A 2018 estimate indicates that there were 226,057 radon-attributable lung cancer deaths in 66 countries that had representative radon surveys. This is a shocking figure, and as it comes from only 66 ...countries it underestimates the worldwide death toll. Any research that enables countries to conduct representative radon surveys and to understand better the risk to citizens from radon is surely welcome. We hope this paper provides a useful methodology for estimating population risk.
The estimation of population weighted average indoor radon levels requires statistically valid sampling methodologies that use a representative sample of occupied homes throughout the country. A literature review indicates that in many population weighted surveys, the sampling methodology may not have been designed to do this. This paper describes a simple, resource efficient methodology which produces statistically valid and reliable estimates based on a small scale sample that is representative of the population distribution. The resource efficient design of this study enables it to be repeated at frequent intervals providing for a longitudinal analysis of the population risk from indoor radon.
This survey was conducted in Ireland using 653 measurements and a representative sampling strategy to provide a baseline population weighted radon exposure for future comparisons. This study estimates the average population weighted indoor radon concentration in Ireland to be 97.83 Bq m−3 (95% Confidence Interval 90.69 Bq m−3 to 105.53 Bq m−3), and that there are an estimated 350 lung cancer cases and 255 deaths per year due to radon exposure. The mortality rate of 5.3 per 100,000 due to indoor radon, demonstrates that radon remains one of the highest preventable causes of death in Ireland.
•Population weighted survey design.•Efficient methodology to produce statistically valid Population Radon Risks.•Study design allows frequent longitudinal studies of Population Radon Risk.•Population weighted indoor radon concentration in Ireland is 97.83 Bq m−3.•350 lung cancer cases per year in Ireland due to radon exposure.
Background
The growing social media presence in healthcare has provided physicians with new ways to engage with patients. However, foot and ankle orthopaedic surgeons have been found to underuse ...social media platforms despite their known benefits for patients and surgeons. Thus, this study sought to investigate the reasons for this phenomenon and to identify potential barriers to social media utilization in clinical practice.
Methods
A 19‐question survey was distributed to active attending physicians identified through the American Orthopaedic Foot & Ankle Society membership database. The survey included demographic, practice characteristics, and social media use questions assessed by a 5‐point Likert scale. Logistic regression was used to identify predictors of positive attitudes toward social media.
Results
Fifty‐eight surgeons were included. Most respondents were male (n = 43, 74.1%), in private practice (n = 31, 53.5%), and described their practice to be greater than 51% elective procedures (n = 46, 79.4%). The average years in practice was 14.8 years (standard deviation, SD: 10.0 years). A total of 32.8% (n = 19) of surgeons reported using social media as part of their clinical practice. Facebook (n = 19, 32.8%), a professional website or blog (n = 18, 31.0%), and LinkedIn (n = 15, 25.9%) were the most used platforms–primarily for practice marketing or brand development (n = 19, 32.8%). A total of 58.6% (n = 34) of surgeons reported they did not use social media. The primary reasons were the time commitment (n = 31, 53.5%), concerns about obscuring professional boundaries (n = 22, 37.9%), and concerns regarding confidentiality (n = 11, 19.0%). Many surgeons reported that social media positively influences foot and ankle surgery (n = 23, 39.7%), although no individual predictors for these views could be identified.
Conclusions
Foot and ankle orthopaedic surgeons tended to view social media use positively, but the time investment and concerns over professionalism and confidentiality pose challenges to its use. Given the influence of a surgeon's social media identity on patient satisfaction and practice building, efforts should be made to streamline social media use for foot and ankle surgeons to establish their online presence.
Level of evidence
Level IV, cross‐sectional study.
Fragility fractures are a large source of morbidity and mortality in the elderly. Orthopaedic surgeons are regularly the main point of contact in patients with lateral compression type 1 pelvis ...fractures, despite many of these being treated non-operatively. This study aims to identify risk factors for mortality and elucidate which follow-up visits have the potential to improve care for these patients.
In all, 211 patients have been identified with fragility lateral compression type 1 fractures at a level 1 trauma centre over a 5-year period. For all patients, we recorded patient demographics, imaging data, hospital readmissions, medical complications and death dates if applicable.
Of the 211 patients identified, 56.4% had at least one orthopaedic follow-up, of which no patient had a clinically meaningful medical intervention initiated. 30-day readmission rate was 19%, and 1-year mortality was 24%. Male sex, need for an assist device, higher Charlson Comorbidity Index and increased age were found to be statistically associated with increased risk of mortality. Patients who followed up with their primary care physician were found to have a statistically lower risk of mortality. Computed tomography scans were obtained in 70% of patients and never limited patient weight-bearing status or found any additional injury not already identified on the radiograph.
For patients with lateral compression type 1 type fragility fractures, orthopaedic surgeons did not offer additional clinically meaningful intervention after the time of initial diagnosis in this patient cohort. The rate of clinical follow-up with a primary care physician is relatively low despite high rates of medical comorbidity. Computed tomography scans were utilised frequently but did not change recommendations. The high rate of medical complications and lack of orthopaedic intervention suggest that we should re-evaluate the role of the orthopaedic surgeon versus the primary care physician as the primary point of medical contact for patients with these injuries.
Abstract
Background
Life expectancy (LE) is an important metric for overall population health and well-being. The gender gap in LE can be used as a population health metric to capture progress and ...monitor health inequality in a specific setting. Health inequality is an expression of universal health care coverage and unequal access to health care and the quality of health care - otherwise known as ‘amenable’ mortality.
Methods
The Global Burden of Disease (GBD) Study- a comprehensive global epidemiologic database has developed and validated two population health metrics across 200+ countries- the Universal Health Coverage (UHC) Index (0-100) and the Healthcare Access and Quality (HAQ) Index (0-100) to monitor progress in these two specific domains for each country. We set out to examine the association of gender gap in LE with UHC and HAQ indices across 27 EU countries and the UK combined for year 2019 employing correlation and linear regression analyses.
Results
Overall, LE ranged from 73.3 years in Bulgaria to 83.1 years in Italy; UHC index was worst in Bulgaria (62.6), while Luxembourg (91.5) was the best performing nation; HAQ index had the highest score in the Netherlands (91.1), while Bulgaria had the lowest score (64.9). Lithuania had the largest gender gap in LE (9.2 years; M:71.5; F: 80.7), while the Netherlands had the narrowest gender gap (3.4 years; M:80.0; F: 83.4). On multivariable linear regression, gender gaps in LE were significantly associated with both HAQ (beta: -0.17; R2=0.66), and UHC (beta: -0.14; R2=0.52) across 27 EU countries and the UK combined.
Conclusions
Gender gap in LE can be a proxy measure to monitor progress in health inequality in terms of universal health care coverage, as well as health care access and quality of health care for a specific population setting. The findings suggest that gender gap in LE can be significantly reduced through expansion of universal health care and improving both access and quality of health care in the EU.
Key messages
• Gender gap in life expectancy can be a good proxy to monitor progress in health inequality for EU countries and the UK combined, which has 5.5 years of gender gap in life expectancy on average in 2019.
• A 10% increase in both universal health care coverage and health care access and quality, can reduce gender gap in life expectancy by 1.4 and 1.7 years, respectively, across EU and the UK combined.
To describe the rare complication of traumatic thoracic duct injury associated significant thoracic spine fractures and describe treatment when conservative treatment is refractory.
A 27-year-old ...male was admitted to the hospital after a motorcycle collision with a three-column extension injury of spinal levels T9-10 and a traumatic thoracic duct injury that was clinically detected on hospital day 9. This case reports documents successful management of a traumatic chylothorax via thoracic duct embolization. Thoracic duct injury is a rare sequela of vertebral fractures. Drainage and observation is considered first line treatment of a chylothorax. However, surgery is indicated if leakage persists after parenteral feeding and a strict non-fat diet for 5–7 days. This case represents a unique instance where a traumatic spine injury was seen in association with thoracic duct injury and chylothorax.
Traumatic thoracic duct injury can occur with significant thoracic spine injuries. Being aware of this potential concomitant injury will prevent a delayed or missed diagnosis. Despite literature that shows that this can be managed conservatively, there are circumstances such as our case where treatment is refractory to non-procedural management. Our case is unique in its description of management in regards to minimally invasive approach to traumatic thoracic duct injury in the context of a spinal fracture.
•Ruminative anxiety may be a psychological vulnerability for chronic pain.•Comorbid ruminative anxiety and chronic pain predicted lower mindfulness.•Mindfulness predicted 8.5–40.9% of variance in ...Fear-Avoidance Model elements.•Non-reaction, non-judgment and awareness were unique predictors of chronic pain.•Mindfulness may treat physical, cognitive and behavioral aspects of chronic pain.
The Fear-Avoidance Model of Chronic Pain proposed by Vlaeyen and Linton states individuals enter a cycle of chronic pain due to predisposing psychological factors, such as negative affectivity, negative appraisal or anxiety sensitivity. They do not, however, address the closely related concept of anxious rumination. Although Vlaeyen and Linton suggest cognitive-behavioral treatment methods for chronic pain patients who exhibit pain-related fear, they do not consider mindfulness treatments. This cross-sectional study investigated the relationship between chronic musculoskeletal pain (CMP), ruminative anxiety and mindfulness to determine if (1) ruminative anxiety is a risk factor for developing chronic pain and (2) mindfulness is a potential treatment for breaking the cycle of chronic pain.
Middle-aged adults ages 35–50 years (N=201) with self-reported CMP were recruited online. Participants completed standardized questionnaires assessing elements of chronic pain, anxiety, and mindfulness.
Ruminative anxiety was positively correlated with pain catastrophizing, pain-related fear and avoidance, pain interference, and pain severity but negatively correlated with mindfulness. High ruminative anxiety level predicted significantly higher elements of chronic pain and significantly lower level of mindfulness. Mindfulness significantly predicted variance (R2) in chronic pain and anxiety outcomes. Pain severity, ruminative anxiety, pain catastrophizing, pain-related fear and avoidance, and mindfulness significantly predicted 70.0% of the variance in pain interference, with pain severity, ruminative anxiety and mindfulness being unique predictors.
The present study provides insight into the strength and direction of the relationships between ruminative anxiety, mindfulness and chronic pain in a CMP population, demonstrating the unique associations between specific mindfulness factors and chronic pain elements.
It is possible that ruminative anxiety and mindfulness should be added into the Fear-Avoidance Model of Chronic Pain, with ruminative anxiety as a psychological vulnerability and mindfulness as an effective treatment strategy that breaks the cycle of chronic pain. This updated Fear-Avoidance Model should be explored further to determine the specific mechanism of mindfulness on chronic pain and anxiety and which of the five facets of mindfulness are most important to clinical improvements. This could help clinicians develop individualized mindfulness treatment plans for chronic pain patients.
Fragility fractures are a significant source of morbidity and have high associated mortality. Identifying risk factors for poor outcomes is essential for guiding treatment and for setting ...expectations for patients and their families. While fragility hip fractures have been abundantly explored, there is a paucity of information regarding proximal humerus fractures (PHF).
We retrospectively review the electronic medical records of 379 patients who presented to a level one trauma center with a PHF secondary to a mechanical fall. Patient demographics, handedness, comorbidities, treatment, imaging data, follow-up data, and death date (if applicable) were recorded.
Our cohort consisted of 279 females and 100 males with an average age of 71.4 years old. Distribution of injuries was 178 left, 141 right, and 7 bilateral. Compared to handedness, 179 were ipsilateral, 141 contralateral, and 59 were unknown. 81.3% of injuries were treated non-operatively, while 18.7% were managed surgically. One-year mortality was 17.4% and two-year mortality was 24.0%.
Males demonstrated a 2.28 increased risk of one-year mortality (p = 0.004). Patients who died within one year of fracture had significantly higher Charlson comorbidity index scores (p < 0.0001) and age (p = 0.0003). Risk of death was significantly lower in patients who underwent surgery compared to those who were treated non-operatively (p = 0.01). Patients who used an assist device prior to fracture had 4.2 increased risk of one-year mortality (p < 0.0001). Patients who presented from nursing homes or assisted living had a 2.1 increased risk of one-year mortality (p = 0.02). Patients with severe liver disease had a 5.5 increased risk of one-year mortality (p < 0.0001) and those with metastatic cancer had a 13.7 increased risk of one-year mortality (p < 0.0001). Bilateral fractures, side of injury in relation to handedness, re-hospitalization, Neer classification, and PCP follow-up within 30 days were not associated with increased mortality.
Increased understanding risk factors for mortality following PHF will allow for more informed patient discussions regarding treatment outcomes and risk of death. Our data suggests that mortality at one year for fragility PHF is universally high regardless of risk factors. This risk is increased in patients who are older, functionally limited, or who have medical comorbidities. Our data demonstrates the importance of medical optimization of patients with a fragility PHF and underscores the importance of fall prevention in high-risk patients.
Cancer is the leading cause of disease-related death for adolescents and young adults (AYAs) in the United States. Parents of AYAs with life-threatening illnesses have expressed the desire to talk to ...their children about end of life (EOL) care, yet, like caregivers of adult patients, struggle to initiate this conversation. Building Evidence for Effective Palliative/End of Life Care for Teens with Cancer is a longitudinal, randomized, controlled, single-blinded clinical trial aimed at evaluating the efficacy of FAmily CEntered disease-specific advance care planning (ACP) for teens with cancer (FACE-TC). A total of 130 dyads (260 subjects) composed of AYAs 14–20years old with cancer and their family decision maker (≥18years old) will be recruited from pediatric oncology programs at Akron Children's Hospital and St. Jude Children's Research Hospital. Dyads will be randomized to either the FACE-TC intervention or Treatment as Usual (TAU) control. FACE-TC intervention dyads will complete three 60-minute ACP sessions held at weekly intervals. Follow-up data will be collected at 3, 6, 12, and 18months post-intervention by a blinded research assistant (RA). The effects of FACE-TC on patient-family congruence in treatment preferences, quality of life (QOL), and advance directive completion will be analyzed. FACE-TC is an evidenced-based and patient-centered intervention that considers QOL and EOL care according to the AYA's representation of illness. The family is involved in the ACP process to facilitate shared decision making, increase understanding of the AYA's preferences, and make a commitment to honor the AYA's wishes.
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