Can Economic Empowerment Reduce Vulnerability of Girls and Young Women to HIV?

In April 2010, the International Center for Research on Women (ICRW), with support from the Nike Foundation, convened an expert meeting of researchers, program implementers, policymakers and donors to explore emerging insights into the linkages between economic empowerment and HIV outcomes for girls and young women. This report synthesizes the key insights, questions, challenges and recommendations that emerged from the meeting. It addresses two key questions:What are the links between economic status and HIV vulnerability of girls and young women?What is the role of economic empowerment in preventing and mitigating HIV among girls and young women?The report also summarizes general principles that should apply to programs and policies aiming to address the vulnerability of girls in a context of poverty and HIV

The PIT: SToPP Trial—A Feasibility Randomised Controlled Trial of Home-Based Physiotherapy for People with Parkinson's Disease Using Video-Based Measures to Preserve Assessor Blinding

Purpose. To trial four-week's physiotherapy targeting chair transfers for people with Parkinson's disease (PwPD) and explore the feasibility of reliance on remote outcome measurement to preserve blinding. Scope. We recruited 47 PwPD and randomised 24 to a focused home physiotherapy programme (exercise, movement strategies, and cueing) and 23 to a control group. We evaluated transfers (plus mobility, balance, posture, and quality of life) before and after treatment and at followup (weeks 0, 4, 8, and 12) from video produced by, and questionnaires distributed by, treating physiotherapists. Participants fed back via end-of-study questionnaires. Thirty-five participants (74%) completed the trial. Excluding dropouts, 20% of questionnaire data and 9% of video data were missing or unusable; we had to evaluate balance in situ. We noted trends to improvement in transfers, mobility, and balance in the physiotherapy group not noted in the control group. Participant feedback was largely positive and assessor blinding was maintained in every case. Conclusions. Intense, focused physiotherapy at home appears acceptable and likely to bring positive change in those who can participate. Remote outcome measurement was successful; questionnaire followup and further training in video production would reduce missing data. We advocate a fully powered trial, designed to minimise dropouts and preserve assessor blinding, to evaluate this intervention

Curses, hallelujahs, and amens : the rhetoric of Daniel Defoe, a case study in didactic fiction

In Modern Dogma and the Rhetoric of Assent, Wayne Booth asserts that "we need a criticism that can explain why some cursings of God and shouts of hallelujah succeed and some fail" (188). He is referring to the dilemma presented by didactic fiction. Such fiction exists in a critical gap for which students of literature have little specific terminology. This study is an exploration into the appropriate criteria for the evaluation of fiction which claims to teach a lesson. Part One examines Defoe's non-fictional rhetoric, searching for rhetorical patterns which might illuminate his didactic fiction. Three significant factors emerge: the role of blame, the role of the audience, and the role of truth. Part Two endeavors to ascertain if these three areas operate similarly in Defoe's major fiction to allow for an effective combination of didacticism and artistry. Three novels, Robinson Crusoe, Moll Flanders, and Roxana, are analyzed in detail

Could in-home sensors surpass human observation of people with Parkinson’s at high risk of falling? An ethnographic study

Self-report underpins our understanding of falls among people with Parkinson’s (PwP) as they largely happen unwitnessed at home. In this qualitative study, we used an ethnographic approach to investigate which in-home sensors, in which locations, could gather useful data about fall risk. Over six weeks, we observed five independently mobile PwP at high risk of falling, at home. We made field notes about falls (prior events and concerns) and recorded movement with video, Kinect, and wearable sensors. The three women and two men (aged 71 to 79 years) having moderate or severe Parkinson’s were dependent on others and highly sedentary. We most commonly noted balance protection, loss, and restoration during chair transfers, walks across open spaces and through gaps, turns, steps up and down, and tasks in standing (all evident walking between chair and stairs, e.g.). Our unobtrusive sensors were acceptable to participants: they could detect instability during everyday activity at home and potentially guide intervention. Monitoring the route between chair and stairs is likely to give information without invading the privacy of people at high risk of falling, with very limited mobility, who spend most of the day in their sitting rooms

Identifying balance impairments in people with Parkinson's disease using video and wearable sensors

Falls and near falls are common among people with Parkinson's (PwP). To date, most wearable sensor research focussed on fall detection, few studies explored if wearable sensors can detect instability. Can instability (caution or near-falls) be detected using wearable sensors in comparison to video analysis? Twenty-four people (aged 60-86) with and without Parkinson's were recruited from community groups. Movements (e.g. walking, turning, transfers and reaching) were observed in the gait laboratory and/or at home; recorded using clinical measures, video and five wearable sensors (attached on the waist, ankles and wrists). After defining 'caution' and 'instability', two researchers evaluated video data and a third the raw wearable sensor data; blinded to each other's evaluations. Agreement between video and sensor data was calculated on stability, timing, step count and strategy. Data was available for 117 performances: 82 (70%) appeared stable on video. Ratings agreed in 86/117 cases (74%). Highest agreement was noted for chair transfer, timed up and go test and 3 m walks. Video analysts noted caution (slow, contained movements, safety-enhancing postures and concentration) and/or instability (saving reactions, stopping after stumbling or veering) in 40/134 performances (30%): raw wearable sensor data identified 16/35 performances rated cautious or unstable (sensitivity 46%) and 70/82 rated stable (specificity 85%). There was a 54% chance that a performance identified from wearable sensors as cautious/unstable was so; rising to 80% for stable movements. Agreement between wearable sensor and video data suggested that wearable sensors can detect subtle instability and near-falls. Caution and instability were observed in nearly a third of performances, suggesting that simple, mildly challenging actions, with clearly defined start- and end-points, may be most amenable to monitoring during free-living at home. Using the genuine near-falls recorded, work continues to automatically detect subtle instability using algorithms. [Abstract copyright: Copyright © 2018. Published by Elsevier B.V.

第902回千葉医学会例会・第15回歯科口腔外科例会

Questionnaire to survey people with Parkinson’s choice of indoor and outdoor footwear, foot problems and fall history. (DOC 574 kb

Medial longitudinal arch development of school children : The College of Podiatry Annual Conference 2015: meeting abstracts

Background Foot structure is often classified into flat foot, neutral and high arch type based on the variability of the Medial Longitudinal Arch (MLA). To date, the literature provided contrasting evidence on the age when MLA development stabilises in children. The influence of footwear on MLA development is also unknown. Aim This study aims to (i) clarify whether the MLA is still changing in children from age 7 to 9 years old and (ii) explore the relationship between footwear usage and MLA development, using a longitudinal approach. Methods We evaluated the MLA of 111 healthy school children [age = 6.9 (0.3) years] using three parameters [arch index (AI), midfoot peak pressure (PP) and maximum force (MF: % of body weight)] extracted from dynamic foot loading measurements at baseline, 10-month and 22-month follow-up. Information on the type of footwear worn was collected using survey question. Linear mixed modelling was used to test for differences in the MLA over time. Results Insignificant changes in all MLA parameters were observed over time [AI: P = .15; PP: P = .84; MF: P = .91]. When gender was considered, the AI of boys decreased with age [P = .02]. Boys also displayed a flatter MLA than girls at age 6.9 years [AI: mean difference = 0.02 (0.01, 0.04); P = .02]. At baseline, subjects who wore close-toe shoes displayed the lowest MLA overall [AI/PP/MF: P < .05]. Subjects who used slippers when commencing footwear use experienced higher PP than those who wore sandals [mean difference = 31.60 (1.44, 61.75) kPa; post-hoc P = .04]. Discussion and conclusion Our findings suggested that the MLA of children remained stable from 7 to 9 years old, while gender and the type of footwear worn during childhood may influence MLA development. Clinicians may choose to commence therapy when a child presents with painful flexible flat foot at age 7 years, and may discourage younger children from wearing slippers when they commence using footwear

Footwear related problems following stroke: qualitative study of the views and experience of people with stroke in the SHOES Study

Purpose: Foot problems and suboptimal footwear are risk factors for falls among the elderly. Footwear choice may therefore be important for people with balance impairment following stroke but little is known about their experience. This study explored foot problems experienced following stroke, factors influencing footwear choices and views of footwear in use.Methods: Eligibility criteria were diagnosis of a stroke, able to walk and willingness to participate. Semi structured interviews with 15 people with stroke [PwS], purposively sampled from respondents to a screening survey. The sampling process drew on information about mobility (with or without falls), reliance on walking aids or other people, able to walk more than ¼ mile. Interviews were conducted in participant’s homes. Participants were asked to make available for discussion items of footwear currently being worn indoors and out. Data were managed and analysed thematically using Framework.Results: The sample comprised 15 people, 8 men and 7 women ranging in age from 52-84 years; mean 71 years with varying levels of mobility. Participants typically experienced impaired mobility with balance problems and felt at risk of falling. Stroke related foot problems, including altered sensation, oedema, and foot drop, predominantly on the stroke affected side, influenced footwear priorities. Footwear choices prioritised comfort, security and convenience, sometimes in tension with concern about appearance. Challenges included choosing appropriate indoor footwear and finding shoes to accommodate orthoses and oedema. Participants highlighted perceived lack of footwear advice from health care professionals [HCPs] and variable experience of shoe shopping.Conclusion(s): Foot problems, as well as gait and balance impairment, have implications for footwear priorities following stroke but PwS feel unsupported in making healthy footwear choices. HCPs could be trained to routinely deliver footwear assessment and advice and facilitate referrals to specialist podiatry services where appropriat

A multi-centre RCT of a falls prevention programme (PDSAFE) for people with Parkinson's: study design and baseline characteristics of participants

Purpose: This is a multi-centre, single-blinded, randomised controlled trial of the effectiveness and cost effectiveness of the PDSAFE intervention to prevent falls among PwP. The aim of this abstract is to present the design and the baseline population characteristics of 396 participants who have been randomised to date. Methods: Eligibility criteria are: confirmed diagnosis of Parkinson’s (P), living at home, having experienced at least one fall in the previous 12 months, can understand and follow instructions. PwP have been recruited from nine centres across England. Participants in the control group receive usual care and an information DVD. Participants in the experimental group receive usual care and PDSAFE, a multimodal physiotherapist delivered, individually tailored and progressive, home-based programme. It focuses on task orientated movement strategy training, functional lower limb strengthening and balance training over six months supported by printed material and visual feedback through tablets and DVDs. The primary outcome is risk of repeat falling between 0-6 months post randomisation and fall data have been collected through monthly self-completed diaries for three months prior and twelve months after randomisation. Results: Between October 2014 and August 2016, 541 eligible participants were recruited. Participants’ mean age = 72 (range 47 to 91); 58 % were male; mean time since Parkinson´s diagnosis = 8 (range 0 to 36) years; mean number of falls in previous 12 months = 21 (range 1 to 1195); mean MMSE score = 28. Twenty four percent lived alone; 70% with a spouse/partner; 6% with a friend/family. Mean baseline UPDRS score = 33 (range 2 to 92). Baseline Hoehn &amp; Yahr scores: 1 = 12%, 2 = 33%, 3 = 41%, 4= 14%. To date, 394 (73%) have been randomised to either the intervention (n=199) or control group (n=197). In the intervention group, 127 participants have completed the PDSAFE intervention with at least 12 physiotherapy sessions; 38 are still undergoing treatment; 32 have withdrawn and two have died. 172 participants have been followed for 12 months. Randomisation will continue until November 2016 and treatment until May 2017. Conclusion(s): PDSAFE is the largest rehabilitation trial evaluating an intervention to reduce falls among PwP. Sufficient numbers of participants have been recruited to achieve the target 80% power assuming a difference of 63% to 50% reduction in repeat falling between the two groups. The main trial results will be available during September 2017