المؤلفون: Lowenstein, Natalie A., Chang, Yuchiao, Mass, Hanna, Mercurio, Angela M., Ukogu, Chierika, Katz, Jeffrey N., Matzkin, Elizabeth G.

المصدر: American Journal of Sports Medicine; Jan2024, Vol. 52 Issue 1, p116-123, 8p

مصطلحات موضوعية: PREOPERATIVE care, STATISTICS, CONFIDENCE intervals, ARTHROSCOPY, MULTIPLE regression analysis, AGE distribution, MENISCECTOMY, HEALTH outcome assessment, CASE-control method, VISUAL analog scale, ACTIVITIES of daily living, PRE-tests & post-tests, DECISION making, DESCRIPTIVE statistics, QUALITY assurance, ODDS ratio, BODY mass index, MENISCUS injuries, PAIN management

مستخلص: Background: Preoperative risk factors contributing to poor outcomes after arthroscopic partial meniscectomy (APM) have not yet been consolidated and codified into an index scoring system used to predict APM success. Purpose: To create an index score using available preoperative factors to predict the likelihood of favorable postoperative outcomes after APM. Study Design: Case-control study; Level of evidence, 3. Methods: A consecutive cohort of patients undergoing primary APM were enrolled in this study. Patients completed pre- and postoperative patient-reported outcome measure (PROM) questionnaires that included the Knee injury and Osteoarthritis Outcome Score (KOOS), visual analog scale (VAS) for pain, Veterans RAND 12-Item Health Survey (VR-12 Physical and Mental), and Marx Activity Rating Scale (MARS). Multivariable logistic regression models were performed to evaluate independent predictors of KOOS Pain, Symptoms, and Activities of Daily Living scores and achievement of the minimal clinically important difference (MCID) and substantial clinical benefit (SCB). The authors assigned points to each variable proportional to its odds ratio, rounded to the nearest integer, to generate the index score. Results: In total, 468 patients (mean age, 49 years [SD, 10.4 years; range, 19-81 years]) were included in this study. In the univariate analysis, shorter symptom duration, lower Kellgren-Lawrence (KL) grade, lower preoperative KOOS Pain value, and lower VR-12 Physical score were associated with a higher likelihood of clinical improvement at 1 year. In the multivariable model for clinical improvement with MCID, symptom duration (<3 months: OR, 3.00 [95% CI, 1.45-6.19]; 3-6 months: OR, 2.03 [95% CI, 1.10-3.72], compared with >6 months), KL grade (grade 0: OR, 3.54 [95% CI, 1.66-7.54]; grade 1: OR, 3.04 [95% CI, 1.48-6.26]; grade 2: OR, 2.31 [95% CI, 1.02-5.27], compared with grade 3), and preoperative KOOS Pain value (score <45: OR, 3.00 [95% CI, 1.57-5.76]; score of 45-60: OR, 2.80 [95% CI, 1.47-5.35], compared with score >60) were independent significant predictors for clinical improvement. The scoring algorithm demonstrated that a higher total score predicted a higher likelihood of achieving the MCID: 0 = 40%, 1 = 68%, 2 = 80%, 3 = 89%, and 4 = 96%. Conclusion: Using this model, the authors developed an index score that, using preoperative factors, can help identify which patients will achieve clinical improvement after APM. Longer symptom duration and higher KL grade were associated with a decreased likelihood of clinical improvement as measured by KOOS Pain at 1 year postoperatively. [ABSTRACT FROM AUTHOR]

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المؤلفون: Williams, Emma E., Katz, Jeffrey N., Leifer, Valia P., Collins, Jamie E., Neogi, Tuhina, Suter, Lisa G., Levy, Bruce, Farid, Alexander, Safran‐Norton, Clare E., Paltiel, A. David, Losina, Elena

المصدر: ACR Open Rheumatology; Oct2022, Vol. 4 Issue 10, p853-862, 10p

مصطلحات موضوعية: KNEE osteoarthritis, DISEASE progression, PHYSICAL therapy, ARTHROSCOPY, MENISCECTOMY, MEDICAL care costs, RISK assessment, TREATMENT effectiveness, COST effectiveness, DESCRIPTIVE statistics, SENSITIVITY & specificity (Statistics), MENISCUS injuries, QUALITY-adjusted life years

مستخلص: Objective: We examined the cost‐effectiveness of treatment strategies for concomitant meniscal tear and knee osteoarthritis (OA) involving arthroscopic partial meniscectomy surgery and physical therapy (PT). Methods: We used the Osteoarthritis Policy Model, a validated Monte Carlo microsimulation, to compare three strategies, 1) PT‐only, 2) immediate surgery, and 3) PT + optional surgery, for participants whose pain persists following initial PT. We modeled a cohort with baseline meniscal tear, OA, and demographics from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial of arthroscopic partial meniscectomy versus PT. We estimated risks and costs of arthroscopic partial meniscectomy complications and accounted for heightened OA progression post surgery using published data. We estimated surgery use rates and treatment efficacies using MeTeOR data. We considered a 5‐year time horizon, discounted costs, and quality‐adjusted life‐years (QALYs) 3% per year and conducted sensitivity analyses. We report incremental cost‐effectiveness ratios. Results: Relative to PT‐only, PT + optional surgery added 0.0651 QALY and $2,010 over 5 years (incremental cost‐effectiveness ratio = $30,900 per QALY). Relative to PT + optional surgery, immediate surgery added 0.0065 QALY and $3080 (incremental cost‐effectiveness ratio = $473,800 per QALY). Incremental cost‐effectiveness ratios were sensitive to optional surgery efficacy in the PT + optional surgery strategy. In the probabilistic sensitivity analysis, PT + optional surgery was cost‐effective in 51% of simulations at willingness‐to‐pay thresholds of both $50,000 per QALY and $100,000 per QALY. Conclusion: First‐line arthroscopic partial meniscectomy has a prohibitively high incremental cost‐effectiveness ratio. Under base case assumptions, second‐line arthroscopic partial meniscectomy offered to participants with persistent pain following initial PT is cost‐effective at willingness‐to‐pay thresholds between $31,000 and $473,000 per QALY. Our analyses suggest that arthroscopic partial meniscectomy can be a high‐value treatment option for patients with meniscal tear and OA when performed following an initial PT course and should remain a covered treatment option. [ABSTRACT FROM AUTHOR]

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المؤلفون: Collins, Jamie E., Shrestha, Swastina, Losina, Elena, Marx, Robert G., Guermazi, Ali, Jarraya, Mohamed, Jones, Morgan H., Levy, Bruce A., Mandl, Lisa A., Williams, Emma E., Wright, Rick W., Spindler, Kurt P., Katz, Jeffrey N.

المصدر: Arthritis & Rheumatology; Aug2022, Vol. 74 Issue 8, p1333-1342, 10p

مصطلحات موضوعية: KNEE osteoarthritis, RELATIVE medical risk, CARTILAGE, CONFIDENCE intervals, SYNOVITIS, ARTHROSCOPY, PHYSICAL therapy, TIME, MENISCECTOMY, REGRESSION analysis, TREATMENT effectiveness, DESCRIPTIVE statistics, MENISCUS injuries, SECONDARY analysis, POISSON distribution, EVALUATION

مستخلص: Objective: To estimate the risk of magnetic resonance imaging (MRI)–based structural changes in knee osteoarthritis (OA) among individuals with meniscal tear and knee OA, using MRIs obtained at baseline and 18 and 60 months after randomization in a randomized controlled trial of arthroscopic partial meniscectomy (APM) versus physical therapy (PT). Methods: We used data from the Meniscal Tear in Osteoarthritis Research (METEOR) trial. MRIs were read using the MRI OA Knee Score (MOAKS). We used linear mixed‐effects models to examine the association between treatment group and continuous MOAKS summary scores, and Poisson regression to assess categorical changes in knee joint structure. Analyses assessed changes in OA between baseline and month 18 and between months 18 and 60. We performed both intention‐to‐treat and as‐treated analyses. Results: The analytic sample included 302 participants. For both treatment groups, more OA changes were seen during the early interval than during the later interval. ITT analysis revealed that, between baseline and month 18, APM was significantly associated with an increased risk of having a worsening cartilage surface area score, involving both any worsening across all knee joint subregions (risk ratio [RR] 1.35 [95% confidence interval (95% CI) 1.14, 1.61]) and the number of subregions damaged (RR 1.44 [95% CI 1.13, 1.85]) having a worsening effusion‐synovitis score (RR 2.62 [95% CI 1.32, 5.21]), and having ≥1 additional subregion with osteophytes (RR 1.24 [95% CI 1.02, 1.50]). Significant associations were detected between months 18 and 60 only for having any subregion with a worsening osteophyte score (RR 1.28 [95% CI 1.04, 1.58]). Conclusion: These findings suggest that the association between APM and MRI‐based structural changes in knee OA is most apparent during the initial 18 months after surgery. The reason for attenuation of this association over longer follow‐up merits further investigation. [ABSTRACT FROM AUTHOR]

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المؤلفون: Santana, Daniel C., Oak, Sameer R., Jin, Yuxuan, Rothy, Alex, Lee, Ling-Ling, Katz, Jeffrey N., Winalski, Carl S., Duryea, Jeff, Jones, Morgan H.

المصدر: American Journal of Sports Medicine; Jul2022, Vol. 50 Issue 8, p2075-2082, 8p

مصطلحات موضوعية: KNEE radiography, SURGICAL complication risk factors, KNEE osteoarthritis, ARTHROSCOPY, MENISCECTOMY, CASE-control method, MAGNETIC resonance imaging, RISK assessment, COMPARATIVE studies, DESCRIPTIVE statistics, ARTICULAR cartilage, DATA analysis software, MENISCUS injuries, DISEASE risk factors

مستخلص: Background: Arthroscopic partial meniscectomy (APM) is widely performed and remains an important therapeutic option for patients with a meniscal tear. However, it is debated whether or not APM accelerates the progression of osteoarthritis (OA) in the long term. Purpose/Hypothesis: The purpose was to compare the progression of OA measured by the change in tibiofemoral joint space width (JSW)—a quantitative measure of OA radiographic severity—across 3 groups with a midterm follow-up: (1) patients undergoing APM; (2) those with a meniscal tear treated nonoperatively; and (3) those without a tear. We hypothesized that the reduction in JSW would be greatest in patients undergoing APM and least in those patients without a tear. Study Design: Cohort study; Level of evidence, 3. Methods: Using the Osteoarthritis Initiative cohort, a total of 144 patients were identified that underwent APM with at least 12 months of follow up and without previous knee surgery. Those with a meniscal tear who did not have APM (n = 144) and those without a tear (n = 144) were matched to patients who had APM by sex, age, Kellgren-Lawrence (KL) grade, and follow up time. Participants underwent magnetic resonance imaging at baseline. Knee radiographs to assess JSW were collected annually or biannually. The change in minimum medial compartment JSW was calculated using a validated automated method. A piecewise linear mixed effects model was constructed to examine the relationship between JSW decline over time and treatment group—adjusting for age, body mass index, smoking status, KL grade, and baseline JSW. Results: All groups had comparable baseline JSW—ranging from 4.33 mm to 4.38 mm. The APM group had a rate of JSW decline of −0.083 mm/mo in the first 12 months and −0.014 mm/mo between 12 and 72 months. The rate of JSW decline in the APM group was approximately 27 times greater in the first 12 months than that in the nonsurgical group (−0.003 mm/mo) and 5 times greater than that in the no tear group (−0.015 mm/mo); however, there was no significant difference between groups for 12 to 72 months (nonsurgical group: −0.009 mm/mo; no tear group: −0.010 mm/mo). The adjusted JSW in the APM group was 4.38 mm at baseline and decreased to 2.57 mm at 72 months; the JSW in the nonsurgical group declined from 4.31 mm to 3.73 mm, and in the no tear group it declined from 4.33 mm to 3.54 mm. There was a statistically significant difference in JSW change between baseline and 72 months for the APM group compared with the other groups (P <.001), but not between the nonsurgical and no tear groups (P =.12). Conclusion: In the first postoperative year, APM results in a faster rate of joint space narrowing compared with knees undergoing nonsurgical management of meniscal tears. Thereafter, there are comparable rates of OA progression regardless of the chosen management. APM results in a persistent decrease in JSW over at least 72 months. An untreated meniscal tear does not contribute to radiographic progression—assessed by JSW—as compared with an intact meniscus. [ABSTRACT FROM AUTHOR]

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المؤلفون: Spindler, Kurt P., Imrey, Peter B., Yalcin, Sercan, Beck, Gerald J., Calbrese, Gary, Cox, Charles L., Fadale, Paul D., Farrow, Lutul, Fitch, Robert, Flanigan, David, Fleming, Braden C., Hulstyn, Michael J., Jones, Morgan H., Kaeding, Christopher, Katz, Jeffrey N., Kriz, Peter, Magnussen, Robert, McErlean, Ellen, Melgaard, Carrie, Owens, Brett D.

المصدر: Orthopaedic Journal of Sports Medicine; Jan2022, Vol. 10 Issue 1, p1-13, 13p

مصطلحات موضوعية: TRAUMA surgery, RESEARCH, CONFIDENCE intervals, MEDICAL cooperation, HEALTH outcome assessment, TREATMENT effectiveness, RANDOMIZED controlled trials, DESCRIPTIVE statistics, ANTERIOR cruciate ligament surgery, STATISTICAL sampling, EVALUATION

مستخلص: Background: BEAR (bridge-enhanced anterior cruciate ligament [ACL] restoration), a paradigm-shifting technology to heal midsubstance ACL tears, has been demonstrated to be effective in a single-center 2:1 randomized controlled trial (RCT) versus hamstring ACL reconstruction. Widespread dissemination of BEAR into clinical practice should also be informed by a multicenter RCT to demonstrate exportability and compare efficacy with bone--patellar tendon–bone (BPTB) ACL reconstruction, another clinically standard treatment. Purpose: To present the design and initial preparation of a multicenter RCT of BEAR versus BPTB ACL reconstruction (the BEAR: Multicenter Orthopaedic Outcomes Network [BEAR-MOON] trial). Design and analytic issues in planning the complex BEAR-MOON trial, involving the US National Institute of Arthritis and Musculoskeletal and Skin Diseases, the US Food and Drug Administration, the BEAR implant manufacturer, a data and safety monitoring board, and institutional review boards, can usefully inform both clinicians on the trial's strengths and limitations and future investigators on planning of complex orthopaedic studies. Study Design: Clinical trial. Methods: We describe the distinctive clinical, methodological, and operational challenges of comparing the innovative BEAR procedure with the well-established BPTB operation, and we outline the clinical motivation, experimental setting, study design, surgical challenges, rehabilitation, outcome measures, and planned analysis of the BEAR-MOON trial. Results: BEAR-MOON is a 6-center, 12-surgeon, 200-patient randomized, partially blinded, noninferiority RCT comparing BEAR with BPTB ACL reconstruction for treating first-time midsubstance ACL tears. Noninferiority of BEAR relative to BPTB will be claimed if the total score on the International Knee Documentation Committee (IKDC) subjective knee evaluation form and the knee arthrometer 30-lb (13.61-kg) side-to-side laxity difference are both within respective margins of 16 points for the IKDC and 2.5 mm for knee laxity. Conclusion: Major issues include patient selection, need for intraoperative randomization and treatment-specific postoperative physical therapy regimens (because of fundamental differences in surgical technique, initial stability construct, and healing), and choice of noninferiority margins for short-term efficacy outcomes of a novel intervention with evident short-term advantages and theoretical, but unverified, long-term benefits on other dimensions. [ABSTRACT FROM AUTHOR]

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المؤلفون: Malone, Nelson C., Williams, Mollie M., Smith Fawzi, Mary C., Bennet, Jennifer, Hill, Caterina, Katz, Jeffrey N., Oriol, Nancy E.

المصدر: International Journal for Equity in Health; 3/20/2020, Vol. 19 Issue 1, p1-9, 9p, 1 Color Photograph, 2 Charts, 4 Graphs, 1 Map

مصطلحات موضوعية: ENDOWMENTS, HEALTH services accessibility, HEALTH insurance, MEDICAL care, MEDICAL referrals, TELEMEDICINE, GOVERNMENT aid, MOBILE hospitals, AT-risk people, DESCRIPTIVE statistics

مصطلحات جغرافية: UNITED States

مستخلص: Background: Mobile health clinics serve an important role in the health care system, providing care to some of the most vulnerable populations. Mobile Health Map is the only comprehensive database of mobile clinics in the United States. Members of this collaborative research network and learning community supply information about their location, services, target populations, and costs. They also have access to tools to measure, improve, and communicate their impact. Methods: We analyzed data from 811 clinics that participated in Mobile Health Map between 2007 and 2017 to describe the demographics of the clients these clinics serve, the services they provide, and mobile clinics' affiliated institutions and funding sources. Results: Mobile clinics provide a median number of 3491 visits annually. More than half of their clients are women (55%) and racial/ethnic minorities (59%). Of the 146 clinics that reported insurance data, 41% of clients were uninsured while 44% had some form of public insurance. The most common service models were primary care (41%) and prevention (47%). With regards to organizational affiliations, they vary from independent (33%) to university affiliated (24%), while some (29%) are part of a hospital or health care system. Most mobile clinics receive some financial support from philanthropy (52%), while slightly less than half (45%) receive federal funds. Conclusion: Mobile health care delivery is an innovative model of health services delivery that provides a wide variety of services to vulnerable populations. The clinics vary in service mix, patient demographics, and relationships with the fixed health system. Although access to care has increased in recent years through the Affordable Care Act, barriers continue to persist, particularly among populations living in resource-limited areas. Mobile clinics can improve access by serving as a vital link between the community and clinical facilities. Additional work is needed to advance availability of this important resource. [ABSTRACT FROM AUTHOR]

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المؤلفون: MacFarlane, Lindsey A., Yang, Heidi, Collins, Jamie E., Guermazi, Ali, Jones, Morgan H., Spindler, Kurt P., Winter, Amelia R., Losina, Elena, Katz, Jeffrey N., Brophy, Robert H., Cole, Brian J., Levy, Bruce A., Mandl, Lisa A., Martin, Scott, Marx, Robert G., Matava, Mathew, Safran-Norton, Clare, Stuart, Michael, Wright, Rick

المصدر: American Journal of Sports Medicine; Mar2019, Vol. 47 Issue 3, p612-619, 8p

مصطلحات موضوعية: OSTEOARTHRITIS treatment, MENISCUS injuries, KNEE diseases, ARTHROSCOPY, LONGITUDINAL method, MAGNETIC resonance imaging, MENISCECTOMY, PHYSICAL therapy, REGRESSION analysis, BODY mass index, KNEE pain, DESCRIPTIVE statistics, THERAPEUTICS

مستخلص: Background: Arthroscopic partial meniscectomy (APM) is used to treat meniscal tears, although its efficacy is controversial. Purpose: This study used magnetic resonance imaging (MRI) to determine characteristics that lead to greater benefit from APM and physical therapy (PT) than from PT alone among patients with meniscal tear and knee osteoarthritis. Study Design: Cohort study; Level of evidence, 2. Methods: Using data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial, the authors first assessed whether the effect of treatment on pain scores at 6 months differed according to baseline MRI features (bone marrow lesions, cartilage and meniscal damage). Second, the authors summed MRI features associated with differential pain relief between APM and PT to create a "damage score," which included bone marrow lesion number and cartilage damage size with possible values of 0 (least damage), 1 (moderate), and 2 (greatest). The authors used linear models to determine whether the association between damage score and pain relief at 6 months differed for APM versus PT. Results: The study included 220 participants: 13%, had the least damage; 52%, moderate; and 34%, greatest. Although treatment type did not significantly modify the association of damage score and change in pain (P interaction = .13), those with the least damage and moderate damage had greater improvement with APM than with PT in Knee injury and Osteoarthritis Outcome Score pain subscale—by 15 and 7 points, respectively. Those with the greatest damage had a similar improvement with APM and PT. Conclusion: Among patients with osteoarthritis and meniscal tear, those with less intra-articular damage on MRI may have greater improvement in pain with APM and PT than with PT alone. However, these results should be interpreted cautiously owing to the limited sample size. [ABSTRACT FROM AUTHOR]

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المؤلفون: Solomon, Daniel H., Losina, Elena, Lu, Bing, Zak, Agnes, Corrigan, Cassandra, Lee, Sara B., Agosti, Jenifer, Bitton, Asaf, Harrold, Leslie R., Pincus, Theodore, Radner, Helga, Yu, Zhi, Smolen, Josef S., Fraenkel, Liana, Katz, Jeffrey N.

المصدر: Arthritis & Rheumatology; Jul2017, Vol. 69 Issue 7, p1374-1380, 7p

مصطلحات موضوعية: CLINICAL trials, INTERPROFESSIONAL relations, LEARNING strategies, MEDICAL cooperation, PROBABILITY theory, PROFESSIONAL employee training, QUALITY assurance, REGRESSION analysis, RESEARCH, RHEUMATOID arthritis, STATISTICAL sampling, RANDOMIZED controlled trials, DESCRIPTIVE statistics

مصطلحات جغرافية: UNITED States

مستخلص: Objective Treat-to-target (TTT) is an accepted paradigm for the management of rheumatoid arthritis (RA), but some evidence suggests poor adherence. The purpose of this study was to test the effects of a group-based multisite improvement learning collaborative on adherence to TTT. Methods We conducted a cluster-randomized quality-improvement trial with waitlist control across 11 rheumatology sites in the US. The intervention entailed a 9-month group-based learning collaborative that incorporated rapid-cycle improvement methods. A composite TTT implementation score was calculated as the percentage of 4 required items documented in the visit notes for each patient at 2 time points, as evaluated by trained staff. The mean change in the implementation score for TTT across all patients for the intervention sites was compared with that for the control sites after accounting for intracluster correlation using linear mixed models. Results Five sites with a total of 23 participating rheumatology providers were randomized to intervention and 6 sites with 23 participating rheumatology providers were randomized to the waitlist control. The intervention included 320 patients, and the control included 321 patients. At baseline, the mean TTT implementation score was 11% in both arms; after the 9-month intervention, the mean TTT implementation score was 57% in the intervention group and 25% in the control group (change in score of 46% for intervention and 14% for control; P = 0.004). We did not observe excessive use of resources or excessive occurrence of adverse events in the intervention arm. Conclusion A learning collaborative resulted in substantial improvements in adherence to TTT for the management of RA. This study supports the use of an educational collaborative to improve quality. [ABSTRACT FROM AUTHOR]

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المؤلفون: Allen, Kelli D., Sanders, Linda L., Olsen, Maren K., Bowlby, Lynn, Katz, Jeffrey N., Mather, Richard C., Williams, John W.

المصدر: Musculoskeletal Care; Jun2016, Vol. 14 Issue 2, p87-97, 11p

مصطلحات موضوعية: HIP joint diseases, KNEE disease treatment, OSTEOARTHRITIS treatment, DECISION making, INTERNET, PATIENT education, PROBABILITY theory, STATISTICAL sampling, WHITE people, DVD-Video discs, DESCRIPTIVE statistics, MANN Whitney U Test, PATIENT decision making, THERAPEUTICS

مستخلص: Introduction Decision aids (DAs) can improve multiple decision-making outcomes, but it is not known whether different formats of delivery differ in their effectiveness or acceptability. The present study compared the effectiveness and acceptability of internet and DVD formats of DAs for osteoarthritis (OA). Methods Patients with hip or knee OA were randomized to view an internet or DVD format DA, which provided information on OA treatments. Measures were collected at baseline, immediately after viewing the DA and then 30 days later. Outcomes included: Hip/Knee OA Decision Quality Instrument - Knowledge Subscale (HK-DQI Knowledge), Decisional Conflict Scale (DCS), Preparation for Decision Making Scale (PDMS), Stage of Decision Making, and Acceptability of DAs. Generalized estimating equations (GEE) were used to examine changes in HK-DQI Knowledge and DCS scores over time, between decision aid groups and within the sample overall. Group differences in the PDMS scale (assessed once, immediately after DA viewing) were estimated using a Wilcoxon rank sums test. Results Among 155 participants in the study, the mean age was 61.8 years, 60.6% were women and 58.1% were Caucasian. HK-DQI Knowledge scores improved over time ( p < 0.001), although there was some attenuation by the 30-day follow-up; there was no difference between the two DA groups ( p = 0.448). DCS scores decreased markedly for both groups ( p < 0.001) and improvements were maintained by the 30-day follow-up (means: internet: baseline = 25.0, 30-day = 6.9; DVD: baseline = 25.0, 30-day = 6.2); there was no difference between the two DA groups ( p = 0.808). PDMS scores were higher for the DVD group than the internet group (85.2 versus 74.9, p = 0.005). Stage of Decision Making became more certain after viewing the DA for both groups, with even more certainty indicated at 30-day follow-up. Acceptability items indicated positive perceptions of both DAs. Discussion Internet and DVD DAs were associated with meaningful, comparable improvements in decision-making outcomes in patients with knee and hip OA. DAs are inexpensive to disseminate and could be valuable tools for enhancing care for OA. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

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المؤلفون: Drain, Paul K., Losina, Elena, Coleman, Sharon M., Bogart, Laura, Giddy, Janet, Ross, Douglas, Katz, Jeffrey N., Bassett, Ingrid V.

المصدر: AIDS Care; Oct2015, Vol. 27 Issue 10, p1231-1240, 10p, 3 Charts, 2 Graphs

مصطلحات موضوعية: DIAGNOSIS of HIV infections, CONFIDENCE intervals, COUNSELING, LONGITUDINAL method, MEDICAL screening, MENTAL health, MULTIVARIATE analysis, REGRESSION analysis, RESEARCH funding, SELF-perception, STATISTICS, SOCIAL support, RANDOMIZED controlled trials, CROSS-sectional method, DATA analysis software, DESCRIPTIVE statistics, ODDS ratio

مصطلحات جغرافية: SOUTH Africa

مستخلص: Poor social support and mental health may be important modifiable risk factors for HIV acquisition, but they have not been evaluated prior to HIV testing in South Africa. We sought to describe self-perceived mental health and social support and to characterize their independent correlates among adults who presented for voluntary HIV testing in Durban. We conducted a large cross-sectional study of adults (≥18 years of age) who presented for HIV counseling and testing between August 2010 and January 2013 in Durban, South Africa. We enrolled adults presenting for HIV testing and used the Medical Outcomes Study’s Social Support Scale (0 [poor] to 100 [excellent]) and the Mental Health Inventory (MHI-3) to assess social support and mental health. We conducted independent univariate and multivariable linear regression models to determine the correlates of lower self-reported Social Support Index and lower self-reported MCH scores. Among 4874 adults surveyed prior to HIV testing, 1887 (39%) tested HIV-positive. HIV-infected participants reported less social support (mean score 66 ± 22) and worse mental health (mean score 66 ± 16), compared to HIV-negative participants (74 ± 21; 70 ± 18;p< 0.0001). In a multivariable analysis, significant correlates of less social support included presenting for HIV testing at an urban hospital, not having been tested previously, not working outside the home, and being HIV-infected. In a separate multivariable analysis, significant correlates of poor mental health were similar, but also included HIV testing at an urban hospital and being in an intimate relationship less than six months. In this study, HIV-infected adults reported poorer social support and worse mental health than HIV-negative individuals. These findings suggest that interventions to improve poor social support and mental health should be focused on adults who do not work outside the home and those with no previous HIV testing. [ABSTRACT FROM AUTHOR]

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