Influence of social support on return to work after total hip or total knee arthroplasty:a prospective multicentre cohort study

OBJECTIVES: There is strong evidence that social support is an important determinant of return to work (RTW). Little is known about the role of social support in RTW after total hip or knee arthroplasty (THA/TKA). Objective was to examine the influence of preoperative and postoperative perceived social support on RTW status 6 months postoperatively. DESIGN: A prospective multicentre cohort study was conducted. SETTING: Orthopaedic departments of four Dutch medical centres; a tertiary university hospital, two large teaching hospitals and a general hospital. PARTICIPANTS: Patients planned to undergo THA/TKA, aged 18-63 and employed preoperatively were included. MAIN OUTCOME MEASURES: Questionnaires were filled out preoperatively and 3 and 6 months postoperatively and included questions to assess patients' perceived social support targeting three sources of social support: from home (friends, family), from work (coworkers, supervisors) and from healthcare (occupational physician, general practitioner, other caregivers). Control variables included age, gender, education, type of arthroplasty and comorbidities. RTW was defined as having fully returned to work 6 months postoperatively. Univariate and multivariate logistic regression analyses were conducted. RESULTS: Enrolled were 190 patients (n=77 THA, n=113 TKA, median age was 56 years, 56% women). The majority returned to work (64%). Preoperatively, social support from the occupational physician was associated with RTW (OR 2.53, 95% CI 1.15 to 5.54). Postoperatively, social support from the occupational physician (OR 3.04, 95% CI 1.43 to 6.47) and the supervisor (OR 2.56, 95% CI 1.08 to 6.06) was associated with RTW. CONCLUSIONS: This study underscores the importance of work-related social support originating from the occupational physician and supervisor in facilitating RTW after primary THA/TKA, both preoperatively and postoperatively. Further research is needed to confirm our results and to understand the facilitating role of social support in RTW, as arthroplasty is being performed on a younger population for whom work participation is critical

Psychosocial Working Conditions Play an Important Role in the Return-to-Work Process After Total Knee and Hip Arthroplasty

Purpose Both personal and work-related factors affect return to work (RTW) after total knee arthroplasty (TKA) and total hip arthroplasty (THA). Little is known about work-related factors associated with the recovery process. This study aimed to determine which work-related factors are associated with time to RTW for both TKA and THA patients. Methods A prospective multicenter survey study was conducted that included patients aged 18-63, had a paid job and were scheduled to undergo primary TKA/THA. Surveys were completed preoperatively, 6 weeks, and 3, 6, and 12 months postoperatively, and included four domains of work-related factors: work characteristics, physical working conditions, psychosocial working conditions and work adjustments. Control variables included age, sex, education, and comorbidity. Time to RTW was defined as days from surgery until RTW. Multivariate linear regression analyses were conducted separately for TKA/THA patients. Results Enrolled were 246 patients (n = 146 TKA, n = 100 THA, median age 56 years, 57% female). Median time to RTW was 79 days (IQR 52.0-146.0). Mainly physical tasks (TKA: B 58.2, 95%CI 9.5-106.8; THA: B 52.1, 95%CI 14.1-90.2) and a combination of physical and mental tasks (TKA: B 50.2, 95%CI 6.4-94.0; THA B 54.0, 95%CI 24.2-83.7) were associated with longer time to RTW after both TKA and THA. More possibilities for personal job development (B - 12.8, 95%CI - 25.3-0.4) and more work recognition (B - 13.2, 95%CI - 25.5 to - 0.9) were significantly associated with shorter time to RTW after TKA. Higher quality of supervisor leadership (B - 14.1, 95%CI - 22.2 to - 6.0) was significantly associated with shorter time to RTW after THA. Conclusion The findings of this study stress the importance of psychosocial working conditions, besides type of job tasks, in RTW after TKA/THA. Further research on work-related factors is needed, as arthroplasty is being performed on an increasingly younger population of knee and hip OA patients for whom participating in work is of critical importance

Patient Characteristics Influence Revision Rate of Total Hip Arthroplasty:American Society of Anesthesiologists Score and Body Mass Index Were the Strongest Predictors for Short-Term Revision After Primary Total Hip Arthroplasty

Background: Outcome and survival after primary total hip arthroplasty (THA) can be affected by patient characteristics. We examined the effect of case-mix on revision after primary THA using the Dutch Arthroplasty Register. Methods: Our cohort included all primary THAs (n = 218,214) performed in patients with osteoarthritis in the Netherlands between 2007 and 2018. Multivariable logistic regression analysis was used to calculate the difference in survivorship in patients with different patient characteristics (age, gender, American Society of Anesthesiologists [ASA] score, body mass index [BMI], Charnley score, smoking, and previous operations to the hip). Results: Case-mix factors associated with an increased risk for revision 1 year after THA were the following: a high ASA score (II and III-IV) (odds ratio [OR] 1.5, 95% confidence interval [CI] 1.1-2.0 and OR 3.0, 95% CI 1.7-5.3), a higher BMI (30-40 and >40) (OR 1.4, 95% CI 1.2-1.5 and OR 2.0, 95% CI 1.4-1.7), age ≥75 years (OR 1.5, 95% CI 1.1-2.0), and male gender (OR 1.3, 95% CI 1.2-1.4). A similar model for 3-year revision showed comparable results. High BMI (OR 1.9, 95% CI 1.3-2.9), a previous hip operation (OR 1.8, 95% CI 1.3-2.5), ASA III-IV (OR 1.2, 95% CI 1-1.6), and Charnley score C (OR 1.5, 95% CI 1.1-2.2) were associated with increased risk for revision. Main reasons for revision in obese and ASA II-IV patients were infection, dislocation, and periprosthetic fracture. Patients with femoral neck fracture and late post-traumatic pathology were more likely to be revised within 3 years, compared to osteoarthritis patients (OR 1.5, 95% CI 1.3-1.7 and OR 1.5, 95% CI 1.2-1.7). Conclusion: The short-term risk for revision after primary THA is influenced by case-mix factors. ASA score and BMI (especially >40) were the strongest predictors for 1-year revision after primary THA. After 3 years, BMI and previous hip surgery were independent risk factors for revision. This will help surgeons to identify and counsel high-risk patients and take appropriate preventive measures

Preoperative characteristics of working-age patients undergoing total knee arthroplasty

Objective Total Knee Arthroplasty (TKA) is performed more in working-age (= 65 years) patients. Aim of this study was therefore to describe demographic, physical, psychological and social characteristics of working TKA patients and to subsequently compare these characteristics with retired TKA patients and the general population. Methods A cross-sectional analysis. Preoperative data of 152 working TKA patients was used. These data were compared with existing data of retired TKA patients in hospital registers and with normative values from literature on the general population. Demographic, physical, psychological and social (including work) characteristics were analyzed. Results The majority (83.8%) of working TKA patients was overweight (42.6%) or obese (41.2%), a majority (72.4%) was dealing with two or more comorbidities, and most (90%) had few depressive symptoms. Mean physical activity level was 2950 minutes per week. Compared to the retired TKA population, working TKA patients perceived significantly more stiffness and better physical functioning and vitality, were more physically active, and perceived better mental health. Compared to the general population working TKA patients perceived worse physical functioning, worse physical health and better mental health, and worked fewer hours. Conclusion This study shows that a majority of working TKA patients are overweight/obese, have multiple comorbidities, but are highly active in light-intensity activities and have few depressive symptoms. Working patients scored overall better on preoperative characteristics than retired patients, and except for physical activity scored overall worse than the general population

Two-year recovery courses of physical and mental impairments, activity limitations, and participation restrictions after total knee arthroplasty among working-age patients.

Purpose: Total knee arthroplasty is increasingly performed on working-age individuals, but little is known about their recovery process. Therefore this study examined recovery courses of physical and mental impairments, activity limitations and participation restrictions among working-age total knee arthroplasty recipients. Associated sociodemographic and health-related factors were also evaluated.Materials and methods: A prospective study among working total knee arthroplasty patients (aged 6 months);Closer collaboration between occupational physicians and orthopedic surgeons might result in increased and earlier ability to work full contractual hours;Rehabilitation after TKA should focus on patients with multiple comorbidities, whereby musculoskeletal diseases may even need additional preoperative treatment to optimize outcomes and prevent work disability

The SPS as accelerator of Pb82+^{82+} ions

In 1994 the CERN SPS was used for the first time to accelerate fully stripped ions of the Pb208 isotope from the equivalent proton momentum of 13 GeV/c to 400 GeV/c. In the CERN PS, which was used as injector, the lead was accelerated as Pb53+ ions and then fully stripped in the transfer line from PS to SPS. The radio frequency swing which is needed in order to keep the synchronism during acceleration is too big to have the SPS cavities deliver enough voltage for all frequencies. For that reason a new technique of fixed frequency acceleration was used. With this technique up to 70% of the injected beam could be captured and accelerated up to the extraction energy, the equivalent of 2.2 1010 charges. The beam was extracted over a 5 sec. long spill and was then delivered to different experiments at the same time

The SPS as lead-ion accelerator

In 1995 the CERN SPS was used during two months to accelerate fully stripped ions of the Pb208 isotope from the equivalent proton momentum of 13 GeV/c to 400 GeV/c. The radio frequency swing which is needed in order to keep the synchronism during acceleration is too big to have the SPS cavities deliver enough voltage for all frequencies. In a first stage, the beam is accelerated from 13 GeV/c to 26 GeV/c using the fixed frequency mode. During this stage the beam is grouped in four 2msec batches, separated by 3msec holes during which the frequency is changed in order to keep synchronism. At 26 GeV the beams are de-bunched and recaptured in order to fill the 3msec holes. From there on the lead ions are then accelerated up to 400 GeV/c with the normal frequency program. The de-bunching and recapture at 26 GeV improved the effective spill at extraction by a factor of three. Intensities up to 3.9 1010 charges could be obtained at 400 GeV/c. The total efficiency of the two RF captures was 64%

LEP1 operation, 1989-1995

In October 1995, the last run foreseen for dedicated Z production at CERN was performed in LEP, thereby bringing to a close the first phase of operation of the machine. A total luminosity of 200 pb-1 has been delivered to each of the four experiments, which together have recorded the decays of over 20 millions Zs. Machine performance has increased to the extent that a good weekend in 1995 saw as much luminosity delivered as in the whole of 1989. This improvement has been made possible by a combination of several things. Over and above general operational expertise, special care went into the treatment and stabilisation of the closed orbit in order to obtain reproducible high performances with vertical beam-beam tune shifts exceeding values of xy = 0.04. Both Pretzel and Bunch Train schemes have been introduced to double the number of bunches, and high-tune optics have been developed to produce low transverse emittances which allow operation at the beam-beam limit throughout physics runs. Included in the integrated luminosity are data taken off the peak of the Z resonance, to allow precise determination of the mass and width of this particle. Accurate measurements of the beam energy during these runs have brought to the fore some unusual effects

Pesticides and Parkinson’s Disease—Is There a Link?

Parkinson’s disease (PD) is an idiopathic disease of the nervous system characterized by progressive tremor, bradykinesia, rigidity, and postural instability. It has been postulated that exogenous toxicants, including pesticides, might be involved in the etiology of PD. In this article we present a comprehensive review of the published epidemiologic and toxicologic literature and critically evaluate whether a relationship exists between pesticide exposure and PD. From the epidemiologic literature, there does appear to be a relatively consistent relationship between pesticide exposure and PD. This relationship appears strongest for exposure to herbicides and insecticides, and after long durations of exposure. Toxicologic data suggest that paraquat and rotenone may have neurotoxic actions that potentially play a role in the development of PD, with limited data for other pesticides. However, both the epidemiology and toxicology studies were limited by methodologic weaknesses. Particular issues of current and future interest include multiple exposures (both pesticides and other exogenous toxicants), developmental exposures, and gene–environment interactions. At present, the weight of evidence is sufficient to conclude that a generic association between pesticide exposure and PD exists but is insufficient for concluding that this is a causal relationship or that such a relationship exists for any particular pesticide compound or combined pesticide and other exogenous toxicant exposure

Religious revelation, secrecy and the limits of visual representation

This article seeks to contribute to a more adequate understanding of the adoption of modern audiovisual mass media by contemporary religious groups. It does so by examining Pentecostal-charismatic churches as well as the Christian mass culture instigated by its popularity, and so-called traditional religion in Ghana, which develop markedly different attitudes towards audiovisual mass media and assume different positions in the public sphere. Taking into account the complicated entanglement of traditional religion and Pentecostalism, approaching both religions from a perspective of mediation which regards media as intrinsic to religion, and seeking to avoid the pitfall of overestimating the power of modern mass media to determine the world, this article seeks to move beyond an unproductive recurrence to oppositions such as tradition and modernity, or religion and technology. It is argued that instead of taking as a point of departure more or less set ideas about the nexus of vision and modernity, the adoption of new mass media by religious groups needs to be analyzed by a detailed ethnographic investigation of how these new media transform existing practices of religious mediation. Special emphasis is placed on the tension between the possibilities of gaining public presence through new media, and the difficulty in authorizing these media, and the experiences they induce, as authentic. Copyright © 2006 SAGE Publications