Prevalence and aetiology of juvenile skeletal fluorosis in the south-west of the Hai district, Tanzania--a community-based prevalence and case-control study.

INTRODUCTION: Fluorosis is endemic throughout the East African Rift valley, including parts of Tanzania. The aim of the study was to identify all cases of deforming juvenile skeletal fluorosis (JSF) in a northern Tanzanian village and to document the extent of dental fluorosis (DF). METHODS: Door-to-door prevalence survey of all residents of the village. Residents were assessed for the presence of DF and JSF. Those with JSF and randomly selected controls from the same age range were further assessed for possible JSF risk factors. RESULTS: The village had a population of 1435. DF was endemic within the population, being present in 911 (75.5%; 95% CI, 73.0-77.9) of dentate individuals who were examined (n = 1207). JSF was present in 56 of 1263 people examined, giving a prevalence of 4.4% (95% CI, 3.3-5.6) and was more common in males. Low body mass index, drinking predominantly well water 3 years previously, not being weaned on bananas, the use of fluoride salts in cooking during childhood and drinking more cups of tea per day were independent predictors of JSF. CONCLUSIONS: Juvenile skeletal fluorosis is a common and preventable public health problem. Providing clean, low-fluoride, piped water to affected communities is of obvious health benefit.

An exploratory study using video analysis of rheumatology specialist nurses conducting methotrexate education consultations with patients.

BACKGROUND: Prior to commencing methotrexate, patients routinely attend an education consultation with a rheumatology nurse. The purpose of the consultation is to discuss the patients' expectations and concerns related to commencing methotrexate, the benefits of treatment, potential side effects and monitoring requirements. The aim of this study was to use video analysis to assess the structure, content and mode of delivery of the consultation. METHODS: Video recordings of 10 patient-nurse consultations, involving four specialist rheumatology nurses, were analysed and transcribed. The consultations were compared with the Calgary-Cambridge (CC) consultation model. Transcripts were thematically analysed. Data were quantitatively assessed for verbal and non-verbal behaviours. FINDINGS: Assessment of the video data using the CC model demonstrated good structure, content and flow of the consultation, influenced by the use of an information leaflet. Consultations generally consisted of communication from nurse to patient rather than a dialogue; the nurse spoke for 69%-86% of the time; clarification of the patient's understanding of the information did not take place in any of the consultations. Thematic analysis also showed that the nurse agenda dominated and the nurse was aware of 'overloading' the patient with information. Cues from the patients to discuss items of importance were often missed. CONCLUSION: Video analysis can be used to identify the aspects of the consultation that work well and those areas of the consultation that could be improved with specific training.

Vascular disease as a cause of death in patients with severe disability due to osteoarthritis and rheumatoid arthritis.

OBJECTIVES: The mechanism of the increased risk of cardiovascular disease in rheumatoid arthritis (RA) remains uncertain. We had the opportunity to compare the causes and ages of death in a population of osteoarthritis (OA) and RA patients who had had similar lower limb disability. METHODS: Death certificates were sought for a population of OA and RA patients who had had knee joint replacements performed by a single orthopaedic surgeon over a 10 year period with a minimum follow up period of 18 years. Primary cause of death was assigned by a blinded clinician and compared between the populations. Competing risk analysis was used to compare RA and OA populations for cardiovascular deaths. RESULTS: The total population was 607 (294 OA; 313 RA). 85% (249) of the OA and 79% (246) of the RA patients had deceased at the time of study in 2008. 85% of the death certificates were found. The RA patients were operated an average of 7.5 years younger and also died 7.5 years younger. The causes of death were similar in the two populations. The ages at death were consistently and similarly older for the OA group for all causes of death. There was a 9% increased risk of cardiovascular death in the RA group but this was not statistically different from the OA group. CONCLUSIONS: OA and RA patients, controlled for lower limb disability, have similar causes of death including cardiovascular disease. However, the RA patients died significantly younger. Cause of death is likely to be related to things that OA and RA share, such as disability and some treatments e.g. NSAIDs, whereas age at death relates to differences, such as age of onset and inflammation.

Differences in fear of falling in the elderly with or without dizzines.

To compare prevalence and risk factors associated with fear of falling (FoF) in two groups of elderly people, 109 patients with recurrent dizziness and 109 controls without dizziness. FoF was defined as a positive response to the single question and with Falls Efficacy Scale of >50. The prevalence of FoF was greater (71.6%) in the dizzy group (control, 31.2%; p<0.001). Factors associated with FoF in the dizzy-group were diabetes, high General Health Questionnaire (GHQ-28) score and poor balance score. In the non-dizzy group, female gender, high GHQ, and poor gait score in Tinetti's scale were the association. Further research is needed to explore the relationship between dizziness and FoF.

Are fibromyalgia patients as inactive as they say they are?

Both fibromyalgia and rheumatoid arthritis (RA) patients self-report similar disability. These diseases are viewed differently by the medical profession as one has ample evidence of tissue damage and inflammation and the other does not. We were interested to see if an objective measure produced similar results. Twelve patients with RA were matched with 12 fibromyalgia patients by sex, age, and Health Assessment Questionnaire (HAQ) score. The 24-h ambulatory activity of these patients was recorded using the Numact monitor. Statistical analysis was performed using independent group t test for the ambulatory activity data and Spearman's correlation coefficients for HAQ and total energy. There were no significant differences found between the two groups in terms of total activity. Other compared analyses for activity included the number of steps taken, vigor of steps, and time spent standing, which were not statistically different. The correlation coefficients of HAQ and total ambulatory activity for the fibromyalgia group were rho = -0.638 (p = 0.026). Patients with RA and fibromyalgia displaying similar levels of self-reported disability have objective evidence of similar levels of total ambulatory activity. There is a statistically significant correlation between self-reported and objective measurements of disability for the fibromyalgia patients. Either of these measures merits further study as outcome measures for fibromyalgia.

Association of 24-hour activity levels with the clinical severity of chronic venous disease.

INTRODUCTION: The pathophysiology underlying the skin changes seen in chronic venous insufficiency (CVI) is multifactorial. Sedentary lifestyle and prolonged sitting and standing at work have been proposed by some authors to be influential in the development of CVI skin changes. This study compared the 24-hour activity profiles in patients with different clinical severities of CVI and normal controls. METHODS: Patients were classified into groups according to CEAP clinical severity classes: mild (C2&C3), moderate (C4) and severe (C5&C6). Activity profiles were measured in 60 patients and 15 controls using a Newcastle Universities Medical Activity (NUMACT) monitor, which recorded the duration spent in supine, sitting, and standing postures as well as duration spent walking and the walking intensity over a 24-hour period. Analysis was performed by Kruskal-Wallis and Mann-Whitney tests and Spearman correlation. RESULTS: Walking intensity was significantly different between the controls and patient groups during prolonged walking (P < .001). The controls spent significantly more time standing in a 24-hour period than any of the CVI clinical groups (P = .036), and the percentage time spent sitting was significantly higher in the patient groups (P = .025). No significant differences were found in the total number of steps taken or total duration spent walking in the 24-hour period between any of the groups. CONCLUSION: This study shows that walking intensity is lower in the more severe clinical groups and may be influenced by the clinical severity of CVI. The study provides evidence that prolonged sitting and reduced standing is associated with increased severity of CVI, which may by an effect of the patient's symptoms rather than a cause of disease progression.