BackgroundOur aim was to examine the association between Street Smart Walk Score® and self-reported outdoor walking among older Canadians, and to determine whether socioeconomic status modifies this association.MethodsWe linked objective walkability data with cross-sectional survey data from the Canadian Community Health Survey Healthy-Aging 2008–2009 Cycle for a sample of 1309 British Columbians aged ≥ 65 years. We examined associations between Street Smart Walk Score and meeting physical activity guidelines (≥150 min of moderate to vigorous activity/week) through self-reported outdoor walking using multivariable logistic regression, and tested for significant interactions with household income.ResultsA ten point higher Street Smart Walk Score was associated with a 17 % higher odds of meeting physical activity guidelines through walking outside (95 % CI: 1.07,1.27). In addition, older adults living in neighbourhoods categorised as Walker’s Paradise were over three times more likely to meet guidelines than those living in Car-dependent/Very car dependent neighbourhoods. We found no evidence that household income moderated the effect of Walk Score on walking outside.ConclusionsNeighbourhood design may be one avenue whereby physical activity levels of older people can be enhanced through outdoor walking, with benefit across socioeconomic strata.

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IMPORTANCEThe use of perioperative, prophylactic, intravenous antibiotics is standard practice to reduce the risk of surgical site infection after oncologic resection and complex endoprosthetic reconstruction for lower extremity bone tumors. However, evidence guiding the duration of prophylactic treatment remains limited.OBJECTIVE To assess the effect of a 5-day regimen of postoperative, prophylactic, intravenous antibiotics compared with a 1-day regimen on the rate of surgical site infections within 1 year after surgery.DESIGN, SETTING, AND PARTICIPANTS This randomized clinical superiority trial was performed at 48 clinical sites in 12 countries from January 1, 2013, to October 29, 2019. The trial included patients with a primary bone tumor or a soft tissue sarcoma that had invaded the femur or tibia or oligometastatic bone disease of the femur or tibia with expected survival of at least 1 year who required surgical management by excision and endoprosthetic reconstruction. A total of 611 patients were enrolled, and 7 were excluded for ineligibility.INTERVENTIONS A 1-or 5-day regimen of postoperative prophylactic intravenous cephalosporin (cefazolin or cefuroxime) that began within 8 hours after skin closure and was administered every 8 hours thereafter. Those randomized to the 1-day regimen received identical saline doses every 8 hours for the remaining 4 days; patients, care providers, and outcomes assessors were blinded to treatment regimen. MAIN OUTCOMES AND MEASURESThe primary outcome in this superiority trial was a surgical site infection (superficial incisional, deep incisional, or organ space) classified according to the criteria established by the Centers for Disease Control and Prevention within 1 year after surgery. Secondary outcomes included antibiotic-related complications, unplanned additional operations, oncologic and functional outcomes, and mortality. RESULTSOf the 604 patients included in the final analysis (mean [SD] age, 41.2 [21.9] years; 361 [59.8%] male; 114 [18.9%] Asian, 43 [7.1%] Black, 34 [5.6%] Hispanic, 15 [2.5%] Indigenous, 384 [63.8%] White, and 12 [2.0%] other), 293 were randomized to a 5-day regimen and 311 to a 1-day regimen. A surgical site infection occurred in 44 patients (15.0%) allocated to the 5-day regimen and in 52 patients (16.7%) allocated to the 1-day regimen (hazard ratio, 0.93; 95% CI, 0.62-1.40; P = .73). Antibiotic-related complications occurred in 15 patients (5.1%) in the 5-day regimen and in 5 patients (1.6%) allocated to the 1-day regimen (hazard ratio, 3.24; 95% CI, 1.17-8.98; P = .02). Other secondary outcomes did not differ significantly between treatment groups.CONCLUSIONS AND RELEVANCE This randomized clinical trial did not confirm the superiority of a 5-day regimen of postoperative intravenous antibiotics over a 1-day regimen in preventing surgical site infections after surgery for lower extremity bone tumors that required an endoprosthesis. The 5-day regimen group had significantly more antibiotic-related complications.

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Neighborhood built environments may play an important role in shaping mobility and subsequent health outcomes. However, little work includes broader mobility considerations such as cognitive ability to be mobile, social connections with community, or transportation choices. We used a population-based sample of Canadian middle aged and older adults (aged 45 and older) from the Canadian Community Health Survey-Healthy Aging (CCHS-HA, 2008–2009) to create a holistic mobility measure: Mobility over Varied Environments Scale (MOVES). Data from CCHS-HA respondents from British Columbia with MOVES were linked with Street Smart Walk Score™ data by postal code (n=2,046). Mean MOVES was estimated across sociodemographic and health characteristics. Linear regression, adjusted for relevant covariates, was used to estimate the association between Street Smart Walk Score™ and the MOVES. The mean MOVES was 30.67 (95% confidence interval (CI) 30.36, 30.99), 5th percentile 23.27 (CI 22.16, 24.38) and 95th percentile was 36.93 (CI 35.98, 37.87). MOVES was higher for those who were younger, married, higher socioeconomic status, and had better health. In unadjusted models, for every 10 point increase in Street Smart Walk Score™, MOVES increased 4.84 points (CI 4.52, 5.15). However, results attenuated after adjustment for sociodemographic covariates: each 10 point increase in Street Smart Walk Score™ was associated with a 0.10 (CI 0.00, 0.20) point increase in MOVES. The modest but important link we observed between walkability and mobility highlights the implication of neighborhood design on the health of middle aged and older adults.

In the event of surgical management of metastases to the humeral shaft, intramedullary nailing (IMN) is often preferred to plate osteosynthesis (PO) fixation despite a lack of consensus. In this study, we hypothesized that plate osteosynthesis will be associated with better functional and pain outcomes, thus better quality of life. Eighteen patients with the diagnosis of humeral shaft metastatic fracture or impending fracture were extracted from a prospective database of 140 metastatic patients collected across three hospitals over a five-year period. Musculoskeletal Tumor Society (MSTS) score, Toronto Extremity Salvage Score (TESS), Quality of Life (QOL) and Brief Pain Inventory (BPI) score were gathered during the year following the surgery. Statistical analysis was performed to compare the mean score differences between the two surgical options at baseline and five follow-up visits. Both treatment options were associated with an increase in functional outcomes based on both MSTS and TESS, and a decrease in pain level. However, no significant difference was found in quality of life and between the two treatment modalities. Thus, based on our results, a similar improvement in functional status and pain level can be achieved surgically by either intramedullary nailing or plating osteosynthesis.

BackgroundWhile recent work emphasizes the multi-dimensionality of mobility, no current measure incorporates multiple domains of mobility. Using existing conceptual frameworks we identified four domains of mobility (physical, cognitive, social, transportation) to create a “Mobility Over Varied Environments Scale” (MOVES). We then assessed expected patterns of MOVES in the Canadian population.MethodsAn expert panel identified survey items within each MOVES domain from the Canadian Community Health Survey- Healthy Aging Cycle (2008–2009) for 28,555 (weighted population n = 12,805,067) adults (≥45 years). We refined MOVES using principal components analysis and Cronbach’s alpha and weighted items so each domain was 10 points. Expected mobility trends, as assessed by average MOVES, were examined by sociodemographic and health factors, and by province, using Analysis of Variance (ANOVA).ResultsMOVES ranged from 0 to 40, where 0 represents individuals who are immobile and 40 those who are fully mobile. Mean MOVES was 29.58 (95% confidence interval (CI) 29.49, 29.67) (10th percentile: 24.17 (95% CI 23.96, 24.38), 90th percentile: 34.70 (CI 34.55, 34.85)). MOVES scores were lower for older, female, and non-white Canadians with worse health and lower socioeconomic status. MOVES was also lower for those who live in less urban areas.ConclusionsMOVES is a holistic measure of mobility for characterizing older adult mobility across populations. Future work should examine individual or neighborhood predictors of MOVES and its relationship to broader health outcomes. MOVES holds utility for research, surveillance, evaluation, and interventions around the broad factors influencing mobility in older adults.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4450-1) contains supplementary material, which is available to authorized users.

Background Little has been published about the association of venous thromboembolism (VTE) and sarcoma. In this study, we sought to identify clinical features of patients with sarcoma presenting at least one VTE episode. Methods Our study was a retrospective case–control study of a single‐institution database with univariate and multivariate analysis using chi‐square and Student's t test. A p value less than .05 was considered significant. Results The overall incidence of VTE in patients with sarcoma was 7.9%. Predictive factors identified by multivariate analysis were metastatic disease and administration of chemotherapy. It was not statistically possible to correlate the risk of VTE with specific sarcoma subtypes, but observations suggested malignant peripheral nerve sheath tumor, osteosarcoma, and liposarcoma as having the highest propension. Conclusion VTE is not infrequent in patients with sarcoma. Adoption of common guidelines for cancer‐associated thrombosis is recommended.