The de Morton Mobility Index (DEMMI): An essential health index for an ageing world

BACKGROUND: Existing instruments for measuring mobility are inadequate for accurately assessing older people across the broad spectrum of abilities. Like other indices that monitor critical aspects of health such as blood pressure tests, a mobility test for all older acute medical patients provides essential health data. We have developed and validated an instrument that captures essential information about the mobility status of older acute medical patients. METHODS: Items suitable for a new mobility instrument were generated from existing scales, patient interviews and focus groups with experts. 51 items were pilot tested on older acute medical inpatients. An interval-level unidimensional mobility measure was constructed using Rasch analysis. The final item set required minimal equipment and was quick and simple to administer. The de Morton Mobility Index (DEMMI) was validated on an independent sample of older acute medical inpatients and its clinimetric properties confirmed. RESULTS: The DEMMI is a 15 item unidimensional measure of mobility. Reliability (MDC(90)), validity and the minimally clinically important difference (MCID) of the DEMMI were consistent across independent samples. The MDC(90) and MCID were 9 and 10 points respectively (on the 100 point Rasch converted interval DEMMI scale). CONCLUSION: The DEMMI provides clinicians and researchers with a valid interval-level method for accurately measuring and monitoring mobility levels of older acute medical patients. DEMMI validation studies are underway in other clinical settings and in the community. Given the ageing population and the importance of mobility for health and community participation, there has never been a greater need for this instrument

Fruit and Vegetable Bucks: Adams County Grocery Store Snap Incentive Program

Veggie Bucks provides a 50% discount on all fresh fruits and vegetables sold through Kennie’s Market produce department at the point of sale for the 5 highest cost items. The incentive period ran January - April, 2017. Intended outcomes include an increase in the number of fresh fruits and vegetables purchased by SNAP recipients at Kennie’s Market locations in Biglerville and Gettysburg by 10% in January-April 2017 compared to baseline figures obtained in 2016, and to familiarize SNAP recipients with fresh fruits and vegetables and to provide information about the ACFMA markets’ Double Dollars program. SNAP recipients were invited to sign up for the program upon showing their ID and EBT card and were provided a Kennie\u27s Frequent Shopper card if they did not have one already

Group A Streptococcal Septic Hip Arthritis in a Child With Spastic Triplegic Cerebral Palsy

Reports of septic hip arthritis in children with cerebral palsy are exceedingly rare. This case report describes a 10-year-old boy with spastic triplegic cerebral palsy (Gross Motor Functional Classification System), who presented with fever and irritability. This case highlights the difficulties in diagnosing septic joint arthritis in patients with cerebral palsy who are nonverbal and have limited mobility. A high index of suspicion is necessary in this population when presented with fever and new limitations in mobility

Improving oversight: development of an educational module on dual-use research in the West

The ‘dual-use’ potential of life science research has been a topic of increasing attention in recent years as part of the growing concern about the inadvertent or deliberate spread of disease. While ‘dual-use’ functions as an umbrella phrase, one sense of it refers to the possibility that ‘the generation and dissemination of scientific knowledge […] could be misapplied for biological weapons development and production.’ Major studies of this sense of the term include the US National Research Council (NRC) and Institute of Medicine’s (IOM) report Biotechnology Research in an Age of Terrorism, the NRC’s Globalization, Biosecurity, and the Future of the Life Sciences, and the British Royal Society’s Scientific and Technological Developments Relevant to the Biological & Toxin Weapons Convention. Echoing sentiments elsewhere, these analyses have underscored the breadth and scale of challenges in preventing the destructive application of the life sciences

Closing the Food Gap in Adams County: A Proposal for Comprehensive Solutions through Community Action

Today, in Adams County, we have two food systems. The 20% who live in poverty survive on food stamps, the food pantry, church donations, and trips to discount food vendors. Those with more financial stability could choose from an abundance of healthy, sustainably produced, local and international foods. We have come to accept these two food systems as the norm without critically analyzing how it is affecting individuals and the health of our communities. In addition to reducing the disparity and closing the food gap, this initiative is focused on building our local economy and educating our community about nutrition and the benefit of local foods in order to promote a more sustainable social, environmental and economic future. This paper begins an investigation of community food security in Adams County and makes recommendations to start the process of finding stronger community solutions. The data represented here is drawn from community discussions and programmatic statistics. It is an initial assessment to be followed up by a more comprehensive study and analysis

Evaluation of primary caregivers\u27 perceptions on home trampoline use

Trampolines are widely used by children, but trampoline injuries can be severe and may require hospital care or even surgery. This pilot study examined the effectiveness of an educational intervention on caregivers\u27 perceptions of trampoline use and safety for their children. Primary caregivers were recruited from the orthopedic clinic at the Children\u27s Hospital at our institution in 2015. Caregivers were asked to complete a survey at two time points, initially in clinic and one week post educational intervention. The educational intervention was a pamphlet outlining trampoline safety data. Data analysis occurred in 2016. From the 100 primary caregivers recruited, 39 caregivers owned a trampoline, and 10 had presented to the emergency department with their child for an injury related to trampoline use. After educational intervention, caregivers had higher rating of perceived danger associated with trampolines (6/10 vs. 8/10, p \u3c 0.001). Additionally, a greater number of caregivers were more knowledgeable on the safe age of trampoline use (56% vs. 91%, p \u3c 0.001) and safe number of jumpers (45% vs. 86%, p \u3c 0.001). Finally, there was a 29% increase in the proportion of caregivers who at least agreed that trampolines are dangerous (pre: 44% vs. post: 73%, p \u3c 0.001), however 50% of caregivers would still allow their child to use a trampoline. Overall, the results of this study show that a simple educational intervention can help to increase knowledge around safe trampoline practices and increase awareness of injury. Further, this study can act as initial evidence for future studies to implement this type of intervention long-term

Embedded motivational interviewing combined with a smartphone application to increase physical activity in people with sub-acute low back pain: a cluster randomised controlled trial

BackgroundModerately vigorous physical activity (PA) may be beneficial for people with sub-acute low back pain (LBP), but may initially be painful for patients and challenging for physical therapists to facilitate.ObjectivesThis study investigated motivational interviewing (MI) delivered by physical therapists and a smartphone app for increasing PA in people with LBP.MethodsA mixed methods cluster randomised controlled trial involving 46 adults with LBP in Melbourne, Australia. Participants attended weekly 30-min physical therapy consultations for 6 weeks. Experimental group physical therapists were taught to embed MI into consultations and patients were provided with a self-directed app. The primary outcome was accelerometer-derived moderately vigorous PA. Secondary outcomes were LBP disability (Oswestry Disability Index), functional capacity (Patient Specific Functional Scale), and self-efficacy (Pain Self-Efficacy Questionnaire). Between-group differences were analysed by ANCOVA post-intervention.ResultsThere was no statistically significant difference between the experimental group and control group for PA. Between-group differences in LBP disability (MD= 19.4 units, 95% CI: 8.5, 30.3), functional capacity (primary MD= −4.1 units, 95% CI: −6.9, −1.3; average MD= −3.1, 95% CI: −4.9, −1.2) and self-efficacy (MD −11.3 units, 95%CI −20.2 to −2.5) favoured the control group with small to moderate effect sizes. There were low levels of overall engagement with the app.ConclusionThe embedded MI intervention was no more beneficial than physical therapy alone for PA and was associated with poorer LBP disability, function, and self-efficacy. The effectiveness of embedding MI and a smartphone app into usual care for LBP was not supported.Keywords: Low back pain; Motivational interviewing; Randomised controlled trial; Smartphone application, app<br/

Developing Community-Based Learning in an Action Model Framework: Faculty Reflect on their Development as Teachers and Scholars

Faculty reflect on their participation in a Community-Based Learning (CBL) Fellowship designed to create a community of teachers and scholars immersed in an integrated model of academic-community engagement at a small liberal arts college. The program created a space to grapple with CBL principles together, provided accountability and encouragement, and became a source of support through isolation and tensions. Traditional philosophies of teaching and scholarship were challenged and faculty embraced their roles as partners in advancing social justice

Hippocampal-dependent appetitive control is impaired by experimental exposure to a Western-style diet

Animals fed a Western-style diet (WS-diet) demonstrate rapid impairments in hippocampal function and poorer appetitive control. We examined if this also occurs in humans. One-hundred and ten healthy lean adults were randomised to either a 1-week WS-diet intervention or a habitual-diet control group. Measures of hippocampal dependent learning and memory (HDLM) and of appetitive control were obtained pre- and post-intervention. HDLM was retested at 3-weeks follow-up. Relative to controls, HDLM performance declined in the WS-diet group (d=0.43), but was not different at follow-up. Appetitive control also declined in the WS-diet group (d=0.47) and this was strongly correlated with HDLM decline (d=1.01). These findings demonstrate that a WS-diet can rapidly impair appetitive control in humans - an effect that could promote overeating in consumers of a WS-diet. The study also suggests a functional role for the hippocampus in appetitive control and provides new evidence for the adverse neurocognitive effects of a WS-diet

The Cognitive Control of Eating and Body Weight: It’s More Than What You “Think”

Over the past decade, a great deal of research has established the importance of cognitive processes in the control of energy intake and body weight. The present paper begins by identifying several of these cognitive processes. We then summarize evidence from human and nonhuman animal models, which shows how excess intake of obesity-promoting Western diet (WD) may have deleterious effects on these cognitive control processes. Findings that these effects may be manifested as early-life deficits in cognitive functioning and may also be associated with the emergence of serious late-life cognitive impairment are described. Consistent with these possibilities, we review evidence, obtained primarily from rodent models, that consuming a WD is associated with the emergence of pathophysiologies in the hippocampus, an important brain substrate for learning, memory, and cognition. The implications of this research for mechanism are discussed within the context of a “vicious-cycle model,” which describes how eating a WD could impair hippocampal function, producing cognitive deficits that promote increased WD intake and body weight gain, which could contribute to further hippocampal dysfunction, cognitive decline, and excess eating and weight gain