Role of Physical Activity in Reducing Cognitive Decline in Older Mexican‐American Adults

The effect of physical activity on cognitive function in older adults from minority and disadvantaged populations is not well understood. This study examined the longitudinal association between physical activity and cognition in older Mexican Americans. The study methodology included a prospective cohort with longitudinal analysis of data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly. General linear mixed models were used to assess the associations and interactions between physical activity and cognitive function over 14 years. Community‐based assessments were performed in participants' homes. Physical activity was recorded for 1,669 older Mexican Americans using the Physical Activity Scale for the Elderly. Cognition was measured using the Mini‐Mental State Examination (MMSE) and separated into memory and nonmemory components. A statistically significant positive association was observed between levels of physical activity and cognitive function after adjusting for age, sex, marital status, education, and comorbid health conditions. There was a statistically significant difference in MMSE scores over time between participants in the third (β = 0.11, standard error (SE) = 0.05) and fourth (β = 0.10, SE = 0.2) quartiles of physical activity and those in the first. The protective effect of physical activity on cognitive decline was evident for the memory component of the MMSE but not the nonmemory component after adjusting for covariates. Greater physical activity at baseline was associated with less cognitive decline over 14 years in older Mexican Americans. The reduction in cognitive decline appeared to be related to the memory components of cognitive function.     

The effect of vaginal pH on labor induction with vaginal misoprostol

Objective.?To estimate the association of vaginal pH on the induction to vaginal delivery interval in labor induction with vaginal misoprostol.

Methods.?Women presenting at term with intact membranes for labor induction were recruited. The pH of the vagina was measured during a digital examination of the cervix to determine the Bishop Score. Labor was induced with 25?μg of vaginal misoprostol placed every 6?h until spontaneous rupture of membranes or active labor occurred. The primary outcome was the induction to vaginal delivery interval in the lower pH (?<?5) versus higher pH (???5) group. Secondary outcomes assessed maternal and neonatal morbidities. Sample size calculated a priori estimated 120 subjects were required for a power of 95% and a 2-tailed α of 0.05.

Results.?120 women met inclusion criteria and had available pH data. There was no difference in the induction to vaginal delivery interval in the lower pH (1455?min) versus higher pH group (1295 minutes, Mean difference 160[?147,468] P?=. 30). No difference was observed for operative delivery rates or neonatal outcomes.

Conclusion.?The pH of the vagina may not affect the length of the induction to vaginal delivery interval in women undergoing labor induction with vaginal misoprostol. Further research is required to determine factors that may influence the efficacy of vaginal misoprostol when used for labor induction.     

O10 The technology behind Colgate® TotalTM toothpaste

In the early 1990s, a break‐through toothpaste, known as Colgate^® Total?, was launched with documented long‐lasting activity against plaque, gingivitis, calculus, tooth decay and bad breath. The technology behind this toothpaste is the combination of triclosan, a polyvinyl methyl ether maleic acid (PVM/MA) copolymer and sodium fluoride (TCF). The function of the copolymer is to ensure optimal oral retention and prolonged release of the antibacterial triclosan. Effective levels of triclosan have been measured in the oral cavity 12 h after brushing the teeth. This allows prolonged control of oral bacteria that can lead to the formation of dental plaque and gingivitis and bad breath. Similarly, the retention of triclosan to oral surfaces during 2 years regular use of the product has led to a significant reduction in incremental coronal caries compared to an ADA‐approved anti‐cavity fluoride toothpaste. Furthermore, significantly less calcium phosphate has been shown to be present in dental plaque after brushing the teeth with the triclosan/copolymer toothpaste, and this has resulted in the reduced formation of tartar. A new variant of the triclosan/copolymer/fluoride toothpaste, having the numerous therapeutic and aesthetic benefits of the original formula, has been made available to consumers. The new dentifrice, which contains an impactful breath freshening flavor, has been documented to be significantly better (P < 0.05) than a control toothpaste in providing sustained control of bad breath over 12 h. After 12 h, breath odor was reduced from 51% compared to the control. The long term retention and subsequent release of triclosan by the copolymer in the TCF formula provide consumers protection against plaque, gingivitis, tartar, caries and bad breath.     

Compliance with clinical practice guidelines in family physicians managing worker''s compensation board patients with acute lower back pain

BACKGROUND CONTEXT: Family physician compliance with acute lower back pain clinical practice guidelines remains uncertain. PURPOSE: To determine the degree of guideline compliance of family physicians managing patients with workers' compensation claims and acute mechanical lower back pain. STUDY DESIGN: Observational study. PATIENT SAMPLE: One hundred thirty-nine family physicians in British Columbia. OUTCOME MEASURES: Compliance with guideline recommendations for history, examination procedures, diagnostic testing and treatments. METHODS: Physician workers' compensation board patient reports for acute lower back pain without leg symptoms and not greater than 2 to 3 weeks duration were scored for guideline adherence up until 12 weeks after onset. RESULTS: Physicians demonstrated a high degree of compliance with the guideline-recommended history, examination procedures and medications, but low compliance with recommended imaging and many treatment recommendations. CONCLUSIONS: Recently published clinical practice guidelines regarding the management of patients with acute mechanical lower back pain have not been fully implemented into the patterns of practice of the family physicians.     

Parents as Agents of Change (PAC) in pediatric weight management: The protocol for the PAC randomized clinical trial

ABSTRACT: BACKGROUND: There is an urgent need to develop and evaluate weight management interventions to address childhood obesity. Recent research suggests that interventions designed for parents exclusively, which have been named parents as agents of change (PAC) approaches, have yielded positive outcomes for managing pediatric obesity. To date, no research has combined a PAC intervention approach with cognitive behavioural therapy (CBT) to examine whether these combined elements enhance intervention effectiveness. This paper describes the protocol our team is using to examine two PAC-based interventions for pediatric weight management. We hypothesize that children with obesity whose parents complete a CBT-based PAC intervention will achieve greater reductions in adiposity and improvements in cardiometabolic risk factors, lifestyle behaviours, and psychosocial outcomes than children whose parents complete a psycho-education-based PAC intervention (PEP). METHODS: This study is a pragmatic, two-armed, parallel, single-blinded, superiority, randomized clinical trial. The primary objective is to examine the differential effects of a CBT-based PAC vs PEP-based PAC intervention on children's BMI z-score (primary outcome). Secondary objectives are to assess intervention-mediated changes in cardiometabolic, lifestyle, and psychosocial variables in children and parents. Both interventions are similar in frequency of contact, session duration, group facilitation, lifestyle behaviour goals, and educational content. However, the interventions differ insofar as the CBT-based intervention incorporates theory-based concepts to help parents link their thoughts, feelings, and behaviours; these cognitive activities are enabled by group leaders who possess formal training in CBT. Mothers and fathers of children (8-12 years of age; BMI greater than or equal to the 85th percentile) are eligible to participate if they are proficient in English (written and spoken) and agree for at least one parent to attend group-based sessions on a weekly basis. Anthropometry, cardiometabolic risk factors, lifestyle behaviours, and psychosocial health of children and parents are assessed at pre-intervention, post-intervention, 6-, and 12-months follow-up. DISCUSSION: This study is designed to extend findings from earlier efficacy studies and provide data on the effect of a CBT-based PAC intervention for managing pediatric obesity in a real-world, outpatient clinical setting.     

Back pain and leg complaints that revealed non–small cell carcinoma: a case study

Objective

The purpose of this case study is to describe the clinical presentation of a patient with a chief complaint of low back and leg pain with no prior diagnosis of lung cancer.

Clinical Features

A 48-year-old man with a history of back pain presented to a chiropractic office with a complaint of low back and left leg pain.

Intervention and Outcome

Abnormal examination and radiographic findings were discovered. The patient was immediately referred to the pulmonologist for co-management. Through the use of advanced imaging and biopsy, stage 4 lung cancer was diagnosed.

Conclusion

Low back pain recurrence in an established patient should constitute a reevaluation of the problem. The cause cannot be assumed to be musculoskeletal in origin even though this may have been the case with the initial complaint. Metastatic disease should be considered with any type of recurrent low back pain.     

Human subject rear passenger symptom response to frontal car-to-car low-speed crash tests

Objective

The purpose of this study was to determine whether healthy adult volunteers report symptoms following exposure to low-speed frontal crashes at low velocities.

Methods

Nineteen medically screened, healthy, informed, and willing volunteers (17 men, 2 women; mean age, 37 years) were exposed to low-speed frontal crashes. All volunteers were seated in the rear seat position of the bullet vehicle. Closing velocities ranged from 4.1 to 8.3 mph (mean, 6.7 mph). For the bullet vehicle, the delta V ranged from 1.4 to 3.9 mph with a mean of 2.8 mph.

Results

Eighty-eight percent of volunteers attributed symptoms of discomfort to their crash exposure. All reported symptoms were transient, and none required medical treatment. The mean duration was 1 day.

Conclusions

Even at relatively low speeds, there is no lower threshold below which it can be reasonably assumed that healthy and prepared volunteer rear seat passengers will not sustain some level of minor injury in a frontal collision. Although the reported mean delta V for injured persons in real-world frontal crashes has been reported to be as high as 8.1 mph, this does not offer any insight into the minimum threshold for such injuries among all at-risk vehicle occupants.     

Lateral closed wedge osteotomy for cubitus varus deformity

Background:

Lateral closed wedge (LCW) osteotomy is a commonly accepted method for the correction of the cubitus varus deformity. The fixation of osteotomy is required to prevent loss of correction achieved. The fixation of the osteotomy by the two screw and figure of eight wire is not stable enough to maintain the correction achieved during surgery. In this prospective study we supplemented the fixation by Kirschner''s (K-) wires for stable fixation and evaluated the results.

Materials and Methods:

Twenty-one cases of the cubitus varus deformity following supracondylar fractures of the humerus were operated by LCW osteotomy during February 2001 to June 2006. The mean age of the patients at the time of corrective surgery was 8.5 years (range 6.6-14 years). The osteotomy was fixed by two screws with figure of eight tension band wire between them and the fixation was supplemented by passing two to three K-wires from the lateral condyle engaging the proximal medial cortex through the osteotomy site.

Result:

The mean follow-up period was 2.5 years (range seven months to 3.4 years). The results were assessed as per Morrey criteria. Eighteen cases showed excellent results and three cases showed good results. Two cases had superficial pin tract infection.

Conclusion:

The additional fixation by K wires controls rotational forces effectively besides angulation and translation forces and maintains the correction achieved peroperatively.