bluuebunny/crossref_metadata_2025 huggingface dataset:
Sonographic comparison of transcutaneous stimulation versus percutaneus stimulation of the tibialis anterior: a pilot study
Authors: M. Sánchez Lorenzo , R. Seoane Pardo , M. Mira Llopis , S. Iannone Lado
Published: December 2019

Background and Aims Previous studies have evaluated electrostimulation of the tibialis anterior muscle via ultrasound. However, to the best of our knowledge, to date, no study has compared percutaneous stimulation compared to transcutaneous stimulation. The aim of this study was to analyze and compare the influence of percutaneous stimulation versus transcutaneous stimulation on the angle and muscle width of the proximal motor point of the tibialis anterior among healthy individuals using ultrasound.

Material and Methods A longitudinal prospective study. The study variables were muscle thickness and pennation angle, measured using ultrasound. A sample of 4 healthy individuals with a mean age of 35.25 years ( ± 2.17), mean height of 1.70m ( ±  0.03) and weight of 67.35kg ( ±  6.32), participated in this study. Stimulation was performed on the tibialis anterior of the dominant leg of each individual (n = 4). The subjects were seated in a vertical position. For position 1, the knee of the dominant leg remained completely extended and the ankle was fixed in a neutral position with an orthosis comprised of Velcro straps which immobilized the ankle and forefoot joints. For position 2, the knee remained flexed 90 degrees with the foot fixed in the orthosis and supported on the floor. The proximal motor point of the tibialis anterior muscle was located. A biphasic symmetric pulse current was used with the maximum tolerated intensity. Transcutaneous stimulation was performed via a small circular electrode, and for percutaneous stimulation a filiform acupuncture needle was used. To capture the ultrasound images, the probe was placed on a system with an articulated mechanical arm and a clamp that enabled the possibility of adjusting the height and/or angle and the position marked on the skin. Normality was contrasted using the Shapiro-Wilk test and sphericity was tested using the Mauchly's test. Analysis of variance was performed (ANOVA) for repeated measures.

Results The comparison of both techniques in position 1 did not show significant differences between the transcutaneous technique versus the percutaneous technique neither for the angle (F = 2.07; p-valor = 0.18), nor for the width (F =0.28; p-value = 0.60). In the case of position 2, significant differences were not found between the transcutaneous technique versus the percutaneous technique, neither for the angle (F = 0.28; p-value = 0.606) nor for the weight (F =0.11; p-value = 0.75).

Conclusions The comparison of transcutaneous stimulation versus percutaneous stimulation in the proximal motor point of the tibialis anterior does not seem to show statistically significant differences for muscle width nor pennation angle.
Musculoskeletal ultrasound as an indicator of physical condition in oncological patients
Authors: MC López-Garzón , I. Cantarero-Villanueva , EP Postigo-Martín , N. Galiano-Castillo
Published: December 2019

Background and Aim In 2018, cancer survival (colorectal and breast cancer) rates at five years are estimated at 68%, which is very promising data, however this makes cancer a chronic disease. The illness itself and its treatment negatively affect muscle strength, functional capacity and body composition of these patients. This hampers the performance of activities of daily living, work and leisure. In recent years, ultrasound has evolved as being a useful, simple and innocuous tool to evaluate the muscle architecture in different groups of the population.

Thus, the aim of this study was to determine whether the muscle architecture of the quadriceps, measured using ultrasound, is associated with muscle strength, functional capacity and body composition in patients with cancer (colorectal and breast cancer) who have completed medical treatment.

Material and Methods A sample of 11 patients (n = 2 breast cancer and n = 9 colorectal cancer) were recruited from the University Hospital Virgen de las Nieves (Granada). An analytical, observational, cross-sectional study was performed in which the width of the quadriceps was assessed (distance between the upper border of the rectus femoris muscle and the superior margin of the femur) in a cross-sectional image using ultrasound (SAMSUNG, HM70A, Seoul, KR) in the dominant lower limb. Furthermore, we evaluated isokinetic muscle strength of knee extensors to 300°/s and isometric muscle strength of the quadriceps using the dynamometer (Humac Norm, 502140, Stoughton, MA), functional capacity using the 6-minute walk test and the percentage of fat and musculoskeletal mass using bioelectrical impedance (InBody 720; Biospace, Seoul, KR). For the analyses, Pearson's correlation coefficients were used before adjusting by age and partial correlation coefficients adjusting by age using IBM SPSS Statistics 21 software (IBM Corporation, Armonk, NY).

Results The width of the quadriceps (mean ±  SD: 3.13 ±  0.57 cm) showed positive associations with isokinetic torque of extensors (r= 0.693), Q isometry (r = 0.657), musculoskeletal mass (r= 0.518), percentage of fat (r= 0.338) and functional capacity (r= 0.606); and negative associations with age (r= -0.158); although significance was only found for the isokinetic torque of extensors, quadriceps isometry and functional capacity (P < 0.05). The partial correlation of the isokinetic torque of extensors with the width of the quadriceps removing the effect of age was (r= 0.686, P= 0.029) and for quadriceps isometry (r= 0.650, P= 0.042). This partial correlation for functional capacity, removing the effect of age was r= 0.593 (P= 0.071).

Conclusion Ultrasound can be a useful tool as an indicator of physical condition, in terms of strength of oncological patients. These findings support the use of ultrasound in the clinical context of oncological physical therapy as a possible method of functional assessment.
Action of galvanic current on an experimentally generated muscle lesion: preliminary findings
Authors: MM Santafe , R. Margalef , F. Minaya Muñoz , F. Valera Garrido
Published: December 2019

Background Recently, Abat et al evaluated the effect of the application of galvanic currents on a model of muscle injury in the rat by injection of intramuscular Notexin. In mice, Notexin causes a lesion of the entire muscle when in humans, complete affectation is exceptional. In this study, we evaluated the action of the galvanic current on muscle regeneration in partially lesioned muscles with bupivacaine.

Aim To evaluate the action of the galvanic current in an animal model with partial muscle lesion generated with Bupivacaine.

Material and Methods The experiments were performed in adult male Swiss mice who were intramuscularly inoculated with Bupivacaine (BPV) in the posterior muscle bundle of the leg. The control subjects were inoculated with physiological saline (PS). The galvanic current protocol used in this study was 1.5mA during 5 seconds and 3 applications (1.5:5:3; Physio Invasiva®, Grupo Prim). The electromyographic recording was performed at 72 hours and at 7 and 10 days, after the first administration (Medelec Synergy Ultrasound machine, concentric recording needle). The number of areas presenting endplate noise were evaluated and the frequency of endplate noise for each of these areas.

Results Considering that the fibers which have been lesioned by bupivacaine are electromyographically silent, a registration of endplate noise was related with muscle regeneration. The number of areas with endplate noise considerably increased in the injured limb which received the galvanic current compared to the limb that was only lesioned in the first 72 hours. After this, there was no other modification in the number of areas. The frequency of the endplate noise of each area has been significantly greater in all the periods studied, indicating that galvanic current has facilitated muscle regeneration. It is worth noting that these are preliminary results and other more direct tests are pending.

Conclusions The functional findings uncovered in this study, enable us to establish that the application of galvanic currents in an animal model of muscle injury reduce the recovery time of the damaged muscle tissue.
Changes produced in the intramuscular tissue via dry needling measured with magnetic resonance imaging
Authors: L. Baraja-Vegas , P. Piqueras-Sanchiz , IJ Bautista , S. Martín Rodríguez
Published: December 2019

Introduction Myofascial trigger points are a common cause of pain and clinically observed local muscle sensitivity. The improvement associated with the muscle relaxation effect (reduction of muscle rigidity) produced by dry needling (DN) is still not well known. Thus, it is thought that the regeneration of the tissue that has been destructed by dry needling via the inflammatory process occurs with the return to normal muscle contractility.

Aims The aim of this study was to identify whether the local inflammatory effect is immediately induced by DN, using magnetic resonance imaging (MRI).

Material and Methods 18 asymptomatic patients were evaluated, with latent trigger points in the medial gastrocnemius (MG). We used an intergroup research design to study differences in MRI signal in the medial gastrocnemius, before and after performing DN. The MG which presented the most pain in response to pressure, was used as the experimental or intervention group, whereas the contralateral MG was used as the control group. MRI was used with signal intensity (STIR), to identify signal changes due to local inflammation. An ANOVA test was performed to analyze the influence of DN in the STIR variable and a Student's t-test for dependent samples was used to compare the perception of pain after DN.

Results The STIR increased by 128.97% after DN in the experimental group. The effect of the interaction showed significant differences (F (1.34) = 235, p = 0.0001, r = 0.93). The Bonferroni post hoc tests showed significant differences [differences in means and 95% confidence interval (95%CI) = 198 (172 - 224)] signal intensity (F (1.34) = 236, p = 0.001; r = 0.93; d = 5.03). Furthermore, a significant group was found (control vs. experimental group) after controlling for the effects of the intervention (F (1.33) = 9.95, p = 0.003, r = 0.48, d = 1.10). Regarding the perception of pain in response to pressure, a significant reduction was found between the pre and post intervention measurements (t (17) = 12.40, p = 0.001, r = 0.65, d = 1.71). The Pearson's correlation coefficient did not display any correlation among any variable.

Conclusion Intramuscular edema appears immediately after (1h) the application of DN, which indicates an inflammatory process with an unexpected reduction in pain perception. Our results are in line with other findings in mice which display signs of an inflammatory response after DN. A limitation of this study was the lack of further MRI measurements to detect when the edema resolved.
Parenteral Nutrition Therapy for an Achondroplastic Patient: Case Report
Authors: Pimentel Rodrigo Fernandes Weyll , Figueiredo Pedro Carlos Muniz
Published: December 2019

Introduction Achondroplasia is the most common form of dwarfism in humans. At the end of the twentieth century, achondroplasia had its natural history investigated and its morbimortality understood. In dwarves, obesity is one of the causes of morbidity, and it is difficult to evaluate it due to the great disproportion among anthropometric data. The characterization of the nutritional needs of these patients represents an interesting dilemma for physicians. In view of these difficulties, the present case report describes an alternative to obtain the ideal weight value of an elderly dwarf in the use of parenteral nutritional therapy.

Case Report A 73-year-old male patient, carrier of achondroplastic dwarfism, was admitted for surgical treatment of colon adenocarcinoma. He was submitted to total colectomy with ileum-rectum anastomosis, evolving with abdominal septic shock by suture dehiscence, which was fixed, and a protective ileostomy was installed. Due to the maintenance of prolonged fasting, without the possibility of starting oral or enteral feeding, the patient used total parenteral nutrition. To estimate the total energy expenditure, we chose to ask the patient what his ideal weight was. The patient used total parenteral nutrition for eight days until he was able to meet his caloric needs orally.

Conclusion In the absence of indirect calorimetry, the ideal weight mentioned by the patient seems to be a good option for the estimation of the caloric expenditure by simplified equations.
Micronutrient Influence in Thyroid Function: A Review
Authors: Nóbrega Aline Guerra Correia
Published: December 2019

The thyroid produces and secretes adequate amounts of hormones that regulate various physiological processes, including growth, development, metabolism, and reproductive function. The production and metabolism of thyroid hormones are dependent on micronutrients such as iodine, selenium, zinc and iron. Iodine is essential for the proper synthesis of thyroid hormones. The risk of iodine deficiency is high in places where the food consumed comes from iodine-deficient sources. To avoid complications, various government strategies have been developed to enrich food with this element. Selenium is incorporated in the deiodinases, which are enzymes that also play an essential role in the metabolism of thyroid hormones, in addition to contributing to the antioxidant defense in the thyroid. Zinc participates in the process of deiodination, in addition to being necessary for the T3 receptor to adopt its biologically active confirmation. Iron is found in hemeproteins, including thyroid peroxidase (TPO), which participates in the first two stages of thyroid hormone biosynthesis. Deficiencies of these elements can impair thyroid function. In general, the influence of micronutrients on thyroid function reveals the need for more research to increase scientific knowledge so that preventive and therapeutic measures can be taken regarding thyroid dysfunctions, to maintain a healthy thyroid.
Analgesia mediated by stress: Possible antalgic mechanism of the dry needling technique
Authors: D. Pecos Martín , I. Lázaro Navas , C. Lorenzo Sánchez-Aguilera , T. Gallego Izquierdo
Published: December 2019

Introduction and Aim One of the possible mechanisms of action of dry needling is stress-induced analgesia, produced by the activation of the sympathetic nervous system (SNS). Cortisol is a steroid hormone, which is considered to be the most representative indicator of physiological states that are altered after a stressful stimulus. Although studies of other invasive techniques exist which measure the cortisol levels, no studies on dry needling have been found which gather this stress indicator. Thus, the aim of this study was to determine the changes produced in the levels of cortisol concentration in saliva after the application of the dry needling technique.

Material and Methods Sixty-two healthy volunteer subjects participated in this randomized controlled single blinded trial performed at the University of Alcalá. Participants were randomly distributed into two intervention groups: deep dry needling (n = 33) and placebo needling (control) (n = 32). The saliva samples were gathered prior to the intervention and 3 minutes after finalization of the same. The level of cortisol in saliva was determined in a laboratory by performing a solid phase enzyme immunoassay using the ELISA® kit. Statistical significance was set at p < 0.05. The differences between both groups were compared based on the percentage of change between the initial level and at three minutes via the Student's t-test for independent samples, estimating the effect size via the Cohen's d test.

Results An increase of the levels of cortisol in saliva of 11.27% ± 4.76 was observed after the deep dry needling; in the group of placebo needling, an increase of 1.51% ± 3.08 was observed. However, when comparing both groups, no statistically significant differences were obtained (p = 0.920), with an effect size of d = 0.42.

Conclusions The dry needling technique leads to an increase in the release of cortisol, one of the hormones involved in the sympathetic-excitatory relationship. This could be related to one of the possible effects of this invasive procedure with mechanisms of stress-induced analgesia. However, further studies are required to deepen our knowledge on the plausible physiological effects which support the application of the dry needling technique.
Effectiveness of percutaneous needle electrolysis and eccentric exercise in chronic Achilles tendinopathy. A case series
Authors: FJ Cerdán Fabregat
Published: December 2019

Objective The objective of the study was to evaluate percutaneous needle electrolysis (PNE) and exercise with eccentric overload on the tendon body in chronic Achilles tendinopathy.

Material and Methods An experimental study involving seven subjects with a total of seven tendons with a medical diagnosis of chronic tendinopathy on the body of the Achilles tendon. A sample of five men (71.43%) and two women (28.57%) with a laterality of five right tendons and two left tendons. The mean age was 34 years (SD: 7.22), 42.86% of the sample was active, practicing regular sports activity (57.14%) at the amateur level. All tendons had over six-weeks evolution. Pain was assessed using the visual analogue scale (VAS) and functionality was analyzed using the VISA-A scale, whereas tendon structure was evaluated using musculoskeletal ultrasound. All subjects belonged to the same group and were applied the same treatment; three sessions of PNE, additionally, eccentric exercise was added every 48 hours after each intervention. This involved a total of six eccentric sessions. A seven-day period was allowed between the first and second session of PNE, whereas between the second and third session, 14 days were allowed.

Results In the initial evaluation, the VAS score was 7.14 points (SD: 0.83) and the VISA-A scale was 34.86 points (SD: 3.72). On the ultrasound examination, the VAS presented changes as a degenerative process. After five weeks, the values on the VAS scale decreased by 75.4% and on the VISA-A scale they increased by 35.2%.

Conclusions The combined programs of PNE plus eccentric exercises are an effective treatment for chronic tendinopathy of the Achilles tendon body.
Coronary Sinus Filling Time as a Predictor of Coronary Microvascular Obstruction and Future Cardiovascular Events after Elective Left Anterior Descending Artery Stenting
Authors: Ramakrishnudu Anakala , Rao Vavilala Satish Kumar
Published: December 2019

Objective The main objective of this article is to study the usefulness of coronary sinus filling time (CSFT) as a predictor of coronary microvascular obstruction (CMVO) and future cardiovascular (CV) events after percutaneous coronary intervention (PCI) for left anterior descending (LAD) in stable coronary artery disease patients.

Materials and Methods We analyzed 50 patients with stable angina who underwent elective PCI for single LAD significant stenosis. After stent deployment, coronary sinus was visualized in left anterior oblique 40 degree cranial 30 degree views, CSFT, and corrected thrombolysis in myocardial infarction frame count (cTFC) calculated from frame count. Post-procedure electrocardiographic changes noted and cardiac biomarker creatine phosphokinase and creatine phosphokinase-myocardial band levels estimated, and follow-up was done for 6 months. Patients classified into two groups: Group 1 with major adverse cardiac events (MACE) and Group 2 (without MACE). CSFT and cTFC measurements were compared among the two groups.

Results Out of 50 patients who were recruited in the study, Group 1 comprises 20 patients, and Group 2 comprises 30 patients. Among the Group 1, 40% were females, while in Group 2, they were 16%. Group 1 showed high CSFT values compared to Group 2, and such are post-procedure ST, T changes (90% in Group 1, 20% in Group 2), cardiac biomarkers elevation (80% in Group 1, 23.3% in Group 2). At 6 months follow-up ejection fraction was lower in Group 1 (31.8 ± 6.4%) compared with Group 2 (58.8 ± 5.8%) at p < 0.0001, and angina (85%) versus (20%). Mean CSFT was significantly more in Group 1 (5.77 ±0.75s) compared with Group 2 (4.61 ± 0.55s) at p < 0.0001. With respect to cTFC, no significant differences were seen between the two groups (p < 0.5628). Receiver operating characteristic curve analysis showed CSFT of > 5.2s was the best cutoff value to differentiate the two groups.

Conclusion CSFT significantly prolonged in patients with adverse cardiac events, and it may be used as a simple and quantitative predictor of CMVO and future CV events after elective PCI.
The Role of Platelets in Premature Neonates with Intraventricular Hemorrhage: A Systematic Review and Meta-Analysis
Authors: Grevsen Alexander K. , Hviid Claus V. B. , Hansen Anne K. , Hvas Anne-Mette
Published: December 2019

Intraventricular hemorrhage (IVH) affects up to 22% of extremely low birth weight neonates. Impaired coagulation might contribute to the pathogenesis of IVH. The aims of this study were to summarize the current knowledge on the role of platelet indices in premature neonates with IVH and to provide an overview of secondary hemostasis parameters as well as fibrinolysis in premature neonates with IVH. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The databases PubMed, Embase, Scopus, and Web of Science were searched on March 7, 2019, without time restrictions. In total, 30 studies were included. Most studies investigated the significance of platelet counts and/or mean platelet volume (MPV). The meta-analysis showed that at day 1 of life, neither platelet count nor MPV differed significantly between neonates with or without IVH (standardized mean difference [SMD]: –0.15 × 109/L, 95% confidence interval [CI]: –0.37 to 0.07 and SMD: 0.22 fl, 95% CI: –0.07 to 0.51, respectively). However, platelet counts < 100 × 109/L were associated with an increased risk of IVH. Secondary hemostasis parameters did not differ between neonates with and without IVH. Fibrinolysis was only sparsely investigated. In conclusion, platelet counts < 100 × 109/L were associated with an increased risk of IVH in premature neonates. The impact of secondary hemostasis was only sparsely investigated but seemed to be minor, and the role of fibrinolysis in IVH in premature neonates needs further research. Whether reduced platelet function is associated with an increased risk of IVH in premature neonates remains to be investigated.
Clinical criteria for the application of percutaneous needle electrolysis in tendinopathies: An expert Consensus cocument and cross-sectional study among physical therapists
Authors: Valera Garrido Fermín , Polidori Fernando , Benavent Canet Jerónimo , Botet Francesc i Sicarrats , Martínez Ramírez Pablo , Calvo Sandra , Belsué Pastora Javier , Minaya Muñoz Francisco
Published: December 2019

Introduction Percutaneous needle electrolysis is a technique of invasive physical therapy which has been applied successfully in tendinopathies over the last decade. This study sought to explore the opinion and criteria employed by physical therapists who apply this technique in tendinopathies.

Material and Methods A cross-sectional study based on a survey of 15 questions to gather the sociodemographic characteristics of attendees and to examine four dimensions associated with the application of percutaneous needle electrolysis (indications, dosage, ultrasound-guidance, supporting therapies). The participants voted on the survey simultaneously after installing the “Votephone” App on their mobile phones or smartphones.

Results The study participants included 212 people who attended the CIFI 2018 conference and four experts. Of those who responded, 74.5% were men, who were mainly dedicated to clinical work (91.8%), and were aged between 25 and 45 years (97.6%). Electrolysis was used by 79% of respondents in their daily practice, for which 32.89% had over six years' experience. Percutaneous needle electrolysis was considered the therapy of choice in the treatment of tendinopathies for 91.03% of respondents, whereas 98.67% used it in situations of chronicity, and for tissue repair purposes (85%). Of all people surveyed, 97.74% considered that ultrasound guidance was essential for its application, employing intensities of between 2-4 mA (59.60%) and combined with therapeutic exercise (77.78%). Ultrasound in B mode (50.85%) and palpation with the needle and reproduction of symptoms (47.46%) are the criteria used to define the area of intervention.

Conclusions Percutaneous needle electrolysis is often used by physical therapists in chronic tendinopathies, applying high intensities (2-4 mA) aimed at repair of the damaged tissue. Attendees considered that the use of ultrasound for assessment and as a guide for the intervention is essential to guarantee a safe application and improve effectiveness. Percutaneous needle electrolysis is most commonly associated with therapeutic exercise.
Two closed ATP- and ADP-dependent conformations in yeast Hsp90 chaperone detected by Mn(II) EPR spectroscopic techniques
Authors: Giannoulis Angeliki , Feintuch Akiva , Barak Yoav , Mazal Hisham , Albeck Shira , Unger Tamar , Yang Feng , Su Xun-Cheng , Goldfarb Daniella
Published: December 2019

Significance

Hsp90 is a homo-dimeric chaperone regulating clients involved in tumorigenesis and signal transduction. Its mechanism of action depends on ATP hydrolysis, which is coupled to a conformational cycle, including “closed” and “open” conformations involving the dimerization of the N-terminal domains, which comprise the ATP binding site. The ATP-bound closed conformation is important for chaperoning activity, while an ADP-bound closed conformation was suggested crucial for client release. We resolved 2 different closed ATP- and ADP-bound conformations for yeast Hsp90 in frozen solutions by measuring Mn(II)–Mn(II) distance distributions, with Mn(II) replacing the essential Mg(II) cofactor in the ATPase site. These results add to our understanding of the mechanism of Hsp90 and set the stage for studies in presence of cochaperones and substrates.
Are predictive equations a valid method of assessing the resting metabolic rate of overweight or obese former athletes?
Authors: Jesus Filipe , Nunes Catarina L. , Matias Catarina N. , Francisco Ruben , Carapeto Bárbara , Macias Hugo , Müller Diogo , Cardoso Miguel , Valamatos Maria J. , Rosa Gil , Sardinha Luís B. , Martins Paulo , Minderico Cláudia S. , Silva Analiza M.
Published: December 2019

Athletes retiring from their sports career, an understudied population, are susceptible to become overweight/obese because of decreased energy expenditure not followed by a reduction in energy intake. Therefore, their energy requirements, through resting metabolic rate (RMR), should be accurately addressed for weight management purposes. This study aimed to determine the validity of predictive equations (PEq) for RMR estimation using indirect calorimetry as the reference method in a sample of overweight/obese former athletes. The study uses cross‐sectional data collected during baseline measurements of a lifestyle intervention (NCT03031951). The RMR of 56 overweight/obese (31.5 (4.0 kg/m2)) individuals (78.6% male, 37.5% obese, 95.8 (14.8 kg), 174.2 (8.7 cm)) was measured by indirect calorimetry and predicted using seven PEq: Harris‐Benedict, Cunningham, Schofield, FAO/WHO/UNU, Owen, Mifflin‐St. Jeor, and Katch‐McArdle. Dual‐energy X‐ray absorptiometry was used to assess body composition. The PEq overestimated the RMR measured by the indirect calorimetry, 70–300 kcal/day (4.3–14.9%). The linear regression between the reference and each of the PEq did not differ from the identity line with estimated values explaining around 50% of the variability of the measured values. The agreement between the methods was weak for all the PEq showing wide limits of agreement. The Harris–Benedict equation was the only one in which the difference between the methods was not related to the magnitude of the measured RMR. Given the weak performance of the various RMR models in overweight/obese former athletes, an effective weight management intervention based on estimated resting energy requirements may be compromised.
Pilot Randomized Controlled Trial of a Digital Storytelling Intervention for Smoking Cessation in Women Living With HIV
Authors: Kim Sun S , Lee Sang A , Mejia Jeannette , Cooley Mary E , Demarco Rosanna F
Published: December 2019

Background

People living with HIV in the USA smoke at a rate nearly three times that of the general population, and Black women are disproportionately affected by HIV infection.

Purpose

This study was conducted to test the preliminary efficacy of a digital storytelling intervention for smoking cessation in U.S. women living with HIV.

Methods

Participants in the treatment arm viewed a film in which women living with HIV talk about quitting smoking, and those in the control arm viewed an attention-control film in which women talk about living with HIV infection. Participants in both arms received eight weekly video-call counseling sessions focused on smoking cessation and nicotine patches or gum during the same period. Participants were followed on a monthly basis from quit day for 3 months.

Results

Of the 53 participants randomized, four withdrew before receiving any intervention, one dropped out during the intervention, and 48 (90.6%) completed the study. No difference was found in the baseline characteristics between the two arms with the exception that the treatment arm had higher nicotine dependence scores [t(1.51) = 2.30, p = .03] than the control arm. Seven day point-prevalence abstinence rates at 3 month follow-up were not found to differ between the two arms. However, the odds of achieving 3 month prolonged abstinence were four times greater (odds ratio = 4.23, 95% confidence interval = 1.10, 16.23) in the treatment arm than the control arm when the analysis was performed with those (n = 49, 92.5%) who received any part of the allotted intervention.

Conclusions

A digital storytelling intervention seems to be a valuable strategy to enhance the effect of conventional tobacco dependence treatment for women living with HIV. However, the underlying mechanism of the effect of digital storytelling necessitates further investigations in a large RCT.

Clinical Trials Registration No. NCT03289676
Babies Rule! Niches, Scaffoldings, and the Development of an Aesthetic Capacity in Humans
Authors: Portera Mariagrazia
Published: December 2019

Where does the human aesthetic come from? How does it develop? By introducing the notion of the ‘niche’ (‘aesthetic niche’) as a key term in an empirically and evolutionarily informed aesthetics, this paper aims to take a fresh look at these and similar questions. It also aims to shed new light on the development and functioning of the aesthetic capacity in humans and its trans-generational transmission. Drawing on recent research developments in evolutionary biology, developmental psychology, and cognitive sciences, I shall argue that the human aesthetic capacity—which I understand as the capacity, involving perceptual, cognitive and emotional processes, to enter into a pleasurable/non-pleasurable and expressive relation with objects, artworks, natural phenomena, or other people—relies on constructed environmental resources (that is, on a niche) for its emergence and its ontogenetic development.
07 Examination of Reliability and Validity of Index of Postural Stability for Patients with Neurological Diseases
Authors: Mochizuki Hisashi
Published: December 2019

Purpose

The purpose of this study was to examine the reliability and validity of the Index of Postural Stability for patients with neurological disease.

Methods

The Index of postural stability (IPS) is a logarithmic value of the ratio between the stability limit and the area of centre of pressure (COP) in standing position, and is based on a probabilistic idea. Subjects were 75 patients with neurological disease (mean age; 63±12 years, 47 with Parkinson's disease, 9 with multiple sclerosis, 8 with Parkinsonism and others 11). Balance ability of subjects were assessed using IPS, Berg balance scale (BBS), Timed Up and Go Test(TUG), Functional Reach Test(FR), and gait ability of subjects were assessed using Functional Gait Category(FAC). IPS was assessed twice at intervals of about 30 minutes. Reliability of IPS was examined using Intraclass correlation coefficient (ICC), Bland-Altman plot and minimal detectable change (MDC). Validity of IPS was examined using correlation coefficients with BBS, TUG, FRT, and FAC.

Results

IPS showed significant and moderate correlation with BBS (r = 0.54), FR (r = 0.36), TUG (r =-0.43). IPS and FAC showed strong correlation (rs= 0.64). ICC of 2 separate measurements was 0.96. From the results of Bland-Altman plot, IPS had no additional error or proportional error (95%CI:-0.048~0.034, r=-0.0088, p=0.94). The MDC of IPS was 0.34.

Discussion

Since IPS has high reproducibility and does not have additional errors or proportional errors, and is also significantly related to other evaluation indexes of balance ability, it is considered that IPS may be a useful evaluation index of balance ability for patients with neurological diseases.
08 Evidence Base for Treatment of Osteoporosis in Older People
Authors: Masud Tahir
Published: December 2019

After the age of fifty years the prevalence of osteoporosis and incidence of osteoporotic fractures rise substantially with age. It is ironic however that the pivotal trials for the common drugs used to treat osteoporosis mainly recruited participants under the age of 80 years leading some to question the use of these drugs in the older population. This talk explores the evidence accumulated for the treatment of osteoporosis in the frailer older population.

The FOSIT trial showed a 47% reduction in non-vertebral fractures with alendronate in people up to 84 years, and a study in long term care in those up to 91 years showed a significant improvement in bone density at the spine and hip. A post hoc analysis of the risedronate HIP trial in people aged 70-100 years with established osteoporosis showed a 47% reduction in hip fractures. In the zoledronic acid Horizon studies fractures were significantly reduced in a population up to the age of 89 years and mortality was reduced by 28%, with half of the participants being older than 75 years. Interestingly a post hoc analysis showed that those participants who ended up having only a single infusion had a reduction of all clinical fractures at 3 years.

The Freedom trial of denosumab was performed in a population aged up to 90 years with significant fracture reduction across all age groups. Studies with the anabolic agent teriparatide showed that vertebral and non-vertebral fracture reduction occurred in both the under and over 75 age groups. Trials with the recently developed agents abaloparatide and romosozumab have shown significant fracture reductions in populations up to ages of 86 and 90 years respectively.

There is now enough evidence to suggest that the oldest old should be considered for osteoporosis treatment as well having a focus on falls reduction.
09 Characteristics of Community Fallers and the Diagnosis of Osteoporosis in the Falls Clinic of a Public Tertiary Hospital
Authors: Nadarajah Reena , Pang Gordon Hwa Mang , Chong Elizabeth Gar Mit , Razali Rizah Mazzuin , Lee Fatt Soon , Yau Weng Keong
Published: December 2019

Introduction

Osteoporosis is a chronic asymptomatic condition. The US National Bone Health Alliance recommends that osteoporosis may be diagnosed by bone mineral density (BMD) testing, the occurrence of low-trauma fractures or through the use of fracture risk algorithms. However, osteoporosis has low screening rates despite having clear treatment benefits.

Methodology

This study aimed to describe the characteristics of patients in the falls clinic with and without osteoporosis and the ways by which diagnosis of osteoporosis was made. A retrospective, descriptive study was carried out on all patients who attended the falls clinic from January 2015 till March 2019, with data collected from its falls database.

Results

A total of 117 patients were included in this study. All patients had a history of fall, either single or recurrent. 43 patients had osteoporosis, of which 72.1% were female (p value <0.05). In this study, age and ethnicity were not found to be risk factors for osteoporosis. Polypharmacy, having three or more comorbidities along with alcohol and smoking habits were also not significantly associated with osteoporosis. This study also showed no differences in terms of history of recurrent falls and level of mobility between the two groups of patients. Of the 43 patients with osteoporosis, six patients (14.0%) were diagnosed by BMD testing prior to their attendance at the falls clinic. 24 patients (55.8%) had a presumptive diagnosis of osteoporosis made based on prior fragility fracture, of which majority were vertebral fractures (45.8%); and the remaining 13 patients (32.0%) were diagnosed to have osteoporosis by BMD testing after their visit to the falls clinic.

Conclusion

Most patients who attended the falls clinic have had a prior fragility fracture, which could have been prevented by treatment. Screening for osteoporosis should therefore be carried out more robustly in the community to prevent injurious falls.
100 Knowledge of Nurses about the Morse Falls Scale
Authors: Ramli Roslawati , Chong Elizabeth G M , Yau Weng Keong
Published: December 2019

Introduction

Falls in the hospital is common. Morse Fall Scale was introduced in 2013 to Hospital Kula Lumpur as a tool for risk assessment in order that prevention strategies could be instituted in accordance to the falls risk. However, the rate of falls was on the rise in the last 5 years despite the use of the tool. The concern was that there is a lack of understanding in the use of the tool or that the scoring was not performed correctly by the nurses.

Method

A validated structured questionnaire regarding the knowledge of Morse Fall Scale was distributed to the registered nurse of the Medical Department Hospital Kuala Lumpur.

Results

209 responses to the questionnaire were collected. The average correct answers were 7 points. Almost a quarter of the nurses had less than 5 correct answers. 50% of this group of nurses has less than 5 years of working experience; most of them only had a diploma and were working in the active medical wards. 17% had full scores, in which 92 % of them had more than 5 years’ experience and had higher nursing qualifications. Overall, the nurses with longer working experience scored 1 point higher than those with a diploma. However, there is no difference in the average score with regards to their place of work, either in clinic or ward. The highest scoring (97.6%) question was the question regarding the purpose of Morse Falls Scale. The least correctly answered (41.6 %) was the question regarding the number of categories in the Morse Falls Scale.

Conclusion

The nurses with more experience understood the use of the scoring and usage of the Morse Falls Scale better. Generally, with an average score of only 7 out of 10, may reflect an inadequacy in the understanding in falls prevention.

References

1. SG Lim, SW Yam. The level of knowledge and competency in the use of the Morse Fall Scale as an assessment tool in the prevention of patient falls, IeJSME, 2016, 10(3): 14-23

2. Cruza S, AL Carvalho P, Barbosa BL. Morse fall scale user’s manual: Quality in supervision and in nursing practice. Procedia - Social and Behavioral Sciences 2015; 171: 334–9.

3. Enein NAE, Ghany ASAE, Zaghloul AA. Knowledge and performance among nurses before and after a training programme on patient falls. Open Journal of Nursing 2012; 2: 358–64.
104 Sociodemographic, Cognitive & Physical Function Characteristics among Older Adult Fallers with and without Cognitive Frailty: Preliminary Results
Authors: Murukesu Resshaya , Singh Devinder Kaur Ajit , Shahar Suzana , Subramaniam Ponnusamy
Published: December 2019

Introduction

Older adults with frailty and cognitive impairment are more susceptible to falls. The risk factor of falls and faller profiles among older adults in general has been established. However, information regarding potential risk factors and faller patterns among older adults with cognitive frailty is limited.

Objective

To examine the sociodemographic, cognitive and physical function characteristics of fallers with and without cognitive frailty.

Methods

A total of 133 community dwelling older adults aged 60 years and above were screened at three older adult activity centres in Kuala Lumpur. Sociodemographic details were obtained via interview. Cognitive Frailty was identified using the Clinical Dementia Rating Scale and Fried Frailty Index. Cognitive function was assessed using the Mini Mental State Examination (MMSE), Digit Span (DS) test and Ray Auditory Verbal Learning Test (RAVLT). The Senior Fitness test was used to asses physical function. Characteristics of falls were documented using a self-administered questionnaire. Data was descriptively analysed; independent T-test was used for continuous variables and chi-square test was used for categorical variables.

Results

Prevalence of falls was 21.1% (n=28). Within fallers, 42.9% (n=12) were cognitively frail and 57.1% (n=16) were not. Fallers with cognitive frailty were significantly older (mean age = 72.31±5.29) (p<0.001), had lower MMSE scores (p<0.01), lower 2 Minute Step test scores (p<0.001) and lower Lawton Instrumental Activities of Daily Living scores (p<0.05). Descriptively, fallers with cognitive frailty were mostly recurrent fallers (67%), sustained falls outdoors due to ‘slip and fall’ and majority sought medical attention after the fall(s).

Conclusion

Fallers with cognitive frailty were older and had lower physical and cognitive function as compared to those without. There is a need to further understand the relationship between falls and cognitive frailty in order to provide holistic fall prevention and management strategies.

Acknowledgement of grant

UKM(DCP-2017-002/2) and Ministry of Higher Education(LRGS/BU/2012/UKM-UKM/K/01).
106 Responding to the First Fall to Prevent the Second: Successful RCT in Reducing Falls using a Person Centred Approach for Older Fallers Presenting to Emergency Departments
Authors: Hill Keith , Barker Anna , Cameron Peter , Flicker Leon , Arendts Glenn , Brand Caroline , Morello Renata , Etherton-Beer Chris , Forbes Andrew , Haines Terence , Hill Anne-Marie , Hunter Peter , Lowthian Judith , Nyman Samuel , Redfern Judith , Smit DeVilliers , Waldron Nicholas , Boyle Eileen , McDonald Ellen , Ayton Darshini
Published: December 2019

Background

The majority of older people who fall and present to Emergency Departments (EDs) are reported not to receive guideline level care to reduce future risk of falls. The aim of this randomized controlled trial was to evaluate whether RESPOND, a 6-month telephone-based patient-centred program had an effect on falls and fall injuries in older people presenting to ED after a fall.

Methods

541 older fallers who presented to a WA or Victorian ED were recruited (inclusion criteria: discharged home <72 hours, could walk without hands-on assistance, use a telephone, and no cognitive impairment (MMSE>23). Intervention participants (n=263, mean age=73) received the RESPOND intervention, comprising (1) home-based risk assessment; (2) six months telephone-based education, coaching, goal setting and support for evidence-based risk factor management; and (3) linkages to existing services; while controls (n=260, mean age=73) received usual care. Primary outcomes were falls and fall injuries in the 12-month follow-up. Secondary outcomes included ED presentations, hospital admissions, fractures, death, falls risk, falls efficacy and quality of life.

Results

Falls rate was significantly lower in the RESPOND group (incidence rate ratio 0.65 [95%CI 0.43-0.99]; p=0.042). Although there was no significant difference in fall injuries (p=0.374), the rate of fractures was significantly lower in the RESPOND group (p=0.03). There were no significant group differences in other secondary outcomes.

Conclusion

The RESPOND falls prevention program reduced falls and fractures, in older people presenting to the ED with a fall. Key learnings for translation include: potential scalability and sustainability of a patient-centred and predominantly telephone-based program.
111 Disparities between Actual and Perceived Fall Risk Affect Participation in 5 Fall Prevention Interventions
Authors: Tan Pey June , Sim Silvia , Ismail Noor Hafizah , Mallya Jagadish , Chan Angelique , Wong Chek Hooi
Published: December 2019

Introduction

Older adults have been found to under- or overestimate their fall risk. However, no studies have investigated implications on help-seeking behaviours in falls prevention. This study examines how disparities between actual and perceived fall risk affects participation in 5 fall prevention interventions among community-dwelling older adults in Singapore.

Methods

This was a cross-sectional survey of a nationally representative sample of community-dwelling adults aged ≥60 years in Singapore identified by stratified random sampling. Having previous falls in the past 12 months (faller/non-faller) indicated actual fall risk. Level of fear-of-falling (cut-off ≥23 on 16-item Falls Efficacy Scale International) was used as perceived fall risk (high/low). Four profiles based on combinations of actual and perceived risk were associated with participation in 5 fall prevention interventions in a multiple logistic regression. The model was adjusted for age, gender, ≥2 comorbidities and knowledge that the intervention is to prevent falls.

Results

Final analysis included 549 older adults (mean age 70.6±6.9 years, 61% females). Majority (46%) were in the Vigorous group (no falls, low fear), 35% Anxious (no falls, high fear), 11% Frail Aware (falls, high fear) and 8% Stoics (falls, low fear). Only those in Anxious and Frail Aware group were significantly more likely to have talked to a healthcare professional on strategies to avoid falls [OR 1.8 (1.1-3.1) and 3.2 (1.6-6.4) respectively] and made home modifications [OR 1.9 (1.3-2.8) and 2.0 (1.1-3.6)] after adjustments. No association was found for participation in exercise, medication review and falls education.

Discussion

Individual profiles with high fear-of-falling component have different help-seeking behaviours compared to those with low fear regardless of history of falls. However, individuals in Frail Aware group have higher likelihood to uptake the interventions compared to Anxious group. Future research should examine other drivers of behaviour that will influence participation in other interventions.