Background: The 155° Grammont reverse shoulder replacement has a long track record of success, but also a high radiographic notching rate. The increased distance between the scapular pillar and the humeral component theoretically decreases postoperative notching. The glenoid component can be shifted inferiorly relative to the glenoid; however, there also is some concern that shifting the glenoid component too far inferiorly (inferior glenoid component overhang > 3.5 mm) may compromise long-term stability of the glenoid component. This study was conducted to determine if clinical outcomes, scapular notching, and complications vary with more inferior placement of the glenoid component. Methods: A retrospective analysis of prospectively collected data was performed in order to compare radiographic outcomes (notching rate and signs of glenoid loosening or component disassembly) and clinical outcomes (range of motion, Constant score, subjective shoulder value, and complication rate) of all patients who underwent reverse shoulder replacement with the glenosphere positioned either flush with the inferior rim of the glenoid (flush group) or with at least 3.5 mm of inferior overhang (overhang group) at a minimum follow-up of 60 months. Ninety-seven patients ultimately met the inclusion criteria, with 41 patients with flush glenoid component and 56 patients with at least 3.5 mm of inferior overhang. Results: Average follow-up was 97.8 months. The overhang group had a lower rate of radiographic notching (37% vs. 82.5%, p < 0.05), better clinical outcomes (improvement in Constant score: +40 vs. +32, p = 0.036), and higher subjective shoulder value (79 vs. 69, p = 0.026) than the flush group. No difference in complications between groups was found. Conclusions In this study, at least 3.5 mm of inferior glenosphere overhang relative to the inferior rim of the glenoid was associated with the lower notching rate without negative effect on the clinical outcomes in 155° Grammont-style reverse shoulder replacement. Therefore, no increase in complications should be expected when using this surgical technique.

OBJECTIVETo calculate the actual expenditures in a county of Dehong prefecture, Yunnan province, China by using the method of National AIDS Spending Assessment (NASA) in 2010.

METHODSData were collected through NASA data collection form based on adapted NASA classification in the county of Dehong prefecture from October to December, 2011, and complemented by semi-structured interview with 16 well trained programmatic and financial representatives in 8 spending units. Data were entered in Resource Tracking Software (RTS) V 2009.3.0, and SPSS 13.0 was used for data processing and analysis.

RESULTSThe NASA estimations showed that the county spent a total of ¥16 235 954 on HIV/AIDS in 2010. Public funds constituted 96.3% of the total expenditure (¥15 630 937), followed by Global Fund which accounted for 3.0% (¥484 585) and private sources which accounted for 0.7% (¥120 432). Findings based on NASA categories showed that AIDS spendings were mainly on 4 areas, and expenditure on Care & Treatment was ¥12 401 382 (76.4% of total expenditure), followed by Prevention which accounted for 14.3% (¥2 325 707), Program Management & Administration which accounted for 7.8% (¥1 268 523) and human resources which accounted for 1.5% (¥240 342). The most beneficial population group was People Living with HIV (PLHIV), accounting for 84.7% of total expenditure. (¥13 753 428), followed by 4.8% for high risk population, including female sex workers and their partners (¥297 333), injection drug users and their partners (¥293 143), men having sex with men and their partners (¥185 136) and 1.5% (¥241 429) for the general population.

CONCLUSIONThe local funds for HIV/AIDS in this county was insufficient. The local government should increase corresponding funds based on central government funding. Care and treatment was the first spending priority in the county and the investment of prevention services needs to be increased. Prevention and treatment and care should be combined to ensure the effectiveness of comprehensive prevention and treatment of AIDS.

Acquired Immunodeficiency Syndrome ; economics ; prevention & control ; China ; Financing, Government ; economics ; Health Expenditures ; Humans ; Outcome and Process Assessment (Health Care) ; Surveys and Questionnaires