Activity Restriction Research Articles

Improving Work Rehabilitation Program at PT. KALPRI

The work rehabilitation program is one of the important efforts made by the company to help employees who are experiencing health conditions that disrupt work productivity to return to work optimally at PT. KALPRI, there has been an increase in the number of employees undergoing work rehabilitation programs accompanied by a low success rate in returning employees to their original positions after undergoing the program. Therefore, this study aims to identify the factors that cause this condition to occur. This research uses a descriptive quantitative approach, using a questionnaire instrument for 71 respondents and conducting in-depth interviews with 5 members of the rehabilitation committee at PT. KALPRI. The collected data is then analyzed to identify the key factors influencing the increase in rehabilitated employees and the program’s low success rate. The research results show that the internal factors causing the rise in the number of employees being rehabilitated are the employees’ unhealthy habits and lifestyles, such as smoking habits, irregular exercise, and rest, which trigger the emergence of various diseases such as cardiovascular, musculoskeletal, and obesity. Externally, the COVID-19 pandemic has also contributed to the increase in the number of employees being rehabilitated due to restrictions on activities that have impacted employee health. Meanwhile, the internal factors that cause the low success rate of the rehabilitation program are the employees’ habits and lifestyles that slow down the healing process, so some employees have to undergo a “long sick” program that extends the rehabilitation period. Externally, the activity restrictions due to the COVID-19 pandemic have also contributed greatly to the low reabsorption of employees after undergoing a rehabilitation program. The findings of this study indicate the need to increase more intensive health interventions and education to change employees’ habits and lifestyles, as well as the need for stronger coordination between the rehabilitation team and management in managing work rehabilitation programs, especially during the pandemic. These efforts are expected to help improve PT. KALPRI’s work rehabilitation program’s success.

Activity restriction and risk of adverse pregnancy outcomes

BackgroundActivity restriction is a common recommendation given to patients during pregnancy for various indications, despite lack of definitive data showing improvements in pregnancy outcomes. ObjectiveTo determine if activity restriction (AR) in pregnancy is associated with decreased odds of adverse pregnancy outcomes (APOs). Study designSecondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) prospective cohort. Nulliparous singletons were followed at 8 sites from October 2010–September 2013. Demographic and clinical data were collected at 4 timepoints, and participants were surveyed about AR recommendations at 22w0d-29w6d and delivery. We excluded participants missing data on AR and age. Participants were grouped according to history of AR, and APOs included: gestational hypertension (gHTN), preeclampsia/eclampsia, preterm birth (PTB), and small for gestational age (SGA) neonate. Associations between AR and APOs were examined using uni- and multivariable logistic regression models adjusting for a priori identified APO risk factors. ResultsOf 10,038 nuMoM2b participants, 9,312 met inclusion criteria and 1,386 (14.9%) were recommended AR; participants identifying as Black (aOR 0.81 [95% CI 0.68–0.98]) or Hispanic (aOR 0.73 [95% CI 0.61–0.87]) were less likely to be placed on AR when compared to those identifying as White. Overall, 3,197 (34.3%) experienced at least one APO (717 [51.7%] of participants with AR compared to 2,480 [31.3%] participants without AR). After adjustment for baseline differences, the AR group had increased odds of gHTN (aOR 1.61 [95% CI 1.35–1.92]), preeclampsia/eclampsia (aOR 2.52 [95% CI 2.06–3.09]) and iatrogenic and spontaneous PTB (aOR 2.98 [95% CI 2.41–3.69]), but not delivery of an SGA neonate. ConclusionAR in pregnancy was independently associated with increased odds of hypertensive disorders of pregnancy and PTB, but future prospective work is needed to determine potential causality. Further, participants identifying as Black or Hispanic were significantly less likely to be recommended AR compared to those identifying as White. While AR is not an evidence-based practice, these findings suggest bias may impact which patients receive advice to limit activity in pregnancy.El resumen está disponible en Español al final del artículo.

Expanded roles of community health workers to sustain malaria services in the Asia-Pacific: A landscaping survey.

Malaria Community Health Workers (CHWs) in the Greater Mekong Subregion (GMS) are an important component of malaria elimination efforts. As malaria declines with intensified efforts to eliminate by 2030, expanding their roles beyond malaria could help to sustain funding and provision of malaria services at the community level. Evidence of how programmes have implemented and managed CHWs performing both malaria and non-malaria roles across the Asia-Pacific region can provide insight into the viability of this strategy. A short survey was distributed to national malaria programmes and implementing organizations in the Asia-Pacific region in 2021-2022. The survey identified CHW programmes in the region, and collected information on malaria and non-malarial services provided by CHWs, characteristics of each identified programme, and the impact of COVID-19 on these programmes. 35 survey responses identified 28 programmes in 14 countries. The most frequently reported services provided by malaria CHWs were health promotion and education for malaria (13/14 countries) and other diseases (11/14); and COVID-19 related activities (10/14). Most programmes were financed wholly through donor funding (18/28 programmes), or donor plus government funding (6/28). Of 21 programmes which performed programme evaluation, only 2 evaluated their impacts on diseases beyond malaria. Declining donor funding, and COVID-19 related travel and activity restrictions were identified as implementation challenges. CHWs across the Asia Pacific provide a range of health services with malaria and are resilient under changing public health landscapes such as the COVID-19 pandemic. Further investigation into the impact of additional roles on malaria CHW performance and targeted health outcomes is needed to verify the benefits and feasibility of role expansion. As the GMS approaches elimination, and funding declines, verifying the cost effectiveness of malaria CHW programmes will be vital to persuade donors and countries to invest in malaria CHWs to sustain malaria services, and strengthen community-based health care.

DEVELOPMENT AND INITIAL TESTING OF A BRIEF, GENERIC, SELF-REPORTED DISABILITY QUESTIONNAIRE: THE UNIVERSAL DISABILITY INDEX

BackgroundDisability is an important multifaceted construct. The aim of this study was to develop and evaluate a brief, generic self-reported disability questionnaire: the Universal Disability Index (UDI).MethodsConvenience sampling was used to collect general population data via an online survey. Data were randomly divided into training and validation subsets. The dimensionality and structure of eight UDI questionnaire items were evaluated using exploratory factor analysis (EFA, training subset) followed by confirmatory factor analysis (CFA, validation subset). To assess concurrent validity, the UDI summed score from the full dataset was compared to the Groningen Activity Restriction Scale (GARS) and the Graded Chronic Pain Scale (GCPS) disability scores. Internal consistency was also assessed.Results403 participants enrolled; 364 completed at least one UDI item. Three single-factor versions of the UDI were assessed (8-item, 7-item, and 6-item). All versions performed well during EFA and CFA (182 cases assigned to each), but none met the RMSEA (Root Mean Square Error of Approximation) criterion (≤ 0.08). All versions of the UDI had high internal consistency (Cronbach's α > 0.90) and were strongly correlated (Pearson's r > 0.7) with both GARS and GCPS disability scores, indicating concurrent validity.ConclusionsA brief, generic self-reported disability questionnaire was found to be valid and to possess good psychometric properties. The UDI has a single factor structure and either a 6-item, 7-item or 8-item version can be used to measure disability. For brevity and parsimony, the 6-item UDI is recommended, but further testing of all versions is warranted.Conflicts of interestNo conflicts of interestSources of fundingNo funding obtained

MEASURING THE PREVALENCE, SEVERITY, AND SOURCES OF DISABILITY: A NEW APPROACH

BackgroundDisability is an important multifaceted construct. Identifying sources of disability could help optimise patient care. The aim of this study was to test an approach that not only estimates severity of disability, but also identifies the source(s) of this disability.MethodsAn online survey was used to collect data from a convenience sample, recruited via email and social media invitations. Two generic measures of disability, the 8-item Universal Disability Index (UDI8) and Groningen Activity Restriction Scale (GARS) were used to estimate the prevalence and severity of disability in this sample. Non-zero UDI8 item responses generated conditional sub-questions, in which participants could attribute their activity limitations to one or more sources (pain, fatigue, worry, mood, and other). This allowed for a decomposition of UDI8 scores into source components.Results403 participants enrolled; 334 completed all UDI8 and GARS items. Of these, 85.3% (285/334) reported at least one restricted activity via the UDI8, while 43.4% (145/334) reported some reduced independence via the GARS. Disability severity increased with age until approximately 40 years, after which it decreased gradually. Pain component scores were high in all individuals with higher and lower disability severity, whereas fatigue component scores were highest in individuals reporting higher disability severity. Worry, mood, and other component scores were not high at any level of disability severity.ConclusionsThis approach should be used to identify the prevalence, severity and sources of disability in the general population and in specific patient groups.Conflicts of interestNo conflicts of interestSources of fundingNo funding obtained

Morbimortality profile by COVID-19 in telework and on-site work in an oil and gas company in Brazil.

As a reflection of the health emergency caused by COVID-19, many countries adopted guidelines, which included activity restrictions. As a result, some companies maintained their activities with on-site work and telework. Analyzing the morbidity and mortality profile due to COVID-19 of workers in telework and on-site work in an oil and gas company. Cross-sectional, quantitative, and analytical study that included 8,394 workers diagnosed with COVID-19 at an oil and gas company in Brazil, from June 2020 to June 2021. The company's Surveillance Program database was used as an information source. The total prevalence of cases was 21.7%. For teleworking and face-to-face workers, they were 20.7% and 23.3%, respectively. There was a predominance of women (19.7%), white ethnicity/colour (64.7%), higher level position (52.6%), age group over 40 years (36.7%), married (53, 8%), working at the company for a period that ranges from 7 to 10 years (17%), administrative activity (68.5%), and a higher number of symptomatic workers and deaths in telework compared to on-site work. The results suggest that testing is important to refrain the virus spread in the company's work environments, as it allowed asymptomatic workers to be diagnosed with COVID-19. The study suggested that on-site work was not a transmission facilitator in the occupational environment, which points out the importance of preventive measures in the workplace and the adoption of remote work for the largest possible number of workers to improve the safety of employees, workers who remained in the on-site work modality.

Nexus between Economic Policy Uncertainty and Bank Liquidity Creation

Purpose: This paper analyzes the effects of economic policy uncertainty (EPU), bank regulations, and credit risk on the asset and liability sides of liquidity creation in developed and developing countries. Methods: The sample comprises 100 companies in developed and developing countries from 2015 to 2021. We used a dynamic Generalized Method of Moments (GMM) estimator to test the hypothesis. We also performed the Sargan test of over-identification or J-statistics to check the validity of instruments in the GMM model. Additionally, we conducted a robustness test on our analysis based on average assets and average capital. Results: We find that Economic Policy Uncertainty (EPU) significantly negatively impacts asset-side liquidity creation in developed and developing countries. However, EPU significantly positively impacts liability-side liquidity creation only in developed countries. Interestingly, higher credit risk can effectively counteract the adverse effects of EPU on asset-side liquidity creation and encourage a positive impact on liability-side liquidity creation in developed and developing countries. Moreover, stricter bank regulations, including activity restriction and capital stringency, can weaken the negative effects of EPU on asset-side liquidity creation in developed and developing countries. However, we do not find any significant effect of higher bank regulations on the relationship between liability-side liquidity creation and EPU. Implications: Since financial institutions can make riskier decisions to keep their businesses going in an uncertain economy, regulators need to act in advance to restore confidence in credit growth and financial resilience. The government should assess the short-term and long-term consequences of any policy implications. Originality: While most studies concentrate on total liquidity creation from a cross-country perspective, our study provides new evidence by breaking down liquidity creation into asset-side and liability-side liquidity creation and examining the research separately in developed and developing countries.

Climatic temperature and precipitation jointly influence body size in species of western rattlesnakes.

Both the metabolic theory of ecology and dynamic energy budget theory predict that climate influences body size through its effects on first-order determinants of energetics: reactive temperatures, carbon resources and oxygen availability. Although oxygen is seldom limiting in terrestrial systems, temperature and resources vary spatially. We used redundancy analyses and variation partitioning to evaluate the influence of climatic temperature, precipitation and their seasonalities on multivariate body size across the distributions of four species of the western rattlesnake group in North America (Crotalus pyrrhus, C. scutulatus, C. oreganus and C. viridis). Most species showed a pattern of increased body size in cooler, mesic climates and decreased body size in warmer, xeric climates. Exceptions to the pattern provided additional context through climatic idiosyncrasies in the distributions of each species. For example, the general pattern of a negative influence of temperature on body size was not apparent for C. oreganus, which ranges across the mildest climates overall among the four species. In contrast to previous studies, we found that seasonality had negligible effects on body size. We suggest that precipitation gradients correlate positively with resource availability in driving intraspecific body size and that temperature compounds this gradient by increasing baseline metabolic demands and restricting activity in particularly warm or otherwise extreme climates.

Comparison of short- and midterm outcomes in patients following ream-and-run and anatomic total shoulder arthroplasties

Anatomic total shoulder arthroplasty (aTSA) may not be an ideal treatment option for young and active patients because of potential activity restriction and concerns about glenoid loosening. The ream-and-run procedure (RnR) allows for the continuance of high-level activity without concerns of a glenoid component failure. Initial RnR publications are promising, although more outcomes studies are needed. Therefore, our primary purpose was to compare outcomes at multiple time points between matched aTSA and RnR cohorts. Second, we sought to examine relationships between patient-reported outcomes and preoperative glenoid pathoanatomy in our RnR cohort Last, we examined postoperative radiographs to determine if the RnR successfully corrected glenoid pathoanatomy and humeral head decentering. We performed a retrospective matched-cohort study comparing patients who underwent an RnR vs. patients who underwent the aTSA procedure between 2017 and 2019. All patients had primary diagnoses of shoulder osteoarthritis and a minimum of 2-year follow-up. Simple Shoulder Test, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and daily and worst pain outcomes were compared between groups at 3 and 6 months, and 1 and 2 years postarthroplasty. Pre- and postoperative glenoid anatomy and humeral decentering were measured radiographically, and correlation analyses were conducted to explore relationships between these factors and 2-year pain and function scores. Forty-six shoulders (23 RnR and 23aTSA) belonging to 43 male patients with an average age of 56.2±8.3 years were included. Eighteen matched pairs were available at 3 and 6 months, 21 matched pairs at 1 year, and all 23 matched pairs at the 2-year time point. RnR patients reported significantly higher daily pain ratings (P=.047) and lower ASES scores (P=.031) compared with the aTSA group 3 months after arthroplasty but reported similar outcomes at 6 months and beyond. Preoperative pathoanatomy outcomes were not directly related to final reported pain or function in the RnR group. Additionally, the RnR was able to correct posterior humeral head decentering in our cohort. Young male patients undergoing RnR can likely expect similar short-term results as young male patients who undergo aTSA. Additionally, the RnR outcomes were not affected by preoperative glenoid wear or humeral head decentering. Our findings support the RnR as a viable surgical alternative for young, active patients with shoulder arthritis.

Potential reduction of CO2 emissions which is the cause of greenhouse gases during COVID-19

Background: The implementation of education in tertiary institutions contributes significantly to greenhouse gas emissions, particularly carbon dioxide (CO2), which causes the greenhouse effect and global warming. The Intergovernmental Panel on Climate Change (IPCC) identifies transportation, energy supply, and industry as the primary sectors driving CO2 emissions over the past 30 years. However, the COVID-19 pandemic unexpectedly reduced CO2 emissions globally by up to 70% due to restricted activities. In 2020, the pandemic led countries, including Indonesia, to enforce Large-Scale Social Restrictions (PSBB) to curb virus spread, which significantly limited community mobility and vehicle use. Climate change, driven by greenhouse gas emissions, is a critical development challenge for Indonesia. Method: The study uses various calculation methods from journals and websites, incorporating expert opinions and the IPCC's method, to analyze emission reductions. Findings: The findings indicate that the COVID-19 pandemic and associated lockdowns reduced CO2 emissions due to decreased fuel consumption and mobility. Conclusion: This period highlights opportunities for strategies like low-carbon development to continue reducing emissions from vehicles. Novelty/Originality of this Study: This study provides a novel contribution by quantitatively assessing CO2 emission reductions during the COVID-19 lockdown, emphasizing the unique context of an unprecedented global event. It conducts a comprehensive literature review to integrate various CO2 calculation methods, particularly highlighting the sophisticated IPCC method, and offers a comparative analysis of emission reduction techniques.

Thermal response of a sky island lizard to climate change

ABSTRACT Climate change models for lizards assume that changes in its climate envelope (the climatic conditions that define a species’ distribution at a given time) are due to species being unable to withstand temperature increases, but this assumption has not been tested to assess its robustness. Studies on lizards’ preferred temperature in thermal gradients can fill this gap. Our aim is to assess the response to climate change of Liolaemus nigroviridis, a sky island lizard, by (i) assessing its thermal preference in a thermal gradient; and (ii) estimating which localities inhabited by the species would exhibit hours of activity restriction (Hr) implying an increased risk of local extinction. The results of this research and the information obtained from the literature concur on the consequences that climate change will have on the thermal ecology of Liolaemus from specialized habitats; the increase in substrate temperature is indeed a factor determining its presence. We also have information that not all populations of L. nigroviridis will be influenced in the same way; the northern populations will be more affected in terms of thermal restrictions and, in addition, Hr will increase at higher elevations. We propose that this be considered for future management for this species.

Forensic psychiatric assessment in autism spectrum disorder: Experience of a forensic psychiatry inpatient clinic from Türkiye.

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by marked differences in communication patterns, reciprocal social interactions, and restricted, stereotyped, and repetitive interests and activities. Various behavioral problems in ASD, more so when accompanied by coexisting psychopathology, can sometimes lead to legal problems. In this study, the cases in which an opinion was requested in terms of criminal responsibility with the diagnosis of ASD in the 5-year period between 2018 and 2022 in the expertise department of psychiatric observation, where psychiatric cases were hospitalized and observed in the Council of Forensic Medicine (CFM), which is the official expert institution in Türkiye, were retrospectively evaluated. The mean age of the group whose criminal responsibility was reduced or removed was 22.9 years (±7.52) and the mean IQ score was 76.63 ± 18.94. The most common crime in this group was intentional injury (5/11), and it is noteworthy that the victims of these crimes were usually relatives of people with ASD (5/6). The criminal acts of people with ASD are usually single-movement, spontaneous, unplanned, impulsive acts. In addition, although there is no problem in cognitive perception in people with high functioning ASD(HF-ASD), various forensic situations may arise due to defects in emotional awareness. When we look at the practices of the CFM in Türkiye, it is seen that in cases where the diagnosis of ASD is clear and can be associated with the crime, criminal responsibility is usually completely eliminated. In HF-ASD types, although it is important to be associated with the crime, it is seen that criminal responsibility is generally reduced.

Addressing the gaps: What social media tells us about patient experiences with hypoglossal nerve stimulation

PurposeHypoglossal nerve stimulation (HNS) can be an effective treatment for moderate to severe obstructive sleep apnea (OSA) in positive airway pressure (PAP) intolerant patients. To better understand patient perceptions of HNS therapy, we explored three Facebook groups pertaining to HNS therapy. Materials and methodsA retrospective analysis of Facebook posts from three HNS-related Facebook groups, from October 1, 2022 to October 1, 2023, was performed. Posts were analyzed for author attitude, content (adverse events, inquiries, or sharing information), and the inclusion of media within the post. ResultsFrom 737 Facebook posts, 752 events were identified, predominantly authored by patients or family (99.5 %). Few posts included media attachments (7.3 %), primarily photos (85.5 %). Post tone was mainly neutral (79.4 %), rather than positive (12.9 %) or negative (7.7 %). Most posts (53.6 %) were queries to the Facebook group, as opposed to sharing information (28.9 %) or detailing adverse events (17.6 %). Notably queries posed by Facebook group members included those pertaining to the postoperative recovery course (10.17 %), physical activity restrictions (6.20 %), HNS therapy eligibility (4.71 %), financial considerations (4.22 %), and more. ConclusionOverall, Facebook group members reported a predominantly neutral tone, typically posting queries to the group rather than sharing information or detailing adverse events. These findings illustrate how diverse data sources, such as social media, can enhance our understanding of patient experiences and identify gaps in patient education with HNS therapy.

The Effectiveness of Treating Osgood-Schlatter Disease (OSD) with Leukocyte-Rich Platelet-Rich Plasma (LR-PRP) Depending on the Duration of the Disease.

Background: Osgood-Schlatter disease (OSD) occurs mainly in physically active adolescents, causing significant physical activity restrictions. The aim of this study is to compare the effectiveness of treating OSD with leukocyte-rich platelet-rich plasma (LR-PRP) depending on the duration of the disease and to attempt to develop an alternative treatment method to the currently used conservative therapy. Methods: Treatment efficacy was evaluated using the VAS, Tegner, Lysholm, and KOOS scales. Subject satisfaction, return to sports activity, potential adverse effects, and X-ray evaluation were likewise used to assess the success of the procedure. Results: Analysis across all scales showed statistically significant treatment effectiveness with LR-PRP in both groups of patients. When comparing the two groups, significantly better treatment outcomes were achieved in the acute phase of OSD. Treatment satisfaction in the acute OSD group was 95%, compared to 64% in the chronic group. The MCID value after LR-PRP injection in acute OSD compared to chronic OSD reached 100% vs. 81% on the VAS scale, 95.5% vs. 55% on the Tegner scale, 95% vs. 47% on the Lysholm scale and 91% vs. 27% on the KOOS scale. No adverse effects were recorded in either group. Conclusions: The high efficacy of LR-PRP treatment in patients with acute OSD, in correlation with high safety, as well as rapid and lasting results, can be an effective and beneficial alternative to conservative treatment. This single procedure seems particularly justified in a group of young professional athletes, where absence from training can lead to serious consequences.

Formation of methodological foundations for the analysis of national development in conditions of foreign economic discrimination

Purpose: is to form a conceptual approach to the analysis of the macroeconomic effects of external sanctions based on increasing the information content of the use of technical indicators in assessing the stability and vulnerability of the national economy to the effects of discriminatory restrictions in foreign economic activity. Methods: the study is based on the processing and analysis of data obtained as a result of content analysis of a significant number of scientific, scientific-practical, and expert sources of information.Methods of scientific generalization and classification, economic, expert and statistical analysis were used.Results: the analysis of the impact of sanctions restrictions on the key indicators of the characteristics of sustainable and innovative development of the discriminated national economy is carried out. An approach to assessing the impact of sanctions is presented based on a conjugate analysis of the dynamics of target groupings of indicators. An example of calculations, visualization and interpretation of the results of assessing sanctions resistance and export-import dependence of the national economy based on a set of technical indicators for significant areas of socio-economic development of the discriminated country is illustrated. The scope of application of the proposed approach in the formation of the development strategy and program (in terms of the implementation of the process of import substitution, ensuring technological independence and structural adaptation of the economy) is justified, taking into account the risks of sanctions restrictions.Conclusions and Relevance: the proposed approach to the analysis of sanctions restrictions based on the combined use of technical criteria for the dynamics of grouped indicators provides an increase in the reliability of estimates of their negative impact. However, aggregated estimates do not allow us to justify selective and targeted measures aimed at adapting the institutional and organizational conditions of the activities of specific economic agents in key areas of the national economy. A possible direction for further research may be the development of methodological and analytical tools for assessing the sanctions stability of economic sectors to substantiate the priorities of ensuring their technological independence.

Bullying experiences in childhood and health outcomes in adulthood.

This study examines whether the experience of being bullied at school has a long-term impact on three health outcomes in adulthood in Japan: subjective health, mental health, and activity restriction due to health conditions. We employed a random effects model and the Karlson-Holm-Breen method to decompose the total effect of being bullied at school on health inequality into a direct effect and an indirect effect working through intervening factors including education, marriage, economic well-being, and social networks. We used the Japanese Life Course Panel Surveys 2007-2020 (waves 1-14), a nationally representative panel data set that includes 2,260 male and 2,608 female respondents. The results demonstrate that for both men and women, the direct effect of being bullied at school was strong and significant. Bullying experiences in childhood had a long-term impact on health outcomes in adulthood, regardless of social background and mediating factors of education, marriage, economic well-being, and social networks. Bullying victimization increased the risk of poor subjective health, low mental health scores, and activity restriction due to health conditions. Intervening factors (especially economic well-being and friendship) mediated the association between bullying experiences and all health outcomes, but their contributions were modest. Policy measures not only to prevent bullying during childhood but also to alleviate its negative consequences in adulthood should be considered to help people who have encountered adverse childhood experiences.

Post-COVID asthenia, sarcopenia and muscle weakness among geriatric patients

Sarcopenia, asthenia, and motor activity restriction are common among geriatric patients in the post-COVID period. The SARS-CoV-2 virus triggers a cytokine storm in the human body and induces a direct viral effect on skeletal muscles. Manifestations of post-acute sequelae of COVID-19 (PASC) can include organ and system dysfunction, asthenia, muscle weakness, dyspnea, chest pain, cognitive impairment, depression, anxiety, and sleep disorders. Hypoxemia, comorbidity, and prolonged inactivity contribute to changes in the structure and functionality of the muscular fibers. One of the recent studies is ALMI-index, which indicates that a decrease in muscle mass of the upper and lower extremities may cause functional limitations in patients with long-COVID conditions. Rehabilitation of patients with post-COVID syndrome involves daily exercise with weights, considering load tolerance; mandatory medication; and nutritional and psychological support.

Association between fear of falling and mortality in middle-aged and older adults: A systematic review and meta-analysis

BackgroundFear of falling (FOF) has emerged as a significant public health issue, contributing to excess disability among middle-aged and older adults. The association between FOF and mortality remains unclear. MethodsProminent electronic databases (PubMed, Web of Science, the Cochrane Library, Embase, CINHAL, PsycINFO, Scopus, China National Knowledge Infrastructure, China Biology Medicine disc, and Wanfang Database) were searched from inception until October 21, 2023 (data updated on June 9, 2024), for cohort or longitudinal studies investigating the association between FOF and mortality. The heterogeneity between studies was quantitatively assessed using I2. A fixed-effect model calculated the pooled effect size. ResultsA total of seven cohort studies, including 27,714 participants, were analyzed in this systematic review and meta-analysis. The meta-analysis results demonstrated a positive association between FOF and mortality, with a significant increase in the risk of mortality for those with FOF (hazard ratio [HR]:1.29, 95 % confidence interval [CI]: 1.19–1.41, p < 0.05). Subgroup analysis indicated that age, male sex, clinical diagnosis of depression, number of chronic diseases, activity restriction due to FOF, and FOF levels were associated with mortality. ConclusionsFOF and mortality have a positive association, which needs to be confirmed by further prospective studies with large samples and long-term follow-up to provide evidence for clinicians to intervene in FOF to reduce mortality in middle-aged and older adults.

Circumferential correction of spinal deformity and instability secondary to bacterial spondylodiscitis

BackgroundSpinal deformity as a sequela of non-tuberculous spondylodiscitis is a rarely discussed clinical entity. Sagittal plane deformity, segmental instability, and persistently active infection overlap in these patients resulting in severe restriction in activity and quality of life. The presence of multiple medical co-morbidities restricts surgical options but nonoperative care may be ineffective and result in persistent, refractory discitis for years. We describe our experience with vertebrectomy and long-segment fixation for patients with post-infectious thoracic or lumbar deformity. MethodsA retrospective chart review of 23 consecutive patients who underwent vertebrectomy and long-segment fixation for thoracic or lumbar deformity secondary to nontuberculous bacterial spondylodiscitis was performed. Pre-, peri- and postoperative data is compiled and analyzed with a focus on the perioperative management algorithm to safely perform an extensive reconstruction in this very sick patient population. ResultsExtremely low preoperative quality of life was evident with 87% (20/23) of patients bedridden primarily due to pain despite 70% (16/23) of patients being strong enough to ambulate (Frankel D or E). Most patients (87%) already had an identified infection under adequate treatment either through blood cultures, prior biopsy or decompressive surgery. A single-stage posterior-only was the primary surgical approach utilized in the majority (83%) of cases. Complications were present in 100% of patients, most commonly perioperative anemia and hypotension requiring vasopressor support and aggressive blood product replacement. One in-hospital mortality occurred secondarily to pulmonary embolism. Mean preoperative segmental angle was 18±10 degrees of kyphosis which was corrected to 1±9 degrees of lordosis (p=0.001). The mean correction of the segmental angle was 19 degrees (standard deviation 23 degrees). Visual analogue scale scores improved from a pre-operative value of 8.8±0.9 to a post-operative value of 2.5±1.4 (p<0.001), which was obtained at the last outpatient follow-up (mean 631 days after surgery). Full self-care including ambulation was achieved in 18/23 (78%) patients, and the infection was successfully treated in 22/23 (96%) patients after long-term antibiotics. ConclusionsPatients with refractory spondylodiscitis on appropriate care and antibiotics are typically considered extremely poor surgical candidates despite non-operative care often being ineffective. Post-infectious deformity may also be so severe as to preclude a limited surgical treatment strategy. This study suggests that extensive circumferential reconstruction for deformity secondary to bacterial spondylodiscitis can be effective in restoring these extremely sick patients to self-care and ambulatory status.

How education policy actors interpret, portray and contest risk in children’s physically active play in schools: a framing analysis

ABSTRACT Children’s physical activity is low and play outdoors has been declining, coinciding with a greater preoccupation with risk in many countries. This study examines how policy actors frame the issue of risk in children’s active physical play in schools. Using a theory-informed, multi-method, qualitative case-study design, 30 participants from a range of sectors involved in policy relevant to children’s physical activity and play in schools participated in interviews and photo-elicitation. Data were analysed using reflexive thematic analysis. Four frames of active physical play in schools were identified. Two ‘risk averse’ frames (protection and productivity) dominated and were primarily expressed by policy actors inside the school system. These frames were characterised by a negative construction of risk, and concerns for adverse outcomes for children and schools. In contrast, two frames were ‘risk tolerant’ (development and flourishing), within which risk was constructed as ‘uncertainty’, which could lead to positive or negative outcomes in play, and supported a child’s holistic learning, development, and wellbeing. While there were some ‘real world’ examples of risk tolerant frames, more commonly they were expressed in the context of how things should or could be in schools. Findings indicate school policies that prioritise injury prevention and productivity goals, may involve a risk-benefit trade-off over other fundamental objectives, elevating some risks above less visible ones, such as the consequences of play and physical activity restriction. Implications for education policy are discussed. Future work should seek to improve understanding of forces contributing to risk averse frames of physically active play in schools and contribute evidence for the benefits of risk-taking for children.