The prevalence of bilateral and ipsilateral radiographic osteoarthritis is high in White, Asian and Native Hawaiian/Pacific Islanders presenting for unilateral knee or hip arthroplasty

BACKGROUND

It is estimated that one-third of patients presenting with unilateral joint pain have contralateral osteoarthritis (OA) at first presentation. Most studies have primarily examined White patient cohorts. The purpose of this study was to determine the prevalence of contralateral joint OA for patients presenting for unilateral total knee (TKA), unicompartmental knee (UKA) or total hip arthroplasty (THA) among Asian, Native Hawaiian/Pacific Islander and White patients.

METHODS

Bilateral radiographic reports at initial presentation of 2,312 subjects who underwent unilateral arthroplasties (332 UKAs, 933 TKAs and 1,047 THAs) were reviewed. The presence of contralateral OA was recorded and compared by racial group and type of arthroplasty performed. Parametric statistical analyses were performed to determine differences between groups. Multivariable analyses were completed for each arthroplasty group to determine the influence on the presence of contralateral OA, presented as odds ratios and 95% confidence intervals.

RESULTS

Contralateral joint OA was present in 86.7%, 90.4% and 70.4% of UKA, TKA and THA patients, respectively. Concurrent hip OA was present in 41.6% and 59.5% of UKA and TKA patients. No racial differences in the prevalence of contralateral knee OA were found for knee arthroplasty patients. White patients (74.6%) had a greater prevalence of contralateral hip OA compared to Asians (66.5%, p = 0.037) amongst THA recipients. Increased age and body mass index were significantly associated with the presence of contralateral knee OA. Increased age, being male and being White were significant contributors for the presence of contralateral hip OA.

CONCLUSION

The prevalence of contralateral joint OA and concurrent hip OA is high in all three racial groups. Due to the extensive prevalence of contralateral and concurrent knee and hip OA, bilateral radiographic evaluation should be considered for all patients presenting with unilateral hip or knee pain due to OA.

The corona pandemic and participatory governance: Responding to the vulnerabilities of secondary school students in Europe

Adolescents in secondary schools have limited susceptibility to the SARS-COV-2 virus, but paradoxically are considered to be carrying the highest psychosocial burden during this pandemic. The aim of our European multi-country qualitative research was to investigate the COVID-19 crisis response in secondary schools and the role of national, regional, and local stakeholders in contributing to a participatory governance approach. We carried out 11 months of qualitative fieldwork, which included 90 respondents from the Netherlands, Ireland, and Finland for in-depth interviews and/or group discussions. Participant observation was conducted in four secondary schools to explore the interplay of day-to-day formal and informal practices of crisis governance. Our findings contribute to a better understanding of what efforts were made to facilitate participatory governance and where a bottom-up approach would have served useful in successfully implementing the COVID-19 mitigation strategies. Moreover, we show how these mitigation strategies have led to unintended consequences, such as students' difficulties with isolation and associated mental health problems, and the struggles of socialization when returning to a physical school environment. Our findings highlight the importance of the school environment in the socio-emotional developments of adolescents. We introduce the TAPIC-R model to analyze good governance, advancing the existing TAPIC model with an emphasis on the role of resilience in shaping participatory governance. We argue this is urgently needed during crises to strengthen engagement of the community, including vulnerable groups and achieve positive outcomes within and across policy structures and action domains.

Squamous Cell Carcinoma of the Vulva: Clinicopathologic Features of Human Papillomavirus (HPV) Associated and Independent Lesions

Introduction/Objective

Vulvar squamous cell carcinoma (VSCC) develops via HPV-associated and HPV-independent pathways. Each subset is notable for distinct precursor lesions, morphology, epidemiology and prognoses. There is no consensus regarding the incidence of HPV-associated VSCC, although the literature estimates a range of 15–79%. The current investigation aims to determine the incidence and clinicopathologic features of HPV-associated and HPV- independent VSCC in a diverse, multi-ethnic population.

Methods/Case Report

Resections specimens of VSCC from 1991 to 2020 were retrospectively identified. Cases were reviewed for confirmation of diagnosis, followed by immunohistochemical staining for p16. Age at diagnosis, ethnicity, body mass index, smoking history, tumor size, depth of invasion, and stage were obtained. Statistical analyses included t and Fisher’s exact tests as appropriate, with p<0.05 considered statistically significant.

Results (if a Case Study enter NA)

Sixty-seven VSCC cases were reviewed. By immunohistochemistry, 34 (51%) were HPV-associated. Age at diagnosis was statistically significant (p = 0.0008), with an average age of 63 years for HPV-associated and 75 years for HPV-independent VSCC.Tumor size approached statistical significance (p = 0.0577), with larger tumors occurring in the absence of HPV. Additionally, the incidence of HPV-independent VSCC nearly doubled every 10 years while the incidence of HPV-associated VSCC remained constant.

Conclusion

In this diverse, multi-ethnic cohort, the incidence of HPV-associated VSCC (51%) is at the higher end of the global range of 15-79%. Differences in age demonstrated statistical significance, supporting existing data describing HPV-associated VSCC diagnosed in relatively younger women. Tumor size approached statistical significance, signaling a correlation between HPV-independent VSCC and larger tumors; findings that may support reports of HPV-independent VSCC being associated with a worse prognosis. The increasing incidence of HPV- independent VSCC compared to a constant rate of HPV-associated VSCC suggests changing patterns of detection and pathogenesis.

A prospective cost-effectiveness analysis of vertical banded gastroplasty for the treatment of morbid obesity

BACKGROUND

Surgical treatment of morbid obesity is gaining in popularity, because conservative treatment is ineffective. However, a cost-effectiveness analysis has never been performed and is the main goal of the present study.

METHODS

21 consecutive morbidly obese patients were tested before and after vertical banded gastroplasty (VBG). Quality of life was assessed with the Nottingham Health Profile and a visual analogue scale. A prevalence-based cost-of-illness analysis of morbid obesity was performed and the cost-effectiveness of VBG assessed.

RESULTS

VBG resulted in a significant weight loss and an improved quality of life. The improved quality of life combined with 3.6 life-years gained after VBG resulted in 12 quality adjusted life-years (QALY) gained in a lifelong scenario. Lifelong costs of illness of morbidly obese persons ranged from $8,304 to $9,367. Total direct costs of VBG were $5,865. The percentage of patients performing paid labor increased from 19% before VBG to 48% after VBG, resulting in an average productivity gain of $2,765 per year. In summary, the cost-effectiveness analysis revealed that surgical treatment of morbid obesity by means of VBG saves $4,004 to $3,928 per QALY (overall dominance).

CONCLUSION

Because treatment of morbid obesity with VBG results in QALYs gained and less costs, there is no doubt that this procedure should be introduced or continued from a societal point of view.