Balance in single-limb stance after surgically treated ankle fractures: a 14-month follow-up

BACKGROUND: The maintenance of postural control is fundamental for different types of physical activity. This can be measured by having subjects stand on one leg on a force plate. Many studies assessing standing balance have previously been carried out in patients with ankle ligament injuries but not in patients with ankle fractures. The aim of this study was to evaluate whether patients operated on because of an ankle fracture had impaired postural control compared to an uninjured age- and gender-matched control group. METHODS: Fifty-four individuals (patients) operated on because of an ankle fracture were examined 14 months postoperatively. Muscle strength, ankle mobility, and single-limb stance on a force-platform were measured. Average speed of centre of pressure movements and number of movements exceeding 10 mm from the mean value of centre of pressure were registered in the frontal and sagittal planes on a force-platform. Fifty-four age- and gender-matched uninjured individuals (controls) were examined in the single-limb stance test only. The paired Student t-test was used for comparisons between patients' injured and uninjured legs and between side-matched legs within the controls. The independent Student t-test was used for comparisons between patients and controls. The Chi-square test, and when applicable, Fisher's exact test were used for comparisons between groups. Multiple logistic regression was performed to identify factors associated with belonging to the group unable to complete the single-limb stance test on the force-platform. RESULTS: Fourteen of the 54 patients (26%) did not manage to complete the single-limb stance test on the force-platform, whereas all controls managed this (p < 0.001). Age over 45 years was the only factor significantly associated with not managing the test. When not adjusted for age, decreased strength in the ankle plantar flexors and dorsiflexors was significantly associated with not managing the test. In the 40 patients who managed to complete the single-limb stance test no differences were found between the results of patients' injured leg and the side-matched leg of the controls regarding average speed and the number of centre of pressure movements. CONCLUSION: One in four patients operated on because of an ankle fracture had impaired postural control compared to an age- and gender-matched control group. Age over 45 years and decreased strength in the ankle plantar flexors and dorsiflexors were found to be associated with decreased balance performance. Further, longitudinal studies are required to evaluate whether muscle and balance training in the rehabilitation phase may improve postural control

Geographical and temporal distribution of SARS-CoV-2 clades in the WHO European Region, January to June 2020

We show the distribution of SARS-CoV-2 genetic clades over time and between countries and outline potential genomic surveillance objectives. We applied three available genomic nomenclature systems for SARS-CoV-2 to all sequence data from the WHO European Region available during the COVID-19 pandemic until 10 July 2020. We highlight the importance of real-time sequencing and data dissemination in a pandemic situation. We provide a comparison of the nomenclatures and lay a foundation for future European genomic surveillance of SARS-CoV-2.Peer reviewe

Instagranimal: Animal Welfare and Animal Ethics Challenges of Animal-Based Tourism

Animals of countless species, wild as well as tame, can now entertain tourists on their holidays. The popularity, however, of animal-based tourism comes with significant risks for the welfare of these animals. Many animals are kept in small confinements, are broken down to interact obediently with tourists, or are made to perform, entertain, transport or even give their lives for human leisure. In this paper, the challenges of animal-based tourism are presented from the perspectives of interdisciplinary researchers. The challenges are discussed based on a two-day symposium with workshop sessions. We bring attention to the problem of cultural relativism and the difficulty of imposing universal standards of animal welfare. We conclude that reforms and individual travel decisions as a result of biosecurity concerns will impact animal welfare. In addition to this, we observe that technology has a dual role to play in enhancing edutainment but also potentially inviting new challenges. In the end, we declare some possibilities for compassionate animal based tourism.publishedVersio

Instagranimal: Animal Welfare and Animal Ethics Challenges of Animal-Based Tourism

Animals of countless species, wild as well as tame, can now entertain tourists on their holidays. The popularity, however, of animal-based tourism comes with significant risks for the welfare of these animals. Many animals are kept in small confinements, are broken down to interact obediently with tourists, or are made to perform, entertain, transport or even give their lives for human leisure. In this paper, the challenges of animal-based tourism are presented from the perspectives of interdisciplinary researchers. The challenges are discussed based on a two-day symposium with workshop sessions. We bring attention to the problem of cultural relativism and the difficulty of imposing universal standards of animal welfare. We conclude that reforms and individual travel decisions as a result of biosecurity concerns will impact animal welfare. In addition to this, we observe that technology has a dual role to play in enhancing edutainment but also potentially inviting new challenges. In the end, we declare some possibilities for compassionate animal based tourism

Accessibility of basic paediatric emergency care in Malawi : analysis of a national facility census

Background Emergency care is among the weakest parts of health systems in low-income countries with both quality and accessibility constraints. Previous studies estimated accessibility to surgical or emergency care based on population travel times to nearest hospital with no assessment of hospital readiness to provide such care. We analysed a Malawi national facility census with comprehensive inventory audits and geocoded facility locations to identify hospitals equipped to provide basic paediatric emergency care with estimated travel times to these hospitals from non-equipped facilities and in relation to Malawi's population distribution. Methods We analysed a Malawi national facility census in 2013-2014 to identify hospitals equipped to manage critically ill children according to an extended version of WHO Emergency Triage, Assessment and Treatment (ETAT) guidelines. These guidelines include 25 components including staff, transport, equipment, diagnostics, medications, fluids, feeds and consumables that defined an emergency-equipped hospital in our study. We estimated travel times to emergency-equipped hospitals from non-equipped facilities and relative to population distributions using geocoded facility locations and an established accessibility mapping approach using global road network datasets from OpenStreetMap and Google. Results Four (3.5, 95% CI: 1.3-8.9) of 116 Malawi hospitals were emergency-equipped. Least available items were nasogastric tubes in 34.5% of hospitals (95% CI: 26.4-43.6), blood typing services (40.4, 95% CI: 31.9-49.6), micro nebulizers (50.9, 95% CI: 41.9-60.0), and radiology (54.2, 95% CI: 45.1-63.0). Nationally, the median travel time from non-equipped facilities to the nearest emergency-equipped hospital was 73 min (95% CI: 67-77) ranging 1-507 min. Approximately one-quarter (27%) of Malawians lived over 120 min from an emergency-equipped hospital with significantly better accessibility in Central than North and South regions (16% vs. 38 and 35%,p &lt; 0.001). Conclusions There are unacceptable deficiencies in accessibility of basic paediatric emergency care in Malawi. Reliable supply chains for essential drugs and commodities are needed, particularly nasogastric tubes, asthma drugs and blood, along with improved capacity for time-sensitive referral. Further child mortality reductions will require substantial investments to expand basic paediatric emergency care into all Malawi hospitals for better managing critically ill children at highest mortality risk

Contextualizing the quality of primary education in urban and rural settings : The case of Iringa Region, Tanzania

The purpose of the article is to discuss the term ‘quality’ in relation to primary education in Tanzania, and to contextualize quality and identify the premises for obtaining quality in primary school education in rural and urban settings. To understand opinions about the quality of education and the current situation in primary schools, the author conducted interviews with teachers and focus group discussions with parents and caregivers in Iringa town and three villages in Iringa Region. The findings indicate a general consensus, regardless of geographical setting, that quality in primary education is primarily measurable through national exams. However, surrounding circumstances such as infrastructure and poverty have a great impact on the quality of education in rural primary schools. Lack of water and electricity, and poor transport networks have consequences for schooling by limiting children’s, parents’, and teachers’ access to school supplies and limiting the ability of officials to carry out monitoring activities. The author concludes that the premises for providing and receiving education vary to a great extent, depending on geographical setting, and favour urban youths with respect to their further education