DAS-28-based EULAR response and HAQ improvement in rheumatoid arthritis patients switching between TNF antagonists

INTRODUCTION No definitive data are available regarding the value of switching to an alternative TNF antagonist in rheumatoid arthritis patients who fail to respond to the first one. The aim of this study was to evaluate treatment response in a clinical setting based on HAQ improvement and EULAR response criteria in RA patients who were switched to a second or a third TNF antagonist due to failure with the first one. METHODS This was an observational, prospective study of a cohort of 417 RA patients treated with TNF antagonists in three university hospitals in Spain between January 1999 and December 2005. A database was created at the participating centres, with well-defined operational instructions. The main outcome variables were analyzed using parametric or non-parametric tests depending on the level of measurement and distribution of each variable. RESULTS Mean (+/- SD) DAS-28 on starting the first, second and third TNF antagonist was 5.9 (+/- 2.0), 5.1 (+/- 1.5) and 6.1 (+/- 1.1). At the end of follow-up, it decreased to 3.3 (+/- 1.6; Delta = -2.6; p > 0.0001), 4.2 (+/- 1.5; Delta = -1.1; p = 0.0001) and 5.4 (+/- 1.7; Delta = -0.7; p = 0.06). For the first TNF antagonist, DAS-28-based EULAR response level was good in 42% and moderate in 33% of patients. The second TNF antagonist yielded a good response in 20% and no response in 53% of patients, while the third one yielded a good response in 28% and no response in 72%. Mean baseline HAQ on starting the first, second and third TNF antagonist was 1.61, 1.52 and 1.87, respectively. At the end of follow-up, it decreased to 1.12 (Delta = -0.49; p < 0.0001), 1.31 (Delta = -0.21, p = 0.004) and 1.75 (Delta = -0.12; p = 0.1), respectively. Sixty four percent of patients had a clinically important improvement in HAQ (defined as > or = -0.22) with the first TNF antagonist and 46% with the second. CONCLUSION A clinically significant effect size was seen in less than half of RA patients cycling to a second TNF antagonist.

Prevalence and Clinical Features of Isolated Clinical Hypertension and Dipping Profile in a Large Cohort of Untreated Hypertensive Subjects

Aim: To examine the prevalence and clinical features of isolated clinical hypertension (ICH) and the dipping patterns in a large cohort of untreated hypertensive subjects form the Spanish ABPM registry

Compliance with dietary and nutrient recommendations in the European Prospective Investigation into Cancer and Nutrition (EPIC)-Granada cohort at recruitment

BACKGROUND: The overall intake of energy and nutrients in the Granada EPIC-cohort (European Prospective Investigation into Cancer and Nutrition) is examined in order to assess compliance with the Spanish Nutritional Objectives (NO) and the Recommended Intakes (RI). METHODS: During recruitment (1992-1996), 7,789 participants, aged 35-69, were asked about diet through a validated diet history questionnaire. Nutrient intake is compared to the NO and RI that were valid at that time. Risk of inadequate intake is estimated as the percentage of the sample with intakes: ≤ 1/3 RI (high risk), ≤ 2/3 RI- > 1/3 RI (moderate risk), ≤ RI- > 2/3 RI, > RI. Differences in intakes have been analyzed by sex and age, and by smoking status and BMI. RESULTS: The daily intake of nutrients did not meet the NO as the total contribution of energy from proteins and fats exceeded these guidelines. Whilst intake of most nutrients was above the RI, the amount of iron, magnesium and vitamins D and E provided by the diet was not enough to meet the RI: in women aged 20-49 years, about 55% were at moderate risk for iron inadequacy, and a 20% of women for magnesium. Both sexes were at high risk of inadequacy for vitamin D, although sunlight exposure may supply adequate amounts. Never smokers showed a higher compliance to the NO. CONCLUSION: At recruitment, the nutrient profile of the diet was unbalanced. The observed nutrient inadequacy for iron, magnesium and vitamin E might be attributed to inappropriate dietary habits, and may have implications for future disease risk.

The interactional space in CLIL (Content and Language Integrated Learning) and EFL (English as a Foreign Language) classrooms

Aquest estudi pretén investigar els intercanvis verbals mestre/a – aprenent(s) en dos contextos d'instrucció diferents: classes amb un enfocament AICLE (Aprenentatge Integrat de Continguts Curriculars i Llengua Estrangera) on s’aprenen continguts no lingüístics a través de l’anglès, per una banda, i classes 'tradicionals' d'anglès com a llengua estrangera, on l’anglès és alhora objecte d’estudi i vehicle de comunicació, per una altra banda. Més concretament, les preguntes que formula el/la mestre/a, la producció oral dels aprenents i el 'feedback' del/de la mestre/a en els episodis d’atenció a la forma s’han estudiat a la llum de les principals teories provinents del camp de l’Adquisició de Segones Llengües (SLA) per tal de demostrar el seu paper en l’aprenentatge de l’anglès. El corpus de dades prové de l’enregistrament de 7 sessions AICLE i d'11 sessions EFL enregistrades en format àudio i vídeo en dos centres públics d’Educació Primària (EP) de Catalunya. A cadascuna de les escoles, el/la mateix/a mestre/a és l’encarregat/da dels dos tipus d’instrucció amb el mateix grup d’aprenents (10-11 anys d’edat), fet que permet eliminar variables individuals com l'aptitud dels aprenents o l'estil del/de la mestre/a.Els resultats mostren un cert nombre de similituds discursives entre AICLE i EFL donat que ambdós enfocaments tenen lloc en el context-classe amb unes característiques ben definides. Tal com apunta la recerca realitzada en aquest camp, la instrucció AICLE reuneix un seguit de condicions idònies per un major desenvolupament dels nivells de llengua anglesa més enllà de les classes ‘tradicionals’ d’anglès. Malgrat això, aquest estudi sembla indicar que el potencial d'AICLE pel que fa a facilitar una exposició rica a l’anglès i una producció oral significativa no s’explota degudament. En aquest sentit, els resultats d’aquest estudi poden contribuir a la formació dels futurs professors d'AICLE si es busca l’assoliment d’una complementarietat d’ambdós contextos amb l’objectiu últim de millorar els nivells de domini de la llengua anglesa.

Physical activity and energy expenditure in haemodialysis patients: an international survey.

BACKGROUND: The assessment of physical activity and energy expenditure is relevant to the care of maintenance haemodialysis (MHD) patients. In the current study, we aimed to evaluate measurements of physical activity and energy expenditure in MHD patients from different centres and countries and explored the predictors of physical activity in these patients.¦METHODS: In this cross-sectional multicentre study, 134 MHD patients from four countries (France, Switzerland, Sweden and Brazil) were included. The physical activity was evaluated for 5.0 ± 1.4 days (mean ± SD) by a multisensory device (SenseWear Armband) and comprised the assessment of number of steps per day, activity-related energy expenditure (activity-related EE) and physical activity level (PAL).¦RESULTS: The number of steps per day, activity-related EE and PAL from the MHD patients were compatible with a sedentary lifestyle. In addition, all parameters were significantly lower in dialysis days when compared to non-dialysis days (P < 0.001). The multivariate regression analysis revealed that diabetes and higher body mass index (BMI) predicted a lower PAL and older age and diabetes predicted a reduced number of steps.¦CONCLUSIONS: The physical activity parameters of MHD patients were compatible with a sedentary lifestyle. This inactivity was worsened by aging, diabetes and higher BMI. Our results indicate that MHD patients should be encouraged by the health care team to increase their physical activity.

"We do have space in Lausanne. We have a large cemetery": The non-controversy of a non-existent Muslim burial ground

In the context of the administration of spaces assigned by municipalities for the burial of the dead, this article provides a critical analysis of the techniques for the governance of political collectives of citizens implemented by public authorities. More broadly, this article shows how funerary practices (i.e. the social practices surrounding death-the rituals, the legislation, etc.) can be used to develop a critical reading of the social relations that structure the social production of space. To this end, the authors use the conceptual tools provided by critical legal geography to explore the controversy surrounding the development of a 'carré confessionnel' (denominational area) within the Bois-de-Vaux Cemetery in Lausanne, Switzerland. Here, a focus on the techniques that allow 'nomosphere' technicians to convene a subset of the citizens within the public space reveals the administration of cemeteries as a means of governance, a method for mobilising bodies and a paradoxical means of managing flux.

A combination of ascorbic acid and α-tocopherol to test the effectiveness and safety in the fragile X syndrome: study protocol for a phase II, randomized, placebo-controlled trial.

BACKGROUND Fragile X syndrome (FXS) is an inherited neurodevelopmental condition characterised by behavioural, learning disabilities, physical and neurological symptoms. In addition, an important degree of comorbidity with autism is also present. Considered a rare disorder affecting both genders, it first becomes apparent during childhood with displays of language delay and behavioural symptoms.Main aim: To show whether the combination of 10 mg/kg/day of ascorbic acid (vitamin C) and 10 mg/kg/day of α-tocopherol (vitamin E) reduces FXS symptoms among male patients ages 6 to 18 years compared to placebo treatment, as measured on the standardized rating scales at baseline, and after 12 and 24 weeks of treatment.Secondary aims: To assess the safety of the treatment. To describe behavioural and cognitive changes revealed by the Developmental Behaviour Checklist Short Form (DBC-P24) and the Wechsler Intelligence Scale for Children-Revised. To describe metabolic changes revealed by blood analysis. To measure treatment impact at home and in an academic environment. METHODS/DESIGN A phase II randomized, double-blind pilot clinical trial. SCOPE male children and adolescents diagnosed with FXS, in accordance with a standardized molecular biology test, who met all the inclusion criteria and none of the exclusion criteria. INSTRUMENTATION clinical data, blood analysis, Wechsler Intelligence Scale for Children-Revised, Conners parent and teacher rating scale scores and the DBC-P24 results will be obtained at the baseline (t0). Follow up examinations will take place at 12 weeks (t1) and 24 weeks (t2) of treatment. DISCUSSION A limited number of clinical trials have been carried out on children with FXS, but more are necessary as current treatment possibilities are insufficient and often provoke side effects. In the present study, we sought to overcome possible methodological problems by conducting a phase II pilot study in order to calculate the relevant statistical parameters and determine the safety of the proposed treatment. The results will provide evidence to improve hyperactivity control and reduce behavioural and learning problems using ascorbic acid (vitamin C) and α-tocopherol (vitamin E). The study protocol was approved by the Regional Government Committee for Clinical Trials in Andalusia and the Spanish agency for drugs and health products. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01329770 (29 March 2011).

Space for thought: Representation of body boundaries and intellectual efficiency in children

Aim: The psychoanalytic theories of Bion, Anzieu, Berger and Gibello postulate that the development of thinking depends upon the formation of a psychic space. This thinking space has its origin in the body and in our interpersonal relations. This study aims to validate this psychodynamic hypothesis. Method: A group of 8- to 14-year-old children participated in this research. The presence of a thinking space was operationalized by the "barrier" and "penetration" scores on the Rorschach's Fisher and Cleveland scales and intellectual efficiency was measured using a short version of the WISC-IV. Results: Results show that extreme scores on the "barrier" and "penetration" variables predict a lower intellectual level than average scores on the same variables. Conclusion: The development of thinking and personality are undoubtedly linked and the "barrier" and "penetration" variables are useful measures when evaluating the development of a space for thought.

The European Board of Physical and Rehabilitation Medicine : the past, the present and the future [Europejska Rada Medycyny Fizykalnej i Rehabilitacji: przeszłość, teraźniejszość i perspektywy]

Right from the beginning of the development of the medical specialty of Physical and Rehabilitation Medicine (PRM) the harmonization of the fields of competence and the specialist training across Europe was always an important issue. The initially informal European collaboration was formalized in 1963 under the umbrella of the European Federation of PRM. The European Academy of PRM and the UEMS section of PRM started to contribute in 1969 and 1974 respectively. In 1991 the European Board of Physical and Rehabilitation Medicine (EBPRM) was founded with the specific task of harmonizing education and training in PRM in Europe. The EBPRM has progressively defined curricula for the teaching of medical students and for the postgraduate education and training of PRM specialists. It also created a harmonized European certification system for medical PRM specialists, PRM trainers and PRM training sites. European teaching initiatives for PRM trainees (European PRM Schools) were promoted and learning material for PRM trainees and PRM specialists (e-learning, books and e-books, etc.) was created. For the future the Board will have to ensure that a minimal specific undergraduate curriculum on PRM based on a detailed European catalogue of learning objectives will be taught in all medical schools in Europe as a basis for the general medical practice. To stimulate the harmonization of national curricula, the existing postgraduate curriculum will be expanded by a syllabus of competencies related to PRM and a catalogue of learning objectives to be reached by all European PRM trainees. The integration of the certifying examination of the PRM Board into the national assessment procedures for PRM specialists will also have to be promoted.

Genetic differentiation of disjunct populations of the ants Formicaaquilonia and Formica lugubris in Europe.

The species Formica aquilonia and F. lugubris of the mound-building red wood ants have a disjunct boreoalpine distribution in Europe. The populations of F. aquilonia in Finland, Switzerland and the British Isles show little genetic differentiation, whereas the populations of F. lugubris show considerable differentiation. The Central European populations morphologically identified as F. lugubris can be genetically divided into two groups (here called types A and B). Type B is found in the Alps and the Jura mountains, and is genetically inseparable from F. aquilonia. Type A lives sympatrically with type B in the Jura mountains and is also found in the British Isles. Sympatry of the two types in the Jura shows that these are separate species. It remains open whether type B is morphologically atypical F. aquilonia or whether it is a separate species, perhaps with a past history of introgression between F. aquilonia and F. lugubris. The gene frequencies in the Finnish populations of F. lugubris differ from those of both types A and B. Genetic differences within F. lugubris indicate that the populations have evolved separately for a long time. The social structure of F. lugubris colonies also shows geographic variation. The nests in Finland and the British Isles seem to be mainly monogynous and monodomous, whereas the nests in Central Europe are polygynous and form polydomous colonies. F. aquilonia has polygynous and polydomous colonies in all populations studied.

Association of smoking and nicotine dependence with pre-diabetes in young and healthy adults.

INTRODUCTION: Several studies have shown an increased risk of type 2 diabetes among smokers. Therefore, the aim of this analysis was to assess the relationship between smoking, cumulative smoking exposure and nicotine dependence with pre-diabetes. METHODS: We performed a cross-sectional analysis of healthy adults aged 25-41 in the Principality of Liechtenstein. Individuals with known diabetes, Body Mass Index (BMI) >35 kg/m² and prevalent cardiovascular disease were excluded. Smoking behaviour was assessed by self-report. Pre-diabetes was defined as glycosylated haemoglobin between 5.7% and 6.4%. Multivariable logistic regression models were done. RESULTS: Of the 2142 participants (median age 37 years), 499 (23.3%) had pre-diabetes. There were 1,168 (55%) never smokers, 503 (23%) past smokers and 471 (22%) current smokers, with a prevalence of pre-diabetes of 21.2%, 20.9% and 31.2%, respectively (p <0.0001). In multivariable regression models, current smokers had an odds ratio (OR) of pre-diabetes of 1.82 (95% confidential interval (CI) 1.39; 2.38, p <0.0001). Individuals with a smoking exposure of <5, 5-10 and >10 pack-years had an OR (95% CI) for pre-diabetes of 1.34 (0.90; 2.00), 1.80 (1.07; 3.01) and 2.51 (1.80; 3.59) (p linear trend <0.0001) compared with never smokers. A Fagerström score of 2, 3-5 and >5 among current smokers was associated with an OR (95% CI) for pre-diabetes of 1.27 (0.89; 1.82), 2.15 (1.48; 3.13) and 3.35 (1.73; 6.48) (p linear trend <0.0001). DISCUSSION: Smoking is strongly associated with pre-diabetes in young adults with a low burden of smoking exposure. Nicotine dependence could be a potential mechanism of this relationship.