Sitting and standing performance in a total population of children with cerebral palsy: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Knowledge of sitting and standing performance in a total population of children with cerebral palsy (CP) is of interest for health care planning and for prediction of future ability in the individual child. In 1994, a register and a health care programme for children with CP in southern Sweden was initiated. In the programme information on how the child usually sits, stands, stands up and sits down, together with use of support or assistive devices, is recorded annually.</p> <p>Methods</p> <p>A cross-sectional study was performed, analysing the most recent report of all children with CP born 1990-2005 and living in southern Sweden during 2008. All 562 children (326 boys, 236 girls) aged 3-18 years were included in the study. The degree of independence, use of support or assistive devices to sit, stand, stand up and sit down was analysed in relation to the Gross Motor Function Classification System (GMFCS), CP subtype and age.</p> <p>Result</p> <p>A majority of the children used standard chairs (57%), could stand independently (62%) and could stand up (62%) and sit down (63%) without external support. Adaptive seating was used by 42%, external support to stand was used by 31%, to stand up by 19%, and to sit down by 18%. The use of adaptive seating and assistive devices increased with GMFCS levels (p < 0.001) and there was a difference between CP subtypes (p < 0.001). The use of support was more frequent in preschool children aged 3-6 (p < 0.001).</p> <p>Conclusion</p> <p>About 60% of children with CP, aged 3-18, use standard chairs, stand, stand up, and sit down without external support. Adding those using adaptive seating and external support, 99% of the children could sit, 96% could stand and 81% could stand up from a sitting position and 81% could sit down from a standing position. The GMFCS classification system is a good predictor of sitting and standing performance.</p

African Jobless Growth Morphology: Vulnerabilities and Policy Responses

As by product of economic growth, jobs are indeed transformational. In other words, efficiency increases as workers get better at what they do (as more productive jobs appear and less productive one disappear). In fact societies flourish as jobs bring together people from different ethnic and social backgrounds while providing alternatives to conflict. Unfortunately, in many African countries, unemployment rates are low and growth is seldom jobless. Regrettably, most of the poor work long hours and cannot make ends meet while the violation of basic human rights is not uncommon. Again, youth unemployment and unmet job expectations are alarming. Consequently, this paper provides a framework that cuts across sectors and shows that the best policy responses vary across African countries (depending on their levels of development, endowments, demography and institutions). Thus, at all stages of development, forcing economic production to spread evenly across areas is both elusive and expensive. Policy makers should therefore identify and execute strategies that balance development outcomes across areas by means of domestic integration instruments. However, in places where integration is hardest, the policy response should be comprehensively total: institutions that unite, infrastructure that connects, interventions that target, incentives that motivate as well as information and communication technologies that enables or drives

Clinical efficacy and safety of a light mask for prevention of dark adaptation in treating and preventing progression of early diabetic macular oedema at 24 months (CLEOPATRA): a multicentre, phase 3, randomised controlled trial

Background: We aimed to assess 24-month outcomes of wearing an organic light-emitting sleep mask as an intervention to treat and prevent progression of non-central diabetic macular oedema. Methods: CLEOPATRA was a phase 3, single-blind, parallel-group, randomised controlled trial undertaken at 15 ophthalmic centres in the UK. Adults with non-centre-involving diabetic macular oedema were randomly assigned (1:1) to wearing either a light mask during sleep (Noctura 400 Sleep Mask, PolyPhotonix Medical, Sedgefield, UK) or a sham (non-light) mask, for 24 months. Randomisation was by minimisation generated by a central web-based computer system. Outcome assessors were masked technicians and optometrists. The primary outcome was the change in maximum retinal thickness on optical coherence tomography (OCT) at 24 months, analysed using a linear mixed-effects model incorporating 4-monthly measurements and baseline adjustment. Analysis was done using the intention-to-treat principle in all randomised patients with OCT data. Safety was assessed in all patients. This trial is registered with Controlled-Trials.com, number ISRCTN85596558. Findings: Between April 10, 2014, and June 15, 2015, 308 patients were randomly assigned to wearing the light mask (n=155) or a sham mask (n=153). 277 patients (144 assigned the light mask and 133 the sham mask) contributed to the mixed-effects model over time, including 246 patients with OCT data at 24 months. The change in maximum retinal thickness at 24 months did not differ between treatment groups (mean change −9·2 μm [SE 2·5] for the light mask vs −12·9 μm [SE 2·9] for the sham mask; adjusted mean difference −0·65 μm, 95% CI −6·90 to 5·59; p=0·84). Median compliance with wearing the light mask at 24 months was 19·5% (IQR 1·9–51·6). No serious adverse events were related to either mask. The most frequent adverse events related to the assigned treatment were discomfort on the eyes (14 with the light mask vs seven with the sham mask), painful, sticky, or watery eyes (14 vs six), and sleep disturbance (seven vs one). Interpretation: The light mask as used in this study did not confer long-term therapeutic benefit on non-centre-involving diabetic macular oedema and the study does not support its use for this indication. Funding: The Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health Research partnership

Identifying important questions for Cochrane systematic reviews in Eyes and Vision: Report of a priority setting exercise

Introduction Systematic reviews are important to inform decision-making for evidence-based health care and patient choice. Deciding which reviews should be prioritized is a key issue for decision-makers and researchers. Cochrane Eyes and Vision conducted a priority setting exercise for systematic reviews in eye health care. Methods We established a steering group including practitioners, patient organizations, and researchers. To identify potential systematic review questions, we searched global policy reports, research prioritization exercises, guidelines, systematic review databases, and the Cochrane Library (CENTRAL). We grouped questions into separate condition lists and conducted a two-round online modified Delphi survey, including a ranking request. Participants in the survey were recruited through social media and the networks of the steering group. Results In Round 1, 343 people ranked one or more of the condition lists. Participants were eye care practitioners (69%), researchers (37%), patients or carers (24%), research providers/funders (5%), or noneye health care practitioners (4%) and from all World Health Organization regions. Two hundred twenty-six people expressed interest in completing Round 2 and 160 of these (71%) completed the Round 2 survey. Reviews on cataract and refractive error, reviews relevant to children, and reviews on rehabilitation were considered to have an important impact on the magnitude of disease and equity. Narrative comments emphasized the need for reviews on access to eye health care, particularly for underserved groups, including people with intellectual disabilities. Conclusion A global group of stakeholders prioritized questions on the effective and equitable delivery of services for eye health care. When considering the impact of systematic reviews in terms of reducing the burden of eye conditions, equity is clearly an important criterion to consider in priority-setting exercises

Identifying priority review questions for Cochrane Eyes and Vision: protocol for a priority setting exercise

INTRODUCTION: Cochrane Eyes and Vision (CEV) is an international network of individuals working to prepare, maintain and promote access to systematic reviews of interventions to treat, prevent or diagnose eye diseases or vision impairment. CEV plans to undertake a priority setting exercise to identify systematically research questions relevant to our scope, and to formally incorporate input from a wide range of stakeholders to set priorities for new and updated reviews. METHODS AND ANALYSIS: The scope of CEV is broad and our reviews include conditions that are common and have a high global disease burden, for example, cataract and dry eye disease, and conditions that are rare but have a high impact on quality of life and high individual cost such as eye cancer. We plan to focus on conditions prioritised by WHO during the development of the Package of Eye Care Interventions. These conditions were selected based on a combination of data on disease magnitude, healthcare use and expert opinion. We will identify priority review questions systematically by summarising relevant data on research in Eyes and Vision from a range of sources, and compiling a list of 10-15 potential review questions (new and/or updates) for each condition group. We will seek the views of external and internal stakeholders on this list by conducting an online survey. Equity will be a specific consideration. ETHICS AND DISSEMINATION: The study has been approved by the ethics committee of the London School of Hygiene & Tropical Medicine. We will disseminate the findings through Cochrane channels and prepare a summary of the work for publication in a peer-reviewed journal