There is anecdotal evidence of poorer outcomes from prosthetic joint replacement performed in independent treatment centres but very few comparative studies.We compared the early re-operation, dislocation, re-admission, major wound infection and audit rates of 880 total hip (THA) and 874 total knee (TKA) arthroplasties carried out at a regional orthopaedic hospital (Avon Orthopaedic Centre; AOC) with 368 THAs and 365 TKAs from an NHS (WGH) and 67 THAs and 86 TKAs from a private hospital (CNH) independent treatment centre.Early re-operation rates were 9% at CNH, 1.4% at WGH and 0.6% at AOC after THA and 8% at CNH, 1.9% at WGH and 1% at AOC after TKA. After THA, dislocation rates after THA were 6% at CNH and 1.8% at both WGH and AOC. Re-admission rates were 13% at CNH, 0.6% at WGH and 1.2% at AOC. Major wound problems were 20% at CNH, 3.8% at WGH and 0.4% at AOC after THA and 19% at CNH, 1.9% at WGH and AOC (1.1%) after TKA. After TKA, re-admission rates from CNH were 13%, 1% at WGH and 1.1% at AOC. AOC and WGH audited their outcomes. None were available from CNH.Results and audit from independent treatment centres are variable and patients should be warned of this before undergoing treatment at them.
Antecedentes: en el ambiente de las discotecas de todo el mundo existe un aumento significativo del uso de medicamentos con receta. El consumo conjunto de extasis y farmacos se asocia con danos potencialmente graves para la salud. Esto tiene ramificaciones en el caso de personas que combinan de forma deliberada los farmacos con el extasis para lograr un determinado efecto y en quienes toman legalmente farmacos por problemas de salud y de vez en cuando consumen extasis. Este estudio exploratorio se propone investigar los habitos y danos del consumo concomitante de farmacos y extasis y explorar las experiencias de los participantes cuando visitan al medico de cabecera (MC). Metodo: se entrevisto a fondo a 30 consumidores de extasis/farmacos. Resultados: los consumidores admitieron la combinacion deliberada de estimulantes (dexanfetamina, metilfenidato (p.e. Ritalin)), antidepresivos y sildenafil (p.e. Viagra®) con extasis por motivos no medicos. Se descubrio una amplia gama de efectos. Aparecieron claras relaciones entre el consumo de farmacos y extasis, y se analizaron las distinciones entre ellos en terminos de motivaciones para el consumo y consecuencias del mismo. Las actitudes de los MC fueron profesionales y sin prejuicios, y los participantes mostraron escasa resistencia a reconocer el consumo de drogas ilegales. Se limito el cribado de drogas ilegales. Consecuencias: Los resultados tienen importantes repercusiones para el publico de las discotecas en lo referente a estrategias de reduccion del dano y en el descubrimiento de una serie de ambitos para futuras investigaciones.
Understanding the socioeconomic burden of multiple sclerosis (MS) is essential to inform policymakers and payers. Real-world studies have associated increasing costs and worsening quality of life (QoL) with disability progression. This study aims to further evaluate the impact of cognition, fatigue, upper and lower limb function (ULF, LLF) impairments, and disease progression per Expanded Disability Status Scale (EDSS) level, on costs and QoL. This was a cross-sectional cohort study including 20,988 patients from the German NeuroTransData MS registry from 2009 to 2019. QoL analyses were based on EQ-5D-5L. Cost analyses included indirect/direct medical and non-medical costs. Eight subgroups, ranging from 439 to 1812 patients were created based on presence of measures for disease progression (EDSS), cognition (Symbol Digit Modalities Test [SDMT]), fatigue (Modified Fatigue Impact 5-Item Scale [MFIS-5]), ULF (Nine-Hole Peg Test [9HPT]), and LLF (Timed 25-Foot Walk [T25FW]). Multivariable linear regression assessed the independent effect of each test's score on QoL and costs, while adjusting for EDSS and 12 other confounders. Lower QoL was associated with decreasing cognition (p < 0.001), worsening ULF (p = 0.025), and increasing fatigue (p < 0.0001); however, the negative impact of LLF worsening on QoL was not statistically significant (p = 0.54). Higher costs were associated with decreasing cognition (p < 0.001), worsening of ULF (p = 0.0058) and LLF (p = 0.049), and increasing fatigue (p < 0.0001). Each 1-scale-step worsening function of SDMT, MFIS-5, 9HPT, and T25FW scores resulted in €170, €790, €330, and €520 higher costs, respectively. Modeling disability progression based on SDMT, MFIS-5, 9HPT, and T25FW scores as an interaction with EDSS strata found associations with lower QoL and higher costs at variable EDSS ranges. Disease progression in MS measured by 9HPT, SDMT, and MFIS-5 had a significant negative impact on QoL and broad socioeconomic costs independent of EDSS. T25FW had a significant negative association with costs. Cognition, fatigue, ULF, and LLF have stronger impact on costs and QoL in patients with higher EDSS scores. Additional determinants of MS disability status, including SDMT, MFIS-5, 9HPT, and T25FW, should be considered for assessing cost effectiveness of novel therapeutics for MS.
To explore sexual behaviour and risk-taking among British backpackers in Australia and to investigate the influence of substance use and social settings on sexual behaviour abroad.
Methods:
A cross-sectional design was used. The questionnaire gathered information on sexual and substance use behaviour in the 12 months prior to leaving the UK and during backpackers' stays in Australia. A total of 1008 backpackers, recruited in hostels in Sydney and Cairns, were included in the study.
Results:
In total, 73.2% had sex during their stay in Australia, including 68.9% of those who arrived without a partner. Across all backpackers, mean number of sexual partners increased from 0.3 per 4-week period in the UK in the 12 months prior to the trip to 1.0 per 4-week period spent in Australia. Over a third (39.7%) had multiple partners in Australia, increasing to 45.7% in those arriving single. Of those arriving single and having sex, 40.9% reported inconsistent condom use and 24.0% had unprotected sex with multiple partners. Number of sexual partners in the UK, length of stay in Australia at time of interview, planned length of stay, frequent visits to bars/clubs, high frequency of alcohol intake and use of illicit substances in Australia were indicators for risky sexual behaviour.
Conclusions:
Backpackers are at high risk of sexually transmitted infections and other negative sexual health outcomes. Multi-agency sexual health promotion strategies that address the relationship between sex, drugs and alcohol should be targeted at backpackers prior to, and during, their travels.
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