ANCA Status or Clinical Phenotype - What Counts More?

PURPOSE OF REVIEW: There is ongoing debate concerning the classification of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. That is, whether classification should be based on the serotype (proteinase 3 (PR3)- or myeloperoxidase (MPO)-ANCA) or on the clinical phenotype (granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA)). To add clarity, this review focused on integration of the most recent literature. RECENT FINDINGS: Large clinical trials have provided evidence that a serology-based risk assessment for relapses is more predictive than distinction based on the phenotype. Research conducted in the past decade indicated that a serology-based approach more closely resembles the genetic associations, the clinical presentation (i.e., lung involvement), biomarker biology, treatment response, and is also predicting comorbidities (such as cardiovascular death). Our review highlights that a serology-based approach could replace a phenotype-based approach to classify ANCA-associated vasculitides. In future, clinical trials and observational studies will presumably focus on this distinction and, as such, translate into a "personalized medicine."

Is loneliness associated with mild cognitive impairment in low- and middle-income countries?

BACKGROUND: Loneliness may be a risk factor for mild cognitive impairment but studies on this topic are scarce, particularly from low- and middle-income countries (LMICs). Therefore, the aim of the present study was to investigate the association between loneliness and mild cognitive impairment (MCI) in six LMICs (China, Ghana, India, Mexico, Russia and South Africa). METHODS: Cross-sectional, community-based, nationally representative data from the WHO Study on global AGEing and adult health (SAGE) were analyzed. The definition of MCI was based on the National Institute on Ageing-Alzheimer's Association criteria. Multivariable logistic regression analysis and meta-analysis were conducted to assess associations. RESULTS: The final analytical sample consisted of 19,092 and 13,623 individuals aged 50-64 years (middle-aged adults) and ≥65 years (older adults), respectively. Among the middle-aged, overall, loneliness was associated with a non-significant 1.43 (95% confidence interval [CI] = 0.93-2.21) times higher odds for MCI although significant associations were observed in China (OR = 1.51; 95%CI = 1.08-2.09) and South Africa (OR = 3.87; 95%CI = 1.72-8.71). As for older adults, overall, there was a significant association between loneliness and MCI (OR = 1.52; 95%CI = 1.12-2.07). CONCLUSION: In this large representative sample of middle-aged and older adults from multiple LMICs, findings suggest that loneliness is associated with MCI. It may be prudent to consider reducing loneliness in low-economic settings to aid in the prevention of MCI and ultimately dementia.

Using Infodemiology Metrics to Assess Public Interest in Liver Transplantation: Google Trends Analysis.

BACKGROUND: Liver transplantation (LT) is the only curative treatment for end-stage liver disease. Less than 10% of global transplantation needs are met worldwide, and the need for LT is still increasing. The death rates on the waiting list remain too high. OBJECTIVE: It is, therefore, critical to raise awareness among the public and health care providers and in turn increasingly acquire donors. METHODS: We performed a Google Trends search using the search terms liver transplantation and liver transplant on October 15, 2020. On the basis of the resulting monthly data, the annual average Google Trends indices were calculated for the years 2004 to 2018. We not only investigated the trend worldwide but also used data from the United Network for Organ Sharing (UNOS), Spain, and Eurotransplant. Using pairwise Spearman correlations, Google Trends indices were examined over time and compared with the total number of liver transplants retrieved from the respective official websites of UNOS, the Organización Nacional de Trasplantes, and Eurotransplant. RESULTS: From 2004 to 2018, there was a significant decrease in the worldwide Google Trends index from 78.2 in 2004 to 20.5 in 2018 (-71.2%). This trend was more evident in UNOS than in the Eurotransplant group. In the same period, the number of transplanted livers increased worldwide. The waiting list mortality rate was 31% for Eurotransplant and 29% for UNOS. However, in Spain, where there are excellent awareness programs, the Google Trends index remained stable over the years with comparable, increasing LT numbers but a significantly lower waiting list mortality (15%). CONCLUSIONS: Public awareness in LT has decreased significantly over the past two decades. Therefore, novel awareness programs should be initialized.

National work-family policies: Multilevel effects on employee reactions to work/family conflict.

BACKGROUND: Despite considerable differences in national work-family (WF) policies offered in countries around the world, research concerning the implications of such policies for employee reactions to work-family and family-work conflict (WFC/FWC) is limited. OBJECTIVE: The current study examines the contextual role of country-level national WF policies as a moderator of the relationships between individual-level WFC/FWC and job stress, job satisfaction, turnover intentions, organizational commitment, and general health. METHODS: Using archival data sources, the ISSP Work Orientations Survey (2015) and the WORLD Policy Analysis Center Adults Labor Database (2014), multilevel analyses tested the predicted cross-level interaction effect in a sample of 49,637 individuals (54% female; Mage = 48 years) nested across 36 countries. RESULTS: Results were largely counter to expectations: while more supportive national WF policies attenuated the positive relationship between FWC and job stress, it exacerbated the negative relationships between WFC and organizational commitment, WFC and job stress, and FWC and general health. CONCLUSIONS: Our study responds to calls to consider phenomena functioning at multiple levels of analysis. While reactions were more negative in countries with more robust national-level policies, it suggests an unexpected dark side of such policies. That is, it may not be enough to legislate the availability of national-level policies; it may also be needed to ensure that such policies are meeting employees' needs.

In Whom Do We Trust? A Multifoci Person-Centered Perspective on Institutional Trust during COVID-19.

Institutional trust plays a crucial role when a nation is facing mega crises (e.g., the COVID-19 pandemic) and has implications for employee work experiences and well-being. To date, researchers largely consider how institutional trust or trust in government may predict variables of interest in isolation. However, this variable-centered perspective ignores the possibility that there are subpopulations of employees who may differ in their trust in different institutions (i.e., the state government, the federal government). To address this, we examined institutional trust with two foci (i.e., trust in state government and trust in federal government) from a person-centered perspective. Using latent profile analysis and data from 492 U.S.-based employees, we identified five trust profiles: high trustors, federal trustors, state trustors, the ambivalent, and distrusters, and found that these profiles differentially predicted attitudes towards and behavioral compliance with CDC recommended COVID-19 prevention practices, job insecurity, affective commitment, helping behavior, and psychological well-being.

Work and Non-Work Sickness Presenteeism: The Role of Workplace COVID-19 Climate.

OBJECTIVE: To test the role of workplace coronavirus disease (COVID-19) climate in shaping employee attitudes toward the CDC prevention guidelines and subsequent levels of work and non-work sickness presenteeism. METHODS: Three waves of anonymous survey data were collected in October and December 2020 and February 2021. Participants were 304 employed adults in the U.S., of whom half were working onsite. RESULTS: Time 1 workplace COVID-19 climate was positively associated with Time 2 employee attitudes toward the CDC prevention guidelines, which in turn predicted Time 3 levels of non-work and work sickness presenteeism. CONCLUSIONS: The workplace can shape employee attitudes toward the CDC COVID-19 prevention guidelines and their work and non-work sickness presenteeism, thus highlighting the important role companies have in reducing community spread of the novel coronavirus in work and non-work settings.