1,720,976 research outputs found
Parental and offspring bone mass: associations and mechanisms
No full textIntroduction: Although there is evidence that measures of bone size, mineralisation and density are partly inherited, there are scant data available from which to elucidate independent associations of mother and father, and the mechanisms underlying any relationships. The aim of this work was to characterise the independent bone relationships between mother-child and father-child, as differences between the two may point towards an intrauterine effect in early life. As the placenta is the conduit for all maternal intrauterine effects, the role of placental size in offspring bone mass was also explored. Methods: Using two large prospective population-based cohorts, The Southampton Women’s Survey (SWS) and The Avon Longitudinal Study of Parents and Children (ALSPAC), relationships between offspring bone mass at birth through to 17.7 years, and placental size were assessed. Bone mass measurements were obtained using dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT); placental measurements were either obtained in mid-pregnancy (SWS) using ultrasound or at delivery (ALSPAC). Subsequently, correlation and regression methods were used to assess the relationships between DXA and pQCT-derived measurements of parental and offspring bone indices. Results: Parent and offspring bone mass were positively associated, with a greater magnitude of relationship observed for measures of bone size, than bone density. Parent-child bone associations were significantly stronger for mother-child than father-child for several variables, again predominantly those associated with bone size. Placental volume was positively associated with offspring bone mass at birth, with associations remaining during puberty into late childhood. These parent-child relationships were not influenced by placental size or other environmental factors previously shown to affect offspring bone mass. Conclusions: We observed strong relationships between offspring bone mass and both placental size and parental size. Mother-child bone associations were stronger than those for father-child, and were independent of placental size. Whilst direct genetic inheritance offers one mechanistic explanation, increasing understanding of epigenetic mechanisms and the disparity between maternal and paternal associations suggest that such relationships could be in part underpinned by gene-environment interactions in early life, and an effect on placental function.<br/
Epidemiology of osteoporosis
No full textOsteoporosis is a skeletal disorder characterized by low bone mass and micro-architectural deterioration of bone tissue with a consequent increase in the fragility of bone and hence susceptibility to fracture.1 Historically, the term ‘osteoporosis’ first entered medial terminology in France and Germany in the nineteenth century, as a descriptive term emphasizing the porosity of the histological appearances of aged human bone. Prior to this, however, work published by Sir Astley Cooper suggested that certain types of fracture may occur due to age-related reduction in bone mass or quality.2 He described the original classical epidemiological hallmarks of these fractures: incidence rates that increase with age; rates which are higher among women than men; and fractures which are associated with only moderate trauma at sites containing large amounts of trabecular bone. These features are typified by fractures of the proximal femur, distal radius and vertebra, but fractures at other sites – such as the pelvis, proximal humerus, and proximal tibia – show similar patterns. These fractures are the serious and important outcomes of the condition and lead to severe mortality and morbidity, a significant burden on society in general, and a huge economic impact.3 Osteoporotic fractures alone cost the United States around $17.9 billion per annum, and the United Kingdom around £1.7 billion (Table 1).4Table 1
Vitamin D and the postmenopausal population
No full textVitamin D, a hormone critical to the body's maintenance of serum calcium and phosphorus concentrations, is currently the subject of much scientific interest. Low levels of vitamin D have been observed in many populations and epidemiological studies have suggested a link between this biochemical state and a range of diseases, such as cancer, diabetes and multiple sclerosis. While the consequence of vitamin D deficiency is well documented for bone (rickets and osteomalacia), with mixed findings relating to falls and fractures, a causal link between vitamin D deficiency and these wider health outcomes has not been established. If these relationships were found to be causal, the morbidity and mortality resulting from low levels of vitamin D could be substantial; the current evidence base, however, most robustly supports the assessment of serum 25(OH)-vitamin D in the context of specific symptoms, low bone mineral density or biochemical abnormalities, rather than as an entity to treat in its own right or as the basis for a population-wide screening programme.<br/
Supplementary file for the article 'Parent-offspring associations in body composition: Findings from the Southampton Women’s Survey prospective cohort study'
No full textSupplementary Figures to accompany the manuscript Parent-offspring associations in body composition: Findings from the Southampton Women’s Survey prospective cohort study by Moon RJ, D'Angelo S, Holroyd CR, Crozier SR, Godfrey KM, Davies JH, Cooper C and Harvey NC</span
Lupus, vaccinations and COVID-19: what we know now
No full textSevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus causing Coronavirus disease 2019 (COVID-19), has had a huge impact on health services, with a high mortality associated with complications including pneumonia and acute respiratory distress syndrome. Patients with systemic lupus erythematosus (SLE) are at increased risk of viral infections, and recent data suggests they may be at an increased risk of poor outcomes with COVID-19. This may be particularly true for those on rituximab or high dose steroids. A huge international effort from the scientific community has so far resulted in the temporary authorisation of three vaccines which offer protection against SARS-CoV-2, with over 30 other vaccines being evaluated in ongoing trials. Although there has historically been concern that vaccines may trigger disease flares of SLE, there is little convincing evidence to show this. In general lupus patients appear to gain good protection from vaccination, although there may be reduced efficacy in those with high disease activity or those on immunosuppressive therapies, such as rituximab or high dose steroids. Recent concerns have been raised regarding rare clotting events with the AstraZeneca/Oxford vaccine and it is currently unknown whether this risk is higher for those patients with secondary antiphospholipid syndrome. With the possibility of annual COVID vaccination programmes in the future, prospective data collection and registries looking at the effect of vaccination on SLE disease control, the incidence of COVID-19 in SLE patients and severity of COVID-19 disease course would all be useful. As mass vaccination programmes begin to roll out across the world, we assess the evidence of the use of vaccines in SLE patients and in particular vaccines targeting SARS-CoV-2.</p
Amongst patients taking biologic therapies for axial spondyloarthritis, which factors are associated with work non-participation?
No full textBackground: Axial spondyloarthritis (axSpA) frequently presents during working age and therefore impacts work participation. Biologic therapies have demonstrated a positive impact on work-related outcomes in clinical trials but real world data are limited. Therefore, we investigated the prevalence and predictors of work impairment and disability among axSpA patients attending a biologic therapy clinic.Methods: This was a single-centre, cross-sectional study of patients with axSpA treated with biologic therapy. Work participation was assessed with the Work Productivity and Activity Impairment (WPAI) Questionnaire. Work outcomes (presenteeism, absenteeism, health-related job loss) were compared for gender, time since diagnosis, smoking status and disease outcome measures.Results: Data were available for 165 patients (mean age 47.6 years, 75% male, 21% current smokers). Mean time since diagnosis was 15.5 years and mean duration of biologic therapy 4.7 years; 19/165 (11.5%) were on a tapered-dose regimen. Occupational data were available for 144 patients amongst whom 101 (70.1%) were either currently employed or in full time education. Of those eligible to work, 17/118 (14.4%) reported inability to work due to their axSpA. Amongst those in employment, 10.8% reported absenteeism due to axSpA in the week prior to their clinic visit (mean hours missed = 13). The mean work productivity impairment was 23%. Higher disease activity (BASDAI) and markers of global health, quality of life and pain, (BAS-G, ASQoL and spinal pain VAS) were associated with axSpA related job loss, absenteeism and presenteeism.Conclusions: In this group of axSpA patients on biologic therapy (mean age 47.6 years), almost 1 in 6 (14.4%) reported axSpA related job loss. Poor work outcomes: axSpA-related work disability, absenteeism and presenteeism were associated with poorer scores for patient-reported disease outcome measures. Strategies for enhancing work productivity should be directed towards those patients at risk of poor work outcomes. More data are needed including details of the types of work that are most difficult with axSpA
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
The British Society for Rheumatology biologic DMARD safety guidelines in inflammatory arthritis: Executive summary
No full textVariations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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