Expert recommendations on the psychological needs of patients with rheumatoid arthritis.

OBJECTIVE: To establish feasible and practical recommendations for the management of the psychological needs of patients with rheumatoid arthritis (RA) from the moment of diagnosis through the course of the disease. METHODS: A nominal group meeting was held with an RA expert team including rheumatologists and psychologists, at which a guided discussion addressed the most important psychological and emotional needs in RA. Based on the comments collected, and a literature review, a matrix document of recommendations for telematics discussion was prepared, as well as a Delphi survey to test agreement with these recommendations. Agreement was defined if at least 80% of participants voted ≥ 7 (from 1, totally disagree to 10, totally agree). For each recommendation, the level of evidence and grading of recommendations was established following the Oxford criteria, and the degree of agreement through the Delphi. RESULTS: Thirteen recommendations were established, addressing several key processes: (1) identification of psychological problems and needs in patients with RA, and a guideline for their management in daily practice; (2) communication with patients; (3) referral criteria to mental health professionals. CONCLUSIONS: These recommendations are intended to help health care professionals openly address the psychological aspects of patients in daily practice to follow and treat them properly.

Oral pain and eating problems in Spanish adults and elderly in the Spanish National Survey performed in 2005.

AIMS: To analyze and quantify the sociodemographic, behavioral, and clinical factors influencing the oral pain and eating difficulties reported by Spanish 35- to 44-year-old adults and more elderly people in the most recent Spanish National Oral Health Survey. METHODS: Pain and chewing difficulties were gathered in a Likert-scale format from a representative sample of the Spanish general population between the ages of 35 and 44 years (n = 540) and 65 to 74 years (n = 540). Risk factors were identified using bivariate analysis, after which the crude association between risk factors (sociodemographic, behavioral, and clinical) and outcome variables (pain and eating problems) was assessed by adjusted odds ratios, calculated by means of multivariate logistic regression. RESULTS: In the 35- to 44-year-old adults, eating problems were mainly associated with caries and prosthetic treatment needs and oral pain by the number of decayed teeth. In the more elderly individuals, eating problems and oral pain were influenced by prosthetic needs and the number of missing teeth. Female sex was seen to be a risk factor for suffering pain and eating restrictions. Additionally, several independent variables such as social class, place of residence, brushing habits, or periodontal needs became nonsignificant after logistic regression modelling. CONCLUSION: According to this high-specificity regression model, caries and prosthetic treatment needs should be considered key factors in determining the oral well-being of the Spanish population. Missing teeth represent the most relevant influencing factor for the elderly and decayed teeth for younger adults.

Modulation of bitter taste perception by a small molecule hTAS2R antagonist.

Human bitter taste is mediated by the hTAS2R family of G protein-coupled receptors. The discovery of the hTAS2Rs enables the potential to develop specific bitter receptor antagonists that could be beneficial as chemical probes to examine the role of bitter receptor function in gustatory and nongustatory tissues. In addition, they could have widespread utility in food and beverages fortified with vitamins, antioxidants, and other nutraceuticals, because many of these have unwanted bitter aftertastes. We employed a high-throughput screening approach to discover a novel bitter receptor antagonist (GIV3727) that inhibits activation of hTAS2R31 (formerly hTAS2R44) by saccharin and acesulfame K, two common artificial sweeteners. Pharmacological analyses revealed that GIV3727 likely acts as an orthosteric, insurmountable antagonist of hTAS2R31. Surprisingly, we also found that this compound could inhibit five additional hTAS2Rs, including the closely related receptor hTAS2R43. Molecular modeling and site-directed mutagenesis studies suggest that two residues in helix 7 are important for antagonist activity in hTAS2R31 and hTAS2R43. In human sensory trials, GIV3727 significantly reduced the bitterness associated with the two sulfonamide sweeteners, indicating that hTAS2R antagonists are active in vivo. Our results demonstrate that small molecule bitter receptor antagonists can effectively reduce the bitter taste qualities of foods, beverages, and pharmaceuticals.

Dimensional structure of the oral health-related quality of life in healthy Spanish workers.

BACKGROUND: Oral health-related quality of life (OHQoL) is conceived as a multidimensional construct. Here our aim was to investigate the dimensional structure of OHQoL as measured by the Spanish versions of the Oral Impacts on Daily Performance (OIDP) and the Oral Health Impact Profile (OHIP-14) questionnaires applied simultaneously. METHODS: We recruited a consecutive sample of 270 healthy Spanish workers visiting the Employment Risk Prevention Centre for a routine medical check-up. OHIP-14 was self-completed by participants but the OIDP was completed in face-to-face interviews. An Exploratory Factor Analysis (EFA) was performed to identify the underlying dimensions of the OHQoL construct assessed by both instruments. This factorial structure was later confirmed by Confirmatory Factor Analysis (CFA) using several estimators of goodness of fit indices. RESULTS: EFA and the CFA identified and respectively confirmed a set of 3 underlying factors in both questionnaires that could be interpreted as functional limitation, pain-discomfort, and psychosocial impacts. The model achieved was seen to fit properly for both instruments, but the factorial structure was clearer for the OIDP. CONCLUSIONS: The results provide evidence for construct equivalence in the latent factors assessed by both OIDP and OHIP-14, suggesting that OHQoL is a three-dimensional construct. The prevalence of impact on these three factors was coherent between both indicators, pain-discomfort having the highest prevalence, followed by psycho-social impact, and functional limitation.

Assessment of human cytomegalovirus specific T cell immunity in human immunodeficiency virus infected patients in different disease stages following HAART and in long-term non-progressors.

T cell immunity to human cytomegalovirus (HCMV) was assessed in HAART-treated HIV-1 infected patients (9 asymptomatic, CDC group A; and 22 symptomatic, CDC group B), and in eight HIV-1 long term non-progressors. Patients were either prospectively or cross-sectionally examined for CD4(+) T cell counts, HIV RNA load, HCMV leukoDNAemia, HCMV DNA in urine, lymphoproliferative response (LPR) to HCMV and phytohemagglutinin (PHA), and cytokine secretion (IFN-gamma and IL-4) by HCMV-stimulated peripheral blood mononuclear cell (PBMC) cultures. No patient either progressed to clinical AIDS or developed HCMV active infection during the study period. Twenty-nine patients responded to HAART, though 12 patients failed to recover the LPR to HCMV over the study period (three from CDC group A and nine from CDC group B). In contrast to healthy control individuals, most patients displaying positive LPRs LPRs to HCMV had unstable responses. Sustained LPRs to HCMV were significantly associated with high pre-HAART nadir CD4(+) T cell counts. Long-term suppression of HIV viremia correlated with recovery of LPR to HCMV. Sequential PBMC cultures from most patients secreted IFN-gamma (but not IL-4) at normal levels upon HCMV stimulation, irrespective of the pre-HAART nadir CD4(+) T cell counts and CDC group to which patients belonged. Failure to reconstitute IFN-gamma response was associated with very low pre-HAART nadir CD4(+) T cell counts. Control of HCMV infection in the cohort was associated with either recovery or maintenance of IFN-gamma response rather than with reconstitution of LPR to HCMV. A LPR to HCMV was absent in three out of eight long term non-progressors; contrarily, all patients showed preserved IFN-gamma responses.

Trastornos de personalidad y su relación con la violencia / Dysfunctions of personality and their realathionship with violence

Se realizó un estudio prospectivo en el Servicio de Psiquiatría Forense del Hospital Psiquiátrico de La Habana; durante el período de un año correspondiente a (Enero-Diciembre del 2001); en el cual, se evaluaron 1819 pacientes, de los que 655 para un 36 (por ciento) cumplen los criterios de la CIE-10 para Trastornos de Personalidad. Los trastornos de personalidad más frecuentes diagnosticados fueron el F60.3, Inestabilidad Emocional; el F07.0, Trastorno Orgánico; el F61.0 Mixto y el F60.2, Disocial. Los delitos más frecuentes, que se asociaron a estos trastornos de personalidad fueron los relacionados con la vida, la integridad corporal, la seguridad social y contra el normal desarrollo de las relaciones sexuales, la infancia y la familia, destacándose entre los primeros el homicidio, el asesinato y las lesiones y entre los segundos el abuso lascivo, la violación y la corrupción de menores; lo que demuestra una alta incidencia de la violencia en el comportamiento de estos pacientes, influenciado en gran medida por su relación con el medio social, llevándonos a analizar y profundizar los cambios en las conclusiones médicas legales, sobre todo, en aspectos tan importantes como: la imputabilidad y el pronóstico social de los actos violentos