Usual Routines Research Articles

Challenges to consumers travelling with multiple medicines

The need to maintain medicine adherence when travelling is irrefutable, yet how people achieve this goal and the challenges they encounter in doing so have seldom been explored in previous research. This study examined how consumers residing in Australia experience and manage their multiple medicines while travelling. Face-to-face, narrative interviews were conducted in participants’ homes or workplaces and were audio and video-recorded. The coding schema was devised with the input of an Advisory Panel with expertise in multiple medicines. Data were analysed using the constant comparative method. Participants who had experienced medicines mishaps when travelling had learnt to take greater care when planning and preparing for future trips. Prior to travelling, they rarely sought advice regarding their regular medicines from health professionals. Organising and packing their medicines could be extremely time-consuming and confusing; younger participants especially lamented the reduced spontaneity this imposed on their lives. Replicating their usual routines was a successful strategy for many; however, this was challenged by unforeseen events and the lack of privacy. Travel comprised inherent risks to the users of multiple medicines and often required intensive and complicated preparation. Community pharmacists and other health professionals are well placed to advise and assist consumers with complex regimens who are planning to travel, as well as raise general awareness concerning the need for utmost care with multiple medicines.

Patients’ expectations towards going home with a very early supported discharge and home rehabilitation after stroke

Background: After a life-altering event such as stroke, the return home from hospital is an important transition. Previous studies have shown that this transition gives rise to mixed expectations with both uncertainty and hope for the future. However, the hospital stays in these studies were longer than the present average length of hospital stay after stroke in Sweden. This reduced hospital stay implies shorter time to prepare for discharge both for the patient and the professionals. With shorter hospital stays, a well-prepared discharge routine focusing on the expectations and the needs of the patients could help bridge the gap between the hospital and the home. Therefore, more knowledge about patients’ expectations is needed. Purpose: To describe patients’ expectations towards going home with a very early supported discharge and home rehabilitation after stroke. Methods:Thiswas an interview study nestedwithin a randomized controlled trial; Gothenburg very early supported discharge (GOTVED), comparing very early supported discharge from an acute stroke ward and home rehabilitation, with usual care after stroke. A consecutive sample of 10 participants was recruited from the intervention group in GOTVED. Interviews were conducted before discharge and the material analysed with qualitative content analysis. Results: The analysis resulted in four categories and 11 subcategories, which showed that a complexity existed with regards to the participants expectations about their return home. On one hand, the study participants expected it to feel new and unknown to return home and worried not to manage under these new conditions. On the other hand, they had confidence in the new situation and longed for returning to their familiar home environment and to care for themselves. A fear to have new stroke after coming home was mentioned, but this was overshadowed by their wish to return back home and to resume their usual routines. To restart with their old habits was expected to be challenging, and different strategies to cope with the situation was described. The expectations towards the role of the very early supported discharge (VESD) team varied greatly. However, some participants were unfamiliar with the intervention and their own role in the rehabilitation process. Even though the participants assumed that the regular visits from the VESD team would increase the feeling of being secure at home, they also expected that the intervention would interfere with the way they usually lived their life. Conclusion(s): The participants’ had mixed expectations towards going home with a very early supported discharge and home rehabilitation after stroke. This diversity of expectations was found both individually and between the persons. Implications: The person’s narratives about going home should be in focus when preparing for discharge after stroke. Such an approach can reveal the individual needs and expectations and thereby facilitate the transition home, thus being an important aid to bridge the gap between the hospital and the home.

Exercise‐ and Kefir‐induced Internalization of the Anti‐inflammatory Melanocortin 3 Receptor in Monocytes

Exercise decreases chronic inflammation and kefir, a fermented milk product, has the potential to further attenuate inflammation. Exercise may upregulate anti‐inflammatory pathways in monocytes by activating and increasing internalization of melanocortin 1 (MC1R) and 3 receptors (MC3R). Here, we determined the effects of marathon training and kefir supplementation on systemic monocyte cell surface and internal MC1R and MC3R protein expression via flow cytometry. Healthy, adult males and females (18‐24 yrs) were assigned to one of 4 groups: 1) active control + control beverage (C), 2) active control + kefir (K), 3) endurance training + control beverage (EC) or 4) endurance training + kefir (EK). EC and EK completed 15 weeks of marathon training. C and K maintained their usual exercise routines. EK and K supplemented with kefir and C and EC with a calorie/macronutrient matched placebo beverage twice/week. Blood samples were collected (72h post exercise) and stained with CD14 and MC1R or MC3R antibodies. Internal MC3R but not MC1R was increased in EK compared to K (45.16 ± 4.79 vs 24.51 ± 4.62 MFI, P < 0.05) but not EC; additionally, EC was not different from C. Endurance training plus kefir supplementation may act synergistically to decreased chronic inflammation through activation and internalization of the anti‐inflammatory MC3R in monocytes.

Circadian cortisol and fatigue severity in relapsing-remitting multiple sclerosis

Cortisol is a key regulator of the immune system, energy metabolism, and stress, yet its relevance to fatigue experienced by people with relapsing-remitting multiple sclerosis (RRMS) remains uncertain. We examined cortisol secretory activity in RRMS and its association with fatigue severity between-individuals and within-individuals (day-to-day) using a case-control ecological momentary assessment design. While undergoing usual daily routines, 38 people with RRMS and 38 healthy control participants provided saliva samples at strategic time-points over 4 consecutive weekdays to measure the cortisol awakening response (CAR; 0, 30, and 45 min after awakening) and the diurnal cortisol slope (DCS; 6 quasi-random samples provided between 1000 h and 2000 h). Recalled fatigue was measured at baseline, and daily fatigue was measured as the mean average of momentary fatigue ratings provided alongside each DCS sample. Multilevel modeling found CAR output was greater in RRMS than controls, and recalled fatigue in RRMS was associated with both lower waking cortisol level and larger awakening response. Day-to-day, the CAR was not associated with same-day fatigue levels in RRMS. Cortisol appears to have a role in fatigue experienced in RRMS, but whether it is a causal factor remains unclear.

Point-of-care monitoring of warfarin treatment in community dwelling elderly – A randomised controlled study

The objective of this study was to assess clinical effectiveness and costs of launching point-of-care monitoring of warfarin treatment in community dwelling frail elderly patients. A prospective multicentre controlled randomised study over 12 months comparing a point-of-care strategy with usual monitoring routines was carried out in primary healthcare centres and anticoagulation clinics in southeast Sweden. The subjects were community dwelling elderly across rural southeast Sweden on chronic warfarin treatment. Main outcome measures were time in therapeutic range (TTR), rate of treatment-related adverse events and costs. The study comprised 103 elderly people (61% women) mean age 86 yrs (range 75--98) treated with warfarin for median 9 yrs (range 1--18). Patients randomised to start point-of-care monitoring (n = 55) showed 75.9% in TTR before trial vs. 72.6% during trial (ns). The patients randomised to continue on usual monitoring routines (n = 48) showed 75.2% in TTR prior to trial vs. 72.9% during trial (ns). The point-of-care monitoring showed potential savings of SEK 624 per patient annually (based partly on effects that were not statistically significant). The study shows that point-of-care monitoring of warfarin treatment in community dwelling elderly in rural areas is as effective as usual monitoring routines and that it may offer savings to society.

Factors associated with corneal graft survival in the cornea donor study.

The Cornea Donor Study (CDS) showed that donor age is not a factor in survival of most penetrating keratoplasties for endothelial disease. Secondary analyses confirm the importance of surgical indication and presence of glaucoma in outcomes at 10 years. To assess the relationship between donor and recipient factors and corneal graft survival in the CDS. Multicenter prospective, double-masked, controlled clinical trial conducted at 80 clinical sites. One hundred five surgeons enrolled 1090 participants undergoing corneal transplant for a moderate-risk condition, principally Fuchs dystrophy or pseudophakic or aphakic corneal edema (PACE). Forty-three eye banks provided corneas. Corneas from donors younger than 66 years and donors 66 years or older were assigned, masked to donor age. Surgery and postoperative care were performed according to the surgeons' usual routines. Participants were followed up for as long as 12 years. Graft failure, defined as a regrafting procedure or a cloudy cornea for 3 consecutive months. The 10-year cumulative probability of graft failure was higher in participants with PACE than in those with Fuchs dystrophy (37% vs 20%; hazard ratio [HR], 2.1 [99% CI, 1.4-3.0]; P < .001) and in participants with a history of glaucoma before penetrating keratoplasty, particularly with prior glaucoma surgery (58% with prior glaucoma surgery and use of medications to lower intraocular pressure at the time of surgery vs 22% with no history of glaucoma surgery or medication use; HR, 4.1 [99% CI, 2.2-7.5]; P < .001). We found trends toward increased graft failure in recipients who were 70 years or older compared with those younger than 60 years (29% vs 19%; HR, 1.2 [99% CI, 0.7-2.1]; P = .04) or were African American (HR, 1.5; P = .11) or who had a history of smoking (35% vs 24%; HR, 1.6 [99% CI, 0.9-2.8]; P = .02). Lower endothelial cell density (ECD) and higher corneal thickness (CT) at 6 months (6% vs 41% for ECD ≥2700 vs <1700 cells/mm2 [P < .001]; 14% vs 36% for CT <500 vs ≥600 μm [P = .001]), 1 year (4% vs 39% for ECD ≥2700 vs <1700 cells/mm2 [P < .001]; 18% vs 28% for CT <500 vs ≥600 μm [P = .04]), and 5 years (2% vs 29% for ECD ≥1500 vs <500 cells/mm2 [P < .001]; 7% vs 34% for CT <550 vs ≥650 μm [P < .001]) were associated with subsequent graft failure. Most penetrating corneal grafts for Fuchs dystrophy or PACE remain clear at 10 years. The risk for failure is greater for graft recipients with PACE and those with a history of glaucoma. Measurements of ECD and CT during the course of postkeratoplasty follow-up are associated with a risk for failure. However, even with very low ECD and high CT at 5 years, most corneas remain clear at 10 years.

The Effect of Community Traumatic Events on Student Achievement: Evidence from the Beltway Sniper Attacks

Community traumatic events such as mass shootings, terrorist attacks, and natural or man-made disasters have the potential to disrupt student learning in numerous ways. For example, these events can reduce instructional time by causing teacher and student absences, school closures, and disturbances to usual classroom routines. Similarly, they might also disrupt home environments. This paper uses a quasi-experimental research design to identify the effects of the 2002 “Beltway Sniper” attacks on student achievement in Virginia’s public elementary schools. In order to identify the causal impact of these events, the empirical analysis uses a difference-in-differences strategy that exploits geographic variation in schools’ proximity to the attacks. The main results indicate that the attacks significantly reduced school-level proficiency rates in schools within five miles of an attack. Evidence of a causal effect is most robust for math proficiency rates in the third and fifth grades, and third grade reading proficiency, suggesting that the shootings caused a decline in school proficiency rates of about five to nine percentage points. Particularly concerning from an equity standpoint, these effects appear to be entirely driven by achievement declines in schools that serve higher proportions of racial minority and socioeconomically disadvantaged students. Finally, results from supplementary analyses suggest that these deleterious effects faded out in subsequent years.Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.

Daughter of Good Fortune: A Twentieth-Century Chinese Peasant Memoir by Shehong Chen

Reviewed by: Daughter of Good Fortune: A Twentieth-Century Chinese Peasant Memoir by Shehong Chen Guo Chao (bio) Shehong Chen. Daughter of Good Fortune: A Twentieth-Century Chinese Peasant Memoir. Seattle: University of Washington Press, 2015. xii, 348 pp. Paperback $30.00. isbn 978-0-295-99492-5. Daughter of Good Fortune is an autobiography dictated by Chen Huiqin (referred to as "Mother"), a rural woman who has lived in the Jiading area all her life, recorded and edited by Shehong Chen (referred to as her birth name Shezhen), Mother's firstborn, who is now a professor of history at the University of Massachusetts, Lowell. Born in 1931, Mother witnessed a majority of the substantial social changes in rural China since the late 1930s, and relates the events in a microcosmic pattern, that is, the detailed daily life of a rural dweller in southeastern China. Ostensibly, the book is a collection of the life stories of Mother; however, the underlying and advanced intention of the book, as Shehong Chen declares in the preface and Delia Davin reiterates in the introduction, is to outline the progress of societal transformation that rural China underwent in the continual waves of reformations after the 1930s, specifically the establishment of Communist China in 1949, the Land Reform and Collectivization Campaign in the 1950s, the Cultural Revolution in the 1960s, the Economic Reform in the 1980s, and the ongoing transformations dramatically occurring in the new millennium, not officially recorded by a professional historian but personally experienced by a rural woman (Chen, p. x; Davin, p. 3). As an endeavor in oral history, the book bestows on us an enormous amount of primary material. The narrator, Mother, recollects all kinds of stories, major and minor, in sixteen chronological sections. Section 1, as well as the first half of section 2, is a detailed portrait of the usual routines of life in the rural section of Jiading County and a brief introduction of her family, both extended and nuclear, as they maintain a peaceful life before the successive Anti-Fascist War and Civil War broke out in 1937. After the establishment of Communist China, she witnesses a series of the CCP's (Chinese Communist Party) societal campaigns, such as the Quelling of Counterrevolutionaries (e.g., the Ji Brothers in Wangjialong, her hamlet), the Land Reform in 1950, and the new law on matrimony—initially mentioned in the middle of section 2 and elaborated on in section 3—a law which was also validated in the same year and led to fundamental changes in what constituted rural China. [End Page 30] She touches on the trials of the Mutual Aid teams introduced in the spring of 1952, and, later, the Collectivization of 1953 (the policy of Unified Purchasing and Marketing included) in the fourth section. The later effects of radical communization in 1958—disastrous decisions by the Party Central Committee as they affected rural livelihood—are covered in section 5 and the first half of section 6. In the latter half of section 6 and the entirety of section 7, her narrative covers the Cultural Revolution from 1966, which was, as the section is titled, "Years of Ordeal." She still retains memories of the whole family's bitterness from that fanatical time. In 1968, her partner, Chen Xianxi (once referred to as Chen Xianmin in the third section), cadre of the CCP since Liberation, had been baselessly accused by the rebel chief and sent to a so-called study course (xuexiban), a kind of surveillance in essence, and transferred to a pig farm in the following spring of 1969. Following Chen Xianxi's rehabilitation, as late as in the summer of 1970, life took a turn for the better. Two of Mother's children, Shezhen and Shebao, entered universities—Shezhen was accepted into a university from a sewing factory as one of the "worker-peasant-soldier students" in 1974, and Shebao was admitted after the restoration of the university entrance examination in 1978, as is covered in section 8. The Reform Era (not limited to economic reform) initiated by Deng Xiaoping in the early 1980s terminated the Mao Era, and is discussed in section 9 and thereafter. Mother had...

Differential reliance of chimpanzees and humans on automatic and deliberate control of motor actions

Humans are often unaware of how they control their limb motor movements. People pay attention to their own motor movements only when their usual motor routines encounter errors. Yet little is known about the extent to which voluntary actions rely on automatic control and when automatic control shifts to deliberate control in nonhuman primates. In this study, we demonstrate that chimpanzees and humans showed similar limb motor adjustment in response to feedback error during reaching actions, whereas attentional allocation inferred from gaze behavior differed. We found that humans shifted attention to their own motor kinematics as errors were induced in motor trajectory feedback regardless of whether the errors actually disrupted their reaching their action goals. In contrast, chimpanzees shifted attention to motor execution only when errors actually interfered with their achieving a planned action goal. These results indicate that the species differed in their criteria for shifting from automatic to deliberate control of motor actions. It is widely accepted that sophisticated motor repertoires have evolved in humans. Our results suggest that the deliberate monitoring of one’s own motor kinematics may have evolved in the human lineage.

Donor Age and Factors Related to Endothelial Cell Loss 10 Years after Penetrating Keratoplasty: Specular Microscopy Ancillary Study

Objective To examine the effect of donor age and other perioperative factors on long-term endothelial cell loss after penetrating keratoplasty (PKP). Design Multicenter, prospective, double-masked clinical trial. Participants We included 176 participants from the Cornea Donor Study cohort who had not experienced graft failure ≥10 years after PKP for a moderate risk condition (principally Fuchs' dystrophy or pseudophakic/aphakic corneal edema). Methods Corneas from donors 12 to 75 years old were assigned to participants using a randomized approach, without respect to recipient factors. Surgery and postoperative care were performed according to the surgeons' usual routines. Images of the central endothelium were obtained preoperatively and at intervals for 10 years postoperatively. Images were analyzed by a central image analysis reading center to determine endothelial cell density (ECD). Main Outcome Measures Endothelial cell density at 10 years. Results Among study participants with a clear graft at 10 years, the 125 who received a cornea from a donor 12 to 65 years old experienced a median cell loss of 76%, resulting in a 10-year median ECD of 628 cells/mm2 (interquartile range [IQR], 522–850 cells/mm2), whereas the 51 who received a cornea from a donor 66 to 75 years old experienced a cell loss of 79%, resulting in a median 10-year ECD of 550 cells/mm2 (IQR, 483–694 cells/mm2; P adjusted for baseline ECD = 0.03). In addition to younger donor age, higher ECD values were significantly associated with higher baseline ECD (P < 0.001) and larger donor tissue size (P < 0.001). Forty-two of the 176 participants (24%) had an ECD of <500 cells/mm2 at 10 years and only 24 (14%) had an ECD of >1000 cells/mm2. Conclusions Substantial cell loss occurs in eyes with a clear graft 10 years after PKP, with the rate of cell loss being slightly greater with older donor age. Greater preoperative ECD and larger donor tissue size are associated with higher ECD at 10 years. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references. To examine the effect of donor age and other perioperative factors on long-term endothelial cell loss after penetrating keratoplasty (PKP). Multicenter, prospective, double-masked clinical trial. We included 176 participants from the Cornea Donor Study cohort who had not experienced graft failure ≥10 years after PKP for a moderate risk condition (principally Fuchs' dystrophy or pseudophakic/aphakic corneal edema). Corneas from donors 12 to 75 years old were assigned to participants using a randomized approach, without respect to recipient factors. Surgery and postoperative care were performed according to the surgeons' usual routines. Images of the central endothelium were obtained preoperatively and at intervals for 10 years postoperatively. Images were analyzed by a central image analysis reading center to determine endothelial cell density (ECD). Endothelial cell density at 10 years. Among study participants with a clear graft at 10 years, the 125 who received a cornea from a donor 12 to 65 years old experienced a median cell loss of 76%, resulting in a 10-year median ECD of 628 cells/mm2 (interquartile range [IQR], 522–850 cells/mm2), whereas the 51 who received a cornea from a donor 66 to 75 years old experienced a cell loss of 79%, resulting in a median 10-year ECD of 550 cells/mm2 (IQR, 483–694 cells/mm2; P adjusted for baseline ECD = 0.03). In addition to younger donor age, higher ECD values were significantly associated with higher baseline ECD (P < 0.001) and larger donor tissue size (P < 0.001). Forty-two of the 176 participants (24%) had an ECD of <500 cells/mm2 at 10 years and only 24 (14%) had an ECD of >1000 cells/mm2. Substantial cell loss occurs in eyes with a clear graft 10 years after PKP, with the rate of cell loss being slightly greater with older donor age. Greater preoperative ECD and larger donor tissue size are associated with higher ECD at 10 years.

The Effect of Donor Age on Penetrating Keratoplasty for Endothelial Disease: Graft Survival after 10 Years in the Cornea Donor Study

To determine whether the 10-year success rate of penetrating keratoplasty for corneal endothelial disorders is associated with donor age. Multicenter, prospective, double-masked clinical trial. A total of 1090 participants undergoing penetrating keratoplasty at 80 sites for Fuchs' dystrophy (62%), pseudophakic/aphakic corneal edema (34%), or another corneal endothelial disorder (4%) and followed for up to 12 years. Forty-three eye banks provided corneas from donors aged 12 to 75 years, using a randomized approach to assign donor corneas to study participants without respect to recipient factors. Surgery and postoperative care were performed according to the surgeons' usual routines. Graft failure defined as a regraft or, in the absence of a regraft, a cloudy cornea that was sufficiently opaque to compromise vision for 3 consecutive months. In the primary analysis, the 10-year success rate was 77% for 707 corneas from donors aged 12 to 65 years compared with 71% for 383 donors aged 66 to 75 years (difference, +6%; 95% confidence interval, -1 to +12; P = 0.11). When analyzed as a continuous variable, higher donor age was associated with lower graft success beyond the first 5 years (P<0.001). Exploring this association further, we observed that the 10-year success rate was relatively constant for donors aged 34 to 71 years (75%). The success rate was higher for 80 donors aged 12 to 33 years (96%) and lower for 130 donors aged 72 to 75 years (62%). The relative decrease in the success rate with donor ages 72 to 75 years was not observed until after year 6. Although the primary analysis did not show a significant difference in 10-year success rates comparing donor ages 12 to 65 years and 66 to 75 years, there was evidence of a donor age effect at the extremes of the age range. Because we observed a fairly constant 10-year success rate for donors aged 34 to 71 years, which account for approximately 75% of corneas in the United States available for transplant, the Cornea Donor Study results indicate that donor age is not an important factor in most penetrating keratoplasties for endothelial disease.

A qualitative assessment of COPD patients' experiences of pulmonary rehabilitation and guidance by healthcare professionals

The present study aimed to assess COPD patients' experiences during an in-patient pulmonary rehabilitation program and the guidance provided by healthcare professionals. A third aim regarded examining ways to anticipate the transfer to the home environment after completion of the program. Focus groups and semi-structured interviews were used to collect data from seven COPD patients at the beginning and six other COPD patients at the end of an in-patient pulmonary rehabilitation program, supplemented by a focus group and semi-structured interviews with 14 healthcare professionals of the involved disciplines. Data were analyzed using a phenomenological approach. Starting out, patients displayed trouble with acceptance of their disease, they had insufficient knowledge, and showed difficulties in setting specific realistic goals. Seeing fellow patients struggle with similar problems and tailored counseling by healthcare professionals helped them to overcome these barriers. During rehabilitation, patients became more confident in exercising and managing their daily life activities. Many patients evolved a desire to self-regulate their lives. Incorporating health-enhancing behaviors after returning home into their usual daily routines was anticipated to be tough. Patients undergoing pulmonary rehabilitation experience a complex health behavior change process, in which healthcare professionals fulfill a major contributing role. Therefore, guiding patients through this health behavior change process is a vital component of healthcare professionals' work, regarding which the present study made practical implications such as applying a personalized approach by giving tailored advices, applying an autonomy-supportive counseling style, teaching self-management skills, and referring patients to local exercise facilities.

Costing an Injury Prevention Program in Amateur Adult Soccer

To compare the injury-related societal costs of an injury prevention program with usual warm up programs for amateur adult male soccer players. Cost effectiveness analysis of a cluster-randomized controlled trial. Regional amateur male soccer competitions in the Netherlands during the 2009 season. Cost estimates in the Netherlands are made in 2009 Euros (&OV0556;1.00∼US$1.43 in late 2009). Soccer teams from 2 first-class competitions (the second-highest Dutch amateur level) were approached. Male players aged between 18 and 40 years, who were part of the first team at the start of the season, were eligible for inclusion. Twenty-three teams including 479 players were randomized and 456 (95%) were included in the analysis. The injury prevention program was The11, which includes 10 structured exercises developed by the FIFA Medical and Research Centre. The exercises, led by trained coaches, were designed to improve the stability, strength, co-ordination, and flexibility of the trunk, hip, and leg muscles and were performed 2 or 3 times per week as warm-up sessions. Compliance with the exercises was monitored randomly by the researchers. The control teams continued their usual warm-up routines. During the season, individual participants' exposure to training sessions or matches (in minutes) was reported weekly by the coaches. All participants completed questionnaires that included playing and injury history and current occupation and hours worked. Employment (vs studying) was nonsignificantly more common in the control group than the intervention group (68% vs 56%). Costs included those of the intervention, direct healthcare costs of injury, and indirect costs such as hours of work lost, which were recorded on a recovery form. Injuries occurring during the competition season were recorded weekly by the paramedical staff of the team. An injury was defined as a physical complaint sustained by a participant that resulted from a soccer training session or soccer match, whether or not there was lost time from soccer or need for medical attention. Full recovery was defined as participation throughout a training or match session. The players' injury rates were almost identical in the intervention and control groups (0.93 vs 0.94, representing 60.5% and 59.7% of players). The mean cost of The11, per player, was &OV0556;14 for the intervention group and &OV0556;0 for the control group. Direct healthcare costs per player were not significantly lower in the intervention group (difference, &OV0556;-44; 95% confidence interval [CI], -17 to 111). Indirect costs were lower in the intervention group (difference, &OV0556;-172; 95% CI, -352 to -28). The total cost per player was also lower in The11 group (difference, &OV0556;-201; 95% CI, -426 to -15). Direct health care costs per injured player were not significantly lower in the intervention group (difference, &OV0556;-76; 95% CI, -285 to 18). Indirect costs were lower in The11 group (difference, &OV0556;-288; 95% CI, -589 to -49). The total per injured player was, therefore, lower in The11 group (difference, &OV0556;-350; 95% CI, -733 to -51). The injury prevention strategy, The11, did not lower the rate of injuries in adult male soccer players, but the costs per player and per injured player were lower in the intervention group.

A cluster randomized trial of a multi-level intervention, delivered by service staff, to increase physical activity of children attending center-based childcare

ObjectiveTo evaluate the impact of a multi-level intervention on the physical activity levels of 3–5year old children attending center-based childcare services. MethodThe trial was conducted in New South Wales Australia in 2010 in 20 centers with 459 children. The intervention, included: fundamental movement skill sessions; structured activities; staff role modelling; limiting small screen recreation and sedentary time; and anactivity promoting physical environment. Control services continued with usual routines. Physical activity during care was assessed using pedometers at baseline and at six months after baseline. Intervention implementation was assessed via observation of staff physical activity practices and audits of service environment and policy. ResultsMean step counts at baseline and follow-up were 17.20 (CI 15.94–18.46) and 16.12 (CI 14.86–17.30) in the intervention group and 13.78 (CI 12.76–14.80) and 13.87 (CI 12.57–15.17) in the control group (p=0.12). Intervention services showed significantly greater increases in the total minutes that teachers led structured activities, relative to control group services (p=0.02). ConclusionThe intervention showed no significant effect on child step counts per minute despite increasing time that staff delivered structured activity which is likely to be attributable to difficulties experienced by service staff in delivering a number of intervention components.

Family caregivers’ perspectives on dementia-related dressing difficulties at home: The preservation of self model

Alzheimer's caregiving literature acknowledges dressing as a major daily stressor but research on this topic is negligible. A qualitative grounded theory approach was used to explore Alzheimer's family caregivers' perspectives about issues that arise when their family members lose the ability to dress independently. Three focus groups and seven individual interviews were conducted and audio recorded with 25 information rich caregivers. Constant comparative analyses and coding of the transcripts identified six major themes leading to a 'Preservation of Self Model: Care Recipient to Care Giver' that portrays the caregiving trajectory. Initially, caregivers tried to protect the self dignity of the family member by maintaining usual routines and absorbing blame for difficulties. Dressing 'battles' occurred and caregivers learned management through trial and error. Crossing adult-child-gender role boundaries escalated discomfort. When facing unrelenting demands, concern shifted to preservation of the caregivers' health and self. Results suggest that caregivers would benefit from more pro-active dressing counseling to shorten the trial and error periods, dressing aids more relevant to dementia and more knowledgeable helpers. The preservation model can facilitate understanding of the caregiving trajectory and guide intervention support.

Major adverse events, six months after endovascular revascularization for critical limb ischemia in diabetic patients.

This prospective study aimed to evaluate the detailed outcomes of diabetic patients with critical limb ischemia, six months after percutaneous transluminal angioplasty and appropriate multidisciplinary wound care. Totally, 45 consecutive patients (50 limbs) were enrolled and then divided into two groups according to the healing of ulcers. The endpoints were ulcer healing and major adverse events including amputation, mortality, and cardiac or cerebral morbidities, during a six- month follow-up period. During six months follow-up, major amputation was performed for four of 50 limbs (8.0%). A total of nine (20%) patients died and the leading cause was cardiac death (13.3 %). Also, stroke and non-fatal myocardial infarction occurred in three (6.7 %) and one (2.2 %) of the patients, respectively. Among the 29 (59.2 %) healed wounds, 22 (44.9 %) were completely closed. The patients with nonhealing wounds had a higher rate of dialysis (40% vs. 0 %, P-value < 0.001) and more ulcers with stage of D3 according to the Texas Wound Classification (60% vs. 31 %, P-value = 0.016). Other demographic, clinical, ulcer characteristics and procedural characteristics such as number and level of the treated lesions did not differ significantly between the two groups. Based on our findings, it seems that along with current usual therapeutic routines which focus on wound healing and limb salvage, more attention should be paid to simultaneous diagnostic assessments and treatment of cardiovascular disease in this group of patients during short-term follow- up.

Patterns of Family Management of Childhood Chronic Conditions and Their Relationship to Child and Family Functioning

Understanding patterns of family response to childhood chronic conditions provides a more comprehensive understanding of their influence on family and child functioning. In this paper, we report the results of a cluster analysis based on the six scales comprising the Family Management Measure (FaMM) and the resulting typology of family management. The sample of 575 parents (414 families) of children with diverse chronic conditions fell into four patterns of response (Family Focused, Somewhat Family Focused, Somewhat Condition Focused, Condition Focused) that differed in the extent family life was focused on usual family routines or the demands of condition management. Most (57%) families were in either the Family Focused or Somewhat Family Focused pattern. Patterns of family management were related significantly to family and child functioning, with families in the Family Focused and Somewhat Family Focused patterns demonstrating significantly better family and child functioning than families in the other two patterns.

Frames, Framing, and Designed Conversational Processes

In this article, we use the anthropologist Gregory Bateson’s conceptualization of framing and his theory of interpersonal communication process to explore how relational realities develop in designed conversational processes. In recent years, there has been a blossoming of interest in large group methods as a way of achieving whole-system change. Many of these techniques seek to construct alternative spaces or dialogic “containers” in which the usual routines and authority structures are suspended; as such, they require that practitioners give particular attention to issues of framing. By analyzing examples drawn from two World Café events, we attempt to clarify theoretical principles underlying dialogic approaches to organizational change. We also consider the practical implications inherent in Bateson’s ideas, particularly the possibilities they offer for enhancing the facilitator’s awareness of the context in which he or she is a participating member.

Does Warm-Up Have a Beneficial Effect on 100-m Freestyle?

To investigate the effect of warm-up on 100-m swimming performance. Twenty competitive swimmers (with a training frequency of 8.0 ± 1.0 sessions/wk) performed 2 maximal 100-m freestyle trials on separate days, with and without prior warm-up, in a counterbalanced and randomized design. The warm-up distance totaled 1000 m and replicated the swimmers' usual precompetition warm-up strategy. Performance (time), physiological (capillary blood lactate concentrations), psychophysiological (perceived exertion), and biomechanical variables (distance per stroke, stroke frequency, and stroke index) were assessed on both trials. Performance in the 100-m was fastest in the warm-up condition (67.15 ± 5.60 vs 68.10 ± 5.14 s; P = .01), although 3 swimmers swam faster without warm-up. Critical to this was the 1st 50-m lap (32.10 ± 2.59 vs 32.78 ± 2.33 s; P < .01), where the swimmers presented higher distance per stroke (2.06 ± 0.19 vs. 1.98 ± 0.16 m; P = .04) and swimming efficiency compared with the no-warm-up condition (stroke index 3.46 ± 0.53 vs 3.14 ± 0.44 m2 · c1 · s1; P < .01). Notwithstanding this better stroke-kinematic pattern, blood lactate concentrations and perceived exertion were similar between trials. These results suggest that swimmers' usual warm-up routines lead to faster 100-m freestyle swimming performance, a factor that appears to be related to better swimming efficiency in the 1st lap of the race. This study highlights the importance of performing swimming drills (for higher distance per stroke) before a maximal 100-m freestyle effort in similar groups of swimmers.

The self-reported experiences of siblings who have a brother or sister diagnosed with childhood cancer: a systematic review protocol of qualitative evidence

The self-reported experiences of siblings who have a brother or sister diagnosed with childhood cancer: a systematic review protocol of qualitative evidence