The Influence of Socioeconomic Factors on Fear of Falling and Mobility Outcomes after Lower Limb Loss: a Preliminary Study

Background and Purpose: Current research has revealed that as much as 52.4% of individuals with lower limb loss report falling at least once in the past year. Previous research has also indicated that rehabilitation, including physical therapy (PT), generally improves patient outcomes after definitive amputation. Socioeconomic status has been shown to be an important factor in accessing healthcare but has yet to be investigated in this population. The purpose of this study was to investigate the effects of socioeconomic status and access to PT, and how limb loss affects mobility and fear of falling perception. We hypothesized: [1] individuals with socioeconomic difficulty would have reduced access to PT after amputation, and [2] individuals with limb loss will have increased fear of falling and decreased mobility performance when compared to non-amputee, age-matched controls. Subjects: 23 participants (7 females,16 males) mean age 51.30 years old (+ 13.17 SD, range 22-70) with lower limb loss ambulating with a definitive prosthesis. Materials/Methods: Participants completed a survey that included the Fear of Falling Avoidance Behavior Questionnaire (FFABQ), questions to determine their socioeconomic status, and whether they received PT after amputation. Mobility outcomes were measured using the standardized Timed Up and Go test (TUG) and the Six Minute Walk Test (6MWT). Results: There was no statistically significant difference in access to PT after amputation between those with and without financial difficulty (p=.354). However, 75% of participants who had no socioeconomic difficulty reported receiving PT, in comparison to only 25% in those who had socioeconomic difficulty. Additionally, 34.8% of our participants reported socioeconomic difficulties. When comparing the participants with amputation to the non-amputee, age-matched controls, there was a significant difference in the TUG (p\u3c.001), 6MWT (p\u3c.001), and FFABQ (p=.008). On average, participants with limb loss were 4.4 seconds slower on the TUG, walked 136.4m less on the 6MWT, and had an increased FFABQ score of 6.6 points out of 56 points. Discussion: Access to physical therapy and socioeconomic status have been overlooked in current literature for individuals after amputation. While the effect of socioeconomic status on PT access did not reach statistical significance in this preliminary study, only 25% of those who reported socioeconomic difficulty received physical therapy after amputation, compared to 75% in those who reported no difficulty. Further research is needed to determine whether low socioeconomic status is predictive of receiving rehabilitation services post-amputation and long-term outcomes. Our findings also showed that when compared to age-matched non-amputees, amputees tend to have impaired mobility and higher degree of fear of falling. These findings agree with current literature. Conclusion: Although not statistically significant, our preliminary findings showed that socioeconomic difficulty may affect access to physical therapy after amputation. Furthermore, our data demonstrated that individuals with lower limb loss exhibit reduced mobility performance and increased fear of falling when compared to the age-matched controls

Planeación Urbana: crítica y tendencias desde el campo de la Teoría. El caso del estado de México

El objetivo de este trabajo consiste en demostrar la obsolescencia del modelo de planeación urbana en el estado de México, contrastando sus fundamentos con las aportaciones recientes de nuestro campo de conocimiento para poder ofrecer una alternativa de evaluación teórico-crítica de los principios y métodos de la planeación urbana, esperando que estos puedan ser aplicables en realidades semejantes a la nuestra. La experiencia planificadora del estado de México, durante al menos las últimas dos décadas, expresa las escasas posibilidades de tránsito y adopción del conjunto de planteamientos emergentes que se desprenden de la discusión reciente en materia de planeación urbana, por lo que la revisión crítica de su proceso de evolución, junto con las evidencias mostradas, se constituye como la base argumentativa principal. Esta tarea requiere de la revisión y análisis de los fundamentos de nuestra disciplina con el objeto de adaptarlos a las exigencias que se advierten a nivel internacional, tanto desde la perspectiva disciplinaria como desde el ámbito de la acción pública, para poder identificar cuáles son las rutas emergentes por las que habremos de transitar. Se trata de sentar las bases para emprender un proceso de reflexión sobre la pertinencia del modelo de planeación urbana vigente a fin de actualizar sus contenidos disciplinarios y reorientar los esfuerzos de intervención en un momento en el que el planeamiento de nuestras ciudades está en crisis

Planeación urbana en México: un análisis crítico sobre su proceso de evolución

Como aporte a los estudios sobre historia urbana en México, este artículo ofrece una lectura articulada acerca de las principales influencias, actores y fundamentos que -al menos desde los años veinte del siglo pasado- han permeado las iniciativas emprendidas en la construcción del marco teórico (conceptual e instrumental) metodológico de la Planeación Urbana en México). Los estudios históricos sobre la evolución de esta disciplina son escasos y -al menos en el caso de México- están dispersos y fragmentados; por ello, el aporte de este ejercicio de articulación histórica-integral pretende documentar la evolución del Pensamiento Urbano en México durante las primeras décadas del siglo XX y con esa base, perfilar un conjunto de líneas críticas por las que se afirma el agotamiento del modelo de la Planeación Urbana mexicana

An Overview of Transfer Conditions: Exploring Latino Community College Students in Texas

This paper begins exploring the transfer conditions for Latino community college students in Texas. We provide an overview of the high school schooling conditions for Latinos; the experiences of Latinos in the community college; and some models that can increase the transfer and graduation rates for Latina/o community college students.Educatio

A quasi-experimental evaluation of parents as sexual health educators resulting in delayed sexual initiation and increased access to condoms.

OBJECTIVE: To evaluate the effectiveness of an educational intervention for parents of first year high school students in the State of Morelos, Mexico, whose aim was to impact adolescents' sexual behavior, knowledge and access to contraception. MATERIAL AND METHODS: Quasi-experimental prospective study with eleven control and eleven intervention schools using self-administered questionnaires for parents and adolescents pre- and post-intervention. Parent-child dyads in the control and intervention schools were matched according to parents' propensity score; the average treatment effect (ATE) was estimated for adolescent's outcome variables. RESULTS: At follow-up, we found significant differences for adolescents in the intervention schools: 6.8% delayed initiation of sexual intercourse, 14.4% had correct knowledge about emergency contraception (EC), and 164% reported having received condoms from their parents, when comparing with students in control schools. CONCLUSIONS: Our results suggest that parent-focused interventions could be an innovative and effective strategy to promote adolescents sexual health

THE EFFECTS OF OBESITY ON RESULTANT KNEE JOINT LOADS FOR GAIT AND CYCLING

Osteoarthritis (OA) is a degenerative disease of cartilage and bone tissue and the most common form of arthritis, accounting for US$ 10.5 billion in hospital charges in 2006. Obesity (OB) has been linked to increased risk of developing knee OA due to increased knee joint loads and varus-valgus misalignment. Walking is recommended as a weight-loss activity but it may increase risk of knee OA as OB gait increases knee loads. Cycling has been proposed as an alternative weight-loss measure, however, lack of studies comparing normal weight (NW) and OB subjects in cycling and gait hinder identification of exercises that may best prevent knee OA incidence. The objective of this work is to determine if cycling is a better weight-loss exercise than gait in OB subjects as it relates to knee OA risk reduction due to decreased knee loads. A stationary bicycle was modified to measure forces and moments at the pedals in three dimensions. A pilot experiment was performed to calculate resultant knee loads during gait and cycling for NW (n = 4) and OB (n = 4) subjects. Statistical analyses were performed to compare knee loads and knee angles, and to determine statistical significance of results (p \u3c 0.05). Cycling knee loads were lower than gait knee loads for all subjects (p \u3c 0.033). OB axial knee loads were higher than NW axial knee loads in gait (p = 0.004) due to the weight-bearing nature of gait. No differences were observed in cycling knee loads between NW and OB subjects, suggesting cycling returns OB knee loads and biomechanics to normal levels. The lack of significant results in cycling could be due to the small sample size used or because rider weight is supported by the seat. Limitations to this study include small sample size, soft tissue artifact, and experimental errors in marker placement. Future studies should correct these limitations and find knee joint contact force rather than knee resultant loads using v EMG-driven experiments. In conclusion, cycling loads were lower than gait loads for NW and OB subjects suggesting cycling is a better weight-loss exercise than gait in the context of reducing knee OA risk