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Summary: This study evaluated racial differences in bone size and volumetric density at the spine and hip in pre- and postmenopausal Chinese American and White women. Compared with White women, Chinese American women have greater cortical volumetric bone density (vBMD) at the hip, congruent with the results at the peripheral skeleton. Introduction: Chinese American women have lower rates of fracture than White women despite lower areal bone density. At the forearm and tibia, however, Chinese American women have higher cortical vBMD as well as greater trabecular and cortical thickness, but smaller bone area as measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) compared with White women. Since HR-pQCT data are obtained at peripheral sites, it is unclear whether these differences are relevant to the clinically important lumbar spine and hip. This study assesses racial differences in bone size and vBMD at the spine and hip in Chinese American and White women. Methods: QCT of the spine and hip was measured to assess racial differences in bone size, structure, and vBMD in pre- ( n = 83) and postmenopausal ( n = 50) Chinese American and White women. Data were adjusted for weight, height, physical activity, total calcium intake, parathyroid hormone, and 25-hydroxyvitamin D levels. Results: Among premenopausal women, lumbar spine trabecular vBMD was 5.8% greater in Chinese American versus White women ( p = 0.01). At the hip, cortical vBMD was 3% greater at the femoral neck ( p = 0.05) and 3.6% greater at the total hip ( p = 0.01) in premenopausal Chinese American compared with White women. Among postmenopausal women, there was no difference in lumbar spine trabecular vBMD. Cortical vBMD was 4% greater at the total hip ( p = 0.02) and tended to be greater at the femoral neck ( p = 0.058) in Chinese American versus White women. Conclusions: Consistent with earlier findings in the peripheral skeleton, cortical vBMD is greater at the hip in Chinese American versus White women. [ABSTRACT FROM AUTHOR]

Summary: We investigated 383 bone candidate genes for associations between single nucleotide polymorphisms and vertebral trabecular volumetric bone mineral density (vBMD) and cross-sectional area (CSA) in 2,018 Caucasian men aged ≥65 years. SNPs in TGFBR3, SOST, KL, CALCR, LEP, CSF1R, PTN, GNRH2, FGFR2, and MEPE were associated with vBMD and SNPs in CYP11B1, DVL2, DLX5, WNT4, and PAX7 were associated with CSA in independent study samples ( p < 0.005). Inroduction: Vertebral bone mineral density and cross-sectional area are important determinants of vertebral bone strength. Little is known about the specific genetic variants that influence these phenotypes in humans. Methods: We investigated the potential genetic variants associated with vertebral trabecular volumetric BMD and CSA measured by quantitative computed tomography. We initially tested for association between these phenotypes and 4608 tagging and potentially functional single nucleotide polymorphisms (SNPs) in 383 candidate genes in 862 community-dwelling Caucasian men aged ≥65 years in the Osteoporotic Fractures in Men Study. Results: SNP associations were then validated by genotyping an additional 1,156 randomly sampled men from the same cohort. We identified 11 SNPs in 10 genes ( TGFBR3, SOST, KL, CALCR, LEP, CSF1R, PTN, GNRH2, FGFR2, and MEPE) that were consistently associated with trabecular vBMD and five SNPs in five genes ( CYP11B1, DVL2, DLX5, WNT4, and PAX7) that were consistently associated with CSA in both samples ( p < 0.005). Conclusion: None of the SNPs associated with trabecular vBMD were associated with CSA. Our findings raise the possibility that at least some of the loci for vertebral trabecular BMD and bone size may be distinct. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether private practice interventional radiology (IR) groups self-report higher overall productivity given differing case mix and more diagnostic radiology interpretation., Materials and Methods: A 60-question survey was distributed to 3,159 self-identified US IR physicians via the Society of Interventional Radiologists member search engine, with 357 responses (11.3% response rate). Of these responses, there were 258 unique practices from 34 US states., Results: Out of 84 IR group responses, private practice IR (PPIR) physicians reported a minimal trend for higher annual work relative value units (wRVUs) per clinical full-time equivalent compared with academic IR physicians (8,000 versus 7,140, P = .202), but this did not reach statistical significance. PPIR groups reported fewer median weekly hours (50 versus 52), more frequent call (every 6 versus every 5 days), and significantly higher median tenured compensation ($573,000 versus $451,000, P = .000). Out of 179 responses, academic practices reported significantly higher case percentages of interventional oncology and complex hepatobiliary intervention (P <.001), and private practices reported significantly higher percentages of musculoskeletal intervention (P < .001) with a nonsignificant trend for stroke or neurologic intervention (P = .010). Private practices reported more wRVUs from the interpretation of diagnostic imaging, at 26% of total wRVU production compared with 7% of total wRVU production for academic practices (P < .001; n = 131)., Conclusions: Self-reported data from private and academic IR groups suggest minimally higher wRVUs per clinical full-time equivalent among PPIRs with lower weekly work hours, more frequent call, differing case mix, and significantly higher tenured compensation among PPIR groups., (Copyright © 2022 American College of Radiology. Published by Elsevier Inc. All rights reserved.)

Competing Interests: The authors declare no conflict of interest.

Objectives: To analyse the association between patients' socioeconomic position (SEP) and the use of emergency departments (EDs)., Methods: This population-based study included all visits to ED in 2012 by inhabitants of the French Midi-Pyrénées region, recorded by the Regional Emergency Departments Observatory. We compared ED visit rates and the proportion of non-severe visits according to the patients' SEP as assessed by the European Deprivation Index., Results: We analysed 496,388 visits. The annual ED visit rate increased with deprivation level: 165.9 [95% CI (164.8-166.9)] visits per 1000 inhabitants among the most advantaged group, compared to 321.9 [95% CI (320.3-323.5)] per 1000 among the most disadvantaged. However, the proportion of non-severe visits was about 14% of the visits, and this proportion did not differ according to SEP., Conclusions: Although the study shows a difference of ED visit rates, the probability of a visit being non-severe is not meaningfully different according to SEP. This supports the assumption that ED visit rate variations according to SEP are mainly explained by SEP-related differences in health states rather than SEP-related differences in health behaviours.

We found that HIV+/HCV+ women had 7-8% lower areal bone mineral density (aBMD) by dual-energy x-ray absorptiometry (DXA) at the spine, hip, and radius (p < 0.01) and 5-7% lower volumetric BMD (vBMD) by central quantitative computed tomography (cQCT) at the spine and hip (p < 0.05). These data suggest that true deficits in vBMD may contribute to bone fragility and excess fractures reported in HIV+/HCV+ women., Introduction: aBMD by DXA is lower in persons coinfected with HIV and HCV (HIV+/HCV+) than with HIV monoinfection (HIV+). However, weight is often also lower with HCV infection, and measurement of aBMD by DXA can be confounded by adiposity; we aimed to determine whether true vBMD is also lower in HIV+/HCV+ coinfection., Methods: We measured aBMD of the lumbar spine (LS), total hip (TH), femoral neck (FN), and ultradistal radius (UDR) by DXA and vBMD of the spine and hip by cQCT and of the distal radius and tibia by high-resolution peripheral QCT (HRpQCT) in 37 HIV+/HCV+ and 119 HIV+ postmenopausal women. Groups were compared using Student's t tests with covariate adjustment by multiple regression analysis., Results: HIV+/HCV+ and HIV+ women were of similar age and race/ethnicity. HIV+/HCV+ women had lower body mass index (BMI) and trunk fat and were more likely to smoke and less likely to have a history of AIDS. In HIV+/HCV+ women, aBMD by DXA was 7-8% lower at the LS, TH, and UDR (p < 0.01). Similarly, vBMD by cQCT was 5-7% lower at the LS and TH (p < 0.05). Between-group differences in LS aBMD and vBMD remained significant after adjustment for BMI, smoking, and AIDS history. Tibial total vBMD by HRpQCT was 10% lower in HIV+/HCV+ women., Conclusion: HIV+/HCV+ postmenopausal women had significantly lower spine aBMD and vBMD. These deficits in vBMD may contribute to bone fragility and excess fractures reported in HIV+/HCV+ women.

Background: Our objective was to analyse the influence of education on the link between functional limitation (FL) and self-rated health (SRH) in two countries, France and the USA., Methods: The data of the North American NHANES study (n = 9254) and the French National Health Survey (n = 25 559) were used. FL was measured by the ADL and IADL scales. We constructed a logistic regression model with SRH as the outcome and included variables for education, FL and the interaction between education and FL. All results were adjusted for age., Results: Poor SRH was more frequently reported in France than in the USA (24.1% vs. 18.4% for men, 29.0% vs. 19.7% for women). The most highly educated persons in the USA had similar FL (25.4% for men, 32.9% for women) to the least educated French persons (22.8% for men, 31.8% for women). In the USA, FL was associated more strongly with poor SRH in the most educated men than in the least educated. In France, the same interaction was observed although the link was weaker than in the USA. FL was more strongly associated with poor SRH in the most educated women than in the least educated in both countries., Conclusion: Functional limitation had a greater impact on the most highly educated persons in both France and the USA. Using SRH as a measure of health for evaluating social inequalities could lead to underestimation of the true magnitude of functional health inequalities existing within and between countries.

Background: Kaposi's sarcoma (KS) is the most common cancer diagnosed among people with HIV in the United States. Highly active antiretroviral therapy (HAART) is an essential treatment for KS, and recent reports document the emergence of racial disparities in KS incidence and HIV-related mortality in the post-HAART era (1996 to present). The aim of this study was to examine trends in KS survival by race from the beginning of the HIV epidemic through the introduction of HAART., Methods: Median cause-specific survival and adjusted hazard ratios for KS from 1980 to 2004 were calculated by race using Surveillance, Epidemiology, and End Results nine-area data., Results: Median survival among both black and white patients was relatively constant until 1995 (average median survival, 14 and 18 months, respectively). In 1996, white patients experienced an increase in median survival to 103 months. In subsequent years, the increase in median survival was so great that white patients did not reach 50% mortality (follow-up ending December 31, 2007). Survival among black patients increased gradually until its peak in 2001 when median survival had not been reached after 83 months of follow-up. However, subsequent relative decreases to 35 months occurred in 2002 and 2004., Conclusions: The current analysis provides evidence that there have been substantial increases in KS survival among white patients in the HAART era. Black patients have also experienced some improvements but to an attenuated extent., Impact: Careful attention should be paid to the continuing evolution of trends in KS survival and survival disparities., (©2010 AACR.)

Background: The use of self-rated health (SRH) for measuring health inequalities could present some limits. The impact of the same disease on SRH could be different according to health expectations people have which are associated with social characteristics. The aim of this study was to analyse the link between physical health status and SRH, according to level of education., Method: Data from the National Health and Nutrition Examination Survey for the years 2001-4 were used. Multivariate logistic regression analyses were performed for assessing the relation between health status and SRH according to educational level., Results: The sample consisted of 4661 men and 4593 women. Reporting functional limitation was associated more strongly with poor SRH in higher educated women than in lower educated women (OR, 8.73, 95% CI 5.87 to 12.98 vs OR, 3.97, 95% CI 2.93 to 5.38 respectively), as was reporting respiratory disease (OR, 5.17, 95% CI 3.67 to 7.30 vs OR, 2.60, 95% CI 1.72 to 3.95 respectively), cardiovascular disease (OR, 9.79, 95% CI 6.22 to 15.40 vs OR, 3.34, 95% CI 2.29 to 4.87 respectively) and dental problems (OR, 4.37, 95% CI 3.22 to 5.92 vs OR, 2.58, 95% CI 1.97 to 3.39 respectively). Reporting functional limitation was associated more strongly with poor SRH in higher educated men than in lower educated men (OR, 7.71, 95% CI 5.04 to 11.79 vs OR, 4.87, 95% CI 3.30 to 7.18 respectively), as reporting oral problems (OR, 2.62, 95% CI 1.84 to 3.74 vs OR, 3.63, 95% CI 2.81 to 4.68 respectively)., Conclusions: The impact of health problems on SRH is stronger among better educated individuals. This phenomenon could lead to an underestimate of the health inequalities across socioeconomic groups.

Fragility fractures at the trochanter (TR) and the femoral neck (FN) have distinct etiologies, but the underlying age-related structural changes at these proximal femoral sub-regions are poorly understood. 28 young (41+/-3 years) and 124 elderly (74+/-3 years) healthy Caucasian women underwent volumetric quantitative computed tomography at the hip. Integral (i), cortical (c) and trabecular (t) bone mineral density and content (BMD, BMC) were measured. Geometric parameters included cross sectional area (CSA), and volumes of the integral, cortical and trabecular regions (VOL). Structural measures included indices of compressive (Compstr) and bending (BSI) strength. After adjusting for height and weight, an F-test was used to compare the TR and the FN mean values between young and elderly and to test for interaction to compare logarithmic difference of young and elderly (log(Young)-log(Elderly), Y/Ed) between the FN and the TR in an ANOCOVA model. All BMC, iBMD and tBMD values were significantly lower in elderly than in young women, with the largest Y/Ed in the FN tBMC and tBMD (P<0.0011 and P<0.0001). cBMD in young and elderly groups was not significantly different at the TR while at the FN it was greater (P=0.0075) in elderly than young women, showing significant Y/Ed (P=0.0003) dependence on skeletal site. Elderly women had significantly larger iVOL and CSA values (0.0001

This study examined trabecular bone mineral density (BMD) in Japanese women with and without spinal fracture, and compared the results to American women with and without fracture. The quantitative computed tomography (QCT) systems used at the University of California, San Francisco (UCSF) and at Nagasaki University were cross-calibrated. Normative BMD was assessed with the K2HPO4 liquid phantom in 538 Americans aged 20-85 years, and with the B-MAS200 phantom in 577 Japanese aged 20-83 years. These BMD were adjusted for use with the Image Analysis solid phantom using the result of cross-calibration. The trabecular BMD in 111 postmenopausal American women (55 with fracture), and in 185 postmenopausal Japanese women (67 with fracture) were compared for investigation of the difference in BMD values relative to fracture status. The absolute BMD values in Japanese were lower than those in Americans, and the differences were greater with advancing age. The magnitude of the BMD difference was 8.6, 20.5, 38.1 mg/cm3 in women aged 20-24 years, 40-44 years, 60-64 years, respectively. In premenopausal women, BMD began to decrease at the age of 20 in Japanese, whereas the peak bone mass was maintained until the age of 35 in the American women. In immediate postmenopausal women, BMD significantly decreased in both populations. In later postmenopausal women, BMD significantly decreased with age in the Japanese women but decreased less rapidly in the American women. The aging decrease of BMD was 1.4% and 2.2% per year in the later postmenopausal American and Japanese women, respectively. The fracture threshold is considered to be lower in Japanese women. However, the BMD difference between American and Japanese women with fracture was similar to that without fracture. The Z-scores of fracture subjects versus controls were 2.9 in American and 1.8 in Japanese women. In conclusion, Japanese women were found to have a lower BMD and lower fracture threshold than American women. The significant decrease of spinal trabecular BMD in late postmenopause is potentially responsible for the higher prevalence of spinal fracture in Japanese women.

The various therapeutic trials conducted throughout the world demonstrate the benefit of treatment even for a moderate elevation of diastolic pressure (90 or 95 mmHg). At this level of hypertension, treatment is more preventative than curative. This article discusses the benefits and the costs on the individual and collective scale in the context of two opposed strategies: mass treatment after a certain level of blood pressure or treatment of subjects at high risk of cardio-vascular disease. To achieve a collective benefit, all of the hypertensives defined in this way need to be detected, treated and followed-up in the long-term. Stimulation of the present medical system would appear to be more effective and less costly than the creation of specialized structures.

The positive association between alcohol consumption and arterial pressure has been shown in several epidemiological surveys. This strong relationship has been demonstrated in many countries, independent of the known risk factors for hypertension; the dose-response appears to be linear in most studies. The lowering of blood pressure after stopping alcohol consumption and its rise after starting to take alcohol again are good evidence of a causal relationship. The pathophysiology of the hypertensive effect of alcohol is uncertain. Alcohol consumption seems to be a factor to be taken into account in the prevention and treatment of hypertension.