Analysis of Joint Power and Work During Gait in Children With and Without Cerebral Palsy

PurposeTo compare joint work in the lower limb joints during different sub-phases of the gait cycle between Cerebral Palsy (CP) and healthy children.MethodsEighteen CP and 20 healthy children’s gait data were collected. The CP group included orthoses, intra-muscular injection of botulinum toxin and surgery groups. A motion capture system was used to collect gait data. Joint work was calculated as positive and negative components in six subphases during gait and normalised by speed when comparing the groups.ResultsThe CP group had a slower walking speed, smaller stride length and longer stance phase than the healthy group. Hip max positive work was 0.12 ± 0.02 Jkg⁻¹/ms⁻¹ for the CP group in pre-mid-stance but 0.07 ± 0.01 Jkg⁻¹/ms⁻¹ for the healthy group during the terminal phase. In terminal stance, ankle positive work was significantly lower in the CP group (0.12 ± 0.01) than in the healthy group (0.18 ± 0.01). The knee showed a similar distribution of positive work in the stance phase for the two groups. In the ankle and hip, the CP group had energy generation mainly in midstance while the healthy group was mainly in terminal stance. In the ankle, the CP group had larger energy absorption in mid-stance than the healthy children group, while the CP group showed lower energy generation in the terminal stance phase than seen in the healthy group.ConclusionThe qualitative and quantitative analysis of joint work provides useful information for clinicians in the treatment and rehabilitation of CP patients.     

Terapia Hormonal e Hipertensão em Mulheres na Pós-Menopausa: Resultados do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil)

BackgroundHypertension is a major risk factor for cardiovascular morbidity and mortality in post-menopausal women. Although menopausal hormone therapy (MHT) is a very effective treatment for vasomotor symptoms during this period, the influence of this therapy on blood pressure is not yet clear.ObjectiveTo evaluate the relationship between the use of MHT and hypertension in participants of the ELSA-Brasil.MethodsA cross-sectional study using the baseline ELSA-Brasil data in a cohort of 2,138 women who had experienced natural menopause. This study analyzed hypertension, defined as arterial pressure ≥140/90 mmHg or previous antihypertensive use, and use of MHT, with participants being classified into never, past, and current users. Associations were assessed using an adjusted logistic regression model, with statistical significance set at p<0.05.ResultsOverall, 1,492 women (69.8%) had never used MHT, 457 (21.4%) had used it in the past, and 189 (8.8%) were current users. The use of MHT was more common in women who had a body mass index (BMI) <25 kg/m²and triglyceride levels <150 mg/dl, and who were physically less inactive, non-smokers, and non-diabetics. Current MHT users were less likely to have hypertension (OR=0.59; 95% CI: 0.41-0.85) compared to those who had never used MHT. In most cases, MHT was started at or before 59 years of age, within 10 years of becoming menopausal, and its use lasted for up to five years.ConclusionCurrent MHT use was not related to hypertension, particularly in healthy women and in those under 60 years of age.     

How the war on drugs impacts social determinants of health beyond the criminal legal system

There is a growing recognition in the fields of public health and medicine that social determinants of health (SDOH) play a key role in driving health inequities and disparities among various groups, such that a focus upon individual-level medical interventions will have limited effects without the consideration of the macro-level factors that dictate how effectively individuals can manage their health. While the health impacts of mass incarceration have been explored, less attention has been paid to how the “war on drugs” in the United States exacerbates many of the factors that negatively impact health and wellbeing, disproportionately impacting low-income communities and people of colour who already experience structural challenges including discrimination, disinvestment, and racism. The U.S. war on drugs has subjected millions to criminalisation, incarceration, and lifelong criminal records, disrupting or altogether eliminating their access to adequate resources and supports to live healthy lives. This paper examines the ways that “drug war logic” has become embedded in key SDOH and systems, such as employment, education, housing, public benefits, family regulation (commonly referred to as the child welfare system), the drug treatment system, and the healthcare system. Rather than supporting the health and wellbeing of individuals, families, and communities, the U.S. drug war has exacerbated harm in these systems through practices such as drug testing, mandatory reporting, zero-tolerance policies, and coerced treatment. We argue that, because the drug war has become embedded in these systems, medical practitioners can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and by becoming engaged in policy reform efforts.

KEY MESSAGES

• A drug war logic that prioritises and justifies drug prohibition, criminalisation, and punishment has fuelled the expansion of drug surveillance and control mechanisms in numerous facets of everyday life in the United States negatively impacting key social determinants of health, including housing, education, income, and employment.
• The U.S. drug war’s frontline enforcers are no longer police alone but now include physicians, nurses, teachers, neighbours, social workers, employers, landlords, and others.
• Physicians and healthcare providers can play a significant role in promoting individual and community health by reducing the impact of criminalisation upon healthcare service provision and engaging in policy reform.

     

The Change in Retentive Values of Locator Attachments and Hader Clips over Time

Purpose: The aim of this study was to examine early changes in retentive values of implant overdenture attachments during multiple pulls.
Materials and Methods: Two implant attachment systems (Hader bar and clip, Locator system) were used in this study. The experimental groups were divided into yellow Hader clips, white Locator attachments, and green Locator attachments. Each group consisted of 21 matrix attachments. The attachments were placed into a custom-made acrylic resin block seated passively on another acrylic block containing a Hader bar or two Locator abutments with different angulations. Each attachment was subjected to 20 consecutive pulls using a universal testing machine. The peak load-to-dislodgement of the attachments after each pull was documented, and the percent reduction of the peak load-to-dislodgement was calculated. One-way ANOVA and Tukey's honestly significant difference test were used for data analyses. A p ≤ 0.05 was considered significant.
Results: There was a significant difference in the percent reduction in peak load-to-dislodgement between the attachments after the first pull ( p = 0.005) and after the final pull ( p = 0.0001). The yellow Hader clips exhibited the least percent reduction in peak load-to-dislodgement (6.50 ± 3.59%) after the first pull, followed by the white Locator attachments (8.60 ± 4.42%); the green Locator attachments exhibited the greatest reduction (11.05 ± 4.94%).
Conclusion: The results of this in vitro study demonstrate that retentive values of the Locator attachments are reduced significantly after multiple pulls. Although this reduction might not be noticeable to the patient, it is recommended that the clinician place and remove the overdenture multiple times before delivery.     

The effectiveness of protraction face mask therapy: A meta-analysis

This study examined the effectiveness of maxillary protraction with orthopedic appliances in Class III patients. A meta-analysis of relevant literature was performed to determine whether a consensus exists regarding controversial issues such as the timing of treatment and the use of adjunctive intraoral appliances. An initial search identified 440 articles relating to Class III malocclusion. Among those articles, 11 studies in English and 3 studies in foreign languages met the previously established selection criteria. Data from the selected studies were categorized by age and appliance groups for the meta-analysis. The sample sizes were comparable between the groups. The statistical synthesis of changes before and after treatment in selected cephalometric landmarks showed no distinct difference between the palatal expansion group and nonexpansion group except for 1 variable, upper incisor angulation, which increased to a greater degree in the nonexpansion group. This finding implies that more skeletal effect and less dental change are produced in the expansion appliance group. Examination of the effects of age revealed greater treatment changes in the younger group. Results indicate that protraction face mask therapy is effective in patients who are growing, but to a lesser degree in patients who are older than 10 years of age, and that protraction in combination with an initial period of expansion may provide more significant skeletal effects. Overall mean values and corresponding standard deviations for the studies selected can also be used to estimate mean treatment effects expected from the use of protraction face mask.