The Norwich Patellar Instability Score:validity, internal consistency and responsiveness for people conservatively-managed following first-time patellar dislocation

Background: This paper assessed the validity, internal consistency, responsiveness and floor-ceiling effects of the Norwich Patellar Instability (NPI) Score for a cohort of conservatively managed people following first-time patellar dislocation (FTPD).  Methods: Fifty patients were recruited, providing 130 completed datasets over 12 months. The NPI Score, Lysholm Knee Score, Tegner Level of Activity Score and isometric knee extension strength were assessed at baseline, six weeks, six and 12 months post-injury.  Results: There was high convergent validity with a statistically significant correlation between the NPI Score and the Lysholm Knee Score (p < 0.001), Tegner Level of Activity Score (p < 0.001) and isometric knee extension strength (p < 0.002). Principal component analysis revealed that the NPI Score demonstrated good concurrent validity with four components account for 70.4% of the variability. Whilst the NPI Score demonstrated a flooring-effect for 13 of the 19 items, no ceiling effect was reported. There was high internal consistency with a Cronbach Alpha value of 0.93 (95% CI: 0.91 to 0.93). The NPI Score was responsive to change over the 12 months period with an effect size of 1.04 from baseline to 12 months post-injury.  Conclusions: The NPI Score is a valid tool to assess patellar instability symptoms in people conservatively managed following FTPD.  Level of evidence: Level I

Folic acid to reduce neonatal mortality from neural tube disorders

Background Neural tube defects (NTDs) remain an important, preventable cause of mortality and morbidity. High-income countries have reported large reductions in NTDs associated with folic acid supplementation or fortification. The burden of NTDs in low-income countries and the effectiveness of folic acid fortification/supplementation are unclear

Public, private and personal: Qualitative research on policymakers' opinions on smokefree interventions to protect children in 'private' spaces

<p>Abstract</p> <p>Background</p> <p>Governments use law to constrain aspects of private activities for purposes of protecting health and social wellbeing. Policymakers have a range of perceptions and beliefs about what is public or private. An understanding of the possible drivers of policymaker decisions about where government can or should intervene for health is important, as one way to better guide appropriate policy formation. Our aim was to identify obstacles to, and opportunities for, government smokefree regulation of private and public spaces to protect children. In particular, to seek policymaker opinions on the regulation of smoking in homes, cars and public parks and playgrounds in a country with incomplete smokefree laws (New Zealand).</p> <p>Methods</p> <p>Case study, using structured interviews to ask policymakers (62 politicians and senior officials) about their opinions on new smokefree legislation for public and private places. Supplementary data was obtained from the Factiva media database, on the views of New Zealand local authority councillors about policies for smokefree outdoor public places.</p> <p>Results</p> <p>Overall, interviewees thought that government regulation of smoking in private places was impractical and unwise. However, there were some differences on what <it>was </it>defined as 'private', particularly for cars. Even in public parks, smoking was seen by some as a 'personal' decision, and unlikely to be amenable to regulation. Most participants believed that educative, supportive and community-based measures were better and more practical means of reducing smoking in private places, compared to regulation.</p> <p>Conclusions</p> <p>The constrained view of the role of regulation of smoking in public and private domains may be in keeping with current political discourse in New Zealand and similar Anglo-American countries. Policy and advocacy options to promote additional smokefree measures include providing a better voice for childrens' views, increasing information to policymakers about the harms to children from secondhand smoke and the example of adult smoking, and changing the culture for smoking around children.</p

Kinesio Taping reduces pain and improves disability in Low Back Pain patients: a randomised controlled trial

Objectives: Investigate the effects of Kinesio Taping® (KT) on chronic nonspecific low back pain (LBP) Design: Randomised controlled trial with intention-to-treat analysis. Setting: University laboratory. Participants: One hundred eight women with chronic nonspecific LBP underwent an evaluation pre, three and ten days after intervention. Interventions: After randomization, participants were assigned in four groups: KT with tension group (KTT) applied Kinesio Taping® with tension in the region of the erector spinae muscles; KT no tension group (KTNT) applied Kinesio Taping® with no tension at the same region; Micropore® group (MP) applied Micropore® tape on the erector spinae muscles; and Control group (CG) did not receive any intervention. Main outcome measures: The primary outcome was pain sensation, measured by numerical pain rating scale. Secondary outcomes were: disability, trunk range of motion, strength and electromyographic amplitude, measured by Roland Morris Disability questionnaire, inclinometry, dynamometry and electromyography, respectively. Results: Pain relief was observed for KTT group (mean difference=1,963; CI 95%=0,501 - 3,425; p=0,003) and KTNT group (mean diference=1,926; CI 95%=0,464 - 3,388; p=0,004) compared to control group at 3 days after application of the tape. For disability there was difference between control group and KTT group at 3 (mean difference=3,481; CI 95%=0,825 – 6,138; p=0,004) and 10 days (mean difference=3,185; CI 95%=0,395 - 5,975; p=0,016). For all the others variables, there was no differences between group. Conclusion: KT with or without tension reduces pain 3 days after its application. Additionally, when applied with tension it improves disability after 3 and 10 days in LBP patients

Complex systems and the technology of variability analysis

Characteristic patterns of variation over time, namely rhythms, represent a defining feature of complex systems, one that is synonymous with life. Despite the intrinsic dynamic, interdependent and nonlinear relationships of their parts, complex biological systems exhibit robust systemic stability. Applied to critical care, it is the systemic properties of the host response to a physiological insult that manifest as health or illness and determine outcome in our patients. Variability analysis provides a novel technology with which to evaluate the overall properties of a complex system. This review highlights the means by which we scientifically measure variation, including analyses of overall variation (time domain analysis, frequency distribution, spectral power), frequency contribution (spectral analysis), scale invariant (fractal) behaviour (detrended fluctuation and power law analysis) and regularity (approximate and multiscale entropy). Each technique is presented with a definition, interpretation, clinical application, advantages, limitations and summary of its calculation. The ubiquitous association between altered variability and illness is highlighted, followed by an analysis of how variability analysis may significantly improve prognostication of severity of illness and guide therapeutic intervention in critically ill patients

Educators\u27 Perspective of Suicide Prevention Program: Hope Squad

Evidence-based research suggests that schools offer the most extensive intervention opportunities for students at-risk for suicide (Evans & Hurrell, 2016). An important aspect of this system is the implementation and evaluation of school-based suicide prevention programs, such as Hope Squad. Current literature on this program is limited, as this program is relatively new and is being implemented in a growing number of schools across the country. Thus, the present study investigated the perspectives of school personnel on the suicide prevention program, Hope Squad. Following a qualitative method of research, eight participants, who are directly involved with Hope Squad, were interviewed using a semi-structured interview protocol. Through a thematic analysis, categories and themes emerged, including: need for Hope Squad (mental health concerns, being proactive, and social-emotional supports), benefits of Hope Squad (trained and trusted peers, suicide training, mental health awareness, and change in the culture of the school), challenges within Hope Squad (time for training members and stigma), and pandemic response (social media platforms, dramatic decrease in referrals, and delay in training). Schools can facilitate trainings through programs such as Hope Squad, to better equip staff and students to help students at-risk for suicide and create a more positive school environment. The findings from this study can be used to increase awareness of Hope Squad and the perspectives of school personnel towards this suicide prevention program