Efficiently stratifying mid-term death risk in femoral fractures in the elderly: introducing the ASAgeCoGeCC Score.

We evaluated mortality in a cohort of hip fracture patients and implemented a risk prediction score named ASAgeCoGeCC with excellent discrimination. It allowed to separate patients in 3 different risk groups with distinct mortality rates. Recognition of the heterogeneity of patients with femoral fractures may have relevant implications for their management. INTRODUCTION: Usage of risk prediction models to estimate postoperative mortality risk for hip fracture patients represents a useful tool to give insight in the prognosis and assist in clinical decision-making. The aim of this study was to identify a predictive model able to determine the possible presence of distinct subgroups of hip fracture patients by risk classes in the mid-term. METHODS: Three hundred twenty-three hip fracture patients were evaluated, and mortality rates at 30 days, 1, 2, and 4 years were calculated. A multivariate logistic regression analysis using mortality 4 years after fracture as a dependent variable found ASA score, age, cognitive status, gender, and Charlson Comorbidities Index (CCI) as significant risk factors. Using these items, a score named ASAgeCoGeCC was implemented and compared with CCI and Nottingham Hip Fracture Score (NHFS) by a receiver operating characteristic (ROC) curve. RESULTS: The area under the ROC curve for ASAgeCoGeCC was always greater than that of CCI and NHFS and ranged between 0.804 and 0.820 suggesting an excellent discrimination. The ASAgeCoGeCC logistic model showed also a good calibration. Patients were divided in 3 groups: a low risk group, an intermediate risk group with an odds ratio for 4-year mortality of 5.6 (95% CI 2.9-10.6), and a high risk group with an odds ratio 21.6 (95% CI 10.6-44). CONCLUSION: The ASAgeCoGeCC Score is a predictive tool for mortality after hip fracture with good calibration and excellent discrimination properties. It is the first scoring system stratifying hip fracture patients' mortality at 4 years from fracture.

Surgical versus conservative treatment of distal radius fractures in elderly.

The distal radius fractures (DRFs) are the second most common fracture in the elderly population. Despite their frequency, the optimal treatment of these fractures remains controversial. Several dogmatic myths on DRFs management may adversely affect their outcome and despite a strong trend versus surgical options, systematic reviews suggest that conservative treatment remains the safest option for DRFs in most cases.

Comparison of clinical results and patient's satisfaction between direct anterior approach and Hardinge approach in primary total hip arthroplasty in a community hospital.

INTRODUCTION: Aim of the study is to compare clinical results and patient's satisfaction between direct anterior approach and Hardinge approach in primary total hip arthroplasty. METHODS: A group of 30 patients operated with DAA (group B) were compared to 39 patients operated by Hardinge approach (group A). Peri- and postoperative complications, Harris Hip Score (HHS), implant positioning, experienced pain and patient satisfaction were evaluated at a mean follow-up of 30 months. RESULTS: HHS at follow-up was significantly better in group B (92.2 ± 11.9 vs 95.2 ± 4.5 p = 0.04 Student's t test). There was no difference in femoral stem positioning while cup inclination was significantly better in group B (40.6° ± 6.6° vs 44.3° ± 7.9°, p = 0.04 Student's t test). Overall pain recalled by patients was significantly lower in group B. CONCLUSION: The introduction of DAA does not affect patients' final outcome but comes with comparable functional recovery and greater patient satisfaction.

Influence of personality psychology on outcome of total hip arthroplasty: a cross-sectional study on 69 patients.

AIM: Patient's satisfaction after total hip arthroplasty is influenced by many surgical and rehabilitation aspects, but is not available in the literature, a study that analyses the correlation between patient's psychology and clinical results of this procedure. The aim of this study was to investigate the relationship between memory of pain, clinical outcome and subjective satisfaction with the Multidimensional Health Locus of Control. METHODS: We conducted a cross-sectional study on a cohort of 69 patients operated of total hip arthroplasty in our department from November 2008 to August 2011. Pre- and post-operative hip function was assessed by the Harris Hip Score. At the follow-up visit, patient satisfaction was assessed by means of the Patient Satisfaction Questionnaire. The memory of pain was evaluated by a modified questionnaire of pain experience. Multidimensional Health Locus of Control was evaluated in all patients, and results were connected with patient's subjective satisfaction and pain indexes. RESULTS: Patients were divided into two groups about patient satisfaction, those with GPS > 15 and those with GPS ≤ 15. Patients very satisfied showed a significantly higher mean value of IHLC. Regarding pain experience, patients were divided into two categories: those recalling less pain with OvP score ≤11 (Q1 < 3, avg. score Q2-Q4 ≤ 3) and those recalling more pain with OvP score >11. IHLC score resulted significantly higher in patients recalling less pain. DISCUSSION: Multidimensional Health Locus of Control can be considered a predictor of patient's satisfaction after an invasive surgical procedure as total hip arthroplasty.

Identification of snails infected with schistosomes by ELISA employing monoclonal antibodies: Schistosoma mansoni in laboratory snails (Biomphalaria glabrata) and in field snails (Biomphalaria pfeifferi) from Kenya.

An enzyme-linked immunosorbent assay (ELISA) employing monoclonal antibodies was used for detecting Schistosoma mansoni antigens in hemolymph of laboratory snails (Biomphalaria glabrata) in Kenya. Infected laboratory snails shedding cercariae were differentially identified by ELISA from uninfected snails with 100% sensitivity and specificity. Prepatent infections were detected by ELISA from 2 weeks after exposure to miracidia. Thus, ELISA revealed infection 3 weeks before maximal patency was reached (5-6 weeks post-exposure). Infected field snails (B. pfeifferi) shedding cercariae were differentially identified by ELISA, with 100% sensitivity and specificity, from uninfected field snails and from snails naturally infected with other trematodes (echinostomes and strigeids). Prepatent infections with S. mansoni were readily identified by ELISA in field snails. A case is demonstrated where infection rate, as determined by shedding test alone, was 9.8%, whereas the combined figure of prepatent and patent infection rates was 22.9%

Spatial patterns of human water contact and Schistosoma mansoni transmission and infection in four rural areas in Machakos District, Kenya.

This paper presents the results of microgeographical studies of human water contact behavior and Schistosoma mansoni transmission levels and intensity of infection in four rural areas in Machakos District, Kenya. The relationship between intensity of infection (geometric mean egg counts) in 3502 persons aggregated in 120 household clusters and eight independent variables was investigated using straight and stepwise linear regression and mapping techniques. Results indicate that the two water contact variables, mean frequency per person and mean duration per person, as well as mean number of sites used per person, a transmission index and mean distance to the most frequently used site were the strongest predictors of geometric mean egg counts. All three distance variables were usually negatively associated with infection although intensity of infection and water contact declined relatively slowly with distance from the streams. This pattern appears to be owing to a combination of the relatively short distances, a general lack of safe alternative water sources and the use of more distant water contact sites both inside and outside the study area during periods of drought. The study of snail-to-man transmission identified number of infected snails as the major transmission variable and number of contacts as the major predictor variable. Mapping of total egg counts at the household cluster level and total number of infected snails revealed spatial association with transmission sites. All results varied considerably between study areas, owing to differences in exposure levels, transmission patterns and environmental factors. Findings are discussed in relation to the epidemiology and control of schistosomiasis and suggestions are made for further spatial studies.

Importance of the aquatic weed Ceratophyllum to transmission of Schistosoma haematobium in the Volta Lake, Ghana.

Results of 5 years of sampling for Bulinus rohlfsi in human-water contact sites of villages along the Volta Lake, Ghana, have confirmed that the aquatic macrophyte, Ceratophyllum, is the most important ecological factor for sustaining high levels of cercarial transmission of Schistosoma haematobium. Data available so far indicate that growth of this weed largely determines the size of the snail populations. Increasing density of Ceratophyllum correlates with increasing levels of cercarial transmission potential in the water contact sites and of S. haematobium infection in the village populations.

Focal, seasonal and behavioural patterns of infection and transmission of Schistosoma haematobium in a farming village at the Volta Lake, Ghana.

Integrated sampling for human prevalence, intensity, and incidence of Schistosoma haematobium, as well as for human water contact and snail distribution and density was carried out in the Volta lake farming village of Agbenoxoe at various times between 1978 and 1980. Nuclepore filters were used for determining egg output. Snail sampling was by the man-time method. A new system of recording human water contact was introduced for the peculiar condition at Agbenoxoe. Results indicated significant focality of infection and transmission in the compact village, concentration in the 5- to 19-year-old age group, and distinct seasonality of transmission. Water contact was frequent but of short duration. Only a few children under the age of 5 entered the water, and age-specific curves for duration of water contact paralleled the curve for geometric mean of egg counts (log10 of eggs + 1) for males and the prevalence curve for females. Water contact for males was of longer duration than for females and included more time playing and wading. These activities probably accounted for the much higher incidence and prevalence rates recorded for males over females in the village. The concentration of infection, transmission, and water contact in the 5- to 19-year-old age groups at Agbenoxoe and villages like it supports a control strategy of treating only this age span with drugs.

Ecological studies of Bulinus rohlfsi, the intermediate host of Schistosoma haematobium in the Volta Lake.

In the present ecological study of cercarial transmission of Schistosoma haematobium in the Volta Lake, Ghana, habitat observations and sampling of Bulinus truncatus rohlfsi were conducted within a 60-km stretch of shoreline. Observations revealed that human water contact sites in each village undergo constant changes in shape and vegetation. Snail sampling surveys in water contact sites were carried out monthly (for 27 months) in 8 villages using newly designed palm-leaf traps, and in 8 additional villages (for 16 months) using a modification of Olivier & Sneidermann's man-time method. Results to date confirm the finding by Chu & Vanderburg that cercarial transmission in the lake takes place almost exclusively within water contact sites. Additional results indicate that even within individual water contact sites this transmission is focal, most infected snails being found very close to the shoreline. Transmission also varies significantly according to shape, vegetation, and geographical location of the water contact sites, and is distinctly seasonal in most villages. These findings lead us to conclude that control of cercarial transmission in the Volta Lake is both attainable and feasible with existing methods.

Results of three years of cercarial transmission control in the Volta Lake.

After three years of cercarial transmission control using focal application of niclosamide and weed removal in water contact sites (WCSs) in the project area of the Volta Lake, the numbers of WCSs infested with cercariae and infected snails were reduced by over 90% in areas of both high and low endemicity. This, combined with selective population chemotherapy, reduced the prevalence of Schistosoma haematobium infection by 72% in the area of low endemicity and 40% in the area of high endemicity. The intensity of infection in the villages was reduced by 78% in both areas. The overall annual cost of the cercarial transmission control programme was US $1.09 per capita.

Transmission dynamics of miracidia of Schistosoma haematobium in the Volta Lake.

Schistosoma haematobium miracidia were detected in sentinel snails placed in 16 human water contact sites in the Volta Lake, each month from March 1973 to November 1977. Results showed that rates of infection were seasonal, and that infected snails were more often found in water contact sites sheltered by emergent plant growth than in exposed open beach sites with no emergent vegetation. Sentinel snail infection rates were correlated with natural snail infection rates and with epidemiological levels of schistosomiasis in village inhabitants. After two years of chemotherapy and mollusciciding, levels of disease and sentinel snail infection rates dropped in two-thirds of the villages. In the remaining villages, however, the sentinel snail infection rates were not correlated with the fall in epidemiological level, because of ecological changes in the water contact sites.It is concluded that, unless control measures are continued, the constant changes in the lake shore environment will lead to a rapid re-establishment of previous levels of disease transmission.

Observations on the growth and population dynamics of Bulinus rohlfsi in an outdoor laboratory at Volta Lake, Ghana.

Two cohorts of Bulinus rohlfsi were reared separately in an outdoor laboratory at Volta Lake, Ghana. One group was kept in lake water with a mud substratum, the other in lake water without mud. Both cohorts were able to tolerate water temperatures ranging from 22.0 to 35.5 degrees C, but growth and survival were significantly greater for the cohort with mud. The overall intrinsic rate of natural increase, r, per fortnight was 1.096 for the snails having the mud substratum and 1.642 for the cohort not having it. The 'r' values were strongly influenced by high early fecundity of the snails in lake water only and low early fecundity of the snails with mud. Oviposition among the latter cohort was suppressed at times of high turbidity in the water above the mud substratum, caused primarily by suspended clay.

Mixing of Schistosoma haematobium strains in Ghana.

In Ghana, Schistosoma haematobium exists as two strains, one transmitted by Bulinus rohlfsi and the other by B. globosus. In Anyaboni, a resettlement town, where the field station of the UNDP/WHO Schistosomiasis Research and Control Project is located, the residents contract the "rohlfsi" strain of the parasite from the Volta Lake and the "globosus" strain from a stream near the town. The present studies indicate that there is mixing of the two parasite strains on a community and an individual basis. In Anyaboni, the parasite developed well in both B. rohlfsi and B. globosus. In another village 25 km from Accra, where B. globosus was the only vector, the parasite developed well in B. globosus but was refractory in B. rohlfsi. In a village near the Volta Lake where B. rohlfsi was the sole vector, the parasite developed well in B. rohlfsi but was refractory in B. globosus. However, complete separation of the two strains is uncommon in Ghana because extensive mixing has already occurred owing to migration of people and snails.

A comparative evaluation of snail sampling and cercariometry to detect Schistosoma mansoni transmission in a large-scale, longitudinal field-study in Machakos, Kenya.

In an operational Schistosoma mansoni field-study in an area about 20 km 2 (population approximately 8000), transmission detection by simple snail sampling was compared with cercariometry. Between 1985 and 1987, 62 field sites were sampled at fortnightly intervals. Of a total of 2758 field observations, 89.8% gave full snail data; 64.4% full cercarial data; and 61.7% complete data for both methods. The complete data sets showed significant but not strong correlations between Biomphalaria pfeifferi (total and infected with S. mansoni or other trematodes) and cercarial (S. mansoni and non-human) recoveries. Non-human (but not S. mansoni) cercarial recovery decreased with deteriorating cercariometry filter quality. Both snail and cercarial recoveries diminished significantly with increasing water flows at the time of collection. Many samples yielded infected snails or cercariae, but not both, and neither method detected significantly more transmission sites. The method of choice for detecting transmission in a large-scale field-study depends on logistical and financial considerations. Relatively simple snail sampling allows quick, cheap and widespread data collection adequate for most purposes but more complicated cercariometry is still valuable for specific, small-scale studies.

Observations on the effects of different chemotherapy strategies on the transmission of Schistosoma mansoni in Machakos District, Kenya, measured by long-term snail sampling and cercariometry.

Transmission of Schistosoma mansoni was monitored by routine snail sampling for Biomphalaria pfeifferi and by supplementary cercariometric measurements in 4 neighbouring study areas in Machakos District, Kenya. After 1 year, extensive, population-based chemotherapy with a single dose of praziquantel was given in 3 areas, but only minimal treatment in the fourth. In the year preceding treatment, seasonal transmission of S. mansoni and other non-human trematodes occurred in all 4 areas, despite some ecological differences and the effects of earlier treatment campaigns in 1 of the study areas. After treatment of all infected subjects in one area in which there had been earlier chemotherapy campaigns, S. mansoni transmission remained very low. It was reduced for at least 2 years after chemotherapy targeted at either all heavily infected subjects or all infected school children, but it was unaffected in an area where treatment was restricted to those few very heavily infected cases at risk of developing disease. Nowhere was transmission entirely eliminated by chemotherapy and that of non-human trematodes continued unabated. The snail data correspond well with the human, parasitological data. Targeting school children was as effective as more extensive campaigns, but chemotherapy alone never stopped S. mansoni transmission: reinfection was inevitable, at rates determined by ecological factors affecting snail populations.

Water contact observations in Kenyan communities endemic for schistosomiasis: methodology and patterns of behaviour.

A descriptive analysis of observed water contact activities in seven Kenyan (Akamba) communities is presented. The patterns of contact with time of day, month of year, type of activity, degree of immersion, use of soap, use of 'kithima' and day of week are all considered, with particular attention given to how these vary with age and sex. It is noted that (a) patterns of contact vary dramatically between these culturally rather similar communities, (b) contact usually peaks in the second decade of life, (c) generally females, especially young women, spend more time at the water than males and (d) simple (unweighted) total observed duration of contact gives a relatively inflated estimate of exposure in adults, especially young women. The methodology of observation and data handling is described in some detail.

Immunity and morbidity in human schistosomiasis mansoni.

This paper reviews the results of a longitudinal, multidisciplinary study on schistosomiasis mansoni that has been in progress in Machakos District, Kenya, since 1980. Different methods of delivering chemotherapy have been compared in a medium scale operational control programme. It is concluded that treatment only of infected children is an effective and feasible means of control, the frequency of treatment depending on the severity of disease. Within the framework of this programme, detailed studies have been undertaken of immunity to reinfection after treatment and of the reasons for differences in observed morbidity between different areas. An apparent resistance to reinfection, especially in older individuals, may be attributable to the protective effect of IgE antibodies against adult worm antigens. Various factors other than intensity of infection may contribute to severe morbidity, including parasite strain differences, interactions with other infections, nutritional status, and abnormalities in the regulation of pathogenic immune responses to egg antigens.