Prevalence of chronic diseases by immigrant status and disparities in chronic disease management in immigrants: a population-based cohort study, Valore Project

BACKGROUND: For chronic conditions, disparities can take effect cumulatively at various times as the disease progresses, even when care is provided. The aim of this study was to quantify the prevalence of diabetes, congestive heart failure (CHF) and coronary heart disease (CHD) in adults by citizenship, and to compare the performance of primary care services in managing these chronic conditions, again by citizenship. METHODS: This is a population-based retrospective cohort study on 1,948,622 people aged 16 years or more residing in Italy. A multilevel regression model was applied to analyze adherence to care processes using explanatory variables at both patient and district level. RESULTS: The age-adjusted prevalence of diabetes was found higher among immigrants from high migratory pressure countries (HMPC) than among Italians, while the age-adjusted prevalence of cardiovascular disease was higher for Italians than for HMPC immigrants or those from highly-developed countries (HDC). Our results indicate lower levels in all quality management indicators for citizens from HMPC than for Italians, for all the chronic conditions considered. Patients from HDC did not differ from Italian in their adherence to disease management schemes. CONCLUSION: This study revealed a different prevalence of chronic diseases by citizenship, implying a different burden of primary care by citizenship. Our findings show that more effort is needed to guarantee migrant-sensitive primary health care

Immune cell counts and risks of respiratory infections among infants exposed pre- and postnatally to organochlorine compounds: a prospective study

<p>Abstract</p> <p>Background</p> <p>Early-life chemical exposure may influence immune system development, subsequently affecting child health. We investigated immunomodulatory potentials of polychlorinated biphenyls (PCBs) and <it>p,p'</it>-DDE in infants.</p> <p>Methods</p> <p>Prenatal exposure to PCBs and <it>p,p'</it>-DDE was estimated from maternal serum concentrations during pregnancy. Postnatal exposure was calculated from concentrations of the compounds in mother's milk, total number of nursing days, and percentage of full nursing each week during the 3 month nursing period. Number and types of infections among infants were registered by the mothers (N = 190). White blood cell counts (N = 86) and lymphocyte subsets (N = 52) were analyzed in a subgroup of infants at 3 months of age.</p> <p>Results</p> <p>Infants with the highest prenatal exposure to PCB congeners CB-28, CB-52 and CB-101 had an increased risk of respiratory infection during the study period. In contrast, the infection odds ratios (ORs) were highest among infants with the lowest prenatal mono-<it>ortho </it>PCB (CB-105, CB-118, CB-156, CB-167) and di-<it>ortho </it>PCB (CB-138, CB-153, CB-180) exposure, and postnatal mono- and di-<it>ortho </it>PCB, and <it>p,p'</it>-DDE exposure. Similar results were found for pre- and postnatal CB-153 exposure, a good marker for total PCB exposure. Altogether, a negative relationship was indicated between infections and total organochlorine compound exposure during the whole pre- and postnatal period. Prenatal exposure to CB-28, CB-52 and CB-101 was positively associated with numbers of lymphocytes and monocytes in infants 3 months after delivery. Prenatal exposure to <it>p,p'</it>-DDE was negatively associated with the percentage of eosinophils. No significant associations were found between PCB and <it>p,p'</it>-DDE exposure and numbers/percentages of lymphocyte subsets, after adjustment for potential confounders.</p> <p>Conclusion</p> <p>This hypothesis generating study suggests that background exposure to PCBs and <it>p,p'</it>-DDE early in life modulate immune system development. Strong correlations between mono- and di-<it>ortho </it>PCBs, and <it>p,p'</it>-DDE exposures make it difficult to identify the most important contributor to the suggested immunomodulation, and to separate effects due to pre- and postnatal exposure. The suggested PCB and <it>p,p'</it>-DDE modulation of infection risks may have consequences for the health development during childhood, since respiratory infections early in life may be risk factors for asthma and middle ear infections.</p

Demographic, clinical and antibody characteristics of patients with digital ulcers in systemic sclerosis: data from the DUO Registry

OBJECTIVES: The Digital Ulcers Outcome (DUO) Registry was designed to describe the clinical and antibody characteristics, disease course and outcomes of patients with digital ulcers associated with systemic sclerosis (SSc). METHODS: The DUO Registry is a European, prospective, multicentre, observational, registry of SSc patients with ongoing digital ulcer disease, irrespective of treatment regimen. Data collected included demographics, SSc duration, SSc subset, internal organ manifestations, autoantibodies, previous and ongoing interventions and complications related to digital ulcers. RESULTS: Up to 19 November 2010 a total of 2439 patients had enrolled into the registry. Most were classified as either limited cutaneous SSc (lcSSc; 52.2%) or diffuse cutaneous SSc (dcSSc; 36.9%). Digital ulcers developed earlier in patients with dcSSc compared with lcSSc. Almost all patients (95.7%) tested positive for antinuclear antibodies, 45.2% for anti-scleroderma-70 and 43.6% for anticentromere antibodies (ACA). The first digital ulcer in the anti-scleroderma-70-positive patient cohort occurred approximately 5 years earlier than the ACA-positive patient group. CONCLUSIONS: This study provides data from a large cohort of SSc patients with a history of digital ulcers. The early occurrence and high frequency of digital ulcer complications are especially seen in patients with dcSSc and/or anti-scleroderma-70 antibodies

Effect of Medial Soft Tissue Releases During Posterior-Stabilized Total Knee Arthroplasty on Contact Kinematics and Patient-Reported Outcomes

Background: Minimal to extensive medial soft tissue releases are part of the exposure and achieving adequate varus knee balance in total knee arthroplasty (TKA). However, the effect of these releases on knee kinematics and patient-reported outcomes is unclear. Our objective was to compare the post-operative in vivo tibiofemoral contact kinematics of a posterior-stabilized TKA between patients who received minimal medial soft tissue releases intraoperatively to those who received extensive releases. We also compared these groups using patient-reported outcomes. Methods: A prospective imaging study was performed in a single-center over a 14-month period. Patients with end-stage osteoarthritis and varus deformity undergoing primary TKA were included. Baseline data were collected 1 month before surgery. The radiostereometric analysis imaging took place at least 1 year postoperatively and composed of weight-bearing radiographic stereo examinations of knee flexion starting in full extension and in 20 degrees increments of flexion to a maximum of 120 degrees. Intraoperative medial soft tissue releases were recorded. Patient-reported outcomes used included Short-Form 12, Western Ontario and McMaster Osteoarthritis Index, and Knee Society Score. Results: Fifty-one patients were included in the statistical analysis. Demographic characteristics were similar between all. Patients were divided into 3 groups depending on the amount of releases they received. No statistically significant differences in tibiofemoral contact positions or excursions on the medial or lateral condyles were found throughout flexion from 0 degrees to 120 degrees. Postoperative patient-reported outcome scores were not different. Conclusion: Correcting severe varus deformities with extensive medial soft tissue release largely did not alter knee kinematics or clinical outcome scores compared to those with minimal soft tissue release. (C) 2019 Elsevier Inc. All rights reserved

Ultrasound-Guided Motor-Sparing Knee Blocks for Postoperative Analgesia Following Total Knee Arthroplasty: A Cost Analysis

Olawale A Sogbein,1,2 Jacquelyn D Marsh,1 Lyndsay E Somerville,1 James L Howard,1 Brent A Lanting1 1Division of Orthopaedic Surgery, Department of Surgery, London Health Sciences Centre – University Hospital, London, Ontario, Canada; 2Schulich School of Medicine & Dentistry, Western University, London, Ontario, CanadaCorrespondence: Olawale A Sogbein, Tel +1 519-476-1151, Email [email protected]: We recently performed a clinical trial comparing motor sparing blocks (MSB) to periarticular infiltration (PAI) following total knee arthroplasty (TKA). We found that MSBs provided longer analgesia (8.8 hours) than PAI with retention of quadriceps strength, and with similar function, satisfaction, and length hospital stay. However, its potential increased cost could serve as a barrier to its adoption. Therefore, our aim was to compare the costs of MSBs to PAI following TKA.Methods: We conducted a retrospective review of data from our previous RCT. There were 82 patients included in the RCT (n = 41 MSB group, n = 41 PAI group). We compared the mean total costs associated with each group until hospital discharge including intervention costs, health-care professional service fees, intraoperative medications, length of stay, and postoperative opioid use.Results: Seventy patients were included (n = 35 MSB group, n = 35 PAI group). The mean total costs for the MSB group were significantly higher ($1959.46 ± 755.4) compared to the PAI group ($1616.25 ± 488.33), with a mean difference of $343.21 (95$73.28 to $664.11, p = 0.03). The total perioperative intervention costs for performing the MSB was also significantly higher; however, postoperative inpatient costs including length of stay and total opioid use did not differ significantly.Conclusion: Motor sparing blocks had significantly higher mean total and perioperative costs compared to PAI with no significant difference in postoperative inpatient costs. However, its quadricep sparing nature and previously demonstrated prolonged postoperative analgesia can be used to facilitate an outpatient TKA pathway thereby offsetting its increased costs.Keywords: costs, total knee arthroplasty, outpatient arthroplasty, adductor canal blocks, periarticular infiltration, motor sparing block