The Leuven Prolonged Acute Stress Test (L-PAST): A novel paradigm to induce a subjective and glucocorticoid stress response for at least ninety minutes.

Laboratory stress tests typically administer stress acutely, ranging from 3 to 15 minutes. However, everyday stressors usually last longer than ten minutes (e.g., examination stressors, work stressors, and social stressors. Moreover, in some studies, it may be relevant to induce stress for a longer period to affect certain psychological or physiological parameters. To this end, we developed a novel stress test that intends to induce psychosocial stress for 90 minutes. The Leuven Prolonged Acute Stress Test (L-PAST) combines physical (hand immersion in cold water), cognitive (mental arithmetic), and psychosocial (social evaluation and feelings of failure) stress elements of two well-known laboratory stress tests, the Maastricht Acute Stress Test (MAST) and the Montreal Imaging Stress Test (MIST). Fifty healthy women were subjected to both the L-PAST and a sham (control) test in a randomized and counterbalanced manner. The stress response was determined by salivary cortisol measurements and assessment of subjective stress ratings at regular time points during the time preceding the stress period (5 min), the stress period (90 min), and the recovery period (35 min). Cognitive reactivity to failure and subjective pain levels were also assessed at various time points. The childhood trauma questionnaire (CTQ) and the perceived stress scale (PSS) were administered prior to the testing phase. As expected, linear mixed models revealed that the stress response was significantly higher during the L-PAST as indicated by a significant time point by condition interaction effect for both the cortisol response (F(10,450)=12.21, p < 0.0001, ηp2=0.11) and the subjective stress response (F(13,637)=13.98, p < 0.0001, ηp2 = 0.12). Moreover, there was a significant time point by condition interaction effect for cognitive reactivity to failure (F(13,637) = 7.97, p < 0.0001, ηp2 = 0.07) and subjective pain (F(13,637) = 38.52, p < 0.0001, ηp2 = 0.27), indicating that the levels were higher during the L-PAST at most stress induction time points. Lastly, higher CTQ scores were associated with higher subjective pain levels during the L-PAST (F(1,44)=6.05, p = 0.02). Collectively, our results confirm the efficacy of the L-PAST in inducing a prolonged subjective as well as cortisol stress response.

The relationship between cardiorespiratory fitness and inhibitory control following acute stress: An ERP study.

Although the relationships among acute stress, cardiorespiratory fitness (CRF), and cognitive function have been examined, whether CRF is related to behavioral and neuroelectric indices of inhibitory control following acute stress remains unknown. The purpose of the current study was to investigate the combined influence of acute stress and CRF on inhibitory control. Participants, aged 20-30 years, were stratified into the Higher-Fit (n = 31) and the Lower-Fit (n = 32) groups, and completed a Stroop task following the modified Maastricht Acute Stress Test (MAST) in the stress condition and the sham-MAST in the non-stress condition, during which electroencephalography was recorded. Behavioral (i.e., response time and accuracy) and neuroelectric (N2 and P3b components of the event-related potential) outcomes of inhibitory control were obtained. While the Higher-Fit group demonstrated shorter response times and higher accuracy than the Lower-Fit group following both the MAST and the sham-MAST, they also exhibited selective benefits of acute stress on inhibitory control performance (i.e., decreased response times and diminished interference scores). CRF-dependent alterations in neuroelectric indices were also observed, with the Higher-Fit group displaying smaller N2 and greater P3b amplitudes than the Lower-Fit group following the sham-MAST, and increased N2 and attenuated P3b amplitudes following the MAST. Collectively, these findings not only confirm the positive relationship between CRF and inhibitory control but also provide novel insights into the potential influence of CRF on inhibitory control and associated neuroelectric activity following acute stress.

Major determinants of primary non function from kidney donation after Maastricht II circulatory death: A single center experience.

PURPOSE: Organ shortage greatly limits treatment of patients with end-stage chronic kidney. Maastricht type 2 donation after circulatory death (DCD) has been shown to have similar results in long term outcomes in kidney transplantation, when compared with brain dead donation. Our main goal was to assess Maastricht type 2 DCD and evaluate factors that impact on early graft function. METHODS: A retrospective study was conducted in an ECMO Referral Centre. All patients who received a kidney transplant from Maastricht type 2 DCD were included in study. Early graft function and short term outcomes were assessed. RESULTS: From October 2017 to December 2022, 47 renal grafts were collected from 24 uDCD donors. Median warm ischemia time was 106 min (94-115), cannulation time was 10 min (8; 20) and duration of extracorporeal reperfusion (ANOR) was 180 min (126-214). Regarding early graft function, 25% had immediate graft function, 63.6% had delayed graft function and 11.4% had primary non-function (PNF). There was a correlation between cannulation time (p = 0.006) and ANOR with PNF (p = 0.016). CONCLUSIONS: Cannulation time and ANOR were the main factors that correlated with PNF. Better understanding of underlying mechanisms should be sought in future studies to reduce the incidence of PNF.

Endocannabinoids and Stress-Related Neurospsychiatric Disorders: A Systematic Review and Meta-Analysis of Basal Concentrations and Response to Acute Psychosocial Stress.

Background: Dysregulation of the endocannabinoid (eCB) system is implicated in various stress-related neuropsychiatric disorders (SRDs), including anxiety, depression, and post-traumatic stress disorder (PTSD). In this systematic review and meta-analysis, our objectives were to characterize circulating anandamide (AEA) and 2-arachidonoylglycerol (2-AG) concentrations at rest and in response to acute laboratory-based psychosocial stress in individuals with SRDs and without (controls). Our primary aims were to assess the effects of acute psychosocial stress on eCB concentrations in controls (Aim 1), compare baseline (prestress) eCB concentrations between individuals with SRDs and controls (Aim 2), and explore differential eCB responses to acute psychosocial stress in individuals with SRDs compared with controls (Aim 3). Methods: On June 8, 2023, a comprehensive review of the MEDLINE (PubMed) database was conducted to identify original articles meeting inclusion criteria. A total of 1072, 1341, and 400 articles were screened for inclusion in Aims 1, 2, and 3, respectively. Results: Aim 1, comprised of seven studies in controls, revealed that most studies reported stress-related increases in AEA (86%, with 43% reporting statistical significance) and 2-AG (83%, though none were statistically significant except for one study in saliva). However, meta-analyses did not support these patterns (p's>0.05). Aim 2, with 20 studies, revealed that most studies reported higher baseline concentrations of both AEA (63%, with 16% reporting statistical significance) and 2-AG (60%, with 10% reporting statistical significance) in individuals with SRDs compared with controls. Meta-analyses confirmed these findings (p's<0.05). Aim 3, which included three studies, had only one study that reported statistically different stress-related changes in 2-AG (but not AEA) between individuals with PTSD (decrease) and controls (increase), which was supported by the meta-analysis (p<0.001). Meta-analyses showed heterogeneity across studies and aims (I2=14-97%). Conclusion: Despite substantial heterogeneity in study characteristics, samples, and methodologies, consistent patterns emerged, including elevated baseline AEA and 2-AG in individuals with SRDs compared with controls, as well as smaller stress-related increases in 2-AG in individuals with SRDs compared with controls. To consider eCBs as reliable biomarkers and potential intervention targets for SRDs, standardized research approaches are needed to clarify the complex relationships between eCBs, SRDs, and psychosocial stress.

Reference values for nerve conduction studies of the peroneal, tibial, and sural nerve derived from a large population-based cohort: Associations with demographic and anthropometric characteristics-The Maastricht study.

INTRODUCTION/AIMS: Nerve conduction studies (NCSs) are widely used to support the clinical diagnosis of neuromuscular disorders. The aims of this study were to obtain reference values for peroneal, tibial, and sural NCSs and to examine the associations with demographic and anthropometric factors. METHODS: In 5099 participants (aged 40-79 years) without type 2 diabetes of The Maastricht Study, NCSs of peroneal, tibial, and sural nerves were performed. Values for compound muscle action potential (CMAP) and sensory nerve action potential amplitude, nerve conduction velocity (NCV), and distal latency were acquired. The association of age, sex, body mass index (BMI), and height with NCS values was determined using uni- and multivariate linear regression analyses. RESULTS: Detailed reference values are reported per decade for men and women. Significantly lower NCVs and longer distal latencies were observed in all nerves in older and taller individuals as well as in men. In these groups, amplitudes of the tibial and sural nerves were significantly lower, whereas a lower peroneal nerve CMAP was only significantly associated with age. BMI showed a multidirectional association. After correction for anthropometric factors in the multivariate analysis, the association between sex and NCS values was less straightforward. DISCUSSION: These values from a population-based dataset could be used as a reference for generating normative values. Our findings show the association of NCS values with anthropometric factors. In clinical practice, these factors can be considered when interpreting NCS values.

The Short Version of the Italian Maastricht Vital Exhaustion Questionnaire (MVEQ): Psychometric Properties and Relationships with Anxiety, Depression, and Stress in a Community Sample of Older Adults.

Vital Exhaustion (VE) refers to a physical and mental state of excessive fatigue, feelings of demoralization, hopelessness, and increased irritability. The short form of the Maastricht Vital Exhaustion Questionnaire (MVEQ) is a widely used measure to assess VE. Despite its utility is broadly recognized, the validity and reliability of the scale have yet to be examined in the Italian context. The present study aimed to evaluate the psychometric properties of the shortened MVEQ in a community sample of Italian older adults. A total of 722 older adults (Mage = 72.97, SD = 7.71; 60.4% females) completed the MVEQ, as well as other self-report questionnaires assessing anxiety, depression and stress in order to evaluate the criterion-related validity of the scale. A confirmatory factor analysis (CFA) was conducted to examine the original MVEQ latent structure. Internal consistency was assessed through model-based omega coefficient. Test-retest reliability was examined by re-administering the MVEQ after three months to a subsample of 568 participants. Factorial invariance tests across gender were conducted by means of multi-group CFAs. The one-factor model showed an acceptable fit to the data. The MVEQ yielded a reliable total score (ω = 0.822) and showed moderate-to-large correlations with measures of anxiety, depression, and stress (r range 0.30 to 0.75, ps < 0.001). Test-retest reliability was supported by an Intraclass Correlation Coefficient (ICC) of 0.661. Lastly, the scale was factorially invariant across gender. Overall, the MVEQ provided evidence of reliability and criterion-related validity in a sample of Italian older adults and may be useful for both clinical and research practices.

Associations of inner retinal layers with risk of incident dementia: An individual participant data analysis of four prospective cohort studies.

INTRODUCTION: Our main objective was to investigate whether retinal neurodegeneration, estimated from lower thickness of inner retinal layers, was associated with incident all-cause dementia and Alzheimer's disease (AD). METHODS: We performed an individual participant data meta-analysis using unpublished data from four prospective cohort studies with a total of 69,955 participants (n = 1087 cases of incident all-cause dementia; n = 520 cases incident AD; follow-up time median [interquartile range] 11.3 [8.8-11.5] years). RESULTS: General baseline characteristics of the study population were mean (standard deviation) age, 58.1 (8.8) years; 47% women. After adjustment, lower baseline macular retinal nerve fiber layer thickness was significantly associated with a 10% and 11% higher incidence of all-cause dementia and AD, respectively. Lower baseline macular ganglion cell-inner plexiform layer thickness was not significantly associated with these outcomes. DISCUSSION: These findings suggest that retinal neurodegeneration precedes the onset of clinical dementia. Retinal imaging tools may be informative biomarkers for the study of the early pathophysiology of dementia.

[Process and conduct for organ procurement under Maastricht III]. / Processus et conduite pour un prélèvement d'organes dans le cadre du Maastricht III.

The shortage of transplants and their corollary, the need for transplants, have led France to expand its organ procurement options. Since 2005, France has benefited from a new medical, legal and organizational framework for organ procurement from deceased donors after circulatory arrest, in accordance with Maastricht category III.

Controlled donation after circulatory death lung transplantation: Results of the French protocol including in situ abdominal normothermic regional perfusion and ex vivo lung perfusion.

BACKGROUND: The French national protocol for controlled donation after circulatory determination of death (cDCD) includes normothermic regional perfusion (NRP) in case of abdominal organ procurement and additional ex-vivo lung perfusion (EVLP) before considering lung transplantation (LT). METHODS: We made a retrospective study of a prospective registry that included all donors considered for cDCD LT from the beginning of the program in May 2016 to November 2021. RESULTS: One hundred grafts from 14 donor hospitals were accepted by 6 LT centers. The median duration of the agonal phase was 20 minutes [2-166]. The median duration from circulatory arrest to pulmonary flush was 62 minutes [20-90]. Ten lung grafts were not retrieved due to prolonged agonal phases (n = 3), failure of NRP insertion (n = 5), or poor in situ evaluation (n = 2). The remaining 90 lung grafts were all evaluated on EVLP, with a conversion rate of 84% and a cDCD transplantation rate of 76%. The median total preservation time was 707 minutes [543-1038]. Seventy-one bilateral LTs and 5 single LTs were performed for chronic obstructive pulmonary disease (n = 29), pulmonary fibrosis (n = 21), cystic fibrosis (n = 15), pulmonary hypertension (n = 8), graft-versus-host disease (n = 2), and adenosquamous carcinoma (n = 1). The rate of PGD3 was 9% (n = 5). The 1-year survival rate was 93.4%. CONCLUSION: After initial acceptance, cDCD lung grafts led to LT in 76% of cases, with outcomes similar to those already reported in the literature. The relative impacts of NRP and EVLP on the outcome following cDCD LT should be assessed prospectively in the context of comparative studies.

The 2022-2026 Transplantation Plan: objectives and priorities for a new development of kidney transplantation / Le Plan greffe 2022-2026 : objectifs et priorités pour un nouvel essor de la transplantation rénale

The 2022-2026 Transplantation Plan has been launched by the French government to stimulate the activities of organ harvesting and transplantation, after the failure of the previous one. It has been designed by the Biomedicine Agency in collaboration with learning societies, including the SFNDT, and patient associations. The plan is original in its objectives, its regional organization with its driving by the Regional Health Agencies, the involvement of advanced practice nurses and its funding. The ambition is to transplant every transplantable patient. The increase in the number of kidney transplantations, more of all from a living donor, requires the active participation of all the nephrologists, who are the first in delivering information to the patients and their family on advanced chronic kidney disease treatment and living donation.

Le Plan greffe 2022-2026 a été lancé par le Gouvernement pour stimuler le prélèvement et la transplantation rénale, après l'échec du plan précédent. Il a été élaboré par l'Agence de biomédecine en concertation avec les sociétés savantes, dont la Société française de néphrologie, dialyse et transplantation (SFNDT), et les associations de patients. Il est original, du fait de ses objectifs concernant l'activité de prélèvement et de transplantation ­ exprimés non pas en données chiffrées mais en couloirs de croissance ­, de son organisation régionale pilotée par les agences régionales de santé, tendant à aligner les niveaux d'activité entre les régions, de l'implication des infirmières de pratique avancée et de son financement. L'ambition est de donner un accès à la greffe à tous les patients transplantables. L'augmentation du nombre de transplantations rénales, en premier lieu à partir d'un donneur vivant, nécessite l'implication de tous les néphrologues, premiers intervenants dans l'information aux patients sur le traitement de l'insuffisance rénale chronique avancée et le don du vivant.

Does Online Interprofessional Case-Based Learning Facilitate Collaborative Knowledge Construction?

Introduction: COVID-19 pandemic has caused an impact on various sectors of life, including the education sector. During the COVID-19 pandemic, education from various levels could only be carried out online by utilizing various on-line media. In Health professional education context, one of the learning activities that must be shifted in online format was interprofessional education (IPE) program. This study aimed to evaluate students' collaborative knowledge construction to evaluate the effectiveness of online interprofessional case-based learning (CBL) activities. Methods: This interventional study using quantitative and qualitative method involved a total of 476 students; consisted of 204 medical students, 39 midwifery students and 233 nursing students; who took part online interprofessional CBL. All students were divided into 34 mixed profession groups with 14 students each. To evaluate students' collaborative knowledge construction during CBL, data were collected using the Maastricht Peer Activity Rating Scale (MPARS). Qualitative data exploring students' perception regarding online IPE activity and their online CBL process were collected using Focus Group Discussion (FGD). Quantitative data were analysed using statistical tests, and the qualitative data were analysed using thematic analysis. Results: Students' scores for constructive, collaborative, and motivational activities evaluated using MPARS were considered as average to high. However, nursing students scored the lowest compared to the other two fellow professions: medical and midwifery students, on all items of the MPARS. Medical students had the highest MPARS scores. Several themes could be explored during the FGD. Discussion: This study revealed that students could engage in collaborative knowledge construction in interprofessional education implementing online interprofessional CBL. However, students thought that offline collaborative practice will better improve team bonding which is considered as prominent aspect for collaboration. This thought gives idea to the implementation of hybrid online offline learning for IPE.

Trait and state self-compassion interactively predict cortisol recovery following an acute stressor in healthy males.

This study examined the effect of self-compassion induction on cortisol stress recovery following an acute stressor. A total of 67 male university students completed the Maastricht Acute Stress Test and were then randomized to either a self-compassion (a guided self-compassion writing task) or control condition (a writing task just to review the stress test), followed by a 50-minute resting period. Subjective stress and cortisol levels were assessed at - 15, - 10, 0, 10, 20, 30, 40, and 50 min relative to the stress offset. Heart rate and respiratory sinus arrhythmia were monitored throughout the study. Multilevel modeling indicated that self-compassion induction had no significant effect on cortisol recovery. An exploratory analysis examining the moderating effect of trait self-compassion indicated that the effect of self-compassion induction was prominent when trait self-compassion was low but not when it was high. These findings suggest that self-compassion induction may help recovery from stressful experiences, particularly for those who are less self-compassionate.

Multiorgan retrieval and preservation of the thoracic and abdominal organs in Maastricht III donors.

This editorial describes the indications and technical aspects of the simultaneous retrieval of thoracic and abdominal organs in Maastricht III donors as well as the preservation of such organs until their implantation.

A Look at Cycling Safety in a Southern Municipality of the Netherlands.

Objectives Cycling is an important means of transportation in the Netherlands. Unfortunately, the number of cycling accidents and their adverse outcomes (injury and death) are on the rise. We set out to observe the nature of these accidents in Maastricht from 2001 to 2015 and analyzed the recommendations of stakeholders on ways to improve cycling safety. Methods An explanatory sequential mixed methodology was used for this population-based study. In the first phase, a retrospective quantitative analysis of the VIA® accident database for Maastricht was done. This was followed by a thematic analysis of data from five semi-structured interviews. Integration was at the Interpretation stage. Result The first phase showed males (54%) and under-25s (59.9%) had the most cycling accidents, while a larger percentage of females (50.7%) and people >65 years (67%) had adverse outcomes with accidents. More accidents occurred at intersections (52.6%), on shared roads (61.4%), and involved motorized vehicles (95.6%). Bivariate analysis and multivariable logistic regression showed that cycling accidents involving elderly people, women, wet weather or road surfaces, an innocent cyclist, the northeastern district, and morning hours had a higher chance of injury or death. Thematic analysis summarised stakeholder opinions under four themes: role in cycling safety; partners of cycling safety; the importance of accurate data; and investing in safety. Most of the respondents felt improvements in the city's accident database, cycling policy, and infrastructure were needed. Conclusion Our findings suggest that there has been a decrease in the overall number of cycling accidents in the 15-year period studied. However, differences in sociodemographic variables still determine the distribution and severity of accidents in Maastricht. The existing cycling database at the time of the study needed improvements with data collection and the city needs to involve more stakeholders in its policy-making process.

Cortisol reactivity impairs suppression-induced forgetting.

To some extent, we can shape our recollections by intentionally remembering certain experiences while trying to forget others, for example, by intentional suppression. Acute stress impairs suppression-induced forgetting of memories. It is unclear, however, whether these deficits are a direct consequence of the acute stress-induced cortisol response. The present study was designed to examine the stress-induced impairment in suppression-induced forgetting in a subgroup of cortisol responders. We exposed healthy participants to a stress (n = 55) or no-stress control (n = 32) version of the Maastricht Acute Stress Test before they performed the Think / No-Think task. Here, participants aimed to repeatedly retrieve or suppress memories of previously learned cue-target video clips to mimic the complexity of episodic memories. Results on the subsequent memory test revealed that, while the no-stress controls and cortisol non-responders demonstrated suppression-induced forgetting, this effect was absent in cortisol responders. Moreover, the magnitude of suppression-induced forgetting was negatively correlated to stress-induced cortisol increases. The current study extends findings on stress-induced impairments in suppression-induced forgetting by specifically focusing on cortisol reactivity. Furthermore, our findings show the importance of individual differences in cortisol responses as a driving mechanism behind stress-induced alterations in our capacity to actively control our memory.

When the mind says one thing, but the HPA axis says another: Lack of coherence between subjective and neuroendocrine stress response trajectories in healthy men.

Psychological stress triggers the release of cortisol following the activation of the hypothalamic-pituitary-adrenal (HPA) axis and elicits concomitant subjective responses. Coherence among the stress response systems is theoretically expected, presumably to optimize the organism's response to environmental challenges, but has received little empirical support possibly due to the assumption of linear associations. The present study examined the associations between cortisol responses to the Maastricht Acute Stress Test (MAST) and concomitant subjective stress responses as well as mood states over the past weeks in 133 healthy men. Latent class growth analysis (LCGA) was applied on individual cortisol and subjective stress responses to identify homogeneous response trajectories within the larger heterogeneous population and enable testing non-linear relationships while retaining the temporal resolution of the stress responses. LCGA revealed four latent cortisol response classes, labeled as mild responders (n = 15), moderately-low responders (n = 46), moderately-high responders (n = 48), and hyper responders (n = 24). These latent classes were not associated with concomitant subjective stress responses. Similarly, the three distinct latent classes capturing the variability in subjective stress responses were also not associated with concomitant cortisol responses. Experiencing higher levels of stress over the previous weeks, however, increased the likelihood of exhibiting a hyper cortisol stress response profile. Positive and negative affective states, and anxious and depressive symptomology over the previous weeks were not associated with cortisol response trajectories. Contrary to previous findings supporting a quadratic association in healthy females, our results do not support the response coherence hypothesis in healthy males subjected to the MAST, but suggest that recent levels of perceived stress may influence the cortisol response to acute stress.

Eligible neonatal donors after circulatory determination of death (Maastricht type III): A national survey of level III NICUs.

BACKGROUND: Organ donation continues to increase worldwide, but in general paediatric patients remain less likely to receive a transplant. The inclusion of neonates as donors after cDCD should be considered in an effort to increase donation rates. METHODS: The survey for a cross-sectional national study of potential cDCD neonatal donors (Maastricht type III) was sent to all 90 level III Spanish neonatal units to explore: 1) protocols, education, and specific opinions on donation and 2) potential cDCD that could have been eligible over a 2-year period (2014-2015). RESULTS: Forty-five centers (50%) completed the survey, and 38/45 gave information about potential eligible donors. In 16% of the centers specific protocols on neonatal donation exist. All hospitals demanded more specific training, and 65% noted that the donation process could be a problem in the family's dismissal of the child. During the study period 46 805 neonates were admitted in the 38 centers, and 625 neonates died. Ninety-five born at a gestational age ≥34 weeks and above 2000 gr died after an EoL decision, 38 (40%) and 13 (14%) of them due to neonatal encephalopathy and multiple congenital anomalies, respectively. There were 31 (33%) elegible infants who died in less than 120 min due to pathologies that did not contraindicate donation. CONCLUSIONS: Neonatal cDCD could help to reduce the gap between the supply of and demand for organs according to the potentially eligible patients emerging from this study. Training in EoL and donation processes should be provided to healthcare professionals.

Personalized Approach in Eradication of Helicobacter pylori Infection.

The increase in antibiotic resistance to Helicobacter pylori (H. pylori) is associated with a decrease in the effectiveness of eradication therapy. Although some success has been achieved by adjusting therapeutic regimens according to local data on resistance to certain antibiotics, a new approach is needed to ensure a better therapeutic response. Tailored therapy, based on sensitivity tests to antibiotics, is increasingly proving to be a superior therapeutic option, even as a first-line therapy. Moreover, the recently published Maastricht VI guidelines emphasize utilizing a susceptibility-guided strategy in respect to antibiotic stewardship as the first choice for eradication therapy. In addition, polymerase chain reaction (PCR) technology is becoming a standard tool in the diagnosis of H. pylori infections through non-invasive testing, which further optimizes the eradication process. We provide a review regarding the current position of the individualized approach in eradication therapy and its future prospects. Based on novel understandings, the personalized approach is an effective strategy to increase the successful eradication of H. pylori infections.

Evaluation of psychometric properties of the maastricht upper extremity questionnaire (MUEQ) in iranian computer users.

BACKGROUND: Measurement of the essential risk factors for work-related musculoskeletal disorders is a fundamental step in predicting the problem and identifying high-risk individuals. In this regard, Maastricht upper extremity questionnaire (MUEQ) has not been validated in Iran. This study aimed to develop a valid and reliable Persian version of MUEQ. MATERIALS AND METHODS: In this descriptive study, the computer users employed in a governmental informatics administration in Tehran, Iran, were included during the end of 2018 and early 2019. Face and content validity of the MUEQ was conducted, and a six-part questionnaire was provided. The reliability of the questionnaire was obtained using Cronbach's α and test-retest. Concurrent validity was assessed with Nordic Musculoskeletal Questionnaire (NMQ). Exploratory and confirmatory factor analysis, comparison test of independent mean, internal consistency coefficient, test-retest, and Pearson correlation were carried out using the AMOS and SPSS 22 software. RESULTS: Participants consisted of 282 computer users (110 males) with a mean age of 35.17 ± 7.65 years. The mean duration of computer use in a working day was 6.68 ± 2.10 h with a range of 1-12 h. The most prevalent symptoms were existed in the neck (39.1%), back (31.0%), and lower back (30.3%) areas. KMO test and Bartlett's test of sphericity showed that a significant correlation existed among questions. Cronbach's alpha coefficient of the questionnaire varied from 0.61 to 0.83 and test-retest coefficient was higher than 0.7. Correlation coefficient was between NMQ and body posture (r = 0.23, P = 0.004) and between NMQ and work environment (r = 0.28, P = 0.000). Evaluations related to the construct validity and concurrent validity demonstrated that the questionnaire has acceptable construct validity. Six factors of the MUEQ in Root Mean Squared Error Approximation (RMSEA) index (0.062) were acceptable and satisfactory in Parsimony Comparative Fit Index (PCFI), Comparative Fit Index (CFI), Normed Fit Index (NFI), and Parsimony Goodness of Fit Index (PGFI) (0.732, 0.8000, 0.680, and 0.680, respectively). CONCLUSIONS: The Persian version of the MUEQ represented a satisfactory validity and reliability and was suitable for computer users in the assessment of their risk factors of musculoskeletal complaints.

Static foot posture and its relation to clinical variables in ankylosing spondylitis.

AIM: Postural abnormalities of the foot are common in rheumatic diseases. Static foot posture is a poorly studied clinical parameter in ankylosing spondylitis (AS). The aim of the study was to evaluate static foot posture in patients with AS and to determine the potential impact of clinical variables on foot posture. METHOD: Fifty patients with AS and 40 age- and sex-matched healthy controls were enrolled in the study. Disease activity was measured using the Ankylosing Spondylitis Disease Activity Score. Axial mobility was evaluated with the Bath Ankylosing Spondylitis Metrology Index three-point answer scale. Functional status was assessed by the Bath Ankylosing Spondylitis Functional Index and Health Assessment Questionnaire-Disability Index. Enthesitis and foot posture were evaluated by the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and Foot Posture Index-6, respectively. RESULTS: Patients with AS revealed significantly higher scores of foot posture index when compared with controls (P = 0.005). Abnormal foot posture (pronated and supinated) was more common in the patient group (P < 0.01). According to the multinomial logistic regression analysis, a higher MASES score was associated with supinated foot posture in AS patients (odds ratio 1.47, 95% confidence interval 1.03-2.09, P = 0.035). In addition, supinated foot posture was associated with enthesitis of the Achilles tendon (P = 0.002). CONCLUSION: Enthesitis is related to deteriorated static foot posture in patients with AS. Enthesitis of the Achilles tendon is closely associated with the supinated foot posture.