Gender, body mass index and rheumatoid arthritis disease activity: results from the QUEST-RA Study.

OBJECTIVES: To investigate whether body mass index (BMI), as a proxy for body fat, influences rheumatoid arthritis (RA) disease activity in a gender-specific manner. METHODS: Consecutive patients with RA were enrolled from 25 countries into the QUEST-RA program between 2005 and 2008. Clinical and demographic data were collected by treating rheumatologists and by patient self-report. Distributions of Disease Activity Scores (DAS28), BMI, age, and disease duration were assessed for each country and for the entire dataset; mean values between genders were compared using Student's t-tests. An association between BMI and DAS28 was investigated using linear regression, adjusting for age, disease duration and country. RESULTS: A total of 5,161 RA patients (4,082 women and 1,079 men) were included in the analyses. Overall, women were younger, had longer disease duration, and higher DAS28 scores than men, but BMI was similar between genders. The mean DAS28 scores increased with increasing BMI from normal to overweight and obese, among women, whereas the opposite trend was observed among men. Regression results showed BMI (continuous or categorical) to be associated with DAS28. Compared to the normal BMI range, being obese was associated with a larger difference in mean DAS28 (0.23, 95% CI: 0.11, 0.34) than being overweight (0.12, 95% CI: 0.03, 0.21); being underweight was not associated with disease activity. These associations were more pronounced among women, and were not explained by any single component of the DAS28. CONCLUSIONS: BMI appears to be associated with RA disease activity in women, but not in men.

Worker performance and ventilation in a call center: analyses of work performance data for registered nurses.

UNLABELLED: We investigated the relationship between ventilation rates and individual work performance in a call center, and controlled for other factors of the indoor environment. We randomized the position of the outdoor air control dampers, and measured ventilation rate, differential (indoor minus outdoor) carbon dioxide (DeltaCO(2)) concentration, supply air velocity, temperature, humidity, occupant density, degree of under-staffing, shift length, time of day, and time required to complete two different work performance tasks (talking with clients and post-talk wrap-up to process information). DeltaCO(2) concentrations ranged from 13 to 611 p.p.m. We used multivariable regression to model the association between the predictors and the responses. We found that agents performed talk tasks fastest when the ventilation rate was highest, but that the relationship between talk performance and ventilation was not strong or monotonic. We did not find a statistically significant association between wrap-up performance and ventilation rate. Agents were slower at the wrap-up task when the temperature was high (> 25.4 degrees C). Agents were slower at wrap-up during long shifts and when the call center was under-staffed. PRACTICAL IMPLICATIONS: The productivity benefits of ventilation rates that exceed common standards such as ASHRAE Standard 62 may be small (0-2%), and other factors may have a larger impact on productivity. Understaffing and long shifts should be avoided because both showed a negative impact on performance. In this study, high temperature had the largest statistically significant impact on productivity and was caused by occupants fighting over the thermostat setpoint. Care should be taken to avoid high temperatures in call centers. If occupants are allowed to adjust temperature setpoints, then the size and/or duration of the setpoint change should be restricted.

A longitudinal perspective on entitlement income among homeless adults.

OBJECTIVE: Sources of entitlement income were examined in a sample of homeless adults to determine whether certain subgroups more consistently obtain entitlement income and are more likely to continue receiving it over time. METHODS: From a baseline sample of 564 homeless residents of Alameda County, California, 397 were interviewed at both five- and 15-month follow-ups. Information was obtained on income received from public sources in the 30 days before each interview, including general assistance, Aid to Families With Dependent Children (AFDC), Supplemental Security Income, or Social Security Disability Insurance. Data were also obtained on psychiatric diagnosis, race, marital status, education, duration of homelessness in adulthood, household status, and reported disability. RESULTS: At baseline fewer than half of the respondents were receiving any entitlement income. The benefits of almost half of the AFDC and general assistance recipients were terminated during the 15-month period. Respondents who continued receiving entitlement income over the 15-month period were more likely to be black, to be women alone or with children, to have a family history of receiving welfare, and to report a disability. Respondents with dual disorders were six times more likely than others to have their benefits terminated. CONCLUSIONS: Entitlement income is tenuous for many homeless adults, particularly those with dual diagnoses.

Nursing: concepts of professional practice.

As we approach the twenty-first century, nursing is preparing itself to meet the expected health care needs of the population. In this paper, which was recently presented to the Royal College of Nursing National Conference at Hartlepool, Maureen Lahiff sets out her vision of the future.