Safety and efficacy of routine postoperative ibuprofen for pain and disability related to ectopic bone formation after hip replacement surgery (HIPAID): a randomised control trial

Objectives To determine the benefits and risks of a non-steroidal anti-inflammatory drug (NSAID) as prophylaxis for ectopic bone formation in patients undergoing total hip replacement (or revision) surgery.
Design Double blind randomised placebo controlled clinical trial, stratified by treatment site and surgery (primary or revision).
Setting 20 orthopaedic surgery centres in Australia and New Zealand.
Participants 902 patients undergoing elective primary or revision total hip replacement surgery.
Intervention 14 days' treatment with ibuprofen (1200 mg daily) or matching placebo started within 24 hours of surgery.
Main outcome measures Changes in self reported hip pain and physical function 6 to 12 months after surgery (Western Ontario and McMaster University Arthritis index).
Results There were no significant differences between the groups for improvements in hip pain (mean difference -0.1, 95% confidence interval -0.4 to 0.2, P = 0.6) or physical function (-0.1, -0.4 to 0.2, P = 0.5), despite a decreased risk of ectopic bone formation (relative risk 0.69, 0.56 to 0.83) associated with ibuprofen. There was a significantly increased risk of major bleeding complications in the ibuprofen group during the admission period (2.09, 1.00 to 4.39).
Conclusions These data do not support the use of routine prophylaxis with NSAIDs in patients undergoing total hip replacement surgery.
Trial registration NCT00145730.

Obesity prevention and public health

More than 22 million children under five are now obese or overweight. Globally, an estimated 10% of school-aged children, between five and 17 years old, are overweight or obese, and the situation is getting worse. Although recognised clinically for some time as an important condition that increases risk of ill-health in affected individuals, it is only recently, that obesity has been recognised as a population-wide problem that requires preventive action. Obesity is a major contributor to diseases and disability, the associated health costs are enormous, obesity has already reached epidemic proportions in many countries, and incidence is continuing to increase in children and adults. Disturbingly the epidemic is not confined to developed countries, with many developing countries and those in transition affected. While recognised as a major population health problem, our understanding of the causes of the epidemic is poor, there has been relatively little population-based research that has focused on the prevention of unhealthy weight gain, and as a consequence knowledge regarding how and where best to intervene is limited. This book draws together the existing literature and expertise and with a view to helping set the agenda for public health action. The book is divided into three sections. Part 1 provides an overview of the context of the problem. It examines the epidemiology of obesity, the role of behavioural factors, socio-cultural factors and environmental factors in the obesity epidemic. Part 2 reviews interventions across a range of key settings and in different population groups - drawing on existing research that has aimed to increase physical activity, promote healthy eating and prevent obesity at a population level. Given how little research there is that has specifically examined the effectiveness of interventions aimed at preventing obesity per se, Part 3 explores potential opportunities to prevent obesity

Assessment of physical activity among primary school aged children: the Children's Leisure Activities Study (CLASS)

Overweight and obesity rates among children in Australia have increased twofold in the last decade. Physical activity is thought to play an important role in the prevention and treatment of childhood obesity. Children's physical activity data in Australia are incomplete and mainly based on parental proxy reports. One of the reasons for the lack of children's physical activity prevalence data in Australia is the difficulties of measurement. The aim of this study was to develop and examine a reliable, valid and feasible method for assessing physical activity among primary school aged children. A total of 112 grade 5 and 6 children and their parents were recruited from four state primary schools in the eastern and western suburbs of Melbourne. The test-retest reliability of a parental proxy physical activity questionnaire and a children's self report physical activity questionnaire was assessed. The criterion validity of the questionnaires was assessed using accelerometry. Findings suggest that the self report and proxy report questionnaires provided reliable measures of the type, frequency and duration of children's physical activity behaviour. Overall, the criterion validity of the questionnaires was poor. Although accelerometry as an objective measure shows promise, it does not provide the important physical activity behavioural and contextual information that is critical for the development of strategies to promote physical activity among children. We recommend that a combination of self report or proxy and objective measurement (using accelerometry or even pedometry) appears to be the current 'best buy' in the assessment of children's physical activity behaviour.