Ideational Praxis, Play, and Playfulness: A Cross-Sectional Study of Autistic Children.

IMPORTANCE: Assessment of praxis skills is an essential aspect of understanding autistic children's development of play and playfulness. OBJECTIVE: To assess the relationship and influence of ideational praxis skills on play skills and playfulness among autistic children. DESIGN: A cross-sectional study. SETTINGS: Homes, schools, and early care centers across Spain. PARTICIPANTS: Children ages 4 yr 6 mo to 6 yr 11 mo (45 typically developing [TP] and 45 with autism spectrum disorder [ASD]). OUTCOMES AND MEASURES: Student's t tests were used to compare means between the two groups. Pearson's correlation and multiple linear regression were used to determine possible effects of ideational skills on play and playfulness. RESULTS: Scores for the TP group were significantly higher than those of the ASD group on all play dimensions-space management, t(88) = 4.58; material management, t(88) = 5.86; pretense-symbolism, t(88) = 8.12; and participation, t(88) = 7.31-and on the Test of Playfulness (ToP), t(88) = 10.18, and Test of Ideational Praxis (TIP), t(88) = 4.38 (all ps < .001). Multiple linear regression revealed a statistically significant effect of TIP dimensions-space management, F(3, 41) = 4.83, p < .042; material management, F(3.41) = 8.49. p < .001; pretense-symbolism, F(3, 41) = 5.66. p < .002; and participation, F(3.41) = 7.81. p < .001-and on the ToP, F(3, 41) = 5.96. p < .002. CONCLUSIONS AND RELEVANCE: Ideational praxis skills combined with diagnostic information significantly predicted play skills and playfulness, highlighting the influence of ideation on play. Plain-Language Summary: This article provides data supporting the influence of ideational praxis skills on the play skills and playfulness of autistic children. Understanding how ideational praxis skills affect the ability to recognize and act on object affordances might promote greater possibilities for play interactions among autistic children.

Spanish Cultural Adaptation and Inter-Rater Reliability of the Revised Knox Preschool Play Scale.

BACKGROUND: The Revised Knox Preschool Play Scale (RKPPS) is a comprehensive assessment test that observes the level of play development; however, there is no culturally adapted version available with stable psychometric values that would allow its widespread use and provide objective information during clinical evaluations. METHODS: Cross-cultural adaptation included direct and retrospective translations, along with cognitive interviews with pediatric occupational therapists to analyze the comprehensibility of the translation. In addition, a final phase of linguistic revision was carried out to determine the grammatical and semantic fit of the adapted version. Finally, inter-rater reliability was analyzed in a sample of typically developing children aged four to six years old. RESULTS: The processes of translation and back-translation, cognitive interview, and linguistic review determined an adequate grammatical and semantic equivalence to the Spanish cultural context. Almost perfect agreement, with values between 0.82 and 0.94, was obtained for items and play dimensions, indicating that the precision of the measurements between both evaluators was excellent. CONCLUSIONS: The cross-culturally adapted version of the RKPPS meets the necessary adjustments for the sociocultural context and can be used in the clinical practice of occupational therapy.

Factores biopsicosociales y calidad de vida en fibromialgia desde la terapia ocupacional. Un estudio cualitativo / Fatores biopsicossociais e qualidade de vida na fibromialgia a partir da terapia ocupacional - um estudo qualitativo / Biopsychosocial factors and quality of life in fibromyalgia from the perspective of occupational therapy - a qualitative study

Resumen Introducción La Fibromialgia es una enfermedad crónica caracterizada por mialgias localizadas en el aparato locomotor que ocasionan un deterioro funcional. Su tratamiento se basa en el uso de fármacos combinados con intervenciones de diversas modalidades terapéuticas, entre ellas, las propias de la Terapia Ocupacional (TO). Los síntomas de la enfermedad afectan a todas las áreas ocupacionales, evidenciándose en el desempeño diario. Objetivos Los objetivos del presente estudio fueron identificar las ocupaciones con mayor grado de afectación en las personas con Fibromialgia; explorar el impacto de los factores biopsicosociales en las ocupaciones de las personas diagnosticadas de Fibromialgia; conceptualizar de qué manera influye la calidad de la red de apoyo y la situación económica de las personas diagnosticadas de Fibromialgia en la autopercepción de los síntomas de la enfermedad y determinar si existe una relación entre los sucesos negativos en la infancia y la Fibromialgia. Métodos Se empleó una metodología cualitativa desde el enfoque fenomenológico. La recolección de información se realizó mediante encuestas ad hoc administradas a las 8 voluntarias. Posteriormente, se analizaron los resultados a través del programa Atlas. TI® y se transcribieron con el programa Microsoft Word®. Resultados Las personas entrevistadas presentaron limitaciones en las siguientes áreas ocupacionales: actividades instrumentales de la vida diaria (AIVD), ocio y tiempo libre, participación social, descanso y sueño, actividad sexual y trabajo. Se estableció una relación entre la calidad de la red de apoyo y la situación económica con la percepción de los síntomas. También se exploró la relación entre los sucesos negativos en la infancia y la Fibromialgia. Conclusiones Los factores biopsicosociales tienen una influencia crucial en la calidad de vida, pudiendo actuar como factores de protección o de riesgo ante la intensidad de los síntomas.

Resumo Introdução A fibromialgia é uma doença crônica caracterizada por mialgias localizadas no sistema locomotor que causam comprometimento funcional. Seu tratamento é baseado no uso de medicamentos combinado com intervenções de várias modalidades terapêuticas, incluindo as da terapia ocupacional. Os sintomas da doença afetam todas as áreas ocupacionais e são evidentes no desempenho diário. Objetivo Os objetivos deste estudo foram identificar as ocupações com maior grau de afetação em pessoas com fibromialgia, explorar o impacto de fatores biopsicossociais nas ocupações de pessoas diagnosticadas com fibromialgia, conceituar a influência da qualidade da rede de apoio e da situação econômica de pacientes com fibromialgia em sua autopercepção dos sintomas da doença e determinar a possível existência de uma relação entre eventos negativos na infância e fibromialgia. Métodos Foi utilizada uma metodologia qualitativa a partir de uma abordagem fenomenológica. Os dados foram coletados por meio de entrevistas ad hoc administradas aos oito participantes voluntários. Posteriormente, os resultados foram analisados utilizando-se o ATLAS.ti® e transcritos em Microsoft Word®. Resultados Os entrevistados apresentaram limitações nas seguintes áreas ocupacionais: atividades instrumentais de vida diária (AIVD), lazer e tempo livre, participação social, descanso e sono, atividade sexual e trabalho. Foi estabelecida uma relação entre a qualidade da rede de apoio e a situação econômica com a percepção dos sintomas. A relação entre eventos negativos na infância e a fibromialgia também foi explorada. Conclusões Fatores biopsicossociais influenciam crucialmente a qualidade de vida e podem atuar como fatores protetores ou de risco para a intensidade dos sintomas.

Abstract Introduction Fibromyalgia is a chronic disease characterized by localized myalgias in the locomotor system, leading to functional impairment. Its management involves a combination of pharmaceutical treatments and interventions from various therapeutic modalities, including those of occupational therapy. The symptoms of the disease impact all areas of occupation and manifest in daily activities. Objective The objectives of this study were to identify the occupations most affected by fibromyalgia, explore the impact of biopsychosocial factors on the occupations of fibromyalgia patients, assess the influence of the quality of support networks and economic status on self-perceived symptoms, and investigate any relationship between negative events in childhood and fibromyalgia. Methods This qualitative study employs a phenomenological approach. Data were collected through ad hoc interviews with eight participating volunteers. The results were subsequently analyzed using ATLAS.ti® software and transcribed in Microsoft Word®. Results The interviewees reported limitations in the following occupational areas: instrumental activities of daily living (IADL), leisure and free time, social participation, rest and sleep, sexual activity, and work. There was a noted correlation between the quality of support networks and economic status, and the perception of symptoms. The potential relationship between negative childhood events and fibromyalgia was also explored. Conclusions Biopsychosocial factors play a crucial role in quality of life and may serve as either protective or risk factors for symptom intensity.

Motor performance and daily participation in children with and without probable developmental coordination disorder.

AIM: To test the mediating role of motor performance in the relationship between individual and environmental constraints, delayed learning of activities of daily living (ADL), and daily participation in typically developing children and children with probable developmental coordination disorder (DCD). METHOD: Parents of 370 randomly selected children aged 5 to 10 years (194 females; mean age [SD] 7y 5mo [1y 10mo]) were included in the study (321 typically developing, 49 probable DCD). Motor performance, ADL learning, and participation were assessed using the DCDDaily-Questionnaire. Individual variables included child's age and sex, and environmental variables included mother and family educational level, presence of siblings, and area of residence. Direct, indirect, and mediating effects were tested using a partial least squares-based structural equation modelling approach. RESULTS: The model explained 44.5% of the variance of daily participation. Motor performance significantly mediated the effect of individual and environmental constraints, and ADL learning on daily participation. INTERPRETATION: Results suggest that the effect of individual and environmental constraints and delayed learning of ADL on daily participation is mediated by motor performance in typically developing children and children with probable DCD. These findings provide further evidence that interventions to promote participation in children with probable DCD should adopt ecological, task-oriented approaches. Further studies should evaluate model generalizability with clinical samples.

Serum Inflammatory and Prooxidant Marker Levels in Different Periodontal Disease Stages.

BACKGROUND: Periodontitis has been associated to systemic diseases and this association could be due to an increase in circulating inflammatory and oxidative stress biomarkers in the periodontal disease. This study aimed to evaluate the relationship between inflammatory and pro-oxidant markers according to different stages of periodontitis. METHODS: This cross-sectional study included 70 subjects who were divided into three groups according to periodontitis stage: stage II (n = 22), stage III (n = 30), and stage IV (n = 18). We evaluated periodontal parameters and levels of high-sensitivity C-reactive protein (hsCRP), fibrinogen, and malondialdehyde (MDA) in serum, and 8-hydroxy-2'-deoxyguanosine (8-OHdG) in urine. RESULTS: Serum hsCRP and fibrinogen levels were associated with periodontitis severity, which were higher in stage IV than in stages III and II of periodontitis (p = 0.003 and p = 0.025, respectively). We observed a slight yet insignificant increase in MDA levels related to periodontitis severity. Probing depth and clinical attachment loss were associated with serum fibrinogen and hsCRP levels. However, there were no significant associations between periodontal variables and MDA and 8-OHdG levels. CONCLUSION: Our data support an association between periodontitis and systemic inflammation, which increases with periodontal disease severity. This indicates the importance of the early diagnosis and treatment of periodontal disease to avoid the development or worsening of systemic inflammatory diseases.

Influence of Ideational Praxis on the Development of Play and Adaptive Behavior of Children with Autism Spectrum Disorder: A Comparative Analysis.

BACKGROUND: Traditionally, assessment of praxis skills in children with ASD has focused on the evaluation of aspects related to the planning and execution of actions. This study aimed to evaluate the ideational abilities of children with ASD and analyze possible relationships with the development of play and adaptive behaviors. METHODS: 40 children between 4 to 6 years (TD = 20; ASD = 20) were evaluated with the Test of Ideational Praxis, the Revised Knox Preschool Play Scale, and the Adaptive Behavior Assessment System II. RESULTS: Statistically significant relationships were obtained between ideational praxis and play skills development (r = 0.649; p = 0.01), adaptive leisure behavior (r = 0.338; p = 0.04) and social adaptive behavior (r = 0.319; p = 0.04). Results of multiple linear regression models found a linear relationship between ideational praxis and play development (p = 0.005) and adaptive leisure skills (p = 0.004), but not with social interaction skills (p > 0.05). CONCLUSIONS: Objective evaluation with a specific ideational praxis assessment facilitates understanding of the ideational abilities and widens understanding of praxis skills and their impact on play and adaptive behaviors in children with ASD.

Spanish Cultural Adaptation and Inter-Rater Reliability of the Test of Playfulness.

AIM: To adapt the Test of Playfulness (ToP) to the Spanish context (culturally and linguistically) and analyze the inter-rater reliability of the translated version. METHODS: Following a specific methodology for cultural adaptation, direct and back translations were carried out, together with cognitive interviews with pediatric occupational therapists, to analyze the comprehensibility of the translated version. The resulting version was analyzed by a linguistic expert to determine its grammatical and linguistic adequacy. Finally, inter-rater reliability was analyzed in a sample of typically developing children aged between 4 years old and 6 years and 11 months (n = 12). RESULTS: Direct and back translation phases showed a good conceptual equivalence with the original version. The cognitive interviews enabled the identification of difficulties surrounding the understanding and the terminology used in several items. The linguistic expert and the research team revision ensured that final grammatical and conceptual improvements were made. Inter-rater reliability analysis showed an almost perfect degree of agreement (0.82 ≤ κ ≤ 1.00; p < 0.001), as well as stability and a strong positive linear correlation (0.81; p < 0.001). CONCLUSIONS: The translated version of the ToP fits the Spanish context and can be used in the clinical setting of pediatric occupational therapy in Spain.

Participation in Everyday Activities of Children with and without Neurodevelopmental Disorders: A Cross-Sectional Study in Spain.

Children with neurodevelopmental disorders (NDDs) often report significant difficulties performing activities of daily living (ADLs), which may restrict their daily participation. The aim of this study was to investigate the differences in ADLs participation between children with NDDs and typically developing (TD) children, and to explore the associations between different daily participation contexts. A cross-sectional study was conducted that included twenty children with a medical diagnosis of an NDD and 26 sex- and age-matched TD controls. The daily participation across home, community, school, and instrumental living activities was measured using the Child and Adolescent Scale of Participation (CASP). The results show that children with NDDs engaged in lower participation in all CASP contexts (Δ = 1.7-5.5, p < 0.001) and had a significantly higher prevalence of moderate or severe restricted participation than their TD peers (OR = 23.4, 95% CI = 3.6-154.2, p < 0.001). Additionally, a strong association was found between the different contexts of participation (r = 0.642-0.856). Overall, the children with NDDs experienced significant participation restrictions on their daily activities. This study adds to the growing evidence showing that intervention strategies in this population should adopt a participation-oriented approach.

Individual and Environmental Factors Associated with Tobacco Smoking, Alcohol Abuse and Illegal Drug Consumption in University Students: A Mediating Analysis.

Substance abuse is a major and prevalent public health concern among university students. Tobacco smoking, risky alcohol behavior, and illegal drug consumption may lead to health problems and behavioral and academic issues. Several individual and environmental factors associate with substance abuse in this population, and the mediating effect of alcohol abuse in the relationship between tobacco smoking and drug consumption is yet to be explored. The purposes of this study were to evaluate the association of individual and environmental factors and substance use, and to analyze the relationship between tobacco smoking, alcohol abuse, and drug consumption, considering alcohol abuse as a possible mediator. A total of 550 Spanish undergraduate and postgraduate students completed several questionnaires regarding their smoking status, alcohol use, and drug consumption during the last six months. Bivariate and multivariate analyses were conducted to explore associations between factors. Direct, indirect and mediating effects were tested using a partial least squares approach (PLS-SEM). The results indicated that substance abuse is associated with being male, living with other students, and combined substance consumption. PLS-SEM showed a significant effect of tobacco smoking and alcohol abuse on drug consumption. Alcohol abuse plays a mediating role in the relationship between tobacco smoking and drug use.

Psychometric Validation and Reference Norms for the European Spanish Developmental Coordination Disorder Questionnaire: DCDQ-ES.

The Developmental Coordination Disorder Questionnaire (DCDQ) is a widely used and well-validated tool that contributes to the diagnosis of Developmental Coordination Disorder (DCD). The aim of this study was to further analyze the psychometric properties of the European Spanish cross-culturally adapted version of the Developmental Coordination Disorder Questionnaire (DCDQ-ES) in a sample of Spanish children aged 6-11 years and to establish reference norms with respect to age groups. Parents of 540 typically developing children completed the DCDQ-ES. A second sample of 30 children with probable DCD (pDCD) was used to test its discriminant validity. Confirmatory factor analysis supported the original three-factor structure and the internal consistency was excellent (Cronbach's α = 0.907). Significant differences between age groups were found. The pDCD group scored significantly lower than the reference sample in the three subscales and DCDQ-ES total score (p < 0.001; AUC = 0.872). The DCDQ-ES is a reliable and valid tool for screening motor coordination difficulties in Spanish children and for identifying children with probable DCD. The findings of this research suggest that context-specific cut-off scores should be systematically utilized when using cross-cultural adaptations of the DCDQ. Age-specific cut-off scores for Spanish children are provided.

Interrelation of Individual, Country and Activity Constraints in Motor Activities of Daily Living among Typically Developing Children: A Cross-sectional Comparison of Spanish and Dutch Populations.

Motor performance is influenced by individual, environmental, and task constraints. Children perform differently according to individual (i.e., sex), environmental (i.e., country), and task (i.e., type of activity) factors. However, little is known about the effect of the interaction between sex and country factors across different activities of daily living (ADL) learning, participation, and performance. The main aim of this study was to examine the relationship between sex, country, and type of activity in motor-based ADL learning, participation, and performance in five-to-eight-year-old, typically developing children. Additionally, we aimed to compare the prevalence of probable Developmental Coordination Disorder (DCD) across sex and country. The DCDDaily-Q was used to assess ADL learning, participation, and performance in 300 age and sex-matched children from Spain and The Netherlands. The prevalence of probable DCD was determined based on the total ADL performance score. Results showed that differences in ADL learning, participation and performance differed across sex and country (p < 0.05). Prevalence of probable DCD was statistically similar in both countries. These findings show that daily participation and performance in typically developing children may be influenced by individual, country, and task constraints, and that country and sex may have different influences on particular tasks.

Sensory processing patterns in developmental coordination disorder, attention deficit hyperactivity disorder and typical development.

BACKGROUND: Sensory processing difficulties (SPD) are present in children with Developmental Coordination Disorder (DCD) and Attention Deficit and Hyperactivity Disorder (ADHD). However, little is known about sensory processing variability in these disorders. OBJECTIVE: The purpose of this study was to explore SPD among children with DCD, ADHD and co-occurring symptoms in comparison to children with typical development (TD) and to determine how potential social confounders may influence these associations. METHODS: The study involved 452 children aged 6-12 years. The Short Sensory Profile-2 was used to assess sensory processing patterns. Multiple linear regressions were utilized to investigate the relationship between DCD, ADHD and co-occurring symptoms and sensory processing patterns, adjusting for social covariates. RESULTS: Children with DCD and ADHD symptoms showed greater variability of atypical sensory processing patterns compared with TD children. Low registration and sensory sensibility issues were more prevalent in the DCD group. ADHD children showed higher rates of low registration, sensory sensibility and sensory seeking, and all children in the co-occurring symptoms group presented sensory sensibility. CONCLUSION: This study reports significant variability in sensory processing among children with DCD, ADHD and co-occurring symptoms using a population-based sample. These differences can contribute to understand how neurological and social factors correlates across diagnoses.

Identifying Children with Developmental Coordination Disorder via Parental Questionnaires. Spanish Reference Norms for the DCDDaily-Q-ES and Correlation with the DCDQ-ES.

Developmental Coordination Disorder (DCD) is one of the most prevalent neurodevelopmental disorders in school-aged children, with major consequences in psychosocial and physical health. Adequate identification of this disorder is necessary to prompt effective interventions. The aims of this study were to develop the Spanish adjusted reference norms for the DCDDaily-Q and to test the correlation and agreement between the Spanish versions of the DCDDaily-Q (DCDDaily-Q-ES) and the Developmental Coordination Disorder Questionnaire (DCDQ-ES), two reliable instruments to assess motor performance and DCD. Clinically relevant percentiles were calculated for the DCDDaily-Q-ES using a representative sample of Spanish children aged 5 to 10 years (n = 356; M = 7.3 years, SD = 1.8; boys = 50%). Pearson's correlation coefficient and intraclass correlation coefficient (ICC) were used to determine correlation and agreement between questionnaires, respectively. A moderate and significant correlation and agreement between DCDDaily-Q-ES and DCDQ-ES was found (r = 0.406; ICC = 0.381; p < 0.001). Differences in daily participation and performance were found between age groups, but not between boys and girls. Spanish age-adjusted percentiles and cutoff scores for DCDDaily-Q-ES are provided. This study offers further validation and relevant information regarding assessment of DCD and has practical implications for clinical practice and research.

Reference Values for the Adolescent/Adult Sensory Profile in Spain.

IMPORTANCE: In Spain, only one culturally adapted assessment tool is available for children between ages 3 and 11 yr. There are no assessments of adolescent and adult sensory processing, and no normative data. OBJECTIVE: To obtain reference values for the Adolescent/Adult Sensory Profile (AASP) in Spain for adolescents (aged 11-17) and adults (aged 18-64 and ≥65). DESIGN: A multivariate analysis of variance was used to compare specific mean values (-2, -1, +1, and +2 standard deviation [SD]) by age group, gender, geographic area, education level, and employment status. PARTICIPANTS: We randomly recruited 787 participants (55.8% female) aged 11 yr or older (mean age = 32.1, SD = 21.1) in Spain. We excluded those with a diagnosis of depression, chronic disease (e.g., diabetes, cancer, neurological disease), or cognitive disability and those who used medication that could affect the central nervous system. RESULTS: Quadrant mean (SD) scores ranged from 29.3 (6.6) for low registration to 49.1 (8.3) for sensory seeking, with significant differences by age group (p < .001) in all quadrants. Significant differences were also found for scores in different quadrants by gender, geographic area, education level, and employment status. Although statistically significant, the differences between scores were not clinically relevant; the mean scores fell within the typical range for sensory processing. CONCLUSIONS AND RELEVANCE: We offer reference values for the cultural adaptation to Spain of the AASP and recommend its use for the typically developing Spanish population ages 11 and older. WHAT THIS ARTICLE ADDS: We provide normative data for the AASP for three age groups of the Spanish population: adolescents, adults, and older adults.

Prevalence of suspected developmental coordination disorder and associated factors in Spanish classrooms.

BACKGROUND: Developmental Coordination Disorder (DCD) is a multifactorial, neurodevelopmental motor disorder that severely affects the activities of a child's daily life and classroom performance. The aim of this study was to determine the prevalence of suspected DCD in a sample of Spanish schoolchildren and its association with socio-demographic factors. METHODS: We conducted a cross-sectional study including a random sample of 460 children attending mainstream schools in northwest Spain in 2017. A Developmental Coordination Disorder Questionnaire-European Spanish was used to evaluate suspected DCD prevalence. We performed multivariate logistic and linear regression analysis to determine the socio-demographic variables associated with suspected DCD and problematic motor coordination performance. RESULTS: The prevalence of suspected DCD was 12.2%. According to the multivariate analysis, DCD symptoms were significantly associated with males (OR = 3.0), ages above 10 years old (OR = 5.0) and low participation in out-of-school physical activities (OR = 2.3). Preterm birth children were twice as likely to show suspected DCD, although this association was not statistically significant (OR = 2.1). CONCLUSIONS: A high percentage of Spanish schoolchildren are at risk for developing DCD. There is a strong connection between suspected DCD and socio-demographic factors. Protocols aimed to detect DCD and intervention programmes in classrooms designed to promote motor coordination skills need to take these factors into consideration.

Activities of daily living in people with lower limb amputation: outcomes of an intervention to reduce dependence in pre-prosthetic phase.

PURPOSE: The main objective was to assess the change in the functional independence in basic activities of daily living (ADL) following a pre-prosthetic intervention in people with lower-limb amputation (LLA). Secondary objectives were to identify the factors contributing to the success of this intervention, and to analyze the effects on the presence of unmet needs for home adaptation. METHOD: The ADL intervention was early and pre-prosthetic; it was focused on six self-care activities. Fifty-two adults with LLA, who required assistance in self-care, were included. Functional independence (Barthel) was assessed at baseline and after intervention (T2). Successful intervention was defined as independent performance of all self-care activities. RESULTS: There was a significant improvement in Barthel scores between baseline and T2 in toileting (p < 0.001), bed-chair transfers (p < 0.001), dressing (p < 0.001), bathing/showering (p < 0.001), and feeding (p = 0.025). The proportion of homes with an unmet need for adaptation decreased significantly in bathroom (p = 0.008) and other internal areas (p = 0.031). Intervention was successful for 61.5% of participants. In a multivariate model, age was significantly associated with successful intervention (OR 0.66, 95%CI 0.52-0.83). CONCLUSIONS: A short and pre-prosthetic ADL intervention improves functional independence and reduces the need for home adaptation. ADL programs should be included in rehabilitation strategies. Implications for Rehabilitation Because basic activities of daily living (ADL) can be seriously compromised after a lower-limb amputation, it is important for this population to improve or maintain their level of independence. A short and pre-prosthetic ADL intervention is an effective method for an early recovery of functional independence in self-care activities and promotes home adaptation. Age is an important determinant of functional recovery, and most subjects can achieve independence in basic ADL regardless of the level of amputation. A pre-prosthetic ADL program should be included in rehabilitation strategies for adults with lower-limb amputation.

Homebound status among middle-aged and older adults with disabilities in ADLs and its associations with clinical, functional, and environmental factors.

BACKGROUND: Homebound status is associated with poor health, comorbidity, and mortality and represents a major challenge for health systems. However, its prevalence among people with disabilities in the basic activities of daily living (ADLs) is unknown. OBJECTIVES: The objectives were to: (1) examine the prevalence of the homebound status among middle-aged and older adults with disabilities in ADLs, and (2) identify its clinical, functional, and environmental determinants. METHODS: This study included 221 community-dwelling subjects, aged ≥50 years, who applied for long-term care services at the Office for Legal Certification of Long-term Care Need of Coruña (Spain). Each subject had a disability in ADLs and was interviewed by a trained examiner in the subject's home. The participants were considered homebound if they remained inside their home during the previous week. MEASURES: Demographic, clinical, functional, and environmental factors. Multiple logistic regression was used to determine the factors associated with homebound status. RESULTS: The prevalence of homebound status was 39.8%. A multivariate analysis revealed that the presence of architectural barriers at the home entrance (stairs [OR: 6.67, p < 0.001] or a heavy door [OR: 2.83, p = 0.023]), walking ability limitations (OR: 3.26, p = 0.006), and higher age (OR: 1.05, p = 0.04) were associated with homebound status. CONCLUSIONS: Homebound status is a highly prevalent problem among middle-aged and older adults with disabilities in ADLs. Architectural factors in the home and walking ability limitations seem to be important predictors, suggesting that health care interventions should target home adaptations and mobility skills as a means to preventing or decreasing homebound status.

Thermocycling effect on microshear bond strength to zirconia ceramic using Er:YAG and tribochemical silica coating as surface conditioning.

The purpose of this study is to evaluate the thermocycling effect on the microshear bond strength (µSBS) of different self-adhesive resin cements to zirconia using tribochemical silica coating Rocatec™ (ROC) and Er:YAG as surface conditioners. Two hundred forty square-like zirconia samples were polished and randomly assigned in four groups according surface treatment applied as follows: (1) no treatment (NT), (2) silica coating with ROC, 3) Er:YAG laser irradiation (LAS: 2.940 nm, 200 mJ; 10 Hz), and (4) laser followed by Rocatec™ (LAROC). Each group was divided into two subgroups according the resin tested as follows: (A) BiFix SE (BIF) and (B) Clearfil SA (CLE). After 24 h, half of the specimens from each subgroup were tested. The other half was stored and thermocycled (5-55 °C/5,000 cycles). A µSBS test was performed using a universal testing machine (cross head speed = 0.5 mm/min). Failure modes were recorded and observed by scanning electronic microscopy. Data was analyzed with ANOVA, Student's t test, and chi-square tests, and linear regression was performed (p < 0.05). Before thermocycling, both cements showed higher µSBS results with ROC and LAROC. After aging, (1) all BIF specimens evidenced severely decreased adhesion with mostly adhesive failures and (2) CLE maintained the initial results in ROC and LAROC groups, performing better with ROC. Thermocycling did not negatively influence the resin-zirconia µSBS results in the self-adhesive resin cement containing 10-MDP when used on zirconia surface coated with silica, independently of previous Er:YAG surface treatment.

Does the epiphyseal cartilage of the long bones have one or two ossification fronts?

Epiphyseal cartilage is hyaline cartilage tissue with a gelatinous texture, and it is responsible for the longitudinal growth of the long bones in birds and mammals. It is located between the epiphysis and the diaphysis. Epiphyseal cartilage also is called a growth plate or physis. It is protected by three bone components: the epiphysis, the bone bar of the perichondrial ring and the metaphysis. The epiphysis, which lies over the epiphyseal cartilage in the form a cupola, contains a juxtaposed bone plate that is near the epiphyseal cartilage and is in direct contact with the epiphyseal side of the epiphyseal cartilage. The germinal zone corresponds to a group of cells called chondrocytes. These chondrocytes belong to a group of chondral cells, which are distributed in rows and columns; this architecture is commonly known as a growth plate. The growth plate is responsible for endochondral bone growth. The aim of this study was to elucidate the causal relationship between the juxtaposed bone plate and epiphyseal cartilage in mammals. Our hypothesis is that cells from the germinal zone of the epiphyseal side of the epiphyseal cartilage are involved in forming a second ossification front that is responsible for the origin of the juxtaposed bone plate. We report the following: (a) The juxtaposed bone plate has a morphology and function that differs from that of the epiphyseal trabeculae; (b) on the epiphyseal edge of the epiphyseal cartilage, a new ossification front starts on the chondrocytes of the germinal area, which forms the juxtaposed bone plate. This ossification front is formed by chondrocytes from the germinal zone through a process of mineralisation and ossification, and (c) the process of mineralisation and ossification has a certain morphological analogy to the process of ossification in the metaphyseal cartilage of amphibians and differs from the endochondral ossification process in the metaphyseal side of the growth plate. The close relationship between the juxtaposed bone plate and the epiphyseal cartilage, in which the chondrocytes that migrate from the germinal area play an important role in the mineralisation and ossification process of the juxtaposed bone plate, supports the hypothesis of a new ossification front in the epiphyseal layer of the epiphyseal plate. This hypothesis has several implications: (a) epiphyseal cartilage is a morphological entity with two different ossification fronts and two different functions, (b) epiphyseal cartilage may be a morphological structure with three parts: perichondrial ring, metaphyseal ossification front or growth plate, and epiphyseal ossification front, (c) all disease (traumatic or dysplastic) that affects some of these parts can have an impact on the morphology of the epiphyseal region of the bone, (d) there is a certain analogy between metaphyseal cartilage in amphibians and mammalian epiphyseal cartilage, although the former is not responsible for bone growth, (e) comparative histological and anatomy studies are also warranted, to shed light on the phylogenetic study of epiphyseal cartilage throughout the changes that occur in the animal species.