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OBJECTIVE | To investigate the efficacy of 6 weeks of daily low-dose oral prednisolone in improving pain , mobility , and systemic low-grade inflammation in the short term and whether the effect would be sustained at 12 weeks in older adults with moderate to severe knee osteoarthritis ( OA ) . | |
METHODS | A total of 125 patients with primary knee OA were randomized 1:1 ; 63 received 7.5 mg/day of prednisolone and 62 received placebo for 6 weeks . | |
METHODS | Outcome measures included pain reduction and improvement in function scores and systemic inflammation markers . | |
METHODS | Pain was assessed using the visual analog pain scale ( 0-100 mm ) . | |
METHODS | Secondary outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index scores , patient global assessment ( PGA ) of the severity of knee OA , and 6-min walk distance ( 6MWD ) . | |
METHODS | Serum levels of interleukin 1 ( IL-1 ) , IL-6 , tumor necrosis factor ( TNF ) - , and high-sensitivity C-reactive protein ( hsCRP ) were measured . | |
RESULTS | There was a clinically relevant reduction in the intervention group compared to the placebo group for knee pain , physical function , PGA , and 6MWD at 6 weeks . | |
RESULTS | The mean difference between treatment arms ( 95 % CI ) was 10.9 ( 4.8-18 .0 ) , p < 0.001 ; 9.5 ( 3.7-15 .4 ) , p < 0.05 ; 15.7 ( 5.3-26 .1 ) , p < 0.001 ; and 86.9 ( 29.8-144 .1 ) , p < 0.05 , respectively . | |
RESULTS | Further , there was a clinically relevant reduction in the serum levels of IL-1 , IL-6 , TNF - , and hsCRP at 6 weeks in the intervention group when compared to the placebo group . | |
RESULTS | These differences remained significant at 12 weeks . | |
RESULTS | The Outcome Measures in Rheumatology Clinical Trials-Osteoarthritis Research Society International responder rate was 65 % in the intervention group and 34 % in the placebo group ( p < 0.05 ) . | |
CONCLUSIONS | Low-dose oral prednisolone had both a short-term and a longer sustained effect resulting in less knee pain , better physical function , and attenuation of systemic inflammation in older patients with knee OA ( ClinicalTrials.gov identifier NCT01619163 ) . | |
BACKGROUND | Emotional eating is associated with overeating and the development of obesity . | |
BACKGROUND | Yet , empirical evidence for individual ( trait ) differences in emotional eating and cognitive mechanisms that contribute to eating during sad mood remain equivocal . | |
OBJECTIVE | The aim of this study was to test if attention bias for food moderates the effect of self-reported emotional eating during sad mood ( vs neutral mood ) on actual food intake . | |
OBJECTIVE | It was expected that emotional eating is predictive of elevated attention for food and higher food intake after an experimentally induced sad mood and that attentional maintenance on food predicts food intake during a sad versus a neutral mood . | |
METHODS | Participants ( N = 85 ) were randomly assigned to one of the two experimental mood induction conditions ( sad/neutral ) . | |
METHODS | Attentional biases for high caloric foods were measured by eye tracking during a visual probe task with pictorial food and neutral stimuli . | |
METHODS | Self-reported emotional eating was assessed with the Dutch Eating Behavior Questionnaire ( DEBQ ) and ad libitum food intake was tested by a disguised food offer . | |
RESULTS | Hierarchical multivariate regression modeling showed that self-reported emotional eating did not account for changes in attention allocation for food or food intake in either condition . | |
RESULTS | Yet , attention maintenance on food cues was significantly related to increased intake specifically in the neutral condition , but not in the sad mood condition . | |
CONCLUSIONS | The current findings show that self-reported emotional eating ( based on the DEBQ ) might not validly predict who overeats when sad , at least not in a laboratory setting with healthy women . | |
CONCLUSIONS | Results further suggest that attention maintenance on food relates to eating motivation when in a neutral affective state , and might therefore be a cognitive mechanism contributing to increased food intake in general , but maybe not during sad mood . | |
BACKGROUND | Although working smoke alarms halve deaths in residential fires , many households do not keep alarms operational . | |
BACKGROUND | We tested whether theory-based education increases alarm operability . | |
METHODS | Randomised multiarm trial , with a single arm randomly selected for use each day , in low-income neighbourhoods in Maryland , USA . | |
METHODS | Intervention arms : ( 1 ) Full Education combining a health belief module with a social-cognitive theory module that provided hands-on practice installing alarm batteries and using the alarm 's hush button ; ( 2 ) Hands-on Practice social-cognitive module supplemented by typical fire department education ; ( 3 ) Current Norm receiving typical fire department education only . | |
METHODS | Four hundred and thirty-six homes recruited through churches or by knocking on doors in 2005-2008 . | |
METHODS | Follow-up visits checked alarm operability in 370 homes ( 85 % ) 1-3 .5 years after installation . | |
METHODS | number of homes with working alarms defined as alarms with working batteries or hard-wired and number of working alarms per home . | |
METHODS | Regressions controlled for alarm status preintervention ; demographics and beliefs about fire risks and alarm effectiveness . | |
RESULTS | Homes in the Full Education and Practice arms were more likely to have a functioning smoke alarm at follow-up ( OR = 2.77 , 95 % CI 1.09 to 7.03 ) and had an average of 0.32 more working alarms per home ( 95 % CI 0.09 to 0.56 ) . | |
RESULTS | Working alarms per home rose 16 % . | |
RESULTS | Full Education and Practice had similar effectiveness ( p = 0.97 on both outcome measures ) . | |
CONCLUSIONS | Without exceeding typical fire department installation time , installers can achieve greater smoke alarm operability . | |
CONCLUSIONS | Hands-on practice is key . | |
CONCLUSIONS | Two years after installation , for every three homes that received hands-on practice , one had an additional working alarm . | |
BACKGROUND | http://www.clinicaltrials.gov number NCT00139126 . | |
OBJECTIVE | To evaluate the performance ( efficacy , safety and acceptability ) of a new micro-adherent absorbent dressing ( UrgoClean ) compared with a hydrofiber dressing ( Aquacel ) in the local management of venous leg ulcers , in the debridement stage . | |
METHODS | A non-inferiority European randomised controlled clinical trial ( RCT ) was conducted in 37 centres , on patients presenting with venous or predominantly venous , mixed aetiology leg ulcers at their sloughy stage ( with more than 70 % of the wound bed covered with slough at baseline ) . | |
METHODS | Patients were followed over a 6-week period and assessed weekly . | |
METHODS | The primary judgement criteria was the relative regression of the wound surface area after the 6-week treatment period . | |
METHODS | Secondary endpoints were the relative reduction of sloughy tissue and the percentage of patients presenting with a debrided wound . | |
RESULTS | Altogether , 159 patients were randomised to either UrgoClean ( test group ; n = 83 ) or Aquacel ( control group ; n = 76 ) dressings . | |
RESULTS | Regarding the wound healing process predictive factors ( wound area , duration , ABPI value , recurrence ) , at baseline , the two groups were well balanced , for both wound and patient characteristics . | |
RESULTS | Compression therapy was administered to both groups and after a median 42-day treatment period , the percentage of relative reduction of the wound surface area was very similar ( -36.9 % vs -35.4 % in the UrgoClean and control groups , respectively ) . | |
RESULTS | When considering the secondary criteria at week 6 , the relative reduction of sloughy tissue was significantly higher in the UrgoClean group than in the control group ( -65.3 % vs -42,6 % ; p = 0.013 ) . | |
RESULTS | The percentage of debrided wounds was also significantly higher in the test group ( 52.5 % vs 35.1 % ; p = 0.033 ) . | |
CONCLUSIONS | This ` EARTH ' RCT confirmed that the UrgoClean dressing has similar efficacy and safety compared to Aquacel . | |
CONCLUSIONS | However , UrgoClean also showed better autolytic properties than the control group in the management of venous leg ulcers at the sloughy stage . | |
CONCLUSIONS | The new UrgoClean dressing therefore represents a promising therapeutic option within the current range of autolytic dressings available . | |
BACKGROUND | This study was sponsored by a grant from the pharmaceutical company Laboratoires Urgo . | |
BACKGROUND | S. Bohbot and O. Tacca are employees of Laboratoires Urgo . | |
BACKGROUND | S. Meaume , J. Dissemond and G. Perceau have received monetary compensation as presenters for Laboratoires Urgo . | |
BACKGROUND | Data management and statistical analyses were conducted independently by Vertical ( Paris , France ) . | |
OBJECTIVE | Eye movements ( EM ) during recall of an aversive memory is a treatment element unique to Eye Movement Desensitization and Reprocessing ( EMDR ) . | |
OBJECTIVE | Experimental studies have shown that EM reduce memory vividness and/or emotionality shortly after the intervention . | |
OBJECTIVE | However , it is unclear whether the immediate effects of the intervention reflect actual changes in memory . | |
OBJECTIVE | The aim of this study was to test whether immediate reductions in memory vividness and emotionality persist at a 24h follow up and whether the magnitude of these effects is related to the duration of the intervention . | |
METHODS | Seventy-three undergraduates recalled two negative autobiographical memories , one with EM ( `` recall with EM '' ) and one without ( `` recall only '' ) . | |
METHODS | Half of participants recalled each memory for four periods of 24s , the other half for eight periods of 24s . | |
METHODS | Memory vividness/emotionality were self-rated at a pre-test , an immediate post-test , and a 24h follow-up test . | |
RESULTS | In both duration groups , recall with EM , but not recall only , caused an immediate decrease in memory vividness . | |
RESULTS | There were no immediate reductions in memory emotionality . | |
RESULTS | Furthermore , only the ` eight periods ' group showed that recall with EM , but not recall only , caused a decrease in both memory emotionality and memory vividness from the pre-test to the follow-up . | |
CONCLUSIONS | Only self-report measures were used . | |
CONCLUSIONS | The findings suggest that recall with EM causes 24-hchanges in memory vividness/emotionality , which may explain part of the EMDR treatment effect , and these effects are related to intervention duration . | |
OBJECTIVE | Few studies have tested the impact of motivational interviewing ( MI ) delivered by primary care providers on pediatric obesity . | |
OBJECTIVE | This study tested the efficacy of MI delivered by providers and registered dietitians ( RDs ) to parents of overweight children aged 2 through 8 . | |
METHODS | Forty-two practices from the Pediatric Research in Office Settings Network of the American Academy of Pediatrics were randomly assigned to 1 of 3 groups . | |
METHODS | Group 1 ( usual care ) measured BMI percentile at baseline and 1 - and 2-year follow-up . | |
METHODS | Group 2 ( provider only ) delivered 4 MI counseling sessions to parents of the index child over 2 years . | |
METHODS | Group 3 ( provider + RD ) delivered 4 provider MI sessions plus 6 MI sessions from a RD. . | |
METHODS | The primary outcome was child BMI percentile at 2-year follow up . | |
RESULTS | At 2-year follow-up , the adjusted BMI percentile was 90.3 , 88.1 , and 87.1 for groups 1 , 2 , and 3 , respectively . | |
RESULTS | The group 3 mean was significantly ( P = .02 ) lower than group 1 . | |
RESULTS | Mean changes from baseline in BMI percentile were 1.8 , 3.8 , and 4.9 across groups 1 , 2 , and 3 . | |
CONCLUSIONS | MI delivered by providers and RDs ( group 3 ) resulted in statistically significant reductions in BMI percentile . | |
CONCLUSIONS | Research is needed to determine the clinical significance and persistence of the BMI effects observed . | |
CONCLUSIONS | How the intervention can be brought to scale ( in particular , how to train physicians to use MI effectively and how best to train RDs and integrate them into primary care settings ) also merits future research . | |
BACKGROUND | Antithrombin ( AT ) concentrations are reduced after cardiac surgery with cardiopulmonary bypass compared with the preoperative levels . | |
BACKGROUND | Low postoperative AT is associated with worse short - and mid-term clinical outcomes . | |
BACKGROUND | The aim of the study is to evaluate the effects of AT administration on activation of the coagulation and fibrinolytic systems , platelet function , and the inflammatory response in patients with low postoperative AT levels . | |
METHODS | Sixty patients with postoperative AT levels of less than 65 % were randomly assigned to receive purified AT ( 5000 IU in three administrations ) or placebo in the postoperative intensive care unit . | |
METHODS | Thirty patients with postoperative AT levels greater than 65 % were observed as controls . | |
METHODS | Interleukin 6 ( a marker of inflammation ) , prothrombin fragment 1-2 ( a marker of thrombin generation ) , plasmin-antiplasmin complex ( a marker of fibrinolysis ) , and platelet factor 4 ( a marker of platelet activation ) were measured at six different times . | |
RESULTS | Compared with the no AT group and control patients , patients receiving AT showed significantly higher AT values until 48 hours after the last administration . | |
RESULTS | Analysis of variance for repeated measures showed a significant effect of study treatment in reducing prothrombin fragment 1-2 ( p = 0.009 ; interaction with time sample , p = 0.006 ) and plasmin-antiplasmin complex ( p < 0.001 ; interaction with time sample , p < 0.001 ) values but not interleukin 6 ( p = 0.877 ; interaction with time sample , p = 0.521 ) and platelet factor 4 ( p = 0.913 ; interaction with time sample , p = 0.543 ) . | |
RESULTS | No difference in chest tube drainage , reopening for bleeding , and blood transfusion was observed . | |
CONCLUSIONS | Antithrombin administration in patients with low AT activity after surgery with cardiopulmonary bypass reduces postoperative thrombin generation and fibrinolysis with no effects on platelet activation and inflammatory response . | |
OBJECTIVE | We evaluated patients at tertiary [ both percutaneous coronary intervention ( PCI ) and coronary artery bypass grafting ( CABG ) capable ] and primary hospitals in the EARLY-ACS trial . | |
BACKGROUND | Early invasive management is recommended for high-risk non-ST-segment elevation acute coronary syndromes . | |
METHODS | We evaluated outcomes in 9,204 patients presenting to : tertiary sites , primary sites with transfer to tertiary sites ( `` transferred '' ) and those who remained at primary sites ( `` non-transfer '' ) . | |
RESULTS | There were 348 tertiary ( n = 7,455 patients ) and 89 primary hospitals [ n = 1,749 patients ( 729 transferred ; 1,020 non-transfer ) ] . | |
RESULTS | Significant delays occurred in time from symptom onset to angiography ( 49 hr ) , PCI ( 53h ) , and CABG ( 178 hr ) for transferred patients ( P < 0.001 ) . | |
RESULTS | Non-transfer patients had less 30-day death/myocardial infarction [ 9.4 % vs. 11.7 % ( tertiary ) ; adjusted odds ratio ( OR ) : 0.78 ( 0.62-0 .97 ) , P = 0.026 ] ; transferred ( 14.0 % ) and tertiary patients were similar [ adjusted OR : 1.23 ( 0.98-1 .53 ) , P = 0.074 ] . | |
RESULTS | Non-transfer patients had lower 1-year mortality [ 4.3 % vs. 6.3 % ( tertiary ) ; adjusted hazard ratio ( HR ) : 0.64 ( 0.47-0 .87 ) , P = 0.005 ] : there was no difference between transferred and tertiary patients [ 5.2 % vs. 6.3 % ; adjusted HR : 0.80 ( 0.58-1 .12 ) , P = 0.202 ] . | |
RESULTS | Despite similar rates of catheterization , GUSTO severe/moderate bleeding within 120 hr was less in non-transfer [ 3.1 % vs. 6.7 % ( tertiary ) ; adjusted OR : 0.47 ( 0.32-0 .68 ) , P < 0.001 ] , whereas transferred ( 6.1 % ) and tertiary patients were similar [ adjusted OR : 0.94 ( 0.68-1 .30 ) , P = 0.693 ] . | |
RESULTS | There was no difference in non-CABG bleeding . | |
CONCLUSIONS | Timely angiography and revascularization were often not achieved in transferred patients . |