by safety and toxicity issues. Herewith we report the successful production of human fetal hemoglobin (HbF) in Nicotiana benthamiana through Agrobacterium tumefaciens-mediated transient expression. HbF is a heterotetrameric protein composed of two identical α- and two identical γ-subunits, held together by hydrophobic interactions, hydrogen bonds, and salt bridges. In our study, the α- and γ-subunits of HbF were fused in order to stabilize the α-subunits and facilitate balanced expression of α- and γ-subunits in N. benthamiana. Efficient extraction and purification methods enabled production of the recombinantly fused endotoxin-free HbF (rfHbF) in high quantity and quality. The transiently expressed rfHbF protein was identified by SDS-PAGE, Western blot and liquid chromatography-tandem mass spectrometry analyses. The purified rfHbF possessed structural and functional properties similar to native HbF, which were confirmed by biophysical, biochemical, and in vivo animal studies. The results demonstrate a high potential of plant expression systems in producing Hb products for use as blood substitutes.

The Meaning of Sedentary Behavior as Experienced by People in the Transition From Working Life to Retirement: An Empirical Phenomenological Study.

OBJECTIVE: Sedentary behavior (SB) is defined as a mean of >6 hours of daytime sitting or lying down. SB has been shown to increase with older age and is a risk factor for disease. During the transition from working life to retirement, changes in daily life activities occur, risking increased SB. The aim of the present study was to gain a deeper understanding of SB in relation to the transition from working life to retirement as experienced by persons in retirement. METHODS: The study was grounded in a phenomenological life-world perspective. Fourteen semi-structured interviews were conducted with participants aged 64 to 75 years. Data were analyzed using the empirical phenomenological psychological method. RESULTS: The participants described that voluntary sedentary time was positively related to general health and well-being, whereas involuntary sedentary time was negatively related to health. Increased sedentary time was described as natural when aging. Retirement was expressed as a time for rest after hard work and the ability to choose a slower pace in life. Internal and external demands and daily routines interrupted SB, whereas loneliness was perceived to increase SB. Participants strived to find a balance between physical activity and sedentary time. The variations in the participants' descriptions formed 3 typologies: in light of meaningful SB, in the shadow of involuntary SB, and a dual process-postponing SB with physical activity. CONCLUSION: Increased SB was perceived as natural when aging but something that may be postponed by conscious choices. SB was perceived as associated with health, rest, and recovery but also with the risk of deteriorating health. IMPACT: This knowledge of the experienced meaning of SB could guide the design of health promotion interventions and may be helpful in targeting those in need of support and individualizing interventions to decrease SB in retirement. LAY SUMMARY: This study reveals how persons in retirement describe sedentary behavior as something healthy but also as unhealthy and that sedentary behavior is natural in aging and can be postponed by physical activity.

Differences in personality, perceived stress and physical activity in women with burning mouth syndrome compared to controls.

OBJECTIVES: Burning mouth syndrome (BMS) is a long-lasting pain condition which is commonly associated with anxiety symptoms and experience of adverse, stressful life events have been reported by those diagnosed with the syndrome. Stress-related biomarkers have been related to personality traits in BMS and a personality with high stress susceptibility and perceived stress may be of importance. Although biopsychosocial approaches are suggested to manage long-lasting orofacial pain, to date little is known about physical activity in women with BMS. The aim of this study was to investigate if personality, perceived stress and physical activity distinguish women with BMS from controls. METHODS: Fifty-six women with BMS and 56 controls matched on age and gender completed Swedish universities Scales of Personality (SSP), Perceived Stress Questionnaire (PSQ) and a general questionnaire with an item on weekly physical activity frequency. In addition, health-related quality of life was explored by additional questionnaires and reported in a companion article (Jedel et al. Scand J Pain. 2020. PubMed PMID: 32853174). RESULTS: SSP subscales Somatic Trait Anxiety, Psychic Trait Anxiety, Stress Susceptibility and Verbal Trait Aggression differed between women with BMS and controls and the personality factor scores for Neuroticism and Aggressiveness were higher. Perceived stress measured by PSQ index was higher for women with BMS compared to controls. Women with BMS reported lower physical activity frequency compared to controls and those reporting physical activity <4 days/week scored higher on PSQ compared to those with weekly physical activity ≥4 days/week. CONCLUSIONS: Personality distinguished women with BMS from controls in this study. Perceived stress was higher and weekly physical activity was lower in women with BMS compared to controls. Our findings suggest physical activity should be more comprehensively measured in future BMS studies and, by extension, physical activity may be a treatment option for women with BMS. Pain management aiming to restore function and mobility with stress reduction should be considered in clinical decision making for women with BMS who have a personality with stress susceptibility, especially if reporting high perceived stress and insufficient physical activity.

Expression, Purification and Initial Characterization of Functional α1-Microglobulin (A1M) in Nicotiana benthamiana.

α1-Microglobulin (A1M) is a small glycoprotein that belongs to the lipocalin protein family. A major biological role of A1M is to protect cells and tissues against oxidative damage by clearing free heme and reactive oxygen species. Because of this, the protein has attracted great interest as a potential pharmaceutical candidate for treatment of acute kidney injury and preeclampsia. The aim of this study was to explore the possibility of expressing human A1M in plants through transient gene expression, as an alternative or complement to other expression systems. E. coli, insect and mammalian cell culture have previously been used for recombinant A1M (rA1M) or A1M production, but these systems have various drawbacks, including additional complication and expense in refolding for E. coli, while insect produced rA1M is heavily modified with chromophores and mammalian cell culture has been used only in analytical scale. For that purpose, we have used a viral vector (pJL-TRBO) delivered by Agrobacterium for expression of three modified A1M gene variants in the leaves of N. benthamiana. The results showed that these modified rA1M protein variants, A1M-NB1, A1M-NB2 and A1M-NB3, targeted to the cytosol, ER and extracellular space, respectively, were successfully expressed in the leaves, which was confirmed by SDS-PAGE and Western blot analysis. The cytosol accumulated A1M-NB1 was selected for further analysis, as it appeared to have a higher yield than the other variants, and was purified with a yield of ca. 50 mg/kg leaf. The purified protein had the expected structural and functional properties, displaying heme-binding capacity and capacity of protecting red blood cells against stress-induced cell death. The protein also carried bound chromophores, a characteristic feature of A1M and an indicator of a capacity to bind small molecules. The study showed that expression of the functional protein in N. benthamiana may be an attractive alternative for production of rA1M for pharmaceutical purposes and a basis for future research on A1M structure and function.

Health-related quality of life in burning mouth syndrome - a case-control study.

Objectives The cardinal symptom of burning mouth syndrome (BMS) is long-lasting pain and comprehensive health-related quality of life (HRQL) assessments may estimate how well patients with BMS live in relation to their health issues. The aims of the study were to explore general and BMS-specific HRQL based on an HRQL model and to compare HRQL in patients with BMS and age-matched controls. Methods For this case-control study 56 female patients with BMS and 56 female controls completed the following: A general questionnaire with Global items for life satisfaction, general health and oral health; General Population-Clinical Outcomes in Routine Evaluation (GP-CORE); Hospital Anxiety and Depression Scale (HADS); and Oral Health Impact Profile-14 (OHIP-14). Patients with BMS completed additional questionnaires which included BMS-problem severity, a global item for ratings of overall severity perceptions measured by visual analog scale (VAS); and BMS-modified Multidimensional Pain Inventory-Swedish version (MPI-S). BMS-modified MPI-S includes the three subscales Pain severity, Interference and Social support. Results Patients with BMS scored worse on all global items, GP-CORE, HADS and OHIP-14 compared to controls and the differences were large. Patients with severe BMS problems, as defined by a median split on BMS-problem severity, scored worse on the BMS-modified MPI-S subscale Pain severity and the difference was large. Conclusions We found clearly impaired general HRQL in patients with BMS compared to controls. For specific HRQL, the severity of pain was worse among patients with higher overall BMS-problem severity. The HRQL model with global ratings together with physical, psychological and social concepts has capacity to increase comparability and validity of studies, however further evaluations of the measures are needed. The HRQL model may be used over time to increase the understanding of different HRQL aspects and their internal relationships. In clinical settings, with an increased knowledge of one´s own distinctive quality of life abilities and restrictions, the patients with BMS can be guided and supported to manage their long-lasting pain. The HRQL model may be an aid toward bridging distinctions between general and oral health to further encourage collaboration between medicine and odontology.

Plant based production of myoglobin - a novel source of the muscle heme-protein.

Myoglobin is a heme-protein in the muscle of vertebrates with important functions in the oxygenation of tissues and as a regulator in nitric oxide signaling. Myoglobin from many species is also an important nutritional source of bioavailable iron. In this study, we have successfully produced human myoglobin in the leaves of Nicotiana benthamiana by transient expression using a viral vector delivered by Agrobacterium tumefaciens. Analyses confirmed that heme was incorporated and the protein was functional, with observed properties consistent with those of native myoglobins. A relatively high degree of purity could be achieved with low cost methods. The results show the high potential of plants as a production platform for heme proteins, a group of proteins of interest for iron nutrition applications and possible future pharmaceutical development.

Adaptation of Coping Effectiveness Training for Patients With Heart Failure and Patient-Reported Experience of the Intervention.

Although patients with chronic heart failure (CHF) often experience psychological distress, psychosocial aspects are not an integral part of their treatment and care. The aim is to describe the adaptation of Coping Effectiveness Training for patients with CHF and the participants' reported experiences. The intervention workbook and manual were translated into Swedish and adapted for patients with CHF. Patient-reported experience from 33 of 35 participants, that had completed the psychosocial intervention, was measured with an evaluation form consisting of closed and open-ended questions. Most participants thought they benefited from the intervention, were pleased with the structure and did not want to add anything to the program. The benefits experienced were learning how to cope with the illness and meeting other people to share and discuss experiences. There was a variation concerning the group process of how much direction should be given during the discussions. Overall, unique data from patient-reported experience measure showed that the participants were satisfied with the psychosocial intervention, applied for the first time to patients with CHF.

Mass spectrometry-based analysis of cerebrospinal fluid from arthritis patients-immune-related candidate proteins affected by TNF blocking treatment.

BACKGROUND: Signs of inflammation in cerebrospinal fluid (CSF) of rheumatoid arthritis patients correlate positively with fatigue, a central nervous system (CNS)-related symptom that can be partially suppressed by TNF blockade. This suggests a possible role for CNS inflammation in arthritis that may be affected by TNF blockade. We therefore investigated the effects of TNF blockade on the arthritis CSF proteome and how candidate proteins related to clinical measures of disease activity and inflammation. METHODS: Mass spectrometry-based quantitative proteomic analysis was performed on CSF from seven polyarthritis patients before and during infliximab treatment. Treatment-associated proteins were identified using univariate (Wilcoxon signed rank test) and multivariate (partial least squares discriminant analysis (PLS-DA)) strategies. Relations between selected candidate proteins and clinical measures were investigated using the Spearman correlations. Additionally, selected proteins were cross-referenced to other studies investigating human CSF in a thorough literature search to ensure feasibility of our results. RESULTS: Univariate analysis of arthritis CSF proteome revealed a decrease of 35 proteins, predominantly involved in inflammatory processes, following TNF blockade. Seven candidate proteins, Contactin-1 (CNTN1), fibrinogen gamma chain (FGG), hemopexin (HPX), cell adhesion molecule-3 (CADM3), alpha-1B-glycoprotein (A1BG), complement factor B (CFB), and beta-2-microglobulin (B2M), were selected for further studies based on identification by both univariate and multivariate analyses and reported detection in human CSF and known associations to arthritis. Decreased levels of FGG and CFB in CSF after treatment showed strong correlations with both erythrocyte sedimentation rate and disability scores, while CNTN1 and CADM3 were associated with pain. CONCLUSION: Several immune-related proteins in the CSF of arthritis patients decreased during TNF blockade, including FGG and CFB that both correlated strongly with systemic inflammation. Our findings stress that also intrathecal inflammatory pathways are related to arthritis symptoms and may be affected by TNF blockade.

'Best fit' caring skills of an interprofessional team in short-term goal-directed reablement: older adults' perceptions.

This paper reports a study conducted to illuminate older adults' perceptions of multiproffesional team's caring skills as success factors for health support in short-term goal-directed reablement. The fact that older adults are given perquisites to live in their own homes puts great demands on the professional care given them at home. An option offered could be short-term goal-directed reablement delivered by an interprofessional team. This means after periods in hospitals to strengthen their multidimensional health, older adults' reablement processes are supported to return to their daily life as soon as possible. Crucial in making these intentions a reality seems to be identifying the professional's approach that works as success factors for health support in the reablement process. A descriptive qualitative design with a phenomenographic approach based on interviews with 23 older persons who had received short-term goal-directed reablement at home after a period at hospital was used. The study was approved by an ethical board. The analysis revealed four major referential aspects of multiproffesional team's caring skills as success factors for health-support in short-term goal-directed reablement: a motivating caregiver, a positive atmosphere-creating caregiver, a human fellowship-oriented caregiver and a caregiver that goes beyond the expected. In this study, all caring skills in the continuum are perceived as positively loaded necessities in different situations during the reablement process. Caring skills as success factors are initially shown at a practical level, such as how the professional caregivers encourage and motivate the older persons in different training situations. At a deeper level, the caregivers open their hearts and have the capacity to go beyond the expected in the professional caregiver-patient relationship. The multiproffesional team's best fit caring skills during the home reablement process need to be addressed as evidence base in the area of elderly home care.

Evaluation of a Web-Based Stress Management Application-a Feasibility Study.

The aim of the current study was to investigate the feasibility of a Web-based program that promotes behavior change for stress-related problems in terms of the program's acceptability, practicability, and any possible effects. In addition, the aim was also to study how appropriate and realistic the study's process and resource management would be for conducting a randomized controlled trial. A convenience sample consisting of 14 individuals was recruited from a university in Sweden. The participants had access to the program for a duration of 9 weeks. Questionnaires were answered before accessing, during use of, and after completing the program. Both qualitative and quantitative data were collected and analyzed. The program was considered acceptable and practically feasible, though small adjustments have to be made. The program was considered time-consuming, extensive, and in need of some clarifications. Regarding process and resource management, the study participants required minimum support. It was difficult to identify the time point when to send out the process measures because the participants worked at their own pace. Also, one of the process measurements, the motivation to change, remained stable. With some adjustments to the instructions to the study participants and minor changes in the program, the intervention and study's procedure were considered as feasible and can be carried out in a randomized controlled trial.