Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

BACKGROUND

Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories.

METHODS

We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5-19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median).

FINDINGS

From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness.

INTERPRETATION

The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.

FUNDING

UK Medical Research Council, UK Research and Innovation (Research England), UK Research and Innovation (Innovate UK), and European Union.

Knee osteoarthritis after meniscectomy: prevalence of radiographic changes after twenty-one years, compared with matched controls

OBJECTIVE

To study the long-term outcome of surgical removal of a meniscus in the knee with regard to radiographic signs of osteoarthritis (OA).

METHODS

Of the 123 patients who underwent an open meniscectomy due to an isolated meniscus tear in 1973 at Lund University Hospital, 107 were followed up 21 years later by clinical examination and by review of knee radiographs obtained with weight bearing. Seventy-nine of the 107 patients were men, and the mean age of the total study group at examination was 55 years (range 35-77). Sixty-eight sex- and age-matched individuals with healthy knees served as controls.

RESULTS

Mild radiographic changes were found in 76 (71%) of the knees, while more advanced changes, comparable with a Kellgren-Lawrence grade of 2 or higher, were seen in 51 (48%). The corresponding prevalence values in the control group were 12 (18%) and 5 (7%), respectively. The relative risk for the presence of the more advanced radiographic changes representing definite radiographic tibiofemoral OA was 14.0 (95% confidence interval 3.5-121.2), using age- and sex-matched pairs for comparison. No correlation with sex, localization to compartment, type of meniscus tear, or work load was found. Knee symptoms were reported twice as often in the study group as in the controls.

CONCLUSION

Surgical removal of a meniscus following knee injury represents a significant risk factor for radiographic tibiofemoral OA, with a relative risk of 14.0 after 21 years.

Wound tissue oxygen tension predicts the risk of wound infection in surgical patients

OBJECTIVE

To test the hypothesis that subcutaneous wound oxygen tension (PsqO2) has a predictive relation to the development of wound infection in surgical patients.

DESIGN

A noninterventional, prospective study.

SETTING

A university department of surgery.

PATIENTS

One hundred thirty operative general surgical patients at notable risk of infection as predicted by an anticipated Study on the Effect of Nosocomial Infection Control (SENIC) score of 1 or greater.

OUTCOME MEASURES

PsqO2 was measured perioperatively. Its relation to the subsequent incidence of surgical wound infection was then determined and compared with the SENIC score as a criterion standard.

RESULTS

Although the SENIC score and PsqO2 are inversely correlated, PsqO2 is the stronger predictor of infection. Low PsqO2 identified patients at risk and concentrated them in a cohort that was about half the size of that identified by the SENIC score.

CONCLUSIONS

Subcutaneous perfusion and oxygenation are important components of immunity to wound infections. The SENIC score identifies systemic physiological variables that are important to the development of wound infection. Nevertheless, PsqO2 is the more powerful predictor of wound infection. Moreover, PsqO2 can be manipulated by available clinical means, and thus may direct interventions to prevent infection.

Tissue oxygenation, anemia, and perfusion in relation to wound healing in surgical patients

Oxygen tension and collagen deposition were measured in standardized, subcutaneous wounds in 33 postoperative surgical patients. Pertinent clinical and wound parameters were analyzed by Pearson's correlation test and sequential linear regression analysis. Collagen deposition was directly and significantly proportional to wound oxygen tension and measures of perfusion. There were no significant correlations with hematocrit, estimated blood loss, length of operation, smoking, age, weight, sex, or urine output. This study in humans confirms animal experiments showing that collagen deposition and tensile strength in wounds are limited by perfusion and tissue oxygen tension. It appears unnecessary to maintain hemoglobin at normal levels to support repair, provided that peripheral perfusion can be maintained at a high level in compensation for anemia. These circumstances reflect the fact that although oxygen is essential to many aspects of healing, and must be delivered at adequate partial pressures, reparative tissue consumes relatively little of it.

Enzyme-linked immunosorbent assay. II. Quantitative assay of protein antigen, immunoglobulin G, by means of enzyme-labelled antigen and antibody-coated tubes

Alkaline phosphatase from calf intestinal mucosa has been conjugated to a protein antigen, rabbit IgG. Such conjugates, prepared by glutardialdehyde, have been used in a competitive solid phase immunoassay. In this test native antigen inhibits the binding of the conjugate to homologous antibodies adsorbed to plastic tubes. Using this assay 1-100 ng/ml of the antigen could be determined.

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

BACKGROUND

Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents.

METHODS

For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5-19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence.

FINDINGS

We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9-10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes-gaining too little height, too much weight for their height compared with children in other countries, or both-occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls.

INTERPRETATION

The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks.

FUNDING

Wellcome Trust, AstraZeneca Young Health Programme, EU.

Percutaneous transluminal renal angioplasty versus surgical reconstruction of atherosclerotic renal artery stenosis: a prospective randomized study

PURPOSE

The purpose of this prospective randomized study was to compare percutaneous transluminal renal angioplasty (PTRA) and operation as initial therapy with regard to technical results, primary and secondary patency, and effects on blood pressure and renal function in patients with atherosclerotic unilateral renal artery stenosis.

METHODS

Fifty-eight patients who did not have diabetes, who were less than 70 years of age, and who had severe hypertension and significant stenosis were randomized to receive PTRA or operation. Angiography was performed 10 days, 1 year, and 2 years after treatment to verify patency, and blood pressure and renal function were simultaneously evaluated.

RESULTS

Technically, PTRA was successful in 83% and operation in 97% of patients. The primary patency rate after 24 months was 75% in the PTRA group and 96% in the operative group in technically successful cases. The secondary patency rate in the PTRA group was 90% and in the surgical group 97%. To achieve these results four patients in the PTRA group required operation, and one patient in the surgical group required PTRA. Hypertension was cured or improved after additional treatment in 90% of the patients after PTRA and 86% after operation. The corresponding figures for improved or unchanged renal function were 83% and 72%, respectively. After additional treatment, effects on blood pressure and renal function did not differ. Seventeen percent of the patients treated with PTRA required surgical intervention.

CONCLUSIONS

PTRA is recommended as first choice of therapy for atherosclerotic renal artery stenosis causing renovascular hypertension if combined with intensive follow-up and aggressive reintervention.

The topography of the vascular systems in the periodontal and peri-implant tissues in the dog

The present investigation reports an animal experiment the objective of which was to study the vascular topography of the periodontium and the peri-implant soft and hard tissues in the beagle dog. 2 beagle dogs were used. The right mandibular premolars were extracted and healing allowed for 3 months. 2 titanium fixtures a.m. Brånemark were installed in the right premolar region. Abutment connection was performed 3 months later. The contra-lateral mandibular sites were used as tooth harboring control units. A 4-month period of meticulous plaque control was initiated. A clinical and radiographical examination was performed towards the end of this period and revealed that the gingiva and peri-implant mucosa were clinically healthy and that the bone tissue at teeth and implants had a normal height. The carotid arteries were perfused with a mixture of carbon and calf serum. 2 bucco-lingual sections, about 100-150 microns thick, and one mesio-distal section comprising the junctional epithelium and underlying connective tissue were sampled. The sections were treated, cleared and examined in a microscope. The results of the present investigation demonstrated that the vasculature of the gingiva and the supracrestal connective tissue at teeth is derived from two sources, namely the supraperiosteal vessels lateral of the alveolar process and the vessels of the periodontal ligament. The blood vessels of the peri-implant mucosa were found to be terminal branches of larger vessels originating from the periosteum of the bone of the implant site.(ABSTRACT TRUNCATED AT 250 WORDS)

Thirty-year follow-up of ankle fractures

The natural course of ankle fractures was studied in 143 patients treated by closed methods. The average time elapsing from fracture to follow-up was 29 years. Eighty-two per cent had no radiographic signs of arthrosis; 83 per cent were free of symptoms. The most common fracture, supination eversion Stage II (49 cases), gave rise to minimal signs of arthrosis in only one patient, who had moderate symptoms. The suggestion that all ankle fractures must be perfectly reduced is not supported by the findings of the present study.

Scandinavian Sarcoma Group Osteosarcoma Study SSG VIII: prognostic factors for outcome and the role of replacement salvage chemotherapy for poor histological responders

From 1990 to 1997, 113 eligible patients with classical osteosarcoma received neo-adjuvant chemotherapy consisting of high-dose methotrexate, cisplatin and doxorubicin. Good histological responders continued to receive the same therapy postoperatively, while poor responders received salvage therapy with an etoposide/ifosfamide combination. With a median follow-up of 83 months, the projected metastasis-free and overall survival rates at 5 years are 63 and 74%, respectively. Independent favourable prognostic factors for outcome were tumour volume < 190 ml, 24-h serum methotrexate > 4.5 microM and female gender. The etoposide/ifosfamide replacement combination did not improve outcome in the poor histological responders. In conclusion, this intensive multi-agent chemotherapy results in > 70% of patients with classical osteosarcoma surviving for 5 years. The data obtained from this non-randomised study do not support discontinuation and exchange of all drugs used preoperatively in histological poor responders. As observed in previous Scandinavian osteosarcoma studies, female gender appears to be a strong predictor of a favourable outcome.

Course of radiographic damage over 10 years in a cohort with early rheumatoid arthritis

OBJECTIVE

To investigate development of radiographic damage in hands and feet of patients with early rheumatoid arthritis (RA) monitored prospectively for 10 years, and to search for prognostic factors.

PATIENTS AND METHODS

181 patients with early RA (mean disease duration one year) were assessed annually with radiographs of hands and feet during years 0-5 and at year 10. Radiographs were evaluated according to Larsen (range 0-200). Predictive factors for progressive disease for years 0-5 and 5-10 were evaluated by logistic regression analyses.

RESULTS

82/168 (49%) patients had erosions at inclusion and almost all became erosive with time (90% after two years and 96% after 10 years). Radiographic progression was most rapid during the first two years and 75% of all damage occurred during the first five years. The median Larsen score increased from 6 at inclusion to 41 after five years and 54 after 10 years. Only 5.3% of all evaluated joints became maximally eroded, the second metacarpophalangeal joint being the most commonly affected. Mean ESR during the first three months and rheumatoid factor status were significant predictors for radiographic progressive disease, it was not possible to predict non-progressive disease.

CONCLUSIONS

Joint damage in hands and feet developed early and progression was most rapid during the first years of disease. The different rates of progression at different stages should be considered in the design of trials of drugs aimed at retarding joint damage. Disease activity at study start influenced the degree of joint damage during the entire 10 years.

Development of radiographic damage during the first 5-6 yr of rheumatoid arthritis. A prospective follow-up study of a Swedish cohort

The objective of this study was to describe the development of radiographic damage in patients with RA and to search for predictors of radiographic progression over 5 yr. One hundred and thirteen patients, 75 female and 38 male, mean age 53 yr, with definite RA and mean disease duration of 11.4 months, were followed prospectively for 5 yr at an out-patient clinic. Radiographs of the hands and feet were performed annually, and evaluated according to Larsen. The predictive value of demographic, clinical and laboratory variables at study start was evaluated. A stepwise logistic regression model was applied. We found that radiological joint damage occurred early and was significantly progressive during the 5 study years. The rate of progression was most prominent during the first 2 yr. At study start, 53% of the patients had no detectable erosions, but only 11% remained non-erosive. Twenty-six per cent of the patients with the initial presence of erosions did not progress substantially and needed no aggressive therapy. High joint damage progression during the first year, female gender and high baseline ESR could predict 57% of the patients with high total radiographic progression. Age, disease duration, rheumatoid factor, genetic factors, active joint count and the presence of erosions at study start had no predictive value.

Distal radioulnar instability is an independent worsening factor in distal radial fractures

Distal radial fractures in patients who are younger than the age when osteoporosis usually develops are different from fractures in the elderly. Arthroscopy has revealed these fractures often have a complex pattern of fracture related chondral and ligament injuries in the wrist. In Lund, Sweden, of the 92 distal radial fractures that occurred during 1 year in patients younger than the age when osteoporosis usually develops, 76 patients were assessed after more than 1 year (range, 14-38 months). The examination included questions, a visual analogue scale for pain, a physical examination, bilateral radiographic assessment, and wrist score determination according to Gartland and Werley. Instability at clinical examination of the distal radioulnar joint was associated with a worse wrist score and doubled the visual analogue measures for pain at rest and pain at load. This instability was not correlated to any radiographic variable at the time of fracture or at followup. The distal radioulnar joint was painful in 17 of the 27 patients with instability. Radiographic scapholunate dissociation did not affect the outcome. However, radiographic osteoarthrosis Grade 1 was associated with a worse wrist score. The outcome was dependent on the stability of the distal radioulnar joint, which in turn was not correlated to any radiographic parameter. Thus, destabilizing ligamentous injuries are thought to be an important cause of residual problems.

Assessment of perfusion in postoperative patients using tissue oxygen measurements

Subcutaneous tissue oxygen tension was measured as an index of perfusion in 44 postoperative patients. Hypoperfusion was defined as suboptimal tissue oxygen tension unresponsive to increased inspired oxygen but becoming responsive after increased fluid infusion. Twelve of thirty patients who underwent major abdominal and flank operations were found to be suboptimally perfused by this definition despite adequate fluid maintenance according to standard clinical criteria including urine output. Apparently, a significant number of postoperative abdominal surgery patients are not optimally perfused, and this state is not recognized by the present clinical criteria. Tissue oximetry may be a useful objective method of assessing tissue perfusion.

Osteochondritis dissecans of the ankle. A 20-year follow-up study

Thirty patients with osteochondritis dissecans of the ankle have been followed up for an average of 21 years. The histories and radiographs were reviewed, and it was found that most patients had only minor radiographic changes and symptoms. Two patients had developed osteoarthritis but in only one was this severe. Osteochondritis dissecans in the ankle thus seems to differ from the same lesion in the knee where late osteoarthritis often occurs. Two lesions were located on the joint surface of the distal tibia, a site not previously reported.

Correlation between radiographically diagnosed osteophytes and magnetic resonance detected cartilage defects in the tibiofemoral joint

OBJECTIVE

To assess the correlation between the presence of radiographically diagnosed osteophytes in the tibiofemoral joint (TFJ) and (1) magnetic resonance (MR) detected cartilage defects and meniscal lesions in the same joint and (2) knee pain.

METHODS

Fifty-nine people, 29 men and 30 women, with chronic knee pain (aged 41-58 years, mean 50 years) were examined with posteroanterior weightbearing radiograms in semiflexion of both TFJ. The presence and grade of marginal and central osteophytes were assessed. On the same day, an MR examination was performed of the signal knee with proton density and T2 weighted turbo spin-echo sequences on a 1.0 T imager. Cartilage defects and meniscal abnormalities in the TFJ were noted. The subjects were questioned for current knee pain for each knee.

RESULTS

Marginal osteophytes had a sensitivity of 77%, specificity of 83%, and positive predictive value of 87% for MR detected cartilage defects in the TFJ and a sensitivity of 71%, specificity of 68%, and positive predictive value of 71% for meniscal abnormalities. A correlation (p < 0.05) between osteophytes at the medial tibial condyle and knee pain was found.

CONCLUSIONS

With the presence of marginal osteophytes in the TFJ there is a high prevalence of MR detected cartilage defects in the same joint whether joint space narrowing (< 3 mm) is present or not.

Injectable calcium phosphate in the treatment of distal radial fractures

An injectable material which hardened in situ to form a carbonated hydroxyapatite, Norian SRS (Norian Corp., Cupertino, USA), was used as the only treatment of unstable distal radial fractures in six patients. Except for an external dorsal splint for 2 weeks, no other treatment was used. The material maintained reduction except in one case in which there were technical problems during hardening and the material fragmented postoperatively. By 1 year all patients had a satisfactory clinical outcome. There was an early return of motion. The possibility of mobilization 1 or 2 weeks after the operation may reduce postoperative stiffness and increase short-term functional outcome.

Norian SRS versus external fixation in redisplaced distal radial fractures. A randomized study in 40 patients

We compared Norian SRS, an injectable calcium phosphate bone cement, with external fixation in the treatment of redisplaced distal radial fractures by a prospective randomized study in 40 patients (women 50-80 years or men 60-80 years). After rereduction, the fracture was either stabilized by injection of SRS and immobilized with a cast for 2 weeks, or externally fixed with Hoffman's bar for 5 weeks. Each patient was evaluated at 2, 5, 7 weeks and at 3, 6 and 12 months. Functional parameters were grip strength, range of motion and pain. Radiographic parameters were radial angle, ulnar variance and dorsal tilt. The chosen primary effect variable was grip strength at 7 weeks. Patients treated by injection of SRS apatite had better grip strength, wrist extension and forearm supination at 7 weeks. There was no difference in functional parameters at 3 months or later. None of the methods could fully stabilize the fracture: radiographs showed a progressive redislocation over time. The results indicate that SRS can be used in the treatment of unstable distal radial fractures. The more rapid recovery of grip strength and wrist mobility in the SRS group appears to be due to the shorter immobilization time.

Physical Activity, Screen Time, and Sleep Duration of Children Aged 6-9 Years in 25 Countries: An Analysis within the WHO European Childhood Obesity Surveillance Initiative (COSI) 2015-2017

BACKGROUND

Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure time are increasing.

OBJECTIVES

This study aimed to evaluate physical activity (PA), screen time, and sleep duration of girls and boys aged 6-9 years in Europe using data from the WHO European Childhood Obesity Surveillance Initiative (COSI).

METHOD

The fourth COSI data collection round was conducted in 2015-2017, using a standardized protocol that included a family form completed by parents with specific questions about their children's PA, screen time, and sleep duration.

RESULTS

Nationally representative data from 25 countries was included and information on the PA behaviour, screen time, and sleep duration of 150,651 children was analysed. Pooled analysis showed that: 79.4% were actively playing for >1 h each day, 53.9% were not members of a sport or dancing club, 50.0% walked or cycled to school each day, 60.2% engaged in screen time for <2 h/day, and 84.9% slept for 9-11 h/night. Country-specific analyses of these behaviours showed pronounced differences, with national prevalences in the range of 61.7-98.3% actively playing for >1 h/day, 8.2-85.6% were not members of a sport or dancing club, 17.7-94.0% walked or cycled to school each day, 32.3-80.0% engaged in screen time for <2 h/day, and 50.0-95.8% slept for 9-11 h/night.

CONCLUSIONS

The prevalence of engagement in PA and the achievement of healthy screen time and sleep duration are heterogenous across the region. Policymakers and other stakeholders, including school administrators and parents, should increase opportunities for young people to participate in daily PA as well as explore solutions to address excessive screen time and short sleep duration to improve the overall physical and mental health and well-being of children.

A Prospective study on the epidemiology of burns in patients admitted to the Harare burn units

The purpose of this study was to record the causes and the magnitudes of burn injuries prospectively and to evaluate the outcome of treatment of patients admitted to the burn units in Harare. The median age of the 451 patients included was 6 years (range: 1 month to 71 years), 54% were female and 46% male. The burn injuries were caused by flame in 51% of the cases and hot liquids in 47%. The overall median total body surface area burnt was 13% (range: 0.5 to 99%). Parasuicidal burns (attempted suicides) were noted in 11% of the patients with a median total body surface area burnt of 30% and mortality of 73%. Lodgers were overrepresented in the material. Delayed split skin grafting was done on 26% of the patients and early primary excision and skin grafting on 3%. The overall median hospital stay was 15 days (range: 0 to 229 days). The median hospital stay for patients with delayed split skin grafting was 42 days and that for those with primary excision and split skin grafting was 17 days. The overall mortality was 22%. All patients with burns larger than 65% of the total body surface area died. Burn injuries were more frequent and larger with higher mortality in females than in males. Flame was the major cause of the burns. Self-inflicted burns, noted mainly in young women, resulted in 73% mortality. Primary excision and grafting reduced hospital stay by 60% compared to delayed skin grafting.

Detection of infection in loosened hip prostheses: efficacy of sonography

OBJECTIVE

The purpose of this study was to determine the efficacy of sonography in the detection of infection in loosened hip prostheses.

MATERIALS AND METHODS

The normal capsular morphology in 15 asymptomatic patients with total hip replacements was studied sonographically. Sonograms were then obtained in 33 patients who had pain in the hip after arthroplasty and radiologic findings of loosening of the prosthesis. These patients subsequently underwent aspiration and arthrography of the hip. Six of the 33 symptomatic patients proved to have prosthetic joint infection.

RESULTS

On sonograms, the normal pseudocapsule is adherent to the proximal part of the anterior femoral cortex, and the capsule-to-bone distance is less than 3.2 mm (average, 2.6 mm). No hips with a capsule-to-bone distance less than 3.2 mm were infected. Sonograms in the six patients with infection showed marked intraarticular effusion with a mean capsule-to-bone distance of 10.2 mm. Five of these six had extracapsular fluid collections. Two patients with hip dislocations and four with aseptic loosening of the prosthesis had capsular distension on sonograms and cultures of aspirated material that showed no growth.

CONCLUSION

Sonography can be used to diagnose infection around loosened hip prostheses. All patients who had an intraarticular effusion with extraarticular extension seen on sonograms had infection.

Intracapsular pressure and loosening of hip prostheses. Preoperative measurements in 18 hips

We measured the intracapsular pressure preoperatively in 18 hips (17 patients) before revision of a total hip arthroplasty because of aseptic loosening. Distension of the joint capsule was measured with sonography in 13 cases. In extension, the mean intracapsular pressure was 26 (0-60) mmHg, in extension and inward rotation it was 159 (24-280) mmHg, in extension and outward rotation it was 30 (3-67) mmHg and in 45 degrees of flexion it was 12 (0-28) mmHg. A mean of 6 (0.5-20) mL of joint fluid was aspirated after the pressure measurements. Sonography showed increased joint fluid/synovial edema and/or increased capsular thickness, as compared to 34 unrevised, radiographically not loose prosthetic hips, and that the capsular distension correlated to intracapsular pressure during extension and inward rotation. We conclude that the intracapsular pressure usually is elevated in a hip joint with loose prosthetic components, that the intracapsular pressure varies with the position of the hip and that capsular distension reflects increased intracapsular pressure. The increased and often very high pressure, varying during gait, may pump debris away from the joint along the interfaces and even by itself cause osteolysis and loosening.

Socioeconomic inequalities in overweight and obesity among 6- to 9-year-old children in 24 countries from the World Health Organization European region

Childhood overweight and obesity have significant short- and long-term negative impacts on children's health and well-being. These challenges are unequally distributed according to socioeconomic status (SES); however, previous studies have often lacked standardized and objectively measured data across national contexts to assess these differences. This study provides a cross-sectional picture of the association between SES and childhood overweight and obesity, based on data from 123,487 children aged 6-9 years in 24 countries in the World Health Organization (WHO) European region. Overall, associations were found between overweight/obesity and the three SES indicators used (parental education, parental employment status, and family-perceived wealth). Our results showed an inverse relationship between the prevalence of childhood overweight/obesity and parental education in high-income countries, whereas the opposite relationship was observed in most of the middle-income countries. The same applied to family-perceived wealth, although parental employment status appeared to be less associated with overweight and obesity or not associated at all. This paper highlights the need for close attention to context when designing interventions, as the association between SES and childhood overweight and obesity varies by country economic development. Population-based interventions have an important role to play, but policies that target specific SES groups are also needed to address inequalities.

Distinct cytologic features of spindle cell lipoma. A cytologic-histologic study with clinical, radiologic, electron microscopic, and cytogenetic correlations

BACKGROUND

Spindle cell lipoma (SCL) is a relatively uncommon, benign tumor that usually presents in the subcutaneous fat of adult men. Although some studies have addressed the histologic findings of SCL, only a few descriptions of aspiration cytology findings have been published. The cytologic features are poorly defined, and aspirates from SCL may cause diagnostic problems, because SCL shares some features with other fatty/spindle cell or myxoid lesions, benign as well as malignant.

METHODS

Twelve patients underwent fine-needle aspiration (FNA) cytology as the primary diagnostic modality before surgery. FNA findings were evaluated and correlated with histologic features. In addition, radiologic, electron microscopic, and cytogenetic findings were analyzed. The objective of this study was to determine cytologic criteria of SCL by reviewing cytologic specimens in 12 patients with SCL who underwent FNA cytology.

RESULTS

All of the tumors arose in adults, and 10 tumors developed in the subcutaneous tissue of the neck, back, or shoulder girdle. Two patients presented with tumors in atypical locations; one in the tongue and one in the cheek. Cytologically, all 12 tumors were characterized by a mixture of mature adipocytes, uniform spindle cells, and collagen bundles and/or fibers in varying proportions. The presence of a myxoid matrix and of mast cells was less specific and occurred in six aspirates.

CONCLUSIONS

SCL has a characteristic cytologic appearance that, together with clinical data, helps to exclude low-grade liposarcoma as well as other spindle cell and myxoid lesions.

Interposition arthroplasty of the elbow with rheumatoid arthritis

Radiographic bone loss and clinical outcome were evaluated at a median of 6 years after interposition arthroplasty was performed in 35 elbows with rheumatoid arthritis. Seven early postoperative complications, two major and five minor, occurred. Three elbows subsequently required total elbow replacement. Clinical results were good in terms of pain relief but only fair in terms of joint mobility and stability. Radiographic elbow destruction progressed to a higher Larsen stage in half of the elbows. Measurements revealed humeral bone loss in two thirds of the elbows and ulnar bone loss in one third. In comparison with total elbow replacement, the long-term results of interposition arthroplasty were found to be inferior, with a total elbow replacement being required in one tenth of the elbows in the long term. In addition, bone loss often became extensive, making reoperation difficult or impossible. The authors recommend total elbow replacement as the first choice in the surgical treatment of the painful elbow with rheumatoid arthritis and cartilage destruction.