Are primary care physicians ill equipped to evaluate and treat childhood physical inactivity?

ABSTRACT

Objective

To investigate primary care physician clinical practice patterns, barriers, and education surrounding pediatric physical activity (PA), and to compare practice patterns by discipline.     

Trajectory of adherence to home rehabilitation among older adults with hip fractures and cognitive impairment

This study aimed to identify different trajectories of adherence to home rehabilitation for older adults with hip fracture and cognitive impairment, to examine associations between different adherence trajectories and postoperative recovery outcomes, and to explore the predictors of adherence trajectories. Group-based trajectory modeling showed two adherence trajectories: low (39.06%) and high (60.94%) adherence. The high adherence group had better activities of daily living (β=11.77, p<.001), instrumental activities of daily living (β=0.56, p<.01), femoral muscular strength (β=3.35, p<.01) on the fractured side and quality of life (β=-0.81, p=.02) than the low adherence group. Participants who established exercise habits (OR=6.49, p<.01) and consulted a physical therapist (OR=4.29, p=.03) during hospitalization were more likely to be in the high adherence group.     

Distal biceps rupture: Evaluation and management

Injury to the distal biceps occurs in certain high risk groups. Anatomical continuity of the lacertus fibrosus has bearing on the extent of retraction of the torn tendon stump. The objective of clinical and imaging evaluation is to discriminate between tendinosis, partial tear, acute complete tear and chronic complete tear. A complete tear of the distal biceps tendon can be diagnosed clinically with the Hook test. The traditional Hook test and the resisted Hook test are useful clinical tests. Though x-rays are routinely done, MRI remains the investigation of choice. Non-operative treatment has a role in selected patients with partial tear or patients with complete tear who have low functional demands. Operative treatment is the recommended treatment for complete tear of the distal biceps and is associated with good functional outcome and patient satisfaction.     

The effects of hallux valgus and walking speed on dynamic balance in older adults

BackgroundHallux valgus (HV) contributes to deficits in static balance and increased fall risk in older adults. Very limited research has examined dynamic balance deficits in walking in this population. These individuals generally walk slowly, as balance challenge is lesser at slow speeds.Research questionHow does the dynamic balance of older adults with HV differ from healthy controls at controlled slow and fast walking speeds?MethodsNineteen older adults with HV and 13 healthy controls completed 5 continuous walking trials at 1.0 and 1.3 m·s⁻¹ as whole body marker position and ground reaction force data were captured. Dynamic balance was evaluated using whole body center of mass (COM) and center of pressure (COP) inclination angles (IA) and duration of double support.ResultsThere were no differences in measures of dynamic balance between older adults with and without HV at slow and fast speeds. At the faster speed, the peak sagittal plane COM-COP IA increased and the double support duration decreased, while the peak frontal plane COM-COP IA were not affected.SignificanceOlder adults with HV do not exhibit deficits in dynamic balance during continuous walking at comfortable speeds when compared to healthy older adults.     

Technique Tip: Medial prominence bone spur resection in the third-generation percutaneous Chevron-Akin Osteotomy Technique (PECA) for hallux valgus correction

The third-generation percutaneous chevron and Akin osteotomy (PECA) technique for surgical management of hallux valgus has shown improvement in clinical and radiographic outcomes. During this procedure, lateral translation and fixation of the first metatarsal head results in the formation of a bony prominence on the medial side of the distal aspect of the first metatarsal which can cause pain and discomfort to the patient. We describe two techniques to address this bony prominence; either i) excision osteotomy and removal of the fragment or ii) a dorsal closing wedge osteotomy retaining the bony fragment.Level of EvidenceLevel V, expert opinion     

The Impact of Job Conditions on Health-Related Quality of Life among Working Japanese Older Adults: A Five-Year Longitudinal Study Using J-MICC Okazaki Study Data

ObjectivesThe number of older adults who continue working after retirement is increasing in Japan. Little is known about how job conditions affect older adults’ health. We examined the association between job conditions and health-related quality of life (HRQOL) during a five-year follow-up study.MethodsThis study included participants aged 65 years or older from the Japan Multi-Institutional Collaborative Cohort Study in the Okazaki area recruited at baseline between 2007 and 2011 and followed up five years later. Participants completed a self-reported questionnaire on the physical and mental health aspects of HRQOL (SF-8™), employment status, and job conditions (job satisfaction, skill use, and job suitability).ResultsData of 1,146 men and 522 women were analyzed (mean age: 69.1 and 68.6 years, respectively). Generalized mixed linear regression analysis revealed that, compared to the not-working group, skill use was positively associated with mental health aspects among men (skill use × time: β = 0.16, SE = 0.08, p < 0.05), while poor job satisfaction and job suitability were negatively associated with mental health aspects among women (job satisfaction, not satisfied × time: β = -0.93, SE = 0.47, p < 0.05; job suitability, not suitable × time: β = -1.06, SE = 0.50, p < 0.05).ConclusionsRegarding job conditions among older adults, skill use in men was marginally associated with mental health, and poor job satisfaction and suitability in women were negatively associated with mental health. Considering the job conditions of older workers is necessary to protect their mental health.     

Mikania micrantha extract enhances cutaneous wound healing activity through the activation of FAK/Akt/mTOR cell signaling pathway

Mikania micrantha (MM) has been traditionally used for various health benefits, including mental health, anti-inflammatory, wound dressing, and healing of sores. However, the molecular mechanisms and dose required for the wound healing activity of MM have yet to be reported. Therefore, a study was conducted to evaluate the wound healing potential of a cold methanolic extract of MM through in vitro and in vivo studies. Human dermal fibroblast adult (HDFa) cells were treated with 0 (control), 75 ng/ml, 125 ng/ml, 250 ng/ml, and 500 ng/ml of MMmethanolic extract (MME) for 24 h. MME at 75 ng/ml has significantly (p˂0.05) promoted HDFa cell proliferation and migration. Further, MME has also been shown to enhance the invasiveness of human umbilical vascular endothelial cells (HUVECs), indicating the neovasculature for wound healing. The tube formation assay demonstrated a significant (p<0.05) increase in the angiogenic effect of the MME starting at a concentration of 75 ng/ml as compared to the control. Treatment of excision wounds in Wistar rats with 5% and 10% MME ointment significantly enhanced wound contraction compared to control animals. Incision wounds in rats treated with 5% and 10% MME showed a significant (p<0.01) increase in tensile strength compared to control. HDFa cells, and granulation tissue collected on day 14 post-wounding, revealed the modulation of the FAK/Akt/mTOR cell signaling pathway during the enhancement of wound healing. The results of gel zymography showed increased activity of MMP-2 and MMP-9 in the HDFa cells after treatment with the extract.  It is concluded that MMEcan potentially accelerate cutaneous wound healing.