Lateral Ankle Sprain and Subsequent Ankle Sprain Risk: A Systematic Review

ObjectiveTo evaluate the evidence regarding the association between lateral ankle sprain (LAS) history and the subsequent LAS risk, as well as sex differences in the observed associations.Data SourcesPubMed, CINAHL, and SPORTDiscus were searched through July 2020 for articles on LAS history and incidence during the study period.Study SelectionStudies were included if they were prospective in nature and the authors reported the number of participants with and those without a history of LAS at study initiation as well as the number of participants in each group who sustained an LAS during the investigation.Data ExtractionData were study design parameters as well as the number of participants with and those without an LAS history and the number of subsequent LASs that occurred in both groups. Risk ratios (RRs) with 95% CIs compared the risk of LAS during the study period between those with and those without an LAS history for each investigation.Data SynthesisA total of 19 studies involving 6567 patients were included. The follow-up periods ranged from 14 weeks to 2 years. Assessment scores indicated the studies were of moderate to high quality. A significantly higher risk of LAS during the study period was observed among those with a history of LAS in 10 of 15 studies (RR range = 1.29–6.06). Similar associations were seen in 4 of 6 studies of all-male samples (RR range = 1.38–8.65) and 1 of 4 studies with an all-female sample (RR = 4.28).ConclusionsStrong evidence indicates that a previous LAS increased the risk of a subsequent LAS injury. Men with a history of LAS appeared to be at a higher risk of sustaining a subsequent LAS, but women were not. However, further data are needed to draw definitive conclusions from the limited number of sex-specific studies.     

Therapeutic Interventions for Increasing Ankle Dorsiflexion After Ankle Sprain: A Systematic Review

Context:

Clinicians perform therapeutic interventions, such as stretching, manual therapy, electrotherapy, ultrasound, and exercises, to increase ankle dorsiflexion. However, authors of previous studies have not determined which intervention or combination of interventions is most effective.

Objective:

To determine the magnitude of therapeutic intervention effects on and the most effective therapeutic interventions for restoring normal ankle dorsiflexion after ankle sprain.

Data Sources:

We performed a comprehensive literature search in Web of Science and EBSCO HOST from 1965 to May 29, 2011, with 19 search terms related to ankle sprain, dorsiflexion, and intervention and by cross-referencing pertinent articles.

Study Selection:

Eligible studies had to be written in English and include the means and standard deviations of both pretreatment and posttreatment in patients with acute, subacute, or chronic ankle sprains. Outcomes of interest included various joint mobilizations, stretching, local vibration, hyperbaric oxygen therapy, electrical stimulation, and mental-relaxation interventions.

Data Extraction:

We extracted data on dorsiflexion improvements among various therapeutic applications by calculating Cohen d effect sizes with associated 95% confidence intervals (CIs) and evaluated the methodologic quality using the Physiotherapy Evidence Database (PEDro) scale.

Data Synthesis:

In total, 9 studies (PEDro score = 5.22 ± 1.92) met the inclusion criteria. Static-stretching interventions with a home exercise program had the strongest effects on increasing dorsiflexion in patients 2 weeks after acute ankle sprains (Cohen d = 1.06; 95% CI = 0.12, 2.42). The range of effect sizes for movement with mobilization on ankle dorsiflexion among individuals with recurrent ankle sprains was small (Cohen d range = 0.14 to 0.39).

Conclusions:

Static-stretching intervention as a part of standardized care yielded the strongest effects on dorsiflexion after acute ankle sprains. The existing evidence suggests that clinicians need to consider what may be the limiting factor of ankle dorsiflexion to select the most appropriate treatments and interventions. Investigators should examine the relationship between improvements in dorsiflexion and patient progress using measures of patient self-reported functional outcome after therapeutic interventions to determine the most appropriate forms of therapeutic interventions to address ankle-dorsiflexion limitation.Key Words: chronic ankle instability, range of motion, stretching, joint mobilization

Key Points

• A static-stretching intervention as part of a standardized home exercise program had the strongest effects on ankle-dorsiflexion improvement after acute ankle sprains.
• Clinicians need to consider what may be the limiting factor of ankle dorsiflexion to select the most appropriate treatments and interventions.
• Investigators should examine the long-term effects of treatments on ankle dorsiflexion and a relationship between an improvement in ankle dorsiflexion and measures of patient self-reported and physical function to determine the most appropriate forms of therapeutic interventions to address limited dorsiflexion.

Lateral ankle sprain has been documented to be the most common lower extremity injury sustained during sport participation.^1–4 Approximately 85% of all ankle sprains result from an inversion mechanism and damage to the lateral ligamentous complex of the ankle.⁵ Injury to the lateral ligamentous complex at the ankle joint results in pain, swelling, and limited osteokinematics.⁶ A loss of normal ankle dorsiflexion usually is observed at the talocrural joint after lateral ankle sprain.^7–12The amount of available ankle dorsiflexion plays a key role in the cause of lower extremity injuries.^7,13–22 Limitation of dorsiflexion may be a predisposition to reinjury of the ankle^11,16 and several future lower limb injuries, including plantar fasciopathy,^13,20,21 lateral ankle sprains,^13,15,17,19 iliotibial band syndrome,¹⁴ patellofemoral pain syndrome,¹⁸ patellar tendinopathy,²² and medial tibial stress syndrome.¹⁴The importance of restoring ankle dorsiflexion after an acute ankle sprain often is emphasized in rehabilitation guidelines,⁹ and proper recovery of ankle dorsiflexion is a vital component of ankle rehabilitation. Inadequate restoration of ankle dorsiflexion may increase the risk of developing recurrent ankle sprain^11,16 and limit functional activities, such as walking, with long-term pain and disability.²³ Limited ankle-dorsiflexion range of motion (ROM) after lateral ankle sprain has been considered a predisposing factor for recurrent ankle sprain because diminished dorsiflexion prevents the ankle from reaching its closed-pack position by holding the ankle in a hypersupinated position. Therefore, ensuring appropriate restoration of ankle dorsiflexion after ankle sprain has important clinical implications for restoring full functional abilities, ultimately leading to reduced risk of recurrent ankle sprain.Clinicians perform several therapeutic interventions, such as stretching, manual therapy, electrotherapy, ultrasound, and exercises, to increase ankle dorsiflexion. However, the intervention or combination of interventions that most effectively improves ankle dorsiflexion has not been established. In previous systematic reviews,^24–26 researchers have examined the effects of specific intervention techniques of manipulative therapy on various outcome variables. In addition, Bleakley et al²⁷ conducted a systematic review with a comprehensive search of various therapeutic interventions to provide evidence for the management of ankle sprains and the prevention of long-term complications; however, the authors focused only on patients with an acute ankle sprain. Therefore, the purpose of this systematic review was to determine the magnitude of therapeutic intervention effects on and the most effective therapeutic interventions for restoring normal ankle dorsiflexion after ankle sprain. In contrast to previous reviews,^24–26 we comprehensively searched the existing literature to determine the effectiveness of various therapeutic intervention techniques in restoring ankle dorsiflexion in patients with acute, subacute, or recurrent ankle sprains. By providing a quantitative estimate of the magnitude of the effect of therapeutic interventions, our review provides a new perspective on the evidence of interventions to restore ankle dorsiflexion in various stages of ankle-sprain conditions.     

Predictive Factors for Lateral Lymph Node Metastasis and Skip Metastasis in Papillary Thyroid Carcinoma

Endocrine Pathology - In papillary thyroid cancer (PTC) patients, cervical lymph node metastases are common, which disseminate sequentially from the central neck to the lateral neck. However, there...     

摇拔戳手法治疗急性外侧踝关节扭伤的运动学量化研究

目的 利用运动捕捉技术量化摇拔戳手法治疗急性外侧踝关节扭伤的运动学操作特征,为手法的规范化操作及教学传承提供客观依据。方法 由专业医师在60例急性外侧踝关节扭伤受试者上进行摇拔戳手法治疗,在手法操作过程中运用运动捕捉系统软件提取有效的运动学指标,分析和总结规律。结果 将踝关节摇转6周的平均用时为11.36 s;对踝关节实施拔伸和戳按手法各1次,两种手法平均用时为3.42 s;对踝关节实施拔伸后平均位移为36.94 mm,戳按后平均位移为22.44 mm;将踝部拔伸时平均运动角度为23.27°,戳按时平均运动角度为22.76°;摇拔戳手法治疗过急性外侧踝关节扭伤,将踝关节摇转时平均线速度为58.28 mm/s,拔戳时平均线速度为23.81 mm/s;将踝关节摇转时线加速度为0.43 mm/s2,拔戳时线加速度为0.54 mm/s2。结论 摇拔戳手法可应用推广于临床,在操作时应遵循“顺势而为、和缓匀速、连续进行”的原则,在遵循踝关节生理特点前提下,缓慢匀速地对扭伤的外侧踝关节连续进行摇拔戳手法治疗。     

Biological Factors Involved in Implant-Anchored Orthodontics and in Prosthetic-Implant Therapy: A Literature Review

During the past few years, the application of orthodontic miniscrews and dental implants has been expanded. However, failures have necessitated ongoing investigation of potential risk factors. The aim of this overview was to conduct an assessment of the immunological response following application of cortical temporary anchorage devices—titanium miniscrew implants—in orthodontic patients. A scrupulous search of the database revealed only two matching items; therefore studies evaluating the immune response subsequent to insertion of dental implants were reviewed. Thorough assessment revealed the following as factors associated with dental implant rejection: (1) correlation of the volume of gingival and peri-implant crevicular fluid and the amount of interleukin (IL)-1β with mucosal inflammation, thus serving as a peri-implantitis evaluation index; (2) significantly more frequent marginal bone loss around implants in patients with IL-1B-511 2/2 genotype; (3) humoral response to Staphylococcus aureus. However, since there is almost no evidence-based evaluation of the allergic/inflammatory reaction either to orthodontic titanium miniscrews themselves or in adolescents and young adults, who comprise the largest group of orthodontic patients, this issue requires further investigation. It is essential in order to achieve successful, sophisticated and modern treatment of malocclusions.     

Factors Contributing to Chronic Ankle Instability: A Strength Perspective

OBJECTIVE: To examine the concept of dynamic ankle stability and closely critique the relevant research over the past 50+ years focusing on strength as it relates to those with chronic ankle instability (CAI). DATA SOURCES: We reviewed the literature regarding the assessment of strength related to CAI. We searched MEDLINE and ISI Web of Science from 1950 through 2001 using the key words functional ankle instability, chronic ankle instability, strength, ankle stability, chronic ankle dysfunction, and isokinetics. DATA SYNTHESIS: An overview of dynamic stability in the ankle is established, followed by a comprehensive discussion involving the variables used to assess ankle strength. Additionally, a historical look at deficits in muscular stability leading to CAI is provided, and a compilation of numerous contemporary approaches examining strength as it relates to CAI is presented. CONCLUSIONS/RECOMMENDATIONS: Although strength is an important consideration during ankle rehabilitation, deficits in ankle strength are not highly correlated with CAI. More contemporary approaches involving the examination of reciprocal muscle-group ratios as a measure of strength have recently been investigated and offer an insightful, albeit different, avenue for future exploration. Evidence pertaining to the effects of strength training on those afflicted with CAI is lacking, including what, if any, implication strength training has on the various measures of ankle strength.     

Systematic Review of Postural Control and Lateral Ankle Instability,Part II: Is Balance Training Clinically Effective

Objective:

To answer the following clinical questions: (1) Can prophylactic balance and coordination training reduce the risk of sustaining a lateral ankle sprain? (2) Can balance and coordination training improve treatment outcomes associated with acute ankle sprains? (3) Can balance and coordination training improve treatment outcomes in patients with chronic ankle instability?

Data Sources:

PubMed and CINAHL entries from 1966 through October 2006 were searched using the terms ankle sprain, ankle instability, balance, chronic ankle instability, functional ankle instability, postural control, and postural sway.

Study Selection:

Only studies assessing the influence of balance training on the primary outcomes of risk of ankle sprain or instrumented postural control measures derived from testing on a stable force plate using the modified Romberg test were included. Studies had to provide results for calculation of relative risk reduction and numbers needed to treat for the injury prevention outcomes or effect sizes for the postural control measures.

Data Extraction:

We calculated the relative risk reduction and numbers needed to treat to assess the effect of balance training on the risk of incurring an ankle sprain. Effect sizes were estimated with the Cohen d for comparisons of postural control performance between trained and untrained groups.

Data Synthesis:

Prophylactic balance training substantially reduced the risk of sustaining ankle sprains, with a greater effect seen in those with a history of a previous sprain. Completing at least 6 weeks of balance training after an acute ankle sprain substantially reduced the risk of recurrent ankle sprains; however, consistent improvements in instrumented measures of postural control were not associated with training. Evidence is lacking to assess the reduction in the risk of recurrent sprains and inconclusive to demonstrate improved instrumented postural control measures in those with chronic ankle instability who complete balance training.

Conclusions:

Balance training can be used prophylactically or after an acute ankle sprain in an effort to reduce future ankle sprains, but current evidence is insufficient to assess this effect in patients with chronic ankle instability.     

自杀与幸福感关系的研究进展

自杀是全球都关注的严重公共卫生问题。数据报告表明,我国自杀率尤其是农村自杀率明显下降,分析认为与我国农村城市化进程加快,农村女性幸福感上升有关。幸福感作为自杀的保护因素,为自杀预防提供一条全新的出口。本文试图综合评述国内外有关自杀与幸福感的关系研究文献,为自杀的预防干预和自杀遗族的创伤治疗及家庭功能研究提供文献依据和未来方向。     

外侧楔形鞋垫对足踝生物力学影响的有限元分析

目的 探究外侧楔形鞋垫对足踝内部组织(包括足骨、关节和韧带)的生物力学影响。 方法 建立并验证足踝-鞋垫-地面三维有限元模型,探究步态 3 个关键瞬间赤足模型和鞋垫干预模型的足底压力分布、关节接触压力、跖骨及主要韧带的应力。 结果 5°外侧楔形鞋垫模型足底峰值压力比赤足模型减小 65. 8% 。 鞋垫干预使楔舟关节处峰值接触压力减小;距下关节处峰值接触压力和第 4、5 跖骨处峰值应力增大。 结论 本研究量化评估了外侧楔形鞋垫对足踝各部分的生物力学影响,提出了可适当减小外侧楔形鞋垫第 4、5 跖骨处倾斜角度的设计建议。     

Gene Therapy for Fabry Disease: A Review of the Literature

Fabry disease is an X-linked lysosomal storage disorder caused by a deficiency of the lysosomal enzyme, α-galactosidase A. The lack of adequate enzymatic activity results in a systemic accumulation of neutral glycosphingolipids, predominantly globotriaosylceramide, in the lysosomes of, especially, endothelial and smooth muscle cells of blood vessels. Enzyme replacement therapy is at present the only available specific treatment for Fabry disease; however, this therapy has important drawbacks. Gene-mediated enzyme replacement is a reasonable and highly promising approach for the treatment of Fabry disease. It corresponds to a single gene disorder in which moderately low levels of enzyme activity should be sufficient for clinical efficacy and, thanks to cross-correction mechanisms, the transfection of a small number of cells will potentially correct distant cells too. This article summarizes the studies that have been carried out concerning gene therapy for the treatment of Fabry disease. We briefly review the literature from earlier studies in the 1990s to the current achievements.     

Amyotrophic Lateral Sclerosis and Agricultural Environments: A Systematic Review

The aim of this study was to examine the relationship between the risk of amyotrophic lateral sclerosis (ALS) and exposure to rural environments. Studies were identified through OVID MEDLINE and EMBASE search up to September 2013 using as keywords rural residence, farmers, and pesticide exposure. Twenty-two studies were included for this meta-analysis. Summary odds ratios (ORs) were calculated using random effect model by type of exposure index, and subgroup analyses were conducted according to study design, gender, region, case ascertainment, and exposure assessment. The risk of ALS was significantly increased with pesticide exposure (OR, 1.44; 95% CI, 1.22-1.70) and with farmers (OR, 1.42; 95% CI, 1.17-1.73), but was not significant with rural residence (OR, 1.25; 95% CI, 0.84-1.87). The risk estimates for subgroup analysis between pesticide exposure and ALS indicated a significant positive association with men (OR, 1.96), and in studies using El Escorial criteria for ALS definition (OR, 1.63) and expert judgment for pesticide exposure (OR, 2.04) as well. No significant publication bias was observed. Our findings support the association of pesticide exposure and an increased risk for ALS, stressing that the use of more specific exposure information resulted in more significant associations.     

Fatigue in Cancer: A Review of Literature

Fatigue is a common symptom of advanced cancer limiting one''s activity and affecting the quality of life. It is a multidimensional symptom complex with subjective and objective components. Hence, its definition and assessment seems arbitrary, incomplete, and elusive. Components of fatigue often merge with other ‘disease states’ as anemia, depression and so on, compounding difficulty to assess it separately. Fatigue has a high prevalence rate, and lasts longer in chronic diseases like cancer. Its association with treatment modalities like chemotherapy, radiotherapy alongside the primary disease process makes it seemingly ubiquitous in many cases. Systemic manifestation of cancer causes excess demand on body resources on cell repair, uncontrolled growth with metabolite accumulation causing fatigue. Co-morbid conditions of organic and psychological nature causes fatigue. There are many assessment tools for fatigue with different uses and objectives, simple and reproducible tools like Brief Fatigue Inventory, Edmonton Symptom assessment scale seem feasible in everyday practice. Management of fatigue is not straightforward and rewarding. Although treatment of cause appears to be an attractive option, it is not possible in all cases. Therapeutic agents targeting cytokine load is in early stages of study and available results are not favorable. Specific measures aimed at pain relief, prevention/treatment of sepsis, management of depression, avoidance of drugs causing fatigue, restoring the metabolic profile are important. Methyl phenidate, megestrol, and modafinil are some drugs with promising effect to treat fatigue, though confirmatory studies are yet to be established. Non-pharmacological methods are also helpful. Forewarning patients on upcoming fatigue, active regular exercise, and stress management are some of them. Fatigue being a multidimensional entity, single mode of therapy is insufficient. Combined modality tailored to individual patient need and understanding may be the right way to battle this ill-understood symptom. This review article examines the etiopathogenesis and management strategies of fatigue in cancer.     

Patient-Reported Outcome Measures in Individuals With Chronic Ankle Instability: A Systematic Review

Context A comprehensive systematic literature review of the health-related quality-of-life (HRQOL) differences among individuals with chronic ankle instability (CAI), ankle-sprain copers, and healthy control participants has not been conducted. It could provide a better indication of the self-reported deficits that may be present in individuals with CAI.Objective To systematically summarize the extent to which HRQOL deficits are present in individuals with CAI.Conclusions The evidence suggested that CAI is associated with functional and HRQOL deficits, particularly when examined with region-specific PROs. However, PROs do not appear to differ between copers and healthy controls.Key Words: region-specific outcomes, ankle sprains, patient-centered care

Key Points

• Chronic ankle instability (CAI) is most likely associated with decreased health-related quality of life as measured by patient-reported outcomes.
• Patient-reported outcomes did not appear to be affected in ankle-sprain copers.
• Given that region-specific outcomes were worse in individuals with CAI than in ankle-sprain copers and healthy control participants, they should be considered when treating CAI and ankle sprains.

Ankle sprains are the most commonly reported injury in collegiate and high school athletics, accounting for roughly 16% of all injuries^1,2; however, other estimates have indicated that ankle sprains compose up to 45% of all athletic injuries.^3,4 These injuries have placed an enormous burden on the health care industry, with an estimated $4.4 billion spent annually on treatment.⁵ Not only are ankle sprains prevalent and costly injuries, at least one third of individuals who sustain acute ankle sprains will develop chronic ankle instability (CAI).^6–8 This condition is characterized by residual symptoms that include feelings of “giving way” and instability, recurrent ankle sprains, and functional loss after 1 or more acute ankle sprains.⁹ Residual symptoms associated with CAI can persist for decades,¹⁰ making it difficult for an individual to lead an active, healthy lifestyle. Furthermore, the repetitive trauma associated with recurrent ankle sprains often contributes to more advanced conditions, such as ankle osteoarthritis,¹¹ for which effective treatments are lacking.Traditionally, CAI research has focused primarily on the pathophysiology of this condition by concentrating efforts on identifying mechanical and functional insufficiencies from a disease-oriented perspective.^12–14 In the last decade, researchers¹⁵ have expanded their efforts to include the patient''s perception of his or her health status, as patient-based outcomes are increasingly recognized in health care. These changes have led to the development of several patient-reported outcomes (PROs) to measure functional limitations in patients with CAI, including the Ankle Joint Functional Assessment Tool (AJFAT),¹⁶ Foot and Ankle Ability Measure (FAAM),¹⁷ and Chronic Ankle Instability Scale.¹⁸ These 3 instruments are self-reported and have been used for many ankle conditions. Their development has enabled researchers and clinicians to collect outcomes that examine a range of activities of daily living (ADLs) and sport tasks from the patient''s perspective.In the CAI literature, both discriminative (eg, Ankle Instability Instrument,¹⁹ Cumberland Ankle Instability Tool [CAIT])²⁰ and evaluative (eg, FAAM) PROs have been used. Discriminative instruments are used to identify individuals with a particular pathologic condition (eg, CAI), whereas evaluative instruments measure an individual''s perceived level of function.²¹ Donahue et al²² reviewed 7 instruments used to discriminate between participants with and without CAI and recommended both the CAIT and Ankle Instability Instrument to determine ankle-stability status. Furthermore, Eechaute et al²³ assessed the clinimetric qualities of 4 evaluative instruments and concluded that the Foot and Ankle Disability Index (FADI) and FAAM were the most appropriate tools for quantifying functional limitations in patients with CAI. Despite these findings, the use of PROs has been inconsistent in the CAI literature. To strengthen the reporting of CAI participant information and to further our knowledge about the limitations associated with this condition, the International Ankle Consortium²⁴ recently released a position statement in which it endorsed specific patient-selection criteria for CAI research and advocated for the use of PROs to better describe this population. In addition to the discriminatory and evaluative instruments used to quantify region-specific function in individuals with CAI, other investigators^25,26 have used PROs to measure health-related quality of life (HRQOL) via generic and dimension-specific instruments. Therefore, further examining PROs used in the CAI literature may allow us to better describe the population and improve our understanding of the condition for future research and clinical practice.A variety of PROs have been used to compare HRQOL in individuals with CAI and ankle-sprain copers (ie, individuals with a history of 1 ankle sprain and no residual symptoms) or healthy control participants. Compared with ankle-sprain copers and healthy populations, individuals with CAI appear to exhibit HRQOL deficits.²⁵ However, to our knowledge, a comprehensive review of the differences among groups has not been conducted. Providing a comprehensive systematic review that critically appraises the research literature may offer a better indication of the self-reported deficits that may be present in those with CAI. Therefore, the purpose of our systematic review was to determine the extent to which HRQOL deficits are present in individuals with CAI.     

A Literature Review of Laboratory-Acquired Brucellosis

Brucellosis is a bacterial zoonotic disease which has been associated with laboratory-acquired infections. No recent reviews have addressed the characteristics of laboratory-acquired brucellosis (LAB). English-language literature was reviewed to identify reports of laboratory exposures to Brucella spp. and LAB cases between 1982 and 2007. Evaluation of 28 case reports identified 167 potentially exposed laboratory workers, of whom 71 had LAB. Nine reports were identified that summarized an additional 186 cases of LAB. Only 18 (11%) exposures were due to laboratory accidents, 147 (88%) exposures were due to aerosolization of organisms during routine identification activities, and the circumstances of 2 (1%) exposures were unknown. Brucella melitensis was the causative agent in 80% (135/167) of the exposures. Workers with high-risk exposures were 9.3 times more likely to develop LAB than workers with low-risk exposures (95% confidence interval [CI], 3.0 to 38.6; P < 0.0001); they were also 0.009 times likelier to develop LAB if they took antimicrobial PEP than if they did not (95% CI, 0 to 0.042; P < 0.0001). The median incubation period in case and summary reports was 8 weeks (range 1 to 40 weeks). Antimicrobial PEP is effective in preventing LAB. The incubation period may be used to identify appropriate serological and symptom surveillance time frames for exposed laboratory workers.     

eHealth Literacy Interventions for Older Adults: A Systematic Review of the Literature

Background

eHealth resources offer new opportunities for older adults to access health information online, connect with others with shared health interests, and manage their health. However, older adults often lack sufficient eHealth literacy to maximize their benefit from these resources.

Objective

This review evaluates the research design, methods, and findings of eHealth literacy interventions for older adults.

Methods

A systematic review of peer-reviewed research articles from 28 databases in 9 fields was carried out in January 2013. Four rounds of screening of articles in these databases resulted in a final sample of 23 articles.

Results

Findings indicated a significant gap in the literature for eHealth literacy interventions evaluating health outcomes as the outcome of interest, a lack of theory-based interventions, and few studies applied high-quality research design.

Conclusions

Our findings emphasize the need for researchers to develop and assess theory-based interventions applying high-quality research design in eHealth literacy interventions targeting the older population.     

Preparation of Children for Hospitalization: A Selected Review of the Research Literature

An overview of the empirical literature on the preparation ofchildren for hospitalization and surgery reveals a number ofmethodological inadequacies which subject the data to multipleinterpretations. These investigations often lack appropriatecontrol groups, do not control for relevant variables, and attemptto assess the child's emotional response to hospitalizationwithout demonstrating the reliability of the measures used.As a result, the efficacy of a number of procedures presumedto facilitate the child's adjustment to the hospital experienceremains to be clearly demonstrated.