Donna Thorpe

The effect of virtual reality gaming on dynamic balance in older adults

BACKGROUND physical therapy interventions that increase functional strength and balance have been shown to reduce falls in older adults. AIM this study compared a virtual reality group (VRG) and a control group (CG). DESIGN randomised controlled 6-week intervention with pre- and post-test evaluations. SETTING outpatient geriatric orthopaedic and balance physical therapy clinic. POPULATION forty participants were randomised into two groups. METHOD the VRG received three different Nintendo® Wii FIT balance interventions three times per week for 6 weeks and the CG received no intervention. RESULTS compared with the CG, post-intervention measurements showed significant improvements for the VRG in the 8-foot Up & Go test [median decrease of 1.0 versus -0.2 s, (P=0.038) and the Activities-specific Balance Confidence Scale (6.9 versus 1.3%) (P=0.038)]. CONCLUSION virtual reality gaming provides clinicians with a useful tool for improving dynamic balance and balance confidence in older adults.

Effects of meat consumption and vegetarian diet on risk of wrist fracture over 25 years in a cohort of peri- and postmenopausal women.

BACKGROUND Evidence suggesting that a diet high in fruits and vegetables may be beneficial to bone health has sparked interest in the potential benefit of a vegetarian diet. However, other studies have raised a question regarding the adequacy of protein in such a diet. OBJECTIVE The aim of the present study was to take a whole foods approach in examining the effects of foods high in protein on the risk of wrist fracture (WF) in a cohort with a significant proportion consuming a meat-free diet. DESIGN A cohort study of women who completed two lifestyle surveys 25 years apart. SUBJECTS One thousand eight hundred and sixty-five peri- and postmenopausal women at the time of the first survey. RESULTS There was a significant interaction between meat consumption and foods high in vegetable protein. Among vegetarians, those who consumed the least vegetable protein intake were at highest risk for fracture. However, increasing levels of plant-based high-protein foods decreased WF risk, with a 68% reduction in risk (hazard ratio (HR) = 0.32, 95% confidence interval (CI) 0.13-0.79) in the highest intake group. Among those with lowest vegetable protein consumption, increasing meat intake decreased the risk of WF, with the highest consumption decreasing risk by 80% (HR = 0.20, 95% CI 0.06-0.66). CONCLUSIONS The finding that higher consumption frequencies of foods rich in protein were associated with reduced WF supports the importance of adequate protein for bone health. The similarity in risk reduction by vegetable protein foods compared with meat intake suggests that adequate protein intake is attainable in a vegetarian diet.

Frequency in usage of FCAT-approved anatomical terms by North American anatomists.

It has been 10 years since the Federative Committee on Anatomical Terminology (FCAT) published Terminologia Anatomica (TA), the current authority on anatomical nomenclature. There exists a perceived lack of unity among anatomists to adopt many FCAT recommended anatomical terms in TA. An e‐mail survey was sent to members of the American Association of Anatomists (AAA) to determine the frequency of FCAT term usage by North American anatomists. The survey consisted of 29 questions, including 25 different sets of synonymic names for selected gross anatomical structures or related terms. Overall results indicate that the FCAT preferred term had the highest frequency of usage in only 44.0% of the survey questions. As frequency of use of FCAT terms decreased, the corresponding frequency of use of non‐FCAT terms increased. Some questions showed almost complete compliance with the FCAT preferred terms (highest = 98.4% usage) to almost complete disregard for the FCAT terms (lowest = 0.8% usage). A slight association (P = 0.06) may exist between FCAT familiarity and concern for usage of synonymic terms. The more familiar anatomists were with the FCAT, the more concerned they were with anatomic synonyms. Anat Sci Ed 2:94‐106, 2009.

A multicenter study of the incidence and factors associated with redo Nissen fundoplication in children

AIM The objective of this study was to identify the incidence and factors associated with redo Nissen fundoplication in children. METHODS After Institutional Review Board approval (5100277), data for children under 18 years of age from two childrens hospitals with fundoplication performed between January 1994 and December 2010 were reviewed. Children with one fundoplication were compared to those with redos to identify factors associated with redo. Variables were compared using t-tests for continuous and chi-square tests for categorical variables. Logistic regression evaluated for independence. RESULTS There were 823 patients and 54.7% were male. A redo fundoplication was required in 100 (12.2% of cohort); 82 had 1 redo, 14 had 2 redos, and 4 had 3 redos. Follow-up ranged from 0.01 to 16.9 years (median: 2.9 years). Factors associated with redo were: younger age at first fundoplication, (p=0.002), hiatal dissection (p<0.001), and male gender (p=0.008). Independent predictors of redo were: hiatal dissection at first fundoplication, OR: 8.45 (95% CI: 2.45-29.11), retching, OR: 3.59 (95% CI: 1.56-8.25) and younger age at first fundoplication, OR: 0.98 (95% CI: 0.97-0.98). CONCLUSION The incidence of redo fundoplication in children is 12.2%. The risk of redo is significantly increased if patients are younger, have retching, and if the esophageal hiatus is dissected at the first fundoplication.

The effect of vigorous physical activity and risk of wrist fracture over 25 years in a low-risk survivor cohort

Recent studies have suggested that a high level of recent physical activity increases the risk of a wrist fracture in postmenopausal women. The relationship of more distant past physical activity to wrist fracture is less clear, and most studies have relied on recall of physical activity much earlier in life. The aim of this study was to assess the risk of wrist fracture in a subset of women who had completed a recent questionnaire and also had participated in a cohort study 25 years earlier, 1865 women who were perimenopausal and postmenopausal in 1976 and had completed the 1976 and 2002 Adventist Health Study lifestyle questionnaires. Data on risk factors including physical activity were collected from the 1976 survey. Subjects reported wrist fractures occurring since baseline, and the approximate time of fracture, in the 2002 questionnaire. Incidence of wrist fracture was 3.7/1000 person-years of follow up. There was a dose–response inverse relationship between level of physical activity and wrist fracture with a 37% reduction of risk for the highest level of physical activity with respect to the lowest level (HR, 0.63; 95% CI, 0.45, 0.89). The effect of physical activity changed little in the final multivariable model (HR, 0.61; 95% CI, 0.43, 0.87). In this cohort of women with a relatively low incidence of wrist fracture, higher levels of physical activity at baseline were protective against risk of fracture during 25 years of follow-up.

Legumes and meat analogues consumption are associated with hip fracture risk independently of meat intake among Caucasian men and women: the Adventist Health Study-2

OBJECTIVE In contrast to non-vegetarians, vegetarians consume more legumes and meat analogues as sources of protein to substitute for meat intake. The present study aimed to assess the association between foods with high protein content (legumes, meat, meat analogues) by dietary pattern (vegetarians, non-vegetarians) and hip fracture incidence, adjusted for selected lifestyle factors. DESIGN A prospective cohort of Adventist Health Study-2 (AHS-2) enrollees who completed a comprehensive lifestyle and dietary questionnaire between 2002 and 2007. SETTING Every two years after enrolment, a short questionnaire on hospitalizations and selected disease outcomes including hip fractures was sent to these members. SUBJECTS Respondents (n 33,208) to a baseline and a follow-up questionnaire. RESULTS In a multivariable model, legumes intake of once daily or more reduced the risk of hip fracture by 64% (hazard ratio = 0·36, 95% CI 0·21, 0·61) compared with those with legumes intake of less than once weekly. Similarly, meat intake of four or more times weekly was associated with a 40% reduced risk of hip fracture (hazard ratio = 0·60, 95% CI 0·41, 0·87) compared with those whose meat intake was less than once weekly. Furthermore, consumption of meat analogues once daily or more was associated with a 49 % reduced risk of hip fracture (hazard ratio = 0·51, 95% CI 0·27, 0·98) compared with an intake of less than once weekly. CONCLUSIONS Hip fracture incidence was inversely associated with legumes intake and, to a lesser extent, meat intake, after accounting for other food groups and important covariates. Similarly, a high intake of meat analogues was associated with a significantly reduced risk of hip fracture.

Contrast in Usage of FCAT-Approved Anatomical Terminology between Members of Two Anatomy Associations in North America.

Almost 12 years since the publishing of Terminologia Anatomica (TA) by the Federative Committee on Anatomical Terminology (FCAT), there has yet to be a unified adoption of FCAT‐recommended anatomical terms by North American anatomists. A survey was sent to members of the Human Anatomy & Physiology Society (HAPS) to compare the frequency of FCAT term usage with a previous study involving the American Association of Anatomists (AAA). The HAPS differed from AAA in being composed mostly of biologists (56.5%) who teach anatomy with only 18.3% of respondents having terminal degrees in anatomy. The survey included the same 25 sets of synonymic names for selected gross anatomical structures or related terms used for the AAA survey. Overall results indicate that the FCAT preferred term had the highest frequency of usage in only 40.0% of the survey questions, demonstrating 4% lower compliance than AAA respondents. Compliance with FCAT preferred terms ranged from 92.2% to 1.7% usage. When compared with AAA anatomists, there were reversals in predominant usage between FCAT and non‐FCAT terms for six sets of anatomical structures: HAPS respondents predominantly used non‐FCAT terms for adrenal gland (88.7%), antecubital fossa (57.4%), patellar tendon (65.2%), ligamentum capitis femoris (36.5%), while preferring the FCAT anterior circumflex humeral artery (45.2%) and anterior/posterior preferred over ventral/dorsal (41.7%). Almost 54% of HAPS anatomists were not familiar with the FCAT, nearly 21% higher than the AAA. Anat Sci Educ 3:25–32, 2010.

Pulmonary hypertension predicts mortality in infants with omphalocele

OBJECTIVE The objective of this study was to identify predictors of mortality in infants with omphalocele. METHODS Medical records of infants with omphalocele born between January 1992 and June 2012, with follow-up toDecember 2012, were retrospectively reviewed. Survivors and non-survivors were compared. Evidence for pulmonary hypertension was sought between the second and seventh day after birth. All included infants had increased right ventricular pressures (RVP >40 mmhg) on echocardiogram on the second day of life with increased oxygen requirements, therefore, the finding of increased pressure was not considered a result of the transitional circulation. Logistic regression was used to evaluate the importance and independence of various factors. RESULTS Of 51 infants whose records were reviewed, 13 died (25%) and 38 survived (75%). The median time to death was 34 days (range: 4 -408 days). The median follow-up time for those who died was 1.5 years (range: 0.01-15 years) and for survivors was 2.6 years (range: 0.08-15 years). Logistic regression revealed that respiratory insufficiency at birth (OR: 14.8; 95% CI: 2.5-85.0) and pulmonary hypertension (OR: 6.4; 95% CI: 1.1-39.0) were independently associated with mortality. CONCLUSION Respiratory insufficiency after birth and pulmonary hypertension are independent predictors of mortality in infants with omphalocele.

Factors Associated with Mortality after Nissen Fundoplication in Children

PURPOSE The purpose of this article was to identify factors associated with mortality after Nissen fundoplication in children. METHODS After Institutional Review Board approval, children younger than 18 years, from two childrens hospitals, with Nissen fundoplication performed between January 1994 and December 2010, were retrospectively reviewed. Inclusion required complete data and follow-up to October 2011. Survivors and nonsurvivors were compared, using t-tests for continuous and chi-square tests for categorical variables, to identify factors associated with mortality. Patient factors present before the first fundoplication were analyzed. Surgical factors were surgical complications, gastrostomy placement, operative technique, and redos. Logistic regression evaluated for independence of variables. RESULTS A total of 823 children were identified, 412 were included and 63 died (15.3%). The median follow-up time for the cohort was 3.7 years (mean, 4.5 ± 3.2 years). For nonsurvivors, the median time to death after fundoplication was 6.0 months (mean, 13.2 ± 8.0 months). Significant factors after univariate analysis were surgical complications (p = 0.001), female gender (p = 0.001), neurological impairment (p = 0.010), and fundoplication performed before the age of 18 months (p = 0.035). Independent predictors were surgical complications, odds ratio (OR), 3.30 (95% confidence interval [CI], 1.31-8.29), neurological impairment, OR, 2.58 (95% CI, 1.38-4.83), fundoplication before the age of 18 months, OR, 2.46 (95% CI, 1.23-4.94), and female gender, OR, 2.25 (95% CI, 1.26-4.00). CONCLUSION After Nissen fundoplication in children, surgical complications, neurological impairment, fundoplication performed before the age of 18 months, and female gender are associated with mortality. The median time to death for nonsurvivors was 6 months.

On “Muscle architecture predicts maximum strength…” Moreau NG, Simpson KN, Teefey SA, Damiano DL. Phys Ther. 2010;90:1619–1630.

Regarding Figure 2 in this article,1 I would like to note the apparent conflict between what the scatterplots in Figure 2 show and what the …