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PubMed1978

Physicians' attitudes toward early intervention.

Fourteen pediatricians serving Boston neighborhood health centers and fourteen pediatric neurologists in the greater Boston area were interviewed in order to determine their attitudes toward early intervention for infants with developmental disorders. The two groups differed significantly over the potential of early treatment for promoting optimal motor, cognitive, and affective development in the disadvantaged infant. Both groups viewed prevention of musculoskeletal deformities as appropriate for physically handicapped children and supported early intervention for the parents. When referral for treatment was delayed or withheld, the prime reasons given were an expression of a maturationist viewpoint, a desire for a definitive diagnosis prior to initiating treatment, the assumption that an adequate family can function without professional involvement, and misinterpretation of professional roles.

Attitude of Health Personnel↗
PubMed2002

The effects of a medical care utilization review program on back and neck injury claims.

A number of quality-based evaluation and treatment protocols have been developed and marketed for the management of work-related musculoskeletal problems. Yet, little is known about their effectiveness in improving patient outcomes. We evaluated one such approach adopted by the Department of Labor and Industries, which insures approximately two-thirds of the non-federal workforce in Washington State. The outcomes of back and neck injury claims (primarily sprains and strains) filed in the 2 months after the program was fully operational were compared with two comparable groups of claims from the same base population filed before the program's availability. There were no statistically significant differences between groups in the number of days of work loss, medical costs, and permanent partial disability awards granted during the 2 years after injury. The quality-based program used as an adjunct to claims management failed to improve outcomes.

Absenteeism↗
PubMed2005

Editorial comment.

Explore the source record for details and available documents.

Developing Countries↗
PubMed2006

Parathyroid hormone-related protein regulates intestinal calcium transport in sea bream (Sparus auratus).

Parathyroid hormone-related protein (PTHrP) is a factor associated with normal development and physiology of the nervous, cardiovascular, immune, reproductive, and musculoskeletal systems in higher vertebrates. It also stimulates whole body calcium uptake in sea bream (Sparus auratus) larvae with an estimated 60% coming from intestinal uptake in seawater. The present study investigated the role of PTHrP in the intestinal calcium transport in the sea bream in vitro. Unidirectional mucosal-to-serosal and serosal-to-mucosal 45Ca fluxes were measured in vitro in duodenum, hindgut, and rectum mounted in Ussing chambers. In symmetric conditions with the same saline, bathing apical and basolateral sides of the preparation addition of piscine PTHrP 1-34 (6 nM) to the serosal surface resulted in an increase in mucosal to serosal calcium fluxes in duodenum and hindgut and a reduction in serosal to mucosal in the rectum, indicating that different mechanisms are responsive to PTHrP along the intestine. In control asymmetric conditions, with serosal normal and mucosal bathed with a saline similar in composition to the intestinal fluid, there was a net increase in calcium uptake in all regions. The addition of 6 nM PTHrP 1-34 increased net calcium uptake two- to threefold in all regions. The stimulatory effect of PTHrP on net intestinal calcium absorption is consistent with a hypercalcemic role for the hormone. The results support the view that PTHrP, alone or in conjunction with recently identified PTH-like peptides, counteracts in vivo the hypocalcemic effects of stanniocalcin.

Animals↗
PubMed2002

The biology of foetal development and injury.

This oversimplified view of foetal development and the risk to injury aims to highlight the following: assuming there is a normal environment, gene expression will generate a protein chain that should fold to the expected stereological shape to function normally. Here we must take into consideration the important role played by external (environmental) factors. Abnormal organogenesis or foetal injury are, in all likelihood, due to abnormal genes or genes expressing themselves 'out of sinc', that is to say 'outside' their time allocated for expression. This type of injury is difficult to correct. Morphogenesis, or the continuous remodelling of formed organ/systems can be more amenable to correction since the basic layout of the organ already exists. The common denominator to organogenesis and morphogenesis, at cellular/tissue levels, is the harmonic interplay between cell multiplication, cell migration, cell differentiation, cell death, the generation of intercellular matrix and its resorption. All of this must take place at the 'right time'. Any departure from it may lead to injury, whether clinically detectable or not.

Animals↗
PubMed2006

Non-invasive distal femoral expandable endoprosthesis for limb-salvage surgery in paediatric tumours.

We report our early experience with the use of a non-invasive distal femoral expandable endoprosthesis in seven skeletally immature patients with osteosarcoma of the distal femur. The patients had a mean age of 12.1 years (9 to 15) at the time of surgery. The prosthesis was lengthened at appropriate intervals in outpatient clinics, without anaesthesia, using the principle of electromagnetic induction. The patients were functionally evaluated using the Musculoskeletal Tumour Society scoring system. The mean follow-up was 20.2 months (14 to 30). The prostheses were lengthened by a mean of 25 mm (4.25 to 55) and maintained a mean knee flexion of 110 degrees (100 degrees to 120 degrees ). The mean Musculoskeletal Tumour Society score was 68% (11 to 29). Complications developed in two patients; one developed a flexion deformity of 25 degrees at the knee joint, which was subsequently overcome and one died of disseminated disease. The early results from patients treated with this device have been encouraging. The implant avoids multiple surgical procedures, general anaesthesia and assists in maintaining leg-length equality.

Adolescent↗
PubMed1992

Prevention and treatment of glucocorticoid-induced osteoporosis. A pathogenetic perspective.

Since the discovery of cortisol and the synthesis of related compounds, these potent pharmacologic agents have been progressively more widely utilized in allergic, pulmonary, and rheumatologic conditions. Organ transplantation represents a new group of patients added to the already large pool of subjects receiving glucocorticoids. However, glucocorticoids cause major side effects involving several organ systems, including the cardiovascular, endocrine, gastrointestinal, ophthalmologic, and musculoskeletal systems. Among the most dramatic side effects is the development of glucocorticoid-induced osteoporosis. Glucocorticoid use in the treatment of chronic obstructive pulmonary disease accounts for the majority of male patients with osteoporosis seen in our mineral metabolism clinic. This article focuses on glucocorticoid-induced osteoporosis in the adult with an emphasis on the clinical aspects of this condition. It is intended not as an extensive review on the subject but as a practical guide to help clinicians prevent and treat this condition in adult patients.

Bone Remodeling↗
PubMed1996

Measuring function of the shoulder. A cross-sectional comparison of five questionnaires.

Measures of both generic and disease-specific health status are being developed and used with increasing frequency for the appraisal of musculoskeletal conditions. The purpose of this study was to compare prospectively the validity of five questionnaires in the assessment of function of the shoulder. Ninety subjects who had various problems related to the shoulder agreed to enter the study. All of the subjects completed a questionnaire package that included the Shoulder Pain and Disability Index, the Simple Shoulder Test, the Subjective Shoulder Rating Scale, the Modified American Shoulder and Elbow Surgeons Shoulder Patient Self-Evaluation Form, and the Shoulder Severity Index as well as a measure of generic health status (the acute version of the Short Form 36 [SF-36]) and two questions that asked the patient to rate the severity of the problem and his or her over-all health. Frequency distributions were created and compared among questionnaires. Spearman rank correlations were calculated to compare the questionnaires with each other and with other assessments. One-way analysis of variance was used to determine the ability of the questionnaires to discriminate between self-rated severity of the problem and over-all health. The frequency distributions were similar among the five shoulder questionnaires, but those of the five shoulder questionnaires differed from that of the SF-36. The correlations were good (0.73 < or = r < or = 0.80) among all of the five shoulder questionnaires except the Subjective Shoulder Rating Scale; they were lower with the Subjective Shoulder Rating Scale and the physical function dimension of the SF-36 (0.12 < or = r < or = 0.60). The shoulder questionnaires discriminated between levels of severity (p < 0.0001) but not between levels of over-all health (0.10 < or = p < or = 0.86). In this concurrent comparison of measures of shoulder-specific outcome in the same subjects, the shoulder questionnaires performed similarly, both in describing function of the shoulder and in discriminating between levels of severity. The shoulder questionnaires performed differently than the SF-36, which confirms the need to use both disease-specific and generic health-status measures to evaluate patients who have a problem related to the shoulder.

Adult↗
PubMed2005

Operative treatment of calcaneal fractures in elderly patients.

BACKGROUND: Operative intervention is an accepted treatment for fractures of the calcaneus. However, the literature discourages surgery for these fractures in the elderly. The purpose of this paper was to review the outcomes of surgical treatment of displaced fractures of the calcaneus in elderly patients. METHODS: Between November 1987 and June 2000, forty-two patients (forty-four fractures) who were sixty-five years of age or older underwent surgery for a calcaneal fracture. The mechanism of injury, fracture pattern, and medical comorbidities were recorded. Thirty-five patients with a total of thirty-seven fractures were available for follow-up, which was conducted with physical and radiographic examinations and outcomes assessment with the Short Form-36 (SF-36), the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale, and the Short Musculoskeletal Function Assessment survey. RESULTS: The minimum duration of follow-up was two years, and the average duration was forty-four months. All but one fracture (97% of the fractures) healed at an average of 110 days. The average active range of motion was 38 degrees of plantar flexion, 10 degrees of dorsiflexion, 16 degrees of inversion, and 11 degrees of eversion. The average American Orthopaedic Foot and Ankle Society score was 82.4 points, the average SF-36 score was 52.8 points, and the average Short Musculoskeletal Function Assessment score was 20.4 points. Posttraumatic subtalar arthritis developed in twelve patients. There were twelve minor complications and four major complications (three cases of osteomyelitis and one nonunion), all of which were treated successfully. CONCLUSIONS: Open reduction appears to be an acceptable method of treatment for displaced calcaneal fractures in elderly patients. Careful patient selection is necessary because individuals presenting with severe osteopenia, those who are unable to walk or are able to walk only about the house, and those with a medical condition that precludes surgery may be better candidates for nonoperative care.

Aged↗
PubMed2002

[Methodology of an epidemiologic prevalence study in rheumatology: the Chiavari study].

OBJECTIVES: Goals of epidemiological studies are the description of the measures of frequency of diseases, the attempt to clarify possible etiopathogenic mechanisms, and the provision of data to support health policy decisions. To increase the familiarity of rheumatologists toward epidemiology, we describe the methodology used in a prevalence study of musculoskeletal complaints performed in Chiavari, Italy. METHODS: A questionnaire, originally developed by the Epidemiology Unit of the Arthitis Research Council in Manchester, UK, to investigate the prevalence of rheumatoid arthritis, was used after translation and validation. 4456 subjects aged 16 years or more listed in four general practices were invited to participate in the study and to fill the ARC questionnaire. The 3294 responders reported a) any past occurrence of joint swelling lasting more than four weeks and the distribution of the swollen joints on a mannequin; b) any joint pain lasting more than four weeks; c) current joint pain or swelling; d) morning stiffness; e) whether they had been previously told by a doctor they had arthritis. RESULTS: Four steps were necessary to obtain a 74% response, i.e. direct contact, two mailings and a phone interview. The performance of the different questions was good. The prevalence of the most common conditions among patients answering positively to the questions regarding morning stiffness and symmetrical swelling of joints was as follows: osteoarthritis 2.60%, fibromyalgia 1.30%, carpal tunnel syndrome 1.14%, rheumatoid arthritis 0.31%, and psoriatic arthritis 0.10%. CONCLUSIONS: Methodological issues regarding the selection of the population and sample to study, the development of a questionnaire, and the problems in obtaining valid informations are discussed.

Adolescent↗
PubMed1999

Diagnosing regional pain: the view from primary care

There is a general lack of new evidence on which to base practical and useful diagnostic classifications of regional musculoskeletal pain for primary care. However, the 'red flag' system, developed and now disseminated successfully in the management of low back pain, seems to be applicable to the initial management of other regional pain. In this scheme, signs and symptoms of serious disease are sought, and their presence is the indication for the investigation or referral of individual patients. In their absence, the low predictive value of many signs, tests and even diagnostic labels argues against their routine use in primary care. Simple decisions based on separation into articular versus non-articular, and acute versus chronic, are favoured by the most recent expert consensus statements. In addition, the presence or absence of more widespread pain, and of other non-specific features of chronic pain, is likely to be helpful in managing regional syndromes. Prospective studies of the prognostic value of symptoms, signs and diagnostic labels remain a research priority in this field.

Journal Article↗
PubMed2004

Adipose-derived adult stem cells for cartilage tissue engineering.

Tissue engineering is a promising therapeutic approach that uses combinations of implanted cells, biomaterial scaffolds, and biologically active molecules to repair or regenerate damaged or diseased tissues. Many diverse and increasingly complex approaches are being developed to repair articular cartilage, with the underlying premise that cells introduced exogenously play a necessary role in the success of engineered tissue replacements. A major consideration that remains in this field is the identification and characterization of appropriate sources of cells for tissue-engineered repair of cartilage. In particular, there has been significant emphasis on the use of undifferentiated progenitor cells, or "stem" cells that can be expanded in culture and differentiated into a variety of different cell types. Recent studies have identified the presence of an abundant source of stem cells in subcutaneous adipose tissue. These cells, termed adipose-derived adult stem (ADAS) cells, show characteristics of multipotent adult stem cells, similar to those of bone marrow derived mesenchymal stem cells (MSCs), and under appropriate culture conditions, synthesize cartilage-specific matrix proteins that are assembled in a cartilaginous extracellular matrix. The growth and chondrogenic differentiation of ADAS cells is strongly influenced by factors in the biochemical as well as biophysical environment of the cells. Furthermore, there is strong evidence that the interaction between the cells, the extracellular biomaterial substrate, and growth factors regulate ADAS cell differentiation and tissue growth. Overall, ADAS cells show significant promise for the development of functional tissue replacements for various tissues of the musculoskeletal system.

Adipocytes↗
PubMed1991

Clinical applications of contrast agents in body imaging.

Although parenteral contrast agents are now widely used in the central nervous system, progress in the development of applications in the remainder of the body has been slow. Both intravenous Gd-DTPA and magnetic iron oxide particles have many potential applications but the former will probably require faster imaging techniques and the latter will require reformulation to produce a less toxic preparation. In spite of these problems methods have been developed for the diagnosis of myocardial infarction, breast carcinoma, and musculoskeletal tumors. Interesting preliminary results are available for other applications of contrast agents in the body and many of these are likely to become routine over the next 5 years.

Contrast Media↗