Total ankle replacement in patients under the age of 50. Should the indications be revised?

BackgroundHigh physical demand and young age are currently considered contraindications for total ankle replacement. This study aimed to compare its results between patients under the age of 50 and those aged 50 or older.Methods103 patients derived from an ongoing prospective multicentric study with a mean follow-up of 41 (range, 24–72) months were included in this study. Clinical status (AOFAS score), range of motion (ROM), complication and survivorship rates were compared between <50 and ≥50 patients.ResultsROM and AOFAS score were significantly higher, as were their increases relatively to pre-operative values in patients <50. Complication and survivorship rates were comparable between both groups.ConclusionsAt medium-term, ankle replacement is at least as effective in patients under the age of 50 as in those with aged 50 or older. Long-term results will allow to assess whether surgical indications for should be revised.     

A Descriptive Study of Women Presenting to an Obstetric Triage Unit With No Prenatal Care

ObjectiveTo describe women presenting to an obstetric triage unit with no prenatal care (PNC), to identify gaps in care, and to compare care provided to World Health Organization (WHO) standards.MethodsWe reviewed the charts of women who gave birth at Women’s Hospital in Winnipeg and were discharged between April 1, 2008, and March 31, 2011, and identified those whose charts were coded with ICD-10 code Z35.3 (inadequate PNC) or who had fewer than 2 PNC visits. Three hundred eighty-two charts were identified, and sociodemographic characteristics, PNC history, investigations, and pregnancy outcomes were recorded. The care provided was compared with WHO guidelines.ResultsOne hundred nine women presented to the obstetric triage unit with no PNC; 96 (88.1%) were in the third trimester. Only 39 women (35.8%) received subsequent PNC, with care falling short of WHO standards. Gaps in PNC included missing time-sensitive screening tests, mid-stream urine culture, and Chlamydia and gonorrhea testing. The mean maternal age was 26.1 years, and 93 women (85.3%) were multigravidas. More than one half of the women (51.4%) were involved with Child and Family Services, 64.2% smoked, 33.0% drank alcohol, and 32.1% used illicit drugs during pregnancy. Two thirds of the women (66.2%) lived in inner-city Winnipeg. Only 63.0% of neonates showed growth appropriate for gestational age. Two pregnancies ended in stillbirth; there was one neonatal death, and over one third of the births were preterm.ConclusionMost women who present with no PNC do so late in pregnancy, proceed to deliver with little or no additional PNC, and have high rates of adverse outcomes. Thus, efforts to improve PNC must focus on facilitating earlier entry into care. This would also improve compliance with WHO guidelines for continuing care. Treatment protocols could improve gaps in obtaining urine culture and in Chlamydia and gonorrhea testing.     

Development of a food composition database to study complementary feeding: An Italian experience

Food Composition Databases (FCDBs) are important tools for epidemiological research, public health nutrition and education, clinical practice and nutrition declaration on food labels. The aim of this paper is to describe the methodology used to compile a FCDB for the analysis on the dietary intake of an Italian cohort of infants, and to assess its strengths and weaknesses. Dietary data were collected using a 3-DD records compiled at 6, 9 and 12 months of age of the infants. We developed a FCDB that contains data from the Italian and the USDA food composition databases and other sources. Our FCDB includes 563 food derived from the analysis of 623 3-DD records. Non-commercial products are more consumed than commercial products (25.5% vs. 9.1% at 6 months, 58.4% vs. 18.1% at 9 months and 77.8% vs. 11.3% at 12 months) but the latter are the main source of missing data (>70% in each database, with the exception of the energy components), which is one of the major weaknesses of this tool. An integrated system of data collection (NUTRIRETE.lab) that brings together food composition data from public and private laboratories will allow us to build a more complete and representative food composition database.