Psoriatic arthritis with psychological comorbidities: an overview of systematic reviews on incidence, prevalence, and geographic disparities.

Systematic reviews and meta-analysis evaluating the prevalence, incidence, and psychological comorbidities of psoriatic arthritis (PsA) are increasing, so it's time to perform an overview of systematic reviews. To summarize the pooled prevalence, incidence, and psychological comorbidities rates of PsA, and to explore possible continent disparities. In this overview of systematic reviews the CINAHL, EMBASE, PsycINFO, and PubMed were searched to October 25, 2023. This overview included systematic reviews with meta-analysis of people with PsA, providing the pooled prevalence or incidence rates of PsA in general, or clinical populations and/or psychological comorbidities. The Preferred Reporting Items for Overviews of Reviews (PRIOR) statement was followed. AMSTAR-2 assessed the quality of reviews. The degree of overlap was calculated using the corrected covered area (CCA). Maps were developed using the location of where primary studies were conducted using DataWrapper App. The protocol was prospectively registered with Open Science Framework registry. Pooled prevalence and incidence rates of PsA or its associated psychological comorbidities in general or specific populations. We also collected locations from the primary studies of the included meta-analyses. Only the assessment of prevalence rates of PsA in people with psoriasis showed slight overlap (CCA = 3.3%). Items 2, 3, 4, 7, 8, 10, 12, and 13 were poorly reported in AMSTAR-2. The pooled prevalence of PsA ranged from 0.13 to 0.15% in the general population, and 15.5% to 19.7% in people with psoriasis. The pooled incidence of PsA ranged from 8.26 to 9.27 cases per 100,000 inhabitants to 0.87 cases in individuals with hidradenitis suppurativa. The pooled prevalence of psychological comorbidities was 11.9-20% for depression, 19-33% anxiety, 38% alexithymia, and 72.9% in poor sleep quality. Only the pooled incidence of depression was assessed with 21.3 per 1000-person year. PsA seems to be prevalent and incident not only in people with psoriasis, but also in general population. Depression and anxiety symptoms may be present in some patients with PsA. Finally, continent disparities exist, and methodological and clinical issues were found, which could be helpful in the future agenda of the epidemiology of PsA.

Multimodal exercise programs may improve posttraumatic stress disorders symptoms and quality of life in adults with PTSD: An overview of systematic reviews with meta-analysis.

OBJECTIVE: This overview of reviews aimed to summarize the effectiveness of exercise, regular physical activity or mind-body exercises on posttraumatic stress disorder (PTSD) symptoms and comorbidities associated with PTSD (e.g. depression symptoms) among individuals without age, gender, race, ethnicity or setting restrictions. DATA SOURCES: The CINAHL, Embase, PubMed and SPORTDiscus databases were searched from inception to November 16, 2023. REVIEW METHODS: Systematic reviews with meta-analysis of randomized clinical trials evaluating exercise, regular physical activity or mind-body exercises were considered. Control groups and outcome measures were not restricted. AMSTAR 2 assessed the methodological quality of reviews. The overlap between reviews was calculated. RESULTS: A total of 14 systematic reviews were included meta-analyzing 23 distinct randomized clinical trials. There was a very high overlap between reviews (corrected covered area = 16%). PTSD symptoms, depression symptoms, anxiety symptoms, sleep quality, substance abuse and quality of life were meta-analyzed. No reviews meta-analyzed the effects of regular physical activity. Overall, the meta-analyses found multicomponent exercise programs may have positive results in reducing PTSD symptoms and improving quality of life. In addition, the results of yoga were inconsistent across the meta-analyses for PTSD symptoms, and no differences between groups were found in favor of yoga for depression symptoms. Finally, no specific conclusions could be made about anxiety symptoms, sleep quality and substance abuse. CONCLUSION: A multicomponent exercise program may be effective in improving PTSD symptoms and quality of life, whereas yoga may be ineffective for depression symptoms in adults with PTSD.

No effects were found in favor of Hatha or Iyengar yoga exercises for improving cancer-related fatigue, depression symptoms, or quality of life: a systematic review with meta-analysis and metaregression.

OBJECTIVE: To summarize the evidence on the effectiveness of Hatha or Iyengar yoga exercises on cancer-related fatigue, depression symptoms, and the overall quality of life in adults with cancer. METHODS: A systematic review with meta-analysis was conducted. The CINAHL (via EBSCOhost), Embase, PubMed, and SPORTDiscus (via EBSCOhost) databases were searched from inception to 7th November 2022. Clinical trials evaluating cancer-related fatigue, depression symptoms, and the overall quality of life were included. The risk of bias was assessed using the Cochrane Risk of Bias tool 2. The Template for Intervention Description and Replication (TIDieR) checklist was used to check if the interventions reviewed were described in detail to be implemented in the clinical setting. The Grading of Recommendations, Assessment, Development, and Evaluations approach was used to rate the certainty of evidence. Meta-regressions, sensitivity analyses, and subgroup meta-analyses were conducted to explore sources of heterogeneity. RESULTS: Eleven studies were included (N = 777 participants). Overall, Hatha, Iyengar, and the combination of both yoga styles did not improve any of the outcomes of interest. In addition, five studies had a high risk of bias, and six studies had some concerns about biases. Weaknesses in reporting modifications during the development of the study were observed (TIDieR item 10). The certainty of evidence ranged from low to very low across the outcomes. CONCLUSIONS: We could not make sound clinical recommendations with the current quality of the findings.

Meta-DiSc 2.0: a web application for meta-analysis of diagnostic test accuracy data.

BACKGROUND: Diagnostic evidence of the accuracy of a test for identifying a target condition of interest can be estimated using systematic approaches following standardized methodologies. Statistical methods for the meta-analysis of diagnostic test accuracy (DTA) studies are relatively complex, presenting a challenge for reviewers without extensive statistical expertise. In 2006, we developed Meta-DiSc, a free user-friendly software to perform test accuracy meta-analysis. This statistical program is now widely used for performing DTA meta-analyses. We aimed to build a new version of the Meta-DiSc software to include statistical methods based on hierarchical models and an enhanced web-based interface to improve user experience. RESULTS: In this article, we present the updated version, Meta-DiSc 2.0, a web-based application developed using the R Shiny package. This new version implements recommended state-of-the-art statistical models to overcome the limitations of the statistical approaches included in the previous version. Meta-DiSc 2.0 performs statistical analyses of DTA reviews using a bivariate random effects model. The application offers a thorough analysis of heterogeneity, calculating logit variance estimates of sensitivity and specificity, the bivariate I-squared, the area of the 95% prediction ellipse, and the median odds ratios for sensitivity and specificity, and facilitating subgroup and meta-regression analyses. Furthermore, univariate random effects models can be applied to meta-analyses with few studies or with non-convergent bivariate models. The application interface has an intuitive design set out in four main menus: file upload; graphical description (forest and ROC plane plots); meta-analysis (pooling of sensitivity and specificity, estimation of likelihood ratios and diagnostic odds ratio, sROC curve); and summary of findings (impact of test through downstream consequences in a hypothetical population with a given prevalence). All computational algorithms have been validated in several real datasets by comparing results obtained with STATA/SAS and MetaDTA packages. CONCLUSION: We have developed and validated an updated version of the Meta-DiSc software that is more accessible and statistically sound. The web application is freely available at www.metadisc.es .

Face Recognition on a Smart Image Sensor Using Local Gradients.

In this paper, we present the architecture of a smart imaging sensor (SIS) for face recognition, based on a custom-design smart pixel capable of computing local spatial gradients in the analog domain, and a digital coprocessor that performs image classification. The SIS uses spatial gradients to compute a lightweight version of local binary patterns (LBP), which we term ringed LBP (RLBP). Our face recognition method, which is based on Ahonen's algorithm, operates in three stages: (1) it extracts local image features using RLBP, (2) it computes a feature vector using RLBP histograms, (3) it projects the vector onto a subspace that maximizes class separation and classifies the image using a nearest neighbor criterion. We designed the smart pixel using the TSMC 0.35 µm mixed-signal CMOS process, and evaluated its performance using postlayout parasitic extraction. We also designed and implemented the digital coprocessor on a Xilinx XC7Z020 field-programmable gate array. The smart pixel achieves a fill factor of 34% on the 0.35 µm process and 76% on a 0.18 µm process with 32 µm × 32 µm pixels. The pixel array operates at up to 556 frames per second. The digital coprocessor achieves 96.5% classification accuracy on a database of infrared face images, can classify a 150×80-pixel image in 94 µs, and consumes 71 mW of power.

A Small Step, a Giant Leap: Somatic Hypermutation of a Single Amino Acid Leads to Anti-La Autoreactivity.

The anti-La mab 312B, which was established by hybridoma technology from human-La transgenic mice after adoptive transfer of anti-human La T cells, immunoprecipitates both native eukaryotic human and murine La protein. Therefore, it represents a true anti-La autoantibody. During maturation, the anti-La mab 312B acquired somatic hypermutations (SHMs) which resulted in the replacement of four aa in the complementarity determining regions (CDR) and seven aa in the framework regions. The recombinant derivative of the anti-La mab 312B in which all the SHMs were corrected to the germline sequence failed to recognize the La antigen. We therefore wanted to learn which SHM(s) is (are) responsible for anti-La autoreactivity. Humanization of the 312B ab by grafting its CDR regions to a human Ig backbone confirms that the CDR sequences are mainly responsible for anti-La autoreactivity. Finally, we identified that a single amino acid replacement (D > Y) in the germline sequence of the CDR3 region of the heavy chain of the anti-La mab 312B is sufficient for anti-La autoreactivity.

And Yet It Moves: Oxidation of the Nuclear Autoantigen La/SS-B Is the Driving Force for Nucleo-Cytoplasmic Shuttling.

Decades ago, we and many other groups showed a nucleo-cytoplasmic translocation of La protein in cultured cells. This shuttling of La protein was seen after UV irradiation, virus infections, hydrogen peroxide exposure and the Fenton reaction based on iron or copper ions. All of these conditions are somehow related to oxidative stress. Unfortunately, these harsh conditions could also cause an artificial release of La protein. Even until today, the shuttling and the cytoplasmic function of La/SS-B is controversially discussed. Moreover, the driving mechanism for the shuttling of La protein remains unclear. Recently, we showed that La protein undergoes redox-dependent conformational changes. Moreover, we developed anti-La monoclonal antibodies (anti-La mAbs), which are specific for either the reduced form of La protein or the oxidized form. Using these tools, here we show that redox-dependent conformational changes are the driving force for the shuttling of La protein. Moreover, we show that translocation of La protein to the cytoplasm can be triggered in a ligand/receptor-dependent manner under physiological conditions. We show that ligands of toll-like receptors lead to a redox-dependent shuttling of La protein. The shuttling of La protein depends on the redox status of the respective cell type. Endothelial cells are usually resistant to the shuttling of La protein, while dendritic cells are highly sensitive. However, the deprivation of intracellular reducing agents in endothelial cells makes endothelial cells sensitive to a redox-dependent shuttling of La protein.

Biological Activity of Sacha Inchi (Plukenetia volubilis Linneo) and Potential Uses in Human Health: A Review.

Sacha inchi (Plukenetia volubilis Linneo) is an ancestral plant originating in the Amazon jungle that has been adopted as a food source due to its high nutritional value, which has gradually been recognized to have potential benefits for human health. Diverse prospective studies have evaluated the effect of consuming components from the plant, derivatives from its seeds, leaves and shell on preventing the risk of cardiovascular disease, chronic inflammatory disease, dermatitis and controlling tumor proliferation, especially given its recognized high content of essential fatty acids, phenolic compounds and vitamin E, showing antioxidant, hypolipidemic, immunomodulation and emollient activity, as well as the capacity to remove heavy metals from aqueous solutions. This review offers a complete description of the existing information on the use and biological activity of P. volubilis L., based on its essential lipid components and evidenced on its use in the field of human health, in prevention, therapeutic and nutritional contexts, along with industrial uses, making it a promising bioresource.

Some reflections on the use of inappropriate comparators in CEA.

Although the choice of the comparator is one of the aspects with a highest effect on the results of cost-effectiveness analyses, it is one of the less debated issues in international methodological guidelines. The inclusion of an inappropriate comparator may introduce biases on the outcomes and the recommendations of an economic analysis. Although the rules for cost-effectiveness analyses of sets of mutually exclusive alternatives have been widely described in the literature, in practice, they are hardly ever applied. In addition, there are many cases where the efficiency of the standard of care has never been assessed; or where the standard of care has demonstrated to be cost-effective with respect to a non-efficient option. In all these cases the comparator may lie outside the efficiency frontier, so the result of the CEA may be biased. Through some hypothetical examples, the paper shows how the complementary use of an independent reference may help to identify potential inappropriate comparators and inefficient use of resources.

Immunological Memory to Zika Virus in a University Community in Colombia, South America.

Zika virus appeared in South America in 2015, generating alarm worldwide as it causes microcephaly and autoimmunity. This study aims to determine the serological footprint of the incoming epidemic in a student community and to characterize the memory functional cell response during post convalescence. In a cross-sectional study, Zika-specific IgG using LIA immunoassay was found in 328 university students (CI=95%), while in the second phase, the functional cellular memory response for IFN-γ and IL-2 was quantified using post-stimulus ELISpot with inactivated virus, starting with individuals seropositive for Zika and control individuals (seropositive only for Dengue and seronegative for Zika-Dengue). Depending on the antigen used, memory humoral response (IgG) against Zika Virus was observed in >60% of the population; seropositivity for NS1 was 21.1% higher than E antigen with high intensity. The analysis of cell functionality in 22 individuals seropositive for Zika virus revealed either IFN-γ+ or IL-2+ cells in 86.3% of cases (Th1 profile), presenting multifunctionality in 50% (11 individuals), 64% of which presented> 6 SFC/104 PBMCs (>600 SFC/106 PBMC), reflecting memory circulating cells. A good agreement (Kappa= 0.754) was observed between the coexistence of both cellular and humoral responses but not in their intensity.

Mapping of the Gastrointestinal Short Form Questionnaire (GSF-Q) into EQ-5D-3L and SF-6D in patients with gastroesophageal reflux disease.

BACKGROUND: The short, self-administered Gastroesophageal Reflux Disease (GERD) Symptom Frequency Questionnaire (GSFQ) is a specific Quality of Life (QoL) instrument which measures the impact of GERD symptoms on QoL. This study aims to map the specific scores in GSFQ into two generic instruments: SF-6D and EQ-5D-3 L, in order to obtain utility estimates derived from the GERD condition. METHOD: A national representative sample of GERD patients was selected, stratified by gender, age (< 45, ≥45 years) and GERD severity (0-I, II-IV Savary-Miller score) for validation purposes. Age, gender, BMI, GERD diagnose, GERD severity, associated comorbidities and risk factors were recorded. GSFQ, SF-6D, EQ-5D-3 L, and the HRQoL Visual Analogue Scale (VAS) were answered by patients. Several mapping methods were estimated, regression using dummy variables, and linear, quadratic and cubic regression using optimal factor scores. The use of a GERD aggregated summary severity derived from the GSFQ was dimed the best predictor. Overall Mean Absolute Error (MAE), overall Mean Absolute Percentage Error (MAPE) were used as goodness-of-fit (GOF) indexes to compare models. RESULTS: A total of 3405 patients were recruited by 490 clinicians. Mean age was 49 (±14.4) years and 49.8% were women. Reported comorbidities were clustered in 6 antecedents and 15 concomitant pathologies. Aggregation of levels for the frequency of symptoms items was found more suitable for estimation. Regression weights were found to follow a monotonous progressive pattern. Overall MAE ranged from 0.092 to 0.094 for SF-6D utility prediction and from 0.008 to 0.08 for EQ-5D-3 L, while MAPE values ranged from 27.9 to 29% for SF-6D and from 36.8 to 38.4% for EQ-5D-3 L. Cubic regression GOF demonstrated a better fit. CONCLUSIONS: It is possible to translate specific GSFQ scores assessing GERD condition into generic SF-6D and EQ-5D-3 L utility values. Although regression using dummy variables is a suitable mapping procedure, other alternative mapping methods convey better fit, in particular cubic regression.

Development and validation of a new questionnaire measuring treatment satisfaction in patients with non-valvular atrial fibrillation: SAFUCA®.

OBJECTIVE: To develop a new questionnaire with good psychometric properties to measure satisfaction with medical care in patients with non-valvular atrial fibrillation. METHOD: The initial instrument was composed of 37 items, arranged in 6 dimensions: efficacy, ease and convenience, impact on daily activities, satisfaction with medical care, undesired effects of medication, and overall satisfaction. Items and dimensions were extracted from reviewing existing instruments, 3 focus groups with chronic patients, and a panel of 8 experts. Additionally, 3 visual analog scales measuring quality of life, effectiveness, and overall satisfaction were administered. A convenience sample of 119 patients was used for item reduction. Classic psychometric theory and item analysis techniques were used (exploratory factor and confirmatory factor analysis, test-retest, and correlation with visual scales). A validation sample of 230 patients was used to assess convergent validity, and an additional 220 patients sample was used to discriminate between treatment and compliance groups. RESULTS: The questionnaire was reduced in length to 25 items, but the impact dimension had split in treatment inconvenience and treatment control. Overall reliability was high (α = 0.861) with acceptable dimensional reliabilities (α = 0.764-0.908). Individual dimensions correlated to varying degrees. Test-retest correlations were high (r = 0.784-0.965), and correlations with visual and already validated scales were substantial. Differences were detected between antivitamin K and new-oral-anticoagulant treatments in several dimensions (p < 0.05). Treatment satisfaction was related with compliance. CONCLUSION: This new 25-item questionnaire has good psychometric properties for measuring satisfaction with medical care in patients with this condition. It is capable of detecting differences between different treatments.

Acceptance and Commitment Therapy for Chronic Pain: An Overview of Systematic Reviews with Meta-Analysis of Randomized Clinical Trials.

This overview of reviews aimed to summarize the evidence from systematic reviews and meta-analyses of randomized clinical trials of the efficacy of acceptance and commitment therapy (ACT) for adults with chronic pain in relation to pain intensity, pain-related functioning, quality of life, and psychological factors. The Cumulative Index of Nursing and Allied Health Literature (CINAHL), Embase, PsycINFO, PubMed, and the Cochrane Library databases were searched from inception to July 2, 2023. AMSTAR 2 was used to assess the methodological quality of systematic reviews. The overlap among reviews was calculated. Nine reviews comprising 84 meta-analyses of interest were included. At post-treatment, some meta-analyses mainly showed that ACT can reduce depression symptoms, anxiety symptoms, psychological inflexibility, and pain catastrophizing; and can improve mindfulness, pain acceptance, and psychological flexibility. At three-month follow-up, ACT can reduce depression symptoms and psychological inflexibility, as well as improve pain-related functioning and psychological flexibility. At six-month follow-up, ACT can improve mindfulness, pain-related functioning, pain acceptance, psychological flexibility, and quality of life. At six-twelve-month follow-up, ACT can reduce pain catastrophizing and can improve pain-related functioning. Some methodological and clinical issues are identified in the reviews, such as a very high overlap between systematic reviews, the fact that the certainty of the evidence is often not rated and specific details needed to replicate the interventions reviewed are often not reported. Overall, however, randomized clinical trials and systematic reviews show that ACT can improve outcomes related to chronic pain (eg, pain-related functioning). Future systematic reviews should address the methodological and clinical concerns identified here to produce higher-quality findings. PERSPECTIVE: Despite certain methodological and clinical issues, randomized clinical trials and systematic reviews of ACT appear to show that it can improve outcomes related to chronic pain (eg, psychological factors).

Exercise or mind-body exercises for psychiatry symptoms and quality of life in schizophrenia spectrum and other psychotic disorders: an overview of systematic reviews with meta-analysis.

PURPOSE: This overview of systematic reviews with meta-analysis aimed to summarize the effects of exercise, regular physical activity, and mind-body exercises on negative symptoms, depression symptoms, and quality of life in schizophrenia spectrum and other psychotic disorders. MATERIAL AND METHODS: The CINAHL, Embase, PubMed, SPORTDiscus, and the Cochrane Library databases were searched up to November 10, 2023. AMSTAR 2 was used and the overlap between reviews was calculated. RESULTS: Eighteen reviews were included. No reviews meta-analyzed regular physical activity. Aerobic exercise may be more effective than yoga, treatment-as-usual, or multiple controls for reducing negative symptoms. Tai chi may be more effective than multiple controls for decreasing negative symptoms. Aerobic exercise or multimodal exercise programs may be more effective than multiple controls for reducing depression symptoms. Yoga may be more effective than waitlist for decreasing depression symptoms. Aerobic exercise may be more effective than multiple controls for improving quality of life. Yoga may be more effective than treatment-as-usual for improving quality of life. The rest of the meta-analyses found no differences between groups or combined different types of interventions in their meta-analyses. CONCLUSIONS: Despite these results, important methodological concerns were detected that precluded us from making sound clinical recommendations. PROTOCOL REGISTRATION: https://doi.org/10.17605/OSF.IO/7V5QZ.

This overview of reviews evaluates exercise and mind-body exercise for schizophrenia and other psychotic disorders.Aerobic exercise or tai chi may reduce negative symptoms in these psychiatric disorders.Yoga may reduce depression symptoms and improve quality of life in these psychiatric disorders.

Cost-effectiveness Analysis of Maternal Immunization with RSVpreF Vaccine for the Prevention of Respiratory Syncytial Virus Among Infants in Spain.

INTRODUCTION: Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory infections (ALRI) in children under one year of age. In high-income countries, RSV infections cause a significant overload of care every winter, imposing a significant burden to the healthcare system, which has made the development of prevention strategies a major global health priority. In this context, a new bivalent RSV prefusion F protein-based vaccine (RSVpreF) has recently been approved. The objective of this study was to evaluate the cost-effectiveness of vaccinating pregnant women with the RSVpreF vaccine to prevent RSV in infants from the Spanish National Healthcare System (NHS) perspective. METHODS: A hypothetical cohort framework and a Markov-type process were used to estimate clinical outcomes, costs, quality-adjusted life years (QALY) and cost-per-QALY gained (willingness-to-pay threshold: €25,000/QALY) for newborn infants born to RSV-vaccinated versus unvaccinated mothers over an RSV season. The base case analysis was performed from the NHS perspective including direct costs (€2023) and applying a discount of 3% to future costs and outcomes. To evaluate the robustness of the model, several scenarios, and deterministic and probabilistic analyses were carried out. All the parameters and assumptions were validated by a panel of experts. RESULTS: The results of the study showed that year-round maternal vaccination program with 70% coverage is a dominant option compared to no intervention, resulting in direct cost savings of €1.8 million each year, with an increase of 551 QALYs. Maternal vaccination could prevent 38% of hospital admissions, 23% of emergency room visits, 19% of primary care visits, and 34% of deaths due to RSV. All scenario analyses showed consistent results, and according to the probabilistic sensitivity analysis (PSA), the probability of maternal vaccination being cost-effective versus no intervention was 99%. CONCLUSIONS: From the Spanish NHS perspective, maternal vaccination with bivalent RSVpreF is a dominant alternative compared with a non-prevention strategy.

Exercise and mind-body exercise for feeding and eating disorders: a systematic review with meta-analysis and meta-regressions.

PURPOSE: To develop a systematic review with meta-analysis to summarize the effectiveness of exercise, regular physical activity, and mind-body exercise on harmful exercise habits, psychological factors, and quality of life in people clinically diagnosed with feeding and eating disorders. MATERIAL AND METHODS: Randomized clinical trials and pilot randomized clinical trials were considered. RESULTS: Twelve studies were included. No studies evaluated athletes. No studies examined regular physical activity as the targeted intervention. Quality of life could not be meta-analyzed. Overall, meta-analyses showed that exercise or mind-body exercise was not more effective than controls in reducing depression symptoms, harmful exercise habits, eating behaviors, or emotional regulation skills. However, important methodological and clinical issues were detected in the included studies. This affected the certainty of evidence of the meta-analyzed outcomes which ranged from low to very low. No studies reported in sufficient detail their interventions to be replicated. CONCLUSIONS: Overall, exercise and mind-body exercise may be ineffective in improving meta-analyzed outcomes. However, the certainty of evidence ranged from low to very low and the body of knowledge in this field needs to be increased to reach robust conclusions.

Exercise and mind-boy exercises were not more effective than controls for eating behaviors in eating disorders.Exercise and mind-boy exercises were not more effective than controls for depression symptoms in eating disorders.Clinicians should be aware no specific exercises can be recommended for treating psychological factors in eating disorders.

Unveiling relevant emotions, cognitions, and behaviours from the viewpoint of people with chronic low back pain: A qualitative study with patient involvement.

OBJECTIVE: To gain insight into the emotions, cognitions, and behaviours experienced by people with chronic low back pain (CLBP) undergoing invasive treatment in a pain unit. DESIGN: A cross-sectional qualitative study based on individual interviews. This study included patient involvement in its design and development. METHODS: An interpretative phenomenological approach was adopted to understand the multidimensional experience of patients. The interview script was a translated, adapted, and expanded version of the one proposed by Cognitive and Functional Therapy. A mixed coding method was applied to structure the interviews. Three themes were created, with the three most frequently reported emotions, cognitions, and behaviours as subthemes. A patient with CLBP approved the initial protocol and the aim of the study. Subsequently, the patient contributed questions to the interview script, checked the coding process, and approved the final version of the manuscript. RESULTS: Twenty-two patients undergoing epidural infiltrations in a pain unit were interviewed. (i)"Fears", (ii)"Frustration", and (iii)"Worry" were the three most commonly expressed emotions. Cognitions related to (i)"Pain predictability", (ii)"Pain description and perception", and (iii)"Pain interference/disability" were also widely reported. The theme "Behaviours" was composed of the following subthemes: (i)"Strategies for managing symptoms", (ii)"Social behaviours", and (iii)"Strategies for coping with daily tasks". Noteworthily, cognitions related to the (i)"Diagnosis", (ii)"Health system attention", and (iii)"Medical prescriptions" arose from questions provided by patient involvement. CONCLUSION: Patients with CLBP expressed a wide variety of emotions, cognitions, and behaviours that must be considered by health professionals with the goal of providing the best patient-centred care.

How can clinicians enhance self-efficacy beliefs in osteoarthritis? An overview of systematic reviews with meta-analysis.

This overview of reviews aimed to synthesize the effectiveness of non-pharmacological approaches to enhance self-efficacy in people with osteoarthritis. The CINAHL, Embase, PsycINFO, PubMed, SPORTDiscus, and the Cochrane Library databases were searched from inception to December 2023. We considered systematic reviews with meta-analysis of randomized clinical trials evaluating any non-pharmacological intervention. We used AMSTAR 2 to assess the methodological quality of reviews. The overlap between reviews was calculated. We included eight systematic reviews with meta-analysis evaluating 30 different clinical trials. Overall, mind-body exercises, psychological interventions, and self-management strategies may improve arthritis self-efficacy. Specifically, the meta-analyses showed tai chi exercises, coping skills training, and the arthritis self-management program are more effective than controls to enhance arthritis self-efficacy in people with hip and/or knee osteoarthritis. In addition, inconsistent results were detected across meta-analyses regarding the effectiveness of multidisciplinary interventions. Finally, the degree of overlap between all reviews was moderate (CCA = 6%) and many included reviews reported most of the items of AMSTAR 2. Tai chi exercises, coping skills training, and the arthritis self-management program may be beneficial for enhancing arthritis self-efficacy. Open Science Framework Registration: https://doi.org/10.17605/OSF.IO/VX2T6 .

Detecting changes in patient treatment satisfaction with medicines: the SATMED-Q.

BACKGROUND AND OBJECTIVE: The Treatment Satisfaction with Medicines Questionnaire (SATMED-Q) has shown appropriate psychometric properties exploring patients' satisfaction with treatment. Responsiveness (sensitivity to change) and known-group validity, however, still remained unknown. Thus, the goal of this study was to explore such psychometric properties for the SATMED-Q. METHODS: We used data from a 6-month prospective study carried out in pain clinics, which included patients with chronic refractory pain of neuropathic origin who needed a change in their therapies. Sensitivity to change was assessed by comparing changes in the total and domain scores between baseline and end-of-trial visits according to patients' response criterion: pain reduction 50% or more (responder). Also, correlations between changes in pain intensity and satisfaction scores were computed. Known-groups validity was explored by comparing the degree of satisfaction between groups of different levels of pain. RESULTS: The sample was formed with 728 subjects (57.8 years, 61.0% women). After changing their therapy, 47% of the patients were considered responders, and pain intensity was reduced by an average of 42.9%±32.4% (P<0.001), which was significantly correlated (r =-0.524, P<0.001) with total treatment satisfaction improvement. The total score in the SATMED-Q was significantly higher in responders than in nonresponders: 80.9 (79.6-82.3) versus 66.5 (65.0-98.0) (P<0.001). Also, the instrument showed different scores of satisfaction according to different degrees of pain (mild, moderate, severe), F = 116.8 (P<0.001) in the total composite score and domains. CONCLUSION: The SATMED-Q was sensitive to changes in patients' satisfaction with treatment. In addition, patients' different heath statuses are correlated with different levels of satisfaction with treatment.

Cost-Effectiveness of Lorlatinib for the Treatment of Adult Patients with Anaplastic Lymphoma Kinase Positive Advanced Non-Small Cell Lung Cancer in Spain.

Purpose: The objective of the present study was to evaluate the efficiency of lorlatinib compared to alectinib and brigatinib for the treatment of adult patients with anaplastic lymphoma kinase (ALK)-positive advanced non-small cell lung cancer (NSCLC) previously not treated, in Spain. Methods: A partitioned survival model comprised progression free, non-intracranial progression, intracranial progression, and death health states was constructed to estimate the total costs, life-years gained (LYG) and quality-adjusted life years (QALYs) accumulated in a lifetime horizon. Overall survival (OS) and progression-free survival (PFS) for lorlatinib were obtained from the CROWN study. For alectinib and brigatinib, a network meta-analysis of randomized controlled trials was conducted to estimate OS and PFS hazard ratios versus crizotinib. Utilities were estimated based on EQ-5D-5L data derived from the CROWN (lorlatinib), ALEX (alectinib) and ALTA-1L (brigatinib) studies. According to the Spanish National Health Service perspective the total costs (expressed in euros using a 2021 cost year) included drug acquisition and the administration's subsequent treatment, ALK+ advanced NSCLC management and adverse-event management, and palliative care. Unitary costs were obtained from local cost databases and literature. Costs, LYGs and QALYs were discounted at 3% annually. Deterministic and probabilistic sensitivity analyses were used to test the model's robustness. Results: Lorlatinib provided higher health outcomes (+0.70 LYG/patient, +1.42 QALYs/patient) and lower costs (-€9239/patient) than alectinib. Lorlatinib yielded higher LYG (+1.74) and QALYs (+2.30) versus brigatinib but higher costs/patient (+€36,627), resulting in an incremental-cost-effectiveness-ratio of €15,912/QALY gained. Conclusion: The results of this study suggest that lorlatinib may be a dominant treatment option versus alectinib. Considering a willingness-to-pay threshold of €25,000/QALY, lorlatinib may be an efficient option compared to brigatinib.