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Background Youth have experienced unprecedented restrictions during the COVID-19 pandemic. It is important to ascertain youth's perceptions of how the lockdown restrictions have impacted their well-being. Given the varying restrictions imposed in different countries, exploring the impact relative to the specific restrictions is imperative. This study investigated youth's views on the impact of a third national lockdown on their well-being and physical activity. Methods Following informed parental consent, youth aged 8-18 years attending state schools in Wales, UK, were invited to complete an online questionnaire using an individualised link sent to the email addresses provided by parents (January 2021). A total of 4,259 survey links were issued. The questionnaire included questions on children's physical activity, mental well-being and experience of COVID-19. This study reports on free text responses from an optional two-part open-ended question on their experience during restrictions employed to manage the COVID-19 pandemic in Wales. The questions were (a) How does lockdown make you feel?, followed by (b) Why do you feel this way?. Flexible thematic analysis was employed to analyse the data and identify themes and sub-themes. Results Valid responses were received from 1,681 youth (11.8±2.3 years; 50% girls). Most participants expressed only a negative emotional response to their lockdown experience. Whilst there were no overall sex differences in the responses, age differences were observed. Specifically, the 12-13 year-old age group reported the lowest number of negative responses, compared to 8-9 year-olds who reported the highest. Six distinct negative emotional responses were identified: sadness, anger, worry, loneliness, boredom, laziness. Nevertheless, a small cohort of participants identified positive emotional responses that focused on being happy. Mixed emotions were also reported by participants which were most prevalent amongst 16-18 year-olds and least reported in 10-11 year-olds. Finally, the inability to participate in team sports was reported negatively, however, some youth reported the additional time facilitated greater participation in exercise. Conclusions The predominance of negative emotions highlights the significant and potentially long-lasting impact the lockdowns have had on youth's mental well-being. In addition, the findings evidence that youth associated sport participation with their mental health. Furthermore, the age differences identified highlight that youth's developmental stage, both emotionally and societally, should be considered in the recovery response to improve and reduce further deterioration in youth's mental health. This evidence should be considered when ministers evaluate the wider evidence to inform future restrictions required to manage the exit from COVID-19 and other future pandemics.

ObjectivesTo evaluate whether a home-based rehabilitation programme for people assessed as being at risk of a poor outcome after knee arthroplasty offers superior outcomes to traditional outpatient physiotherapy.DesignA prospective, single-blind, two-arm randomised controlled superiority trial.Setting14 National Health Service physiotherapy departments in the UK.Participants621 participants identified at high risk of a poor outcome after knee arthroplasty using a bespoke screening tool.InterventionsA multicomponent home-based rehabilitation programme delivered by rehabilitation assistants with supervision from qualified therapists versus usual care outpatient physiotherapy.Main outcome measuresThe primary outcome was the Late-Life Function and Disability Instrument (LLFDI) at 12 months. Secondary outcomes were the Oxford Knee Score (a disease-specific measure of function), Knee injury and Osteoarthritis Outcome Score Quality of Life subscale, Physical Activity Scale for the Elderly, 5 dimension, 5 level version of Euroqol (EQ-5D-5L) and physical function assessed using the Figure of 8 Walk test, 30 s Chair Stand Test and Single Leg Stance.Results621 participants were randomised between March 2015 and January 2018. 309 were assigned to CORKA (Community Rehabilitation after Knee Arthroplasty) home-based rehabilitation, receiving a median five treatment sessions (IQR 4–7). 312 were assigned to usual care, receiving a median 4 sessions (IQR 2–6). The primary outcome, LLFDI function total score at 12 months, was collected for 279 participants (89%) in the home-based CORKA group and 287 participants (92%) in the usual care group. No clinically or statistically significant difference was found between the groups (intention-to-treat adjusted difference=0.49 points; 95% CI −0.89 to 1.88; p=0.48). There were no statistically significant differences between the groups on any of the patient-reported or physical secondary outcome measures at 6 or 12 months.There were 18 participants in the intervention group reporting a serious adverse event (5.8%), only one directly related to the intervention, all other adverse events recorded throughout the trial related to underlying chronic medical conditions.ConclusionsThe CORKA intervention was not superior to usual care. The trial detected no significant differences, clinical or statistical, between the two groups on either primary or secondary outcomes. CORKA offers an evaluation of an intervention utilising a different service delivery model for this patient group.Trial registration numberISRCTN13517704.

Supplemental Digital Content is available in the text., Introduction: Achieving and maintaining target serum trough infliximab levels improves outcomes in children and young adults with inflammatory bowel disease. Our goal was to improve adherence to an infliximab therapy guideline. The primary aim was to increase the percentage of patients with infliximab levels ≥5 μg/mL and results checked in the last 12 months from 73% to ≥80% from July 2017 to January 2018. Methods: We participated in Intermediate Improvement Science Series, a course at Cincinnati Children’s Hospital Medical Center designed to catalyze change using quality improvement methodology. We implemented interventions through plan-do-study-act cycles. Our outcome measure was balanced by 2 process measures to determine what actions impacted improvement. These measures included the percentage of infusion plans revised in response to a drug level 5 μg/mL, and results checked in the last 12 months, from 73% to 80%. Conclusions: Quality improvement methodology was effective in improving provider adherence to infliximab therapeutic drug monitoring guidelines. Improvement in adherence to guidelines directly improved the percentage of patients achieving target infliximab levels at any time during infliximab therapy.

Background: Pressure injuries (PIs) represent a frequent, often preventable, secondary complication of spinal cord injury (SCI) with serious consequences to health, societal participation,...

In the UK, many academic staff are not sufficiently physically active and experience high levels of poor mental health. Designing theoretical workplace physical activity in- terventions may help this population become active and improve their mental health. This study examined the construct validity of the Transtheoretical Model (TTM) in academic staff to design physical activity interventions for mental health purposes. One-hundred fifty-eight academic staff employed in a teaching or research capacity completed online surveys on their current stage of change of physical activity, self-efficacy, perceived benefits and barriers of being active, distress, and wellbeing. Analyses of variance compared stages of physical activity against psychological and mental health variables. Overall, most individuals were in the action and maintenance stages of the TTM. Self-efficacy and benefits increased, while barriers of physical activity decreased with each successive stage, indicating that the mediators of physical activity changed in accordance with the TTM. Additionally, distress decreased and wellbeing increased significantly with each successive stage, indicating better mental health amongst active individuals. This study supports the use of the TTM to structure work-place physical activity interventions for mental health purposes for academic staff. Strategies should be employed to strengthen self-efficacy in those individuals think-ing about or intending to become active.

Background Previsit planning (PVP) has been an integral part of clinical care for paediatric patients with inflammatory bowel disease (IBD) at Cincinnati Children’s Hospital Medical Center since 2007. Over the past years, we have adopted several programmes to improve health maintenance supervision for our paediatric patients with IBD but did not have a sustainable way to provide health maintenance updates for every patient at every encounter that was concise and complete in the setting of an increasing patient population and fewer support staff to complete the work. Methods Using quality improvement methods, we completed several Plan-Do-Study-Act (PDSA) cycles aimed at improving our centre’s ability to provide complete health maintenance ‘bundle’ recommendations from 0% to 90% of patients over a period of 11 months. Results First steps included consensus gathering and summarising evidence into guidelines suitable for the group. PDSAs centred on consensus building from standardised guidelines, using empty checklists for simulated and real patients, and use of autofilled checklists. After several PDSA cycles, we have improved our ability to provide complete health maintenance PVP from 0% to nearly 100% with very little variation. Conclusion Using the health maintenance PVP process, we can now sustainably provide health maintenance guidance for all outpatient clinic visits. We have begun to scale up this work and anticipate over the coming months that we will be able to expand the health maintenance PVP to provide complete PVP for over 90% of patients for any scheduled encounter including biologic infusion visits. We anticipate that using this reliable process we can improve remission rates and reduce preventable infections for these at-risk patients.

Purpose To evaluate the effectiveness of educational programs in reducing urinary tract infections (UTIs) in individuals with spinal cord injuries (SCI). Methods A search of all relevant literature published up to and including July 2012 was conducted using multiple databases. Methodological quality was rated using the PEDro tool for randomized control trials (RCTs) and the Downs and Black tool for non-RCTs; levels of evidence were assigned using a modified Sackett scale. Findings Four articles were selected for review. As a result of an education program, a level 2 prospective control trial reported a reduction in number of UTIs (p = .02), but a level 2 RCT did not. A pre–post study found a reduction in number of UTIs while a case–control study did not; however, these studies did not compute statistics. Conclusions There is limited positive evidence that education programs reduce the incidence of UTIs. Clinical relevance Optimal urinary health of individuals with SCI may be optimized via education programs that provide information and enhance skills.

To examine the effectiveness of botulinum toxin type A (BTX-A) on neurogenic detrusor overactivity (NDO) in individuals with spinal cord injury (SCI).MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for all relevant articles published from 1980 to June 2012.Trials examining the use of BTX-A injections into the detrusor wall in the treatment of NDO after SCI were included if (1) ≥ 50% of study sample comprised subjects post-SCI; (2) outcomes of interest were assessed before and after treatment with a single injection of BTX-A; and (3) the sample size was ≥ 3.A standardized mean difference ± SE (95% confidence interval) was calculated for at least 1 of the following outcomes in every study: postvoid residual urine volume, reflex detrusor volume, bladder capacity, bladder compliance, catheterization frequency, and maximum flow rate. Results from all studies were then pooled using a random-effects model. Treatment effect sizes were interpreted as small,0.2; moderate,0.5; or large,0.8.Fourteen studies representing data from 734 subjects were included. After BTX-A injection, large treatment effects were observed in postvoid residual urine volume, reflex detrusor volume, bladder capacity, bladder compliance, and catheterization frequency (P.01). Rate of incontinence episodes was reduced from 23% to 1.31% after BTX-A treatment. No significant decrease in max flow rate was observed (P=.403).Results of the meta-analysis indicate BTX-A is effective in treating NDO after SCI. The use of BTX-A was associated with a decrease in incontinence episodes, catheter use, and bladder pressures.

The purpose of this review of clinical guidelines and best practices literature is to suggest prevention options and a treatment approach for intermittent catheter users that will minimize UTI. Recommendations are based both on evidence in the literature and an understanding of what is currently attainable within the Alberta context, through collaboration between both major tertiary care centres (Edmonton and Calgary) and between various professionals who regularly encounter these patients, including nursing, physiatry, and urology. Key references used to prepare this document included Canadian sources such as; SCIRE, along with the American Urological Association (AUA) and European Urological Association (EUA) documents on the topic and resources from Paralyzed Veterans of America. No details on neurogenic bladder management exist in the Canadian Urological Association list of publications. Finally, the impetus for preparing these protocols arose due to concerns identified by a survey of individuals with SCI regarding perceived gaps in knowledge and practice among caregivers and physicians about SCI and UTI prevention and management.

Twentieth-century US public relations historiography has focused primarily on corporate public relations and agencies, incorporating a “great man” perspective and largely excluding women and minorities. This scholarship allows us to begin to build a narrative, presented here, but the authors call for an expansion of what is considered public relations and of who practiced it. Public relations was often used by people in areas such as politics, churches, higher education institutions, and social service agencies who were not trying to invent public relations; rather they were solving problems by using communication to inform and persuade their audiences. The activism of suffragist and women’s rights advocate Alice Paul, and Henry Lee Moon, NAACP public relations director, illustrates that American public relations history is broad, diverse, and expansive.

Mehta S, Hill D, Foley N, Hsieh J, Ethans K, Potter P, Baverstock R, Teasell RW, Wolfe D, the Spinal Cord Injury Rehabilitation Evidence Research Team. A meta-analysis of botulinum toxin sphincteric injections in the treatment of incomplete voiding after spinal cord injury. Objective To conduct a systematic review and meta-analysis to examine the effect of injecting botulinum toxin A (BTX-A) into the detrusor sphincter on improving bladder emptying in individuals with spinal cord injury (SCI). Data Sources MEDLINE, CINAHL, EMBASE, and PsycINFO databases were searched for all relevant articles published from 1980 to September 2011. Data Selection All trials examining the use of BTX-A injections into the detrusor sphincter for the treatment for incomplete bladder emptying after SCI were included if at least 50% of the study sample comprised subjects with SCI, and if the SCI sample size was 3 or greater. Data Extraction A standardized mean difference (SMD) ± SE and 95% confidence interval (CI) were calculated for each outcome of interest, and the results were pooled using a fixed or random effects model, as appropriate. Outcomes assessed included postvoid residual urine volume (PRV), detrusor pressure (PDet), and urethral pressure (UP). Effect sizes were interpreted as small, 0.2; moderate, 0.5; and large, 0.8. Data Synthesis A relatively limited number of studies (2 randomized controlled trials, 6 uncontrolled trials) were identified. The 8 studies included results from 129 subjects. There was a statistically significant decrease in PRV at 1 month (SMD=1.119±.140; 95% CI, .844–1.394; P P =.009); pooled PDet decreased from 88.7 to 20.5cmH 2 O. A large statistical effect size on UP (SMD=.896±.291; 95% CI, .327–1.466; P =.002) and an improvement from 119.7 to 102.3cmH 2 O were seen. The systematic review also indicated a 50% reduction in urinary tract infections based on 3 studies. Discontinuation or reduction in catheter usage was reported in 4 studies after BTX-A. Conclusions Results of the meta-analysis indicate that BTX-A is effective in reducing PRV and demonstrating a statistically significant reduction in PDet and UP 1 month postinjection. However, the clinical utility of BTX-A is yet to be determined.

This paper reports findings from three focus groups, involving 24 people, aged 65 to 79 years (20 women, four men), concerning their knowledge of safety on stairs. Findings indicate that older people use their stairs as and when necessary, but tend to avoid stair use when it becomes more difficult. The location of essential facilities in some homes (e.g. the lavatory), however, may lead to increased use of stairs for some. Despite recognition of hazardous behaviour, participants reported that they continued to engage in activities which may increase risk of falling, e.g. leaving objects on stairs and using stairs in the dark. Cleaning stairs presents problems in some cases due to difficulties with access or the need to use heavy and awkward equipment. Focus group participants recognised that medications and use of alcohol may increase the risk of falling, but it seems that individuals may not always appreciate when they personally are at increased risk. Most participants indicated they had given only limited thought to stair safety prior to the focus groups. Possibilities for prevention are reviewed, including modifications to the stair environment and equipment design, coupled with safety education, to raise awareness of risks and strategies for dealing with these.

(2001). The practice and social evolution of the Javanese Gamelan: Evolution and continuity. Contemporary Theatre Review: Vol. 11, No. 1, pp. 19-27.

Background. Retraining walking following spinal cord injury using visually guided tasks may be especially efficacious because it engages the motor cortex, whose input may facilitate improvements in functional walking. Objectives. To contrast 2 methods of retraining, one emphasizing precise, visually guided walking over obstacles and on targets (Precision Training), the other emphasizing mass practice of walking on a treadmill (Endurance Training). Methods. A randomized, single-blind, crossover design was used. Twenty-two participants, ≥7 months postinjury, were randomly allocated to start with Precision or Endurance Training. Each phase of training was 5 times per week for 2 months, followed by a 2-month rest. Measures of walking speed, distance, skill, confidence, and depression were obtained before training, then monthly thereafter. Results. Both forms of training led to significant improvements in walking, with Endurance Training inducing bigger improvements in walking distance than Precision Training, especially for high-functioning walkers who had initial walking speeds >0.5 m/s. The largest improvements in walking speed and distance occurred in the first month of Endurance Training, with minimal changes in the second month of training. In contrast, improvements in walking skill occurred over both months during both types of training. Retention of over ground walking speed, distance, and skill was excellent for both types of training. Conclusions. Intensive walking training in the chronic phase after spinal cord injury is effective in improving over ground walking. Visually guided tasks for training individuals with chronic spinal cord injury were not superior to mass practice on a treadmill.