Accounting for access to healthcare: Analyzing interview talk of hard-to-reach regions' residents and mobile medical units' professionals in Greece.

This study explores how social actors account for psychosocial barriers to healthcare access. Interviews with 17 residents in remote regions of Greece and 12 professionals employed by Mobile Medical Units were analyzed using the tools and concepts of critical discursive social psychology. Analysis indicated that, oriented to different accountability concerns, residents tended to attribute reluctance to seek medical help to structural barriers, while professionals leaned toward psychological and individual-centered explanations. Findings also highlighted the construction of living in hard-to-reach areas as both a "cure" and a "curse" for residents' capacity to achieve a healthy status, representing remote communities as both enhancing solidarity and social support and as promoting stigmatization against illness and social isolation. Building upon prior discourse-oriented approaches in health psychology, the study seeks to exemplify how a discursive and rhetorically oriented research agenda can be employed to explore how health inequalities are enacted and (re)produced in social interactions.

Post-Arthroplasty Spatiotemporal Gait Parameters in Patients with Hip Osteoarthritis or Developmental Dysplasia of the Hip: An Observational Study.

Total hip arthroplasty (THA) is a preferred treatment for primary osteoarthritis (OA) or secondary degenerative arthropathy due to developmental hip dysplasia (DDH). Gait analysis is considered a gold standard for evaluating post-arthroplasty walking patterns. This study compared post-THA spatiotemporal gait parameters (SGPs) between OA and DDH patients and explored correlations with demographic and clinical variables. Thirty patients (15 per group) were recorded during gait and their SGPs were analyzed. Functionality was evaluated with the Oxford Hip Score (OHS). The OA patients were significantly older than DDH patients (p < 0.005). Significant and moderate to strong were the correlations between SGPs, age, and four items of the OHS concerning hip pain and activities of daily life (0.31 < Pearson's r < 0.51 all p < 0.05). Following THA, both groups exhibited similar levels of the examined gait parameters. Post-arthroplasty SGPs and OHS correlations indicate limitations in certain activities. Given the absence of pre-operative data and the correlation between age and SGPs and OHS, ANCOVA testing revealed that age adjusts OHS and SGP values, while pre-operative diagnosis has no main effect. These findings indicate that hip OA or DDH do not affect postoperative SGPs and patients' functionality. Future studies should examine both kinematic and kinetic data to better evaluate the post-THA gait patterns of OA and DDH patients.

Scapholunate Advanced Collapse (SLAC) and Scaphoid Nonunion Advanced Collapse (SNAC): A Review of Treatment Options for Stage II.

Scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) represent clinical entities identified by a pattern of predictable degenerative changes. They are the most common causes of wrist arthritis. Both entities can remain asymptomatic for many years and may go undiagnosed. Diagnosis is usually confirmed through clinical examination, which reveals progressive wrist pain and instability. Radiographically, degenerative changes in the radiocarpal and midcarpal joints are present, as well as nonunion of the scaphoid fracture in SNAC. The management differs according to the stage. Particularly in this review article, we reviewed the treatment options for stage II SLAC and SNAC wrist. In addition to the well-described surgical techniques such as proximal row carpectomy and four-corner fusion, alternatives such as capitolunate arthrodesis, three-corner fusion, and soft tissue procedures like capsulodesis and tenodesis are available. Proximal row carpectomy and partial arthrodeses yield comparable results. Soft tissue procedures are viable alternatives and are preferred in younger patients to avoid early salvage operations.

Excessive Knee Internal Rotation during Grand Plié in Classical Ballet Female Dancers.

Classical ballet dancers are exposed daily to physically demanding movements. Among these, the Grand Plié stands out for its biomechanical complexity, particularly the stress applied to the knee joint. This study investigates the knee kinematics of healthy professional classical ballet dancers performing the Grand Plié. Twenty dancers were evaluated with a motion analysis system using a marker-based protocol. Before measurements, the self-reported Global Knee Functional Assessment Scale was delivered for the knees' functional ability, and the passive range of knee motion was also assessed. The average score on the Global Knee Functional Assessment Scale was 94.65 ± 5.92. During a complete circle of the Grand Plié movement, executed from the upright position, the average maximum internal rotation of the knee joint was 30.28° ± 6.16°, with a simultaneous knee flexion of 134.98° ± 4.62°. This internal rotation observed during knee flexion exceeds the typical range of motion for the joint, suggesting a potential risk for knee injuries, such as meniscal tears. The findings provide an opportunity for future kinematic analysis research, focusing on the movement of the Grand Plié and other common ballet maneuvers. These data have the potential to yield valuable information about the knee kinematics concerning meniscus damage.

Rotational Thromboelastometry as a Diagnostic Tool for Persistent Infection in Two-Stage Exchange Arthroplasty.

Background/Objectives: There is a lack of reliable biomarkers for diagnosis of infection eradication prior to second-stage reimplantation in two-stage exchange arthroplasty for periprosthetic joint infections (PJIs). The aim of this study was to assess the diagnostic accuracy of rotational thromboelastometry (ROTEM) for persistent infection in two-stage exchange arthroplasties. Methods: A pilot, retrospective analysis was performed including 70 patients who underwent a two-stage exchange arthroplasty for PJI. They were categorized as patients without (n = 64) or patients with persistent infection (n = 6) prior to reimplantation. Definition of persistent infection prior to reimplantation was based on the 2018 ICM criteria. Conventional coagulation biomarkers and ROTEM parameters were compared between groups. Results: Higher FIBTEM MCF values were associated with persistent infection (odds ratio [OR], 1.30, 95% confidence interval [CI], 1.04-1.63; p = 0.020), and FIBTEM MCF had the highest diagnostic accuracy for persistent infection prior to second-stage reimplantation (AUC, 0.907; 95% CI, 0.812-1.000). A cut-off value ≥ 18 mm for FIBTEM MCF was found to have 100.0% sensitivity and 73.4% specificity for diagnosing persistent infection prior to second-stage reimplantation. Moreover, the diagnostic accuracy of FIBTEM MCF was higher than that of fibrinogen levels (p = 0.036) and D-dimer (p = 0.006). Conclusions: Our findings indicate that ROTEM parameters have the potential to identify persistent infections before reimplantation in two-stage exchange arthroplasties for PJI. Such coagulation biomarkers could provide guidance regarding the optimal timing for reimplantation. Further studies in larger populations are warranted to validate the diagnostic accuracy of ROTEM parameters for persistent PJI.

Unraveling the "golden ratio": a pilot study investigating acute-to-chronic workload ratio in breast cancer patients undergoing active treatment.

Training load monitoring is a common practice in sports medicine for supporting athletes' health and performance. Despite progress in exercise oncology research for breast cancer patients, training load monitoring is underutilized. This study retrospectively investigated the relationship between maintained training load within a defined range and physical and health outcomes of ten breast cancer patients during active anticancer treatment who underwent a 12-week exercise program. Intervention consisted of endurance and resistance training, three times a week, with each session lasting 30-45 min. Assessments were conducted at baseline, 6 and 12 weeks after enrollment, evaluating physical function (6-min walk test-6MWT, and sit-to-stand), muscle strength, body composition, sleep quality (Pittsburgh Sleep Quality Index-Pittsburgh Sleep Quality Index), quality of life (EORTC-QLQ-C30), heart rate variability and physical activity levels (International Physical Activity Questionnaire-International Physical Activity Questionnaire). The Physiological Cost Index/Energy Expenditure Index (PCI/EEI) was estimated using the 6MWT and Heart rate. Training load monitoring was performed by session rating of perceived exertion (sRPE, relative intensity multiplying with session duration). Acute-to-Chronic Workload Ratio (ACWR) (7:28, rolling average) was calculated accordingly. Analyses were performed within-subjects across time points and between-subjects, comparing those who maintained from weeks 6-12 an ACWR of 0.8-1.3 with those who did not. Adherence rates were similar between groups. Physical function improved in the total sample with large effect sizes (Δ6MWT = 56.5 m [95%CI: 6-100 m], effect size [w] = 0.52, p = 0.006; ΔSit-to-Stand = 1.5 [95%CI: 1-5], effect size [w] = 0.681, p < 0.001), demonstrating greater changes in patients with higher ACWR. Sleep quality improvements were higher in the appropriate ACWR group (p = 0.016). A positive correlation was demonstrated between global health status and 6MWT change from baseline to 12 weeks (ρ = 0.689, p = 0.04). Despite a small sample size, patients maintaining sufficient relative training load presented greater physical fitness and sleep quality improvements. Thus, training load monitoring may enhance exercise program benefits in breast cancer patients under active treatment.