Carrie Brown

A Randomized Cross-over Air Filtration Intervention Trial for Reducing Cardiovascular Health Risks in Residents of Public Housing near a Highway

Exposure to traffic-generated ultrafine particles (UFP; particles <100 nm) is likely a risk factor for cardiovascular disease. We conducted a trial of high-efficiency particulate arrestance (HEPA) filtration in public housing near a highway. Twenty residents in 19 apartments living <200 m from the highway participated in a randomized, double-blind crossover trial. A HEPA filter unit and a particle counter (measuring particle number concentration (PNC), a proxy for UFP) were installed in living rooms. Participants were exposed to filtered air for 21 days and unfiltered air for 21 days. Blood samples were collected and blood pressure measured at days 0, 21 and 42 after a 12-hour fasting period. Plasma was analyzed for high sensitivity C-reactive protein (hsCRP), interleukin-6 (IL-6), tumor necrosis factor alpha-receptor II (TNF-RII) and fibrinogen. PNC reductions ranging from 21% to 68% were recorded in 15 of the apartments. We observed no significant differences in blood pressure or three of the four biomarkers (hsCRP, fibrinogen, and TNF-RII) measured in participants after 21-day exposure to HEPA-filtered air compared to measurements after 21-day exposure to sham-filtered air. In contrast, IL-6 concentrations were significantly higher following HEPA filtration (0.668 pg/mL; CI = 0.465–0.959) compared to sham filtration. Likewise, PNC adjusted for time activity were associated with increasing IL-6 in 14- and 21-day moving averages, and PNC was associated with decreasing blood pressure in Lags 0, 1 and 2, and in a 3-day moving average. These negative associations were unexpected and could be due to a combination of factors including exposure misclassification, unsuccessful randomization (i.e., IL-6 and use of anti-inflammatory medicines), or uncontrolled confounding. Studies with greater reduction in UFP levels and larger sample sizes are needed. There also needs to be more complete assessment of resident time activity and of outdoor vs. indoor source contributions to UFP exposure. HEPA filtration remains a promising, but not fully realized intervention.

Medical complications of anorexia nervosa and their treatments: an update on some critical aspects

Anorexia nervosa has the highest mortality rate of any psychiatric disorder. Many of the deaths are attributable to medical complications which arise as the malnutrition and weight loss worsens. Every body system may be adversely affected by anorexia nervosa. Yet, remarkably, most of the medical complications of anorexia nervosa are treatable and reversible with optimal medical care, as part of a multidisciplinary team who are often involved in the care of these patients. Herein, we will describe the medical complications of anorexia nervosa and their treatments.

Risk of knee oa with obesity, sarcopenic obesity and sarcopenia

Obesity, defined by anthropometric measures, is a well‐known risk factor for knee osteoarthritis (OA), but there is a relative paucity of data regarding the association of body composition (fat and muscle mass) with risk of knee OA. We undertook this study to examine the longitudinal association of body composition categories based on fat and muscle mass with risk of incident knee OA.

Efficacy of a Work Disability Prevention Program for People with Rheumatic and Musculoskeletal Conditions: The Work It Study Trial

Work disability rates are high among people with rheumatic and musculoskeletal conditions. Effective disability preventive programs are needed. We examined the efficacy of a modified vocational rehabilitation approach delivered by trained occupational therapists and physical therapists on work limitation and work loss over 2 years among people with rheumatic and musculoskeletal conditions.

Thresholds in the relationship of quadriceps strength with functional limitations in women with knee osteoarthritis

To investigate thresholds of strength below which individuals with knee osteoarthritis (OA) may have more difficulty carrying out physical functions of daily life. Individuals below such thresholds might benefit more from strengthening interventions than those with greater strength.

Association of Varus Knee Thrust during Walking with Worsening WOMAC Knee Pain: The Multicenter Osteoarthritis Study

To investigate the 2‐year association of varus knee thrust observed during walking to the odds of worsening Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) knee pain in older adults with or at risk of osteoarthritis (OA).OBJECTIVE To investigate the two-year association of varus knee thrust observed during walking to the odds of worsening WOMAC knee pain in older adults with or at risk of OA. METHODS Video recordings of self-paced walking trials of Multicenter Osteoarthritis Study (MOST) participants were assessed for the presence of varus thrust at baseline. Knee pain was assessed using the WOMAC questionnaire at baseline and at two years. Logistic regression was used to estimate the odds of worsening (defined as either any increase in WOMAC score or clinically-important worsening) knee pain, adjusting for age, sex, race, BMI, clinic site, gait speed, and static knee aligment. Analyses were repeated stratified by baseline radiographic OA status and among the subset of knees without baseline WOMAC pain. RESULTS 1623 participants contributed 3204 knees. Varus thrust was observed in 31.5% of knees. Knees with varus thrust had 1.44 times (95% CI: 1.19, 1.73) the odds of any and 1.37 times (95% CI: 1.11, 1.69) the odds of clinically-important worsening WOMAC pain compared to knees without thrust. Knees with thrust without baseline WOMAC pain had 2.01 (95% CI: 1.47, 2.74) times the odds of incident total pain. CONCLUSION Results indicate that varus thrust is a risk factor for worsening and incident knee pain. Targeting varus thrust through non-invasive therapies could prevent development or worsening of knee pain in older adults with or at risk for knee OA. This article is protected by copyright. All rights reserved.

Concurrent change in quadriceps strength and physical function over 5 years in The Multicenter Osteoarthritis Study

Quadriceps weakness, associated with functional limitations, is a target of treatment of knee osteoarthritis (OA). Limited data exist on the relationship between modest strength increases and improvements in function. The aim of this study was to evaluate concurrent change in strength and physical function over 5 years.