Jonathan Gardner

In an eight-nation survey of people with chronic conditions, patients in the Netherlands were most positive about their country's health care system—reporting affordable, accessible care with low rates of errors—while U.S. patients were the most likely to say their system was in need of major revision.

The study, published online, showed that patients in all nations report gaps in care when being discharged from the hospital, such as providing written care plans, follow-up care, instructions about symptoms to watch for, and what institution to contact with questions about condition or treatments.

The survey included more than 9,000 patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States from March through May 2008. Patients had developed hypertension, heart disease, diabetes, arthritis, chronic lung conditions, depression, or cancer, and the share of patients with two or more conditions ranged from 51% in New Zealand to 71% in the United States, according to the survey.

The researchers, from the Commonwealth Fund, a New York-based charitable foundation, said just 9% of patients in the Netherlands called for health care restructuring, significantly less than the 33% of the respondents in the United States (Health Aff. 2008 Nov. 13 [doi 10.1377/hlthaff.28.1.w1]).

"It goes back to primary care as the core of [the Dutch] system," Robin Osborn, vice president of the International Program in Health Policy and Practice at the Commonwealth Fund, said in a teleconference to discuss the findings. "Patients register with a doctor. There is gatekeeping. The benefit is great. Eighty percent of the patients had been with their doctors for 5 years or more," In the United States, just 53% of subjects had been with their physicians 5 years or more.

U.S. patients faced the greatest cost and access issues, with 41% spending more than $1,000 out of pocket, significantly more than the seven other countries, with France (5%) and the United Kingdom (4%) paying the lowest.

U.S. patients were significantly more likely (43%) than all other countries to skip doses of prescribed medicine or not fill prescriptions because of costs.

U.S. patients were also significantly more likely than most other countries to say it was "very difficult" to get out-of-hours care, according to the survey. Australia and Canada had similar negative response levels at 34% and 33%, respectively.

The United States scored comparatively well on care when patients transition from hospital care to the community. U.S. patients were significantly less likely than all other countries to report gaps in discharge information, the survey found. In the United States, 38% of hospital patients reported deficiencies; the highest rate was in France, with 71% of hospital patients reporting gaps, the report said.

The United States scored well on waiting times, the researchers found. Of patients needing to see a specialist, 74% waited less than 4 weeks, with Germany (68%) and the Netherlands (69%) also having short waits. Forty-two percent of Canadians reported waits of 2 months or longer, significantly higher than all other countries, according to the survey.

In an eight-nation survey of people with chronic conditions, patients in the Netherlands were most positive about their country's health care system—reporting affordable, accessible care with low rates of errors—while U.S. patients were the most likely to say their system was in need of major revision.

The study, published online, showed that patients in all nations report gaps in care when being discharged from the hospital, such as providing written care plans, follow-up care, instructions about symptoms to watch for, and what institution to contact with questions about condition or treatments.

The survey included more than 9,000 patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States from March through May 2008. Patients had developed hypertension, heart disease, diabetes, arthritis, chronic lung conditions, depression, or cancer, and the share of patients with two or more conditions ranged from 51% in New Zealand to 71% in the United States, according to the survey.

The researchers, from the Commonwealth Fund, a New York-based charitable foundation, said just 9% of patients in the Netherlands called for health care restructuring, significantly less than the 33% of the respondents in the United States (Health Aff. 2008 Nov. 13 [doi 10.1377/hlthaff.28.1.w1]).

"It goes back to primary care as the core of [the Dutch] system," Robin Osborn, vice president of the International Program in Health Policy and Practice at the Commonwealth Fund, said in a teleconference to discuss the findings. "Patients register with a doctor. There is gatekeeping. The benefit is great. Eighty percent of the patients had been with their doctors for 5 years or more," In the United States, just 53% of subjects had been with their physicians 5 years or more.

U.S. patients faced the greatest cost and access issues, with 41% spending more than $1,000 out of pocket, significantly more than the seven other countries, with France (5%) and the United Kingdom (4%) paying the lowest.

U.S. patients were significantly more likely (43%) than all other countries to skip doses of prescribed medicine or not fill prescriptions because of costs.

U.S. patients were also significantly more likely than most other countries to say it was "very difficult" to get out-of-hours care, according to the survey. Australia and Canada had similar negative response levels at 34% and 33%, respectively.

The United States scored comparatively well on care when patients transition from hospital care to the community. U.S. patients were significantly less likely than all other countries to report gaps in discharge information, the survey found. In the United States, 38% of hospital patients reported deficiencies; the highest rate was in France, with 71% of hospital patients reporting gaps, the report said.

The United States scored well on waiting times, the researchers found. Of patients needing to see a specialist, 74% waited less than 4 weeks, with Germany (68%) and the Netherlands (69%) also having short waits. Forty-two percent of Canadians reported waits of 2 months or longer, significantly higher than all other countries, according to the survey.

In an eight-nation survey of people with chronic conditions, patients in the Netherlands were most positive about their country's health care system—reporting affordable, accessible care with low rates of errors—while U.S. patients were the most likely to say their system was in need of major revision.

The study, published online, showed that patients in all nations report gaps in care when being discharged from the hospital, such as providing written care plans, follow-up care, instructions about symptoms to watch for, and what institution to contact with questions about condition or treatments.

The survey included more than 9,000 patients in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States from March through May 2008. Patients had developed hypertension, heart disease, diabetes, arthritis, chronic lung conditions, depression, or cancer, and the share of patients with two or more conditions ranged from 51% in New Zealand to 71% in the United States, according to the survey.

The researchers, from the Commonwealth Fund, a New York-based charitable foundation, said just 9% of patients in the Netherlands called for health care restructuring, significantly less than the 33% of the respondents in the United States (Health Aff. 2008 Nov. 13 [doi 10.1377/hlthaff.28.1.w1]).

"It goes back to primary care as the core of [the Dutch] system," Robin Osborn, vice president of the International Program in Health Policy and Practice at the Commonwealth Fund, said in a teleconference to discuss the findings. "Patients register with a doctor. There is gatekeeping. The benefit is great. Eighty percent of the patients had been with their doctors for 5 years or more," In the United States, just 53% of subjects had been with their physicians 5 years or more.

U.S. patients faced the greatest cost and access issues, with 41% spending more than $1,000 out of pocket, significantly more than the seven other countries, with France (5%) and the United Kingdom (4%) paying the lowest.

U.S. patients were significantly more likely (43%) than all other countries to skip doses of prescribed medicine or not fill prescriptions because of costs.

U.S. patients were also significantly more likely than most other countries to say it was "very difficult" to get out-of-hours care, according to the survey. Australia and Canada had similar negative response levels at 34% and 33%, respectively.

The United States scored comparatively well on care when patients transition from hospital care to the community. U.S. patients were significantly less likely than all other countries to report gaps in discharge information, the survey found. In the United States, 38% of hospital patients reported deficiencies; the highest rate was in France, with 71% of hospital patients reporting gaps, the report said.

The United States scored well on waiting times, the researchers found. Of patients needing to see a specialist, 74% waited less than 4 weeks, with Germany (68%) and the Netherlands (69%) also having short waits. Forty-two percent of Canadians reported waits of 2 months or longer, significantly higher than all other countries, according to the survey.

Direct-to-consumer advertising may have a limited effect on demand for medication, based on analysis of Canadians exposed to U.S. advertising published online.

Researchers from Harvard Medical School, Boston, and University of Alberta, Edmonton, found that the introduction of U.S. advertising campaigns for etanercept (Enbrel) and mometasone (Nasonex)—to which English-speaking Canadians were exposed through broadcast, print, and online media—did not cause a statistically significant change in prescribing patterns in English-speaking areas, when compared with French-speaking areas of Canada, where exposure was limited (BMJ 2008;337:a1055 [doi:10.1136/bmj.a1055]).

An advertising campaign for tegaserod (Zelnorm), however, did cause a statistically significant increase in English-speaking areas.

"People tend to think that if direct-to-consumer advertising wasn't effective, [pharmaceutical companies] wouldn't be doing it," investigator Dr. Stephen Soumerai, professor of ambulatory care and prevention at Harvard, said in a statement. "But as it turns out, decisions to market directly to consumers [are] based on scant data."

Dr. Soumerai and his colleagues studied Canadians because although direct-to-consumer advertising is illegal in Canada, English speakers close to the border are exposed to U.S. advertising. About 30% of television watched by English-speaking Canadians is foreign sourced, the researchers said, citing Statistics Canada data. But because the advertising is in English, French speakers can serve as a control group because they view much less foreign-sourced media—about 5%, the researchers said.

Consulting data from IMS Health Canada, the researchers said they detected no statistically different changes in prescribing patterns in English- and French-speaking provinces following the January 2003 introduction of U.S. direct-to-consumer advertising for etanercept and the December 2004 start of the campaign for mometasone. But, for tegaserod, prescribing rates grew 42% in English-speaking provinces in the first month after the start of an August 2003 campaign.

The trend was not sustained, and within 2 years, tegaserod prescription rates were the same in both English- and French-speaking provinces, the researchers said. The trend in Canada was not as pronounced as in the U.S. Medicaid program, which saw its prescribing of tegaserod rise 56%, the researcher wrote. Tegaserod since has been withdrawn from the market.

The researchers acknowledged that their findings may not be generalizable to other drugs advertised directly to consumers. They added that differences in drug coverage, exposure to advertising, television viewing patterns, culture, and the health care system at large may have had an effect on their findings.

Direct-to-consumer advertising may have a limited effect on demand for medication, based on analysis of Canadians exposed to U.S. advertising published online.

Researchers from Harvard Medical School, Boston, and University of Alberta, Edmonton, found that the introduction of U.S. advertising campaigns for etanercept (Enbrel) and mometasone (Nasonex)—to which English-speaking Canadians were exposed through broadcast, print, and online media—did not cause a statistically significant change in prescribing patterns in English-speaking areas, when compared with French-speaking areas of Canada, where exposure was limited (BMJ 2008;337:a1055 [doi:10.1136/bmj.a1055]).

An advertising campaign for tegaserod (Zelnorm), however, did cause a statistically significant increase in English-speaking areas.

"People tend to think that if direct-to-consumer advertising wasn't effective, [pharmaceutical companies] wouldn't be doing it," investigator Dr. Stephen Soumerai, professor of ambulatory care and prevention at Harvard, said in a statement. "But as it turns out, decisions to market directly to consumers [are] based on scant data."

Dr. Soumerai and his colleagues studied Canadians because although direct-to-consumer advertising is illegal in Canada, English speakers close to the border are exposed to U.S. advertising. About 30% of television watched by English-speaking Canadians is foreign sourced, the researchers said, citing Statistics Canada data. But because the advertising is in English, French speakers can serve as a control group because they view much less foreign-sourced media—about 5%, the researchers said.

Consulting data from IMS Health Canada, the researchers said they detected no statistically different changes in prescribing patterns in English- and French-speaking provinces following the January 2003 introduction of U.S. direct-to-consumer advertising for etanercept and the December 2004 start of the campaign for mometasone. But, for tegaserod, prescribing rates grew 42% in English-speaking provinces in the first month after the start of an August 2003 campaign.

The trend was not sustained, and within 2 years, tegaserod prescription rates were the same in both English- and French-speaking provinces, the researchers said. The trend in Canada was not as pronounced as in the U.S. Medicaid program, which saw its prescribing of tegaserod rise 56%, the researcher wrote. Tegaserod since has been withdrawn from the market.

The researchers acknowledged that their findings may not be generalizable to other drugs advertised directly to consumers. They added that differences in drug coverage, exposure to advertising, television viewing patterns, culture, and the health care system at large may have had an effect on their findings.

Direct-to-consumer advertising may have a limited effect on demand for medication, based on analysis of Canadians exposed to U.S. advertising published online.

Researchers from Harvard Medical School, Boston, and University of Alberta, Edmonton, found that the introduction of U.S. advertising campaigns for etanercept (Enbrel) and mometasone (Nasonex)—to which English-speaking Canadians were exposed through broadcast, print, and online media—did not cause a statistically significant change in prescribing patterns in English-speaking areas, when compared with French-speaking areas of Canada, where exposure was limited (BMJ 2008;337:a1055 [doi:10.1136/bmj.a1055]).

An advertising campaign for tegaserod (Zelnorm), however, did cause a statistically significant increase in English-speaking areas.

"People tend to think that if direct-to-consumer advertising wasn't effective, [pharmaceutical companies] wouldn't be doing it," investigator Dr. Stephen Soumerai, professor of ambulatory care and prevention at Harvard, said in a statement. "But as it turns out, decisions to market directly to consumers [are] based on scant data."

Dr. Soumerai and his colleagues studied Canadians because although direct-to-consumer advertising is illegal in Canada, English speakers close to the border are exposed to U.S. advertising. About 30% of television watched by English-speaking Canadians is foreign sourced, the researchers said, citing Statistics Canada data. But because the advertising is in English, French speakers can serve as a control group because they view much less foreign-sourced media—about 5%, the researchers said.

Consulting data from IMS Health Canada, the researchers said they detected no statistically different changes in prescribing patterns in English- and French-speaking provinces following the January 2003 introduction of U.S. direct-to-consumer advertising for etanercept and the December 2004 start of the campaign for mometasone. But, for tegaserod, prescribing rates grew 42% in English-speaking provinces in the first month after the start of an August 2003 campaign.

The trend was not sustained, and within 2 years, tegaserod prescription rates were the same in both English- and French-speaking provinces, the researchers said. The trend in Canada was not as pronounced as in the U.S. Medicaid program, which saw its prescribing of tegaserod rise 56%, the researcher wrote. Tegaserod since has been withdrawn from the market.

The researchers acknowledged that their findings may not be generalizable to other drugs advertised directly to consumers. They added that differences in drug coverage, exposure to advertising, television viewing patterns, culture, and the health care system at large may have had an effect on their findings.

Direct-to-consumer advertising may have a limited effect on demand for medication, based on analysis of Canadians exposed to U.S. advertising published online.

Researchers from Harvard Medical School, Boston, and University of Alberta, Edmonton, found that the introduction of U.S. advertising campaigns for etanercept (Enbrel) and mometasone (Nasonex)—to which English-speaking Canadians were exposed through broadcast, print, and online media—did not cause a statistically significant change in prescribing patterns in English-speaking areas, when compared with French-speaking areas of Canada, where exposure was limited (BMJ 2008;337:a1055 [doi:10.1136/bmj.a1055

An advertising campaign for tegaserod (Zelnorm), however, did cause a statistically significant increase in English-speaking areas. “People tend to think that if direct-to-consumer advertising wasn't effective, [pharmaceutical companies] wouldn't be doing it,” investigator Dr. Stephen Soumerai, professor of ambulatory care and prevention at Harvard, said in a statement. “But as it turns out, decisions to market directly to consumers [are] based on scant data.”

Dr. Soumerai and his colleagues studied Canadians because although direct-to-consumer advertising is illegal in Canada, English speakers close to the border are exposed to U.S. advertising. About 30% of television watched by English-speaking Canadians is foreign sourced, the researchers said, citing Statistics Canada data.

But because the advertising is in English, French speakers can serve as a control group because they view much less foreign-sourced media—about 5%, the researchers said.

Consulting data from IMS Health Canada, the researchers said they detected no statistically different changes in prescribing patterns in English- and French-speaking provinces following the January 2003 introduction of U.S. direct-to-consumer advertising for etanercept and the December 2004 start of the campaign for mometasone. But, for tegaserod, prescribing rates grew 42% in English-speaking provinces in the first month after the start of an August 2003 campaign, according to the researchers. The trend was not sustained, and within 2 years, tegaserod prescription rates were the same in both English- and French-speaking provinces, the researchers said. Furthermore, the trend in Canada was not as pronounced as in the U.S. Medicaid program, which saw its prescribing of tegaserod rise 56%, the researcher wrote. Tegaserod since has been withdrawn from the market.

The researchers acknowledged that their findings may not be generalizable to other drugs advertised directly to consumers. They added that differences in drug coverage, exposure to advertising, television viewing patterns, culture, and the health care system at large may have had an effect on their findings.

Direct-to-consumer advertising may have a limited effect on demand for medication, based on analysis of Canadians exposed to U.S. advertising published online.

Researchers from Harvard Medical School, Boston, and University of Alberta, Edmonton, found that the introduction of U.S. advertising campaigns for etanercept (Enbrel) and mometasone (Nasonex)—to which English-speaking Canadians were exposed through broadcast, print, and online media—did not cause a statistically significant change in prescribing patterns in English-speaking areas, when compared with French-speaking areas of Canada, where exposure was limited (BMJ 2008;337:a1055 [doi:10.1136/bmj.a1055

An advertising campaign for tegaserod (Zelnorm), however, did cause a statistically significant increase in English-speaking areas. “People tend to think that if direct-to-consumer advertising wasn't effective, [pharmaceutical companies] wouldn't be doing it,” investigator Dr. Stephen Soumerai, professor of ambulatory care and prevention at Harvard, said in a statement. “But as it turns out, decisions to market directly to consumers [are] based on scant data.”

Dr. Soumerai and his colleagues studied Canadians because although direct-to-consumer advertising is illegal in Canada, English speakers close to the border are exposed to U.S. advertising. About 30% of television watched by English-speaking Canadians is foreign sourced, the researchers said, citing Statistics Canada data.

But because the advertising is in English, French speakers can serve as a control group because they view much less foreign-sourced media—about 5%, the researchers said.

Consulting data from IMS Health Canada, the researchers said they detected no statistically different changes in prescribing patterns in English- and French-speaking provinces following the January 2003 introduction of U.S. direct-to-consumer advertising for etanercept and the December 2004 start of the campaign for mometasone. But, for tegaserod, prescribing rates grew 42% in English-speaking provinces in the first month after the start of an August 2003 campaign, according to the researchers. The trend was not sustained, and within 2 years, tegaserod prescription rates were the same in both English- and French-speaking provinces, the researchers said. Furthermore, the trend in Canada was not as pronounced as in the U.S. Medicaid program, which saw its prescribing of tegaserod rise 56%, the researcher wrote. Tegaserod since has been withdrawn from the market.

The researchers acknowledged that their findings may not be generalizable to other drugs advertised directly to consumers. They added that differences in drug coverage, exposure to advertising, television viewing patterns, culture, and the health care system at large may have had an effect on their findings.

Direct-to-consumer advertising may have a limited effect on demand for medication, based on analysis of Canadians exposed to U.S. advertising published online.

Researchers from Harvard Medical School, Boston, and University of Alberta, Edmonton, found that the introduction of U.S. advertising campaigns for etanercept (Enbrel) and mometasone (Nasonex)—to which English-speaking Canadians were exposed through broadcast, print, and online media—did not cause a statistically significant change in prescribing patterns in English-speaking areas, when compared with French-speaking areas of Canada, where exposure was limited (BMJ 2008;337:a1055 [doi:10.1136/bmj.a1055

An advertising campaign for tegaserod (Zelnorm), however, did cause a statistically significant increase in English-speaking areas. “People tend to think that if direct-to-consumer advertising wasn't effective, [pharmaceutical companies] wouldn't be doing it,” investigator Dr. Stephen Soumerai, professor of ambulatory care and prevention at Harvard, said in a statement. “But as it turns out, decisions to market directly to consumers [are] based on scant data.”

Dr. Soumerai and his colleagues studied Canadians because although direct-to-consumer advertising is illegal in Canada, English speakers close to the border are exposed to U.S. advertising. About 30% of television watched by English-speaking Canadians is foreign sourced, the researchers said, citing Statistics Canada data.

But because the advertising is in English, French speakers can serve as a control group because they view much less foreign-sourced media—about 5%, the researchers said.

Consulting data from IMS Health Canada, the researchers said they detected no statistically different changes in prescribing patterns in English- and French-speaking provinces following the January 2003 introduction of U.S. direct-to-consumer advertising for etanercept and the December 2004 start of the campaign for mometasone. But, for tegaserod, prescribing rates grew 42% in English-speaking provinces in the first month after the start of an August 2003 campaign, according to the researchers. The trend was not sustained, and within 2 years, tegaserod prescription rates were the same in both English- and French-speaking provinces, the researchers said. Furthermore, the trend in Canada was not as pronounced as in the U.S. Medicaid program, which saw its prescribing of tegaserod rise 56%, the researcher wrote. Tegaserod since has been withdrawn from the market.

The researchers acknowledged that their findings may not be generalizable to other drugs advertised directly to consumers. They added that differences in drug coverage, exposure to advertising, television viewing patterns, culture, and the health care system at large may have had an effect on their findings.

Improving living conditions, reducing income disparities, and measuring the effects of specific steps to reduce inequities in health care all are necessary to eliminate the effects that deprivation has on global public health, the World Health Organization said in a report.

The WHO report on social determinants of health called for better education, particularly in early childhood; improvements in workplace conditions and full and fair employment; urban and rural development that increases affordable housing and improves sanitation; development of social programs, including health care programs; and reduction in disparities in wealth and power.

Measurement of both the problems and how well any solutions worked is necessary to reduce the disparities and would include goal setting on health equity, using health-equity surveillance systems in member states and impact-assessment tools, as well as convening a global meeting periodically to assess progress.

Wealth and economic development are not solutions, WHO officials said, pointing to sharp disparities in life expectancy in a relatively high-income city like Glasgow, Scotland, even as relatively low-income countries like Sri Lanka have narrowed health inequities.

“Central to the commission's recommendations is creating the conditions for people to be empowered, to have freedom to lead flourishing lives,” said Sir Michael Marmot, a professor of epidemiology and public health at University College London, and chair of the WHO Commission on Social Determinants of Health, which prepared the report.

“Nowhere is lack of empowerment more obvious than in the plight of women in many parts of the world,” Dr. Marmot said in a written statement. “Health suffers as a result. Following our recommendations would dramatically improve the health and life chances of billions of people.”

Improving living conditions, reducing income disparities, and measuring the effects of specific steps to reduce inequities in health care all are necessary to eliminate the effects that deprivation has on global public health, the World Health Organization said in a report.

The WHO report on social determinants of health called for better education, particularly in early childhood; improvements in workplace conditions and full and fair employment; urban and rural development that increases affordable housing and improves sanitation; development of social programs, including health care programs; and reduction in disparities in wealth and power.

Measurement of both the problems and how well any solutions worked is necessary to reduce the disparities and would include goal setting on health equity, using health-equity surveillance systems in member states and impact-assessment tools, as well as convening a global meeting periodically to assess progress.

Wealth and economic development are not solutions, WHO officials said, pointing to sharp disparities in life expectancy in a relatively high-income city like Glasgow, Scotland, even as relatively low-income countries like Sri Lanka have narrowed health inequities.

“Central to the commission's recommendations is creating the conditions for people to be empowered, to have freedom to lead flourishing lives,” said Sir Michael Marmot, a professor of epidemiology and public health at University College London, and chair of the WHO Commission on Social Determinants of Health, which prepared the report.

“Nowhere is lack of empowerment more obvious than in the plight of women in many parts of the world,” Dr. Marmot said in a written statement. “Health suffers as a result. Following our recommendations would dramatically improve the health and life chances of billions of people.”

Improving living conditions, reducing income disparities, and measuring the effects of specific steps to reduce inequities in health care all are necessary to eliminate the effects that deprivation has on global public health, the World Health Organization said in a report.

The WHO report on social determinants of health called for better education, particularly in early childhood; improvements in workplace conditions and full and fair employment; urban and rural development that increases affordable housing and improves sanitation; development of social programs, including health care programs; and reduction in disparities in wealth and power.

Measurement of both the problems and how well any solutions worked is necessary to reduce the disparities and would include goal setting on health equity, using health-equity surveillance systems in member states and impact-assessment tools, as well as convening a global meeting periodically to assess progress.

Wealth and economic development are not solutions, WHO officials said, pointing to sharp disparities in life expectancy in a relatively high-income city like Glasgow, Scotland, even as relatively low-income countries like Sri Lanka have narrowed health inequities.

“Central to the commission's recommendations is creating the conditions for people to be empowered, to have freedom to lead flourishing lives,” said Sir Michael Marmot, a professor of epidemiology and public health at University College London, and chair of the WHO Commission on Social Determinants of Health, which prepared the report.

“Nowhere is lack of empowerment more obvious than in the plight of women in many parts of the world,” Dr. Marmot said in a written statement. “Health suffers as a result. Following our recommendations would dramatically improve the health and life chances of billions of people.”

Obese patients with osteoarthritis experience greater gains in physical function 7 years after undergoing total knee arthroplasty than do obese controls who did not have the surgery, according to an English study.

Based on data from 688 patients, there is no justification to withhold knee replacements from obese patients on the grounds that obesity is a risk factor for OA. At least one National Health Service trust has been reported to apply such a policy, the investigators wrote (Ann. Rheum. Dis. 2008 July 24 [doi:10.1136/ard.2008.093229]).

In a subgroup of 108 obese patients (body mass index greater than or equal to 30 kg/m

“Improvements in physical function following [TKA] for osteoarthritis are sustained,” wrote Janet Cushnaghan of the University of Southampton, England, and her associates. “These benefits extend to [obese patients] and, provided appropriate selection criteria are applied with regard to fitness for surgery, there seems no justification for withholding TKA.”

The researchers studied patients and controls aged 45 and older who had taken part in an earlier case-control study of knee OA. That study compared patients placed on a waiting list for TKA between 1995 and 1997 with controls in the community. Functional status and BMI were measured as part of data collection.

During 2001–2004, the authors wrote to the original study group with a questionnaire about their surgery and included the functional status sections of the SF-36 form. A total of 325 patients and 363 controls were included in this analysis.

Overall, at a mean follow-up of 7 years, median physical function scores in patients who underwent TKA improved from 20 to 26; scores in controls fell from 89 to 75.

Mental health scores on the SF-36 form improved equally in both groups. Vitality scores declined in both groups, but the decline was greater in patients than in controls (a loss of 10 points vs. a loss of 5 points).

Of 82 patients older than age 75, the median physical function score stayed steady at 17 points; scores declined from 83 to 43 points in 87 controls in that age group.

The researchers said their findings might have been biased by migration, although subjects were as likely to have moved, demonstrating greater function, as to have entered nursing care, demonstrating poorer function.

They also said OA might have been undetected in the controls at baseline, which would have biased their findings in favor of the intervention group.

Obese patients with osteoarthritis experience greater gains in physical function 7 years after undergoing total knee arthroplasty than do obese controls who did not have the surgery, according to an English study.

Based on data from 688 patients, there is no justification to withhold knee replacements from obese patients on the grounds that obesity is a risk factor for OA. At least one National Health Service trust has been reported to apply such a policy, the investigators wrote (Ann. Rheum. Dis. 2008 July 24 [doi:10.1136/ard.2008.093229]).

In a subgroup of 108 obese patients (body mass index greater than or equal to 30 kg/m

“Improvements in physical function following [TKA] for osteoarthritis are sustained,” wrote Janet Cushnaghan of the University of Southampton, England, and her associates. “These benefits extend to [obese patients] and, provided appropriate selection criteria are applied with regard to fitness for surgery, there seems no justification for withholding TKA.”

The researchers studied patients and controls aged 45 and older who had taken part in an earlier case-control study of knee OA. That study compared patients placed on a waiting list for TKA between 1995 and 1997 with controls in the community. Functional status and BMI were measured as part of data collection.

During 2001–2004, the authors wrote to the original study group with a questionnaire about their surgery and included the functional status sections of the SF-36 form. A total of 325 patients and 363 controls were included in this analysis.

Overall, at a mean follow-up of 7 years, median physical function scores in patients who underwent TKA improved from 20 to 26; scores in controls fell from 89 to 75.

Mental health scores on the SF-36 form improved equally in both groups. Vitality scores declined in both groups, but the decline was greater in patients than in controls (a loss of 10 points vs. a loss of 5 points).

Of 82 patients older than age 75, the median physical function score stayed steady at 17 points; scores declined from 83 to 43 points in 87 controls in that age group.

The researchers said their findings might have been biased by migration, although subjects were as likely to have moved, demonstrating greater function, as to have entered nursing care, demonstrating poorer function.

They also said OA might have been undetected in the controls at baseline, which would have biased their findings in favor of the intervention group.

Obese patients with osteoarthritis experience greater gains in physical function 7 years after undergoing total knee arthroplasty than do obese controls who did not have the surgery, according to an English study.

Based on data from 688 patients, there is no justification to withhold knee replacements from obese patients on the grounds that obesity is a risk factor for OA. At least one National Health Service trust has been reported to apply such a policy, the investigators wrote (Ann. Rheum. Dis. 2008 July 24 [doi:10.1136/ard.2008.093229]).

In a subgroup of 108 obese patients (body mass index greater than or equal to 30 kg/m

“Improvements in physical function following [TKA] for osteoarthritis are sustained,” wrote Janet Cushnaghan of the University of Southampton, England, and her associates. “These benefits extend to [obese patients] and, provided appropriate selection criteria are applied with regard to fitness for surgery, there seems no justification for withholding TKA.”

The researchers studied patients and controls aged 45 and older who had taken part in an earlier case-control study of knee OA. That study compared patients placed on a waiting list for TKA between 1995 and 1997 with controls in the community. Functional status and BMI were measured as part of data collection.

During 2001–2004, the authors wrote to the original study group with a questionnaire about their surgery and included the functional status sections of the SF-36 form. A total of 325 patients and 363 controls were included in this analysis.

Overall, at a mean follow-up of 7 years, median physical function scores in patients who underwent TKA improved from 20 to 26; scores in controls fell from 89 to 75.

Mental health scores on the SF-36 form improved equally in both groups. Vitality scores declined in both groups, but the decline was greater in patients than in controls (a loss of 10 points vs. a loss of 5 points).

Of 82 patients older than age 75, the median physical function score stayed steady at 17 points; scores declined from 83 to 43 points in 87 controls in that age group.

The researchers said their findings might have been biased by migration, although subjects were as likely to have moved, demonstrating greater function, as to have entered nursing care, demonstrating poorer function.

They also said OA might have been undetected in the controls at baseline, which would have biased their findings in favor of the intervention group.

Women who eat nut products such as peanut butter daily throughout pregnancy may significantly increase their children's risk of developing asthma symptoms, according to a Dutch cohort study.

At 8 years of age, children whose mothers reported daily consumption of nut products were at significantly increased risk for steroid use (odds ratio 1.62), dyspnea (OR 1.58), and wheeze (OR 1.42), compared with children of women who reported only rarely (no more than three times per month) eating nut products. The data were adjusted for factors such as parental atopy, maternal smoking in pregnancy, and breast-feeding. The associations were independent of the children's diets.

The investigators stressed that these findings should be replicated in other studies “before influencing dietary advice given to pregnant women” (Am. J. Respir. Crit. Care Med.;177:1-8).

Previous research on the effectiveness of maternal dietary allergen avoidance during pregnancy in prevention of childhood allergic disease has been “inconclusive,” wrote Saskia M. Willers of the environmental epidemiology division at Utrecht University, the Netherlands, and associates. They added that their study is the first to use longitudinal statistical methods to assess the relationship over an extended period.

The researchers enrolled 4,146 women (1,327 atopic and 2,819 nonatopic). Complete data were available for 2,832 children whose mothers completed questionnaires at baseline on their dietary habits during pregnancy. The questionnaires assessed frequency of the women's consumption of vegetables, fresh fruit, fish, eggs, milk, milk products, nuts, and nut products; possible responses ranged from “never” to “several times per day.”

“Because we mentioned peanut butter as an example of nut products in the questionnaire and because peanut butter is a commonly used spread on sandwiches in the Netherlands … we assumed that the largest proportion of nut products is peanut butter,” the researchers wrote.

Children were followed up at 3 months and then once a year from ages 1 through 8; a dietary assessment was conducted at age 2. At age 8, 13.2% of the children had asthma symptoms, and another 3.9% had asthma diagnosed by a doctor.

Daily consumption of nut products was the only factor assessed that showed a significant association with increased incidence of asthma symptoms. In an interview, Ms. Willers noted that the lack of a significant association between asthma symptoms and daily consumption of nuts—as opposed to nut products—may have been due to the small sample size of women (1.4%) who ate nuts daily. In addition, she said, the nut products consumed were made largely from peanuts, but women who ate nuts daily also may have eaten less allergenic types of nuts.

In a crude analysis, women who ate fruit daily were significantly less likely to have children who wheezed than were those who ate fruit only regularly or rarely (odds ratio 0.82), but that association disappeared after adjustment for socioeconomic factors, parental atopy, and other factors.

The researchers said their findings are limited by their inability to obtain more information on specific foods and portion sizes. They said they included the main food groups associated with asthma, but other foods and nutrients cannot be ruled out as having been responsible for the asthmatic symptoms identified.

One of the study investigators reported having received an unrestricted research grant from GlaxoSmithKline over a 3-year period; the remaining authors reported no financial conflicts.

Women who eat nut products such as peanut butter daily throughout pregnancy may significantly increase their children's risk of developing asthma symptoms, according to a Dutch cohort study.

At 8 years of age, children whose mothers reported daily consumption of nut products were at significantly increased risk for steroid use (odds ratio 1.62), dyspnea (OR 1.58), and wheeze (OR 1.42), compared with children of women who reported only rarely (no more than three times per month) eating nut products. The data were adjusted for factors such as parental atopy, maternal smoking in pregnancy, and breast-feeding. The associations were independent of the children's diets.

The investigators stressed that these findings should be replicated in other studies “before influencing dietary advice given to pregnant women” (Am. J. Respir. Crit. Care Med.;177:1-8).

Previous research on the effectiveness of maternal dietary allergen avoidance during pregnancy in prevention of childhood allergic disease has been “inconclusive,” wrote Saskia M. Willers of the environmental epidemiology division at Utrecht University, the Netherlands, and associates. They added that their study is the first to use longitudinal statistical methods to assess the relationship over an extended period.

The researchers enrolled 4,146 women (1,327 atopic and 2,819 nonatopic). Complete data were available for 2,832 children whose mothers completed questionnaires at baseline on their dietary habits during pregnancy. The questionnaires assessed frequency of the women's consumption of vegetables, fresh fruit, fish, eggs, milk, milk products, nuts, and nut products; possible responses ranged from “never” to “several times per day.”

“Because we mentioned peanut butter as an example of nut products in the questionnaire and because peanut butter is a commonly used spread on sandwiches in the Netherlands … we assumed that the largest proportion of nut products is peanut butter,” the researchers wrote.

Children were followed up at 3 months and then once a year from ages 1 through 8; a dietary assessment was conducted at age 2. At age 8, 13.2% of the children had asthma symptoms, and another 3.9% had asthma diagnosed by a doctor.

Daily consumption of nut products was the only factor assessed that showed a significant association with increased incidence of asthma symptoms. In an interview, Ms. Willers noted that the lack of a significant association between asthma symptoms and daily consumption of nuts—as opposed to nut products—may have been due to the small sample size of women (1.4%) who ate nuts daily. In addition, she said, the nut products consumed were made largely from peanuts, but women who ate nuts daily also may have eaten less allergenic types of nuts.

In a crude analysis, women who ate fruit daily were significantly less likely to have children who wheezed than were those who ate fruit only regularly or rarely (odds ratio 0.82), but that association disappeared after adjustment for socioeconomic factors, parental atopy, and other factors.

The researchers said their findings are limited by their inability to obtain more information on specific foods and portion sizes. They said they included the main food groups associated with asthma, but other foods and nutrients cannot be ruled out as having been responsible for the asthmatic symptoms identified.

One of the study investigators reported having received an unrestricted research grant from GlaxoSmithKline over a 3-year period; the remaining authors reported no financial conflicts.

Women who eat nut products such as peanut butter daily throughout pregnancy may significantly increase their children's risk of developing asthma symptoms, according to a Dutch cohort study.

At 8 years of age, children whose mothers reported daily consumption of nut products were at significantly increased risk for steroid use (odds ratio 1.62), dyspnea (OR 1.58), and wheeze (OR 1.42), compared with children of women who reported only rarely (no more than three times per month) eating nut products. The data were adjusted for factors such as parental atopy, maternal smoking in pregnancy, and breast-feeding. The associations were independent of the children's diets.

The investigators stressed that these findings should be replicated in other studies “before influencing dietary advice given to pregnant women” (Am. J. Respir. Crit. Care Med.;177:1-8).

Previous research on the effectiveness of maternal dietary allergen avoidance during pregnancy in prevention of childhood allergic disease has been “inconclusive,” wrote Saskia M. Willers of the environmental epidemiology division at Utrecht University, the Netherlands, and associates. They added that their study is the first to use longitudinal statistical methods to assess the relationship over an extended period.

The researchers enrolled 4,146 women (1,327 atopic and 2,819 nonatopic). Complete data were available for 2,832 children whose mothers completed questionnaires at baseline on their dietary habits during pregnancy. The questionnaires assessed frequency of the women's consumption of vegetables, fresh fruit, fish, eggs, milk, milk products, nuts, and nut products; possible responses ranged from “never” to “several times per day.”

“Because we mentioned peanut butter as an example of nut products in the questionnaire and because peanut butter is a commonly used spread on sandwiches in the Netherlands … we assumed that the largest proportion of nut products is peanut butter,” the researchers wrote.

Children were followed up at 3 months and then once a year from ages 1 through 8; a dietary assessment was conducted at age 2. At age 8, 13.2% of the children had asthma symptoms, and another 3.9% had asthma diagnosed by a doctor.

Daily consumption of nut products was the only factor assessed that showed a significant association with increased incidence of asthma symptoms. In an interview, Ms. Willers noted that the lack of a significant association between asthma symptoms and daily consumption of nuts—as opposed to nut products—may have been due to the small sample size of women (1.4%) who ate nuts daily. In addition, she said, the nut products consumed were made largely from peanuts, but women who ate nuts daily also may have eaten less allergenic types of nuts.

In a crude analysis, women who ate fruit daily were significantly less likely to have children who wheezed than were those who ate fruit only regularly or rarely (odds ratio 0.82), but that association disappeared after adjustment for socioeconomic factors, parental atopy, and other factors.

The researchers said their findings are limited by their inability to obtain more information on specific foods and portion sizes. They said they included the main food groups associated with asthma, but other foods and nutrients cannot be ruled out as having been responsible for the asthmatic symptoms identified.

One of the study investigators reported having received an unrestricted research grant from GlaxoSmithKline over a 3-year period; the remaining authors reported no financial conflicts.

Chronic conditions such as heart disease and stroke are now the biggest killers worldwide, signifying the shift of global disease burden away from communicable diseases, the World Health Organization said in its annual international health statistics report.

The WHO added that of the eight leading causes of death worldwide, tobacco use contributes to six. It noted that only 5% of the world's population is covered by any one measure to control tobacco use.

The report on the 193 WHO-member countries indicated that three diseases—ischemic heart disease, cerebrovascular disease, and chronic obstructive pulmonary disease—will constitute 34.9% of deaths worldwide by 2030, up from 27% in 2004. By comparison, the top three communicable diseases of today—lower respiratory infections, diarrheal diseases, and HIV/AIDS—will constitute just 6.5% of deaths worldwide in 2030, down from 14.1% today.

“We are definitely seeing a trend towards fewer people dying of infectious diseases across the world,” Dr. Ties Boerma, director of the WHO's Department of Health Statistics and Informatics, said in a written statement. “We tend to associate developing countries with infectious diseases, such as HIV/AIDS, tuberculosis, and malaria. But in more and more countries the chief causes of death are noncommunicable diseases, such as heart disease and stroke.”

Among the chronic or behavior-related diseases on the increase around the world will be trachea, bronchus, and lung cancers, representing 3.4% of deaths in 2030 compared with 2.3% in 2004; diabetes, representing 3.3% of deaths in 2030 compared with 1.9% in 2004; and hypertensive heart disease, representing 2.1% of deaths in 2030 compared with 1.7% in 2004, according to the WHO.

The WHO said road traffic accidents are expected to increase also, to 3.6% of deaths in 2030 from 2.2% of deaths in 2004.

Other findings:

▸ Maternal mortality rates. In 2005 rates were 400 deaths for every 100,000 live births; rates were 450 in developing countries and 900 in sub-Saharan Africa.

▸ Decreasing HIV/AIDS prevalence in sub-Saharan Africa. Rates dropped from 6% of the population in 2000 to 5% in 2007.

▸ Differences in life expectancy in Europe. In northern, southern, and western Europe, the life expectancy at birth was 78.6 for both sexes in 2005, an increase since 1950 of 15 years in southern Europe, 11 years in western Europe, and 9 years in northern Europe. In Eastern Europe, the life expectancy advanced less than 4 years over the same period, from 64.2 years in 1950 to 67.8 years in 2005.

Chronic conditions such as heart disease and stroke are now the biggest killers worldwide, signifying the shift of global disease burden away from communicable diseases, the World Health Organization said in its annual international health statistics report.

The WHO added that of the eight leading causes of death worldwide, tobacco use contributes to six. It noted that only 5% of the world's population is covered by any one measure to control tobacco use.

The report on the 193 WHO-member countries indicated that three diseases—ischemic heart disease, cerebrovascular disease, and chronic obstructive pulmonary disease—will constitute 34.9% of deaths worldwide by 2030, up from 27% in 2004. By comparison, the top three communicable diseases of today—lower respiratory infections, diarrheal diseases, and HIV/AIDS—will constitute just 6.5% of deaths worldwide in 2030, down from 14.1% today.

“We are definitely seeing a trend towards fewer people dying of infectious diseases across the world,” Dr. Ties Boerma, director of the WHO's Department of Health Statistics and Informatics, said in a written statement. “We tend to associate developing countries with infectious diseases, such as HIV/AIDS, tuberculosis, and malaria. But in more and more countries the chief causes of death are noncommunicable diseases, such as heart disease and stroke.”

Among the chronic or behavior-related diseases on the increase around the world will be trachea, bronchus, and lung cancers, representing 3.4% of deaths in 2030 compared with 2.3% in 2004; diabetes, representing 3.3% of deaths in 2030 compared with 1.9% in 2004; and hypertensive heart disease, representing 2.1% of deaths in 2030 compared with 1.7% in 2004, according to the WHO.

The WHO said road traffic accidents are expected to increase also, to 3.6% of deaths in 2030 from 2.2% of deaths in 2004.

Other findings:

▸ Maternal mortality rates. In 2005 rates were 400 deaths for every 100,000 live births; rates were 450 in developing countries and 900 in sub-Saharan Africa.

▸ Decreasing HIV/AIDS prevalence in sub-Saharan Africa. Rates dropped from 6% of the population in 2000 to 5% in 2007.

▸ Differences in life expectancy in Europe. In northern, southern, and western Europe, the life expectancy at birth was 78.6 for both sexes in 2005, an increase since 1950 of 15 years in southern Europe, 11 years in western Europe, and 9 years in northern Europe. In Eastern Europe, the life expectancy advanced less than 4 years over the same period, from 64.2 years in 1950 to 67.8 years in 2005.

Chronic conditions such as heart disease and stroke are now the biggest killers worldwide, signifying the shift of global disease burden away from communicable diseases, the World Health Organization said in its annual international health statistics report.

The WHO added that of the eight leading causes of death worldwide, tobacco use contributes to six. It noted that only 5% of the world's population is covered by any one measure to control tobacco use.

The report on the 193 WHO-member countries indicated that three diseases—ischemic heart disease, cerebrovascular disease, and chronic obstructive pulmonary disease—will constitute 34.9% of deaths worldwide by 2030, up from 27% in 2004. By comparison, the top three communicable diseases of today—lower respiratory infections, diarrheal diseases, and HIV/AIDS—will constitute just 6.5% of deaths worldwide in 2030, down from 14.1% today.

“We are definitely seeing a trend towards fewer people dying of infectious diseases across the world,” Dr. Ties Boerma, director of the WHO's Department of Health Statistics and Informatics, said in a written statement. “We tend to associate developing countries with infectious diseases, such as HIV/AIDS, tuberculosis, and malaria. But in more and more countries the chief causes of death are noncommunicable diseases, such as heart disease and stroke.”

Among the chronic or behavior-related diseases on the increase around the world will be trachea, bronchus, and lung cancers, representing 3.4% of deaths in 2030 compared with 2.3% in 2004; diabetes, representing 3.3% of deaths in 2030 compared with 1.9% in 2004; and hypertensive heart disease, representing 2.1% of deaths in 2030 compared with 1.7% in 2004, according to the WHO.

The WHO said road traffic accidents are expected to increase also, to 3.6% of deaths in 2030 from 2.2% of deaths in 2004.

Other findings:

▸ Maternal mortality rates. In 2005 rates were 400 deaths for every 100,000 live births; rates were 450 in developing countries and 900 in sub-Saharan Africa.

▸ Decreasing HIV/AIDS prevalence in sub-Saharan Africa. Rates dropped from 6% of the population in 2000 to 5% in 2007.

▸ Differences in life expectancy in Europe. In northern, southern, and western Europe, the life expectancy at birth was 78.6 for both sexes in 2005, an increase since 1950 of 15 years in southern Europe, 11 years in western Europe, and 9 years in northern Europe. In Eastern Europe, the life expectancy advanced less than 4 years over the same period, from 64.2 years in 1950 to 67.8 years in 2005.

Obese patients with osteoarthritis experience greater gains in physical function 7 years after undergoing total knee arthroplasty than do obese controls who did not have the surgery, according to an English study.

Based on the results of this study of 688 patients, there is no justification to withhold knee replacements from obese patients on the grounds that obesity is a risk factor for osteoarthritis, the investigators wrote (Ann. Rheum. Dis. 2008 July 24 [doi:10.1136/ard.2008.093229

In a subgroup of 108 obese patients (body mass index greater than or equal to 30 kg/m

“Our results build on those of earlier investigations in indicating that improvements in physical function following [TKA] for osteoarthritis are sustained,” wrote Janet Cushnaghan of the University of Southampton, England, and her associates. “These benefits extend to [obese patients] and, provided appropriate selection criteria are applied with regard to fitness for surgery, there seems no justification for withholding TKA from patients who are obese.”

The researchers studied patients and controls aged 45 and older who had taken part in an earlier case-control study of knee osteoarthritis. That study compared patients placed on a waiting list for TKA between 1995 and 1997 with controls in the community. Functional status and BMI were measured as part of data collection.

During 2001-2004, the authors wrote to the original study group with a questionnaire about their surgery and included the functional status sections of the SF-36 form. A total of 325 patients and 363 controls were included in this analysis.

Overall, at a mean follow-up of 7 years, median physical function scores in patients who underwent TKA improved from 20 to 26; scores in controls fell from 89 to 75.

Mental health scores on the SF-36 form improved equally in both groups. Vitality scores declined in both groups, but the decline was greater in patients than in controls (a loss of 10 points compared with a loss of 5 points).

Of 82 patients older than age 75 at baseline, the median physical function score stayed steady at 17 points; scores declined from 83 to 43 points in 87 controls in that age group.

The researchers said their findings might have been biased by migration, although subjects were as likely to have moved, demonstrating greater function, as to have entered nursing care, demonstrating poorer function.

They also noted that might have been undetected in the controls at baseline, which would have biased their findings in favor of the intervention group.

They noted, however, that the long follow-up and size of the study suggest that their findings are valid.

Obese patients with osteoarthritis experience greater gains in physical function 7 years after undergoing total knee arthroplasty than do obese controls who did not have the surgery, according to an English study.

Based on the results of this study of 688 patients, there is no justification to withhold knee replacements from obese patients on the grounds that obesity is a risk factor for osteoarthritis, the investigators wrote (Ann. Rheum. Dis. 2008 July 24 [doi:10.1136/ard.2008.093229

In a subgroup of 108 obese patients (body mass index greater than or equal to 30 kg/m

“Our results build on those of earlier investigations in indicating that improvements in physical function following [TKA] for osteoarthritis are sustained,” wrote Janet Cushnaghan of the University of Southampton, England, and her associates. “These benefits extend to [obese patients] and, provided appropriate selection criteria are applied with regard to fitness for surgery, there seems no justification for withholding TKA from patients who are obese.”

The researchers studied patients and controls aged 45 and older who had taken part in an earlier case-control study of knee osteoarthritis. That study compared patients placed on a waiting list for TKA between 1995 and 1997 with controls in the community. Functional status and BMI were measured as part of data collection.

During 2001-2004, the authors wrote to the original study group with a questionnaire about their surgery and included the functional status sections of the SF-36 form. A total of 325 patients and 363 controls were included in this analysis.

Overall, at a mean follow-up of 7 years, median physical function scores in patients who underwent TKA improved from 20 to 26; scores in controls fell from 89 to 75.

Mental health scores on the SF-36 form improved equally in both groups. Vitality scores declined in both groups, but the decline was greater in patients than in controls (a loss of 10 points compared with a loss of 5 points).

Of 82 patients older than age 75 at baseline, the median physical function score stayed steady at 17 points; scores declined from 83 to 43 points in 87 controls in that age group.

The researchers said their findings might have been biased by migration, although subjects were as likely to have moved, demonstrating greater function, as to have entered nursing care, demonstrating poorer function.

They also noted that might have been undetected in the controls at baseline, which would have biased their findings in favor of the intervention group.

They noted, however, that the long follow-up and size of the study suggest that their findings are valid.

Obese patients with osteoarthritis experience greater gains in physical function 7 years after undergoing total knee arthroplasty than do obese controls who did not have the surgery, according to an English study.

Based on the results of this study of 688 patients, there is no justification to withhold knee replacements from obese patients on the grounds that obesity is a risk factor for osteoarthritis, the investigators wrote (Ann. Rheum. Dis. 2008 July 24 [doi:10.1136/ard.2008.093229

In a subgroup of 108 obese patients (body mass index greater than or equal to 30 kg/m

“Our results build on those of earlier investigations in indicating that improvements in physical function following [TKA] for osteoarthritis are sustained,” wrote Janet Cushnaghan of the University of Southampton, England, and her associates. “These benefits extend to [obese patients] and, provided appropriate selection criteria are applied with regard to fitness for surgery, there seems no justification for withholding TKA from patients who are obese.”

The researchers studied patients and controls aged 45 and older who had taken part in an earlier case-control study of knee osteoarthritis. That study compared patients placed on a waiting list for TKA between 1995 and 1997 with controls in the community. Functional status and BMI were measured as part of data collection.

During 2001-2004, the authors wrote to the original study group with a questionnaire about their surgery and included the functional status sections of the SF-36 form. A total of 325 patients and 363 controls were included in this analysis.

Overall, at a mean follow-up of 7 years, median physical function scores in patients who underwent TKA improved from 20 to 26; scores in controls fell from 89 to 75.

Mental health scores on the SF-36 form improved equally in both groups. Vitality scores declined in both groups, but the decline was greater in patients than in controls (a loss of 10 points compared with a loss of 5 points).

Of 82 patients older than age 75 at baseline, the median physical function score stayed steady at 17 points; scores declined from 83 to 43 points in 87 controls in that age group.

The researchers said their findings might have been biased by migration, although subjects were as likely to have moved, demonstrating greater function, as to have entered nursing care, demonstrating poorer function.

They also noted that might have been undetected in the controls at baseline, which would have biased their findings in favor of the intervention group.

They noted, however, that the long follow-up and size of the study suggest that their findings are valid.

Custom-made foot orthotics can reduce foot pain caused by rheumatoid arthritis, pes cavus, and hallus vagus, according to a Cochrane Collaboration meta-analysis.

The authors stressed, however, that there are very few high-quality studies evaluating the use of orthotics to treat such conditions, weakening the clinical relevance of their conclusions.

The researchers evaluated a total of 11 randomized controlled trials and controlled clinical trials, which together had 1,332 subjects. The strongest evidence supporting the use of customized orthotics was in the treatment of painful pes cavus (high arch). They also found evidence supporting orthotic use to treat foot pain associated with juvenile idiopathic arthritis, rheumatoid arthritis, plantar fasciitis, and hallux valgus.

“Custom foot orthoses can be an effective treatment for a variety of conditions, but there are still many causes of foot pain for which the benefit of this treatment is unclear,” Fiona Hawke, the lead researcher, who works at the Central Coast campus of the University of Newcastle (Australia), said in a written statement. “There is also a lack of data on the long-term effects of treating with orthoses.”

PIPainful pes cavus. The researchers found a single study that showed custom orthotics were superior to sham orthotics at 3 months in treating 154 patients with this disorder. Those wearing custom orthoses showed a statistically significant weighted mean difference of 10.9 points on the pain domain of the foot health status questionnaire and 11 points in the function domain (Cochrane Database Syst. Rev. 2008 July 15 [Epub doi: 10.1002/14651858.CD006801.pub2

PIJuvenile idiopathic arthritis. A single study of 33 children showed that custom foot orthotics were linked to significant improvements at 3 months in pain, function, and disability, compared with a standardized intervention (supportive shoes). Weighted mean improvements of 19.2 on the pain scale of the foot function index, 19.4 on the index's activity limitation scale, and 18.6 on the disability scale were reported.

PIRheumatoid arthritis. A single study with 101 subjects found foot orthotics were more effective than no intervention in reducing rear foot pain after 30 months.

PIPlantar fasciitis. A study of 92 subjects assessed at 3 and 12 months demonstrated a statistically significant improvement in foot-pain related function for those who used custom orthotics to treat plantar fasciitis, compared with those using sham orthoses. Treated subjects reported a weighted mean improvement of 10.4 at both time points on the foot health status questionnaire. The investigators did not measure a statistically significant improvement over standard interventions, however, and found that customized orthotics were less effective than stretching and mobilization over 2 weeks.

PIPainful bunions with hallux valgus. Foot orthotics were shown to be more effective than no intervention over 6 months in a study of 138 participants, with a weighted mean improvement of 9 on the 100-mm visual analog scale. However, that study did not find a statistically significant improvement over 12 months.

Researchers found data supporting the benefit of custom foot orthotics for some. Vivian E. Lee/Elsevier Global Medical News

Custom-made foot orthotics can reduce foot pain caused by rheumatoid arthritis, pes cavus, and hallus vagus, according to a Cochrane Collaboration meta-analysis.

The authors stressed, however, that there are very few high-quality studies evaluating the use of orthotics to treat such conditions, weakening the clinical relevance of their conclusions.

The researchers evaluated a total of 11 randomized controlled trials and controlled clinical trials, which together had 1,332 subjects. The strongest evidence supporting the use of customized orthotics was in the treatment of painful pes cavus (high arch). They also found evidence supporting orthotic use to treat foot pain associated with juvenile idiopathic arthritis, rheumatoid arthritis, plantar fasciitis, and hallux valgus.

“Custom foot orthoses can be an effective treatment for a variety of conditions, but there are still many causes of foot pain for which the benefit of this treatment is unclear,” Fiona Hawke, the lead researcher, who works at the Central Coast campus of the University of Newcastle (Australia), said in a written statement. “There is also a lack of data on the long-term effects of treating with orthoses.”

PIPainful pes cavus. The researchers found a single study that showed custom orthotics were superior to sham orthotics at 3 months in treating 154 patients with this disorder. Those wearing custom orthoses showed a statistically significant weighted mean difference of 10.9 points on the pain domain of the foot health status questionnaire and 11 points in the function domain (Cochrane Database Syst. Rev. 2008 July 15 [Epub doi: 10.1002/14651858.CD006801.pub2

PIJuvenile idiopathic arthritis. A single study of 33 children showed that custom foot orthotics were linked to significant improvements at 3 months in pain, function, and disability, compared with a standardized intervention (supportive shoes). Weighted mean improvements of 19.2 on the pain scale of the foot function index, 19.4 on the index's activity limitation scale, and 18.6 on the disability scale were reported.

PIRheumatoid arthritis. A single study with 101 subjects found foot orthotics were more effective than no intervention in reducing rear foot pain after 30 months.

PIPlantar fasciitis. A study of 92 subjects assessed at 3 and 12 months demonstrated a statistically significant improvement in foot-pain related function for those who used custom orthotics to treat plantar fasciitis, compared with those using sham orthoses. Treated subjects reported a weighted mean improvement of 10.4 at both time points on the foot health status questionnaire. The investigators did not measure a statistically significant improvement over standard interventions, however, and found that customized orthotics were less effective than stretching and mobilization over 2 weeks.

PIPainful bunions with hallux valgus. Foot orthotics were shown to be more effective than no intervention over 6 months in a study of 138 participants, with a weighted mean improvement of 9 on the 100-mm visual analog scale. However, that study did not find a statistically significant improvement over 12 months.

Researchers found data supporting the benefit of custom foot orthotics for some. Vivian E. Lee/Elsevier Global Medical News

Custom-made foot orthotics can reduce foot pain caused by rheumatoid arthritis, pes cavus, and hallus vagus, according to a Cochrane Collaboration meta-analysis.

The authors stressed, however, that there are very few high-quality studies evaluating the use of orthotics to treat such conditions, weakening the clinical relevance of their conclusions.

The researchers evaluated a total of 11 randomized controlled trials and controlled clinical trials, which together had 1,332 subjects. The strongest evidence supporting the use of customized orthotics was in the treatment of painful pes cavus (high arch). They also found evidence supporting orthotic use to treat foot pain associated with juvenile idiopathic arthritis, rheumatoid arthritis, plantar fasciitis, and hallux valgus.

“Custom foot orthoses can be an effective treatment for a variety of conditions, but there are still many causes of foot pain for which the benefit of this treatment is unclear,” Fiona Hawke, the lead researcher, who works at the Central Coast campus of the University of Newcastle (Australia), said in a written statement. “There is also a lack of data on the long-term effects of treating with orthoses.”

PIPainful pes cavus. The researchers found a single study that showed custom orthotics were superior to sham orthotics at 3 months in treating 154 patients with this disorder. Those wearing custom orthoses showed a statistically significant weighted mean difference of 10.9 points on the pain domain of the foot health status questionnaire and 11 points in the function domain (Cochrane Database Syst. Rev. 2008 July 15 [Epub doi: 10.1002/14651858.CD006801.pub2

PIJuvenile idiopathic arthritis. A single study of 33 children showed that custom foot orthotics were linked to significant improvements at 3 months in pain, function, and disability, compared with a standardized intervention (supportive shoes). Weighted mean improvements of 19.2 on the pain scale of the foot function index, 19.4 on the index's activity limitation scale, and 18.6 on the disability scale were reported.

PIRheumatoid arthritis. A single study with 101 subjects found foot orthotics were more effective than no intervention in reducing rear foot pain after 30 months.

PIPlantar fasciitis. A study of 92 subjects assessed at 3 and 12 months demonstrated a statistically significant improvement in foot-pain related function for those who used custom orthotics to treat plantar fasciitis, compared with those using sham orthoses. Treated subjects reported a weighted mean improvement of 10.4 at both time points on the foot health status questionnaire. The investigators did not measure a statistically significant improvement over standard interventions, however, and found that customized orthotics were less effective than stretching and mobilization over 2 weeks.

PIPainful bunions with hallux valgus. Foot orthotics were shown to be more effective than no intervention over 6 months in a study of 138 participants, with a weighted mean improvement of 9 on the 100-mm visual analog scale. However, that study did not find a statistically significant improvement over 12 months.

Researchers found data supporting the benefit of custom foot orthotics for some. Vivian E. Lee/Elsevier Global Medical News

Custom-made foot orthotics can reduce foot pain caused by rheumatoid arthritis, pes cavus, and hallus vagus, according to a Cochrane Collaboration meta-analysis.

The authors stressed, however, that there are very few high-quality studies evaluating the use of orthotics to treat such conditions, weakening the clinical relevance of their conclusions.

The researchers evaluated a total of 11 randomized controlled trials and controlled clinical trials, which together had 1,332 subjects. The strongest evidence supporting the use of customized orthotics was in the treatment of painful pes cavus (high arch).

They also found evidence supporting orthotic use to treat foot pain associated with juvenile idiopathic arthritis, rheumatoid arthritis, plantar fasciitis, and hallux valgus.

“Custom foot orthoses can be an effective treatment for a variety of conditions, but there are still many causes of foot pain for which the benefit of this treatment is unclear,” Fiona Hawke, the lead researcher, who works at the Central Coast campus of the University of Newcastle (Australia), said in a written statement.

“There is also a lack of data on the long-term effects of treating with orthoses.”

▸ Painful pes cavus. The researchers found a single study that showed custom orthotics were superior to sham orthotics at 3 months in treating 154 patients with this disorder.

Those wearing custom orthoses showed a statistically significant weighted mean difference of 10.9 points on the pain domain of the foot health status questionnaire and 11 points in the function domain (Cochrane Database Syst. Rev. 2008 July 15 [Epub doi: 10.1002/14651858.CD006801.pub2

▸ Juvenile idiopathic arthritis. A single study of 33 children showed that custom foot orthotics were linked to significant improvements at 3 months in pain, function, and disability, compared with a standardized intervention (supportive shoes).

Weighted mean improvements of 19.2 on the pain scale of the foot function index, 19.4 on the index's activity limitation scale, and 18.6 on the disability scale were reported.

▸ Rheumatoid arthritis. A single study with 101 subjects found foot orthotics were more effective than no intervention in reducing rear foot pain after 30 months.

▸ Plantar fasciitis. A study of 92 subjects assessed at 3 and 12 months demonstrated a statistically significant improvement in foot pain-related function for those who used custom orthotics to treat plantar fasciitis, compared with those using sham orthoses.

Treated subjects reported a weighted mean improvement of 10.4 at both time points on the foot health status questionnaire.

The investigators did not measure a statistically significant improvement over standard interventions, however, and found that customized orthotics were less effective than stretching and mobilization over 2 weeks.

▸ Painful bunions with hallux valgus. Foot orthotics were shown to be more effective than no intervention over 6 months in a study of 138 subjects, with a weighted mean improvement of 9 on the 100-mm visual analog scale.

That study did not find a statistically significant improvement over 12 months, however.

Researchers found data supporting the benefit of custom foot orthotics for some. Vivian E. Lee/Elsevier Global Medical News

Custom-made foot orthotics can reduce foot pain caused by rheumatoid arthritis, pes cavus, and hallus vagus, according to a Cochrane Collaboration meta-analysis.

The authors stressed, however, that there are very few high-quality studies evaluating the use of orthotics to treat such conditions, weakening the clinical relevance of their conclusions.

The researchers evaluated a total of 11 randomized controlled trials and controlled clinical trials, which together had 1,332 subjects. The strongest evidence supporting the use of customized orthotics was in the treatment of painful pes cavus (high arch).

They also found evidence supporting orthotic use to treat foot pain associated with juvenile idiopathic arthritis, rheumatoid arthritis, plantar fasciitis, and hallux valgus.

“Custom foot orthoses can be an effective treatment for a variety of conditions, but there are still many causes of foot pain for which the benefit of this treatment is unclear,” Fiona Hawke, the lead researcher, who works at the Central Coast campus of the University of Newcastle (Australia), said in a written statement.

“There is also a lack of data on the long-term effects of treating with orthoses.”

▸ Painful pes cavus. The researchers found a single study that showed custom orthotics were superior to sham orthotics at 3 months in treating 154 patients with this disorder.

Those wearing custom orthoses showed a statistically significant weighted mean difference of 10.9 points on the pain domain of the foot health status questionnaire and 11 points in the function domain (Cochrane Database Syst. Rev. 2008 July 15 [Epub doi: 10.1002/14651858.CD006801.pub2

▸ Juvenile idiopathic arthritis. A single study of 33 children showed that custom foot orthotics were linked to significant improvements at 3 months in pain, function, and disability, compared with a standardized intervention (supportive shoes).

Weighted mean improvements of 19.2 on the pain scale of the foot function index, 19.4 on the index's activity limitation scale, and 18.6 on the disability scale were reported.

▸ Rheumatoid arthritis. A single study with 101 subjects found foot orthotics were more effective than no intervention in reducing rear foot pain after 30 months.

▸ Plantar fasciitis. A study of 92 subjects assessed at 3 and 12 months demonstrated a statistically significant improvement in foot pain-related function for those who used custom orthotics to treat plantar fasciitis, compared with those using sham orthoses.

Treated subjects reported a weighted mean improvement of 10.4 at both time points on the foot health status questionnaire.

The investigators did not measure a statistically significant improvement over standard interventions, however, and found that customized orthotics were less effective than stretching and mobilization over 2 weeks.

▸ Painful bunions with hallux valgus. Foot orthotics were shown to be more effective than no intervention over 6 months in a study of 138 subjects, with a weighted mean improvement of 9 on the 100-mm visual analog scale.

That study did not find a statistically significant improvement over 12 months, however.

Researchers found data supporting the benefit of custom foot orthotics for some. Vivian E. Lee/Elsevier Global Medical News

Custom-made foot orthotics can reduce foot pain caused by rheumatoid arthritis, pes cavus, and hallus vagus, according to a Cochrane Collaboration meta-analysis.

The authors stressed, however, that there are very few high-quality studies evaluating the use of orthotics to treat such conditions, weakening the clinical relevance of their conclusions.

The researchers evaluated a total of 11 randomized controlled trials and controlled clinical trials, which together had 1,332 subjects. The strongest evidence supporting the use of customized orthotics was in the treatment of painful pes cavus (high arch).

They also found evidence supporting orthotic use to treat foot pain associated with juvenile idiopathic arthritis, rheumatoid arthritis, plantar fasciitis, and hallux valgus.

“Custom foot orthoses can be an effective treatment for a variety of conditions, but there are still many causes of foot pain for which the benefit of this treatment is unclear,” Fiona Hawke, the lead researcher, who works at the Central Coast campus of the University of Newcastle (Australia), said in a written statement.

“There is also a lack of data on the long-term effects of treating with orthoses.”

▸ Painful pes cavus. The researchers found a single study that showed custom orthotics were superior to sham orthotics at 3 months in treating 154 patients with this disorder.

Those wearing custom orthoses showed a statistically significant weighted mean difference of 10.9 points on the pain domain of the foot health status questionnaire and 11 points in the function domain (Cochrane Database Syst. Rev. 2008 July 15 [Epub doi: 10.1002/14651858.CD006801.pub2

▸ Juvenile idiopathic arthritis. A single study of 33 children showed that custom foot orthotics were linked to significant improvements at 3 months in pain, function, and disability, compared with a standardized intervention (supportive shoes).

Weighted mean improvements of 19.2 on the pain scale of the foot function index, 19.4 on the index's activity limitation scale, and 18.6 on the disability scale were reported.

▸ Rheumatoid arthritis. A single study with 101 subjects found foot orthotics were more effective than no intervention in reducing rear foot pain after 30 months.

▸ Plantar fasciitis. A study of 92 subjects assessed at 3 and 12 months demonstrated a statistically significant improvement in foot pain-related function for those who used custom orthotics to treat plantar fasciitis, compared with those using sham orthoses.

Treated subjects reported a weighted mean improvement of 10.4 at both time points on the foot health status questionnaire.

The investigators did not measure a statistically significant improvement over standard interventions, however, and found that customized orthotics were less effective than stretching and mobilization over 2 weeks.

▸ Painful bunions with hallux valgus. Foot orthotics were shown to be more effective than no intervention over 6 months in a study of 138 subjects, with a weighted mean improvement of 9 on the 100-mm visual analog scale.

That study did not find a statistically significant improvement over 12 months, however.

Researchers found data supporting the benefit of custom foot orthotics for some. Vivian E. Lee/Elsevier Global Medical News