Postpartum excretion of internal teat sealant after selective dry cow treatment of dairy cows.

To comply with antibiotic restriction policies in the European Union, internal teat sealants (TS) are increasingly used at drying off (DO) in selective dry cow treatment protocols to maintain udder health. Post-calving TS residue attachment to milking equipment and associated cleaning difficulties is a reason for some farmers to stay away from blanket TS use. Our objective was therefore to improve insight in TS excretion visibility and to compare quantity, pattern, and presence versus absence of TS excretion post-calving between the typical 2 cow categories at DO: High (H) and Low (L) SCC cows, treated with antibiotic (AB) plus TS (H-ABTS) or TS only (L-TS), respectively. In herds in the Netherlands (n = 3), and Germany (n = 4), cows were enrolled at DO, and categorized as H-ABTS (n = 93), or L-TS (n = 99). Post-calving, quarter level TS visibility, quantities, patterns, and percentage of TS infused and excreted post-calving were recorded from 50 mL of pre-milk of every quarter at each of the first 15 or 16 milkings. Udder quarter health status was determined by bacteriological culture and somatic cell counting of quarter milk samples taken at DO and at d 3 post-calving and by clinical mastitis incidence from DO until 30 DIM. Univariable and multivariable models were created to explore associations of TS excretion presence versus absence at the first 3 milkings. Irrespective of SCC category, both laboratory personnel, and farmers saw TS residues at the first milking in an equal 72% of quarters. Compared with laboratory as the gold standard, farmer sensitivity to spot TS in pre-milk was 74.5% at the first milking, decreasing to a maximum of 8.3% at the last 3 milking's. At the first milking, TS excretion quantities showed a bimodal distribution pattern and the mean percentage of TS infused (3.83 g) that was excreted in pre-milk at the first milking, was higher in the L-TS (45.5%) compared with the H-ABTS cow category (32%). At the second and third milking, mean adjusted TS percentage excreted was higher in the H-ABTS (8.5% and 1.8%, respectively) compared with the L-TS category (4.6% and 0.4% respectively). The multivariable model of the first 3 milkings showed parity at both the first and second milking, and study group at both the second and third milking, was significantly associated to TS presence. The univariable model showed no association between TS presence at the first milking and udder health. In conclusion, in pre-milk of the first milking, TS residue excretion was bimodal, higher in L-TS cows, more likely present in multiparous cows, and not associated with udder health. At the second and third milking, excretion was higher in H-ABTS cows and TS presence was only more likely in multiparous cows at the second milking.

Health-related predictors of falls and fractures in women over 40.

SUMMARY: A longitudinal study of women aged 40-80 predicted single falls from a previous fall history and deficient vestibular integration. Multiple falls were predicted by a fall history, low activity levels, more medical conditions and deficient vestibular integration. Low bone mineral density, more medical conditions and fall history predicted fractures. INTRODUCTION: The purpose of this study was to identify potentially modifiable health-related factors predicting falls and fractures, focussing on women over 40. METHODS: Four hundred and forty-nine women aged 40-80 years from the Longitudinal Assessment of Women study participated. Demographic information (age, BMI, medications, medical conditions and activity level), balance assessments (including timed up & go and modified clinical test for sensory interaction of balance) and measurements of bone mineral density and body composition were collected in 2001; fall and fracture data were gathered in 2003, 2005, 2007, 2008 and 2010 to determine incidence. RESULTS: Multinomial logistic regression revealed that single falls could be predicted by a history of previous falls (OR 3.08) and being unsteady in bipedal stance on foam with eyes closed (OR 1.99). Multiple falls were predicted by a history of falls at baseline (OR 4.69), low levels of activity (OR 2.17), greater number of medical conditions (OR 1.12) and being unsteady in bipedal stance on foam with eyes closed (OR 4.21). Low bone mineral density (OR 3.13), greater number of medical conditions (OR 1.32) and a history of falls (OR 3.04) were predictive of fractures. CONCLUSIONS: Poor health, decreased balance, and inactivity are predictive of falls and low bone mineral density, low activity level and poor health predictive fractures. Results suggest failing the balance test bipedal stance on foam with eyes closed in the presence of low activity and poor health is a valid quick screening tool for detecting potential fallers for referral for in-depth balance assessment and intervention.

Is the Wii Fit a new-generation tool for improving balance, health and well-being? A pilot study.

BACKGROUND: The Nintendo Wii Fit is a new product that is purported to improve balance, strength, flexibility, fitness and general well-being. Currently, there are no controlled trials published to support such claims. AIM: The aim of this research was to determine the feasibility of Wii Fit in improving balance, strength, flexibility and fitness for healthy women aged between 30 and 60 years. METHOD: Ten women aged 30-58 years were recruited to the study. Intervention involved a 30-min session, twice weekly for 10 weeks. The manufacturer's pre-programmed Wii Fit regime determined for age and physical ability was followed. All women were assessed before and after the 10 weeks' intervention. Demographic information collected included age, weight, and self-reported information related to habitual physical activity, regular medication, hormone replacement therapy and well-being. Balance measures included the modified Clinical Test for Sensory Integration of Balance, reaction time and unilateral stance with velocity of sway recorded. Clinical measures of balance and mobility included the Step Test, the timed Up & Go test (TUG) and the TUG(cognitive). Somatosensory testing included touch, vibration and knee-joint re-positioning ability; ankle flexibility and the muscle strengths of quadriceps, hip abductors and adductors were also measured. Cardiovascular fitness was measured using a 6-min walk test. RESULTS: Balance (unilateral stance, eyes open (p < 0.05) and lower limb muscle strength (p < 0.05) showed significant improvement but changes in touch, vibration, proprioception, cardiovascular endurance, mobility, weight change, activity level and well-being were not significant. CONCLUSION: Activity fostered by Wii Fit showed an immediate effect on balance and strength that needs confirmation by statistically powered studies.

Controlling balance decline across the menopause using a balance-strategy training program: a randomized, controlled trial.

OBJECTIVE: To evaluate effectiveness and long-term benefits of a specific balance-strategy training program in sedentary women aged 40-60 years and whether participation leads to adoption of a more active lifestyle. METHOD: Fifty healthy women were admitted to the randomized, controlled trial on the basis of their activity level. Subjects were randomly assigned to an intervention or control group, with the former attending twice-weekly for 12 weeks. Assessments made pre- and post-intervention and at 9 months follow-up included: personal demographics, hormone replacement therapy medication, activity level, balance measures, somatosensory function, ankle flexibility and leg muscle strength. RESULTS: The intervention group showed improvement in balance measures (p < 0.030), right ankle tactile sensation (p = 0.027), ankle flexibility (p < 0.000) and muscle strength (p < 0.018) of quadriceps, hip abductors and external rotators, compared with the control group immediately after intervention. At 9 months follow-up, the intervention effect was maintained for all measures and a latent improvement of somatosensory measures (tactile acuity of foot (p < 0.05), joint repositioning sense (p < 0.010), and vibration threshold of the left knee (p < 0.016)) revealed. The intervention group also adopted a more active lifestyle (p = 0.000). CONCLUSION: These results provide evidence that this physiotherapist-designed program preserves/reverses the balance decline associated with age and leads to adoption of a more active lifestyle.

Falling is not just for older women: support for pre-emptive prevention intervention before 60.

OBJECTIVE: This study aimed to report falls and identify factors that might predict a fall in women aged between 40 and 80 years and thus provide evidence of earlier falls and need for morbidity preventive intervention. DESIGN AND PARTICIPANTS: A prospective cohort study design over 5 years. Personal demographic data of age, co-morbidities, number of prescribed medications, falls, activity level and living situation were obtained at face-to-face interview. Height, weight, body mass index and postural stability were measured in participating women living independently in the community. RESULTS: Women were categorized into age decade cohorts, with 463 remaining at the year 5 assessment. At baseline, 8% of the women in their forties, 14% in their fifties, 25% in their sixties and 40% in their seventies had fallen in the previous 12 months. Over the 5-year study period, 21% of women in their forties and fifties, 31% of women in their sixties and 47% in their seventies had fallen. Multiple fallers mostly comprised women in their sixties and seventies. Parametric modeling and the classification tree approach revealed age and number of co-morbidities to be most predictive of a fall. Women < 60 years old had an increased risk of a fall by 8% and women > 60 years an increased risk of a fall by 35% with every additional co-morbidity. Stability and other demographics were not predictive of falling. CONCLUSIONS: For women over 40 years old, the number of co-morbidities increased the risk of a fall. The falls risk escalated with additional co-morbidities if they were over 60 years. Preventive program participation to maintain good health beginning by the forties appears vital to prevent falls.

Transcutaneous electrical nerve stimulation and chronic intractable angina pectoris.

The treatment trial being reported investigated whether the frequency and severity of pain in 11 patients with chronic intractable angina pectoris were decreased by TENS applied adjacent to T1 and T5 spinous processes. Pulse and blood pressure were measured before, during and after each treatment. Results showed a significant decrease in frequency and severity of pain. Rate pressure product was calculated to try to identify the mode of action. The mean RPP before TENS application, compared with the mean RPP at 30 minutes and at 90 minutes, was significantly reduced. It was concluded from these results that TENS should be considered as an adjunct to medical management in those patients with angina pectoris not satisfactorily controlled by optimal medication.

Post stroke recovery of balanced sitting and ambulation ability.

The primary aim of this retrospective audit was to determine whether sitting balance ability at initial physiotherapy assessment post stroke could predict ambulation ability at discharge. Also considered were the side affected by the stroke, sensory loss, dysphasia, whether they affected outcome and whether ambulation ability determined social destination at discharge. Forty stroke patients were treated during the 12-month study period. All patients received early physiotherapy treatment in the acute then rehabilitation wards. The average length of hospital stay was 47.7 ± 28.2 [SD] days. All patients achieved independent sitting balance at discharge, with a significant improvement (p < 0.001) from initial assessment. Twenty-seven achieved independent ambulation by discharge. This was shown to have a significant (p < 0.001) relationship to early independent sitting balance but was not significantly related to side of stroke or sensory loss.

Wheelchair design for people with neuromuscular disability.

The observation that wheelchairs often failed to provide the mobility and support needed by patients with neuromuscular disability facilitated this study. Three groups of subjects with multiple sclerosis, spinal cord injury and muscular dystrophy were examined to determine their various disabilities and anthropometric measurement. These were then compared with wheelchair dimensions in an endeavour to determine whether the problem was wheelchair design or poor prescription. An evaluation of wheelchair use was also included. Results showed that several wheelchair dimensions including seat depth, arm rest height, backrest height and lack of contour support failed to match the sample population, indicating the need for greater care in selection of wheelchairs for patients with neuromuscular disabilities in addition to the need for design revision.

The Use of EMG Biofeedback in Quadriceps Strengthening Exercise for Rheumatoid Arthritis Patients: A Clinical Trial.

A clinical trial involving rheumatoid arthritis patients hospitalized due to an exacerbation of their disease, was initiated in order to determine whether EMG biofeedback when used in conjunction with isometric exercise enhanced quadriceps strengthening. The parameters of muscle bulk, strength and motor unit activity were measured before, during and after the trial to determine any improvements occurring. Results showed that in predominantly elderly patients there was no significant increase in quadriceps strengthening when EMG biofeed-back was used. Further, for subjects under 45 years of age, EMG biofeedback was not shown to effect significant improvement.

A study of repeated lateral pinch grip in myotonic dystrophy.

BACKGROUND AND PURPOSE: Subjects with myotonic dystrophy present with progressive muscle weakness, myotonia and fatigue. The aim of this study was to determine whether there was a difference in response to fatiguing exercise in myotonic dystrophy individuals compared to normal subjects. If no difference was found, a similar response to a physiotherapy exercise programme as seen in normal subjects might be expected. METHOD: Ten individuals with myotonic dystrophy were compared to eight normal subjects in their response to ten repetitions of maximal lateral pinch grip efforts each five seconds in duration and separated by a ten-second rest. The root mean square (RMS) values, initial median frequency (Fmed) and slope of the median frequencies were recorded by electromyography (EMG) for the first dorsal interosseus, flexor pollicis brevis, flexor digitorum profundus and extensor digitorum communis muscles in the forearm and hand. Simultaneously, the rate of grip development, rate of grip release and work done during each grip effort were recorded by dynamometer. The RMS values for all muscles from subjects with myotonic dystrophy increased over the ten repetitions. RESULTS: The initial Fmed for all myotonic dystrophy muscles was lower than for the normal subjects. The Fmed slopes for the first and last repetition showed no significant difference to the normal subjects. Rate of grip development was no different between groups over ten repetitions. Rate of grip release was slower and work done less for the individuals with myotonic dystrophy. CONCLUSION: Results suggest the main difference between muscles affected by myotonic dystrophy and normal ones was the smaller size of muscle fibres. The increase in rate of grip release that was found is supportive of the 'warm-up' phenomenon. This appears to indicate that muscles affected by myotonic dystrophy could benefit from standard physiotherapeutic exercise methods.

Linking stability to demographics, strength and sensory system function in women over 40 to support pre-emptive preventive intervention.

OBJECTIVE: To investigate differences in demographics, strength and sensory system function of 254 women aged 40-80 years categorized as stable, unsteady or unstable using simple balance tests. METHOD: Demographics (age, height, weight, medications, co-morbidities, falls history, activity level), measures of quadriceps, hip abductor and adductor strength, somatosensory, visual and vestibular function were recorded. Subjects were categorized as stable (completed all trials), unsteady (failed one/two trials) or unstable (failed all trials) after three 10-s trials of bilateral stance (foam surface, eyes closed (EC)) and one-leg stance (firm surface, eyes open (EO)), and the results were compared. RESULTS: Both balance tasks identified women in their fifties as unstable ( approximately 9%), with 60% of these women failing both tasks. More women were unsteady or unstable on foam EC (27%) than in one-leg stance EO (20%). Unsteady and unstable categories of women were older, reported more co-morbidities and medications and less activity than stable women. The women categorized as unstable in either test recorded weaker hip muscles, higher vibration thresholds, greater joint positioning error, reduced edge contrast sensitivity, low-contrast visual acuity and reduced dynamic visual acuity than the stable categories (p < 0.01). The two tests detected differences in characteristics of unstable women, with those failing one-leg stance EO being heavier, and those failing foam EC having weaker quadriceps. CONCLUSION: These data link instability in women from the fifties to multiple demographic and sensorimotor factors associated with increased risk of falls, thus supporting use of balance tests in primary-care settings to assist referral for diagnostic assessment and pre-emptive interventions.

Positive effects of exercise on falls and fracture risk in osteopenic women.

UNLABELLED: Exercise may affect osteopenic women at risk of falls and fractures. A workstation approach to exercise was evaluated in a randomised study of 98 women. The intervention group improved in measures of balance, strength and bone density. This study supports a preventative exercise approach that aims to reduce risk factors for fractures and falls, in women already at risk, through balance training and weight-bearing activity. INTRODUCTION: The objective of this study was to determine the effects of a workstation balance training and weight-bearing exercise program on balance, strength and bone mineral density (BMD) in osteopenic women. A single-blinded randomised controlled trial (RCT) was undertaken for 20 weeks with measurements at baseline and completion. MATERIALS AND METHODS: Ninety-eight (98) community-dwelling osteopenic women aged 41-78 years were recruited through the North Brisbane electoral roll. Subjects were randomised via computer-generated random numbers lists into either a control (receiving no intervention), or exercise group (two one-hour exercise sessions per week for 20 weeks with a trained physiotherapist). Assessments at baseline and post-intervention included balance testing (five measures), strength testing (quadriceps, hip adductors / abductors / external rotators and trunk extensors), and DXA scans (proximal femur and lumbar spine). Baseline assessment showed no significant differences between groups for all demographics and measures except for subjects taking osteoporosis medication. The percentage differences between pre- and post-intervention measurements were examined for group effect by ANOVA using an intention-to-treat protocol. RESULTS: Ninety-eight women (mean age 62.01 years, SD 8.9 years) enrolled in the study. The mean number of classes attended for the 42 participants in the exercise group who completed the program was 28.2 of a possible 40 classes (71%). At the completion of the trial the intervention group showed markedly significant better performances in balance (unilateral and bilateral stance sway measures, lateral reach, timed up and go and step test) (p < 0.05) with strong positive training effects reflecting improvements of between 10% to 71%. Similarly there were gains in strength of the hip muscles (abductors, adductors, and external rotators), quadriceps and trunk extensors with training effects between 9% and 23%. CONCLUSIONS: Specific workstation exercises can significantly improve balance and strength in osteopenic women. This type of training may also positively influence bone density although further study is required with intervention over a longer period. A preventative exercise program may reduce the risk of falls and fractures in osteopenic women already at risk.

Changes in activity level in women aged 40-80 years.

OBJECTIVES: The purpose of this study was to report habitual physical activity levels in women and document the change in level of activity and factors affecting this change over a 5-year period. METHODS: A 5-year prospective cohort design was used. Women aged 40-80 years, living independently in the community, were recruited via the electoral role. The effects were investigated, first, of age, activity level, history of falls, number of co-morbidities and medications, body mass index and stability at baseline on change in activity level and, second, change in these demographics on activity level over the study period. RESULTS: Data from 459 women who completed our study are reported. Only activity level and body mass index at baseline significantly affected change in activity level (p<0.000). Change in activity level was not influenced by change in demographics over the study period. The forties and fifties cohorts accounted for the baseline body mass index effect on activity change (p<0.04). In the forties cohort, number of medical conditions at base line (p<0.03) and, in the sixties cohort, increase in number of medical conditions (p=0.011) affected activity level change. CONCLUSIONS: Activity level at baseline and body mass index in younger women were most likely to affect change over time. Being unsteady or having already fallen did not stimulate change.

Shoulder pain following tetraplegia: a follow-up study 2-4 years after injury.

OBJECTIVES: To investigate (1) the characteristics of shoulder pain following discharge from rehabilitation for tetraplegia, (2) the relationship between pain and any associated risk factors and (3) the relationship between pain and functional activities, and pain and quality of life. DESIGN: Longitudinal study. SETTING: Spinal Injuries Unit, Australia. METHODS: Participants (n=27) were surveyed between 2 and 4 years postinjury. Prospective data on shoulder pain during rehabilitation had been collected previously and allowed comparison with the follow-up data. Data collected included pain intensity and quality, the Wheelchair User's Shoulder Pain Index (WUSPI) and perceived effect of pain on quality of life. RESULTS: Shoulder pain prevalence was 70%. Pain was associated with discharge motor level of C6-T1 (P=0.003). Pain was most commonly located in the shoulder joint. Pain was primarily aggravated by movement and cold weather and relieved by rest. The most painful activity was lifting an object from overhead. Quality of life was affected by pain in 68.4% of participants. CONCLUSION: Shoulder pain is common following rehabilitation for tetraplegia and is associated with injury level. Pain is reported during daily tasks and adversely affects quality of life. Areas for further research are identified.

A longitudinal physical profile assessment of skeletal muscle manifestations in myotonic dystrophy.

OBJECTIVES: To develop an assessment that describes the skeletal muscle manifestations in myotonic dystrophy subjects and then use it to quantify the presentation of skeletal muscle disability and to show change over time. DESIGN: A quantified skeletal muscle assessment was developed and applied three times over a two-year period at intervals around 12 months. Thirty-six subjects with myotonic dystrophy and 20 subjects without neuromuscular disability were evaluated. The assessment comprised manual muscle testing of five pairs of muscles, measuring neck flexor strength with a strain gauge, respiratory function tests, power and lateral pinch grip strength, all tests of impairment. Assessment of the ability to move from sitting to standing and fasten buttons tested disability. RESULTS: Results from subjects with myotonic dystrophy were compared to the normal data. The subjects with myotonic dystrophy were significantly weaker in proximal upper limb muscles, quadriceps, tibialis anterior muscles and neck flexor muscles as well as power and lateral pinch grips. There was also significant reduction in forced expiratory volume at one second (FEV1) and forced vital capacity (FVC). Significant disability was seen in the myotonics in moving from sitting to standing and in fastening buttons. Over the two-year study period proximal upper limb and lower limb muscle strength, FVC and sit-to-stand ability declined significantly. Power grip declined but lateral pinch grip and FEV1 improved significantly. Button fastening ability improved significantly. CONCLUSION: The test developed was shown to be reliable and sensitive to the change in skeletal muscle manifestations in subjects with myotonic dystrophy who were shown to be significantly weaker than normal subjects.

Medial-lateral postural stability in community-dwelling women over 40 years of age.

OBJECTIVE: To document the change in medial-lateral balance in women aged between 40 and 80 years. DESIGN: A cross-sectional study of six measures of medial-lateral balance was undertaken. SETTING: The Betty Byrne Henderson Centre for Women and Ageing, Royal Women's Hospital, Australia. SUBJECTS: Five hundred and three community-dwelling women between 40 and 80 years of age were randomly recruited from a large metropolitan region with 366 subjects admitted after applying exclusion criteria. MEASUREMENTS: The clinical measurements included the lateral reach and step tests while laboratory measurements were gathered from the Balance Master software programs for unilateral stance and limits of stability. RESULTS: A significant decline in all measures (p < 0.02) was evident between the forties and sixties age decade cohorts. The clinical step test showed a significant (p < 0.001) decline between the forties and fifties groups. A significant correlation was shown between step test and unilateral stance (p < 0.001) and movement velocity, reaction time and end-point excursion centre of gravity (COG) on the limits of stability test (p < 0.001). CONCLUSIONS: This new evidence demonstrates that there is a significant decline in medial-lateral balance in women that occurs between their forties and sixties. Suggestions for further study were made.