International Variations in Bladder Cancer Incidence and Mortality

Context

Previous studies have reported substantial worldwide regional variations in bladder cancer (BCa) incidence and mortality.

Objective

To describe contemporary international variations in BCa incidence and mortality rates and trends using the most recent data from the International Agency for Research on Cancer (IARC).

Evidence acquisition

Estimated 2008 BCa incidence and mortality rates for each country by sex were obtained from GLOBOCAN. Recent trends in incidence for 43 countries and in mortality for 64 countries were assessed by join-point model using data from the IARC's Cancer Incidence in Five Continents and from the World Health Organisation's mortality database, respectively.

Evidence synthesis

The highest incidence rates for both men and women are found in Europe, the United States, and Egypt, and the lowest rates are found in sub-Saharan Africa, Asia, and South America. Mortality rates are highest in parts of Europe and northern Africa and lowest in Asia, Central America, and middle Africa. Incidence rates among men decreased in 11 of 43 countries (46 registries) (North America, western and northern Europe), remained stable in 20, and increased in 12 countries (southern, central, and eastern Europe). Among women, incidence rates decreased in 10 countries, stabilised in 22 countries, and increased in 12 countries. Mortality rates among men decreased in 32 of 65 countries (throughout all world regions except Central and South America), stabilised in 30 countries, and increased in 3 (Romania, Slovenia, and Cuba). Among women, mortality rates decreased in 24 countries, remained stable in 36 countries, and increased in 5 countries (central and eastern Europe).

Conclusions

Incidence and mortality rates in general decreased in most Western countries but increased in some eastern European and developing countries. These patterns in part may reflect differences in the stage and extent of the tobacco epidemic, changes in coding practices, prevalence of schistosomiasis (Africa), and occupational exposure.     

Are Bilateral Total Joint Arthroplasty Patients at a Higher Risk of Developing Pulmonary Embolism Following Total Hip and Knee Surgery?

Despite developments in prophylactic methods, venous thromboembolism (VTE) continues to be a serious complication following total joint arthroplasty. The new AAOS/ACCP guidelines on preventing pulmonary embolism (PE) after total hip/knee arthroplasty (THA/TKA) do not make specific recommendations for bilateral vs. unilateral procedures. In-patient PE rates were examined for patients undergoing unilateral or simultaneous bilateral TKA/THA at our institution in 2011. Of the 7,437 THA/TKA surgeries completed at our institution in 2011, 36 patients suffered from PE (0.48%). The rate of PE for unilateral TKA was 0.61% vs. 1.87% for bilateral (P < 0.001) and for unilateral THA was 0.17% vs. 0.52% for bilateral THA. Despite patients being screened before being cleared to undergo bilateral THA/TKA, they remain at higher risk for VTE.     

Effects of an integrated poultry value chain,nutrition, gender and WASH intervention (SELEVER) on hygiene and child morbidity and anthropometry in Burkina Faso: A secondary outcome analysis of a cluster randomised trial

Nutrition-sensitive agriculture programmes have the potential to improve child nutrition outcomes, but livestock intensification may pose risks related to water, sanitation and hygiene (WASH) conditions. We assessed the impact of SELEVER, a nutrition- and gender-sensitive poultry intervention, with and without added WASH focus, on hygiene practices, morbidity and anthropometric indices of nutrition in children aged 2−4 years in Burkina Faso. A 3-year cluster randomised controlled trial was implemented in 120 villages in 60 communes (districts) supported by the SELEVER project. Communes were randomly assigned using restricted randomisation to one of three groups: (1) SELEVER intervention (n = 446 households); (2) SELEVER plus WASH intervention (n = 432 households); and (3) control without intervention (n = 899 households). The study population included women aged 15−49 years with an index child aged 2−4 years. We assessed the effects 1.5-years (WASH substudy) and 3-years (endline) post-intervention on child morbidity and child anthropometry secondary trial outcomes using mixed effects regression models. Participation in intervention activities was low in the SELEVER groups, ranging from 25% at 1.5 years and 10% at endline. At endline, households in the SELEVER groups had higher caregiver knowledge of WASH-livestock risks (∆ = 0.10, 95% confidence interval [CI] [0.04−0.16]) and were more likely to keep children separated from poultry (∆ = 0.09, 95% CI [0.03−0.15]) than in the control group. No differences were found for other hygiene practices, child morbidity symptoms or anthropometry indicators. Integrating livestock WASH interventions alongside poultry and nutrition interventions can increase knowledge of livestock-related risks and improve livestock-hygiene-related practices, yet may not be sufficient to improve the morbidity and nutritional status of young children.     

Preoperative Predictors of Postoperative Opioid Usage,Pain Scores,and Referral to a Pain Management Service in Total Knee Arthroplasty

Background

Little is known about preoperative predictors of postoperative pain and referral to a recuperative pain management service after total knee arthroplasty (TKA).

Questions/Purposes

We sought to identify the preoperative predictors of postoperative pain scores, referral to a pain management service, and narcotic usage in patients undergoing primary total knee arthroplasty.

Methods

We performed a prospective cohort study of 97 TKAs from a single surgeon. Pre and 6-week postoperative WOMAC, visual analog pain scale (VAS) scores, narcotic usage, and catastrophizing pain scores were collected.

Results

After adjusting for all other variables, higher age and catastrophizing pain scores were associated with lower odds of postoperative opioid usage. Increasing age and BMI were associated with lower odds of being referred to pain management. There was no relationship between self-reported preoperative pain tolerance and postoperative change in WOMAC or VAS pain scores.

Conclusions

This information may help surgeons advise their patients preoperatively and set expectations during the recovery period.

Electronic supplementary material

The online version of this article (doi:10.1007/s11420-014-9418-4) contains supplementary material, which is available to authorized users.