Case 264

History A 28-year-old woman presented to the emergency department with painful swelling of the third finger on her right hand, which developed quickly. She had no relevant medical or surgical history. Her pain was worse at night, with stiffness decreasing during the morning. Clinical examination revealed generalized swelling of the third finger, cyanotic skin, and fingernail splitting on the second finger of the left hand ( Fig 1 ). Laboratory test results were normal, with no evidence of inflammatory disease. Radiographs of both hands were obtained (Fig 2). CT scanning (Fig 3) and MRI (Fig 4) were also performed

Imaging of traumatic injury and impingement of anterior knee fat.

Fat is not just used by the body as bulk tissue. In addition to its role in storing energy and regulating hormone action, fat is used in some parts of the body for its mechanical properties. The anatomy of anterior knee fat is more complex than it appears at first sight and is capable of withstanding considerable compressive and shear stress. Specific lesions occur when such mechanical stress exceeds the physiological limits and are yet little known. Superficial fat can be the site of either acute injury by closed degloving called the Morel-Lavallée lesion or chronic injury, when subject to repeat excessive shear forces, due to more complex and less well-defined disruptions that result in pseudo-bursitis. There are three main anterior, intracapsular and extrasynovial fat pads in the knee joint, which are the infrapatellar fat pad (IFP) or Hoffa's fat pad, the quadriceps fat pad and the prefemoral fat pad. The IFP plays an important role as a mechanical shock absorber and guides the patella tendon and even the patella itself during flexion-extension movements. In response to repeated excessive stress, an inflammatory reaction and swelling of the IFP is first observed, followed by a fibrotic reaction with metaplastic transformation into fibrous, cartilaginous or bone tissue. More rarely, the two other deep fat pads (quadriceps and prefemoral) can, if subject to repeated stress, undergo similar restructuring inflammatory reactions with metaplasia resulting in tissue hardening, anterior pain and partial loss of functio

Bone abnormalities of the knee: MRI features

The knee is one of the most studied anatomical structures by magnetic resonance imaging (MRI). Bone abnormalities are very frequently detected, whether or not related to the symptoms for which imaging was indicated. The aim of this pictorial study is to review the most commonly observed bone abnormalities of the knee, bearing in mind that the interpretation of MR images should always take into consideration both clinical and laboratory data, as well as the results of conventional X-ray imaging

How to tackle social inequalities in health in urban areas through political action on green spaces: A research protocol on the Health in All Policies approach concerning green spaces in the French Healthy Cities network

International audienc

Correction to: The GREENH-City interventional research protocol on health in all policies

Abstract After publication of the article [1], it has been brought to our attention that in the original publication the third author’s name was spelt incorrectly. The correct spelling is “Emmanuelle Faure”. This was previously spelt as “Emmannuelle Faure”. The original article has been revised to reflect this

The GREENH-City interventional research protocol on health in all policies

Abstract Background This paper presents the research protocol of the GoveRnance for Equity, EnviroNment and Health in the City (GREENH-City) project funded by the National Institute for Cancer (Subvention N°2017–003-INCA). In France, health inequities have tended to increase since the late 1980s. Numerous studies show the influence of social, economic, geographic and political determinants on health inequities across the life course. Exposure to environmental factors is uneven across the population and may impact on health and health inequities. In cities, green spaces contribute to creating healthy settings which may help tackle health inequities. Health in All Policies (HiAP) represents one of the key strategies for addressing social and environmental determinants of health inequities. The objective of this research is to identify the most promising interventions to operationalize the HiAP approaches at the city level to tackle health inequities through urban green spaces. It is a participatory interventional research to analyze public policy in real life setting (WHO Healthy Cities). Method/design It is a mixed method systemic study with a quantitative approach for the 80 cities and a comparative qualitative multiple case-studies of 6 cities. The research combines 3 different lens: 1/a political analysis of how municipalities apply HiAP to reduce social inequities of health through green space policies and interventions 2/a geographical and topological characterization of green spaces and 3/ on-site observations of the use of green spaces by the inhabitants. Results City profiles will be identified regarding their HiAP approaches and the extent to which these cities address social inequities in health as part of their green space policy action. The analysis of the transferability of the results will inform policy recommendations in the rest of the Health City Network and widely for the French municipalities. Discussion/conclusion The study will help identify factors enabling the implementation of the HiAP approach at a municipal level, promoting the development of green spaces policies in urban areas in order to tackle the social inequities in health

Espaces verts urbains et équité en santé : quelle méthode d'analyse ?

Introduction Espace du quotidien, de détente et de récréation, lieu de promenade, de rencontre et de pratiques sportives, l'espace vert est vecteur de bien-être et de santé. Au regard des multiples bénéfices potentiels que représente l'exposition des populations aux espaces verts urbains et des problématiques contemporaines de santé, l'accessibilité de tous à ces lieux constitue un enjeu majeur de santé publique. Le projet de recherche GREENH-City (Inca RI 2017-03) propose, parmi les communes du Réseau Français des Villes Santé de l'OMS, d'analyser en quelle mesure les politiques municipales intègrent des démarches de santé dans toutes les politiques, de promotion de l'équité et les appliquent aux politiques de verdissement. L'objectif de cette communication est d'examiner les enjeux théoriques et méthodologiques de l'analyse socio-spatiale des espaces verts urbains dans le contexte français afin, notamment, d'objectiver l'accessibilité de tous aux espaces verts, quels que soient les territoires de vie ou les situations socio-économiques des populations. Méthode Les données municipales, nationales (Institut national de l'information géographique et forestière) et internationales (« Open Street Map ») disponibles pour appréhender les espaces verts, ainsi que des indicateurs socio-économiques (Institut national de la statistique et des études économiques) permettent en effet d'appréhender les surfaces et types d'espaces verts disponibles, des distances d'accès moyens des ménages aux espaces verts, et ce, au regard des disparités socio-économiques infra-urbaines en présence. Par exemple, les espaces verts d'une ville peuvent s'avérer beaucoup plus accessibles à une partie de la population (accessibilité pédestre très aisée) et cette même population peut disposer d'une surface moyenne par habitant très restreinte. Une analyse comparative et multiscalaire permet d'illustrer la diversité des situations. En effet, l'ampleur des écarts entre classes sociales ou entre quartiers dépend des contextes urbains considérés. De telles analyses permettent d'interroger la démarche, les échelles et les outils de mesure à mobiliser lorsque l'on interroge l'équité et l'accessibilité aux espaces verts urbains. Des analyses qualitatives des usages et des pratiques de ces espaces par les individus devront également compléter cette approche. En effet, un espace potentiellement disponible n'est pas forcément approprié, utilisé de façon optimale. En mobilisant une approche mixte et comparative, la recherche développée dans le cadre du projet GREENH-City permettra d'apporter des réponses à cet enjeu majeur

Health in all policies and urban green spaces: the baseline study of the GREENH-City project

National audienc