Two-year Visit Research Articles

The Longitudinal Effects of Posterior Spinal Fusion with Derotation on Axial Deformity in Adolescent Idiopathic Scoliosis.

Retrospective case series. To characterize the change in angle of trunk rotation (ATR), axial vertebral rotation (AVR), and body surface rotation (BSR) in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF) with en-bloc derotation across multiple postoperative visits. Previous research has documented ATR, AVR, and BSR correction for AIS patients after surgery. However, there is a lack of evidence on the sustainability of this correction over time. This was a retrospective study from a single-center prospective surface topographic registry of patients with AIS, age 11-20 at time of surgery, who underwent PSF with en-bloc derotation. Patients with previous spine surgery were excluded. ATR was measured with a scoliometer, AVR through EOS radiographic imaging, and BSR via surface topographic scanning, Data collection occurred at: preoperative, six-week, three-month, six-month, one-year, and two-year postoperative visits. BSR and AVR were tracked at the preoperative apical vertebral level, and the level with maximum deformity, at each respective timepoint. Generalized estimating equations models were used for statistical analysis. Covariates included age, sex, and body mass index. 49 patients (73.4% female, mean age 14.6±2.2 years, mean preoperative coronal curve angle 57.9°±8.5, and 67% major thoracic) were evaluated. ATR correction was significantly improved at all postoperative timepoints and there was no significant loss of correction. AVR Max and AVR Apex were significantly improved at all timepoints but there was a significant loss of correction for AVR Apex between the six-week and one-year visit (P=0.032). BSR Max achieved significant improvement at the three-month visit. BSR Apex was significantly improved at the three-month and one-year visit. ATR and AVR demonstrated significant axial plane correction at two-years postoperative in patients undergoing PSF for AIS. BSR did not maintain significant improvement by the two-year visit.

The prospective relationship between weight-based discrimination and eating pathology among youth

Among adults and adolescents, weight-based discrimination is associated with disordered eating. However, these relationships remain understudied in children. Given that weight-based discrimination is commonly reported among youth, and that childhood is a crucial developmental period for the onset of disordered eating, the current study assessed prospective associations between weight-based discrimination and eating pathology among participants in the Adolescent Brain Cognitive Development Study. At the one-year visit, children indicated whether they had experienced discrimination due to their weight within the past year. Parents completed a computerized clinical interview to determine the presence of sub-or-full threshold eating disorders (AN, BN, and BED) among their children. At the two-year visit, children completed the same assessment. Height and fasting weight were obtained. Logistic regressions, adjusting for age, sex, race/ethnicity, family income, BMI%ile, and parent-reported presence of the respective eating disorder at one-year, were conducted to assess the associations between weight-based discrimination and eating pathology. Participants were 10,299 children who completed measures at both the one- and two-year visits (Mage at one-year: 10.92 ± 0.64, 47.6 % female, 45.9 % racial/ethnic minority). The presence of weight-based discrimination, reported by 5.6 % (n = 574) of children, was significantly associated with a greater likelihood of reporting AN, BN, and BED one-year later (ORs: 1.94–4.91). Findings suggest that weight-based discrimination may confer additional risk for the onset of disordered eating, above and beyond the contribution of body weight. Intersectional research is needed to examine the role of multiple forms of discrimination in relation to the development of eating pathology.

Effects of Spinal Fusion for Idiopathic Scoliosis on Lower Body Kinematics During Gait*

Study DesignProspective. ObjectivesThe purpose of this study was to compare gait among patients with scoliosis undergoing posterior spinal fusion and instrumentation (PSFI) to typically developing subjects and determine if the location of the lowest instrumented vertebra impacted results. Summary of Background DataPSFI is the standard of care for correcting spine deformities, allowing the preservation of body equilibrium while maintaining as many mobile spinal segments as possible. The effect of surgery on joint motion distal to the spine must also be considered. Very few studies have addressed the effect of PSFI on activities such as walking and even fewer address how surgical choice of the lowest instrumented vertebra (LIV) influences possible motion reduction. MethodsIndividuals with scoliosis undergoing PSFI (n = 38) completed gait analysis preoperatively and at postoperative years 1 and 2 along with a control group (n = 24). Comparisons were made with the control group at each time point and between patients fused at L2 and above (L2+) versus L3 and below (L3–). ResultsThe kinematic results of the AIS group showed some differences when compared to the Control Group, most notably decreased range of motion (ROM) in pelvic tilt and trunk lateral bending. When comparing the LIV groups, only minor differences were observed, and the results showed decreased coronal trunk and pelvis ROM at the one-year visit and decreased hip rotation ROM at the two-year visit in the L3– group. ConclusionsPatients with AIS showed decreased ROM preoperatively with further decreases postoperatively. These changes remained relatively consistent following the two-year visit, indicating that most kinematic changes occurred in the first year following surgery. Limited functional differences between the two LIV groups may be due to the lack of full ROM used during normal gait, and future work could address tasks that use greater ROM. Level of EvidenceLevel II.

Rethinking obesity counseling: having the French Fry Discussion.

Childhood obesity is a complex problem that warrants early intervention. General recommendations for obesity prevention and nutrition counseling exist. However, these are notably imprecise with regard to early and targeted interventions to prevent and treat obesity in pediatric populations. This study examines family medicine primary care providers' (PCPs) perceived barriers for preventing and treating pediatric obesity and their related practice behavior during well-child visits. Methods. A written survey addressing perceived barriers and current practices addressing obesity at well-child visits were administered to PCPs at eleven family medicine clinics in the Duke University Health System. Results. The most common perceived barriers identified by PCPs to prevention or treatment of obesity in children were families not getting enough exercise (93%) and families too often having fast food meals (86%). Most PCPs do not discuss fast foods at or prior to the twelve-month well-child visit. The two-year visit is the first well-child visit at which a majority of PCPs (68%) discuss fast food. Conclusion. No clear consensus exists as to when PCPs should discuss fast food in early well-child checks. Previous research has shown a profound shift in children's dietary habits toward fast foods, such as French fries, that occurs between the one- and two-year well-child checks. Consideration should be given to having a “French Fry Discussion” at every twelve-month well-child care visit.

A clinical evaluation of a self-etching primer and a giomer restorative material: Results at eight years

The authors evaluated the performance of a giomer restorative material (Beautifil, Shofu, Kyoto, Japan) with a self-etching primer (FL-Bond, Shofu) for posterior restorations. Two clinicians placed 26 Class I restorations and 35 Class II restorations in 31 patients ranging in age from 21 to 62 years (mean age, 34 years). Inclusion criteria required patients to have molar-supported permanent dentition free of any edentulous spaces and no clinically significant occlusal interference, as well as one or more permanent molars or premolars requiring new or replacement Class I or II restorations. Two of the authors examined the restorations using modified U.S. Public Health Service/Ryge criteria for color match, marginal adaptation, anatomy, surface roughness, marginal staining, interfacial staining, proximal and occlusal contacts, secondary caries, postoperative sensitivity and luster. The two authors examined all restorations at the one-year recall visit, 58 at the two-year visit, 47 at the three-year visit, 39 at the four-year visit and 41 at the eight-year visit (16 Class I and 25 Class II restorations). During the eight-year period, they detected no changes with respect to surface roughness, postoperative sensitivity or secondary caries. The majority of changes recorded were for marginal adaptation at occlusal (29 percent) and proximal (16 percent) surfaces and marginal staining at occlusal (15 percent) and proximal (32 percent) surfaces. The McNemar test showed significant changes between baseline and the eight-year evaluation only for marginal adaptation at occlusal surfaces (P = .0047) and marginal staining at proximal surfaces (P = .04). None of the restorations failed. Most of the restorations maintained good quality during the observation period. Beautiful restorative material and FL-Bond bonding system, when placed in Class I and II preparations, achieved clinically acceptable results after eight years of service.

Harriet Martineau: An economic view of Victorian arts and letters

It is sometimes interesting to see the disdpline of economics from another point of view. Popular writers have often moved into and out of an academic disdpline, either leaving their mark on the disdpline or having the discipline leave amark on their popular work. In the case of Harriet Martineau, a Victorian popular writer, the interest in economics came early, and while she has had tittle if any lasting effect on economics, it had a lasting effect on her. Still, she is of interest to economists, because a close interest by an ~mateur can make the professional stop and think. Are we really always so correct in our disdplinary view of the world? For Ms. Martineau, her first published work was a treatise in economics and it colored her subsequent world view and her subsequent work. She began her career with a major educational work on economics, the///ustrations of Political Economy (1832-34). The tlmlnoo of her work on political economy makes her of interest to economists because we can trace the effects that economics had on the rest of her work, whether she was writing on the condition of women, philosophy, travel, or arts and letters. The purpose of t hi~ short paper is to see how political economy affected her analysis of the arts and literature. Martinean began to formally develop thi~ analysis during a two-year visit to America after fini.~hing the Illustrations. Like many a nineteenth-century visitor, Martinean dismiesed American arts and letters out of hand. As we will show, she attributed their defidendes not to the abundance of market imperfections but instead to an immature society which had not yet learned the importance of laissez faire.