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Background Informal caregivers of people with dementia provide the majority of health-based care to people with dementia. Providing this care requires knowledge and access to resources, which caregivers often do not receive. We set out to evaluate the effect of online educational tools on informal caregiver self-efficacy, quality of life, burden/stress, depression, and anxiety, and to identify effective processes for online educational tool development. Methods We conducted a scoping review of articles on online educational interventions for informal caregivers of people with dementia searching CINAHL, MEDLINE, EMBASE, and PubMed from 1990 to March 2018, with an updated search conducted in 2020. The identified articles were screened and the data were charted. Results 33 articles that reported on 24 interventions were included. There is some evidence that online interventions improve caregiver-related outcomes such as self-efficacy, depression, dementia knowledge, and quality of life; and decrease caregiver burden. Common findings across the studies included the need for tailored, stage-specific information applicable to the caregiver’s situation and the use of psychosocial techniques to develop the knowledge components of the interventions. Conclusion We demonstrate the importance of having caregivers and health-care professionals involved at all stages of tool conceptualization and development. Online tools should be evaluated with robust trials that focus on how increased knowledge and development approaches affect caregiver-related outcomes.

Gun violence is a leading cause of premature death and a driver of racial disparities in life expectancy in the United States. Community-based interventions are the foremost policy strategy for reducing gun violence without exacerbating harm associated with criminal justice approaches. However, little is known about the interventionist workforce. In 2021, we used a researcher-guided survey to obtain a near-census of Chicago violence interventionists ( n = 181, 93% response rate). Workers were mostly male (84%) and Black (80.9%), with a mean age of 43.6 years. Interventionists commonly experienced work-related exposure to violence and direct victimization. A total of 59.4% witnessed someone being shot at, whereas 32.4% witnessed a victim struck by gunfire. During work hours, 19.6% were shot at, while 2.2% were nonfatally shot. Single-year rates of gun violence victimization exceeded those of Chicago police. Results suggest that investment in community violence intervention should prioritize improving worker safety and reducing violence exposure while developing support for vulnerable frontline practitioners.

Preseason functional tests have been previously associated with noncontact time-loss lower extremity injuries in a variety of athletic populations. This study aimed to determine the effectiveness of one or more functional tests to discriminate injury risk in a cohort of female collegiate volleyball players in the United States.Prospective cohort study.National Collegiate Athletic Association Division IIIII, National Association of Intercollegiate Athletics female volleyball players; PARTICIPANTS: 130 female volleyball players (mean age: 19.31 ± 1.1 years).Lower extremity functional test, single limb hop for distance, standing long jump, previous injury history, lower quarter Y-balance test, and limb symmetry index were measured prior to the season beginning. Noncontact time-loss lower quarter injuries were tracked during the season.Athletes with suboptimal scores on the single limb hop test (70% of height) and standing long jump (80% of height), combined with a previous history of injury, were three times more likely to sustain an injury during the season (OR = 3.0; 95% CI: 1.09 to 8.30). Individual functional tests did not discriminate injury risk.A battery of preseason functional tests and injury history discriminates injury risk in female collegiate volleyball players.

WHAT IS KNOWN ON THE SUBJECT?: Arts-based research is an established and accepted research approach and systematic reviews have been published on this methodology. There are many possible data collection techniques and study designs within arts-based research, which have been implemented but not yet systematically reviewed. Rationales and challenges for arts-based research have covered participants' experiences of being in arts-based studies in health service research. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The main results of this systematic review are that mental health recovery concepts are effectively communicated by visual arts-based research and participation in these studies is progressive and connecting for mental health consumers. This paper adds new knowledge about participants' experiences specifically in visual arts-based studies, where the participants are mental health consumers. The results are significant because they support visual arts-based research in its development and popularity, both as a research approach and as an empowerment intervention. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The results of this systematic review can enhance the fields of qualitative research methods and mental health nursing. Recommendations for professional development can be advanced from consumers' ideas and experiences of recovery reported in this review. Nurse scientists and consumer researchers can take into consideration visual arts-based data collection techniques for use as research and empowerment interventions with mental health consumer participants.INTRODUCTION: Art creation has been found to be therapeutic to mental health consumers, making the prospect of art creation's conceivable benefits as a mental health research strategy worthy of consideration.This systematic review aims to explore experiences of recovery among adults with a mental illness using visual art methods.Following a comprehensive database search, 14 suitable studies were identified. These involved adult participants with a formal mental health diagnosis, or who self-identify as having a mental illness. The studies employed arts-based methodologies with participant-created, visual art as their data. Articles underwent data extraction and quality appraisal with the JBI-QARI (Qualitative Assessment and Review Instrument).Results were categorised and further aggregated into two synthesised findings according to Joanna Briggs Institute (JBI) guidelines. The synthesised findings are: (1) Creative artmaking enables the use of visual metaphors which can aid expression of feelings, externalisation of identity, and personal learning, and (2) Interpersonal and self-connectedness through inclusion in community, receiving support when needed, and progressing through loss, are beneficial for mental health recovery.These findings are comparable to those already existing in the literature, and suggest that visual arts-based research methods are as dependable as other qualitative research methods. Additionally, this systematic review reveals that when conducting research studies, there are benefits for mental health consumer participants when visual arts-based methods are used.A visual arts-based research intervention can be concluded to have the effect of an empowerment intervention, as well as being a credible research method.

Contains fulltext : 235277.pdf (Publisher’s version ) (Closed access) BACKGROUND: Balancing the risks of recurrent ischaemic stroke and intracranial haemorrhage is important for patients treated with antithrombotic therapy after ischaemic stroke or transient ischaemic attack. However, existing predictive models offer insufficient performance, particularly for assessing the risk of intracranial haemorrhage. We aimed to develop new risk scores incorporating clinical variables and cerebral microbleeds, an MRI biomarker of intracranial haemorrhage and ischaemic stroke risk. METHODS: We did a pooled analysis of individual-patient data from the Microbleeds International Collaborative Network (MICON), which includes 38 hospital-based prospective cohort studies from 18 countries. All studies recruited participants with previous ischaemic stroke or transient ischaemic attack, acquired baseline MRI allowing quantification of cerebral microbleeds, and followed-up participants for ischaemic stroke and intracranial haemorrhage. Participants not taking antithrombotic drugs were excluded. We developed Cox regression models to predict the 5-year risks of intracranial haemorrhage and ischaemic stroke, selecting candidate predictors on biological relevance and simplifying models using backward elimination. We derived integer risk scores for clinical use. We assessed model performance in internal validation, adjusted for optimism using bootstrapping. The study is registered on PROSPERO, CRD42016036602. FINDINGS: The included studies recruited participants between Aug 28, 2001, and Feb 4, 2018. 15 766 participants had follow-up for intracranial haemorrhage, and 15 784 for ischaemic stroke. Over a median follow-up of 2 years, 184 intracranial haemorrhages and 1048 ischaemic strokes were reported. The risk models we developed included cerebral microbleed burden and simple clinical variables. Optimism-adjusted c indices were 0·73 (95% CI 0·69-0·77) with a calibration slope of 0·94 (0·81-1·06) for the intracranial haemorrhage model and 0·63 (0·62-0·65) with a calibration slope of 0·97 (0·87-1·07) for the ischaemic stroke model. There was good agreement between predicted and observed risk for both models. INTERPRETATION: The MICON risk scores, incorporating clinical variables and cerebral microbleeds, offer predictive value for the long-term risks of intracranial haemorrhage and ischaemic stroke in patients prescribed antithrombotic therapy for secondary stroke prevention; external validation is warranted. FUNDING: British Heart Foundation and Stroke Association.

Previously, variation in retinal vascular caliber has been reported in association with chronic kidney disease (CKD) but findings remain inconsistent. To help clarify this we conducted individual participant data meta-analysis and aggregate data meta-analysis on summary estimates to evaluate cross-sectional associations between retinal vascular caliber and CKD. A systematic review was performed using Medline and EMBASE for articles published until October 2018. The aggregate analysis used a two-stage approach combining summary estimates from eleven studies (44,803 patients) while the individual participant analysis used a one-stage approach combining raw data from nine studies (33,222 patients). CKD stages 3-5 was defined as an estimated glomerular filtration rate under 60 mL/min/1.73m2. Retinal arteriolar and venular caliber (central retinal arteriolar and venular equivalent) were assessed from retinal photographs using computer-assisted methods. Logistic regression estimated relative risk of CKD stages 3-5 associated with a 20 μm decrease (approximately one standard deviation) in central retinal arteriolar and venular equivalent. Prevalence of CKD stages 3-5 was 11.2% of 33,222 and 11.3% of 44,803 patients in the individual participant and aggregate data analysis, respectively. No significant associations were detected in adjusted analyses between central retinal arteriolar and venular equivalent and CKD stages 3-5 in the aggregate analysis for central retinal arteriolar relative risk (0.98, 95% confidence interval 0.94-1.03); venular equivalent (0.99, 0.95-1.04) or individual participant central retinal arteriolar (0.99, 0.95-1.04) or venular equivalent (1.01, 0.97-1.05). Thus, meta-analysis provided little evidence to suggest that cross sectional direct measurements of retinal vascular caliber was associated with CKD stages 3-5 in the general population. Hence, meta-analyses of longitudinal studies evaluating the association between retinal parameters and CKD stages 3-5 may be warranted.

OBJECTIVE: Diabetes summer camps provide children and adolescents with type 1 diabetes opportunities to learn about the disease and its management in a supportive environment to help improve glycaemic control, self-reliance and quality of life. The objective of this quantitative review was to assess the advantages of attending summer camps and study any adverse psychological effects.METHODS: Studies with a pre/post study design in children and adolescents attending summer camp were systematically reviewed. Five bibliographic databases were searched and relevant data extracted. Random effects meta-analyses were used to combine the individual study results to derive pooled estimates and meta-regression was used to explore between-study heterogeneity.RESULTS: Studies in the literature report short-term improvements in the glycaemic control, diabetes knowledge (DK), quality of life (QOL) anxiety, diabetes self-management and self-esteem. Thirty-three studies were identified, and those outcomes reported in five or more studies were included in meta-analyses. There were significant benefits with a pooled mean change for glycated haemoglobin (95%CI) of -0.59(-0.95,-0.23)% (-6.4(-10.4,-2.5)mmol/mol), and for standardised DK score of 1.99(1.28,2.70) but corresponding changes for QOL 0.17(-0.06,0.39) and for anxiety -0.32(-0.70,0.06) were not significant. However, all outcomes showed considerable between-study heterogeneity little of which was explained by study characteristics.CONCLUSION: The findings suggests short-term benefits of camp on metabolic control, DK, QOL and anxiety in T1D children and adolescents, although the latter two were not statistically significant. Further research is warranted with more methodological rigor and longer-term follow-up to determine if there are long-term benefits associated with camp attendance. This article is protected by copyright. All rights reserved.

Background The main underlying risk factors associated with coronary heart disease (CHD) are modifiable and oxidative injury and systemic inflammatory damage represent key aetiological factors associated with the development and progression of CHD and premature mortality. Objective To examine associations of plasma antioxidant status with all-cause mortality and fatal or non-fatal cardiovascular events. Design The PRIME study prospectively evaluated 9709 men aged 50–59 years between 1991 and 1993 in Northern Ireland and France who were free of CHD at recruitment and followed annually for deaths and cardiovascular events for 10 years. Serum concentrations of vitamin C, retinol, two forms of vitamin E (α- and γ-tocopherol) and six carotenoids were quantified by high-performance liquid chromatography. Baseline conventional risk factors were considered, as well as socioeconomic differences and lifestyle behaviours including diet, smoking habit, physical activity, and alcohol consumption through Cox regression analyses. Results At 10 years, there were 538 deaths from any cause and 440 fatal or non-fatal cardiovascular events. After adjustment for country, age, systolic blood pressure, diabetes, body mass index, cholesterol, high density lipoprotein cholesterol, triglycerides, height, total physical activity, alcohol consumption and smoking habit, higher levels of all antioxidants were associated with significantly lower risk of all-cause mortality, with the exception of γ-tocopherol. Only retinol was significantly associated with decreased risk of cardiovascular events in a fully adjusted model. Conclusions Low antioxidant levels contribute to the gradient of all-cause mortality and cardiovascular incidence independent of lifestyle behaviours and traditional cardiovascular and socioeconomic risk factors.

Objective The objective of this study is to describe agreement between administrative and self-report data on the number and type of chronic conditions (CCs) and determine whether associations between CC count and health service use differ by data source. Study Design and Setting We linked Canadian Community Health Survey and administrative data for a cohort of adults aged 45+ years in Ontario and identified 12 CCs from both data sources. Agreement was described by count and constituent CCs. We estimated associations between CC count (self-report and administrative data) and health service use (administrative data only) over 1 year. Results Among 71,317 adults, 26.9% showed agreement on both count and constituent CCs but agreement declined with increasing CCs. Health service use increased with CC count but the association was stronger when CCs were measured with administrative data. For example, when measured with administrative data, the odds of a general practitioner visit for 5+ CCs vs. none was 20.3 (95% CI 20.0–20.5) but when using self-report data, the estimate was 8.0 (95% CI 7.8–8.2). Conclusion Agreement on the number of CCs was low and resulted in different estimates on the association with health service use, illustrating the challenges in CC measurement and the ability to interpret the effects on outcomes.

To critically synthesize the literature that describes men's help-seeking and engagement with general practice.Integrative literature review.CINAHL plus, Medline and APA PsycInfo were searched for papers published between 1999 and March 2021.After screening titles and abstracts, full-text papers were screened against inclusion / exclusion criteria. All included papers were assessed for methodological quality. Findings were extracted, critically examined and synthesized into themes.Twenty studies met the inclusion criteria. Thematic analysis revealed four themes related to; (1) structural barriers, (2) internal barriers, (3) men's understanding of the role of general practice, and (4) self-care and help-seeking. The findings indicate that men can find general practice unwelcoming and unaccommodating. Men can also experience psychological barriers that impact engagement and help-seeking. Men predominantly view general practice as a source of acute health care and do not appreciate the role of general practice in preventive health care and advice.This review has provided insight into the issues around the barriers to health care engagement, men's understanding of the role of general practice and their associated help-seeking. Seeking to further understand these issues could assist in the development of strategies to promote engagement of men with general practice health care.This review highlights research about men's engagement with general practice and the missed opportunities in receiving preventive health care and education. Enhancing men's engagement with general practice has the potential to reduce the impact of their health on quality of life and improve health outcomes.

Background There are limited data on performance of biomarkers to predict pre-eclampsia (PE) in high-risk women. This study investigated the ability of FABP4, PAPP-A, PlGF, sFlt-1 and sEng to predict PE in a high-risk group. Methods Non-fasting samples were analysed at 11 + 0–13 + 6 (V1) and 19 + 0–21 + 6 weeks (V2) ( n = 195). Logistic regression models were determined. Area under (AUC) the receiver operating characteristic (ROC) curve analysis was performed. The added value of biomarkers to clinical characteristics for PE prediction was quantified using integrated discrimination improvement (IDI) and net reclassification improvement (NRI) indices. Results Prevalence of PE was 12%. Lower concentrations of sFlt-1:PlGF (V1) and PlGF and PlGF:sEng (V2) were seen in women who developed PE. Controlling for baseline characteristics (V1), a doubling of sFlt-1 (pg/mL) (median 896.0, IQR 725.5–1097.0) and sFlt-1:PlGF (median 21.2, IQR 14.7–32.3) was associated with reduction in odds of PE (OR 0.20, 95% CI 0.06–0.65, P = 0.007 and OR 0.48, 95% CI 0.25–0.92, P = 0.04). Addition of sFlt-1 and sFlt-1:PlGF to baseline characteristics non-significantly improved AUC (0.74) (AUC 0.77, P = 0.40 and 0.76, P = 0.39). NRI and IDI analyses confirmed added clinical utility of sFlt-1 (NRI = 0.539, P = 0.01 and IDI = 0.052, P = 0.03). In V2, doubling of PlGF:sEng (median 71.9, IQR 47.0–102.8) was associated with reduction in the risk of PE (OR 0.56, 95% CI 0.35–0.98, P = 0.04). The addition of PlGF:sEng to baseline characteristics non-significantly improved AUC from 0.78 to 0.82 ( P = 0.25) and improved reclassification of cases (NRI = 0.682, P = 0.002). Conclusions Screening tests incorporating first trimester sFlt-1 and second trimester PlGF:sEng have potential to aid PE prediction in high-risk pregnancies.

GERAS DANcing for Cognition and Exercise is a therapeutic dance program for older adults with cognitive or mobility impairments. Using a pre-/posttest study design, we investigated the effect of 12 weeks of dance on the short performance physical battery (SPPB). In 107 participants aged 61–93 (mean 76.1, SD = 7.0; 20% men), over 90% had multifrailty and/or cognitive impairment. The mean attendance rate was 18/24 classes (75%). A substantial minimal clinically important difference (>0.4) occurred for SPPB total (+0.53, SD = 2.04, p = .002) and chair stands (+0.45, SD = 0.92, p n = 38)—indicative of sarcopenia and physical frailty—had the most marked improvement (SPPB total: +1.45, SD = 1.97, p SD = 1.27, p = .006; chair stands: +0.68, SD = 0.97, p

Activity monitors, such as Fitbits®, are being used increasingly for research purposes and data have been validated in healthy community-dwelling older adults. Given the lack of research in older adults with neurocognitive disorders, we investigated the consistency of sleep data recorded from a wrist-worn activity monitor in this population.Fitbit® activity monitors were worn by hospitalized older adults as part of a parent study investigating sleep and step count in patients recovering from hip fracture surgery in a tertiary care academic hospital in Hamilton, Canada between March 2018 and June 2019. In this secondary analysis, we compared the proportion of missing sleep data between participants with and without a neurocognitive disorder and used a multivariable model to assess the association between neurocognitive disorder and missing sleep data.Of 67 participants included in the analysis, 22 had a neurocognitive disorder (median age: 86.5 years). Sleep data were missing for 47% of the neurocognitive disorder group and 23% of the non-neurocognitive disorder group. The presence of a neurocognitive disorder was associated with an increased likelihood of missing sleep data using the Fitbit® activity monitors (adjusted odds ratio: 3.41; 95% confidence interval: 1.06-11.73,The inconsistent nature of sleep data tracking in hospitalized older adults with neurocognitive disorders highlights the challenges of using interventions in patient populations who are often excluded from validation studies. As opportunities expand for activity monitoring in persons with neurocognitive disorders, novel technologies not previously studied in this group should be used with caution.

Adhering to a Mediterranean diet (MD) is associated with reduced CVD risk. This study aimed to explore methods of increasing MD adoption in a non-Mediterranean population at high risk of CVD, including assessing the feasibility of a developed peer support intervention. The Trial to Encourage Adoption and Maintenance of a MEditerranean Diet was a 12-month pilot parallel group RCT involving individuals aged ≥ 40 year, with low MD adherence, who were overweight, and had an estimated CVD risk ≥ 20 % over ten years. It explored three interventions, a peer support group, a dietician-led support group and a minimal support group to encourage dietary behaviour change and monitored variability in Mediterranean Diet Score (MDS) over time and between the intervention groups, alongside measurement of markers of nutritional status and cardiovascular risk. 118 individuals were assessed for eligibility, and 75 (64 %) were eligible. After 12 months, there was a retention rate of 69 % (peer support group 59 %; DSG 88 %; MSG 63 %). For all participants, increases in MDS were observed over 12 months (P < 0·001), both in original MDS data and when imputed data were used. Improvements in BMI, HbA1c levels, systolic and diastolic blood pressure in the population as a whole. This pilot study has demonstrated that a non-Mediterranean adult population at high CVD risk can make dietary behaviour change over a 12-month period towards an MD. The study also highlights the feasibility of a peer support intervention to encourage MD behaviour change amongst this population group and will inform a definitive trial.

Plasma interaction with water results in the dissociation of water (H 2 O) molecules leading to the formation of oxidative and reductive species such as hydroxyl radicals (•OH), hydrogen peroxide (H 2 O 2 ), atomic oxygen (O), atomic hydrogen (H), molecular hydrogen (H 2 ), and aqueous electrons. The reactive species generated are responsible for degradation of toxic chemicals such as PFOA. In our previous study 1 , we analyzed mineralization of 50 ppm PFOA with a gas-liquid plasma reactor using nanosecond pulses and varying the pulse frequency between 0.25kHz - 10kHz. The highest F - production rate of 1.57×10 -8 moles/s was observed at 5 kHz. The highest energy efficiency of 9.12×10 -9 moles/J was observed at 0.25 kHz.

AIM The aim was to investigate the role of systemic inflammation in the relationship between periodontitis, edentulism, and all-cause mortality in a group of men in Northern Ireland aged 58-72 years. MATERIALS AND METHODS A representative sample of 1558 men had a detailed dental examination between 2001 and 2003. The primary end point was death from any cause. Cox's proportional hazards model was used to assess the longitudinal relationship between periodontitis, edentulism, and all-cause mortality. Accelerated failure time modelling was performed to investigate the mediating role of systemic inflammation. RESULTS Mean age of the men at baseline was 64.3 (standard deviation 2.9) years. During a median follow-up of 17 years, 500 (32.1%) men died. After adjustment for confounding variables, compared to men with no/mild periodontitis, edentulous men had a hazard ratio for all-cause mortality of 1.52 (95% confidence interval [CI] 1.16-1.99) p

ObjectiveTo evaluate the pattern of frailty across several of social stratifiers associated with health inequalities.Design, setting and participantsCross-sectional baseline data on 51 338 community-living women and men aged 45–85 years from the population-based Canadian Longitudinal Study on Aging (collected from September 2011 to May 2015) were used in this study.Primary outcomes and measuresA Frailty Index (FI) was constructed using self-reported chronic conditions, psychological function and cognitive status and physical functioning variables. Social stratifiers were chosen based on the Pan-Canadian Health Inequalities Reporting Initiative, reflecting key health inequalities in Canada. Unadjusted and adjusted FIs and domain-specific FIs (based on chronic conditions, physical function, psychological/cognitive deficits) were examined across population strata.ResultsThe overall mean FI was 0.13±0.08. It increased with age and was higher in women than men. Higher mean FIs were found among study participants with low income (0.20±0.10), who did not complete secondary education (0.17±0.09) or had low perceived social standing (0.18±0.10). Values did not differ by Canadian province of residence or urban/rural status. After simultaneously adjusting for population characteristics and other covariates, income explained the most heterogeneity in frailty, especially in younger age groups; similar patterns were found for men and women. The average frailty for people aged 45–54 in the lowest income group was greater than that for those aged 75–85 years. The heterogeneity in the FI among income groups was greatest for the psychological/cognitive domain.ConclusionsOur results suggest that especially in the younger age groups, psychological/cognitive deficits are most highly associated with both overall frailty levels and the gradient in frailty associated with income. If this is predictive of later increases in the other two domains (and overall frailty), it raises the question whether targeting mental health factors earlier in life might be an effective approach to mitigating frailty.

Introduction Despite increasing dementia rates, few culturally informed cognitive assessment tools exist for Indigenous populations. The Canadian Indigenous Cognitive Assessment (CICA) was adapted with First Nations on Manitoulin Island, Canada, and provides a brief, multi‐domain cognitive assessment in English and Anishinaabemowin. Methods Using community‐based participatory research (CBPR) methods, we assessed the CICA for inter‐rater and test–retest reliability in 15 individuals. We subsequently evaluated validity and established meaningful CICA cut‐off scores in 55 individuals assessed by a geriatrician. Results The CICA demonstrated strong reliability (intra‐class coefficient = 0.95 [0.85,0.98]). The area under the curve (AUC) was 0.98 (0.94, 1.00), and the ideal cut‐point to identify likely cases of dementia was a score of less than or equal to 34 with sensitivity of 100% and specificity of 85%. Discussion When used with older First Nations men and women living in First Nations communities, the CICA offers a culturally safe, reliable, and valid assessment to support dementia case‐finding.

The prevalence of patellar tendinopathy has been reported to be as high as 50% in elite male volleyball (VB) players; however, the rate of injury in female collegiate VB athletes is unknown. The purpose of this study was to 1) identify the prevalence of ultrasonographic evidence of patellar tendon abnormality at the start of the preseason in female collegiate VB players; 2) report the incidence of tendinopathy during the season; and 3) determine if the preseason presence of tendon abnormality is associated with onset of disease. One hundred and six female collegiate VB players had both patellar tendons imaged. Incidence of patellar tendinopathy was tracked during the course of the 4-month season. Twenty-two athletes presented with ultrasonographic evidence of patellar tendon abnormality in at least one knee at the start of the preseason. The incidence of time-loss patellar tendinopathy was 0.26 (95% CI: 0.04, 0.85) per 1000 athletic exposures. This study was unable to determine if preseason presence of tendon abnormality was associated with a greater risk of tendinopathy due to power. The prevalence of tendon abnormality in the preseason and the incidence of patellar tendinopathy in female collegiate VB players are lower than that observed in other populations.

An extensive monitoring, verification, and accounting (MVA) program was carried out from 2011 to 2016 as part of the Illinois Basin – Decatur Project (IBDP), a large-scale carbon capture and storage (CCS) demonstration project in Decatur, Illinois, USA. As part of the monitoring program, a near-surface monitoring network for soil gas was used to characterize the natural variability of CO2 and identify anomalies that could be associated with CO2 leakage in the vadose zone. In the fall of 2011, 21 permanent soil gas sampling nests were installed on-site and three nests were installed off-site as reference locations. Soil gas was collected from three depth intervals (15–30, 47–61, 107–122 cm) at each nest. Fixed gas (CO2, N2, O2, and light hydrocarbon) concentrations, stable carbon isotopic composition (δ13C), and radiocarbon (14C) content of CO2 in soil gas were monitored during the pre-injection, injection, and post-injection phases from 2011 to 2016. Both CO2 concentrations and carbon isotopic compositions showed large spatial and temporal variations; however, the relationships among CO2, N2, and O2 concentrations in soil gas indicated that these variations should be attributed to natural processes and not CO2 leakage. Soil CO2 concentrations responded to temperature and precipitation variations and increased with increasing soil depth. While 14C cannot be used to determine the occurrence of CO2 leakage at IBDP site due to the indistinctive signature between injected CO2 and soil gas CO2, experiences at IBDP validated that δ13C can serve as an effective natural tracer at this site. Results from this project have value for future industrial CCS projects that plan to use soil gas monitoring techniques for site characterization and leakage detection.

Background The Lower Quarter Y-Balance Test (YBT-LQ) is used by sports medicine professionals to measure an athlete's dynamic balance. The YBT-LQ is used by clinicians to track recovery during clinical rehabilitation, assess an athlete's readiness to return to sport after injury, and to identify athletes potentially at-risk for a time-loss injury. Normative data for the YBT-LQ are lacking for female collegiate volleyball (VB) players. The purpose of this study was to examine preseason YBT-LQ scores and their relationships to level of competition, starter status, player position, and prior lower quadrant (i.e., low back and lower extremities) injury history. Methods One-hundred thirty-four female collegiate VB players (mean age = 19.3 ± 1.1 years) representing athletes from three levels of competition (D II = 32, D III = 77, NAIA = 25) participated in this study. Athletes reported their prior injury history and performed the YBT-LQ testing protocol. Results NAIA and D III athletes demonstrated significantly greater reach measures on the YBT-LQ than D II athletes in several directions. Starters demonstrated significantly greater reach measures in five out of eight reach directions. Liberos/defensive specialists/setters demonstrated significantly greater posterolateral and composite reach measures bilaterally. There was no difference in reach measures based on prior history of lower quadrant (low back and lower extremities) injury. Conclusion This study provides normative data for YBT-LQ in female collegiate volleyball players. The data presented in this report may be used by coaches and rehabilitation professionals when evaluating dynamic balance in healthy volleyball players and by clinicians to compare an injured athlete's recovery to norms. Level of evidence 3b.

Background Most studies that examine comorbidity and its impact on health service utilization focus on a single index-condition and are published in disease-specific journals, which limit opportunities to identify patterns across conditions/disciplines. These comparisons are further complicated by the impact of using different study designs, multimorbidity definitions and data sources. The aim of this paper is to share insights on multimorbidity and associated health services use and costs by reflecting on the common patterns across 3 parallel studies in distinct disease cohorts (diabetes, dementia, and stroke) that used the same study design and were conducted in the same health jurisdiction over the same time period. Methods We present findings that lend to broader Insights regarding multimorbidity based on the relationship between comorbidity and health service use and costs seen across three distinct disease cohorts. These cohorts were originally created using multiple linked administrative databases to identify community-dwelling residents of Ontario, Canada with one of diabetes, dementia, or stroke in 2008 and each was followed for health service use and associated costs. Results We identified 376,434 indviduals wtih diabetes, 95,399 wtih dementia, and 29,671 with stroke. Four broad insights were identified from considering the similarity in comorbidity, utilization and cost patterns across the three cohorts: 1) the most prevalent comorbidity types were hypertension and arthritis, which accounted for over 75% of comorbidity in each cohort; 2) overall utilization increased consistently with the number of comorbidities, with the vast majority of services attributed to comorbidity rather than the index conditions; 3) the biggest driver of costs for those with lower levels of comorbidity was community-based care, e.g., home care, GP visits, but at higher levels of comorbidity the driver was acute care services; 4) service-specific comorbidity and age patterns were consistent across the three cohorts. Conclusions Despite the differences in population demographics and prevalence of the three index conditions, there are common patterns with respect to comorbidity, utilization, and costs. These common patterns may illustrate underlying needs of people with multimorbidity that are often obscured in literature that is still single disease-focused. Electronic supplementary material The online version of this article (10.1186/s12913-019-4149-3) contains supplementary material, which is available to authorized users.

Les outils cliniques employes dans les etablissements de soins peuvent fournir des informations pronostiques importantes aux professionnels de la sante. Dans cette etude observationnelle prospective d'un an, nous avons examine l'association entre les scores au Short Performance Physical Battery (SPPB), d'une part, et les consultations a l'urgence et les hospitalisations au cours de l'etude, d'autre part. Au total, 191 patients ayant ete nouvellement referes a une clinique geriatrique externe de Hamilton (Ontario) ont ete contactes, et parmi eux, 120 pris part a l'etude. Le SPPB et d'autres evaluations ont ete realises dans le cadre de consultations de routine. Les dossiers medicaux electroniques ont ete examines pour determiner le nombre de consultations a l'urgence et d'hospitalisations dans l'annee qui a suivi l'evaluation de base. Des analyses de regression logistique ont ete utilisees pour identifier des predicteurs des consultations a l'urgence et des hospitalisations. Le score moyen au SPPB dans la cohorte etudiee (moyenne d'âge = 80,6 ans, ecart-type = 6,3 ans ; 53 % de femmes) etait de 6,3 (ecart-type = 3,2). Au cours de cette periode d'un an, le score au SPPB etait associe au nombre de consultations a l'urgence [RR = 0,90 (0,78-1,03)] et d'hospitalisations [RR = 0,84 (0,72-0,97)], apres ajustement pour l'âge, le sexe et les comorbidites. Tools applied at the point of care can provide valuable prognostic information for practitioners. In this one-year, prospective observational study, we examined the association of the short performance physical battery (SPPB) and one-year emergency department (ED) visits and hospitalizations. Overall, 191 new referrals attending an outpatient geriatric clinic in Hamilton, Ontario, were approached, and 120 were enrolled. SPPB and other assessments were completed during the routine clinical visit. ED visits and hospitalizations within one year of the baseline assessment were abstracted from electronic medical records. Logistic regression analyses were used to determine ED visits and hospitalization predictors. The mean SPPB score in the study cohort (mean age 80.6, SD 6.3 years; 53% female) was 6.3 (SD 3.2). SPPB score was associated with a one-year ED visit (OR = 0.90 [0.78–1.03]) and hospitalization (OR = 0.84 [0.72–0.97]) after adjusting for age, sex, and co-morbidities.

Four key articles published in 2018 have been selected to represent clinical situations where recent evidence may prompt changes in practice relevant to the nursing home population. There is no evidence of benefit for levothyroxine replacement in mild subclinical hypothyroidism. Duloxetine may be considered as an option for the treatment of pain and stiffness in osteoarthritis of the knees. Supplemental oxygen in the absence of hypoxemia is unnecessary and potentially harmful. Methylphenidate has modest benefit in treating apathy in dementia. For each subject, a brief review of the pertinent article is followed by a “bottom line” recommendation.

OBJECTIVE To investigate whether there was an association between chronic periodontitis (CP) and reduced respiratory function. METHODS A group of dentate 58- to 72-year-old men in Northern Ireland had a comprehensive periodontal examination. Parallel to the periodontal examination, participants completed questionnaires gathering information on their medical history, social circumstances, demographic background and tobacco use. A physical examination assessed anthropometric measures. Fasting blood samples were obtained and analysed for high-sensitivity C-reactive protein (hs-CRP). Spirometry measures were performed using a wedge bellows spirometer (Vitalograph S Model). The primary outcome variable of interest was the percentage predicted forced expiratory volume in one-second (% predicted FEV1 ). Analysis included multiple linear regression with adjustment for various confounders and a regression-based mediation analysis. RESULTS A total of 1,380 men were included in the analysis. The mean age was 63.7 years (SD 3.0). Multiple linear regression analysis showed that a doubling in mean clinical attachment loss (CAL) equated to a -3.33% (95% CI: -4.80, -1.86), p

Background Researchers often use survey data to study the effect of health and social variables on physician use, but how self-reported physician use compares to administrative data, the gold standard, in particular within the context of multimorbidity and functional limitations remains unclear. We examine whether multimorbidity and functional limitations are related to agreement between self-reported and administrative data for physician use. Methods Cross-sectional data from 52,854 Ontario participants of the Canadian Community Health Survey linked to administrative data were used to assess agreement on physician use. The number of general practitioner (GP) and specialist visits in the previous year was assessed using both data sources; multimorbidity and functional limitation were from self-report. Results Fewer participants self-reported GP visits (84.8%) compared to administrative data (89.1%), but more self-reported specialist visits (69.2% vs. 64.9%). Sensitivity was higher for GP visits (≥90% for all multimorbidity levels) compared to specialist visits (approximately 75% for 0 to 90% for 4+ chronic conditions). Specificity started higher for GP than specialist visits but decreased more swiftly with multimorbidity level; in both cases, specificity levels fell below 50%. Functional limitations, age and sex did not impact the patterns of sensitivity and specificity seen across level of multimorbidity. Conclusions Countries around the world collect health surveys to inform health policy and planning, but the extent to which these are linked with administrative, or similar, data are limited. Our study illustrates the potential for misclassification of physician use in self-report data and the need for sensitivity analyses or other corrections.