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PubMed2006

Radiological evaluation of unstable (acute) slipped capital femoral epiphysis treated by pinning with Kirschner wires.

Treatment of slipped capital femoral epiphysis is still controversial with regard to the implants used for stabilization and the need for prophylactic treatment of the contralateral, unaffected, side. The objective of this study was to ascertain whether prophylactic transfixation of the epiphysis with Kirschner wires in patients with unstable slipped capital femoral epiphysis resulted in significant disturbance of the growth plate and impairment of further growth of the femoral neck and head. Between 1990 and 1999, 29 patients with unstable slipped capital femoral epiphysis were simultaneously treated with internal fixation of the epiphysis and metaphysis with 3-4 Kirschner wires on the affected and the not (yet) affected side. After a mean follow-up of 3.5 years, we evaluated the hip joints radiologically, analysing different roentgenological parameters (CCD angle, femoral head diameter, length of the femoral neck and sphericity of the femoral head). CCD angle, femoral head diameter and length of the femoral neck showed statistically significant (P<0.001, Student's t-test) differences between the affected and unaffected, but prophylactically pinned, sides. Asphericity of the femoral head was found in six cases only on the affected side, whereas all hips, which were operated prophylactically, showed spherical femoral heads at follow-up (P<0.02, Pearson's chi test). These results indicate that the slip itself may cause impairment of the femoral growth plate in patients with unstable slipped capital femoral epiphysis and not stabilization with Kirschner wires. Compared with other series from the literature using different implants (screws, nails), prophylactic transfixation of the epiphysis and metaphysis with Kirschner wires is less compromising to the growth plate on the not (yet) affected side.

Acute Disease↗
PubMed1999

Social capital and its relevance to health and family policy.

It is important to consider the global context in which we operate and in which the association between society and health is to be explored. We are in a democratic world, with an economy that emphasises the market and a post-modern culture. The ancient elements of state, market and community are discernible in avaricious combinations and, if we are seeking a just social order, it is important that we apply appropriate analytical methods to social understanding. While social capital is an arresting term, its ambiguity limits its broad applicability and even makes it dangerous. Sir Richard Doll and his colleague Richard Peto once described epidemiological insight as a boundary-setting exercise, delimiting territory within which basic and clinical science can explore mechanisms. When it comes to matters of social and personal well-being, the same approach may serve us well. Social capital, defined differently by everyone who uses it, must be given some stability and be subject to good quality epidemiological research, not too dissimilar to that which has underpinned epidemiology's immense success in public health over the decades. Despite social capital's complexity, there are growing efforts to measure it and relate it to desirable social functions, but the ability of social capital to capture fully the subtle interplay of individuals and society so essential for their health and happiness is questionable.

Community Participation↗
PubMed1999

Social capital and community effects on population and individual health.

Social capital refers to those features of social relationships--such as levels of interpersonal trust and norms of reciprocity and mutual aid--that facilitate collective action for mutual benefit. Social capital is believed to play an important role in the functioning of community life across a variety of domains, ranging from the prevention of juvenile delinquency and crime, the promotion of successful youth development, and the enhancement of schooling and education to the encouragement of political participation. More recently, researchers have begun to apply the concept to explain variations in health status across geographic localities. In preliminary analyses, the higher the stocks of social capital (as indicated by measures of trust and reciprocity in social surveys), the higher appear to be the health achievement of a given area. Strengthening the social capital within communities may provide an important avenue for reducing socioeconomic disparities in health.

Adult↗
PubMed2004

Social capital and collective efficacy in Hungary: cross sectional associations with middle aged female and male mortality rates.

OBJECTIVES: Social capital, collective efficacy, and religious involvement have each been linked to population health. This study examined the relations between these measures and male/female mortality rates in Hungary. DESIGN: Cross sectional, ecological study. SETTING: 150 sub-regions of Hungary. PARTICIPANTS AND METHODS: 12643 people were interviewed in 2002 (the "Hungarostudy 2002" survey). Social capital was measured by lack of social trust, reciprocity between citizens, and membership in civil organisations. Collective efficacy was measured by survey items from the Project on Human Development in Chicago Neighborhoods. Religious involvement was measured by church attendance. MAIN OUTCOME MEASURE: Gender specific all cause mortality rates for the middle aged population (45-64 years) in the 150 sub-regions of Hungary, provided by the Central Statistical Office (CSO). RESULTS: Social capital, collective efficacy, as well as religious involvement were each significantly associated with middle age mortality. After education, collective efficacy showed the strongest association with mortality in both men and women. Among men, socioeconomic status, collective efficacy, social distrust, competitive attitude, reciprocity, and membership of civic organisations explained 68.0% of the sub-regional variations in mortality rates. Among women the same variables explained only 29.3% of the variance in mortality rates. Religious involvement was protective among women. CONCLUSION: Collective efficacy and social capital are significant predictors of mortality rates in both men and women across sub-regions of Hungary. Gender differences in the relative importance of social factors may help to explain the differential impact of economic transformation on mortality rates for men and women in Central-Eastern European countries.

Cross-Sectional Studies↗
PubMed2003

Impact of different aspects of social participation and social capital on smoking cessation among daily smokers: a longitudinal study.

OBJECTIVE: To investigate differences in different aspects of social participation and social capital among baseline daily smokers that had remained daily smokers, become intermittent smokers, or stopped smoking at one year follow up. DESIGN/SETTING/PARTICIPANTS/MEASUREMENTS: 12,507 individuals, aged 45-69 years, interviewed at baseline between 1992 and 1994 and at a one year follow up were investigated in this longitudinal study. The three groups of baseline daily smokers were compared to the reference population (baseline intermittent smokers and non-smokers) according to different aspects of social participation and social capital. A multivariate logistic regression model was used to assess differences in different aspects of social participation and social capital. RESULTS: The baseline daily smokers that remained daily smokers at the one year follow up had significantly increased odds ratios of non-participation in study circles in other places than at work, meeting of organisations other than unions, theatre/cinema, arts exhibition, church, sports events, large gatherings of relatives, and private parties compared to the reference population. The baseline daily smokers that had become intermittent smokers at the one year follow up had significantly increased odds ratios of non-participation in church services. The baseline daily smokers that had stopped smoking had increased odds ratios of non-participation in having attended a meeting of organisations other than labour unions during the past year, having been to a theatre or cinema, and of having visited an arts exhibition during the past year. All three categories of baseline daily smokers had significantly decreased odds ratios of non-participation in night club/entertainment. CONCLUSIONS: The baseline daily smokers that had remained daily smokers at the one year follow up had particularly high rates of non-participation compared to the reference population in both activities specifically related to social capital, such as other study circles, meetings of organisations other than labour unions, and church attendance and cultural activities such as theatre/cinema and arts exhibition, although significantly lower participation in cultural activities and meetings of other organisations was also observed among daily smokers that had stopped smoking. All three baseline daily smoker groups had higher rates of having visited a night club during the past year.

Aged↗
PubMed1992

Potential movements of capital and labor in northeast Asia.

"This paper provides background information for potential movements of capital and labor within Northeast Asia. First, it reviews recent geopolitical changes...and the current state of capital and labor movements between the countries of Northeast Asia along the broad theme of regional cooperation. Second, the paper assesses potential movements of capital and labor in the near future based on planned or anticipated development projects in the region. Finally, political and social barriers to movements of capital and labor and some measures to facilitate such...movements are discussed."

Asia↗
PubMed2006

Social capital and quality of life in old age: results from a cross-sectional study in rural Bangladesh.

The objective of this article is to identify determinants of quality of life (QoL) and investigate their association with individual- and community-level social capital among older people in rural Bangladesh. A cross-sectional study of 1,135 elderly persons (aged >/= 60 years) was conducted in a rural district in Bangladesh. Independent variables included age, sex, education, economic status of the elderly person, and individual- and community-level social capital. Self-rated QoL was the dependent variable. Descriptive analyses were done to show group differences in QoL and logistic regression analyses to identify determinants of QoL. Advanced age, poor household economic status, and low social capital at individual and community levels were significant determinants of poor QoL among the elderly. This population-based study provided empirical evidence that social capital both at individual and community levels was directly associated with the QoL of elderly people in rural Bangladesh.

Aged↗
PubMed2005

Contextualizing and assessing the social capital of seniors in congregate housing residences: study design and methods.

BACKGROUND: This article discusses the study design and methods used to contextualize and assess the social capital of seniors living in congregate housing residences in Calgary, Alberta. The project is being funded as a pilot project under the Institute of Aging, Canadian Institutes for Health Research. DESIGN/METHODS: Working with seniors living in 5 congregate housing residencies in Calgary, the project uses a mixed method approach to develop grounded measures of the social capital of seniors. The project integrates both qualitative and quantitative methods in a 3-phase research design: 1) qualitative, 2) quantitative, and 3) qualitative. Phase 1 uses gender-specific focus groups; phase 2 involves the administration of individual surveys that include a social network module; and phase 3 uses anamolous-case interviews. Not only does the study design allow us to develop grounded measures of social capital but it also permits us to test how well the three methods work separately, and how well they fit together to achieve project goals. This article describes the selection of the study population, the multiple methods used in the research and a brief discussion of our conceptualization and measurement of social capital.

Aged↗
PubMed1999

Child centered literacy orientation: a form of social capital?

OBJECTIVE: To describe the home literacy environment and to identify financial, human, and social capital variables associated with the presence or lack of Child Centered Literacy Orientation (CCLO) in families with young children who regularly attend pediatric primary care clinics. DESIGN: Cross-sectional case-control analysis of structured parent interviews conducted in two hospital-based and four community-based pediatric clinics in New England. SUBJECTS: Parents of 199 healthy 1- to 5-year-old children whose mean age was 30 +/- 15 (SD) months were interviewed. Parents were primarily mothers (94%) with a mean age of 28 +/- 7 (SD) years 60% of whom were single. Educational levels of study parents varied: 43% had not graduated from high school, 29% had a high school equivalency, and 28% had at least a year of college or vocational training. This was a multiethnic parent group. Sixty-five percent were bilingual or non-English speaking. Fifty-eight percent were born outside of the continental United States. Parents were primarily of low-income status with 85% receiving Women, Infant, and Children (WIC) food supplements, Aid to Families With Dependent Children, and/or Medicaid. RESULTS: Half of the parents interviewed reported that they rarely read books. Sixty percent of children had fewer than 10 books at home and two-thirds of these households contained fewer than 50 books total. When asked open-ended questions, 28% of parents said that sharing books with their child was one of their three favorite activities together, 14% said that looking at books was one of their child's three favorite things to do, and 19% reported sharing books at bedtime at least six times each week. Thirty-nine percent of families had at least one of these three literacy-related responses present and so were said to have a CCLO. A backwards stepwise multiple logistic regression on CCLO was performed with family financial, human, and social capital variables. Parents married or living together (odds ratio [OR] 2.56, 95% confidence interval [CI] = 1.21-5.42), higher adult-to-child ratios in the home (OR 1.92, 95% CI = 1.20-3.05), households speaking only English (OR 2.67, 95% CI = 1.24-5.76), parents reading books themselves at least a few times a week (OR 2.86, 95% CI = 1.38-5.91), and homes with more than 10 children's books (OR 3.3, 95% CI = 1.6-6.83), were all independently and significantly associated with the presence of CCLO. Older child age and higher parent education remain in the model but were not significant at the P <.05 level. Ethnicity and income status were dropped for lack of additional significance from this model, which described 24% of the variance in CCLO. CONCLUSION: Although two-parent families and higher adult-to-child ratios in the home appear to be social capital variables with protective effects, low-income, single-parent, and minority or immigrant families are at significant risk for lacking both children's books and a CCLO. We suggest that CCLO may itself be another form of social capital reflecting parental goals and expectations for their children. We speculate that interventions which provide children's books and information about reading with children to impoverished families with young children may facilitate more parent-child book sharing. Pediatricians and other primary care providers serving underserved populations may have a unique opportunity to encourage activities focusing on young children and promoting literacy.

Analysis of Variance↗
PubMed2005

Building on leadership and social capital to create change in 2 urban communities.

There has been an appeal to reduce health inequities by increasing community involvement and social capital. Poder es Salud/Power for Health is a community-based participatory prevention research project that seeks to address health disparities in the African American and Latino communities by enhancing community-level social capital. We provide specific examples of how this intervention uses community health workers and popular education to reduce language and cultural barriers and enhance community social capital. Although the communities share fundamental challenges related to health disparities, the ways in which the Latino and African American communities identify health concerns, create solutions, and think about social capital vary. Members of the project are working together to identify opportunities for cross-cultural collaboration.

Black or African American↗
PubMed2000

Giving means receiving: the protective effect of social capital on binge drinking on college campuses.

OBJECTIVES: We tested whether higher levels of social capital on college campuses protected against individual risks of binge drinking. METHODS: We used a nationally representative survey of 17,592 young people enrolled at 140 4-year colleges. Social capital was operationalized as individuals' average time committed to volunteering in the past month aggregated to the campus level. RESULTS: In multivariate analyses controlling for individual volunteering, sociodemographics, and several college characteristics, individuals from campuses with higher-than-average levels of social capital had a 26% lower individual risk for binge drinking (P < .001) than their peers at other schools. CONCLUSIONS: Social capital may play an important role in preventing binge drinking in the college setting.

Adolescent↗
PubMed2000

Acetabular development in developmental dysplasia of the hip complicated by lateral growth disturbance of the capital femoral epiphysis.

BACKGROUND: Lateral growth disturbance of the capital femoral epiphysis is the most common type of physeal arrest complicating the treatment of developmental hip dysplasia. Although this type of physeal damage has been assumed to result in poor acetabular development, the natural history of dysplastic hips affected by this pattern of growth disturbance is still unclear. To investigate this issue, we evaluated acetabular development in a retrospective study of fifty-eight hips in forty-eight patients who had lateral physeal arrest after management of developmental hip dysplasia. METHODS: Of the fifty-eight hips, thirty-six were reduced closed and twenty-two were reduced open. The average age of the patients was twenty-two months (range, three to ninety-seven months) at the time of the reduction and twenty-one years (range, ten to fifty-five years) at the time of the latest follow-up evaluation. Hips rated as Severin class I (an excellent result) or II (a good result) were defined as having a satisfactory result, and those rated as Severin class III (a fair result) or IV (a poor result) were considered to have an unsatisfactory result. Specific femoral head changes were sought in the complete radiographic files on all hips. Various radiographic parameters of hip integrity, including the degree of lateral tilt of the capital femoral epiphysis, were measured over time, and comparisons were made between hips classified as satisfactory and those classified as unsatisfactory at four time-points: before the reduction, at two years after the reduction, at six to eight years of age, and at the time of the final follow-up. RESULTS: Lateral growth disturbance of the capital femoral epiphysis was first evident by an average of ten years of age (range, four to fourteen years of age). There was no consistent early pattern of changes in the epiphysis, physis, or metaphysis related to later development of valgus tilt of the epiphysis. Thirty-four hips (59 percent) were rated as satisfactory and twenty-four were rated as unsatisfactory at the latest follow-up evaluation. Hips classified as unsatisfactory exhibited poor acetabular development by an average age of seven years. The inclination of the epiphyseal plate became progressively more horizontal or even reversed over time; however, serial measurements of inclination were not significant predictors of Severin classification. CONCLUSIONS: Lateral growth disturbance of the capital femoral epiphysis is not necessarily associated with poor acetabular development, as when dysplasia does occur it is generally evident prior to the identification of the physeal arrest. It is important to monitor acetabular development after reduction rather than search for radiographic changes of physeal arrest, which are difficult to detect in young children.

Acetabulum↗
PubMed2001

Histopathologic changes in growth-plate cartilage following ischemic necrosis of the capital femoral epiphysis. An experimental investigation in immature pigs.

BACKGROUND: The developing capital femoral epiphysis consists of a secondary center of ossification surrounded by epiphyseal cartilage. Between the epiphyseal cartilage and the secondary center of ossification is a growth plate, which contributes to the circumferential increase in size of the secondary center of ossification during development. The main objective of this study was to describe the histopathologic changes that occur in the growth plate surrounding the secondary center of ossification during the early and reparative phases following the induction of ischemic necrosis of the capital femoral epiphysis in immature pigs. METHODS: Ischemic necrosis of the capital femoral epiphysis was induced in eighteen piglets by placing a nonabsorbable suture ligature around the femoral neck following a capsulotomy and transection of the ligamentum teres. The animals were killed three days to eight weeks following the induction of ischemia, and visual, radiographic, and histologic assessments were performed. RESULTS: Two to four weeks after the induction of ischemic necrosis, the growth plate surrounding the secondary center of ossification became necrotic. The observed histopathologic changes included chondrocyte death, loss of safranin-O staining of the matrix of the necrotic growth-plate cartilage, an absence of vascular invasion of terminal hypertrophic chondrocytes, and a decrease in the amount of primary spongiosa, indicating cessation of endochondral ossification. In the reparative phase, at four to eight weeks postoperatively, chondrocyte clusters and intense safranin-O staining were observed in the epiphyseal cartilage around the necrotic growth-plate cartilage. In the peripheral region of the femoral head, necrotic growth-plate cartilage surrounding the secondary center of ossification was resorbed by a fibrovascular tissue from the marrow space. By six weeks, new accessory centers of ossification with restored endochondral ossification were observed in the peripheral epiphyseal cartilage. New ossification centers contributed to the fragmented radiographic appearance of the secondary center of ossification. The physis appeared essentially normal in most animals, although five of the eighteen piglets showed mild or moderate histopathologic changes. CONCLUSIONS: In this model, ischemic necrosis of the capital femoral epiphysis resulted in necrosis of the growth plate surrounding the secondary center of ossification. Small new ectopic centers of ossification appeared in the epiphyseal cartilage, explaining in part the fragmented radiographic appearance of the secondary center of ossification.

Animals↗
PubMed2006

"Social capital," GNP per capita, relative income, and health: an ecological study of 23 countries.

The effects of social capital, income inequality, and absolute per capita income were investigated in an ecological analysis of 23 rich and poor countries. Trust was chosen as an indicator of social capital, and GNP (gross national product) per capita and Gini index measured absolute and relative income, respectively. These independent variables were analyzed in a linear regression model with the dependent variables adult mortality rate (25-64 years), life expectancy, and infant mortality rate (IMR). Separate analyses were performed for poor and rich countries as well as all countries combined. Social capital (trust) showed no significant association with the three health outcomes. A particularly strong relationship was found between Gini index and IMR for rich countries, and GNP per capita and life expectancy for all countries. In the group of poor countries, GNP per capita and Gini index in the same model were associated with IMR. The results contradict the suggested impact of social capital on health, and instead support the notion that economic factors such as absolute income and relative income distribution are of importance.

Adult↗
PubMed2002

Spontaneous femoral capital physeal fractures in adult cats: 26 cases (1996-2001).

OBJECTIVE: To determine clinical, radiographic, and histologic abnormalities in adult cats > 1 year old with spontaneous (ie, nontraumatic) femoral capital physeal fractures. DESIGN: Retrospective study. ANIMALS: 26 cats. PROCEDURE: Medical records of cats > 1 year old with femoral capital physeal fractures and no history of trauma were examined. RESULTS: Mean +/- SD age of the cats was 22.5 +/- 6.5 months. Twenty-five cats were neutered males. Mean weight of the cats was significantly greater than mean weight of a group of age- and sex-matched control cats. Of 16 cats for which age at the time of neutering was known, 14 had been neutered before 6 months of age. Nine cats had bilateral fractures. Severity of femoral neck osteolysis and sclerosis increased with increased duration of clinical signs. The contralateral femoral capital physis, distal femoral physes, and proximal tibial physes were radiographically open in 13 of 18,19 of 24, and 24 of 24 cats, respectively. Histologically, the epiphysis contained normal articular cartilage and bone, but attached growth plate cartilage lacked the normal columnar arrangement of chondrocytes. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that adult cats with spontaneous femoral capital physeal fractures were most likely to be heavier, neutered males with delayed physeal closure.

Age Factors↗
PubMed2004

Surgical reduction and stabilization for repair of femoral capital physeal fractures in cats: 13 cases (1998-2002).

OBJECTIVE: To evaluate anatomic reduction and surgical stabilization of femoral capital physeal fractures in cats. DESIGN: Retrospective study. ANIMALS: 13 cats. PROCEDURE: Medical records of cats with unilateral or bilateral femoral capital physeal fractures evaluated from 1998 to 2002 were reviewed. Age and weight of cats at the time of surgery; breed; sex; concurrent injuries; severity of lameness before and 1, 2, 4, 6, and 8 weeks after surgery; the amount of fracture reduction achieved and number of Kirschner wires (K-wires) used; degree of degenerative joint disease of the hip joint and lysis of the femoral neck and head observed after surgery; whether K-wires were removed after surgery; and complications after surgery were evaluated. RESULTS: Thirteen cats with 16 capital physeal fractures were identified. There was significant improvement in the severity of clinical lameness in all cats from weeks 1 through 4 after surgery. There was no correlation between the scores of the individuals who evaluated radiographs for fracture reduction and placement of K-wires. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that surgical stabilization and repair of femoral capital physeal fractures facilitate a short recovery period and a good prognosis for return to normal function in cats.

Animals↗
PubMed1998

Family capital and Hong Kong adolescents' academic achievement.

This study examined relationships between the economic, human, social, and cultural capital of families and adolescents' academic achievement. Data were collected from 387 14-yr.-old Hong Kong students (187 girls, 200 boys), who completed questionnaires to assess their perceptions of the various dimensions of family capital. Academic achievement was measured by performance in Chinese language, English language, and mathematics. The findings indicated that different combinations of the dimensions of family capital combined to contribute to moderate amounts of variance in adolescent girls' academic performance, whereas social capital was the only family measure to have a meaningful and significant modest association with adolescent boys' academic achievement.

Achievement↗
PubMed2006

Slipped capital femoral epiphysis: current concepts.

Slipped capital femoral epiphysis is a common hip disorder in adolescents, with an incidence of 0.2 (Japan) to 10 (United States) per 100,000. The etiology is unknown, but biomechanical and biochemical factors play an important role. Symptoms at presentation include pain in the groin, thigh, or knee. Ambulatory patients also may present with a limp. Nonambulatory patients present with excruciating pain. The slipped capital femoral epiphysis is classified as stable when the patient can walk and unstable when the patient cannot walk, even with the aid of crutches. Because the epiphysis slips posteriorly, it is best seen on lateral radiographs. The treatment of choice for stable slipped capital femoral epiphysis is single-screw fixation in situ. This method has a high probability of long-term success, with minimal risk of complications. In the patient with unstable slipped capital femoral epiphysis, urgent hip joint aspiration followed by closed reduction and single- or double-screw fixation provides the best environment for a satisfactory result, while minimizing the risk of complications.

Epiphyses↗