Background:Osteoarthritis (OA) currently affects 10% of the American population. There has been a recent push to determine exactly what causes OA and how it can be treated most effectively. Serum vitamin D levels have been associated with OA and may have an effect on articular cartilage remodeling.Purpose:To critically review the published research on the effect of vitamin D on articular cartilage and the development of OA as well as on the mechanism behind cartilage regeneration and degeneration.Study Design:Review.Methods:A systematic search of PubMed and the Web of Science was performed for relevant studies published in the English language through April 30, 2016, using the terms vitamin D, articular cartilage, and osteoarthritis.Results:On a molecular level, 1α,25(OH)2D3, the activated form of vitamin D, plays a role in articular cartilage degeneration. Vitamin D binds to vitamin D receptors, triggering a signaling cascade that leads to chondrocyte hypertrophy. In clinical trials, vitamin D deficiency poses a risk factor for OA, and those with decreased cartilage thickness are more likely to be vitamin D–insufficient.Conclusion:The role of vitamin D supplementation in the treatment or prevention of OA remains uncertain. More research is needed to reconcile these conflicting findings.

This study investigates determinants of pediatric orthopedic surgery patients' parent or guardian (caregiver) satisfaction with the physician in an outpatient office setting. This was a cross-sectional survey study of 200 English-speaking caregivers of pediatric patients that checked into the pediatric orthopedic clinic at the authors' institution from 1 March 2017 to 1 November 2018. Questionnaires given in clinic include the Newest Vital Sign and The Literacy in Musculoskeletal Problems survey to measure general and musculoskeletal health literacy, respectively, demographic information, expected/ estimated wait time, Consultation and Relational Empathy Measure, and Consumer Assessment of Healthcare Providers and Systems Clinician and Group. After multivariate regression, only perceived physician empathy as measured by the Consultation and Relational Empathy Measure score was significantly correlated with caregiver satisfaction (P < 0.0001), accounting for 56% of the variability of caregiver satisfaction scores. The odds of a satisfaction score of at least 9 out of 10 were 21% higher for every unit increase of the Consultation and Relational Empathy Measure score [odds ratio = 1.21 (P < 0.0001)].After logistic regression, the caregiver's gender was also correlated with patient satisfaction and the odds of a patient satisfaction score ≥9 for males was less than 1/4th that of females [odds ratio = 0.16 (P = 0.040)]. The most important determinant of caregiver satisfaction with the physician in an outpatient pediatric orthopedic setting is perceived physician empathy. This accounts for the majority of the caregiver's satisfaction. This is the first study to determine this relationship in pediatric orthopedic surgery.

Empathy is the cornerstone of the patient–physician relationship and is consistently ranked by patients as one of the most important factors in the quality of their care. In this paper we examine the degree to which perceived physician empathy is associated with the characteristics of the caregiver (parent or legal guardian) and physician in pediatric orthopedic surgery. This was a cross-sectional survey study of 200 English-speaking caregivers of pediatric patients at a large children's hospital. The Consultation and Relational Empathy (CARE) Measure was used to measure perceived physician empathy. Only if the caregiver felt carefully listened to by the physician ( p-value < 0.001), and if the physician showed respect for what the caregiver had to say ( p-value = 0.007) were statistically significant and positively associated with perceived physician empathy. The most significant determinant of perceived physician empathy is whether the caregiver felt listened to during the encounter. Other factors such as caregiver demographics, health literacy, self-rated mental health, wait time, and time spent with the physician do not significantly affect perceived physician empathy.

Background: Approximately 33% of Americans have inadequate health literacy, which is associated with increased hospitalization and use of emergency care, poorer control of chronic diseases, infrequent use of preventative measures, and suboptimal treatment outcomes. Aims and Objectives: The purpose of this study was to evaluate the general and musculoskeletal health literacy of the parents or guardians (caregivers) of pediatric patients presenting to a general pediatric orthopedic clinic and identify risk factors for limited health literacy. Study Design: This cross-sectional study obtained a convenience sample of 200 English speaking caregivers of children presenting with musculoskeletal complaints. Caregivers who were taking their children for either first-time or follow-up visits were included in the study. Participants were excluded if they did not meet the aforementioned criteria, had any cognitive impairment, were unable to read English, or were unable to sign their own consent. Setting: The general pediatric orthopedic clinic of a large children’s hospital. Materials and Methods: Caregivers completed a demographic survey, the Literacy in Musculoskeletal Problems questionnaire, and the Newest Vital Sign to measure musculoskeletal and general health literacy, respectively. Statistics: The data was summarized using frequencies and proportions for categorical variables as well as mean and standard deviation for quantitative variables. In the univariate analysis the group comparisons were conducted using the chi-squared test for categorical variables. Multivariable logistic regression was used to model the odds of adequate musculoskeletal health literacy. Results: Limited musculoskeletal health literacy was seen in 46.7% of participants. Inadequate general health literacy was observed in 18.0% of participants. Non-Hispanics (p = 0.0210), those who worked in a health care (p = 0.0055), and those with a level of education of some college or greater (p = <0.0012) were more likely to have adequate musculoskeletal health literacy on multivariable logistic regression. Only at least some college experience correlated with adequate general health literacy (p = 0.003) upon multivariable logistic regression. Conclusion: Almost half of all caregivers who bring their children to a pediatric orthopedic clinic have limited musculoskeletal health literacy and may lack the necessary comprehension required for making informed decisions about their child’s care. Limited musculoskeletal health literacy is more prevalent than limited general health literacy.