Paediatric admissions to hospitals in the Cape Town Metro district: A survey

A point prevalence survey of 381 paediatric medical inpatients in the 11 public hospitals in Cape Town in November 2007 showed that 70% of them were in central hospitals, with 39.4% requiring level 3 (sub-specialist) care. Numbers of children in hospital and their levels of health care requirement did not vary by sub-district of residence. Seventy-seven per cent of patients were under 5 years of age; 5% were teenagers. Few patients changed level of care during admission, but 10% did not need to be in hospital at the time of review. Median length of stay was 4 days, with children with level 3 needs having the longest lengths of stay. An under-provision of level 1 beds was demonstrated. HIV infection had been identified in 12% of admissions. While children with level 3 problems were well catered for in terms of bed provision, level 1 and step-down/home care provision were deficient or inefficiently utilised

Integrating Best Evidence into Practice: Outcomes of a Community-Based 12-week Exercise and Education Intervention in Women with Cancer

Objective Cancer-related fatigue is the most commonly reported side effect of cancer treatment, affecting 70-100% of patients and current literature suggests exercise is an important component of managing this side effect. The specific objective of this project was to evaluate the effectiveness of a 12-week evidence-based cancer exercise and education intervention on outcomes of fatigue, pain, depression, sleep disturbance and quality of life for women with cancer; the intervention was delivered by an interprofessional team in a medically-based wellness center. Methods The team was led by a physical therapist and included medical and radiation oncologists, general surgeons, nurses and cancer survivors, who developed the structure, content and format of this 12-week community-based intervention. The intervention consisted of group exercise sessions and education. Women with any type of cancer were eligible to enroll regardless of whether or not they were on active cancer treatment. Women were not eligible to enroll if they had any contraindication to exercise. Groups of no more than 15, completed hour-long supervised group exercise sessions twice weekly that were led by a physical therapist or exercise specialist. These sessions included resistance training, aerobic, flexibility, balance, aquatic or yoga exercises. The weekly education sessions included topics such as nutrition, sleep disturbance, depression, coping, lymphedema, exercise habits, healing arts, women’s health, spirituality, and stress management. This intervention was offered at no cost to participants, with funding provided by the hospital foundation. Participants reported their pre- and post-intervention perceptions of fatigue, pain, depression, sleep disturbance and quality of life on a 0 -10 point Likert scale (0 = none, 10 = worst). We used the related-sample Wilcoxon Signed Rank test to compare pre- and post- intervention scores and independent sample Mann-Whitney U test to compare change scores between those on and off treatment. Results Approximately 80% (n=139) of the women having a mean age of 53.6 years (SD=11.8; range 23-87) completed the 12-week intervention. Upon completion, we found significant decreases in the perceptions of self-reported fatigue (-5.5, p\u3c.001), pain (-0.5, p=.017), depression (-1.0, p\u3c.001), sleep disturbance (-0.5, p\u3c.001), and quality of life (-1.4, p\u3c.001). However, a subgroup analysis revealed that the impact of the intervention varied according to treatment status. Specifically, perceptions of fatigue decreased significantly for the 49 women who were on treatment (-1.4 vs. -0.03 p=.007) as compared to the 90 women who had completed treatment. Women on active treatment reported significantly higher levels of fatigue at the start of the intervention than did the women who had completed treatment (6.4 vs. 5.0, p\u3c.0001). Our findings indicate that implementation of an evidence-based exercise and education intervention in a medically-based wellness center is effective in improving self-reported outcomes for women with cancer. The most significant impact of the intervention appeared to be in decreasing fatigue for women on active cancer treatment

Feasibility of mHealth technology use among a sample of isolated rural men at high risk for cardiovascular disease

Purpose/Hypothesis: Isolated rural men are considered a health disparities group at high risk for cardiovascular disease. The increasing availability of technologies for self-monitoring for healthy eating, activity and weight loss (ie mHealth) may show promise for engaging rural men in lifestyle modification. This study investigated the feasibility of men from rural isolated areas to use a fitness monitor with text messaging support over a 3- week period. The study examined the men’s daily monitor use for tracking activity and eating, and assessed via written survey, their perspectives about mHealth. Number of Subjects: Twelve men, ages 40 to 69, from a US Department of Agriculture defined isolated rural area, participated. These men were a purposive sample originally recruited to participate in a focus group about their perceptions of the utility of mHealth. The men (50.9 6 8.6 yrs) had a baseline BMI of 25 to 44 kg/m2 (34.8 6 6.6 kg/m2). Eligibility included having cell/smartphones capable of sending/ receiving text messages, access to a computer, willing to use a fitness monitor and have research personnel access the men’s logs. Materials/Methods: Men participated in 2 visits at a community center located within 70 miles of their residence, at baseline and 3 weeks. Assessments included baseline health histories and vital sign biomarkers. The men received training using the fitness monitor with supporting technologies (cell/ smartphone and computer) and were asked to wear the monitor daily for 3 weeks. Men received 1–3 text messages/day for 3 weeks for reminders, education and motivation for self-monitoring. At visit 2, men completed post-intervention surveys about their fitness monitoring. Descriptive data were used for analysis. Results: Men were overweight (n 5 3) or obese (n 5 9) and most (9/12) were hypertensive with only four being treated with medications. One man was hypertensive stage 2 under no treatment and another was pre-hypertensive. Nine of 12 men wore the monitor during all 21 days, two wore it 9 and 15 days respectively and one lost the monitor. Survey data of the 12 men revealed seven checking their step count more than 5 times/day, 6 reported using the associated smart phone app and seven used the optional sleep log feature. Eleven of 12 men manually entered food into the log and most (9/12) did this on $15 days. Ten men indicated the log was helpful in learning about eating; though only 3 indicated it was easy to log food. All men reported reading reminder and motivational text messages sent during the study and 11 plan to continue using the fitness monitor. Conclusions: Men were not well managed for blood pressure or overweight/obesity. Both the log records and the survey results indicated that using fitness monitors was feasible and acceptable among this population. Clinical Relevance: Using mHealth appears feasible as an action-oriented tool for therapists to recommend for lifestyle self-monitoring in isolated rural men. The findings reinforce the important role of therapists in routinely assessing vital signs and making referrals as appropriate

Nonlinear dynamics indicates aging affects variability during gait

Objective. To investigate the nature of variability present in time series generated from gait parameters of two different age groups via a nonlinear analysis. Design. Measures of nonlinear dynamics were used to compare kinematic parameters between elderly and young females. Background. Aging may lead to changes in motor variability during walking, which may explain the large incidence of falls in the elderly. Methods. Twenty females, 10 younger (20–37 yr) and 10 older (71–79 yr) walked on a treadmill for 30 consecutive gait cycles. Time series from selected kinematic parameters of the right lower extremity were analyzed using nonlinear dynamics. The largest Lyapunov exponent and the correlation dimension of all time series, and the largest Lyapunov exponent of the original time series surrogated were calculated. Standard deviations and coefficient of variations were also calculated for selected discrete points from each gait cycle. Independent t-tests were used for statistical comparisons. Results. The Lyapunov exponents were found to be significantly different from their surrogate counterparts. This indicates that the fluctuations observed in the time series may reflect deterministic processes by the neuromuscular system. The elderly exhibited significantly larger Lyapunov exponents and correlation dimensions for all parameters evaluated indicating local instability. The linear measures indicated that the elderly demonstrated significantly higher variability. Conclusions. The nonlinear analysis revealed that fluctuations in the time series of certain gait parameters are not random but display a deterministic behavior. This behavior may degrade with physiologic aging resulting in local instability. Relevance Elderly show increased local instability or inability to compensate to the natural stride-to-stride variations present during locomotion. We hypothesized that this may be the one of the reasons for the increases in falling due to aging. Future efforts should attempt to evaluate this hypothesis by making comparisons to pathological subjects (i.e. elderly fallers), and examine the sensitivity and specificity of the nonlinear methods used in this study to aid clinical assessment

Comparison of gait patterns between young and elderly women: an examination of coordination

This study investigated intralimb coordination during walking in Young and Elderly women using the theoretical model of dynamical systems. Twenty females, ten Young (M age = 24.6 yrs, SD = 3.2 yrs), and ten Elderly (M age = 73.7 yrs, SD = 4.9 yrs), were videotaped during free speed gait and gait perturbed by an ankle weight. Two parameters, one describing the phasing relationship between segments (mean absolute relative phase) and the other the variability of this relationship (deviation in phase), were calculated from the kinematics. Two-way ANOVA (age and weight) with repeated measures on weight indicated that during the braking period the weight increased the mean absolute relative phase between the shank and the thigh and decreased it between the foot and the shank. The Elderly women had significantly smaller values for the mean absolute relative phase between the shank and the thigh during the braking period. For the same period, deviation in phase increased for the segmental relationship between the shank and the thigh. The findings suggest that changes in intralimb coordination take place due to asymmetrical weighting and the aging process. These changes are mostly present during the braking period

Obesity and Physical Function in Rural Women who enroll in a Lifestyle Modification Intervention for Reducing Blood Pressure

Purpose: Rural women have high prevalence of obesity and prehypertension. Obesity, if associated with poor physical function, may have implications for applying activity guidelines for women volunteering for lifestyle modification. This study examined associations of body mass index (BMI) and percent body fat with measures of 1-mile walk time, post-walk perceived exertion, and 10-repetition chair stands in rural women ages 40-69. Methods: Cross-sectional baseline data were collected using standardized methods from 289 rural women with prehypertension who volunteered for a lifestyle clinical trial for reducing blood pressure. ANOVAs and linear regression were used for analysis. Results: With exception of the chair stands measure across categories of BMI, group differences were noted in all measures across categories of BMI and percent body fat, with women in the two highest categories demonstrating the poorest performance. These two body composition measures were significant predictors for 1-mile walk-time and 10-repetition chair stands, after controlling for confounding variables. Conclusions: Poorer scores were observed in performance-based measures in women with higher BMI and percent body fat, though mean scores were above thresholds for functional limitation. Physical performance needs to be assessed and addressed by physical therapists when providing lifestyle interventions for overweight and obese women

Role of transport performance on neuron cell morphology

The compartmental model is a basic tool for studying signal propagation in neurons, and, if the model parameters are adequately defined, it can also be of help in the study of electrical or fluid transport. Here we show that the input resistance, in different networks which simulate the passive properties of neurons, is the result of an interplay between the relevant conductances, morphology and size. These results suggest that neurons must grow in such a way that facilitates the current flow. We propose that power consumption is an important factor by which neurons attain their final morphological appearance.Comment: 9 pages with 3 figures, submitted to Neuroscience Letter

Quenched QCD at finite density

Simulations of quenched $QCD$ at relatively small but {\it nonzero} chemical potential $\mu$ on $32 \times 16^3$ lattices indicate that the nucleon screening mass decreases linearly as $\mu$ increases predicting a critical chemical potential of one third the nucleon mass, $m_N/3$, by extrapolation. The meson spectrum does not change as $\mu$ increases over the same range, from zero to $m_\pi/2$. Past studies of quenched lattice QCD have suggested that there is phase transition at $\mu = m_\pi/2$. We provide alternative explanations for these results, and find a number of technical reasons why standard lattice simulation techniques suffer from greatly enhanced fluctuations and finite size effects for $\mu$ ranging from $m_\pi/2$ to $m_N/3$. We find evidence for such problems in our simulations, and suggest that they can be surmounted by improved measurement techniques.Comment: 23 pages, Revte