Musculoskeletal Problems in Children in General Practice

Musculoskeletal diseases are extremely common and have important consequences for the individual and for society. The World Health Organization (WHO) declared musculoskeletal diseases to be a problem in both the developed and developing world. WHO has, together with the United Nations and European governments declared 2000-10 the “bone and joint decade”, with the aim of improving the health related quality of life of people with musculoskeletal conditions by means of research and by raising awareness of this growing problem. A British study showed that a quarter of the listed population of a general practice consults at least once a year for a musculoskeletal problem. The British healthcare system is comparable to the system in the Netherlands. A Dutch study, the second Dutch national survey of general practice (DNSGP-2) performed by NIVEL in 2001, on which some of the articles of this thesis are based, showed that in adults a musculoskeletal problem is the most common reason to consult the general practitioner and that in children it is the third most common reason to consult the general practitioner

Self-reported and measured weight, height and body mass index (BMI) in Italy, the Netherlands and North America

Background: Self-reported values of height and weight are used increasingly despite warnings that these data - and derived body mass index (BMI) values - might be biased. The present study investigates whether differences between self-reported and measured values are the same for populations from different regions, and the influences of gender and age. Methods: Differences between self-reported and measured weights, heights and resulting BMIs are compared for representative samples of the adult population of Italy, the Netherlands and North America. Results: We observed that weight is under-reported (1.1 ± 2.6 kg for females and 0.4 ± 3.1 kg for males) and height over-reported (1.1 ± 2.2 cm for females and 1.7 ± 2.1 cm for males), in accordance with the literature. This leads to an overall underestimation of BMI values (0.7 ± 1.2 kg/m2 or 2.8 for females and 0.6 ± 1.1 kg/m2 or 2.3 for males). When BMI values are assigned to four categories (from 'underweight' to 'obesity'), 11.2 of the females and 12.0 of the males are categorized too low when self-reported weights and heights are used, with an extreme of 17.2 for Italian females. Older people tend to relatively over-report height and under-report weight, but the magnitude differs between countries and gender. Conclusion: We conclude that, apart from a general overestimation of height and underestimation of weight resulting in an underestimation of BMI, substantial differences are observed between countries, between females and males and between age groups. © The Author 2010. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved

Increase the strength characteristics of polymer films by radiation graft polymerization

The possibility of increasing the strength characteristics of polymer films based on polyethylene and polyamide by radiation graft polymerization was investigated. Two methods of graft polymerization (direct method and the method of polymer mixtures cross-linking) on the PMMA films surface were studied. The possibility of increasing the strength and elasticity of polymeric films by radiation modification of polymethyl methacrylate was shown

Effect of a 6-month vegan low-carbohydrate (‘Eco-Atkins’) diet on cardiovascular risk factors and body weight in hyperlipidaemic adults: a randomised controlled trial

Objective: Low-carbohydrate diets may be useful for weight loss. Diets high in vegetable proteins and oils may reduce the risk of coronary heart disease. The main objective was to determine the longer term effect of a diet that was both low-carbohydrate and plant-based on weight loss and low-density lipoprotein cholesterol (LDL-C). Design, setting, participants A parallel design study of 39 overweight hyperlipidaemic men and postmenopausal women conducted at a Canadian university-affiliated hospital nutrition research centre from April 2005 to November 2006. Intervention Participants were advised to consume either a low-carbohydrate vegan diet or a high-carbohydrate lacto-ovo vegetarian diet for 6 months after completing 1-month metabolic (all foods provided) versions of these diets. The prescribed macronutrient intakes for the low-carbohydrate and high-carbohydrate diets were: 26% and 58% of energy from carbohydrate, 31% and 16% from protein and 43% and 25% from fat, respectively. Primary outcome Change in body weight. Results: 23 participants (50% test, 68% control) completed the 6-month ad libitum study. The approximate 4 kg weight loss on the metabolic study was increased to −6.9 kg on low-carbohydrate and −5.8 kg on high-carbohydrate 6-month ad libitum treatments (treatment difference (95% CI) −1.1 kg (−2.1 to 0.0), p=0.047). The relative LDL-C and triglyceride reductions were also greater on the low-carbohydrate treatment (treatment difference (95% CI) −0.49 mmol/L (−0.70 to −0.28), p<0.001 and −0.34 mmol/L (−0.57 to −0.11), p=0.005, respectively), as were the total cholesterol:HDL-C and apolipoprotein B:A1 ratios (−0.57 (−0.83, −0.32), p<0.001 and −0.05 (−0.09, −0.02), p=0.003, respectively). Conclusions: A self-selected low-carbohydrate vegan diet, containing increased protein and fat from gluten and soy products, nuts and vegetable oils, had lipid lowering advantages over a high-carbohydrate, low-fat weight loss diet, thus improving heart disease risk factors. Trial Registration clinicaltrials.gov (http://www.clinicaltrials.gov/), #NCT00256516

Retrospective methods to estimate radiation dose at the site of breast cancer development after Hodgkin lymphoma radiotherapy.

BACKGROUND: An increased risk of breast cancer following radiotherapy for Hodgkin lymphoma (HL) has now been robustly established. In order to estimate the dose-response relationship more accurately, and to aid clinical decision making, a retrospective estimation of the radiation dose delivered to the site of the subsequent breast cancer is required. METHODS: For 174 Dutch and 170 UK female patients with breast cancer following HL treatment, the 3-dimensional position of the breast cancer in the affected breast was determined and transferred onto a CT-based anthropomorphic phantom. Using a radiotherapy treatment planning system the dose distribution on the CT-based phantom was calculated for the 46 different radiation treatment field set-ups used in the study population. The estimated dose at the centre of the breast cancer, and a margin to reflect dose uncertainty were determined on the basis of the location of the tumour and the isodose lines from the treatment planning. We assessed inter-observer variation and for 47 patients we compared the results with a previously applied dosimetry method. RESULTS: The estimated median point dose at the centre of the breast cancer location was 29.75 Gy (IQR 5.8-37.2), or about 75% of the prescribed radiotherapy dose. The median dose uncertainty range was 5.97 Gy. We observed an excellent inter-observer variation (ICC 0.89 (95% CI: 0.74-0.95)). The absolute agreement intra-class correlation coefficient (ICC) for inter-method variation was 0.59 (95% CI: 0.37-0.75), indicating (nearly) good agreement. There were no systematic differences in the dose estimates between observers or methods. CONCLUSION: Estimates of the dose at the point of a subsequent breast cancer show good correlation between methods, but the retrospective nature of the estimates means that there is always some uncertainty to be accounted for

What is the clinical course of transient synovitis in children: A systematic review of the literature

Background: Transient synovitis of the hip (TS) is considered to be a self-limiting disease in childhood. However, because the etiology is unclear and some cases precede Legg-Perthes' disease, data on follow-up are important. Our aim was to summarize the knowledge on the clinical course of TS in children. Methods: The study design was a systematic review and a literature search was conducted in Medline and Embase. Studies describing short and/or long-term follow-up of TS in children were included. Case reports, reviews and studies describing traumatic hip pain were excluded. Study quality was scored and data extraction was performed. The main outcome measures were short-term and long-term clinical course, and recurrence of symptoms. Results: A total of 25 studies were included of which 14 were of high quality. At two-week follow-up, almost all children with TS were symptom free. Those with symptoms persisting for over one month were more prone to develop other hip pathology, such as Legg-Perthes' disease. The recurrence rate of TS ranged from 0-26.3%. At long-term follow-up, 0-10% of the children diagnosed with TS developed Legg-Perthes' disease. Hip pain after intensive physical effort and limited range of motion of the hip at long-term follow-up was reported in 12-28% and in 0-18% of the children, respectively.Conclusions: The majority of the studies indicate that children with TS recover within two weeks; recurrence was seen in 0-26% of the cases. Children with TS should be followed at least six months to increase the likelihood of not missing Legg-Perthes' disease

Effect of endotoxin on cholesterol biosynthesis and distribution in serum lipoproteins in Syrian hamsters

Infection and inflammation increase serum triglyceride and cholesterol levels in rodents and rabbits. Endotoxin (LPS) has been used as a model of infection and its effects on triglyceride metabolism have been previously characterized. In the present study we demonstrate that both low (100 ng/100 g body weight) and high dose (100 μg/100 g body weight) LPS increase serum cholesterol levels in hamsters. The increase in serum cholesterol is first observed 16 h after LPS and persists for at least 24 h. This increase is primarily due to an increase in low density lipoprotein (LDL) cholesterol. High density lipoprotein (HDL) cholesterol levels decrease after LPS treatment. Both low and high dose LPS increase hepatic cholesterol synthesis (low dose 85%, high dose 205%) and total HMG-CoA reductase activity (low dose 2.97-fold, high dose 9.96-fold). However, the proportion of HMG-CoA reductase in the active form is reduced by LPS treatment. Additionally, the mass of HMG-CoA reductase protein in the liver, measured by Western blotting, is increased after LPS. Moreover, LPS increases hepatic HMG-CoA reductase mRNA levels (low dose 3.1-fold, high dose 14.2-fold). The increase in hepatic HMG- CoA reductase mRNA levels is first seen 4 h after LPS and persists for at least 24 h. In contrast, LPS had only minimal effects on hepatic LDL receptor protein and mRNA levels. These results suggest that LPS increases serum cholesterol levels by increasing hepatic cholesterol synthesis. LPS administration decreases apoE mRNA levels in the liver while having no effect on apoA-I mRNA levels. These results suggest that HMG-CoA reductase is a member of a group of hepatic proteins that are positively regulated by inflammatory stimuli (acute phase proteins) while apoE can be considered a negative acute phase protein in hamsters. It is possible that increases in hepatic HMG-CoA reductase provide cholesterol that allows for the increased production of lipoproteins and elevations in serum lipid levels that may be beneficial to the body's host defense.Peer reviewe