RESUMEN
OBJECTIVES: The purpose of the study was to determine if physical activity (PA) is a risk factor for persistent or recurrent hip pain in young and middle-aged persons with and without radiographic findings of cam or pincer morphology (CPM). METHODS: A population sample of persons aged 20-49 with (cases) and without (controls) hip pain in Metro Vancouver, Canada, was selected through random digit dialing (RDD). Self-reported PA was expressed as average energy expenditure (MET-hours) per year, over lifetime. CPM was defined as alpha angle >55°, lateral centre edge angle (LCE) >40°, or positive cross-over sign. RESULTS: Data were obtained for 500 subjects, 269 cases and 231 controls. Prevalence of radiographic CPM was 49% in the cases and 44% in the controls. In a logistic regression model adjusted for age, gender and CPM, total lifetime PA, including occupational, domestic and recreational activities, was significantly associated with hip pain (Odds ratio (OR) 1.30 per 1000 MET-hours, 95% CI 1.15-1.38). The effect of total PA was observed in those with CPM (1.44, 1.17-1.78) and without CPM (1.23, 1.04-1.45). For domestic activities, the association was seen only in those with CPM (significant interaction). When PA was categorized into quartiles, higher levels of PA were associated with a greater risk of pain. CONCLUSIONS: PA, as measured by average energy expenditure over lifetime is a risk factor for hip pain in young and middle-aged persons. For some activities, the risk is likely increased in persons with radiographic evidence of CPM.
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Ejercicio Físico/fisiología , Dolor Musculoesquelético/etiología , Adulto , Distribución por Edad , Colombia Británica/epidemiología , Estudios de Casos y Controles , Dolor Crónico/epidemiología , Dolor Crónico/etiología , Dolor Crónico/patología , Femenino , Pinzamiento Femoroacetabular/complicaciones , Pinzamiento Femoroacetabular/epidemiología , Pinzamiento Femoroacetabular/patología , Humanos , Masculino , Persona de Mediana Edad , Dolor Musculoesquelético/epidemiología , Dolor Musculoesquelético/patología , Recurrencia , Factores de Riesgo , Distribución por Sexo , Adulto JovenRESUMEN
The purpose of this study was to evaluate the validity and reliability of a radiographic diagnosis of femoroacetabular impingement (FAI) by a non-radiologist. Symptomatic FAI is prevalent and thought to be a cause of hip osteoarthritis. However, the diagnosis is often delayed by 1-2 years, in large part because radiographic findings are often subtle and clinicians have been unaware of their significance. The purpose of this study was to evaluate the validity of a radiographic diagnosis of FAI by a non-radiologist. A population-based sample of 701 subjects was recruited in Vancouver, Canada. For the current study, 50 subjects were selected-40 randomly from the population sample and 10 from an orthopedic practice with confirmed FAI. An anterior-posterior pelvis and bilateral Dunn radiographs were acquired and read by a fellowship-trained musculoskeletal radiologist and a third-year medical student who received basic training in radiographic signs of FAI. Three radiographic signs were evaluated: the lateral center edge angle, alpha angle and crossover sign. Validity was assessed using sensitivity and specificity, Bland-Altman limits of agreement and kappa. The sample contained 65% women (n = 31), was 62% Caucasian and 38% Chinese and had a mean age of 38.3 years. For correctly diagnosing FAI, the non-radiologist reader had a sensitivity of 0.83 and specificity of 0.87. Intra-rater κ value was 0.72, and prevalence-adjusted bias-adjusted κ was 0.76. This study provides evidence that a non-radiologist can accurately and reliably identify FAI on plain films.
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Acetábulo/diagnóstico por imagen , Competencia Clínica , Pinzamiento Femoroacetabular/diagnóstico por imagen , Fémur/diagnóstico por imagen , Adulto , Puntos Anatómicos de Referencia , Colombia Británica , Femenino , Humanos , Masculino , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Reproducibilidad de los ResultadosRESUMEN
OBJECTIVE: To conduct a preliminary investigation into the consistency of approach between three Ayurvedic medicine experts on treatments for inflammatory polyarthritis. METHODS: A convenience sample of three experienced Ayurvedic practitioners was recruited. These practitioners independently assessed three subjects with inflammatory polyarthritis for health status, treatment history, and lifestyle, conducted a physical examination, and then independently determined the treatment plan. The treatment plan was recorded on standardized collection forms. The subject examination order was randomized for each practitioner. Following completion of the assessments, a facilitated discussion among the practitioners permitted each to discuss all aspects of the recommended therapies. Proceedings were audio-taped and the content analyzed. RESULTS: All three practitioners agreed upon a unified concept of Ayurvedic disease origin, disease diagnosis, and treatment approach for each patient. Seven specific treatment groupings (i.e. modalities) emerged: diet, exercise, relaxation, analgesic, anti-inflammatory, immune-enhancing, and detoxification/cleansing. Based on the single visit, the practitioners agreed upon 17 of 21 treatment groups for the three patients. CONCLUSION: Despite Ayurvedic medicine's individualized approach, considerable agreement existed among the practitioners studied. The identified Ayurvedic treatment approaches require investigation in a controlled clinical setting.
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Artritis Psoriásica/diagnóstico , Artritis Psoriásica/terapia , Artritis Reumatoide/diagnóstico , Artritis Reumatoide/terapia , Medicina Ayurvédica , Anciano , Competencia Clínica , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Pautas de la Práctica en Medicina , Muestreo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
PURPOSE: This article proposes a model of the ecological approach in health promotion programs. Based on system theory, the model identifies intervention settings and targets as two independent dimensions for assessing the integration of this approach in programs. Additional objectives are to present and pretest an analytical procedure that allows the assessment of integration of the ecological approach in programs. DESIGN: This was a descriptive study of the integration of the ecological approach in a sample of health promotion programs. SUBJECTS: Subjects were 44 health promotion programs drawn from the population of Canadian federally funded programs. MEASURES: Descriptions of programs were obtained by telephone interviews. A coding scheme was applied to the data to identify intervention settings and targets for each program. Using this information, a summative score of the integration of the ecological approach was estimated for each program. RESULTS: Single-setting programs were the dominant pattern in the sample. Individuals whose health was of concern were very frequently the direct targets of the programs. However, organizational and interpersonal environments were also often directly targeted. Single-setting or single-intervention strategy programs outnumbered ecological programs. CONCLUSION: The proposed model and analytical procedure is a useful framework for the assessment of integration of the ecological approach in health promotion programs. The pilot test having been conducted on a convenience sample, future work should replicate the study in a representative sample of programs.
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Ecología , Promoción de la Salud , Canadá , Humanos , Modelos Teóricos , Evaluación de Programas y Proyectos de Salud , Muestreo , Medio SocialRESUMEN
To investigate the influence of stimulus modality on the slowing produced by hypoxia, thresholds were estimated using reaction time (RT) and the event-related brain potential P300. Six trained subjects responded to oddball light flashes or tone pips while breathing low-oxygen mixtures that were manipulated to produce arterial blood oxygen saturations (SaO2) ranging from 77-86%. Both RT and P300 were slowed in a dose-dependent manner. The threshold for slowing was independent of stimulus modality for both measures, and estimated to be in the range 81-82% SaO2. P300 amplitude dissociated from the response time measures by exhibiting an inverted-U dose-response function. We draw three conclusions from these results: a) the failure to observe a higher visual threshold for the response time measures is inconsistent with the traditional belief that audition is relatively insensitive to hypoxia; b) the equal sensitivity of P300 latency and RT to hypoxia implicates stimulus evaluation processes in slowing; and c) P300 amplitude may reflect the activity of physiological compensatory mechanisms to hypoxia.
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Potenciales Evocados Auditivos/fisiología , Potenciales Evocados Visuales/fisiología , Hipoxia/fisiopatología , Oxígeno/sangre , Tiempo de Reacción/fisiología , Umbral Sensorial/fisiología , Adulto , Análisis de Varianza , Percepción Auditiva , Relación Dosis-Respuesta a Droga , Electroencefalografía , Femenino , Humanos , Hipoxia/sangre , Masculino , Oximetría , Percepción VisualRESUMEN
There has been considerable interest in the possibility that short-term memory (STM) plays a role in the cognitive deficits produced by hypoxia. Claims have been made that two aspects of STM are impaired, the storage of information and the speed of retrieval of information, but a close examination of the evidence reveals that the whole issue remains an open question. Each aspect was investigated in a separate experiment using well trained subjects who breathed low oxygen mixtures adjusted to control arterial oxyhemoglobin saturation between 64%-66%. Exp. 1 assessed storage capacity with the dichotic listening paradigm. Hypoxia degraded the accuracy of recall, but this was probably an impairment of auditory perception and there was no evidence that storage was impaired. Exp. 2 assessed retrieval speed with Sternberg's memory scanning paradigm. As expected, hypoxia increased reaction time, but this could be accounted for by the slowing of an early stage of perceptual processing. No evidence was found to indicate that stages involving either retrieval from STM or binary decision were slowed. We conclude that STM storage and retrieval are not directly affected by hypoxia, and propose that either direct or indirect slowing of the central executive of working memory may account for the cognitive deficits produced by this stressor.