Gone Too Soon: priorities for action to prevent premature mortality associated with mental illness and mental distress.

Globally, too many people die prematurely from suicide and the physical comorbidities associated with mental illness and mental distress. The purpose of this Review is to mobilise the translation of evidence into prioritised actions that reduce this inequity. The mental health research charity, MQ Mental Health Research, convened an international panel that used roadmapping methods and review evidence to identify key factors, mechanisms, and solutions for premature mortality across the social-ecological system. We identified 12 key overarching risk factors and mechanisms, with more commonalities than differences across the suicide and physical comorbidities domains. We also identified 18 actionable solutions across three organising principles: the integration of mental and physical health care; the prioritisation of prevention while strengthening treatment; and the optimisation of intervention synergies across social-ecological levels and the intervention cycle. These solutions included accessible, integrated high-quality primary care; early life, workplace, and community-based interventions co-designed by the people they should serve; decriminalisation of suicide and restriction of access to lethal means; stigma reduction; reduction of income, gender, and racial inequality; and increased investment. The time to act is now, to rebuild health-care systems, leverage changes in funding landscapes, and address the effects of stigma, discrimination, marginalisation, gender violence, and victimisation.

Biological, Psychological, and Social Determinants of Depression: A Review of Recent Literature.

Depression is one of the leading causes of disability, and, if left unmanaged, it can increase the risk for suicide. The evidence base on the determinants of depression is fragmented, which makes the interpretation of the results across studies difficult. The objective of this study is to conduct a thorough synthesis of the literature assessing the biological, psychological, and social determinants of depression in order to piece together the puzzle of the key factors that are related to this condition. Titles and abstracts published between 2017 and 2020 were identified in PubMed, as well as Medline, Scopus, and PsycInfo. Key words relating to biological, social, and psychological determinants as well as depression were applied to the databases, and the screening and data charting of the documents took place. We included 470 documents in this literature review. The findings showed that there are a plethora of risk and protective factors (relating to biological, psychological, and social determinants) that are related to depression; these determinants are interlinked and influence depression outcomes through a web of causation. In this paper, we describe and present the vast, fragmented, and complex literature related to this topic. This review may be used to guide practice, public health efforts, policy, and research related to mental health and, specifically, depression.

Treatment of developmental dislocation of hip: does changing the hip abduction angle in the hip spica affect the rate of avascular necrosis of the femoral head?

Avascular necrosis (AVN) of the femoral head is a serious complication in the management of developmental dislocation of the hip. Increasing the abduction angle increases its stability but compromises the vascularity of the femoral head. From our database of 240 children treated for developmental dislocation of hip by the two senior authors between 1998 and 2008, we defined two groups of children who underwent closed or medial open reduction of the hip after a failed Pavlik treatment or if patients presented late. In group 1, the reduced hip was immobilized in around 90° flexion, 60° abduction, and 0-10° internal rotation. In group 2 the hip was immobilized in around 45° of hip abduction with flexion and internal rotation as before. The first and second authors independently analysed these two groups blinded to the hip abduction angle. Our hypothesis was that a reduction in the hip abduction angle would reduce the incidence of AVN in the second group without compromising the stability. All eligible children were included, and there were 42 children in group 1 and 44 children in group 2. An almost equal number of children underwent closed and medial open reduction in both the groups. The age at reduction was a mode of 6 months (range 6-13 months) and 7 months (range 7-12 months), respectively. The abduction angle in the first group had a mode of 60° (range 52-70°) and the second group had a mode of 45° (range 38-50°). Radiographic evidence of AVN as described by Salter and colleagues was seen in eight children (19%) in the first group and seven children (16%) in the second group (P=0.78). Redislocation occurred in one child in the second group and none in the first group. In summary, the results show a nonsignificant reduction in the incidence of AVN when the hip abduction angle was reduced with no significant increased risk of redislocation.

Fusion of double-layered patella using a single small fragment partially threaded screw: a case report.

BACKGROUND: The double-layered patella (DLP) was first described by Büttner in 1925 and is now considered pathognomonic for multiple epiphyseal dysplasia. In this study, we describe the case of an 11-year-old girl with multiple epiphyseal dysplasia and right-sided DLP. METHODS: The patient presented with intermittent unilateral anterior knee pain and swelling. There was a reproducible high-pitched click with every step. Imaging showed a DLP in good alignment. Surgical management comprised open debridement and fixation of the 2 patellar layers using one 3.5 mm (removed-) partially threaded AO small fragment screw. RESULTS: Standard radiographs of the right knee, 3 years postoperatively, showed sound union of the 2 patellae. The patient now plays sports, and recent examination showed a full range of movement with no instability, effusion, or tenderness. CONCLUSIONS: We conclude that surgical fusion of the patellar fragments in DLP using a single small fragment partially threaded screw provides excellent outcome at 3 years follow-up. CLINICAL RELEVANCE: This case report shows a comparatively simple and economical surgical solution to the problem of DLP.

Prognostic significance of stability in slipped upper femoral epiphysis: a systematic review and meta-analysis.

OBJECTIVE: To examine associations of major complications after surgical treatment of slipped upper femoral epiphysis (SUFE) with condition- and treatment-related risk factors. STUDY DESIGN: This systematic review and meta-analysis of observational studies used an electronic literature search of Embase and Medline supplemented by a manual search of bibliographies. The studies enrolled children and adolescents with SUFE, defined stable and unstable disease, and reported at least 3 primary endpoints: avascular necrosis (AVN), chondrolysis, and reoperation. Random-effects meta-regression analysis was performed when possible. RESULTS: The weighted risk for AVN, derived from intercept-only meta-regression, was estimated as 5.3% (95% confidence interval [CI], 3.4%-7.2%). Patients with unstable slips had a 9.4-fold greater risk of developing AVN. Instability proved to be an independent predictor for AVN. The weighted risk of chondrolysis was 0.8% (95% CI, 0.2%-1.4%), associated with unstable slips and osteotomies. The risk of reoperation was estimated at 5.5% (95% CI, 1.7%-9.3%). Loss of fixation was the primary reason for reoperation. CONCLUSIONS: Current evidence indicates that unstable slips are at a significantly higher risk for AVN than stable slips, regardless of the attempted surgical approach. Little clinical information is available regarding chondrolysis and reoperation in relation to the stability of the physis.

Oral midazolam for removal of Kirschner wires in the children's orthopaedic outpatient department: a randomized controlled trial.

BACKGROUND: Use of Kirschner wires (K-wires) is common in pediatric elbow fracture treatment. We investigate whether anxiety levels at removal of wires may be reduced using oral midazolam. METHODS: This was a prospective randomized controlled trial with 2 groups, with midazolam and with placebo. RESULTS: Forty-two children with an average age of 7.1 years (range, 3.6-12.3 y) had complete documentation for analysis. The change in anxiety scores was not significantly different between the 2 groups. Forty-five percent of children in the midazolam group had reduced anxiety levels compared with 18% of children given placebo, but this difference was not significant (P=0.102). The anxiety scores before and after wire removal in the midazolam group were not significantly different from the placebo group scores. CONCLUSIONS: We do not recommend the routine administration of midazolam (0.2 mg/kg) to all children requiring K-wire removal in the outpatient department. LEVEL OF EVIDENCE: I.

Clopidogrel and Proximal Femoral Fractures: Does Timing of Surgery Affect Blood Loss and Length of Admission? A Preliminary Study Prior to Multicenter Trial.

INTRODUCTION: Clopidogrel is a potent oral antiplatelet agent that is commonly prescribed to patients with cardiovascular disease. Patients presenting with proximal femoral fractures often have cardiovascular comorbidity, with many taking clopidogrel on admission. Scientific literature reports increased surgical bleeding in patients receiving clopidogrel, though not specifically hip surgery. This study looked at whether patients who had a seven-day delay prior to operative treatment had less bleeding than those who did not, and looked at the differences in length of admission between the two groups. METHODS: A retrospective review was undertaken. Patients were identified from the in-patient pharmacy stock records from July 2005 to July 2006. Data was statistically analyzed using the chi-squared test. RESULTS: Of 21 patients identified, 20 met the inclusion criteria, nine had a seven-day delay before operation (Group A), and 11 had a mean one-day delay (Group B). Mean drop in postoperative hemoglobin was 1.8 g/l in Group A compared to 3.1 g/l in Group B (p < 0.05). Number of complications was similar (Group A = 8 vs. Group B = 9) as was mortality (Group A = 1 vs. Group B = 2). Admission length was longer in patients who had a seven-day delay in surgery (Group A = 32 vs. Group B = 22 days) (p < 0.05). CONCLUSION: Patients should be considered for early operation provided there are no additional bleeding risk factors, as although postoperative hemoglobin is lower, mortality and complication rates are similar, and length of admission is shorter.

Compartment syndrome with an isolated Salter Harris II fracture of the distal tibia.

A 14-year-old boy sustained a Salter Harris II fracture to his right distal tibia after a fall from his skateboard. He rapidly went on to develop the signs and symptoms of compartment syndrome, and he underwent emergency fasciotomy. This resulted in relief of his symptoms. After this procedure, his fracture was fixed with a single anteroposterior screw. He made a full and uncomplicated recovery, with no clinical or radiological evidence of epiphyseal growth arrest.

Factors predicting the outcome of primary clubfoot surgery.

BACKGROUND: We aimed to determine the rate of further surgery, the functional outcome and the factors associated with outcome after primary clubfoot surgery. METHOD: We conducted a retrospective study of a cohort of all children who were less than 2 years of age at the time of surgery for idiopathic clubfoot deformity at the Hospital for Sick Children, Toronto, Ont., a tertiary care pediatric hospital. Of the 91 families who could be contacted, 63 agreed to return. The children's charts were reviewed, and their feet were given a Functional Rating System (FRS) score. RESULTS: Of the original operated population (n = 126), 75% were male and 41% had bilateral clubfoot. The average age at the time of surgery was 8 months, and the mean follow-up was 80.6 months. Further surgery was performed in 19% of cases. The mean FRS outcome score was 79. On average, the FRS score increased by 1.9 points as age at the time of surgery increased by 1 month. Only the presurgical talocalcaneal index was associated with the need for further surgery. CONCLUSION: The need for further surgery was 19% overall. Children who had surgery closer to 12 months of age had better functional results. Therefore, surgery should probably be performed in the second, rather than the first, 6 months of life.

HOXD10 M319K mutation in a family with isolated congenital vertical talus.

Congenital vertical talus (CVT) is a primary dislocation of the talonavicular joint that often occurs in neuromusculoskeletal syndromes, but may also be seen as an isolated abnormality. Six families with isolated CVT were ascertained. DNA was isolated from 21 affected individuals and 17 unaffected individuals from these families, as well as from five sporadic patients with CVT. Variable expressivity was noted in three families, manifesting as clubfoot in three individuals. Genome-wide linkage analysis generated a maximum two-point logarithm of odds score on chromosome 2q with D2S1353 (Zmax = 1.43 at theta(max) = 0.1), 17 Mb from the HOXD gene cluster. DNA from one affected individual of each family was subjected to mutational analysis of the HOXD10 gene. A single missense mutation was identified (M319K, 956T > A) in the homeodomain recognition helix of the HOXD10 gene that segregated with disease in one large British family. This mutation was recently described in a family of Italian descent with CVT and Charcot-Marie-Tooth deformity HOXD10 gene mutations were not identified in any of the other families or sporadic patients with CVT, suggesting that genetic heterogeneity underlies this disorder.

Internal fixation of a patella fracture using an absorbable suture.

This case report describes the use of an absorbable suture for the fixation of a patella fracture in a child. In this case the fracture was held satisfactorily by the suture until union. This technique means that there is no need for a second operation to remove the fixation material.