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Identifying Predictors of Osteoarthritis

Identifying Predictors of Osteoarthritis

Osteoarthritis (OA) is a significant health problem, with studies suggesting that the condition affects up to 10% of men and 18% of women over the age of 60. Previous research has suggested that some physical risk factors may be associated with a higher rate of early onset OA. “There is an increasing need to address joint damage and its relationship to injuries, participation in sports, being physically active, being overweight or obese, and occupational activity so that we can better inform patients on strategies to prevent OA,” says Sarah A. Richmond, CEP, MSc, PhD. “This information can also help clinicians address the rising healthcare burden associated with OA.” New Data In the Journal of Orthopaedic and Sports Physical Therapy, Dr. Richmond and colleagues published a systematic review and meta-analysis that addressed this issue. According to the results, there was an increased risk for either knee or hip OA in individuals with previous joint injuries, those who were overweight or obese, and those who had physically demanding occupations, especially jobs that involved squatting or kneeling activities. Some findings, however, remain inconclusive, including levels of physical activity and sport-specificity in individuals who did not suffer an injury.   “Overall, joint injury was a significant risk factor for knee OA, with individuals who had suffered a previous knee injury at a three- to eight-fold greater risk of OA than individuals with no history of injury,” Dr. Richmond says. Joint injury was also a risk factor for hip OA, as was previous meniscectomy with or without ACL injury. Important Implications Dr. Richmond notes that a clear understanding of the implications of the risk...
Life Expectancy Trends in HIV

Life Expectancy Trends in HIV

Considerable improvements in survival among patients with HIV have occurred since the introduction of combination antiretroviral therapy (ART) and as these drugs have become more effective, simpler to use, and better tolerated over time. Studies have consistently shown that ART helps increase the lifespan of people with HIV and reduce risks for new infections. “ART has revolutionized how clinicians care for HIV-positive individuals and has had a major effect at both the individual and societal levels,” says Hasina Samji, PhD. As life expectancy has increased since the introduction of ART, research has shown that more and more people with HIV are experiencing age-related comorbid conditions—as evidenced in the general population—such as cancer. “These comorbidities can impact the length of time people with HIV live as well as their quality of life,” says Robert S. Hogg, PhD. In published analyses, there has been a small but persistent gap with regard to the lifespan of people infected with HIV and those who are uninfected, especially within certain subgroups of patients. About 20 years ago, the estimated life expectancy was 57.0 years for men with HIV and 61.7 years for women with HIV living in the United States. For Canada, the corresponding rates were 59.7 years for men and 63.9 years for women. “While ART has been shown to help increase survival among adults with HIV on a global level, the effect of this therapy on life expectancy in the U.S. and Canada has not been well characterized,” says Dr. Samji. “Furthermore, there is a dearth of studies examining potential differences in life expectancy across sex, race, or transmission groups.” Longer Longevity In a study...

The Ongoing Decline of Resident Education

A paper from Johns Hopkins looked at traditional, every fourth night calls compared to reduced-hours interns working staggered shifts of an every fifth night call or “night float.” “Night float” means working a shift that begins in the evening and ends in the morning, typically 8:00 PM to 8:00 AM. The study found that although interns working on the “night float” or every fifth night shifts got significantly more sleep than the control group of interns working longer shifts every fourth night, “both the every fifth night and night float models increased hand-offs, decreased availability for teaching conferences, and reduced intern presence during daytime work hours. Residents and nurses in both experimental models perceived reduced quality of care, so much so with night float that it was terminated early.” [Emphasis added] A JAMA Surgery paper received far less attention but had a similar theme. It surveyed 213 surgical interns from 11 university hospitals in July 2011 and May 2012 (the first academic year that the new 16-hour limit was in force). Although 82% of the interns reported a neutral or good quality of life, more than one-quarter had symptoms of emotional exhaustion and depersonalization, and 32% said their work-life balance was poor. Two-thirds said they thought about their satisfaction with being a surgeon daily or weekly, and 14% said they considered dropping out of surgery training at least weekly. More than half of the residents said that the work-hour changes had decreased their time spent in the operating room. At the end of their intern year, 44% said they did not believe that the work-hour limits led to reduced...
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