EMGO Institute for Health and Care Research

<h3>Objective</h3> Cardiovascular diseases (CVD) are the leading cause of mortality and morbidity worldwide. Emerging evidence suggests that exposure to nanomaterials and ultrafine particles (UFP) may alter cardiovascular function and contribute to the burden of CVD. Such exposures often occur in occupational settings involving nanomaterial production or high-energy processes like welding, printing, machining, and combustion. However, the cardiovascular effects of occupational exposure to nanomaterials and UFP remain poorly characterized, posing challenges for (occupational) health professionals. To summarize the existing evidence on cardiovascular health effects associated with occupational exposure to nanomaterials and UFP, identify commonly used biomarkers and diagnostic techniques, and highlight knowledge gaps requiring further investigation. <h3>Material and Methods</h3> A comprehensive search was conducted in MEDLINE, EMBASE, and Web of Science from inception to April 2024. Studies were eligible if they assessed health outcomes among workers exposed to nanomaterials or UFP in occupational settings. A total of 6020 unique records were screened, of which 66 studies met the inclusion criteria. Of these, 16 studies reported cardiovascular outcomes. <h3>Results</h3> The included studies employed various designs, with the majority being cross-sectional (n=11). Common workplace exposures included carbon nanotubes/fibers, titanium dioxide, and UFP from various industrial processes. The most frequently studied outcomes were cardiovascular inflammation and function. Reported biomarkers included elevated levels of VCAM-1, ICAM-1, endothelin-1, and hs-CRP. Some studies also reported changes in metabolic markers and vascular function; however, findings related to clinical measures such as blood pressure, heart rate variability, and autonomic function were inconsistent. <h3>Conclusion</h3> Occupational exposure to nanomaterials and UFP may be associated with early alterations in cardiovascular function. However, evidence on specific functional or structural disorders remains limited. This review highlights the need for longitudinal studies with detailed exposure assessment and standardized diagnostic tools to better understand causal pathways and inform occupational health policy.

We aimed to investigate the effect of TFT on voice-hearing in people with PTSD and psychosis using experience sampling method (ESM). A secondary aim was to explore how changes in voice-hearing are related to changes in PTSD. This is an adjunct longitudinal ESM study of a sub-group of participants (N = 39) from a randomised controlled trial that compared TFT to a waiting-list control group. Voice-hearing participants filled in 10 daily voice-hearing-related questionnaires for six consecutive days at baseline and post-treatment at pseudo-random times during the day. PTSD symptom severity was assessed at baseline and post-treatment. Multilevel linear regression was used to test the effect of TFT on voice-hearing and to analyse the relationship between changes in voice-hearing and changes in PTSD. The intention-to-treat analysis showed a significant interaction effect between time and treatment condition (p < .00001) with a small effect size (dppc2 = -0.27), indicating a larger decrease in voice-hearing in the TFT group than in the waiting-list control group. Also, a significant association was observed between changes in PTSD symptoms and changes in voice-hearing (p < .00001). Our findings tentatively suggest that, even when voices are not targeted directly, TFT for PTSD can alleviate distressing voices.

Ankle sprains are frequent injuries in general practice. However, no effective treatment is available yet. To examine the effectiveness of an unsupervised e-health-supported neuromuscular training programme in combination with usual care compared with usual care alone in patients with acute lateral ankle sprains in general practice. Randomised controlled trial with 1-year follow-up among patients (14-65 years) who visited the GP with an acute lateral ankle sprain within 3 weeks of injury. The intervention group received, in addition to usual care, an unsupervised e-health-supported neuromuscular training programme and the control group received usual care alone. The primary outcome was self-reported re-sprains during 52 weeks of follow-up. Secondary outcomes were ankle function, pain in rest and during activity, subjective recovery, and return to the same type and level of sport. In total, 165 participants (mean age 38.3 years and 69 [41.8%] male) were included. No statistically significant difference in the occurrence of a re-sprain were found between the intervention 20.7% (17/82) and control group 24.1% (20/83) (hazard ratio 1.14, 95% confidence interval = 0.59 to 2.21). Also, no statistically significant differences in secondary outcomes were found between groups. The adherence rate to the programme was low (6.1%, 5/82). The rate of re-sprains was relatively high and an unsupervised e-health-supported neuromuscular training programme does not yield meaningful effects and does not encourage adherence in preventing re-sprains in patients in general practice. More research is necessary to indicate the best treatment modality and way of delivery for these patients.

Abstract Atopic dermatitis (AD) is a common inflammatory skin condition and prior genome-wide association studies have identified 71 associated loci. In the current study we conducted the largest AD GWAS to date (discovery N=1,086,394, replication N=3,604,027), combining previously reported cohorts with additional available data. We identified 81 loci (29 novel) in the European-only analysis and 15 additional loci in the multi-ancestry analysis (6 novel). All 81 variants replicated in a separate European analysis. Eleven variants from the multi-ancestry analysis replicated in at least one of the populations tested (European, Latino or African). While four variants appeared to be specific to individuals of Japanese ancestry. AD loci showed enrichment for DNAse I hypersensitivity and eQTL signals in blood. At each locus we prioritised candidate genes by integrating multi-omic data. The implicated genes are predominantly in immune pathways of relevance to atopic inflammation and some offer drug repurposing opportunities.

IntroductionMany people with psychotic disorders experience symptoms of post-traumatic stress disorder (PTSD). In recent years, several trauma-focused therapies (TFTs), including cognitive restructuring (CR), prolonged exposure (PE), and eye movement desensitization and reprocessing (EMDR) have been studied and found to be safe and effective in reducing PTSD symptoms in individuals with psychosis. However, studies were conducted in different countries, with varying inclusion criteria, therapy duration, control groups, and trial outcomes. RE.PROCESS will be the first study to compare the impact of CR, PE, and EMDR with a waiting list control condition within the same context.Methods and analysisThis is the protocol of a pragmatic, single-blind, multicentre, superiority randomized controlled trial, in which CR, PE, and EMDR are compared to a waiting list control condition for TFT (WL) in a naturalistic treatment setting. Inclusion criteria are as follows: age ≥ 16 years; meeting full DSM-5 diagnostic criteria for PTSD on the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), with a total CAPS score ≥ 23; and a psychotic disorder in the schizophrenia spectrum confirmed by the Structured Clinical Interview for DSM-5 (SCID-5). Participants (N=200) will be randomly allocated to 16 sessions of one of the TFTs or WL, in addition to receiving treatment as usual (TAU) for psychosis. The primary objective is to compare the effects of CR, PE, and EMDR to WL on researcher-rated severity of PTSD symptoms over time from baseline to 6-month follow-up. Secondary objectives are to examine these effects at the separate time-points (i.e., mid-treatment, post-treatment, and at 6-month follow-up) and to test the effects for clinician-rated presence of PTSD diagnosis, and self-rated severity of (complex) PTSD symptoms.DiscussionThis is the first RCT to directly compare the effects of CR, PE, and EMDR within the same context to TAU on PTSD symptoms in individuals with psychosis and PTSD. Secondary effects on clinical and functional outcomes will be investigated both directly after therapy and long term.Trial registrationISRCTN ISRCTN56150327. Registered 18 June 2019.

ObjectiveChildhood obesity is associated with alterations in hypothalamus–pituitary–adrenal axis activity. We tested the hypothesis that multiple alterations in the metabolism of glucocorticoids are required for the development of hypertension in children who become overweight.MethodsSpot urine for targeted gas chromatography-mass spectrometry steroid metabolome analysis was collected from (1) overweight/hypertensive children (n = 38), (2) overweight/non-hypertensive children (n = 83), and (3) non-overweight/non-hypertensive children (n = 56).ResultsThe mean (± s.d.) age of participants was 10.4 ± 3.4 years, and 53% of them were male. Group 1 and group 2 had higher excretion rates of cortisol and corticosterone metabolites than group 3 (869 (interquartile range: 631–1352) vs 839 (609–1123) vs 608 (439–834) μg/mmol creatinine × m2 body surface area, P < 0.01, for the sum of cortisol metabolites), and group 1 had a higher excretion rate of naive cortisol than group 3. Furthermore, groups differed in cortisol metabolism, in particular in the activities of 11β-hydroxysteroid dehydrogenases, as assessed from the ratio of cortisol:cortisone metabolites (group 2 < group 3), 5α-reductase (group 1 > group 2 or 3), and CYP3A4 activity (group 1 < group 2 or 3).DiscussionThe sequence of events leading to obesity-associated hypertension in children may involve an increase in the production of glucocorticoids, downregulation of 11β-hydroxysteroid dehydrogenase type 1 activity, and upregulation of 5α-reductase activity, along with a decrease in CYP3A4 activity and an increase in bioavailable cortisol.

BackgroundPrevious research has shown that muscle imbalances may be an important risk factor for lower limb injuries in runners. No studies have evaluated hip musculature imbalance in sprinters. Identifying pre-season strength and imbalances of the hip gluteal musculature can have an important impact on injury prevention within this population.ObjectiveTo describe the muscle performance and imbalances between limbs related to the hip extensor, external rotators and abductors muscles in sprinters.DesignAthletes were assessed during the pre-season period. Muscle function performance of the hip extensors, external rotators and abductors were tested.ParticipantsAll participants (n=69) were federated at the Spanish athletics federation and involved in high-level track and field training sessions (minimum 5 sessions per week) for at least the last 3 years. All of them had undertaken similar training demands in the past.InterventionsWe measured the maximum number of repetitions without compensatory movements of each leg during the straight knee bridge exercise (test 1), hip external rotation in prone (test 2) and hip abduction in side-line (test 3). Data analysis and comparison in between limbs were calculated.ResultsNo significant differences in between limbs were observed in all three tests (p<0,005). The assessment of the hip external rotators (test 2), have shown the worse performance among this population with 30,8% of the athletes on the dominant limb and 35,3% on non-dominant limb not being able to perform even 1 rep without compensation.ConclusionsWe did not observe significant imbalances in between limbs. The hip external rotators muscles demonstrated the worst performance with a high number of athletes not being able to perform the test. The weakness of the external rotators and compensations associated with it can have several different impacts on the lower limb function during running, therefore possible importance for injury prevention strategies.

BackgroundTo be able to provide high-quality palliative care, there need to be a number of organizational structures available in the nursing homes. It is unclear to what extent such structures are actually present in nursing homes in Europe. We aim to examine structural indicators for quality of palliative care in nursing homes in Europe and to evaluate the differences in terms of availability of and access to palliative care, infrastructure for residents and families, multidisciplinary meetings and quality improvement initiatives.MethodsA PACE cross-sectional study (2015) of nursing homes in Belgium, England, Finland, Italy, the Netherlands and Poland. Nursing homes (N = 322) were selected in each country via proportional stratified random sampling. Nursing home administrators (N = 305) filled in structured questionnaires on nursing home characteristics. Organization of palliative care was measured using 13 of the previously defined IMPACT structural indicators for quality of palliative care covering four domains: availability of and access to palliative care, infrastructure for residents and families, multidisciplinary meetings and quality improvement initiatives. We calculated structural indicator scores for each country and computed differences in indicator scores between the six countries. Pearson’s Chi-square test was used to compute the p-value of each difference.ResultsThe availability of specialist palliative care teams in nursing homes was limited (6.1–48.7%). In Finland, Poland and Italy, specialist advice was also less often available (35.6–46.9%). Up to 49% of the nursing homes did not provide a dedicated contact person who maintained regular contact with the resident and relatives. The 24/7 availability of opioids for all nursing home residents was low in Poland (37.5%).ConclusionsThis study found a large heterogeneity between countries in the organization of palliative care in nursing homes, although a common challenge is ensuring sufficient structural access to specialist palliative care services. Policymakers and health and palliative care organizations can use these structural indicators to identify areas for improvement in the organization of palliative care.