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With growing flexibilization in the labour market, continuous and consistent career trajectories have become less the norm, and workers facing unemployment may need to look for employment opportunities outside the occupation they are trained in. But what are their employment chances? And what are the chances of returning to the occupation they were trained in after having worked in a different occupation? Despite much research on how employers evaluate job candidates with vertical skill mismatches (e.g. over-qualification and under-qualification) and unemployment, there is little research to investigate how employers view horizontal mismatch in comparison to unemployment, and whether a combination of both generates multiplicative negative effects. Using data gathered from an employer survey experiment in Switzerland and Greece, we find that in Switzerland both unemployment and horizontal mismatch significantly reduce employment chances, but the scarring effect of horizontal mismatch is much stronger. In contrast, in Greece horizontal mismatch significantly reduces employment chances but unemployment does not. Furthermore, we found that horizontal mismatch scarring is significantly stronger in Switzerland than in Greece. These findings suggest that the scarring effects of both unemployment and horizontal mismatch vary across contexts. Further analyses show that, rather than experiencing multiplicative scarring effects, unemployment does not add further disadvantages to mismatched candidates in either country, highlighting the importance of occupational specificity of skills in labour market matching. Overall, these findings facilitate a more nuanced understanding of demand-side labour market processes, highlighting the distinct interactive effects of unemployment and horizontal mismatch across national contexts.Students with learning disabilities (LDs) experience heightened levels of social isolation, but researchers have not fully explored its various dimensions at school or determined which aspects contribute to educational gaps associated with LDs. Using the National Longitudinal Study of Adolescent to Adult Health, we find that middle and high school students with LDs are more likely to experience most types of isolation. Student with LDs have fewer friends, their friends are less educationally ambitious, they feel more detached and disliked at school, and they are more likely to avoid friendships, though surprisingly not more likely to be actively rejected. Mediation analyses indicate that the aspect of social isolation that contributes most to the LD-gap in high school graduation is one's number of school friends and their educational expectations. Perceptions of social isolation are also consequential, and together these account for nearly one-quarter of the LD-gap in high school graduation, net of past grades.Is labour market vulnerability associated with harsher preferences on asylum-seeking policy? If so, how might the size of the existing foreign-born population condition this effect? We unpack these dynamics across 20 European countries using 2014 ESS and EU-SILC data. In doing so, we examine the relevance of labour market vulnerability both directly and in combination with individual-level exposure to people of a different race or ethnicity; and the perceived or actual size of the foreign-born population. Results suggest that exposure to labour market risk is associated with a preference for harsher treatment, but that this relationship is driven by respondents with little to no interactions with the existing minority population. We also find that labour market vulnerability is associated with higher (lower) preferred severity in countries with a large (small) presumed foreign-born population. The actual size of the foreign-born population, by contrast, does not appear to matter.Systemic lupus erythematosus (SLE) is an autoimmune inflammatory condition that may involve multiple organ systems. Although the antinuclear antibody (ANA) test is positive in nearly every case of SLE, it is not specific for this disease and must be interpreted in the appropriate clinical context. Key features that warrant ANA testing include unexplained multisystem inflammatory disease, symmetric joint pain with inflammatory features, photosensitive rash, and cytopenias. ANA staining patterns and more specific autoantibody testing may be helpful in diagnosis of suspected SLE or ANA-associated disease. For patients with nonspecific symptoms, such as malaise and fatigue, ANA testing is of limited value.Knee osteoarthritis (OA) is a common and morbid condition. No disease-modifying therapies exist; hence the goals of current treatment are to palliate pain and to retain function. [https://www.selleckchem.com/products/calcium-folinate.html read more] OA pain is significantly influenced by the placebo effect. Nonpharmacologic interventions are essential and have been shown to improve outcomes. Canes, unloading braces, and therapeutic heating/cooling may be valuable. Pharmacotherapy options include topical and oral nonsteroidal anti-inflammatory drugs, duloxetine, and periodic intra-articular glucocorticoids and hyaluronans. Opioids, intra-articular stem cells, and platelet-rich plasma are not recommended. Novel targets such as nerve growth factor are under investigation and may be approved soon for OA pain.Rheumatoid arthritis (RA) is a chronic, progressive inflammatory disorder that manifests as a symmetric polyarthritis of small and large joints that may lead to joint and periarticular structural damage and the consequences of systemic inflammation. This overview of early RA examines the unmet needs and challenges in RA, how to best diagnose RA, and pitfalls in early diagnosis and treatment. The rules for referral to a rheumatologist are reviewed. Primary care physicians are at the front line of early diagnosis and need to start disease-modifying therapy as soon as a diagnosis of RA is established.Management of women with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and obstetric antiphospholipid syndrome (APS) during pregnancy presents unique clinical challenges. Women with both RA and SLE can have disease flares during pregnancy, leading to pregnancy complications, such as preeclampsia, small-for-gestational-age infants, and preterm delivery. Disease should be under control prior to conception. Women with obstetric APS need to be anticoagulated during pregnancy. Many but not all antirheumatic medications can be used during pregnancy and lactation.Spondyloarthritis is a common rheumatologic disease, present in up to 2% of the population, characterized by inflammatory arthritis, often with enthesitis, dactylitis, spondylitis, and skin disease. It has historically been characterized as ankylosing spondylitis, psoriatic arthritis, arthritis associated with inflammatory bowel disease, reactive arthritis, and undifferentiated spondyloarthritis. These subsets are now classified as axial-predominant and peripheral-predominant spondyloarthritis. This article provides an updated understanding of disease classification and practical advice about diagnosis to aid in the determination of which patients should be referred to rheumatology. It is important to provide patients the opportunity to have early and effective therapy.Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are considered 2 diseases on the same spectrum due to their many underlying similarities. In recent years, both diseases have witnessed both diagnostic and treatment advances, which shaped the way we manage them. In this article, the authors focus on different diagnostic modalities in GCA as well as the presence of different clinical phenotypes and the role of screening for aortic involvement. The authors also discuss traditional treatments and the role of evolving steroid-sparing agents in the management of both GCA and PMR.Gout is the most common inflammatory arthritis in the United States. Gouty arthritis is associated with significant morbidity and mortality and is the result of chronic hyperuricemia. Gout is effectively managed and potentially cured by decreasing the overall urate burden with serum urate-lowering therapy. When serum urate is maintained at less than 6.0 mg/dL, urate deposition is resolved, and gout can be cured. Unfortunately, because of less than optimal physician monitoring and dose escalation, many patients do not achieve these urate levels.Fibromyalgia is a chronic pain condition manifested by chronic generalized pain, fatigue, disordered sleep, and cognitive difficulties, persistent for at least 3 months. Other common complaints/conditions include symptoms of irritable bowel syndrome, headaches, intermittent paresthesias, and various mood disorders. Women are more commonly affected than men. The treatment approach should be individualized and focused on associated mood disorders, sleep, exercise, correction of maladaptive responses to pain, and coping with stress.Patients with rheumatic disease, including those with systemic lupus erythematous, rheumatoid arthritis, and spondyloarthritis, use total hip and knee arthroplasties at high rates. They represent a particularly vulnerable population in the perioperative setting because of their diseases and the immunosuppressant therapies used to treat them. Careful planning among internists, medical specialists, and the surgical team must therefore occur preoperatively to minimize risks in the postoperative period, particularly infection. Management of immunosuppressant medications, such as conventional synthetic disease-modifying antirheumatic drugs and targeted therapies including biologics, is one avenue by which this infectious risk can be mitigated.Although statins are generally safe and well tolerated, some patients experience muscle complaints that can be attributed to their use. Those with muscle discomfort but no demonstrable muscle weakness or creatine kinase (CK) elevations may have statin-associated muscle symptoms. Individuals with elevated CK levels, with or without muscle discomfort or weakness, may have statin-associated myotoxicity. Rare patients have statin-associated autoimmune myopathy, a disease characterized by proximal muscle weakness, elevated CK levels, and autoantibodies recognizing hydroxy-methyl-glutaryl coenzyme A reductase. In this review, the author provides the clinician with a practical approach to diagnosing and managing patients with each of these statin side effects.Individuals with rheumatoid arthritis, systemic lupus erythematosus, or gout have increased risk of cardiovascular disease (CVD) compared with the general population. This risk relates to a combination of traditional cardiovascular risk factors and disease-specific factors. Screening for CVD is important because CVD contributes to significant morbidity and mortality. Management includes tight control of disease activity to reduce inflammation, but with care to minimize use of nonsteroidal anti-inflammatory drugs and prolonged courses of high-dose corticosteroids. Traditional cardiovascular risk factors should be managed with a combination of lifestyle interventions and pharmacotherapy. The decision to start antihypertensive and lipid-lowering therapy should be based on individual CVD risk.