Low Correlation between Gait and Quality of Life in Advanced Knee Osteoarthritis.

Advanced knee osteoarthritis patients' gait usually undergoes alterations leading to decreased mobility and lower functional performance, which can result in a worsening of their quality of life (QoL). While several authors have reported a moderate correlation between gait parameters and QoL assessed by generic questionnaires, the literature is scarce. This study aimed to explore the relationship between gait and QoL parameters assessed by a generic and a disease-specific questionnaire in patients with advanced knee osteoarthritis. In this single-centre, prospective, observational study, 129 patients with advanced knee osteoarthritis scheduled for elective total knee replacement were selected. The patients' gait was evaluated by means of a validated wireless device while they walked 30 m at a comfortable speed. Patient function was also analysed using the Knee Society Score (KSS). QoL was measured with the EQ-5D and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaires. Patients showed a mean walking speed of 0.95 ± 0.19 m/s, a mean cadence of 105.6 ± 9.9 steps/min, and a mean stride length of 1.25 ± 0.17 m on both legs. They presented poor knee status (KSS < 60) and poor QoL, with an EQ-5D of 0.44 ± 0.24 and a total KOOS of 29.77 ± 13.99. Positive low correlations (r <0.5, p <0.5) were found only between the speed, propulsion and stride length of both legs, and the overall and ADLs subscale scores of the total KOOS questionnaire. In conclusion, several gait parameters have a significant low correlation with the QoL of patients with advanced knee osteoarthritis, as assessed by an osteoarthritis-specific questionnaire.

Prevalence of Malnutrition and Nutritional Characteristics of Patients With Inflammatory Bowel Disease.

BACKGROUND AND AIMS: This study sought to determine the prevalence of malnutrition in patients with inflammatory bowel disease, to analyse the dietary beliefs and behaviours of these patients, to study their body composition, to evaluate their muscular strength and to identify the factors associated with malnutrition in these patients. METHODS: This was a prospective, multicentre study. Crohn's disease and ulcerative colitis patients from 30 Spanish centres, from the outpatient clinics, were included. A questionnaire of 11 items was applied to obtain data from patients' dietary behaviour and beliefs. Patients who accepted were evaluated to assess their nutritional status using Subjective Global Assessment and body mass index. Body composition was evaluated through bioelectrical impedance. RESULTS: A total of 1271 patients were included [51% women, median age 45 years, 60% Crohn's disease]. Of these, 333 patients underwent the nutritional evaluation. A total of 77% of patients declared that they avoided some foods to prevent disease relapse. Eighty-six per cent of patients avoided some foods when they had disease activity because of fear of worsening the flare. Sixty-seven per cent of patients modified their dietary habits after disease diagnosis. The prevalence of malnutrition was 16% [95% confidence interval = 12-20%]. In the multivariate analysis, history of abdominal surgery, active disease and avoidance of some foods during flares were associated with higher risk of malnutrition. CONCLUSIONS: The prevalence of malnutrition in inflammatory bowel disease patients was high. We identified some predictive factors of malnutrition. Most of the patients had self-imposed food restrictions, based on their beliefs.

Usefulness of optical coherence tomography parameters of the optic disc and the retinal nerve fiber layer to differentiate glaucomatous, ocular hypertensive, and normal eyes.

PURPOSE: To assess Stratus optical coherence tomography (OCT) original parameters for identifying glaucomatous damage and to evaluate differences among glaucomatous, ocular hypertensive, and normal eyes. DESIGN: Cross-sectional prospective study. SUBJECTS AND METHODS: The study was conducted at 2 centers. The study population consisted of 55 normal individuals, 95 patients with ocular hypertension (OHT), and 79 patients with glaucoma. Retinal nerve fiber layer (RNFL) and optic nerve head OCT protocols were used to evaluate all study participants. Measurements taken were RNFL thickness, several ratios, RNFL asymmetry between both eyes, rim volume, rim width, disc area, cup area, rim area, cup/disc (C/D) area ratio, and horizontal and vertical C/D ratios. The main outcome measures were the differences in OCT parameters among groups and the areas under the receiver operating characteristic curves (AROC). RESULTS: Mean RNFL thickness around the disc, and superior and inferior RNFL thickness, were significantly thinner in glaucomatous eyes than in OHT or normal eyes (P<0.001). Rim parameters were significantly smaller in glaucomatous eyes than in normal (P<0.001) and OHT eyes (P=0.01). C/D ratios were significantly greater in glaucomatous eyes than in OHT (P<0.001) and normal (P<0.001) eyes. Significant differences were found between normal and OHT eyes in 7 disc parameters. No difference was found among groups in parameters describing RNFL asymmetry between both eyes. The AROC curves of the other RNFL and disk parameters ranged from 0.741 to 0.85. CONCLUSIONS: Almost all RNFL and disc parameters showed significant differences and discriminated between glaucomatous and normal eyes. There were significant differences in some optic nerve parameters, but no RNFL parameters, between normal and OHT eyes.

Direct health care costs of diabetic patients in Spain.

OBJECTIVE: The goal of this study was to estimate the health care resources spent by type 1 and type 2 diabetic patients in Spain during the year 2002. RESEARCH DESIGN AND METHODS: This is a cost-of-illness study focusing on direct health care costs estimated from primary and secondary sources of information. A prevalence of diabetes ranging from 5 to 6% of the adult population was determined. Total cost is composed of six items: insulin and oral hypoglycemic agents, other drugs, disposable and consumable goods (glucose test strips, needles, and syringes), hospitalization, primary care visits, and visits to endocrinologists and dialysis. RESULTS: The estimated direct cost of diabetes in 2002 ranges from 2.4 to 2.67 billion euro. Hospital costs were the most (933 million euro), followed by noninsulin, nonhypoglycemic agent drugs (777-932 million euro). Much lower are the costs of insulin and oral hypoglycemic agents (311 million euro), primary care visits (181-272 million euro), specialized visits (127-145 million euro), and disposable elements (70-81 million euro). Expenditures for all drugs and consumable goods ranged between 1.16 and 1.3 billion euro, representing 48-49% of total cost, which is 15% higher than hospital costs. CONCLUSIONS: The direct health care costs of diabetic patients are high (6.3-7.4% of total National Health System expenditure). Their average annual cost is 1,290-1,476 euro. For individuals without diabetes, the average annual cost is 865 euro.