Digital health technologies for osteopaths and allied healthcare service providers: A scoping review

BackgroundDigital health technologies are poised to revolutionise the healthcare industry by improving accessibility to services and patient outcomes. The novel coronavirus disease-19 (COVID-19) pandemic has presented unprecedented challenges for the delivery of allied healthcare and has catalysed rapid adoption of telehealth. As such, allied healthcare consumers and providers stand to benefit from the capabilities of the digital health movement, ultimately justifying a scoping review of current and emerging technologies.ObjectiveTo provide decision makers with up-to-date information on the allied health applications of new and emerging digital health technologies; their evidence of efficacy, scope of use, and limitations.MethodsA scoping review of the literature was conducted, guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. To synthesise original research, MEDLINE, CINAHL, and EMBASE databases were searched from 2010 to June 2020 and reference lists were examined for randomised control trials analysing the efficacy of these technologies in allied health applications.ResultsA total of 14 articles were included with a focus on common musculoskeletal conditions managed by allied health service providers. Studies were selected for data extraction after abstract and full-text screening by three independent reviewers. The results of this review indicate that telehealth technology effectively monitors and progresses patient care, while mobile health applications provide remote support and enable data collection.ConclusionEmerging trends suggest that digital technologies serve as promising adjuncts to allied healthcare. Further research is warranted regarding the safety and efficacy of digital health technologies in this context.     

Hormones and health outcomes in aging men

Increasing age is a predictor of ill-health and mortality related to cardiovascular disease and to frailty, a syndrome characterized by deterioration of multiple organ systems leading to loss of physiological reserve, diminished capacity to cope with stressors, and increased risk of disability and death. As men grow older, their levels of testosterone decline while the prevalence of ill-health increases. Observational studies have linked lower testosterone levels with cardiovascular disease and mortality in middle-aged and older men. More recently, lower testosterone has been shown to predict reduced sexual activity and frailty in aging men. Additional studies are needed to determine whether lower testosterone is a biomarker or a potentially treatable risk factor for poorer health outcomes in older men. During aging, the response of the pituitary–thyroid axis alters to manifest higher thyrotropin levels. The presences of subclinical hypo- and hyper-thyroidism predict adverse cardiovascular outcomes. Newer results indicate that in euthyroid older men, differences in free thyroxine levels within the normal range predict specific health outcomes including frailty. Clarification of the roles of endogenous testosterone and thyroxine in the genesis of ill-health during male aging offers the prospect of future intervention to preserve health and well-being in this growing population.     

徐州市居民糖尿病的脆弱性调查分析

目的掌握徐州市居民罹患糖尿病的脆弱性情况,为进一步的干预提供科学依据。方法采用多阶段分层随机抽样方法,抽取徐州市15～69岁居民共4980人,进行统一的问卷调查,分析应对糖尿病的脆弱性。结果被调查人群中不知道肥胖易患糖尿病者共2427例（48：73％）,不清楚糖尿病常见症状者2053例（41．22％）,不知道父母患糖尿病子女易患糖尿病者共2746例（55．14％）,不知道糖尿病会演变成其他疾病者2771例（55．64％）,从未测血糖者共3424例（68．76％）：1556例测过血糖中检出糖尿病116例,患病率为7．46％,其中未采取措施控制血糖者30例（25．86％）;文化程度、家庭每月人均收入低者应对糖尿病脆弱性较高。结论徐州市居民罹患糖尿病脆弱性偏高,不同居民罹患糖尿病脆弱性不同,针对不同年龄、文化程度、收入等不同层次的人群加大多样化的健康教育和干预措施,降低居民罹患糖尿病的脆弱性。     

自动乳腺容积超声检查的临床应用进展

乳腺癌是女性常见的恶性肿瘤,钼靶和手持超声是诊断乳腺疾病的常用手段,而自动乳腺容积超声检查是一种新的乳腺超声自动扫描成像技术,一定程度上可以弥补钼靶与手持超声的不足,本文就自动乳腺容积超声在乳腺疾病应用价值上进行综述。     

Methodological considerations for near-infrared spectroscopy to assess mitochondrial capacity after spinal cord injury

Background: Skeletal muscle mitochondrial activity is reduced by?～?50–60% after SCI, resulting in impaired energy expenditure, glucose utilization and insulin sensitivity. Near infra-red spectroscopy (NIRS) is a non-invasive tool that can be used to assess mitochondrial capacity.

Objectives: (1) Highlight methodological limitations impacting data acquisition and analysis such as subcutaneous adipose tissue (SAT) thickness, movement artifacts, inadequate muscle stimulation, light interference, and ischemic discomfort. (2) Provide technical considerations to improve data acquisition and analysis. This may serve as guidance to other researchers and clinicians using NIRS.

Study Design: cross-sectional observational design.

Settings: Clinical research medical center.

Participants: Sixteen men with 1?>?year post motor complete SCI.

Methods: NIRS signals were obtained from right vastus lateralis muscle utilizing a portable system. Signals were fit to a mono-exponential curve.

Outcome Measures: Rate constant and r ² values for the fit curve, indirectly measures mitochondrial capacity.

Results: Only four participants produced data with accepted rate constants of 0.002–0.013?s^?1 and r ² of 0.71–0.87. Applications of studentized residuals ≥2.5 resulted in sparing data from another four participants with rate constants of 0.010–0.018?s^?1and r ² values ranging from 0.86–0.99.

Conclusions: Several limitations may challenge the use of NIRS to assess mitochondrial capacity after SCI. Acknowledging these limitations and applying additional data processing techniques may overcome the discussed limitations and facilitate data sparing.     

TMD患者精神抑郁与疼痛、颌骨功能的关系

目的：比较各型颞下颌关节紊乱病（TMD）患者精神抑郁水平，并且探讨精神抑郁水平与自我报告疼痛、颌骨功能受限的关系。方法：韩国国立汉城大学齿科病院TMD与颌面疼痛门诊经过颞下颌关节紊乱研究诊断标准（RDC／TMD）确诊为TMD患者58名。要求每一名患者回答RDC／TMD韩语版病史问卷，并且建立TMD与颌面疼痛门诊标准病历。根据RDC／TMD分为3组：面肌疼痛组、关节盘移位组和其他关节病组（骨关节炎、骨关节痛和骨关节病）。应用RDC／TMD评价精神抑郁水平、疼痛强度和颌骨功能受限情况。结果：抑郁症状指数和疼痛强度在3组患者之间均存在显著性差异。抑郁症状指数与疼痛强度成正相关，疼痛强度与颌骨功能受限程度成正相关。结论：TMD以肌筋膜疼痛组最多见．且该组患者抑郁症状指数最高。对TMD患者进行精神抑郁水平评价是相当重要的。     

Low back pain-related meta-analysis: Caution is needed when interpreting published research results

The systematic reviews (SRs) including a meta-analysis are considered as the top level of evidence. Although the existence of more than a hundred of low back pain (LBP)-related SRs seems very appealing and might therefore suggest significant evidence on the topic, a deep analysis indicates that several of these SRs included only very few studies. Other SRs raise concerns because they included some randomized controlled trials which had a low methodological quality, or some studies which differed significantly regarding the studied populations and/or the experimental procedure. The sometimes controversial results of different SRs conducted on the same topic also highlight the significant influence of the inclusion/exclusion criteria used in the SRs to select the articles. To conclude, although meta-analysis is at the top of the evidence pyramid and have several strengths, the conclusions drawn from SRs should always be interpreted with caution because they can also have weaknesses. This is true, whether it be for LBP-related SRs including a meta-analysis, or any other. Therefore a critical analysis of any SR is always needed before integrating the results of the SR in its own clinical practice. Furthermore, clinical reasoning remains crucial, especially to consider the potential differences between one’s patient and the patients included in the meta-analysis.