Racial differences in expectations of joint replacement surgery outcomes

OBJECTIVE: Prior studies have indicated racial differences in patients' expectations for joint replacement surgery outcomes. The goal of this study was to measure these differences using a well-validated survey instrument and to determine if the differences could be explained by racial variation in disease severity, socioeconomic factors, literacy, or trust. METHODS: Detailed demographic, clinical, psychological, and social data were collected from 909 male patients (450 African American, 459 white) ages 50-79 years with moderate or severe osteoarthritis (OA) of the hip or knee receiving primary care at 2 veterans affairs medical centers. The previously validated Joint Replacement Expectations Survey was used to assess expectations for pain relief, functional improvement, and psychological well-being after joint replacement. RESULTS: Among knee OA patients (n = 627), the unadjusted mean expectation score (scale 0-76) for African American patients was 48.7 versus 53.6 for white patients (mean difference 4.9, P < 0.001). For hip OA patients (n = 282), the unadjusted mean expectation score (scale 0-72) for African Americans was 45.4 versus 51.5 for whites (mean difference 6.1, P < 0.001). Multivariable adjustment for disease severity, socioeconomic factors, education, social support, literacy, and trust reduced these racial differences to 3.8 points (95% confidence interval [95% CI] 1.2, 6.3) among knee OA patients and 4.2 points (95% CI 0.4, 8.0) among hip patients. CONCLUSION: Among potential candidates for joint replacement, African American patients have significantly lower expectations for surgical outcomes than white patients. This difference is not entirely explained by racial differences in demographics, disease severity, education, income, social support, or trust.     

Dysuria,heat stress,and muscle injury among Nicaraguan sugarcane workers at risk for Mesoamerican nephropathy

Objectives:Nicaraguan sugarcane workers, particularly cane cutters, have an elevated prevalence of chronic kidney disease of unknown origin, also referred to as Mesoamerican nephropathy (MeN). The pathogenesis of MeN may include recurrent heat stress, crystalluria, and muscle injury with subsequent kidney injury. Yet, studies examining the frequency of such events in long-term, longitudinal studies are limited.Methods:Using employment and medical data for male workers at a Nicaraguan sugarcane company, we classified months of active work as either work as a cane cutter or other sugarcane job and determined occurrence of dysuria, heat events and muscle events. Work months and events occurred January 1997 to June 2010. Associations between cane cutting and each outcome were analyzed using logistic regression based on generalized estimating equations for repeated events, controlling for age.Results:Among 242 workers with 7257 active work months, 19.5% of person-months were as a cane cutter. There were 160, 21, and 16 episodes of dysuria, heat events, and muscle events, respectively. Compared with work months in other jobs, cane cutting was associated with an elevated odds of dysuria [odds ratio 2.40 (95% confidence interval 1.56–3.68)]. The number of heat and muscle events by cane cutter and other job were limited.Conclusions:Working as a cane cutter compared with other jobs in the sugarcane industry was associated with increased dysuria, supporting the hypothesis that cane cutters are at increased risk of events suspected of inducing or presaging clinically evident kidney injury.     

Mapping Malaria Transmission Intensity in Malawi, 2000–2010

Substantial development assistance has been directed towards reducing the high malaria burden in Malawi over the past decade. We assessed changes in transmission over this period of malaria control scale-up by compiling community Plasmodium falciparum rate (PfPR) data during 2000–2011 and used model-based geostatistical methods to predict mean PfPR_2–10 in 2000, 2005, and 2010. In addition, we calculated population-adjusted prevalences and populations at risk by district to inform malaria control program priority setting. The national population-adjusted PfPR_2–10 was 37% in 2010, and we found no evidence of change over this period of scale-up. The entire population of Malawi is under meso-endemic transmission risk, with those in districts along the shore of Lake Malawi and Shire River Valley under highest risk. The lack of change in prevalence confirms modeling predictions that when compared with lower transmission, prevalence reductions in high transmission settings require greater investment and longer time scales.     

Individual and country-level factors associated with self-reported and accelerometer-based physical activity in old age: a cross-national analysis of European countries

This study aimed to investigate associations between individual-level (personality traits, quality of life) and country-level (gross domestic product per capita, number of policies and action plans for physical activity) factors with self-reported and accelerometer-based physical activity and cross-level interactions among European countries. Based on the Survey of Health, Ageing and Retirement in Europe (SHARE) from 2019–2020, self-reported physical activity (N = 46,617 from 27 countries) and accelerometer-based average acceleration and intensity gradient (N = 855 from 10 countries) were analyzed. Mixed-model regressions with two levels (individuals nested within countries) were used for analyses. Between countries differences accounted for relatively small portions of the variability in self-reported physical activity (intraclass correlation, ICC = 7.5%), average acceleration (ICC = 3.5%), and intensity gradient (ICC = 1.9%). There were more associations between individual- and country-level factors and self-reported physical activity than with accelerometer-based physical activity. The association between individual-level variables and accelerometer-based physical activity did not differ between countries. Cross-level interactions suggested that associations between some personality traits and self-reported physical activity were stronger in countries with lower GDP. Both individual- and country-level factors are related to participation in more intensive physical activities. Adults with less resilient personality traits living in countries with lower resources are at the highest risk for physical inactivity. Supplementary InformationThe online version contains supplementary material available at 10.1007/s10433-022-00737-8.     

Updated concepts in extracapsular pseudophakia: posterior chamber pseudophakia

Some concepts regarding posterior chamber pseudophakia have been set forth. Clearly, this is still investigational, and it is for that reason that I would urge the readers to exercise great judgement and wait for the results of laboratory testing of this rhetorical hypothesis. Currently, I am proceeding most patiently with posterior chamber pseudophakia in Rhesus monkeys using the Harris-McGhan lens, the Praeger suture style modification, and the Shearing posterior chamber lens. The ultimate answers will probably be answered over a due course of time in the human subject, but suffice it to say that the scientific approach to this problem must first be meticulously studied by the ocular histopathologist after surgery has been accomplished in primates. If, after an adequate trial with primates, the ocular histopathologist establishes this to be a safe and effective technique, then a conservative study should be undertaken wherein a number of humans will have this procedure done using different types of lenses by surgeons familiar with the lens and technique.     

The alcohol use inventory as predictor of drinking by male heavy social drinkers

To investigate the utility of the Alcohol Use Inventory (AUI) with heavy nonproblem drinkers, 36 male undergraduate heavy social drinkers kept daily records of their drinking and noods for 3 months and for 1 month at 6–7 months after completing several scales. Factor analysis of the AUI revealed five factors with this sample. Reporting adverse after-effects and other drug use was associated with greater daily drinking over the next 3 months and better moods, but not with intoxication per se. Reporting sustained daily drinking on the AUI was strongly predictive of a greater number of intoxicated days during the subsequent 2 months, and was also associated with more depression and anger over time. Reporting drinking in order to improve social, mental, and emotional functioning was unrelated to drinking rates, but was strongly related to anxiety, depression, and anger over time. The Daily Quantity of Alcohol scale was unrelated to actual daily alcohol intake. A small social desirability response bias was found for several scales, but it had little effect on the above relationships. Thus, the AUI shows promise for use with heavy social drinkers and should be investigated further.     

Five years' follow-up in the surgical management of cataracts in high myopia treated with the Kelman phacoemulsification technique

With the advent of phacoemulsification, much interest has again been rekindled in extracapsular cataract surgery and its effects on the vitreoretinopathies associated in high myopia. Since 1972, 278 patients with high myopia greater than --7.50 D, as as determined by axial length echography, have been operated on by the author. The five-year follow-up with statistical analysis of these cases is presented. Comments as to the merits of extracapsular versus intracapsular surgery in high myopia will be set forth.