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Objective To investigate whether surgery by open reduction and internal fixation provides benefit compared with non-operative treatment for displaced, intra-articular calcaneal fractures.Design Pragmatic, multicentre, two arm, parallel group, assessor blinded randomised controlled trial (UK Heel Fracture Trial).Setting 22 tertiary referral hospitals, United Kingdom.Participants 151 patients with acute displaced intra-articular calcaneal fractures randomly allocated to operative (n=73) or non-operative (n=78) treatment. Main outcome measuresThe primary outcome measure was patient reported Kerr-Atkins score for pain and function (scale 0-100, 100 being the best possible score) at two years after injury. Secondary outcomes were complications; hindfoot pain and function (American Orthopaedic Foot and Ankle Society score); general health (SF-36); quality of life (EQ-5D); clinical examination; walking speed; and gait symmetry. Analysis was by intention to treat.Results 95% follow-up was achieved for the primary outcome (69 in operative group and 74 in non-operative group), and a complete set of secondary outcomes were available for 75% of participants. There was no significant difference in the primary outcome (mean Kerr-Atkins score 69.8 in operative group v 65.7 in non-operative group; adjusted 95% confidence interval of difference −7.1 to 7.0) or in any of the secondary outcomes between treatment groups. Complications and reoperations were more common in those who received operative care (estimated odds ratio 7.5, 95% confidence interval 2.0 to 41.8).Conclusions Operative treatment compared with non-operative care showed no symptomatic or functional advantage after two years in patients with typical displaced intra-articular fractures of the calcaneus, and the risk of complications was higher after surgery. Based on these findings, operative treatment by open reduction and internal fixation is not recommended for these fractures.Trial registration Current Controlled Trials ISRCTN37188541.

The oral glucose tolerance test (OGTT) identifies a proportion of people who have a diabetic post-challenge blood glucose, but a non-diabetic fasting value. The prevalence of isolated post-challenge hyperglycaemia (IPH) is variable but has been reported to account for as much as 70 % of all undiagnosed diabetes in elderly women [1] and is also common amongst the non-obese [2].The clinical significance of IPH has not been fully explored but it is particularly relevant now since the American Diabetes Association (ADA) Expert Committee has recommended that fasting glucose alone be used in both clinical and epidemiological settings to diagnose diabetes [3]. In the Rancho Bernardo study [1], elderly women with IPH had a significantly raised risk of fatal cardiovascular disease compared with non-diabetic women. If data from other populations confirm that IPH is common and is an independent risk factor for diabetes-related end-points, then this would suggest that the post-challenge glucose concentration provides valuable information that is additional to that provided by the fasting glucose.We report here on the relation between IPH (as well as other categories of diabetes) and mortality us- Diabetologia (1999) Abstract Aims/hypothesis. The aim of this study was to examine the possible link between isolated post-challenge hyperglycaemia (2-h post-challenge plasma glucose ³ 11.1 mmol/l, and fasting plasma glucose < 7.0 mmol/l) and mortality. Methods. The data from three population based longitudinal studies (in Mauritius, Fiji and Nauru) were pooled and mortality rates were determined in 9179 people who were followed for between 5 and 12 years. Results. There were 595 people with previously diagnosed diabetes, and 799 with newly diagnosed diabetes, of whom 243 (31) had isolated post-challenge hyperglycaemia. In comparison with people without diabetes, people with isolated post-challenge hyperglycaemia had an increased risk of all-cause mortality [Cox proportional hazards ratio (95 % CI): 2.7 (1.8±3.9) ± men; 2.0 (1.3±3.3) ± women], and of cardiovascular mortality [2.3 (1.2±4.2) ± men; 2.6 (1.3±5.1) ± women]. In addition, men with isolated post-challenge hyperglycaemia had a high risk of cancer death [8.0 (3.6±17.9)]. Conclusion/interpretation. These data show that isolated post-challenge hyperglycaemia, which can only be identified by the 2-h glucose, is common, and at least doubles the mortality risk. This should be considered in the design of screening programmes that use only fasting glucose [Diabetologia (1999

BackgroundBirth control is the conscious control of the birth rate by methods which temporarily prevent conception by interfering with the normal process of ovulation, fertilization, and implantation. High contraceptive prevalence rate is always expected for controlling births for those countries that are experiencing high population growth rate. The factors that influence contraceptive prevalence are also important to know for policy implication purposes in Bangladesh. This study aims to explore the socio-economic, demographic and others key factors that influence the use of contraception in Bangladesh.MethodsThe contraception data are extracted from the 2014 Bangladesh Demographic and Health Survey (BDHS) data which were collected by using a two stage stratified random sampling technique that is a source of nested variability. The nested sources of variability must be incorporated in the model using random effects in order to model the actual parameter effects on contraceptive prevalence. A mixed effect logistic regression model has been implemented for the binary contraceptive data, where parameters are estimated through generalized estimating equation by assuming exchangeable correlation structure to explore and identify the factors that truly affect the use of contraception in Bangladesh.ResultsThe prevalence of contraception use by currently married 15–49 years aged women or their husbands is 62.4%. Our study finds that administrative division, place of residence, religion, number of household members, woman’s age, occupation, body mass index, breastfeeding practice, husband’s education, wish for children, living status with wife, sexual activity in past year, women amenorrheic status, abstaining status, number of children born in last five years and total children ever died were significantly associated with contraception use in Bangladesh.ConclusionsThe odds of women experiencing the outcome of interest are not independent due to the nested structure of the data. As a result, a mixed effect model is implemented for the binary variable ‘contraceptive use’ to produce true estimates for the significant determinants of contraceptive use in Bangladesh. Knowing such true estimates is important for attaining future goals including increasing contraception use from 62 to 75% by 2020 by the Bangladesh government’s Health, Population & Nutrition Sector Development Program (HPNSDP).Electronic supplementary materialThe online version of this article (10.1186/s12889-018-5098-1) contains supplementary material, which is available to authorized users.