Green space,urbanity, and health: how strong is the relation?

STUDY OBJECTIVES: To investigate the strength of the relation between the amount of green space in people's living environment and their perceived general health. This relation is analysed for different age and socioeconomic groups. Furthermore, it is analysed separately for urban and more rural areas, because the strength of the relation was expected to vary with urbanity. DESIGN: The study includes 250 782 people registered with 104 general practices who filled in a self administered form on sociodemographic background and perceived general health. The percentage of green space (urban green space, agricultural space, natural green space) within a one kilometre and three kilometre radius around the postal code coordinates was calculated for each household. METHODS: Multilevel logistic regression analyses were performed at three levels-that is, individual level, family level, and practice level-controlled for sociodemographic characteristics. MAIN RESULTS: The percentage of green space inside a one kilometre and a three kilometre radius had a significant relation to perceived general health. The relation was generally present at all degrees of urbanity. The overall relation is somewhat stronger for lower socioeconomic groups. Elderly, youth, and secondary educated people in large cities seem to benefit more from presence of green areas in their living environment than other groups in large cities. CONCLUSIONS: This research shows that the percentage of green space in people's living environment has a positive association with the perceived general health of residents. Green space seems to be more than just a luxury and consequently the development of green space should be allocated a more central position in spatial planning policy.     

The role of psychological symptoms and social group memberships in the development of post-traumatic stress after traumatic injury

Objectives. The costs associated with traumatic injury are often exacerbated by the development of post-traumatic stress symptoms. However, it is unclear what decreases the development of post-traumatic symptoms over time. The aim of the present research was to examine the role of psychological symptoms and social group memberships in reducing the development of post-traumatic stress symptoms after orthopaedic injuries (OIs) and acquired brain injuries (ABIs). Design and Methods. A longitudinal prospective study assessed self-reported general health symptoms, social group memberships, and post-traumatic stress symptoms among participants with mild or moderate ABI (n= 62) or upper limb OI (n= 31) at 2 weeks (T1) and 3 months (T2) after injury. Results. Hierarchical regressions revealed that having fewer T1 general health symptoms predicted lower levels of T2 post-traumatic stress symptoms after OI but forming more new group memberships at T1 predicted lower levels of T2 post-traumatic stress symptoms after ABI. Conclusion. A focus on acquiring group memberships may be particularly important in reducing the development of post-traumatic stress symptoms after injuries, such as ABI, which result in long-term life changes. STATEMENT OF CONTRIBUTION: WHAT IS ALREADY KNOWN ON THIS SUBJECT?: ? Post-traumatic stress symptoms are a common outcome after accidental traumatic injury. ? Persistent post-traumatic stress symptoms can be a risk factor for the development of PTSD. WHAT DOES THIS STUDY ADD?: ? New insight into the contributions of general health symptoms and social group memberships in the development of post-traumatic stress symptoms after accidental injury. ? The development of post-traumatic stress symptoms over time is associated with higher levels of general health symptoms among individuals with orthopaedic injuries; They are associated with lower levels of social group memberships among individuals with acquired brain injuries.     

The association of magnetic resonance imaging (MRI)-detected structural pathology of the knee with crepitus in a population-based cohort with knee pain: the MoDEKO study

Osteoarthritis (OA) is the most common arthropathy of the knee joint¹. Symptoms reported by patients and signs noted during physical examination guide clinicians in identifying subjects with knee OA ^{[2] , [3] and [4]} .Pain is one of the most important symptoms reported by subjects with knee OA ^{[2] and [3]} . Although very common, pain is a non-specific symptom, related to pathology in several structures within the knee joint, and includes synovitis⁵, subchondral bone marrow lesions⁶, and joint effusion⁷. Further, pain is a subjective symptom that cannot be directly measured or assessed during physical examination.Crepitus or crepitation in association with arthritis is defined as a crackling or grinding sound on joint movement with a sensation in the joint. Crepitus may occur with or without pain and is a common finding during physical examination in subjects with knee OA ^{[2] , [3] , [4] , [8] and [9]} .It is not known whether crepitus is related to pathology in various structures within the knee. The aim of our study was to determine the cross-sectional associations of structural pathologies within the knee with crepitus in a population-based cohort with knee pain, using magnetic resonance imaging (MRI).Subjects with knee pain were recruited as a random population sample, with crepitus assessed in each compartment of the knee using a validated and standardized approach during physical examination¹⁰. MRI of the knee was performed to assess cartilage morphology, meniscal morphology, osteophytes, cruciate ligaments, and collateral ligaments. For both compartment-specific and whole-knee analyses, a multiple logistic regression analysis was performed to assess the associations of MRI-detected structural pathology with crepitus, adjusting for potential confounders. Variables were selected by backwards elimination within each compartment and in the overall knee models, and only statistically significant variables remained in the “selected” models; remaining variables in these models are adjusted for each other. An increased risk for compartment-specific crepitus was associated with osteophytes at the patellofemoral (PF) and lateral tibiofemoral (LTF) joints. Crepitus was associated with osteophytes and medial collateral ligament (MCL) pathology at the medial tibiofemoral (MTF) compartment, but cartilage damage was negatively associated with crepitus at this compartment. In the selected whole-knee model, only meniscal tears were associated with an increased risk for general crepitus. Thus, it seems that crepitus may be associated with pathology in several internal structures.     

Do we need radiographs to diagnose osteoarthritis?

The usefulness of plain radiography in the diagnosis of osteoarthritis is reviewed. While plain radiography is frequently used to define osteoarthritis in research and is traditionally discussed as a diagnostic modality in clinical practice, recent magnetic resonance imaging studies suggest that plain radiography has limited ability to detect osteoarthritic features at an early stage of disease such as might be encountered in general practice. Nevertheless, X-rays do play a role in the diagnostic process in general practice, but their usefulness relates more importantly to the exclusion of other diagnostic possibilities rather than confirmation of disease. More research is needed to develop diagnostic tools for osteoarthritis, particularly in clinical practice, as well as algorithms and guidelines for use of plain radiography in patients with chronic joint pain.