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Background: The Ponseti method of congenital idiopathic clubfoot correction has traditionally specified plaster of Paris (POP) as the cast material of choice; however, there are negative aspects to using POP. We sought to determine the influence of cast material (POP v. semirigid fibreglass [SRF]) on clubfoot correction using the Ponseti method. Methods: Patients were randomized to POP or SRF before undergoing the Ponseti method. The primary outcome measure was the number of casts required for clubfoot correction. Secondary outcome measures included the number of casts by severity, ease of cast removal, need for Achilles tenotomy, brace compliance, deformity relapse, need for repeat casting and need for ancillary surgical procedures. Results: We enrolled 30 patients: 12 randomized to POP and 18 to SRF. There was no difference in the number of casts required for clubfoot correction between the groups (p = 0.13). According to parents, removal of POP was more difficult (p < 0.001), more time consuming (p < 0.001) and required more than 1 method (p < 0.001). At a final follow-up of 30.8 months, the mean times to deformity relapse requiring repeat casting, surgery or both were 18.7 and 16.4 months for the SRF and POP groups, respectively. Conclusion: There was no significant difference in the number of casts required for correction of clubfoot between the 2 materials, but SRF resulted in a more favourable parental experience, which cannot be ignored as it may have a positive impact on psychological well-being despite the increased cost associated. Contexte: La methode de Ponseti pour la correction du pied bot congenital idiopathique a de tout temps specifie l'utilisation du platre de Paris comme materiau de choix; il y a toutefois certains inconvenients associes au platre de Paris. Nous avons voulu determiner l'influence du materiau utilise (platre de Paris c. fibre de verre semirigide) sur la correction du pied bot selon la methode de Ponseti. Methodes: Les patients ont ete assignes aleatoirement soit au platre de Paris soit a la fibre de verre semi-rigide en vue de l'intervention de Ponseti. Le principal parametre mesure etait le nombre de platres requis pour corriger le pied bot. Les parametres secondaires incluaient le nombre de platres en fonction de la gravite, la facilite de retrait du platre, la necessite de sectionner le tendon d'Achille, le port assidu de l'attelle, le retour de la difformite, la necessite d'autres platres et interventions chirurgicales auxiliaires. Resultats: Nous avons inscrit 30 patients: 12 ont ete assignes au platre de Paris et 18 a la fibre de verre. On n'a note aucune difference entre les groupes quant au nombre de platres requis pour la correction du pied bot (p = 0,13). Selon les parents, le retrait du platre de Paris etait plus difficile (p < 0,001), prenait plus de temps (p < 0,001) et necessitait le recours a plus d'une methode (p < 0,001). Au moment du dernier suivi a 30,8 mois, les intervalles moyens avant un retour de la difformite necessitant la pose d'un autre platre et/ou une chirurgie ont ete de 18,7 et 16,4 mois dans les groupes traites au moyen de la fibre de verre semi-rigide et du platre de Paris, respectivement. Conclusion: On n'a note aucune difference significative entre les 2 materiaux quant au nombre de platres requis pour corriger le pied bot, mais la fibre de verre a donne lieu a une experience plus agreable pour les parents, ce qui ne peut etre ignore en raison de l'impact potentiellement positif sur le bien-etre psychologique, et ce, malgre un cout plus eleve., Congenital idiopathic clubfoot is a 3-dimensional deformity that includes cavus and adductus of the midfoot, combined with hindfoot varus and equinus. (1-13) The goal of treatment is to correct all [...]

A study was conducted to evaluate and compare the risk of injury associated with body checking among youth ice hockey players in a league as against those that were not subjected to body checking. Results indicated that such players subjected to body checking had a 3-fold higher risk of game-related injuries including concussion, severe injury and severe concussion.

Perinatal stroke causes hemiparetic cerebral palsy (HCP) and lifelong disability. Constraint-induced movement therapy (CIMT) and neurostimulation may enhance motor function, but the individual factors associated with responsiveness are undetermined. We explored the clinical and neurophysiological factors associated with responsiveness to CIMT and/or brain stimulation within a clinical trial. PLASTIC CHAMPS was a randomized, blinded, sham-controlled trial (n = 45) of CIMT and neurostimulation paired with intensive, goal-directed therapy. Primary outcome was the Assisting Hand Assessment (AHA). Classification trees created through recursive partitioning suggested clinical and neurophysiological profiles associated with improvement at 6-months. Both clinical (stroke side (left) and age >14 years) and neurophysiological (intracortical inhibition/facilitation and motor threshold) were associated with responsiveness across treatment groups with positive predictive values (PPV) approaching 80%. This preliminary analysis suggested sets of variables that may be associated with response to intensive therapies in HCP. Further modeling in larger trials is required. [ABSTRACT FROM AUTHOR]

Community health workers (CHWs) effectively improve maternal, newborn and child health (MNCH) outcomes in low-to-middle-income countries. However, CHW retention remains a challenge. This retrospective registry analysis evaluated medium-term retention of volunteer CHWs in two rural Ugandan districts, trained during a district-wide MNCH initiative. From 2012 to 2014, the Healthy Child Uganda partnership facilitated district-led CHW programme scale-up. CHW retention was tracked prospectively from the start of the intervention up to 2 years. Additional follow-up occurred at 5 years to confirm retention status. Database analysis assessed CHW demographic characteristics, retention rates and exit reasons 5 years post-intervention. A multivariable logistic regression model examined 5-year retention-associated characteristics. Of the original cohort of 2317 CHWs, 70% were female. The mean age was 38.8 years (standard deviation, SD: 10.0). Sixty months (5 years) after the start of the intervention, 84% of CHWs remained active. Of those exiting (n = 377), 63% reported a 'logistical' reason, such as relocation (n = 96), new job (n = 51) or death (n = 30). Sex [male, female; odds ratio (OR) = 1.53; 95% confidence interval (CI): 1 · 20-1 · 96] and age group (<25 years, 30-59; OR = 0.40; 95% CI: 0.25-0.62) were significantly associated with 5-year retention in multivariable modelling. Education completion (secondary school, primary) was not significantly associated with retention in adjusted analyses. CHWs in this relatively large cohort, trained and supervised within a national CHW programme and district-wide MNCH initiative, were retained over the medium term. Importantly, high 5-year retention in this intervention counters findings from other studies suggesting low retention in government-led and volunteer CHW programmes. Encouragingly, findings from our study suggest that retention was high, not significantly associated with timing of external partner support and largely not attributed to the CHW role i.e. workload and programme factors. Our study showcases the potential for sustainable volunteer CHW programming at scale and can inform planners and policymakers considering programme design, including selection and replacement planning for CHW networks. [ABSTRACT FROM AUTHOR]

Discriminant analysis procedures that assume parsimonious covariance and/or means structures have been proposed for distinguishing between two or more populations in multivariate repeated measures designs. However, these procedures rely on the assumptions of multivariate normality which is not tenable in multivariate repeated measures designs which are characterized by binary, ordinal, or mixed types of response distributions. This study investigates the accuracy of repeated measures discriminant analysis (RMDA) based on the multivariate generalized estimating equations (GEE) framework for classification in multivariate repeated measures designs with the same or different types of responses repeatedly measured over time. Monte Carlo methods were used to compare the accuracy of RMDA procedures based on GEE, and RMDA based on maximum likelihood estimators (MLE) under diverse simulation conditions, which included number of repeated measure occasions, number of responses, sample size, correlation structures, and type of response distribution. RMDA based on GEE exhibited higher average classification accuracy than RMDA based on MLE especially in multivariate non-normal distributions. Three repeatedly measured responses namely severity of epilepsy, current number of anti-epileptic drugs, and parent-reported quality of life in children with epilepsy were used to demonstrate the application of these procedures. [ABSTRACT FROM AUTHOR]