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Differentiating maximal and submaximal voluntary strength measures for the purposes of medico-legal assessments and para sport classification: A systematic review.
Paix, EL, Tweedy, SM, Connick, MJ, Beckman, EM
European journal of sport science. 2021;(11):1518-1550
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Abstract
Measurement of maximum voluntary muscle contractions are effort-dependent - valid measurement requires maximal voluntary effort (MVE) from participants. Submaximal efforts (SMEs) yield invalid and potentially misleading results. This is particularly problematic in medico-legal and Para sport assessments where low strength scores may confer a personal advantage. Therefore, objective methods for accurately differentiating MVE and SME are required. This systematic review aimed to identify, appraise and synthesise evidence from scientific studies evaluating the validity of objective methods for differentiating MVE from SME during maximal voluntary contractions. Four electronic databases were searched for original research articles published in English and secondary references appraised for relevance yielding 25 studies for review. Methods were categorised based on eight distinct underlying theories. For isokinetic strength assessment, methods based on two theories - Strength-measure Ratios and Inter-Trial Strength Consistency - correctly classified 100% MVE and > 92% SME. Consequently, research evaluating the relative suitability of these methods for translation into practice is warranted. During isometric strength assessments, methods based on Deceptive Visual Feedback and Force-length properties warrant further investigation. Both methods yielded statistically significant differences between MVE and SME, with minimal overlap in values, but their sensitivity and specificity have not been evaluated.
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Considerations for physical employment standards in the aging workforce.
Flower, DJC, Tipton, MJ, Milligan, GS
Work (Reading, Mass.). 2019;(4):509-519
Abstract
BACKGROUND If current population and health trends continue, workplace demographics will look significantly different by the turn of the century. Organizations will no longer have a steady pipeline of younger workers and will likely need to rely on older workers to remain competitive in the global marketplace. The future multi-generational workforce will bring with it the challenge of maximizing contributions from each generation whilst at the same time addressing the health, safety and wellbeing needs of all workers. OBJECTIVE This review provides an insight into aging and older workers, and presents recommendations to promote worker longevity. METHODS This narrative review draws on evidence from 108 published sources. RESULTS The relationship between age and work is not simple; factors including the physical nature of the job and worker's health and fitness interact with age to either increase or decrease the potential effect of age. Evidence suggests that the issues arising from an aging workforce can be managed through polices that focus on active aging through: attitude management; flexible working and the provision of occupational health. CONCLUSION The integration of such interventions would require company and organizational commitment from the top down with educational programs at all levels to ensure understanding and participation.
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The risk of stroke and associated risk factors in a health examination population: A cross-sectional study.
Li, RC, Xu, WD, Lei, YL, Bao, T, Yang, HW, Huang, WX, Tang, HR
Medicine. 2019;(40):e17218
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Abstract
Health examination is an important method for early detection of people with different risk of stroke. This study estimates the risk of stroke and identify risk factors for people who underwent health examinations at the Health Examination Center at West China Hospital, Sichuan University from July 2014 to February 2018.A total of 31,464 people were recruited in this study and divided into 3 groups (low risk, moderate risk, and high risk) according to risk of stroke. We explored possible factors associated with the risk of stroke by using multivariable stepwise logistic regression analysis.Among the participants, 17,959 were at low risk, 11,825 were at moderate risk, and 1680 were at high risk. Age, smoking, alcohol consumption, body mass index, uric acid, diastolic pressure, systolic pressure, triglycerides, low-density lipoprotein cholesterol, glucose, and brachial-ankle pulse wave velocity (baPWV) were independent significant risk factors for stroke, whereas high-density lipoprotein cholesterol was an independent protective factor for stroke. Interestingly, with increasing age, the percentage of people at moderate or high risk of stroke was increased. The percentages of people at moderate and high risk of stroke were also increased with respect to the stages of baPWV.This study showed that >40% of the participants were at moderate or high risk of stroke, especially the older participants. Several factors were related to the risk of stroke, especially baPWV. Some preventive action may be adopted early, and more attention can be paid to the health examination population.
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Behavioral economics and diabetic eye exams.
Williams, AM, Liu, PJ, Muir, KW, Waxman, EL
Preventive medicine. 2018;:76-87
Abstract
Diabetic retinopathy is a common microvascular complication of diabetes mellitus and is the leading cause of new blindness among working-age adults in the United States. Timely intervention to prevent vision loss is possible with early detection by regular eye examinations. Unfortunately, adherence to recommended annual diabetic eye exams is poor. Public health interventions have targeted traditional barriers to care, such as cost and transportation, with limited success. Behavioral economics provides an additional framework of concepts and tools to understand low screening rates and to promote regular diabetic eye exams for populations at risk. In particular, behavioral economics outlines biases and heuristics that affect decision-making and underlie pervasive barriers to care, such as not viewing diabetic eye exams as a priority or perceiving oneself as too healthy to need an examination. In this review, we examine the literature on the use of behavioral economics interventions to promote regular diabetic eye exams. From the results of the included studies, we outline how concepts from behavioral economics can improve eye examination rates. In particular, the default bias, present bias, and self-serving bias play a significant role in precluding regular diabetic eye examinations. Potential tools to mitigate these biases include leveraging default options, using reminder messages, providing behavioral coaching, applying commitment contracts, offering financial incentives, and personalizing health messages. When combined with traditional public health campaigns, insights from behavioral economics can improve understanding of pervasive barriers to care and offer additional strategies to promote regular preventive eye care for patients with diabetes.
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Anemia in Older Adults.
Lanier, JB, Park, JJ, Callahan, RC
American family physician. 2018;(7):437-442
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Abstract
Anemia is associated with increased morbidity and mortality in older adults. Diagnostic cutoff values for defining anemia vary with age, sex, and possibly race. Anemia is often asymptomatic and discovered incidentally on laboratory testing. Patients may present with symptoms related to associated conditions, such as blood loss, or related to decreased oxygen-carrying capacity, such as weakness, fatigue, and shortness of breath. Causes of anemia in older adults include nutritional deficiency, chronic kidney disease, chronic inflammation, and occult blood loss from gastrointestinal malignancy, although in many patients the etiology is unknown. The evaluation includes a detailed history and physical examination, assessment of risk factors for underlying conditions, and assessment of mean corpuscular volume. A serum ferritin level should be obtained for patients with normocytic or microcytic anemia. A low serum ferritin level in a patient with normocytic or microcytic anemia is associated with iron deficiency anemia. In older patients with suspected iron deficiency anemia, endoscopy is warranted to evaluate for gastrointestinal malignancy. Patients with an elevated serum ferritin level or macrocytic anemia should be evaluated for underlying conditions, including vitamin B12 or folate deficiency, myelodysplastic syndrome, and malignancy. Treatment is directed at the underlying cause. Symptomatic patients with serum hemoglobin levels of 8 g per dL or less may require blood transfusion. Patients with suspected iron deficiency anemia should be given a trial of oral iron replacement. Lower-dose formulations may be as effective and have a lower risk of adverse effects. Normalization of hemoglobin typically occurs by eight weeks after treatment in most patients. Parenteral iron infusion is reserved for patients who have not responded to or cannot tolerate oral iron therapy.
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Effectiveness of peer support to increase uptake of retinal examination for diabetic retinopathy: study protocol for the DURE pragmatic cluster randomized clinical trial in Kirinyaga, Kenya.
Mwangi, N, Ng'ang'a, M, Gakuo, E, Gichuhi, S, Macleod, D, Moorman, C, Muthami, L, Tum, P, Jalango, A, Githeko, K, et al
BMC public health. 2018;(1):871
Abstract
BACKGROUND All patients with diabetes are at risk of developing diabetic retinopathy (DR), a progressive and potentially blinding condition. Early treatment of DR prevents visual impairment and blindness. The natural history of DR is that it is asymptomatic until the advanced stages, thus annual retinal examination is recommended for early detection. Previous studies show that the uptake of regular retinal examination among people living with diabetes (PLWD) is low. In the Uptake of Retinal Examination in Diabetes (DURE) study, we will investigate the effectiveness of a complex intervention delivered within diabetes support groups to increase uptake of retinal examination. METHODS The DURE study will be a two-arm pragmatic cluster randomized clinical trial in Kirinyaga County, Kenya. Diabetes support groups will be randomly assigned to either the intervention or usual care conditions in a 1:1 ratio. The participants will be 700 PLWD who are members of support groups in Kirinyaga. To reduce contamination, the unit of randomization will be the support group. Peer supporters in the intervention arm will receive training to deliver the intervention. The intervention will include monthly group education on DR and individual member reminders to take the eye examination. The effectiveness of this intervention plus usual care will be compared to usual care practices alone. Participant data will be collected at baseline. The primary outcome is the proportion of PLWD who take up the eye examination at six months. Secondary outcomes include the characteristics of participants and peer supporters associated with uptake of eye examination for DR. Intention-to-treat analysis will be used to evaluate the primary and secondary outcomes. DISCUSSION Eye care programs need evidence of the effectiveness of peer supporter-led health education to improve attendance to retinal screening for the early detection of DR in an African setting. Given that the intervention combines standardization and flexibility, it has the potential to be adopted in other settings and to inform policies to promote DR screening. TRIAL REGISTRATION Pan African Clinical Trial Registry PACTR201707002430195 , registered 25 July 2017, www.pactr.org.
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Reliability of a Skin Diagnostic Device in Assessing Hydration and Erythema.
Huimin, K, Rowledge, AM, Borzdynski, CJ, Miller, C, Frescos, N, McKenzie, G, Perry, E, McGuiness, W
Advances in skin & wound care. 2017;(10):452-459
Abstract
OBJECTIVE To examine the reliability of a skin diagnostic device, the SD202 (Courage+Khazaka GmBH, Cologne, Germany), in assessing hydration and erythema of periwound skin and pressure injury-prone areas. DESIGN Intrarater reliabilities from 3 cross-sectional and prospective studies are reported. SETTING AND PARTICIPANTS Patients attending an outpatient, nurse-led wound dressing clinic (n = 16), a podiatrist-led high-risk foot clinic (n = 17), and residents (n = 38) at a single residential aged-care facility. MAIN OUTCOME MEASURE Skin hydration and erythema levels assessed using the SD202. MAIN RESULTS High internal consistency was maintained for consecutive skin hydration and erythema measures at a single point on the venous leg ulcer periwound (α > .996 and α > .970 for hydration and erythema, respectively) and for the pressure-prone areas of the sacrum (α > .916), right (α > .994) and left (α > .967) ischium, right (α > .989) and left (α > .916) trochanter, right (α > .985) and left (α > .992) calcaneus, and right (α > .991) and left (α > .990) lateral malleolus. High consistency was also found for the measures obtained at 4 different locations around the periwound for the venous leg ulcer (α > .935 and α > .870 for hydration and erythema, respectively). In diabetic foot ulcer assessment, acceptable internal consistency of hydration measures around the periwound was observed (α > .634). Internal consistency of erythema measures was variable, ranging from low to high reliability, particularly among predebridement measures. CONCLUSIONS Using the protocols outlined in this study, the SD202 demonstrates high reliability for assessing skin hydration and erythema levels. It is possible that the SD202 can be used in clinical practice as an appropriate tool for skin hydration and erythema assessment.
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Clinical and laboratory parameters associated with acute kidney injury in patients with snakebite envenomation: a prospective observational study from Myanmar.
Aye, KP, Thanachartwet, V, Soe, C, Desakorn, V, Thwin, KT, Chamnanchanunt, S, Sahassananda, D, Supaporn, T, Sitprija, V
BMC nephrology. 2017;(1):92
Abstract
BACKGROUND Snakebite-related acute kidney injury (AKI) is a common community-acquired AKI in tropical countries leading to death and disability. The aims of this study were to (1) determine the occurrence of snakebite-related AKI, (2) assess factors at presentation that are associated with snakebite-related AKI, and (3) determine the outcomes of patients with snakebite-related AKI. METHODS We conducted a prospective observational study of patients with snake envenomation at the three academic tertiary care hospitals in Yangon, Myanmar between March 2015 and June 2016. Patient data including baseline characteristics, clinical and laboratory findings, hospital management, and outcomes were recorded in a case report form. A stepwise multivariate logistic regression analysis using a backward selection method determined independent factors significantly associated with AKI. RESULTS AKI was observed in 140 patients (54.3%), the majority of whom were AKI stage III (110 patients, 78.6%). AKI occurred at presentation and developed during hospitalization in 88 (62.9%) and 52 patients (37.1%), respectively. Twenty-seven patients died (19.3%), and 69 patients (49.3%) required dialysis. On multivariate logistic regression analysis, (1) snakebites from the Viperidae family (odds ratio [OR]: 9.65, 95% confidence interval [CI]: 2.42-38.44; p = 0.001), (2) WBC >10 × 103 cells/μL (OR: 3.55, 95% CI: 1.35-9.34; p = 0.010), (3) overt disseminated intravascular coagulation (OR: 2.23, 95% CI: 1.02-4.89; p = 0.045), (4) serum creatine kinase >500 IU/L (OR: 4.06, 95% CI: 1.71-9.63; p = 0.001), (5) serum sodium <135 mmol/L (OR: 4.37, 95% CI: 2.04-9.38; p < 0.001), (6) presence of microscopic hematuria (OR: 3.60, 95% CI: 1.45-8.91; p = 0.006), and (7) duration from snakebite to receiving antivenom ≥2 h (OR: 3.73, 95% CI: 1.48-9.37; p = 0.005) were independently associated with AKI. Patients bitten by Viperidae with normal renal function who had serum sodium <135 mmol/L had a significantly higher urine sodium-to-creatinine ratio than those with serum sodium ≥135 mmol/L (p < 0.001). CONCLUSIONS Identifying factors associated with snakebite-related AKI might help clinicians to be aware of snakebite patients who are at risk of AKI, particularly patients who demonstrate renal tubular dysfunction after Viperidae bites.
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Physical Examination Findings Among Children and Adolescents With Obesity: An Evidence-Based Review.
Armstrong, S, Lazorick, S, Hampl, S, Skelton, JA, Wood, C, Collier, D, Perrin, EM
Pediatrics. 2016;(2):e20151766
Abstract
Overweight and obesity affects 1 in 3 US children and adolescents. Clinical recommendations have largely focused on screening guidelines and counseling strategies. However, the physical examination of the child or adolescent with obesity can provide the clinician with additional information to guide management decisions. This expert-based review focuses on physical examination findings specific to children and adolescents with obesity. For each physical examination element, the authors define the finding and its prevalence among pediatric patients with obesity, discuss the importance and relevance of the finding, describe known techniques to assess severity, and review evidence regarding the need for additional evaluation. The recommendations presented represent a comprehensive review of current evidence as well as expert opinion. The goal of this review is to highlight the importance of conducting a targeted physical examination during pediatric weight management visits.
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Diagnosis and management of hair loss in children.
Castelo-Soccio, L
Current opinion in pediatrics. 2016;(4):483-9
Abstract
PURPOSE OF REVIEW Hair loss is common in infants and children and the ability to distinguish why a child is losing hair enables providers to distinguish hair loss that is related to infection, autoimmune conditions, nutrition, medications, trauma/traction, or underlying genetic disorders such as ectodermal dysplasias. Making these distinctions leads to best management and guidance for patients and their families. RECENT FINDINGS Careful physical examination of the hair, scalp, skin, and nails coupled with dermoscopy or trichoscopy, or both, can yield more accurate and faster diagnosis. Biopsy is rarely needed in children for hair loss conditions. SUMMARY Hair loss, particularly on the scalp, can affect all ages and can impact patients socially and emotionally. The majority of hair loss in children is nonscarring. Diagnosis begins with a good history, including personal and family history, medication use, a thorough physical examination, and use of dermoscopy or trichoscopy, or both. With these, providers can begin to divide hair loss into congenital vs. acquired, and then further subdivide into focal vs. diffuse and scarring vs. nonscarring. Secondary change, including scale and erythema, can further help with diagnosis.