scholarly journals An ecological study of NHS funded elective hip arthroplasties in England from 2003/04 to 2012/13

2019 ◽  
Vol 112 (7) ◽  
pp. 292-303
Author(s):  
Shailen Sutaria ◽  
Graham Kirkwood ◽  
Allyson M Pollock
Keyword(s):  
Hip Arthroplasty ◽  
Ecological Study ◽  
Relative Difference ◽  
Risk Selection ◽  
Private Provision ◽  
Private Providers ◽  
Affluent Area ◽  
Hip Arthroplasties ◽  
The Impact ◽  
Relative Slope

Objectives To examine the impact of NHS-funded private provision on NHS provision, access and inequalities. Design Ecological study using routinely collected NHS inpatient data. Setting England. Participants All individuals undergoing an NHS-funded elective hip arthroplasty in England from 2003/2004 to 2012/2013. Main outcome measures Annual crude and standardised rates of hip arthroplasties per 100,000 population performed by NHS and private providers between 2004/2005 and 2012/2013. Results Age standardised rates of hip arthroplasty increased from 116.4 (95% CI 115.4–117.4) to 148.7 (147.6–149.8) per 100,000 between 2004/2005 and 2012/2013. Provision shifted from NHS providers to private providers from 2007/2008; NHS provision decreased 8.6% and private provision increased 188% between 2007/2008 and 2012/2013. There is evidence of risk selection; private sector hip arthroplasties on NHS patients from the most affluent areas increased 228% from 10.8 (10.2–11.5) to 35.4 (34.3–36.5) per 100,000 compared to an increase of 186% from 8.8 (8.1–9.4) to 25.2 (24.1–26.4) per 100,000 among patients from the least affluent areas between 2007/2008 and 2012/2013. There was no statistically significant (p > 0.05) widening in any measure of inequality (absolute, relative difference and slope and relative slope of index inequality) in hip arthroplasty rates between 2004/2005 and 2012/2013. Conclusion Private provision substituted for NHS provision and did not add to overall provision favouring patients living in the most affluent area. Continuing the trend towards private provision and reducing NHS provision is likely to result in risk selection and widening inequalities in provision of elective hip arthroplasty in England.

scholarly journals An ecological study of publicly funded elective hip arthroplasties in Brazil and Scotland: do access inequalities reinforce the inverse care law?

JRSM Open ◽  
2020 ◽  
Vol 11 (5) ◽  
pp. 205427042092077
Author(s):  
Jonathan Filippon ◽  
Stephen Bremner ◽  
Ligia Giovanella ◽  
Allyson Pollock
Keyword(s):  
Public Sector ◽  
Confidence Interval ◽  
Hip Arthroplasty ◽  
Ecological Study ◽  
Publicly Funded ◽  
The Public ◽  
Unified Health System ◽  
Inverse Care Law ◽  
And Gender ◽  
Hip Arthroplasties

Objectives To compare elective hip arthroplasty rates funded by the public sector in Brazil and Scotland. Design Ecological study, 2009–13, of crude and directly standardised rates of elective primary hip arthroplasty rates (per 100,000) funded by the public sector at national and regional level for age (30 + years) and gender in Brazil and Scotland. Setting National Health Service Scotland and Unified Health System in Brazil. Participants Over 30 s who had undergone an elective hip arthroplasty funded by the public sector. Main outcome measures Publicly funded standardised elective hip arthroplasty rates in Brazil and Scotland. Results Between 2009 and 2013, there was a seven-fold difference in treatment rates between Brazil and Scotland, and an eight-fold regional difference in Brazil; Brazil (7.8–8.3/100,000, increase of 0.5 per 100,000, 95% confidence interval (CI) (0.3, 0.7) from 2009/10 to 2012/13) and Scotland (from 61.1 to 57.7/100,000, decrease of 3.4 per 100,000, 95% confidence interval (1.4, 5.8) per 100,000); a two-fold difference in number of public beds per head of population (Brazil 158.3/100,000 vs. Scotland 305.1/100,000) and general medical workforce (Brazil 198.8/100,000 vs. Scotland 327.4/100,000); numbers of orthopaedic surgeons per head of population in the two countries were similar in 2013 (Brazil 5.2/100,000 vs. Scotland 4.3/100,000). Conclusion Although the ‘inverse care law’ is seen in both countries, access to publicly funded hip arthroplasties in Brazil is worse than in Scotland; the distribution of specialists and higher treatment rates in Brazil is highly skewed towards wealthier areas, perpetuating historical regional inequalities.

scholarly journals Crise Económica em Portugal: Evolução da Incidência de Depressão e Correlação com o Desemprego

2020 ◽  
Vol 33 (13) ◽  
Author(s):  
Inês Laplanche Coelho ◽  
Mafalda Sousa-Uva ◽  
Nuno Pina ◽  
Sara Marques ◽  
Carlos Matias-Dias ◽  
...  
Keyword(s):  
Social Vulnerability ◽  
Ecological Study ◽  
Preventive Measures ◽  
Portuguese Population ◽  
Sentinel Network ◽  
Unemployment Rates ◽  
Positive Correlation ◽  
National Statistics ◽  
Using Data ◽  
The Impact

Introduction: Previous studies have found an increase in the incidence rate of depression between 2007 – 2013 in Portugal, with a positive correlation with the unemployment rate, namely, in men. So, it was hypothesized that this increase is related with the situation of economic crisis. This study aimed to investigate if the correlation between unemployment rates and the incidence of depression is maintained in the post-crisis period of economic recovery in Portugal (2016 – 2018).Material and Methods: An ecological study was carried out, using data from the General Practitioners Sentinel Network concerning depression incidence (first episodes and relapses) and data from the National Statistics Institute on unemployment rates in the Portuguese population. The correlation coefficient was estimated using linear regression and the results were disaggregated by sex.Results: Between 2016 and 2018, there was a consistent decrease in the incidence of depression in both sexes. During the 1995 – 2018 period, a positive correlation was observed between unemployment and depression, with a coefficient of 0.833 (p = 0.005) in males and of 0.742 (p = 0.022) in females.Discussion: The reduction in the incidence of depression in both sexes observed between 2016 – 2018 corroborates a positive correlation between unemployment and depression in the Portuguese population, previously observed between 2007 – 2013.Conclusion: This study highlights the need to monitor the occurrence of mental illness in the Portuguese population, especially in moments of greatest social vulnerability in order to establish preventive measures, as a way to mitigate the impact of future economic crises.

scholarly journals The influence of bone quality on radiological outcome in 50 consecutive acetabular fractures treated with a pre-contoured anatomic suprapectineal plate

2021 ◽  
Author(s):  
Maximilian J. Hartel ◽  
Tareq Naji ◽  
Florian Fensky ◽  
Frank O. Henes ◽  
Darius M. Thiesen ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Bone Mass ◽  
Bone Quality ◽  
Hip Arthroplasty ◽  
Mass Density ◽  
Acetabular Fractures ◽  
Bone Mass Density ◽  
Radiological Outcome ◽  
Total Hip ◽  
The Impact

Abstract Purpose To investigate the range of indications of an anatomical-preshaped three-dimensional suprapectineal plate and to assess the impact of the bone mass density on radiologic outcomes in different types of acetabular fractures. Patients and methods A consecutive case series of 50 acetabular fractures (patient age 69 ± 23 years) treated with suprapectineal anatomic plates were analyzed in a retrospective study. The analysis included: Mechanism of injury, fracture pattern, surgical approach, need for additional total hip arthroplasty, intra- or postoperative complications, as well as bone mass density and radiological outcome on postoperative computed tomography. Results Most frequently, anterior column fracture patterns with and without hemitransverse components as well as associated two column fractures were encountered. The anterior intrapelvic approach (AIP) was used in 98% (49/50) of the cases as primary approach with additional utilization of the first window of the ilioinguinal approach in 13/50 cases (26%). Determination of bone density revealed impaired bone quality in 70% (31/44). Postoperative steps and gaps were significantly greater in this subgroup (p < 0.05). Fracture reduction quality for postoperative steps revealed anatomic results in 92% if the bone quality was normal and in 46% if impaired (p < 0.05). In seven cases (14%), the plate was utilized in combination with acute primary arthroplasty. Conclusion A preshaped suprapectineal plate provides good radiological outcomes in a variety of indications in a predominantly geriatric cohort. Impaired bone quality has a significantly higher risk of poor reduction results. In cases with extensive joint destruction, the combination with total hip arthroplasty was a valuable option.

scholarly journals Improved adherence with Medicines Use Review service in Slovenia: a randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Urška Nabergoj Makovec ◽  
Igor Locatelli ◽  
Mitja Kos
Keyword(s):  
Medication Adherence ◽  
Controlled Trial ◽  
Test Group ◽  
Multiple Linear Regression Model ◽  
Relative Difference ◽  
Control Group ◽  
Adherence Support ◽  
Medicines Use ◽  
The Impact ◽  
Medicines Use Review

Abstract Background Based on several existing patient-oriented activities, Medicines Use Review (MUR) service was standardized and officially adopted in Slovenia in 2015. Service aims to provide adherence support and ensure safe and effective medicines use. Therefore, the aim of the study was to evaluate the benefits of MUR in Slovenia, primarily the impact on medication adherence. Methods A randomised controlled trial was performed in community pharmacies to compare MUR with standard care. Patients were randomised into either the test (patients received MUR by a certified MUR provider at visit 1), or control group. The study primary outcome was self-reported adherence to multiple medications, assessed by electronic ©Morisky Widget MMAS-8 Software at the first visit (V1) and after 12 weeks (V2). A sub-analysis of intentional and unintentional non-adherence was performed. MUR impact was defined as the relative difference in ©MMAS-8 score after 12 weeks between the test and control group. A multiple linear regression model was used to predict MUR impact based on baseline adherence (low versus medium and high). Several secondary outcomes (e.g. evaluation of drug-related problems (DRPs)) were also assessed. Results Data from 153 (V1) and 140 (V2) patients were analysed. Baseline adherence was low, moderate and high in 17.6, 48.4 and 34.0% patients, respectively. In the low adherence subpopulation, test group patients showed a 1.20 point (95% CI = 0.16–2.25) increase in total ©MMAS-8 score (p = 0.025) compared to control group patients. A 0.84 point (95% CI = 0.05–1.63) increase was due to intentional non-adherence (p = 0.038), and a 0.36 point (95% CI = − 0.23-0.95) was due to unintentional non-adherence (p = 0.226). Additionally, statistically significant decrease in the proportion of patients with manifested DRPs (p < 0.001) and concerns regarding chronic medicines use (p = 0.029) were revealed. Conclusion MUR service in Slovenia improves low medication adherence and is effective in addressing DRPs and concerns regarding chronic medicines use. Trial registration ClinicalTrials.gov - NCT04417400; 4th June 2020; retrospectively registered.

Assessment of an Orthopaedic Templating Software Package for Uncemented Total Hip Arthroplasty

2020 ◽  
Vol 4 (04) ◽  
pp. 155-157
Author(s):  
Michael Newman ◽  
David Hartwright
Keyword(s):  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Acetabular Cup ◽  
Total Hip ◽  
Pelvic Radiograph ◽  
Uncemented Total Hip Arthroplasty ◽  
Femoral Stems ◽  
Hip Arthroplasties ◽  
Acetabular Components ◽  
Insight Into

AbstractThe aim of this study was to assess a large, single-surgeon dataset of uncemented total hip arthroplasties that had been templated using software. This assessment compared preoperative templated predictions with what was implanted with regard to (1) femoral prosthesis size and (2) acetabular cup size. The operation notes for two types of uncemented total hip arthroplasty performed by a single surgeon between January 9, 2008, and March 21, 2019, were assessed. The data were refined so that only those that were fully templated on a correctly calibrated pelvic radiograph were included. This provided a total of 153 cases. The predicted software template was compared with actual implanted component sizes. With regard to the femoral stems, the templating software was exactly correct in 45.75% of cases and was accurate to within one size in 87.59% of cases. With regard to the acetabular component, the templating software was exactly correct in 52.94% of cases and was accurate to within one size (2 mm) in 86.94% of cases. Templating software offers an accurate prediction of the size of uncemented femoral and acetabular components. In addition, the benefits of templating include cognitive rehearsal, insight into potentially challenging aspects of surgery, and highlighting intraoperative issues where there is a large intraoperative deviation from what is templated. This study demonstrates the congruence and reproducibility of templating software when compared with other smaller studies performed in the literature.

A systematic review of short metaphyseal loading cementless stems in hip arthroplasty

2019 ◽  
Vol 101-B (5) ◽  
pp. 502-511 ◽  
Author(s):  
S. Lidder ◽  
D. J. Epstein ◽  
G. Scott
Keyword(s):  
Systematic Review ◽  
Hip Arthroplasty ◽  
Harris Hip Score ◽  
Ethical Practice ◽  
Term Survival ◽  
The Mean ◽  
Review Reports ◽  
Femoral Implants ◽  
Hip Arthroplasties

Aims Short-stemmed femoral implants have been used for total hip arthroplasty (THA) in young and active patients to conserve bone, provide physiological loading, and reduce the incidence of thigh pain. Only short- to mid-term results have been presented and there have been concerns regarding component malalignment, incorrect sizing, and subsidence. This systematic review reports clinical and radiological outcomes, complications, revision rates, and implant survival in THA using short-stemmed femoral components. Materials and Methods A literature review was performed using the EMBASE, Medline, and Cochrane databases. Strict inclusion and exclusion criteria were used to identify studies reporting clinical and radiological follow-up for short-stemmed hip arthroplasties. Results A total of 28 studies were eligible for inclusion. This included 5322 hips in 4657 patients with a mean age of 59 years (13 to 94). The mean follow-up was 6.1 years (0.5 to 20). The mean Harris Hip Score improved from 46 (0 to 100) to 92 (39 to 100). The mean Oxford Hip Score improved from 25 (2 to 42.5) to 35 (12.4 to 48). The mean Western Ontario & McMaster Universities Osteoarthritis Index improved from 54 (2 to 95) to 22 (0 to 98). Components were aligned in a neutral coronal alignment in up to 90.9% of cases. A total of 15 studies reported component survivorship, which was 98.6% (92% to 100%) at a mean follow-up of 12.1 years. Conclusion Short-stemmed femoral implants show similar improvement in clinical and radiological outcomes compared with conventional length implants. Only mid-term survivorship, however, is known. An abundance of short components have been developed and used commercially without staged clinical trials. Long-term survival is still unknown for many of these components. There remains tension between innovation and the moral duty to ensure that the introduction of new implants is controlled until safety and patient benefit are demonstrated. Implant innovation and subsequent use should be driven by proven clinical outcomes, rather than market and financial forces, and ethical practice must be ensured. Cite this article: Bone Joint J 2019;101-B:502–511.

scholarly journals Prevalence of internalizing disorders, symptoms, and traits across age using advanced nonlinear models

2021 ◽  
pp. 1-10
Author(s):  
Hanna M. van Loo ◽  
Lian Beijers ◽  
Martijn Wieling ◽  
Trynke R. de Jong ◽  
Robert A. Schoevers ◽  
...  
Keyword(s):  
Internalizing Symptoms ◽  
Nonlinear Models ◽  
Generalized Additive Models ◽  
Population Sample ◽  
Internalizing Disorders ◽  
Relative Difference ◽  
Additive Models ◽  
Point Prevalence ◽  
Cross Sectional ◽  
The Impact

Abstract Background Most epidemiological studies show a decrease of internalizing disorders at older ages, but it is unclear how the prevalence exactly changes with age, and whether there are different patterns for internalizing symptoms and traits, and for men and women. This study investigates the impact of age and sex on the point prevalence across different mood and anxiety disorders, internalizing symptoms, and neuroticism. Methods We used cross-sectional data on 146 315 subjects, aged 18–80 years, from the Lifelines Cohort Study, a Dutch general population sample. Between 2012 and 2016, five current internalizing disorders – major depression, dysthymia, generalized anxiety disorder, social phobia, and panic disorder – were assessed according to DSM-IV criteria. Depressive symptoms, anxiety symptoms, neuroticism, and negative affect (NA) were also measured. Generalized additive models were used to identify nonlinear patterns across age, and to investigate sex differences. Results The point prevalence of internalizing disorders generally increased between the ages of 18 and 30 years, stabilized between 30 and 50, and decreased after age 50. The patterns of internalizing symptoms and traits were different. NA and neuroticism gradually decreased after age 18. Women reported more internalizing disorders than men, but the relative difference remained stable across age (relative risk ~1.7). Conclusions The point prevalence of internalizing disorders was typically highest between age 30 and 50, but there were differences between the disorders, which could indicate differences in etiology. The relative gap between the sexes remained similar across age, suggesting that changes in sex hormones around the menopause do not significantly influence women's risk of internalizing disorders.

scholarly journals The impact of reducing the femoral stem length in total hip arthroplasty during gait

2021 ◽  
Author(s):  
Anatole Vilhelm Wiik ◽  
Adeel Aqil ◽  
Bilal Al-Obaidi ◽  
Mads Brevadt ◽  
Justin Peter Cobb
Keyword(s):  
Total Hip Arthroplasty ◽  
Gait Analysis ◽  
Hip Arthroplasty ◽  
Femoral Stem ◽  
Short Stem ◽  
Stem Length ◽  
Practical Consideration ◽  
Total Hip ◽  
Long Stem ◽  
The Impact

Abstract Aim The length of the femoral stem in total hip arthroplasty (THA) is a practical consideration to prevent gait impairment. The aim of this study was to determine if reducing the femoral stem length in THA would lead to impaired gait biomechanics. Methods Patients uniformly with the same brand implant of differing lengths (100 mm vs 140–166 mm) were taken retrospectively from a prospective trial introducing a new short stem. Twelve patients without any other disorder to alter gait besides contralateral differing length stem THA were tested at differing gradients and speed on a validated instrumented treadmill measuring ground reaction forces. An anthropometrically similar group of healthy controls were analysed to compare. Results With the same posterior surgical approach, the offset and length of both hips were reconstructed within 5 mm of each other with an identical mean head size of 36 mm. The short stem was the last procedure for all the hips with gait analysis occurring at a mean of 31 and 79 months postoperatively for the short and long stem THA, respectively. Gait analysis between limbs of both stem lengths demonstrated no statistical difference during any walking condition. In the 90 gait assessments with three loading variables, the short stem was the favoured side 51% of the time compared 49% for the long stem. Conclusion By testing a range of practical walking activities, no lower limb loading differences can be observed by reducing the femoral stem length. A shorter stem demonstrates equivalence in preference during gait when compared to a reputable conventional stem in total hip arthroplasty.

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