Jump-landing mechanics in patellar tendinopathy in elite youth basketballers

Patellar tendinopathy (PT) is a leading cause of morbidity in jump-landing athletes. Landing mechanics are identified as a factor associated with PT and/or patellar tendon abnormality. This study aimed to identify key jump-landing variables associated with PT. Thirty-six junior elite basketball players (men n = 18, women n = 18) were recruited from a Basketball Australia development camp. Three-dimensional (3D) kinematic and ground reaction force (GRF) data during a stop-jump task were collected as well as ultrasound scans of the patellar tendons and recall history of training load data. Mixed-model factorial analyses of variance were used to determine any significant between-group differences. Of the 23 participants included for statistical analyses, 11 had normal bilateral patellar tendons (controls) and eight reported PT (currently symptomatic); however, the four participants categorized as asymptomatic with patellar tendon abnormality on diagnostic imaging were excluded from statistical analyses due to their small sample size. Athletes with PT displayed a similar knee flexion angle at initial foot-ground contact (IC) and hip extension strategy during a stop-jump horizontal landing. Despite a similar kinematic technique, athletes with PT utilized a strategy of a longer stance duration phase from IC to peak force. This strategy did not lead to those athletes with PT decreasing their peak vertical GRF nor patellar tendon force during landing but enabled these athletes to land with a lower rate of loading (control 59.2 ± 39.3 vs. PT 29.4 ± 33.7 BW.s-1). Athletes with PT still reported significantly reduced training volume (control 4.9 ± 1.8 vs PT 1.8 ± 1.1 sessions/wk; total training time/wk control 2.4 ± 1.0 vs PT 1.4 ± 1.1 h/wk).     

Influence of Hormonal Contraceptive Use and Health Beliefs on Sexual Orientation Disparities in Papanicolaou Test Use

Objectives. Reproductive health screenings are a necessary part of quality health care. However, sexual minorities underutilize Papanicolaou (Pap) tests more than heterosexuals do, and the reasons are not known. Our objective was to examine if less hormonal contraceptive use or less positive health beliefs about Pap tests explain sexual orientation disparities in Pap test intention and utilization.Methods. We used multivariable regression with prospective data gathered from 3821 females aged 18 to 25 years in the Growing Up Today Study (GUTS).Results. Among lesbians, less hormonal contraceptive use explained 8.6% of the disparities in Pap test intention and 36.1% of the disparities in Pap test utilization. Less positive health beliefs associated with Pap testing explained 19.1% of the disparities in Pap test intention. Together, less hormonal contraceptive use and less positive health beliefs explained 29.3% of the disparities in Pap test intention and 42.2% of the disparities in Pap test utilization.Conclusions. Hormonal contraceptive use and health beliefs, to a lesser extent, help to explain sexual orientation disparities in intention and receipt of a Pap test, especially among lesbians.Reproductive health screenings, such as Papanicolaou (Pap) tests, are a necessary part of quality health care.1 These screenings can detect precancerous conditions that may lead to cervical cancer if not treated. Despite the health benefits, sexual minority (e.g., lesbian, bisexual) female adolescents and young adults underutilize Pap tests.2–7 In a previous study with the cohort employed in this study, sexual minorities, compared to heterosexuals, were less likely to have had a Pap test within the last year or in their lifetime.8 We now extend this finding by exploring how hypothesized determinants of Pap testing intentions and behaviors help to explain sexual orientation disparities. A more thorough understanding of factors that explain underutilization may enable targeted clinical care and public health messages.It has been proposed that lesbians are less likely than heterosexuals to regularly visit a gynecologist because of their lower likelihood of hormonal contraceptive use.6,7 Other factors that may explain screening disparities include lower risk perception3 of cervical cancer and negative attitudes and beliefs toward Pap tests.9 Previous studies report that lesbians, in contrast to heterosexuals, perceive themselves to be at lower risk for contracting the human papillomavirus (HPV) and subsequently developing cervical cancer. Common reasons include the belief that sex between women is intrinsically safe because of limited fluid transmission, feeling invisible in gay male-focused sexual health promotions and therefore feeling “safe” because of a lack of messaging, and the emphasis in the “safer sex” discourse that one needs to only worry about penile penetrative sex.10 Physician recommendations have proved to be the strongest factor associated with Pap test utilization among all women.11 However, 10% of bisexuals and lesbians report being discouraged by physicians from getting a Pap test.12 Sexual minority adolescents may be particularly at risk because negative perceptions and attitudes about HPV are associated with lower screening rates among adolescents.13The Health Belief Model (HBM) is a psychological model that aims to explain and predict health behaviors. To our knowledge, it has yet to be applied to Pap test use within various sexual orientation groups but has effectively explained health disparities in other populations.14 The model includes 4 constructs focused on an individual’s attitudes and beliefs: susceptibility, severity, benefits, and barriers.15 An additional concept, cues to action, is thought to further motivate behavior,16 as are normative beliefs.The Institute of Medicine states that more data on Pap test use among sexual minority women are needed to better inform medical, governmental, and educational policies.17 Therefore, we examined sexual orientation group disparities in hormonal contraceptive use and HBM constructs (i.e., risk perception, attitudes and beliefs, cues to action) as they relate to Pap testing among adolescents and young adults. We hypothesized that unlike completely heterosexuals, sexual minorities

1. use hormonal contraceptives less frequently (and therefore may not see a health care provider as frequently who could provide a Pap test);
2. perceive themselves to be at lower risk for cervical cancer;
3. perceive themselves to be at lower severity of cervical cancer, if a diagnosis did occur;
4. believe there are fewer benefits to Pap test use;
5. believe there are more barriers to Pap test use;
6. hold fewer normative beliefs about Pap test use;
7. receive fewer cues to action for Pap test use; and
8. perceive fewer other individuals utilizing Pap tests.

Additionally, we hypothesized that these factors would partially explain (i.e., mediate) sexual orientation group disparities in Pap test intention and utilization.     

The effects of femoral component design on the patello-femoral joint in a PS total knee arthroplasty

Introduction

Anterior knee pain following TKA performed utilizing the PFC Sigma system still represents a cause of failure. The purpose of this study was to evaluate whether or not a recent change in the femoral design (PFC Sigma PS) had a positive impact on the patello-femoral complication rate.

Materials and methods

A consecutive series of 100 TKA using the PFC Sigma PS system was followed prospectively for a minimum of 3 years. All patellae were replaced and a standard lateral release was never performed. Radiographic analysis following the Knee Society Score (KSS) included antero-posterior weight-bearing, lateral and bilateral axial radiographs. TKA rotational alignment was recorded at the final follow-up in 30 consecutive knees by performing a CT evaluation.

Results

Good to excellent clinical results according to the KSS were achieved in 94 % of the knees. Survival without need of reoperation for any reason was 98 % at 3 years minimum follow-up; two reoperations were done for removal of fibromatous intra-articular tissue (“Clunk syndrome”). There were no revisions for septic or aseptic loosening of the components. The mean ROM improved from 104° preoperatively to 115° (97°–132°) postoperatively: postoperative flexion was 120° or more in 58 % of the knees. Severe anterior knee pain was present in 9 % of patients. Radiographic evaluation showed 90 knees with a tibio-femoral anatomical axis between 8° and 2° of valgus (±3° from the intraoperative goal). CT evaluation of 30 consecutive knees showed that the femoral component positioning in relationship to the trans-epicondylar axis had only 2.80° of external rotation (±2.10°) with respect to a planned external rotation of 3°. This difference was statistically significant.

Conclusions

Although the PFC Sigma PS system provides good and predictable results for tricompartmental arthritis of the knee, anterior mechanism complications still represent a reason for dissatisfaction in a substantial group of patients.     

Testicular microlithiasis: The importance of self‐examination

Aim: To explore the issue of appropriate management of testicular microlithiasis. We report the third ever case of tumour arising from a testis previously known to have microlithiasis in childhood and review the literature to provide an evidence‐based approach to management of testicular microlithiasis. Methods: Case report and review of previous literature. Results and Conclusions: Although there is a strong association between testicular microlithiasis and testicular malignancy at diagnosis, there are only three reported cases of subsequent tumour development in childhood. Testicular microlithiasis is an increasingly recognised entity. There is insufficient evidence in the current literature to support any regime of clinical surveillance. Self‐examination is the most important factor in the early detection of testicular malignancy.     

Locoregional therapies for hepatocellular carcinoma: Which patients are most likely to gain a survival advantage?

Background and Aim: Locoregional therapies for hepatocellular carcinoma (HCC) are considered to confer a survival advantage, however, the patient group that should be targeted is not clearly defined. This study aimed to determine the impact on survival of locoregional therapies compared with supportive care, within prognostic categories as stratified by the Cancer of the Liver Italian Program (CLIP) scoring system. Methods: A prospective database was used to identify those patients who were treated with either locoregional therapy (n = 128) or supportive care (n = 92). Survival analysis was performed for groups matched by CLIP score at presentation. Comparison of important prognostic factors was undertaken and univariate and multivariate analysis was performed to assess determinants of survival. Results: Use of locoregional therapies was only associated with a survival benefit in patients with a CLIP score of 1 or 2. In this group, the median survival in patients who received locoregional therapies was 25.0 months (95% confidence interval 22.7–27.4) compared with 8.9 months (95% confidence interval 7.3–10.5) for supportive care (P = 0.001). For patients with CLIP scores of 3 or greater, no survival benefit of locoregional therapies was observed. Multivariate analysis revealed locoregional intervention, CLIP score, tumor symptoms, α‐fetoprotein level, bilirubin and alkaline phosphatase level as independent prognostic indicators. Conclusion: Locoregional therapies should be targeted specifically to patients with non‐advanced hepatocellular carcinoma as assessed by validated scoring systems. Use of these therapies in patients with advanced disease does not appear to be associated with a survival benefit and may expose patients to unnecessary harm.