Background-Athletes who return to sport participation after anterior cruciate ligament reconstruction (ACLR) have a higher risk of a second anterior cruciate ligament injury (either reinjury or contralateral injury) compared with non-anterior cruciate ligament-injured athletes.

ABSTRACT. Objective. Eliminating health disparities, including those that are a result of socioeconomic status (SES), is one of the overarching goals of Healthy People 2010. This article reports on the development of a new, adolescent-specific measure of subjective social status (SSS) and on initial exploratory analyses of the relationship of SSS to adolescents' physical and psychological health.Methods. A cross-sectional study of 10 843 adolescents and a subsample of 166 paired adolescent/mother dyads who participated in the Growing Up Today Study was conducted. The newly developed MacArthur Scale of Subjective Social Status (10-point scale) was used to measure SSS. Paternal education was the measure of SES. Indicators of psychological and physical health included depressive symptoms and obesity, respectively. Linear regression analyses determined the association of SSS to depressive symptoms, and logistic regression determined the association of SSS to overweight and obesity, controlling for sociodemographic factors and SES.Results. Mean society ladder ranking, a subjective measure of SES, was 7.2 ؎ 1.3. Mean community ladder ranking, a measure of perceived placement in the school community, was 7.6 ؎ 1.7. Reliability of the instrument was excellent: the intraclass correlation coefficient was 0.73 for the society ladder and 0.79 for the community ladder. Adolescents had higher society ladder rankings than their mothers ( teen ‫؍‬ 7.2 ؎ 1.3 vs mom ‫؍‬ 6.8 ؎ 1.2; P ‫؍‬ .002). Older adolescents' perceptions of familial placement in society were more closely correlated with maternal subjective perceptions of placement than those of younger adolescents (Spearman's rho teens <15 years ‫؍‬ 0.31 vs Spearman's rho teens >15 years ‫؍‬ 0.45; P < .001 for both). SSS explained 9.9% of the variance in depressive symptoms and was independently associated with obesity (odds ratio society ‫؍‬ 0.89, 95% confidence interval ‫؍‬ 0.83, 0.95; odds ratio community ‫؍‬ 0.91, 95% confidence interval ‫؍‬ 0.87, 0.97). For both depressive symptoms and obesity, community ladder rankings were more strongly associated with health than were society ladder rankings in models that controlled for both domains of SSS. T he elimination of health disparities among different population segments, including differences related to socioeconomic status (SES), is the second overarching goal of Healthy People 2010. Recently, the American Academy of Pediatrics also recognized and highlighted the importance of addressing SES as an causative agent in the creation of health differentials and called for additional research to understand the impact of SES across the life course. 1 The inverse, graded relationship between SES and infant, child, and adult health is well established. [2][3][4][5][6][7][8][9][10][11] However, among adolescents, the SES gradient in health is present inconsistently. 12-15 A number of models have been proposed to explain the different patterning of SES effects on adolescent health. 2,16 Choosing the most appropriate model(s) has been...

Objective. To characterize disease activity patterns in a large cohort of children with juvenile idiopathic arthritis (JIA), by applying newly developed preliminary definitions of inactive disease, clinical remission on medication, and clinical remission off medication.Methods. Children with persistent or extended oligoarthritis, polyarthritis (either rheumatoid factor [RF] positive or RF negative), or systemic JIA who had been followed up for a period of at least 4 years were evaluated for episodes of inactive disease, clinical remission on medication, and clinical remission off medication. Descriptive statistics, correlation analyses, and survival analyses were performed.Results. Four hundred thirty-seven children met the criteria for review. Three hundred ninety-one patients (89%) experienced a total of 878 episodes of inactive disease, with a median episode length of 12.7 months. Two hundred twenty-eight episodes of inactive disease (26%) resulted in clinical remission off medication; it was equally as likely that episodes of inactive disease would or would not follow a period of clinical remission on medication. Thirty-six percent of episodes of clinical remission off medication persisted for at least 2 years, and only 6% of such episodes persisted for 5 years. RF-positive patients were the least likely to achieve clinical remission off medication (5%), and patients with persistent oligoarticular JIA were the most likely (68%). Among patients with persistent oligoarticular JIA, most of the disease course was characterized by inactive disease; in most other patients the majority of the disease course involved active disease.Conclusion. Using newly developed preliminary criteria for inactive disease, clinical remission on medication, and clinical remission off medication, we observed that only one-fourth of 878 episodes of inactive disease resulted in clinical remission off medication during followup of at least 4 years. Only a small proportion of episodes of clinical remission off medication were sustained for >5 years. These results highlight the critical need for therapies that have the ability to induce sustained remission of JIA.

Objective. To prospectively validate the preliminary criteria for clinical inactive disease (CID) in patients with select categories of juvenile idiopathic arthritis (JIA).Methods. We used the process for development of classification and response criteria recommended by the American College of Rheumatology Quality of Care Committee. Patient-visit profiles were extracted from the phase III randomized controlled trial of infliximab in polyarticular-course JIA (i.e., patients considered to resemble those with select categories of JIA) and sent to an international group of expert physician raters. Using the physician ratings as the gold standard, the sensitivity and specificity were calculated using the preliminary criteria. Modifications to the criteria were made, and these were sent to a larger group of pediatric rheumatologists to determine quantitative, face, and content validity. Results. Variables weighted heaviest by physicians when making their judgment were the number of joints with active arthritis, erythrocyte sedimentation rate (ESR), physician's global assessment, and duration of morning stiffness. Three modifications were made: the definition of uveitis, the definition of abnormal ESR, and the addition of morning stiffness. These changes did not alter the accuracy of the preliminary set. Conclusion. The modified criteria, termed the "criteria for CID in select categories of JIA," have excellent feasibility and face, content, criterion, and discriminant validity to detect CID in select categories of JIA. The small changes made to the preliminary criteria set did not alter the area under the receiver operating characteristic curve (0.954) or accuracy (91%), but have increased face and content validity. This criteria set has been approved by the American College of Rheumatology (ACR) Board of Directors as Provisional. This signifies that the criteria set has been quantitatively validated using patient data, but it has not undergone validation based on an external data set. All ACR-approved criteria sets are expected to undergo intermittent updates.As disclosed in the manuscript, these criteria were developed with partial financial support from industry sources. The industry supporters were not involved in any stage of criteria development. As a courtesy, the authors sent copies of submitted manuscripts to their industry supporters, but review and approval of the manuscripts were neither requested nor given.Although current ACR practice is to decline requests for review of criteria that have been supported by industry, an exception was made in this case due to prior ACR project support and because the ACR policy change took place after the industry support was solicited and received by the investigators. ACR is an independent professional, medical and scientific society which does not guarantee, warrant or endorse any commercial product or service. The ACR reviewed this manuscript on its merits and found the criteria to be methodologically rigorous and clinically meaningful. The ACR received no compensati...