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Background: Chronic pain is a major healthcare issue that often requires an interdisciplinary treatment approach. Defining relevant treatment goals is one of the crucial steps in creating successful rehabilitation schemes. Therefore, the first aim was to explore goals that patients suffering from chronic pain aim to achieve. The second aim was to translate those goals into measurable functional outcome variables which can be used to measure treatment success.Methods: An online survey was developed and spread through local pain alliances in six European countries. Participants, patients suffering from chronic pain, were asked to report their most important goals, combined with a rank to denote the importance of each goal. For the highest ranked goals, participants were asked to decompose their goal into functional postures and the number of minutes per posture to achieve this goal.Results: We approached 1,494 persons, of which 487 effectively completed this survey. The highest ranked goals were taking part in family and social activities (72.55%), pain reduction (91.18%) and household tasks (68.14%). Obtaining pain reduction was most often ranked first (55.75%), followed by improving sleep (12.25%) and taking part in family or social activities (11.00%). For all goals, walking was a crucial component.Conclusions: The goals of chronic pain patients are in line with previously explored expectations, denoting the importance of achieving pain relief combined with improvements on the level of activities and participation. This survey indicates that rehabilitation programs should definitely focus on improving walking ability, due to its importance in underpinning overall goal achievement.Significance: Goals and expectations of chronic pain patients are in line with each other. Obtaining pain relief remains the highest ranked goal, however, goals on the level of activities and participation were also highly ranked. Walking seems to be the overall crucial component for goal achievement. [ABSTRACT FROM AUTHOR]

ER and JB were responsible for conceptualisation and study design. JB screened prospective eligible studies, conducted the literature review and wrote the first draft of the manuscript. RE, AF, TG, MP, IP, LT and RW reviewed the literature and contributed to writing. All authors contributed to the manuscript writing, revision, editing, and approved the submitted version., Competing Interests: Competing interests: ER was a named investigator on research funding from Unilever and the American Beverage Association from 2014-2016. No other authors report potential conflicts of interest., (© 2024. The Author(s).)

In April 2022, mandatory kilocalorie (kcal) labelling in the out-of-home food sector was introduced as a policy to reduce obesity in England. Here we examined whether the implementation of this policy was associated with a consumer behaviour change. Large out-of-home food sector outlets subject to kcal labelling legislation were visited pre- and post-implementation, and customer exit surveys were conducted with 6,578 customers from 330 outlets. Kcals purchased and consumed, knowledge of purchased kcals and reported noticing and use of kcal labelling were examined. The results suggested that the introduction of the mandatory kcal labelling policy in England was not associated with a significant decrease in self-reported kcals purchased (B = 11.31, P = 0.564, 95% confidence interval (CI) -27.15 to 49.77) or consumed (B = 18.51, P = 0.279, 95% CI -15.01 to 38 52.03). Post-implementation, participants underestimated the energy content of their purchased meal less (B = 61.21, P = 0.002, 95% CI 21.57 to 100.86) and were more likely to report noticing (odds ratio 2.25, P < 0.001, 95% CI 1.84 to 2.73) and using (odds ratio 2.15, P < 0.001, 95% CI 1.62 to 2.85) kcal labelling, which may have wider public health implications., Competing Interests: Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

There is an ongoing quest for an ideal uniform anesthesia regimen that adequately covers all nociceptive stimuli preventing hypertension and tachycardia while minimizing hypotension and the need for antihypotensive drugs. Recently, the ultra-short-acting benzodiazepine remimazolam was approved for the induction and maintenance of general anesthesia. Combining remimazolam with sevoflurane and propofol may combine the antiemetic properties of propofol, the depressing (immobilizing) effect on spinal motor neurons of sevoflurane, and the hemodynamic stability afforded by remimazolam, making it an attractive addition to the armamentarium of anesthetic agents. We describe five patients in whom general anesthesia was maintained with this triple combination, along with multimodal analgesia. All patients maintained hemodynamic stability at sufficient hypnotic depth, with no observable movement during surgery or episodes of cardiac arrhythmias., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Koch et al.)

Background: Mandatory calorie labelling in the out-of-home food sector was introduced in England in 2022, and menu pricing strategies that ensure cost is equivalent to portion size (proportional pricing) have been proposed as a policy to reduce obesity. Food delivery app-based platforms now contribute significantly to diet, and evidence suggests that those at a socioeconomic disadvantage may have greater exposure to unhealthy options on these platforms. However, public health policies to improve nutritional quality of food ordered from food delivery apps has received limited examination., Objective: This experimental study assessed the impact of calorie labelling and proportional pricing on item and meal size selection, calories ordered, and money spent when selecting food and drinks from three outlet types on a virtual delivery app., Methods: UK adult participants (N = 1126, 49% female), stratified by gender and education level completed an online study where they ordered items from three branded food and beverage outlets (coffee shop, sandwich outlet, fast food outlet) using a virtual delivery app. Participants were presented food and beverage options with vs. without calorie labels and with value (larger portions are proportionally cheaper) vs. proportional pricing., Results: Calorie labelling did not influence portion size selection for any outlets, but significantly reduced calories ordered from the coffee shop (-18.95kcals, 95% CI -33.07 to -4.84) and fast food outlet (-54.19kcals, 95% CI -86.04 to -22.33). Proportional pricing reduced the likelihood of choosing a larger beverage from the coffee shop (OR = 0.58, 95% CI 0.45 to 0.75), but was associated with increased calories ordered from the fast food outlet (51.25kcals, 95% CI 19.59 to 82.90). No consistent interactions were observed with participant characteristics, suggesting that effects of calorie labelling and pricing on outcomes were similar across sociodemographic groups., Conclusions: Calorie labelling on food delivery platforms may effectively reduce calories ordered. Proportional pricing may be useful in prompting consumers to select smaller portion sizes, although further research in real-world settings will now be valuable., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Objectives: To understand the relationships between deprivation and obesity with self-reported disability and disease activity in people with RA, and to determine whether BMI mediates the relationship between area-level deprivation and these outcomes., Methods: Data came from the Rheumatoid Arthritis Medication Study (RAMS), a 1-year multicentre prospective observational cohort of people with RA recruited from rheumatology centres across England commencing MTX for the first time. A total of 1529 and 1626 people were included who had a baseline and at least one follow-up measurement at 6 or 12 months of HAQ-Disability Index (HAQ-DI) and DAS in 28 joints (DAS28), respectively. Linear mixed models estimated the associations of deprivation and obesity with repeated measures HAQ-DI and DAS28. Causal mediation analyses estimated the mediating effect of BMI on the relationship between deprivation and RA outcomes., Results: Higher deprivation and obesity were associated with higher disability [adjusted regression coefficients highest vs lowest deprivation fifths 0.32 (95% CI 0.19, 0.45); obesity vs no obesity 0.13 (95% CI 0.06, 0.20)] and higher disease activity [adjusted regression coefficients highest vs lowest deprivation fifths 0.34 (95% CI 0.11, 0.58); obesity vs no obesity 0.17 (95% CI 0.04, 0.31)]. BMI mediated part of the association between higher deprivation and self-reported disability (14.24%) and DAS (17.26%)., Conclusions: People with RA living in deprived areas have a higher burden of disease, which is partly mediated through obesity. Weight-loss strategies in RA could be better targeted towards those living in deprived areas., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology.)

Objective: To assess the longitudinal associations of socioeconomic position (SEP) with functional limitations and knee joint replacement surgery (JRS) in people with symptomatic knee osteoarthritis (OA), and whether body mass index (BMI) mediated these relationships., Methods: Data came from the English Longitudinal Study of Ageing, a national longitudinal panel study of adults aged ≥50 years. A total of 1,499 participants (62.3% female; mean age 66.5 (standard deviation (SD) 9.4) years; 47.4% obese) self-reporting an OA diagnosis and knee pain, with at least one BMI measurement were included. Mixed effect models estimated longitudinal associations of each SEP variable (education, occupation, income, wealth and deprivation index) and obesity (BMI ≥30.0 kg/m 2 ) with repeated measures of functional limitations. Cox regression analyses estimated associations between SEP indicators and obesity at baseline and risk of knee JRS at follow-up. Structural equation modeling estimated any mediating effects of BMI on these relationships., Results: Lower SEP and obesity at baseline were associated with increased odds of functional limitations in people with knee OA [e.g., difficulty walking 100 yards: no qualification vs. degree adjOR 4.33 (95% CI 2.20, 8.55) and obesity vs. no obesity adjOR 3.06 (95% CI 2.14, 4.37); similar associations were found for the other SEP indicators]. A small proportion of the association between lower SEP and functional limitations could be explained by BMI (6.2-12.5%). Those with lower income, lower wealth and higher deprivation were less likely to have knee JRS [e.g., adjHR most vs. least deprived 0.37 (95% CI 0.19, 0.73)]; however, no clear association was found for education and occupation. Obesity was associated with increased hazards of having knee JRS [adjHR 1.87 (95% CI 1.32, 2.66)]. As the direction of the associations for SEP and obesity with knee JRS were in opposite directions, no mediation analyses were performed., Conclusions: Lower SEP was associated with increased odds of functional limitations but lower hazards of knee JRS among people with knee OA, potentially indicating underutilization of JRS in those with lower SEP. Obesity partially mediated the relationship between lower SEP and increased odds of functional limitations, suggesting adiposity as a potential interventional target., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Witkam, Verstappen, Gwinnutt, Cook, O'Neill, Cooper and Humphreys.)

Objectives: To investigate associations of socioeconomic position (SEP) and obesity with incident osteoarthritis (OA), and to examine whether body mass index (BMI) mediates the association between SEP and incident OA., Methods: Data came from the English Longitudinal Study of Ageing, a population-based cohort study of adults aged ≥50 years. The sample population included 9,281 people. Cox regression analyses were performed to investigate the associations between SEP (measured by education, occupation, income, wealth and deprivation) and obesity (BMI ≥30 kg/m 2 ) at baseline and self-reported incident OA. The mediating effect of BMI on the relationship between SEP and incident OA were estimated using Structural Equation Models., Results: After a mean follow-up time of 7.8 years, 2369 participants developed OA. Number of person-years included in the analysis was 65,456. Lower SEP was associated with higher rates of OA (for example, hazard ratio (HR) lowest vs highest education category 1.52 (95% confidence interval (CI) 1.30, 1.79)). Obesity compared with non-obesity was associated with increased rates of incident OA (HR 1.37 (95% CI 1.23, 1.52)). BMI mediated the relationship between a lower SEP and OA (β = 0.005, p < 0.001) and the direct effect was not significant (β = 0.004, p = 0.212)., Conclusions: Strategies to reduce social inequalities and obesity prevalence may help to reduce OA risk., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2022. Published by Elsevier Inc.)

Background: Consistent evidence suggests a relationship between lower educational attainment and total obesity defined using body mass index (BMI); however, a comparison of the relationships between educational attainment and total obesity (BMI ≥30 kg/m 2 ) and central obesity (waist circumference (WC) > 102 cm for men and WC > 88 cm for women) has yet to be carried out. This systematic literature review (SLR) and meta-analyses aimed to understand whether i) the associations between education and obesity are different depending on the measures of obesity used (BMI and WC), and ii) to explore whether these relationships differ by gender and region., Methods: Medline, Embase and Web of Science were searched to identify studies investigating the associations between education and total and central obesity among adults in the general population of countries in the Organisation for Economic Co-operation and Development (OECD). Meta-analyses and meta-regression were performed in a subset of comparable studies (n=36 studies; 724,992 participants)., Results: 86 eligible studies (78 cross-sectional and eight longitudinal) were identified. Among women, most studies reported an association between a lower education and total and central obesity. Among men, there was a weaker association between lower education and central than total obesity (OR central vs total obesity in men 0.79 (95% CI 0.60, 1.03)). The association between lower education and obesity was stronger in women compared with men (OR women vs men 1.66 (95% CI 1.32, 2.08)). The relationship between lower education and obesity was less strong in women from Northern than Southern Europe (OR Northern vs Southern Europe in women 0.37 (95% CI 0.27, 0.51)), but not among men., Conclusions: Associations between education and obesity differ depending on whether total or central obesity is used among men, but not in women. These associations are stronger among women than men, particularly in Southern European countries., Competing Interests: None., (© 2021 Published by Elsevier Ltd.)