Burden of diseases and injuries attributable to risk factors in the European Union in 2019

Background

In addition to information on mortality and morbidity from diseases and injuries, it is important to identify the attributable burden of risk factors to allow for health planning and prioritization.

Methods

For the whole EU and each country, using estimates and 95% uncertainty intervals from the GBD 2019 study, we report attributable (all-cause and by level 2 risk factors) age-standardized death and DALY rates, as well as summary exposure values (SEV). We evaluate trends by comparing estimates for the year 2019 with those for the year 2010.

Results

Age-standardized death and DALY rates attributable to risk factors declined by 10.7% (95%UI 13.8%-7.6%) and 9.1% (95%UI 12.0%-6.3%), between 2010 and 2019 in the EU. While there was a decreasing trend for both age-standardized death and DALY rates for almost all risk factors, some showed an increasing trend on SEV, including low physical activity and intimate partner violence.

Conclusions

Despite the improvement of health metrics attributable to risk factors, several modifiable behavioral and metabolic risk factors remain unchanged over the years. It is crucial to ensure a swift implementation of evidence-based policies and interventions in EU member states to achieve the targets of the Sustainable Development Goals.

Complement components C1q, C1r/C1s, and C1INH in rheumatoid arthritis. Correlation of in situ hybridization and northern blot results with function and protein concentration in synovium and primary cell cultures

OBJECTIVE

To analyze the synovial site and the cell types expressing C1q, C1r/C1s, and C1-esterase inhibitor (C1INH) and to characterize newly synthesized C1q in patients with rheumatoid arthritis (RA).

METHODS

Tissue and primary cell cultures of synovium from RA patients were analyzed for C1q, C1r/C1s, and C1INH by Northern blotting, in situ hybridization, and pulse-chase experiments for C1q.

RESULTS

The de novo synthesis of C1q, C1r/C1s, and C1INH in synovium and primary cell cultures was proven by Northern blot and by antigenic and functional analysis. In in situ hybridization experiments, the synovial lining cell layer was identified as the site of C1q, C1r, and C1INH expression. In contrast, immunohistologic analysis showed that C1q, C1s, and C1INH proteins were present in a thin film covering the synovial lining cells. In situ hybridization performed on primary cell cultures provided evidence that only macrophages were able to express C1q, whereas fibroblasts and stellate cells synthesized C1r.

CONCLUSION

The synovium is important for the synthesis and secretion of C1q and C1r/C1s, as well as the control protein C1INH, which supports the idea of a locally occurring inflammatory process in RA patients.

[Stress fractures of the tibia in nuclear magnetic resonance tomography]

To demonstrate the usefulness of MR-imaging seven cases of suspected stress fractures are demonstrated and discussed (six stress fractures, one osteoid-osteoma). The results indicate that stress fractures of the tibia may be differentiated early and easily from tumorous lesions, especially in atypical cases. In one case the fracture line could be detected only by MRI. In this respect, MRI is of high diagnostic value in differentiating unclear bone anomalies.

[Clinical course of a late aseptically loosened PCA hip prosthesis shaft]

The surface of the proximal part of a PCA endoprosthesis stem in total hip replacement is structured with small beads to provide good conditions for bone ingrowth. The distal part of the stem has a smooth surface. For the mechanical fixation concept, this means anchorage of the proximal part and free axial mobility of the distal part of the prosthesis. We present a clinical case in which bone remodeling processes finally led to complete loosening of the prosthesis. The described mechanism of loosening could be reconstructed by radiological findings, bone scan, two digital subtraction arthrographies of the hip and by evaluation of the fibrous tissue formation around the stem after explanation. In this case, after an initial period of no measureable bone reactions, distal endosteal bone and proximal radiolucent space developed without loss of contact with the prosthesis. Later, a mechanical interruption between the proximal part of the prosthesis and bone occurred. There was no loosening of the distal part of the prosthesis at this time. Despite remarkable hypertrophy of the distal femoral bone, eventually the distal part of the prosthesis loosened so that a revision arthroplasty had to be performed. The described mechanism of loosening has not be proven to pertain to all such prostheses.

[Magnetic resonance tomographic studies of stress fractures]

Stress fractures can represent a diagnostic problem especially in their differentiation from bone tumours. 6 patients with 7 lesions were examined. MRI visualised the stress fractures and established the diagnosis of stress fracture vs. tumour in 6 cases. In the seventh, biopsy having been performed, a tumour was ruled out. MRI is more sensitive than radiography in the detection of stress fractures, showing the characteristic changes earlier. MRI, being a very sensitive method in the diagnosis of stress fractures and a reliable one in their differentiation from bone tumours, can be applied in cases of unusual clinical course and difficult radiological diagnosis prior to biopsy.

[Palliative surgical interventions in primary and secondary bone tumors]

The treatment of patients with skeletal metastases is becoming increasingly important because of longer survival times of patients with metastatic carcinoma. The most common surgical procedures and their indications in the treatment of metastatic carcinoma involving spine and extremities are described. Some typical clinical examples illustrate the operative techniques.

[Fixation of the cervical spine with a new halo fixation system]

The stable fixation of the cervical spine by means of a halo external fixator is superior in terms of stability compared with alternative methods. A new Halo external fixator system is being introduced which enables uncomplicated handling with which optimal possibilities for positional correction are achieved by means of lockable ball joints. By using carbon enhanced connection rods radiolucency is given.

[Resection of the acromial and sternal end of the clavicle]

The causes of complaints in the acromioclavicular joint include arthrosis after dislocation of the joint, metastases, polyarthritis, tuberculosis, or hyperparathyroidism. Some causes have not yet been identified. If conservative therapy is unsuccessful the condition may be treated by resection of the acromial end of the clavicular, as first described by Gurd and Mumford. The present paper reports the results obtained in 22 patients who were followed up. Complete freedom from pain was achieved in 59% of the cases and improvement in 23.7%, while in 13.6% the results had to be classified as unchanged or poor. An analysis of these results admits the conclusion that with restricted indication and in particular in post-traumatic conditions, it is certainly possible to achieve results which make this technically simple procedure the treatment of choice in arthrosis of the acromioclavicular joint; this is borne out by the literature. In much rarer cases, changes in the sternoclavicular joint have to be surgically treated. Here also, the majority of cases are post-traumatic changes, and here again most of them are conditions following anterior luxation. Analogously to resection at the acromial end of the clavicula, a resection at its sternal end may also produce successful results. With reference to three of the authors' own cases, the clinical picture is considered and the results are presented and discussed; however, since the various surgical techniques cannot be compared, a final evaluation is only possible to a limited extent.

[Bacteriologic studies of the use of incision drapes in orthopedic operations]

The usefulness of plastic adhesive drapes for the prophylaxis of wound infections following to orthopedic operations was investigated in a prospectively randomized study including 123 patients. The drape was used in 68 cases, 55 patients were operated without drape. In order to carry out qualitative bacteriological examinations, smears were taken prior to, one and two hours after the beginning and after the end of the operations. Bacterial infestation in the operation area was found in 30 patients (54.5%) operated without drape and in 30 patients (44.1%) in whose operations the drape was employed. Most of the bacteria found were coagulase-negative staphylococci, in some cases corynebacteria and aerobic spore-forming organisms. There were no postoperative wound infections. No evidence of a significant difference was shown by a statistical evaluation of the results using the chi 2 test. The use of incision drapes for the prophylaxis of postoperative wound infections is therefore not necessary in orthopedic surgery.

[Resection of the acromial end of clavicula in acromioclavicular joint arthrosis]

Arthroses of the acromioclavicular joint mainly occur after trauma and may be the cause of pain in the shoulder region which is difficult to treat. Other possible causes are metastases, hyperparathyroidism, tuberculosis and osteolysis whose pathogenetic mechanism is still unknown. If all conservative treatment methods have been tried without success, lateral resection of the clavicula, first described in 1941 by Gurd and Mumford, is the method of choice. Some of the results obtained by the present authors with 15 patients (of whom 11 were followed up) are presented and compared with those obtained by other authors. Since the results are altogether very good, this operation, which is technically simple to perform, is recommended for arthroses of the acromioclavicular joint of any etiology. In cases with Tossy III ruptures of the joint the procedure described by Weaver and Dunn can be performed in addition.

[Somatosensory evoked potentials in surgery of the spine]

The authors report on their experience using cortical somatosensorially evoked potentials in 23 studies on 21 patients. The method is used intraoperatively when the spinal cord is at risk, for early identification of functional damage to the cord. The potentials found are classified according type of manifestation and compared with the results obtained by other authors.

[Backache in women from a gynecologic and orthopedic viewpoint]

In differential diagnosis of low back pain in women defects of the skeletal system as well as affections of the female genital organs must be considered. In these diseases low back pain may be caused directly by mechanic or indirectly by nervous factors. It is referred to the possibility of differentiation of low back pain by clinical symptoms. Based on new findings particularly osteoporosis makes close cooperation of the two medical specialties-orthopedics and gynecology-necessary, because the question of oestrogen application for prophylaxis and therapy of osteoporosis arises.