Mediators and moderators of change in mindfulness-based stress reduction for painful diabetic peripheral neuropathy.

Painful diabetic peripheral neuropathy (PDPN) is a chronic pain condition with modest response to pharmacotherapy. Participation in mindfulness-based stress reduction (MBSR) leads to improvements in pain-related outcomes but the mechanisms of change are unknown. The present study examined the mediators and moderators of change in 62 patients with PDPN who participated in a randomized controlled trial comparing MBSR to waitlist. Changes in mindfulness and pain catastrophizing were tested simultaneously as mediators. Increased mindfulness mediated the association between participation in MBSR and improved pain severity, pain interference, and the physical component of health-related quality of life (HRQoL) 3 months later. The mediation effect of pain catastrophizing was not significant. Linear moderated trends were also found. Post-hoc moderated mediation analyses suggested that MBSR patients with longer histories of diabetes might increase their mindfulness levels more, which in turn leads to improved pain severity and physical HRQoL. These results allow for a deeper understanding of pathways by which MBSR benefits patients with PDPN.

Novel Picornavirus in Lambs with Severe Encephalomyelitis.

Using metagenomic analysis, we identified a novel picornavirus in young preweaned lambs with neurologic signs associated with severe nonsuppurative encephalitis and sensory ganglionitis in 2016 and 2017 in the United Kingdom. In situ hybridization demonstrated intralesional neuronotropism of this virus, which was also detected in archived samples of similarly affected lambs (1998-2014).

Managing diabetes in people with dementia.

Diabetes and dementia may manifest simultaneously: one is potentially life threatening, the other causes severe, progressive loss of memory and cognitive function. Where they coexist, they present nurses with challenges such as administering life-saving interventions to patients who are unable to give informed consent. This article offers guidance on the clinical and ethical challenges involved in blood glucose monitoring and medicines administration in patients with dementia.

Haemonchus contortus: an overview.

This focus article was prepared by Amanda Carson, Rudolf Reichel, Suzie Bell, Rachael Collins and Jasmine Smith of the APHA Small Ruminant Species Expert Group, and Dave Bartley from the Moredun Research Institute.

Personality disorders in hypochondriasis: prevalence and comparison with two anxiety disorders.

OBJECTIVE: Symptoms of hypochondriasis are sometimes attributed to personality psychopathology by health care providers. The goals of this study were to assess the prevalence of personality disorder (PD) comorbidity in hypochondriasis (HYP) and to compare the PD comorbidity profile of patients with HYP with that found among patients with other disorders characterized by intrusive thoughts and fears. METHODS: Structured Clinical Interview for DSM-IV Axis I and Axis II Disorders (SCID-I and SCID-II) were administered to 179 individuals: 62 with HYP, 46 with obsessive-compulsive disorder (OCD), and 71 with social anxiety disorder (SAD). For group contrasts, the samples were "purified" of the comparison comorbid disorders. General linear models were used to test the combined effect of group (HYP, OCD, SAD), age, and gender on the PD outcome variables. RESULTS: 59.7% of HYP subjects had no Axis II comorbidity. The most common PDs in HYP were paranoid (19.4%), avoidant (17.7%), and obsessive-compulsive (14.5%). HYP significantly differed from SAD in the likelihood of a cluster C disorder, whereas no significant difference was noted for HYP vs. OCD. The proportion of subjects having at least two PDs was not significantly different for HYP vs. OCD or for HYP vs. SAD. CONCLUSION: Although 40% of patients with hypochondriasis have PD comorbidity as assessed by the SCID-II, the amount of PD comorbidity is not significantly different than found among individuals with two comparison anxiety disorders. Therefore, health providers should be aware that PD may complicate the clinical profile of HYP, but they should avoid assuming that PD psychopathology is the primary source of hypochondriacal distress.

Watery mouth disease in lambs.

This focus article has prepared by Rachael Collins and Amanda Carson of the APHA Small Ruminant Expert Group.

Managing liver fluke on hill farms.

This focus article has been prepared by Amanda Carson and Bryony Jones of the APHA Small Ruminant Expert Group and Dai Grove-White of the University of Liverpool.

APHA thin ewe investigation project.

This focus article has been prepared by Suzi Bell, Amanda Carson, Rachael Collins, Lizzy Dunnett, Rudolf Reichel and Moyna Richey of the APHA Small Ruminant Expert Group.

Survey to determine the farm-level impact of Schmallenberg virus during the 2016-2017 United Kingdom lambing season.

Schmallenberg virus (SBV) causes abortions, stillbirths and fetal malformations in naïve ruminants. The impact of the initial outbreak (2011/2012) on British sheep farms has been previously investigated, with higher farmer perceived impacts and increased lamb and ewe mortality reported on SBV-affected farms. After several years of low, or no, circulation the UK sheep flock once again became vulnerable to SBV infection. Re-emergence was confirmed in autumn 2016. This study reports the analysis of a questionnaire designed to determine the farm-level impact of SBV on the 2016/2017 UK lambing period. Higher neonatal lamb mortality, dystocia and associated ewe deaths, and higher perceived impacts on sheep welfare, flock financial performance and farmer emotional wellness were reported on SBV confirmed (n=59) and SBV suspected (n=82), than SBV not suspected (n=74) farms. Additionally, although few farmers (20.4 per cent) reported previously vaccinating against SBV, the majority (78.3 per cent) stated they would vaccinate if purchasing at less than £1 per dose. These results are largely comparable to the findings reported for the 2011/2012 outbreak, highlighting the ongoing impact of SBV on sheep farms. If SBV continues to re-emerge cyclically, the economic and animal welfare costs to the UK sheep farming industry will continue.

COPING IN YOUNG PEOPLE WITH CHRONIC KIDNEY DISEASE (CKD).

BACKGROUND: Chronic kidney disease (CKD) is an irreversible disease with physiological, psychological and psychosocial challenges, especially for young people. OBJECTIVES: The objective of this phenomenological study was to identify coping strategies in two groups of young people aged 12-18 years. In one group, the young people were healthy and in the other group, the young people had stage 4-5 CKD. DESIGN: Young people with CKD (stages 4-5) (n = 7) (mean age = 11.5 yrs.) and young healthy people (n = 7) (mean age = 14 yrs.) were recruited from a Children's Hospital and Youth Club respectively, and were invited to take part in one face-to-face, semi-structured interview. FINDINGS: Data analysis showed 11 different coping themes. CONCLUSION: It can be concluded from the interviews that young healthy people and those with CKD alike, utilise a range of coping strategies. The themes derived can prompt researchers to potentially develop a coping measure for a young CKD population. However, a longitudinal study would help to recognise coping strategies young people adopt over time and provide a pathway for the development of a formal coping framework.

Chronic Pain in the Emergency Department: A Pilot Mixed-Methods Cross-Sectional Study Examining Patient Characteristics and Reasons for Presentations.

Background. Chronic pain (CP) accounts for 10-16% of emergency department (ED) visits, contributing to ED overcrowding and leading to adverse events. Objectives. To describe patients with CP attending the ED and identify factors contributing to their visit. Methods. We used a mixed-method design combining interviews and questionnaires addressing pain, psychological distress, signs of opioid misuse, and disability. Participants were adults who attended the EDs of a large academic tertiary care center for their CP problem. Results. Fifty-eight patients (66% women; mean age 46.5, SD = 16.9) completed the study. The most frequently cited reason (60%) for ED visits was inability to cope with pain. Mental health problems were common, including depression (61%) and anxiety (45%). Participants had questions about the etiology of their pain, concerns about severe pain-related impairment, and problems with medication renewals or efficacy and sometimes felt invalidated in the ED. Although most participants had a primary care physician, the ED was seen as the only or best option when pain became unmanageable. Conclusions. Patients with CP visiting the ED often present with complex difficulties that cannot be addressed in the ED. Better access to interdisciplinary pain treatment is needed to reduce the burden of CP on the ED.

Genetic distinctiveness of the Herdwick sheep breed and two other locally adapted hill breeds of the UK.

There is considerable interest in locally adapted breeds of livestock as reservoirs of genetic diversity that may provide important fitness traits for future use in agriculture. In marginal areas, these animals contribute to food security and extract value from land unsuitable for other systems of farming. In England, close to 50% of the national sheep flock is farmed on grassland designated as disadvantaged areas for agricultural production. Many of these areas are in the uplands, where some native breeds of sheep continue to be commercially farmed only in highly localised geographical regions to which they are adapted. This study focuses on three of these breeds, selected for their adaptation to near identical environments and their geographical concentration in regions close to one another. Our objective has been to use retrotyping, microsatellites and single nucleotide polymorphisms to explore the origins of the breeds and whether, despite their similar adaptations and proximity, they are genetically distinctive. We find the three breeds each have a surprisingly different pattern of retrovirus insertions into their genomes compared with one another and with other UK breeds. Uniquely, there is a high incidence of the R0 retrotype in the Herdwick population, characteristic of a primitive genome found previously in very few breeds worldwide and none in the UK mainland. The Herdwick and Rough Fells carry two rare retroviral insertion events, common only in Texels, suggesting sheep populations in the northern uplands have a historical association with the original pin-tail sheep of Texel Island. Microsatellite data and analyses of SNPs associated with RXFP2 (horn traits) and PRLR (reproductive performance traits) also distinguished the three breeds. Significantly, an SNP linked to TMEM154, a locus controlling susceptibility to infection by Maedi-Visna, indicated that all three native hill breeds have a lower than average risk of infection to the lentivirus.

How young people cope with chronic kidney disease: literature review.

BACKGROUND: Chronic kidney disease (CKD) is a complex, long-term condition occurring in all age groups. It has been reported that the incidence of renal replacement therapy in young people is 7-8 per million population. Notwithstanding those individuals who may receive a donor kidney, many individuals may be disenfranchised by perceptions of helplessness and feelings of powerlessness against a backdrop of diminished health outlook, consequently impacting on capacity for effective coping. AIM: The aim of this review is to explore how young people cope with CKD. METHODS: Three hundred and thirty-seven abstracts were identified. Sixty-three papers were cross-examined using a Critical Appraisal Skills Checklist Tool. RESULTS: Young people face various demands; these may be episodic or ongoing, depending on health and circumstance. The themes this review uncovers are: 'Lack of a Coping Definition'; 'Coping Strategies in Young People'; and 'Barriers to the Understanding of Coping in Young People'. CONCLUSION: More qualitative research is vital to retrieve 'real-life' perceptions from young people coping with kidney disease to identify how care should be made more explicit for them.

Understanding and assessing the impact of end-stage renal disease on quality of life: a systematic review of the content validity of self-administered instruments used to assess health-related quality of life in end-stage renal disease.

Advances in healthcare, combined with an increasing number of adults with end-stage renal disease (ESRD), mean that there is a growing number of people now surviving on renal replacement therapy. The issue of health-related quality of life (HR-QOL) is becoming increasingly important in this area. For this reason, the content validity of various instruments used to measure HR-QOL in an ESRD population were explored. Systematic searches of MEDLINE (1950-2009) were conducted using terms related to ESRD combined with terms associated with measuring HR-QOL. A total of 378 abstracts were identified, detailing the repeated use of six generic measures and four disease-specific measures. The generic HR-QOL measures discussed include the Medical Outcomes 36-Item Short Form Survey (SF-36), the EuroQOL 5 Dimension (EQ-5D), and the WHO QOL assessment (WHOQOL-BREF). The most frequently used disease-specific measure discussed is the Kidney Disease QOL instrument (KDQOL) and its derivative versions (KDQOL-SF, KDQOL-36). The appropriateness of using the SF-36 in this population is challenged and recommendations include using the WHOQOL-BREF in cases when a generic instrument is required and the KDQOL-SF when a more disease-specific measurement is called for.