High-definition trans cranial direct current stimulation and its effects on cognitive function: a systematic review.

High-Definition Transcranial Direct Current Stimulation (HD-tDCS) is focal and improves higher mental functions. Due to the lack of published evidence, we conducted this review on the effect of HD-tDCS on cognitive functions in healthy and diseased individuals. We performed an electronic-data and gray-literature search to obtain the relevant studies for the review. The two distinct literature searches obtained a total of 468 studies. Out of these, a total of 12 studies were conducted on higher mental functions, and of these, two were on disordered consciousness, five were on memory, two were on speech, two were on cognition, and one was on execution. We submitted nine studies with control group to methodological quality assessment using the PEDro Scale. Remaining three studies underwent quality assessment by Quality Assessment Tool for Before-After (Pre-Post) Studies with No Control Group. We found that anodal HD-tDCS stimulation is significantly effective in treating disordered consciousness and improving memory, speech, cognition, and execution.

Transcranial direct current stimulation (tDCS) effects on upper limb motor function in stroke: an overview review of the systematic reviews.

BACKGROUND: Stroke is the prime cause of disability in the elderly population. Transcranial direct current stimulation (tDCS) is an emerging noninvasive brain stimulation in rehabilitating upper limb function post-stroke. However, mixed evidence exists in the literature and ambiguous conclusions regarding the effect of tDCS on upper limb function. OBJECTIVE: This study aimed to assess the current evidence on the effect of (tDCS) on upper limb motor function and activities of daily living in patients after stroke by conducting an overview of systematic reviews. METHODOLOGY: We performed electronic database searches and gray literature searches for the articles. RESULTS: Two distinct literature searches gathered a total of 203 studies. Out of them, six systematic reviews and meta-analyses were included for methodological quality assessment and data extraction. All included studies were determined to be of good to high quality based on a methodological appraisal using the Assessment of Multiple Systematic Reviews checklist. CONCLUSION: Identified evidence suggests that tDCS has superior effects to control interventions in improving functions of the upper limb and activities of daily living in patients who have had a stroke. Moreover, cathodal stimulation over the non-affected brain region was more effective than anodal and dual tDCS stimulation.

Cross-Cultural Adaptation of the Godin-Shephard Leisure-Time Physical Activity Questionnaire for Arabic Population and Testing its Psychometric Properties.

BACKGROUND Physical activity during leisure time is essential to promote health, owing to the decreased physical activity in mechanized working environments. The present study aimed to cross-culturally modify the Godin Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ) into Arabic and to assess its psychometric properties. MATERIAL AND METHODS We conducted this study in various standardized stages. At each stage, the corrections were made by an expert committee. In the initial stage, the English version of the GSLTPAQ was translated into Arabic and then back-translated into English. In the second stage, we ensured the content validity by collecting the opinion of 10 professionals in the medical field. Finally, in the third stage, the Arabic version was applied to the Saudi population to check its test-retest reliability, face validity, internal consistency, and concurrent validity. RESULTS For the Arabic version of the GSLTPAQ, we evaluated the content validity by involving 10 experts, and it was found to be excellent. The scale was applied to 150 office workers in the university to assess psychometric properties. The scale showed remarkable internal consistency (0.99) and high test-retest reliability (0.88). We evaluated the concurrent validity by comparing it with the Copenhagen City Heart Study Leisure Time Physical Activity Questionnaire, and it was shown to have an excellent validity of 0.86 (<0.001). CONCLUSIONS After conducting the careful process of translations, we adapted and created the Arabic version of the GSLTPAQ. It was found to have excellent content validity, test-retest reliability, internal consistency, and concurrent validity.

Correlation and comparison of quadriceps endurance and knee joint position sense in individuals with and without unilateral knee osteoarthritis.

BACKGROUND: Knee osteoarthritis (KOA) is a painful degenerative joint disease that may limit activities of daily living. This study aimed to determine the relationship between quadriceps endurance and knee joint position sense (JPS) in KOA individuals and compare the quadriceps endurance and knee JPS with and without KOA. METHODS: This comparative cross-sectional study was conducted in medical rehabilitation clinics, King Khalid University, Saudi Arabia. This study recruited 50 individuals diagnosed with unilateral KOA (mean age = 67.10 ± 4.36 years) and 50 asymptomatic individuals (mean age = 66.50 ± 3.63 years). Quadriceps isometric endurance capacity (sec) was measured using a fatigue resistance test, and knee JPS (degrees) were assessed using a digital inclinometer and evaluated in sitting and standing positions. RESULTS: Quadriceps isometric endurance showed a significant moderate negative correlation with knee JPS in 20° of flexion (r = -0.48, p < 0.001); 40° of flexion: r = -0.62, p < 0.001; 60° of flexion: r = -0.58, p < 0.001) in sitting and 20° of flexion (r = -0.25, p = 0.084) in standing position in KOA individuals. When compared to the asymptomatic, the quadriceps endurance was lower (p < 0.001), and knee joint position errors were larger (p < 0.001) in KOA individuals. CONCLUSION: Results of this study showed that quadriceps endurance capacity is negatively associated with knee JPS. KOA individuals demonstrated lower quadriceps endurance and larger JPS compared to asymptomatic.

Cervical Joint Position Sense in Individuals With Type 2 Diabetes and Its Correlations With Glycated Hemoglobin Levels: A Cross-Sectional Study.

OBJECTIVE: This study aimed to compare cervical joint position sense (JPS) between individuals with type 2 diabetes (T2D) and healthy individuals and to assess the correlation between glycated hemoglobin (HbA1c) values and cervical JPS in individuals with T2D. METHODS: Ninety-seven individuals with T2D (mean age: 59.0 ± 6.8 years; men = 63 [67.02%], women = 34 [32.98%], and 117 healthy individuals without T2D (mean age: 57.3 ± 6.9 years; men = 70 [79.80%], women = 44 [20.20%]) were recruited into this study. Cervical JPS was evaluated using a cervical range of motion device in cervical flexion, extension, and rotation in left and right directions. Participants were required to relocate their heads actively to a predefined target position with eyes closed, and their reposition accuracy was measured in degrees as joint reposition error (JRE). The HbA1c test was performed on all participants with T2D to determine their average blood sugar level over the previous 2 to 3 months. Cervical JREs were compared and correlated with HbA1c values. RESULTS: The participants with T2D showed significantly larger cervical JREs in all directions compared with the healthy group (flexion: d = 1.23, P < .001; extension: d = 1.85, P < .001; left rotation: d = 1.70, P < .001; right rotation: d = 2.60, P < .001). Pearson correlation coefficient (r) showed significant moderate positive association between HbA1c and cervical JREs in flexion (r = 0.41, P = .001), extension (r = 0.48, P < .001), left rotation (r = 0.38, P < .001), and right rotation (r = 0.37, P < .001) in participants with T2D. CONCLUSION: The magnitude of cervical JPS impairment was significant in individuals with T2D. In addition, HbA1c levels showed a significant negative correlation with cervical JPS.

Development of Arabic Version of Vestibular Disorders Activities of Daily Living Scale: Cross-Cultural Adaptation and Assessment of Psychometric Properties.

BACKGROUND The vestibular disorders activities of daily living (VADL) scale is a valid and reliable scale created 2 decades ago to specifically test the functional problems of patients with vestibular disorders. Since its development, the VADL has been cross-culturally validated and adapted in Spanish, Portuguese, Persian, and Turkish languages. A version is not yet available in Arabic, the primary language of more than 400 million people worldwide. This study aimed to translate the patient-reported VADL into Arabic and test its psychometric properties such as content validity, internal consistency, and test-retest reliability. MATERIAL AND METHODS Our study was conducted in 2 parts. In the first part, we translated and adapted the VADL from English into Arabic with expert input. In the second part, we tested the translated scale content validity by consulting 6 experts in the field. We assessed the scale's internal consistency and test-retest reliability by administering it twice to 31 subjects with vestibular disorders with a 1-week interval between the 2 measurements. RESULTS Translation, adaptation, and pretesting were successful, and we were able to create the VADL-A, an Arabic version of the VADL. The content validity of the VADL-A was 0.96, internal consistency was 0.96, and the test-retest reliability was 0.93. CONCLUSIONS We successfully translated, adapted, and created the VADL-A. Our preliminary testing of basic psychometric properties indicated that the scale has excellent content validity, internal consistency, and test-retest reliability.

Development of a community orientation program (COP) as a community-based medical education method for undergraduate medical students: an experience from India.

BACKGROUND: Intra-regional cultural and linguistic differences are common in low- and middle-income countries. To sensitise undergraduate medical students to the social and contextual determinants of health to achieve the 'health for all' goal, these countries must focus on innovative teaching methods. The early introduction of a Community Orientation Program (COP) as a Community-based Medical Education (CBME) method could be a game changing strategy. In this paper the methods, evaluation, and implication of the COP in an Indian setting are described. METHODS: The curriculum of the COP was developed based on the analysis, design, development, implementation, and evaluation (ADDIE) model for educational intervention. In this learner-centric and supervised educational program, the key aim was to focus on developing students' communication skills, observation power and enhancing their motivation for learning through collaborative learning. To meet the objectives of the COP, a situated learning model under the constructivism theory was adopted. RESULTS: Between 2016 and 2019, 557 students were trained through the COP by visiting more than 1300 households in ten villages. To supplement the students' observations in the community, more than 150 small group discussions, a health education programme for the community and summary presentations were conducted. The students' feedback indicated the need to improve the clinical examinations demonstration quality and increase the number of instruments for clinical examinations. More than 80% of students felt that the program would assist them to improve their communication skills, their understanding of the various socio-demographic factors associated with the common diseases, and it will enable them to respect the local culture during their clinical practice. CONCLUSIONS: Early initiation of the COP as a CBME method in the undergraduate medical curriculum in an Indian setting has shown promising results. Further evidence is required to adopt such a program routinely for under-graduate medical teaching in the low- and middle- income settings.

Functional independence measure (WeeFIM) reference values in Indian children aged 3-7 years: A cross-sectional study.

Background: . We sought to establish reference values of the functional independence measure (WeeFIM; Unified Data System for Medical Rehabilitation, Buffalo, NY, USA) for children aged 3-7 years in India using this cross-sectional study. Methods: . We obtained permission from the Unified Data System for Medical Rehabilitation, a non-profit organization to use the WeeFIM instrument. Participants were recruited randomly from schools. After obtaining written informed consent, direct interviews for WeeFIM II Clinical Guide (version 6.0) were conducted for parent/guardian/teacher of 182 typically developing children. Results: . There was a progressive increase of functional independence with increasing chronological age across all WeeFIM domains. Total score of the WeeFIM instrument showed a similar performance between boys and girls. At the beginning of 3 years, children were at WeeFIM level 3 that is moderate assistance stage in their functional independence, but by the age of 7 years, they became completely independent on all the three domains of WeeFIM functional scale. Conclusions: . We have provided reference values for WeeFIM in children of India aged 3-7 years (35-84 months). There were no differences between boys and girls regarding WeeFIM performance. Children in private schools showed better performance versus children in government schools in the early age ranges. We could not find any effect of socioeconomic status on WeeFIM raw rating or functional independence level.

Direct comparison of three residual risk models for hepatitis B virus window period infections using updated input parameters.

BACKGROUND AND OBJECTIVES: Comparison of two models for estimating residual transfusion transmission risk by NAT screened window period (WP) donations in South African repeat donors gave identical results for HIV but not for HBV. In order to understand discrepant HBV modelling outcomes, the values of input parameters in three HBV WP risk models were reviewed and subsequently applied to the same South African screening data generated by HBsAg PRISM and two NAT assays (Ultrio and Ultrio Plus). Two of the models were also compared using individual donation (ID)-NAT screening data from different geographical regions. METHODS: Values of input parameters were derived from two published data sources and used in three risk models [(1) the incidence rate-WP risk day equivalent model, (2) the NAT yield WP ratio model and (3) the anti-HBc-negative HBsAg yield period ratio model] and subsequently applied to the same ID-NAT screening data. RESULTS: The HBV WP transmission risk in South African repeat donations during a one-year Ultrio Plus NAT screening period was estimated as 22, 43 and 17 per million, respectively, for the three models, as compared to 56, 117 and 48 per million for HBsAg PRISM screening. The approximate two-fold higher estimate calculated with the NAT yield WP ratio model was corroborated in repeat donations from three of four regions in a multi-regional study. When another set of model input values (with shorter viraemia periods and a higher proportion of acute occult infections) was applied to the South African screening data, the relative difference in risk estimates between the three models became smaller. CONCLUSIONS: Window period risk modelling for HBV is more complex than for HIV. Multiple factors affect the modelling outcomes. These include the values used for the length of transient HBsAg and HBV-DNA-positive phases, the proportion of acute occult and vaccine breakthrough infections and the assumption of random appearance of donors throughout the entire acute resolving infection phase. A substantial proportion of HBV WP NAT yields have very low viral load and lack donor follow-up data calling into question their definitive classification into the early acute (infectious) replication stage. Since these possible WP NAT yields most highly impact the NAT yield WP ratio model, we recommend relying on the more conservative estimates of the incidence rate-WP risk day equivalent model.

Effectiveness of Hand-Arm Bimanual Intensive Therapy on Hand Function among Children with Unilateral Spastic Cerebral Palsy: A Meta-Analysis.

BACKGROUND: Hand-arm bimanual intensive therapy (HABIT) has been shown to be an effective method for improving upper-extremity function. However, owing to ambiguity within the evidence of HABIT's effects on hand function among children with unilateral spastic cerebral palsy (CP), this meta-analysis sought to elucidate whether the same was true in this patient population. SUMMARY: A computerized database search yielded 468 studies. After meticulous scrutiny and screening of these studies according to the selection criteria, 4 full-text articles were included in the meta-analysis. All 4 studies underwent a methodological quality assessment according to the Physiotherapy Evidence Database Scale (PEDro), with a score of greater than 8. Five comparisons were then made involving the 4 selected randomized controlled trials (RCTs). The effect size was measured using the correlation coefficient (r value). The effect sizes of the individual studies were 0.006, 0.03, 0.04, 0.22, and 0.15. The total effect size was 0.06. Key Message: This meta-analysis determined that there is a trivial benefit using HABIT when compared to constraint-induced movement therapy or structured and unstructured bimanual therapy in pediatric patients with unilateral spastic CP. More RCTs are needed to substantiate our evidence.

The effect of Kinesio taping on cervical proprioception in athletes with mechanical neck pain-a placebo-controlled trial.

BACKGROUND: Neck proprioception is critical in maintaining neuromuscular control in and around cervical joints. Kinesio™ tape may assist in rehabilitating joint position sense. The current study compares Kinesio™ tape's effects versus a placebo on proprioception in college athletes experiencing mechanical neck pain. METHODS: This study randomized sixty-six athletes with mechanical neck pain into a Kinesio™ tape group (n = 33, mean age = 22.73 years) or placebo group (n = 33, mean age = 23.15 years). The Kinesio™ tape group received standard Kinesio™ taping applications with appropriate tension, while the placebo group received taping applications without tension. OUTCOME MEASURES: The study assessed cervical joint position errors with a cervical range-of-motion (CROM) device, pain intensity with a visual analog scale (VAS), and neck functional disability with a neck disability index (NDI). It tested joint position errors through cervical flexion, extension, rotation left, and rotation right. All the outcome measures were recorded at the baseline and twice more following 3 and 7 days of tape applications. RESULTS: Multivariate analysis of variance test demonstrated a significant reduction in joint position errors in flexion, extension and right rotation following 3 days and 7 days of tape application among the Kinesio™ tape group. There was a significant main effect of time (P < 0.05) for joint position errors in left rotation and VAS after 3 days (p > 0.05), NDI after 3 and 7 days (p > 0.05). CONCLUSIONS: The Kinesio™ tape application after 3 and 7 days effectively decreased joint position errors and neck pain intensity in mechanical neck pain participants compared to placebo, while there was no difference between both groups in the NDI. TRIAL REGISTRATION: ( CTRI/2011/07/001925 ). This study was retrospectively registered on the 27th July, 2011. LEVEL OF EVIDENCE: IIB.

Using a motivator and deterrent questionnaire to predict actual donation return behavior among first-time African-origin blood donors.

BACKGROUND: In South Africa, success in recruiting first-time African-origin blood donors at low risk for HIV infection has been tempered by lower-than-anticipated return rates. We studied whether self-reported motivators and deterrents could predict actual donor return among first-time donors. METHODS: We administered a questionnaire on blood donation motivators and deterrents within 2 months after donation to a cohort of first-time African-origin blood donors in 2014 and followed their return behavior for 1 year. Survey responses associated with return within 1 year were assessed using separate multivariate logistic regression models for motivators and deterrents. RESULTS: A total of 2902 first-time African origin donors with median age of 23 years and female predominance (59%) were included. Within 1 year 1574 (54% of donors) attempted at least one additional donation. Donors were more likely to return if they strongly agreed with the statement "Blood donation is an easy way to make a difference" (odds ratio [OR], 2.0; 95% confidence interval [CI], 1.3-2.9) and "I donated in response to advertisements on the radio, TV or newspaper" (OR, 1.6; 95% CI, 1.2-2.1). English language preference and nonstudent employment status were also associated with donor return. Poor customer service (OR, 0.45; 95% CI, 0.28-0.71), geographic region, and nonstudent employment status were associated with donor return in the deterrent model. CONCLUSIONS: Prosocial motivators and marketing communications predicted return, while poor customer experience predicted nonreturn. This novel design allowed us to study the link between donation motivators and deterrents and actual return for donation in the African context.

Reassessment of hepatitis B virus window periods for two transcription-mediated amplification assays using screening data of South African blood donors.

BACKGROUND: Transcription-mediated amplification assays for HBV DNA detection have transitioned from the Ultrio to the Ultrio Plus assay, which features increased analytic sensitivity due to inclusion of a target enhancer reagent. The impact on HBV detection for different categories of HBV infection has not been fully evaluated. STUDY DESIGN AND METHODS: Hepatitis B virus (HBV) DNA and hepatitis B surface antigen (HBsAg) detection rates as well as viral load (VL) distributions in HBV nucleic acid test (NAT)-yield samples were compared during 1 year of screening of South African blood donors with the Ultrio assay and the subsequent year by the Ultrio Plus version. HBV-DNA concentration at the HBsAg seroconversion point was established by regression analysis using a set of antibody to hepatitis B core antigen-negative acute viremic samples. RESULTS: Ultrio Plus detected twofold more window-period (WP) NAT yield donations and 1.7-fold more occult HBV infections than Ultrio. The VL distribution data indicated that Ultrio not only missed samples of less than 100 copies/mL, but also a substantial number higher than this level. The VL at the HBsAg seroconversion point was estimated at 916 copies/mL, whereas the VL at the NAT-conversion points was calculated at 63 and 4.1 copies/mL for Ultrio and Ultrio Plus. This reduced the infectious WP (compared to HBsAg testing) by 10.3 and 20.4 days, respectively. CONCLUSION: The higher-than-expected increase in HBV-NAT yields after introduction of the Ultrio Plus assay is likely attributable to variable sensitivity of the former Ultrio assay for different HBV samples. Therefore, previously published HBV WP reduction and residual risk estimates based on analytical sensitivity of the Ultrio assay need to be revised.

Assessment of HIV transfusion transmission risk in South Africa: a 10-year analysis following implementation of individual donation nucleic acid amplification technology testing and donor demographics eligibility changes.

BACKGROUND: In 1998 we estimated that 34/million infectious window period donations were entering the blood supply at the South African National Blood Service. Selective use of donations based on donor race-ethnicity reduced this risk to 26/million donations but was deemed unethical. Consequently, in 2005 South African National Blood Service eliminated race-ethnicity-based collection policies and implemented individual-donation nucleic acid testing (ID-NAT). We describe the change in donor base demographics, human immunodeficiency virus (HIV) detection rates, and transfusion-transmissible HIV risk. STUDY DESIGN AND METHODS: In ten years 7.7 million donations were tested for anti-HIV and HIV RNA. Number of donations, HIV prevalence, ID-NAT yield rate, serology yield rate and residual transfusion-transmissible HIV risk were analyzed by donor type, race-ethnicity, age, and sex. Multiple regression analysis was performed to investigate the determinants of HIV-positive and nucleic acid testing yield donations. RESULTS: The combined strategy of increasing donations from black donors and implementing ID-NAT increased the proportion of donations from black donors from 6% in 2005 to 30% in 2015 (p < 0.00001), and reduced the transfusion-transmissible risk from 24 to 13 per million transfusions. ID-NAT interdicted 481 (1:16,100) seronegative window period donations, while one transfusion-transmissible case (0.13 per million) was documented. Race-ethnicity and donor type were highly significant predictors of HIV positivity, with adjusted odds ratio for first-time donors of 12.5 (95% confidence interval, 11.9-13.1) and for black race-ethnicity of 31.1 (95% confidence interval, 28.9-33.4). The proportion of serology yields among HIV-infected donors increased from 0.27% to 2.4%. CONCLUSION: ID-NAT enabled the South African National Blood Service to increase the number of donations from black donors fivefold while enhancing the safety of the blood supply.

Health economic implications of testing blood donors in South Africa for HTLV 1 & 2 infection.

BACKGROUND AND OBJECTIVES: Currently, HTLV screening is not performed in South Africa (SA). This report describes an economic assessment (budget impact and cost-effectiveness) of implementing different HTLV screening strategies. METHODS: A modified version of the Alliance of Blood Operators risk-based decision-making framework was used to assess the risk and consequences of HTLV in the blood supply in SA. We developed a deterministic model of the cost and consequences of four screening strategies: none, universal, all donors once and first time donors only assuming a transfusion-transmission (TT) efficiency of 10% and a manifestation of clinical disease of 6%. RESULTS: Unscreened blood results in 3·55 symptomatic TT-HTLV cases and a total healthcare cost of Rand (R)3 446 950 (US Dollars (USD)229 800) annually. Universal screening would cost R24 000 000 (USD1 600 000) per annum and prevent 3·54 (99·8%) symptomatic TT-HTLV cases in the first year and 0·55 (98·4%) symptomatic TT-HTLV cases in the second year at a cost per TT-HTLV prevented of R6 780 000 (USD450 000) in year one and R43 254 000 (USD2 890 000) in year two. Screening all donors once would cost R16,200,000 (USD1 080 000) or R4 600 000 (USD306 000) per symptomatic TT-HTLV infection prevented in year one. Total costs decrease to R5 100 000 (USD340 000) in year 2 but the cost per TT-HTLV prevented increases to R10 700 000 (USD713 333). CONCLUSION: This analysis contributed to the decision not to implement HTLV screening as the healthcare budget and particularly the budget for blood transfusion in SA is insufficient to provide appropriate treatment. Arguably, available resources can be more efficiently utilized in other healthcare programs.

The prevalence of human T-lymphotropic virus type 1 & 2 (HTLV-1/2) in South African blood donors.

BACKGROUND AND OBJECTIVES: Donated blood is not currently screened for human T-cell lymphotropic virus (HTLV) in South Africa. Several small studies have detected HTLV-1 in South Africa, but prevalence by geographic region or population group is unavailable. MATERIALS AND METHODS: We performed a large seroprevalence study of South African blood donors during 3 months in 2013. All geographic regions except the Western Cape were included, and Black and Coloured (local term for mixed race) donors were oversampled. Identity-unlinked plasma samples were screened with the Abbott Prism HTLV-1/2 assay, and repeatedly reactive samples were tested by the Inno-LIA HTLV-1/2 Score confirmatory assay. Odds ratios were calculated with multivariable logistic regression. RESULTS: Of 46 752 donors tested, 133 (0·28%) were initially reactive, 111 (0·24%) repeatedly reactive and 57 (0·12%) confirmed positive for HTLV-1; none were HTLV-2 positive. Prevalence was 0·062% weighted to annual blood donations but highly concentrated in the Black population group (OR = 20·24 CI: 2·77-147·88); higher in females than males (OR = 1·81 CI: 1·06-3·08); and in donors aged >50 years compared to ages 16-19 (OR = 6·4 CI: 2·95-13·86). After controlling for age, sex and population group, there was no difference in prevalence between new and repeat blood donors or among geographic regions within South Africa. CONCLUSIONS: We conclude that HTLV-1 infection is widespread among the Black population of South Africa and its epidemiology is similar to other endemic areas. Because South Africa is increasing its recruitment of Black blood donors, the implications for blood screening require further consideration.

Cervical proprioception and its relationship with neck pain intensity in subjects with cervical spondylosis.

BACKGROUND: Cervical proprioception is critical in the maintenance of posture and movements, so its assessment in different cervical conditions has gained importance in recent clinical practice. Studies reporting this assessment in subjects with cervical spondylosis (CS) have not previously been investigated. The goals of the study are (1) comparison of joint position error (JPE) in subjects with CS to healthy control group. (2) Correlation of neck pain intensity to cervical proprioception in patients with CS. METHODS: In a Cross-sectional study, 132 subjects with CS and 132 healthy age-matched control subjects were evaluated for cervical JPE with the cervical range of motion device. The subjects were blindfolded and repositioned their heads to a target position, which was determined by the examiner previously and their repositioning accuracy (absolute error in degrees) was measured in the frontal (flexion and extension) and transverse planes (left rotation and right rotation). The CS subjects resting neck pain intensity was assessed using visual analog scale (VAS). RESULTS: CS subjects showed statistically significantly larger JPEs compared to healthy control subjects in all the directions tested (flexion - 95% CI = 2.38-3.55, p < 0.001, extension - 95% CI =3.26-4.33, p < 0.001, left rotation - 95% CI = 2.64 - 3.83, p < 0.001, right rotation - 95% CI = 3.77-4.76, p < 0.001). The mean JPE errors in the CS group ranged from 6.27° to 8.28° and in the control group ranged from 2.36° to 4.48°. Pearson's correlation coefficient showed a significant and positive relationship between neck pain intensity and cervical proprioception (p ≤ 0.001). CONCLUSIONS: Proprioception is impaired in subjects with CS when compared to healthy control group. Higher pain intensity was associated with greater cervical JPE in patients with CS.

The effect of exercise on sleep in adults with type 1 diabetes.

The aim of this pilot study was to investigate the effect of exercise on sleep and nocturnal hypoglycaemia in adults with type 1 diabetes (T1D). In a 3-week crossover trial, 10 adults with T1D were randomized to perform aerobic, resistance or no exercise. During each exercise week, participants completed 2 separate 45-minutes exercise sessions at an academic medical center. Participants returned home and wore a continuous glucose monitor and a wrist-based activity monitor to estimate sleep duration. Participants on average lost 70 (±49) minutes of sleep (P = .0015) on nights following aerobic exercise and 27 (±78) minutes (P = .3) following resistance exercise relative to control nights. The odds ratio with confidence intervals of nocturnal hypoglycaemia occurring on nights following aerobic and resistance exercise was 5.4 (1.3, 27.2) and 7.0 (1.7, 37.3), respectively. Aerobic exercise can cause sleep loss in T1D possibly from increased hypoglycaemia.

Use of Blood Donor Screening to Monitor Prevalence of HIV and Hepatitis B and C Viruses, South Africa.

Among 397,640 first-time blood donors screened in South Africa during 2012-2015, HIV prevalence was 1.13%, hepatitis B virus prevalence 0.66%, and hepatitis C virus prevalence 0.03%. Findings of note were a high HIV prevalence in Mpumalanga Province and the near absence of hepatitis C virus nationwide.

An ecological approach to hearing-health promotion in workplaces.

OBJECTIVE: To develop and assess use, acceptability and feasibility of an ecological hearing conservation programme for workplaces. DESIGN: A school-based public health hearing preservation education programme (Dangerous Decibels®) was adapted for workplaces using the Multi-level Approach to Community Health (MATCH) Model. The programme was delivered in small manufacturing companies and evaluated using a questionnaire before the training and at one week and two-months after training. STUDY SAMPLE: Workers (n = 56) from five small manufacturing companies were recruited. RESULTS: There was a significant improvement in knowledge, attitudes and behaviour of workers at the intrapersonal level; in behaviour motivation and safety culture at the interpersonal and organisational levels; and an overall improvement in hearing-health behaviour after two months post-intervention. CONCLUSIONS: The developed programme offers a simple, interactive and theory-based intervention that is well accepted and effective in promoting positive hearing-health behaviour in workplaces.