Effects of anteriorly-loaded treadmill walking on dynamic gait stability in young adults

BackgroundAnteriorly-loaded walking is common in many occupations and may increase fall risk. Dynamic gait stability, defined by the Feasible Stability Region (FSR) theory, quantifies the kinematic relationship between the body’s center of mass (COM) and base of support (BOS). FSR-based dynamic gait stability has been used to evaluate the fall risk.Research questionHow does front load carriage affect dynamic gait stability, step length, and trunk angle among young adults during treadmill walking?MethodsIn this between-subject design study, 30 healthy young adults were evenly randomized into three load groups (0%, 10%, or 20% of body weight). Participants carried their assigned load while walking on a treadmill at a speed of 1.2 m/s. Body kinematics were collected during treadmill walking. Dynamic gait stability (the primary variable) was calculated for two gait events: touchdown and liftoff. Step length and trunk angle were measured as secondary variables. One-way analysis of variance was conducted to detect any group-related differences for all variables. Post-hoc analysis with Bonferroni correction was performed when main group differences were found.ResultsNo significant differences but medium to large effect sizes were found between groups for dynamic gait stability at touchdown (p = 0.194, η² = 0.114) and liftoff (p = 0.122, η² = 0.139). Trunk angle significantly increased (indicating backward lean) with the front load at touchdown (p < 0.001, η² = 0.648) and liftoff (p < 0.001, η² = 0.543). No significant between-group difference was found related to the step length (p = 0.344, η² = 0.076).SignificanceCarrying a front load during walking significantly alters the trunk orientation and may change the COM-BOS kinematic relationship and, therefore, fall risk. The findings could inform the design of future studies focusing on the impact of anterior load carriage on fall risk during different locomotion.     

Exploring the impact of COVID-19 pandemic lockdown on informal settlements in Tshwane Gauteng Province,South Africa

ABSTRACT

Informal settlements remain a public health problem as they lack basic infrastructure. Furthermore, it is challenging to enforce public health regulations and protocols to prevent the spread of infection during a pandemic. This paper was set out to explore the impact of lockdown during COVID-19 among people living in informal settlements. An exploratory qualitative design was utilised. Purposive sampling was used to select research participants. In-depth one-to-one interviews were held involving 30 research participants through a WhatsApp online telephone platform. A thematic approach underpinned by the four stages of data analysis in interpretive phenomenological analysis was utilised to analyse the data. The study found that during the the research participants were affected by lack of space to practice social distancing, over-burdened infrastructure, lack of savings, loss of income and shortage of food, hunger and diseases, anxiety and depression and poor access to education. There is a need to prioritise the needs of informal settlers and endeavour to establish permanent homes. Health promotion and communication initiatives and pandemic awareness programmes are needed to mitigate the impact of lockdown during a pandemic in informal settlements.     

八段锦干预心力衰竭患者疗效的Meta分析

目的:评估八段锦干预心力衰竭的疗效及安全性。方法:搜索中国知网数据库、中国生物医学文献数据库、万方数据库以及维普中文全文数据库；PubMed、Cochrane Library、web of science、EMBASE。检索时间为建库至2019年2月28日。对纳入的随机对照试验（RCT)用Cochrane手册进行偏倚风险评估，用Rev Man 5.3软件进行Meta分析。结果:纳入6篇文献，7个随机对照研究，共计543例心力衰竭患者。与对照组比较，观察组MLHFQ减少[MD=10.88,95%CI=（8.22，13.54）]，6分钟步行试验(6MWT)提高[MD=107.81,95%CI=（75.83，139.78）]，左心室射血分数(LVEF)提高[MD=3.62,95%CI=（2.04，5.19）]，B型利钠肽(BNP)降低[MD=73.32,95%CI=（45.12，101.53）]，临床疗效[OR=4.00,95%CI=（1.35，11.83）]，中医证候评分[OR=4.57,95%CI=（2.03，10.31）]。结论:八段锦可改善心力衰竭患者的心功能，用于稳定期的康复治疗。     

The epiphyseal scar joint line distance and age are important factors in determining the optimal screw length for medial malleoli fractures

AimThe screw length is important to achieve a stable fixation for medial malleoli fractures. We aimed to evaluate the optimal screw length for different age groups in surgically treated medial malleoli fractures. The second aim was to identify the utility of the distance of epiphyseal scar to joint line or joint line to medullary space for assessment of screw length.Material method368 X-rays and computed tomography (CT) images of ankle joints were retrospectively evaluated for optimal screw length, epiphyseal scar to joint line distance, joint to medullary space distance. The mean screw length for each decade was calculated. The correlations of screw length with age, screw length with distance of epiphyseal scar to joint line, and screw length with distance of joint line to medullary space were evaluated.ResultsThe optimal screw length was obviously decreased in patients in 61–70 and >70 years old group (p = 0.002). As the distance of epiphyseal scar from joint line was increased, the optimal length of screw was also increased (p = 0.001). The distance of epiphyseal scar from joint line was decreased by age (p = 0.011).ConclusionThe optimal screw length was decreased by age and the epiphyseal scar to joint line distance could be a clue for optimal screw length in medial malleoli fractures.     

改良单图像法手工测量髌骨不稳患者胫骨结节-股骨滑车沟间距的可行性分析

目的 探讨改良单图像法手工测量髌骨不稳患者胫骨结节-股骨滑车沟（tibial tuberosity-trochlear groove，TT-TG）间距的可行性。 方法 选取髌骨不稳患者30例。高年资手术医师A、B，使用改良单图像法手工测量髌骨不稳患者TT-TG间距，对比高资年影像学医师C，使用双图法测量髌骨不稳患者TT-TG间距。应用Cronbach′s alpha系数评价结果的可信度。应用组内相关系数（intraclass correlation coefficient，ICC）评价结果的可重复性。使用Bland-Altman分析图评价结果的一致性。 结果 高年资手术医师A、B使用改良单图像法手工测量髌骨不稳患者TT-TG间距分别和高年资影像学医师C使用双图法测量髌骨不稳患者TT-TG间距比较，Cronbach′s alpha系数分别为0.913和0.959，组内相关系数分别为0.913和0.958。Bland-Altman分析图显示，TT-TG间距差值（mm）的均值为-0.276（95%CI：-3.526~2.974）和0.143（95%CI：-3.110~3.397）。A、B医师之间使用改良单图像法手工测量髌骨不稳患者TT-TG间距比较，Cronbach′s alpha系数为0.891，组内相关系数为0.891。Bland-Altman分析图显示TT-TG间距差值（mm）的均值为-0.276（95%CI：-3.526~2.974）。 结论 改良单图像法手工测量髌骨不稳患者TT-TG间距操作简单，可以准确测量出髌骨不稳患者的TT-TG间距，该方法和双图法可以相互替换使用。     

Assessment of backward walking unmasks mobility impairments in post-stroke community ambulators

Background: While over half of stroke survivors recover the ability to walk without assistance, deficits persist in the performance of walking adaptations necessary for safe home and community mobility. One such adaptation is the ability to walk or step backward. Post-stroke rehabilitation rarely includes backward walking (BW) assessment and BW deficits have not been quantified in post-stroke community ambulators.

Objective: To quantify spatiotemporal and kinematic BW characteristics in post-stroke community ambulators and compare their performance to controls.

Methods: Individuals post-stroke (n = 15, 60.1 ± 12.9 years, forward speed: 1.13 ± 0.23 m/s) and healthy adults (n = 12, 61.2 ± 16.2 years, forward speed: 1.40 ± 0.13 m/s) performed forward walking (FW) and BW during a single session. Step characteristics and peak lower extremity joint angles were extracted using 3D motion analysis and analyzed with mixed-method ANOVAs (group, walking condition).

Results: The stroke group demonstrated greater reductions in speed, step length and cadence and a greater increase in double-support time during BW compared to FW (p < .01). Compared to FW, the post-stroke group demonstrated greater reductions in hip extension and knee flexion during BW (p < .05). The control group demonstrated decreased plantarflexion and increased dorsiflexion during BW, but these increases were attenuated in the post-stroke group (p < .05).

Conclusions: Assessment of BW can unmask post-stroke walking impairments not detected during typical FW. BW impairments may contribute to the mobility difficulties reported by adults post-stroke. Therefore, BW should be assessed when determining readiness for home and community ambulation.     

Radiographic Measurements of Patients With Juvenile Hallux Valgus Compared With Age-Matched Controls: A Cohort Investigation

The purpose of this study was to investigate radiographic measurements in a cohort of patients with juvenile hallux valgus (with a hallux valgus angle > 15 degrees ) using standardized weightbearing x-rays compared with an age-matched control group. First metatarsal protrusion distance, metatarsus primus adductus angle, metatarsus adductus, first metatarsal cuneiform angle, calcaneal inclination angle, and talocalcaneal angles were assessed with discriminant functional analysis. A total of 37 sets of data were analyzed from patients with a mean age of 13.45 +/- 1.75 years. The study identified 2 significant components of juvenile hallux valgus: a positive first metatarsal protrusion distance (P <.001) and metatarsal primus adductus angle (P = .002). Discriminant functional analysis was then used to determine the best predictors of juvenile hallux valgus. This analysis allowed only 1 variable, metatarsal protrusion distance, as a predictor of whether juvenile hallux valgus was present (P < .001), with 94.3% accuracy. This study showed that a positive metatarsal protrusion distance is a significant component of juvenile hallux valgus.     

正常者瞳孔间距与咬合垂直距离关系的研究

目的：研究正常[牙合]者瞳孔间距（Interpupillary Distance，IPD）与咬合垂直距离（Occlusal Vertical Dimension，OVD）的关系。方法：对116名福建籍青年正常[牙合]者测量其OVD与IPD，并进行两者相关回归分析。结果：总样本的OVD均值为65．35mm±4．70mm，IPD均值为63．98mm±3．26mm，男性正常[牙合]者OVD均值为68．16mm±4．23mm，IPD均值为65．46mm±2．96mm，女性正常[牙合]者的OVD均值为63．22mm±3．86mm，IPD均值为62．86mm±3．05mm;总样本的IPD与OVD的相关系数r=0．633，男性样本的IPD与0VD的相关系数r=0．563，女性样本的IPD与OVD的相关系数r=0．531。结论：IPD与OVD间存在显著相关性，IPD可以作为需咬合重建患者确定其OVD的参考指标。