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Objective Investigate a profile of cardiovascular disease (CVD) risk factors by sex among individuals with and without OA, and considering single and multisite joint OA. Methods Data source: Cycle-1, Comprehensive-Cohort, Canadian Longitudinal Study on Aging, a national sample of individuals aged 45-85. Systemic inflammatory/metabolic CVD risk factors collected: C-reactive protein (hsCRP), high density lipoprotein, triglycerides, total cholesterol, body mass index (BMI), systolic blood pressure, and hemoglobin A1c. Smoking history was also collected. Respondents indicated doctor-diagnosed OA in the knees, hips and/or hands, and were characterized as yes/no and single/multisite. Individuals with OA were age-sex matched to non-OA controls. Covariates: age, sex, education, income, physical activity, timed-up-and-go, comorbidities. A latent CVD risk variable was derived in females and males; standardized scores were categorized: lowest/mid-low/mid-high/highest risk. Associations with OA were quantified using ordinal logistic regressions. Results 6098 respondents (3049 with OA) had a median age of 63 years, 55.8% female. One-third of OA respondents were in the highest risk category, versus one-fifth of non-OA. Apart from BMI (the largest contributor in both sexes), hsCRP (an inflammation marker) was predominant in females, and metabolic factors and smoking in males. Overall, OA was associated with worse CVD risk quartiles compared to non-OA. OA was increasingly associated with worse CVD risk quartiles with increasing risk thresholds among females with multisite OA but not males. Conclusions Findings suggest unique CVD risks by sex/multisite subgroups, and point to a potentially important role for inflammation in OA over and above traditional CVD risk factors.

OBJECTIVE The focus on disability in osteoarthritis (OA) has largely been on the ability to perform specific activities, which neglects the greater implications for social participation. We investigated the association between OA and social participation, considering activity limitations and instrumental supports as intervening variables in the association. METHODS Data were from 21,214 respondents, ages 45-85 years, from cycle 1 of the Canadian Longitudinal Study on Aging. The questionnaire elicited information regarding self-reported doctor-diagnosed OA, difficulty with 14 activities, perceived availability and receipt of instrumental supports, and 17 social participation activities. Structural equation modeling was used. The primary outcome was social participation, and the primary predictor was OA. The intervening variables included activity limitations, received instrumental supports, and perceived instrumental supports. Latent variables were developed for intervening and social participation variables. The covariates included age, sex, body mass index, income, education, smoking, and comorbidity count. RESULTS The mean age of the respondents was 63 years, 51% were female, and 26.5% reported having OA. Two distinct social participation indicators were identified, including social participation-diversity and social participation-intensity. When intervening variables were not considered, minimal/no association was found between OA and social participation. When intervening variables were considered, unique pathways linking OA and social participation were found. The overall negative association between activity limitations and social participation was partially direct and partially buffered by both receipt of and perceived availability of instrumental supports. In the absence of activity limitations, OA was associated with greater social participation. CONCLUSION Enhanced social participation in people with OA who do not have activity limitations may reflect proactive steps taken by those with mild OA to maintain activity and social engagement. For those with activity limitations, findings highlight the need for interventions to mitigate limitations and draw particular attention to the importance of both provision and awareness of available instrumental supports in maintaining social participation.

Background Context In the lumbar spine osteoarthritis (LS-OA) population having surgery for lumbar spinal stenosis (LSS) symptoms, a significant proportion of patients experience limited benefit following the intervention. Thus, identifying contributing factors to this is important. Individuals with OA often have multiple joint symptoms, yet this has received limited attention in this population. Purpose Document the occurrence of joint symptoms among patients undergoing surgery for LS-OA, and investigate the influence of these symptoms on disability postsurgery. Design Prospective study of consecutive patients followed to 12-month postsurgery. Patient Sample Patients undergoing surgery (decompression surgery, with or without fusion) for neurogenic claudication with or without back pain due to LSS with a primary pathology diagnosis of LS-OA. Outcomes Measures Patient self-reported: Oswestry Disability Index (ODI), completed pre- and 12-month postsurgery; and, completed presurgery, age, sex, education, smoking, comorbid conditions, opioid use, short/long-term disability, depression and anxiety symptoms, back and leg pain intensity, presence of spondylolisthesis, procedure, prior spine surgery, and joints with arthritis and “pain/stiffness/swelling most days of the month” indicated on a homunculus (a joint site count was derived). Assessments: Height and weight, used to calculate body mass index; timed-up-and-go performance-based test. Methods Outcome of interest was achieving a clinically important improvement (CII) in ODI by 12-month postsurgery (yes/no). The association between joint site count and achieving a CII was examined by multivariable logistic regression analyses, adjusted for other measures. Results In all, 165 patients were included. The mean age was 67 years (range: 44–90) and 47% were female. Seventy-seven percent reported 1+ joint site other than the back, 62% reported 2+, and 25% reported 4+. Among those achieving a CII, 21% had 4+ joint sites, compared with 31% among those not achieving a CII. Adjusted analyses: Increasing joint site count was associated with increasing risk (odds ratio [OR]: 1.32, 95% confidence interval [CI]: 1.05, 1.66) of not achieving a CII; for those with 4+ joints, adjusted probability of not achieving a CII exceeded 50%. Also associated with an increased risk of not achieving a CII was presurgery anxiety (OR: 2.97, 95% CI: 1.02, 8.65), opioid use (OR: 2.89, 95% CI: 1.07, 7.82), and worse back pain intensity score (OR: 1.27, 95% CI: 1.05, 1.53). Conclusions Multijoint involvement was highly prevalent in this LS-OA surgical sample. Its association with poorer postsurgery outcome supports a comprehensive approach to OA management and care. Knowledge of multijoint symptoms should inform patient education, shared decision-making, and recommendations for postsurgical rehabilitation and self-management strategies.

Objective To investigate the association of OA risk factors with number of painful joint sites in a representative population sample. Methods Analysis of the 2009 Survey on Living with Chronic Diseases in Canada – Arthritis Component (n = 1614) for respondents reporting symptomatic OA. Variables: painful joints sites (hands, wrists, elbows, shoulders, hips, knees, ankles, feet, back, neck), joint symptom duration, sociodemographic characteristics, smoking, comorbidities and BMI. Zero-truncated negative binomial regressions were used to investigate the association between number of painful joint sites and the variables. Generalizability of findings was assessed by a similar analysis in a clinical hip/knee OA sample. Results The sample comprised 73% women and 56% were aged Conclusion The lack of an association of age and BMI (obesity) with number of painful joint sites in OA raises questions about the role of these risk factors and our understanding of OA as a multi-joint disease. Filling this knowledge gap is critical to making progress with defining OA phenotypes and identifying potential aetiological mechanisms.

Objective The vast majority of published estimates of osteoarthritis (OA) burden are based on an OA diagnosis. These data are limited, as individuals often do not visit a physician until their symptoms are moderate to severe. This study compared individuals with an OA diagnosis to those with OA joint symptoms but without a diagnosis considering a number of sociodemographic and health characteristics. A further distinction was made between individuals with symptoms in one joint site and those with symptoms in multiple joint sites. Methods Data are from 23 186 respondents aged 45 to 85 years from the first cycle of the Canadian Longitudinal Study on Aging. A multinomial logistic regression model examined the relationship between sociodemographic- and health-related characteristics and OA status (diagnosed OA, joint symptoms without OA, no OA or joint symptoms). In addition, logistic regression models assessed the relationship between OA status and usually experiencing pain and having some degree of functional limitation. Results Twenty-one percent of respondents reported a diagnosis of OA, and 25% reported symptoms typical of OA but without an OA diagnosis. Other than being slightly younger, the characteristic profile of individuals with symptoms in two or more joint sites was indistinguishable from that of those with diagnosed OA. Conclusion It may be warranted to consider OA-like multiple joint symptoms when deriving estimates of OA-attributed population health and cost burden.

Background: Low back pain (LBP) is a leading cause of disability globally. Risk-stratification systems (e.g. STarT Back) have been proposed to guide treatment, but with varying success. We investigated factors associated with poor response to standardized LBP education and self-management recommendations stratified by dominant pain location (back or leg). Methods: LBP patients underwent a standardized primary care model of care of education and self-management recommendations. Poor response was defined as an Oswestry Disability Index (ODI) change score

The objective of this study was to investigate a profile of cardiovascular disease (CVD) risk factors by sex among individuals with and without osteoarthritis (OA) and to consider single-site and multisite joint OA.Data were sourced from Cycle 1, Comprehensive Cohort, Canadian Longitudinal Study on Aging, a national sample of individuals ages 45 to 85 years. Systemic inflammatory/metabolic CVD risk factors collected were high-sensitivity C-reactive protein (hsCRP) level, high-density lipoprotein, triglycerides, total cholesterol, body mass index (BMI), systolic blood pressure, and hemoglobin A1c. Smoking history was also collected. Respondents indicated doctor-diagnosed OA in the knees, hips, and/or hands and were characterized as yes/no OA and single site/multisite OA. Individuals with OA were age- and sex-matched to non-OA controls. Covariates were age, sex, education, income, physical activity, timed up and go test findings, and comorbidities. A latent CVD risk variable was derived in women and men; standardized scores were categorized as follows: lowest, mid-low, mid-high, and highest risk. Associations with OA were quantified using ordinal logistic regressions.A total of 6,098 respondents (3,049 with OA) had a median age of 63 years, and 55.8% were women. One-third of OA respondents were in the highest risk category versus one-fifth of non-OA respondents. Apart from BMI (the largest contributor in both sexes), hsCRP level (an inflammation marker) was predominant in women, and metabolic factors and smoking were predominant in men. Overall, OA was associated with worse CVD risk quartiles compared with non-OA. OA was increasingly associated with worse CVD risk quartiles with increasing risk thresholds among women with multisite OA, but not men.Findings suggest unique CVD risks by sex/multisite subgroups and point to a potentially important role for inflammation in OA over and above traditional CVD risk factors.

OBJECTIVE Musculoskeletal disorders (MSDs) are a leading cause of healthy years lost due to premature mortality and disability. Our objective was to investigate whether MSDs were commensurably represented within the published health literature. METHODS MEDLINE bibliometric data were retrieved for 2011 and 2016. The 25 disease branches, including MSDs, were ranked according to published article counts, proportion of all publications, and increase in publications from 2011 to 2016. Rankings were also considered within 5 groupings of general health journals: geriatrics and gerontology, general and internal medicine, multidisciplinary sciences, primary health care, and public health. RESULTS There were 532,283 MEDLINE publications in 2016, a 16% increase over 2011. In 2016, MSDs ranked 13th in publication count, unchanged from 2011. The increase of 11% in MSD publications from 2011 was below the overall increase. Of 2016 publications, only 7% were MSD indexed, dropping from 7.3% in 2011. MSD-indexed publications had their highest ranking (8th) within geriatrics and gerontology, and lowest (19th) within public health. CONCLUSION MSDs appear underrepresented in the published health literature generally, and specifically within public health, despite their significant population impact. A broader focus on noncommunicable diseases associated with mortality omits noncommunicable diseases such as MSDs that are leading contributors to high morbidity and high costs, and such omission likely contributes to the neglect of recognizing MSDs as a health priority.

Background Multijoint involvement in osteoarthritis (OA) has long been documented clinically and in the literature. Even so, the vast majority of OA research has focused on OA in individual joints, particularly the knees, hips or hands. In many “joint-specific” studies, the presence of multijoint symptoms are either ignored or peripherally considered in descriptive and analytical work. The implicit assumption is often that OA is OA, irrespective of whether a single joint or several joints are involved. Objectives To document the occurrence of multijoint symptoms in a clinical sample of individuals with knee and hip OA scheduled for orthopaedic surgery. To examine the joint sites involved and investigate whether the extent of joint involvement is related to demographic and health characteristics. Methods Patients scheduled for total knee or hip replacement for end-stage OA were consecutively recruited from an academic hospital in Toronto, Canada. A health questionnaire completed prior to surgery captured demographic characteristics (age, sex), symptomatic joints other than the surgical joint (right and left shoulders, elbows, wrists, hands, hips, knees, feet, ankle, neck and back), body mass index (BMI), comorbidities (hypertension, depression, diabetes, migraine headaches, cancer, respiratory disease, heart disease, stomach/bowel disease, stroke) and WOMAC hip- and knee-specific pain and function. Results Study questionnaires were completed by 366 hip and 407 knee patients. The mean age of the sample was 65 years (SD=9.2; range 38–89 years), 57% were female. The most frequently reported symptomatic joints among knee patients were the contralateral knee (53.2%), one or both hands (32.1%), and the upper-, mid- or lower-back (31.0%), and among hip patients were one or both knees (49.4%), the back (36.6%), and the contralateral hip (21.3%). The overall mean number of symptomatic joints other than the surgical joint was 3.0 (SD=3.2; range 0–17). Only 19.0% reported the surgical joint as the only symptomatic joint; 23.0% reported 5 or more additional symptomatic joints. Mean hip/knee-specific pain and function scores were significantly worse with increasing symptomatic joint count (p Conclusions In this clinical OA sample, the “average” patient reported multiple symptomatic joints. Increasing age was not associated with increasing frequency of symptomatic joints. Irrespective of age and obesity, multiple symptomatic joints were the rule, not the exception. It was notable that the frequency of co-occurring conditions increased with increasing symptomatic joint count. This may suggest a need to re-examine how OA is characterized and perhaps its underlying etiology as it relates to single vs. multi-joint involvement. Disclosure of Interest None declared

The article discusses the authors' claim that musculoskeletal disorders (MSDs) are not addressed at very many epidemiology and public health conferences in the North American nations of Canada and the U.S., and it mentions the MSD osteoarthritis, as well as the "Global Burden of Disease, Injuries, and Risk Factors" study report. An online literature review search is examined, along with America's public health community and the implication that MSDs can lead to chronic pain and disability.

To date, the impacts of school-based, peer-led nutrition education initiatives have not been summarized or assessed collectively. This review presents the current evidence, identifies knowledge gaps, and provides recommendations for future research. PubMed, Scopus, ERIC and Google Scholar were searched for refereed Canadian and American primary studies published between January 2000 and November 2013, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventeen articles (11 programs) from Canada (24%) and the United States (76%) were identified. The results were summarized in terms of the study population, program design and main outcomes. Common outcome measures included healthy eating knowledge (n = 5), self-efficacy or attitudes towards healthy eating (n = 13), dietary measures (n = 9) and body mass index (n = 4), all of which tended to improve as a result of the programs. More research is needed to ascertain the effect of improvements in knowledge, self-efficacy and attitudes towards healthy eating on food behaviors. When evaluated, programs were generally well received, while the long-term maintenance of positive impacts was a challenge. Studies of sustainability and feasibility to promote long-term impact are a logical next step.

Pathogenicity islands (PAIs) are large DNA segments in the genomes of bacterial pathogens that encode virulence factors. Five PAIs have been identified in the Gram-negative bacterium Salmonella enterica. Two of these PAIs, Salmonella pathogenicity island (SPI)-1 and SPI-2, encode type III secretion systems (TTSS), which are essential virulence determinants. These 'molecular syringes' inject effectors directly into the host cell, whereupon they manipulate host cell functions. These effectors are either encoded with their respective TTSS or scattered elsewhere on the Salmonella chromosome. Importantly, SPI-1 and SPI-2 are expressed under distinct environmental conditions: SPI-1 is induced upon initial contact with the host cell, whereas SPI-2 is induced intracellularly. Here, we demonstrate that a single PAI, in this case SPI-5, can encode effectors that are induced by distinct regulatory cues and targeted to different TTSS. SPI-5 encodes the SPI-1 TTSS translocated effector, SigD/SopB. In contrast, we report that the adjacently encoded effector PipB is part of the SPI-2 regulon. PipB is translocated by the SPI-2 TTSS to the Salmonella-containing vacuole and Salmonella-induced filaments. We also show that regions of SPI-5 are not conserved in all Salmonella spp. Although sigD/sopB is present in all Salmonella spp., pipB is not found in Salmonella bongori, which also lacks a functional SPI-2 TTSS. Thus, we demonstrate a functional and regulatory cross-talk between three chromosomal PAIs, SPI-1, SPI-2 and SPI-5, which has significant implications for the evolution and role of PAIs in bacterial pathogenesis.