Multimodal Management of Coexisting Atlantoaxial Subluxation and Spinal Stenosis in an Older Adult: A Case Report and Literature Review.

This case report investigates the diagnostic and therapeutic challenges caused by the coexistence of atlantoaxial subluxation and spinal stenosis in a 70-year-old male patient with chronic progressive numbness in both hands. A detailed assessment showed that the patient's symptoms were primarily caused by spinal stenosis, not atlantoaxial subluxation. Considering the patient's age and preference for nonsurgical treatment, a conservative chiropractic care plan was implemented, significantly improving his symptoms and quality of life. This case highlights the potential benefit of conservative chiropractic care in managing such complex cases, emphasizes the need for meticulous diagnosis, and requires further research to validate these findings and develop comprehensive management guidelines.

Comparison of assistance preferences of older adults with different functional dependence levels on domestic tasks performed by robots.

BACKGROUND: Robots have the potential to assist older adults in their home-based daily living tasks. Previous studies indicated that older adults generally accept robot assistance. However, the preferences of older adults with different functional dependence levels are lacking. These older adults encounter varying levels of difficulty in daily living and may have distinct preferences for robot assistance. This study aimed to describe and compare the preferences for robot assistance on domestic tasks in older adults with different functional dependence levels. METHODS: This cross-sectional descriptive study recruited a convenience sample of 385 older adults in Hong Kong. They were categorized as independent, partially dependent, and dependent using the Katz Index of Independence in Activities of Daily Living. Their preferences for robot assistance on a list of 48 domestic tasks under six categories were assessed through the Assistance Preference Checklist. Differences in preferences between the three groups were compared using one-way ANOVA test. RESULTS: Findings revealed the differences and similarities in preferences between participants with different dependence levels. In most domestic tasks under the personal care category, dependent and partially dependent older adults reported a significantly lower preferences for human assistance or a higher preferences for robot assistance (p < 0.001), compared with the independent ones. The effect size varied from medium to large (eta squared = 0.07 to 0.52). However, participants, regardless of functional dependence levels, preferred human to assist in some domestic tasks under the health and leisure activities category and preferred robot to assist in most of the domestic tasks under the chores, information management, and manipulating objects category. CONCLUSIONS: Older adults with different levels of functional dependence exhibit different preferences for robotic assistance. To effectively use robots and assist older adults as they age, the specific preferences of older adults must be considered before designing and introducing robots in domestic care.

Tai Chi as a Body-Mind Exercise for Promotion of Healthy Aging in Nursing Home Residents: Appropriateness, Feasibility, and Effectiveness.

The lack of activity, opportunity for providing input and participation in activities, and interaction with other people are the features of institutional living which reinforces dependency among nursing home residents. Residents are usually frustrated with paternalistic-type care. Arranging health-oriented meaningful activities for residents contributes to health promotion and enhancement of healthy aging. Moreover, it contributes to the cultivation of a positive meaning of life which is particularly important as residents reach the late geriatric stages of their lives. With exercise being seen as generally beneficial for health, Tai Chi as a Chinese-based exercise with a body-mind emphasis and unique characteristics becomes a particularly suitable exercise in aiding the residents in this major shift of lifestyle. This paper analyzes the appropriateness, feasibility, and effectiveness of Tai Chi in promoting healthy aging for residents. Theoretical considerations and scientific evaluations lend it appropriate, feasible, and effective in providing physiological and psychosocial health benefits to the residents. This paper recommends the use of Tai Chi to promote healthy aging in nursing home residents. With a rapidly aging population and mounting demand for residential geriatric care worldwide, this paper's timely findings should provide important implications for adopting Tai Chi to advance the quality of care delivered by nursing homes worldwide.

Undiagnosed Osteoporotic Vertebral Fractures in an Octogenarian During the Coronavirus Disease Pandemic.

Osteoporotic vertebral fractures are frequently misdiagnosed or under-recognized in the older population, leading to disease progression and reduced quality of life. This case of an 87-year-old woman with acute back pain highlights the importance of early diagnosis and management of fragility fractures. During the coronavirus disease (COVID-19) pandemic, patients with a history of well-managed osteoporosis experienced worsening symptoms of vertebral collapse due to activity limitations and prolonged immobilization. The initial diagnosis of spinal stenosis delayed appropriate treatment for four months. Serial magnetic resonance imaging revealed compression fractures at L1 and L3, and a dual-energy x-ray absorptiometry scan showed osteoporosis with a T-score of -3.2. Pharmacological therapy, including bisphosphonates, was initiated. A comprehensive rehabilitation program with a multidisciplinary approach, with bracing, and lifestyle changes helped stabilize the spine, reduce pain, and maximized function. Her condition improved with close monitoring and guidance during home exercises. This case exemplifies the necessity of a precise and timely diagnosis of osteoporotic vertebral fractures to initiate management and mitigate disease progression.

Adapting the COVID Stress Scale (CSS) to investigate the level of stress among Hong Kong Chinese people 1 year after the COVID-19 pandemic.

BACKGROUND: Stress is a crucial driver that affects hygiene behavior. The Hong Kong population lacks a COVID-19 or pandemic related stress measure investigating the COVID-19 related stress after one year of outbreak. DESIGN AND METHODS: The original COVID Stress Scale (CSS) was translated and culturally adapted into the Chinese (Cantonese) version (CSS-C). Six hundred and twenty-four participants were recruited from the general public to examine the internal consistency, and concurrent and convergent validity of the CSS-C. The test-retest reliability of CSS-C was examined using 39 university students. RESULTS: People with old age, women, single, low educational level and borderline and abnormal levels of anxiety and depression were likely to perceive high level of COVID-19 related stress. All CSS-C subscales demonstrated good internal consistency, moderate to good test-retest reliability, and weak to moderate correlations with various mental health-related measures. DISCUSSION: The CSS could help monitor the stress associated the current and potential future pandemics.

A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy.

This study examined the incidence and severity of adverse events (AEs) of patients receiving chiropractic spinal manipulative therapy (SMT), with the hypothesis that < 1 per 100,000 SMT sessions results in a grade ≥ 3 (severe) AE. A secondary objective was to examine independent predictors of grade ≥ 3 AEs. We identified patients with SMT-related AEs from January 2017 through August 2022 across 30 chiropractic clinics in Hong Kong. AE data were extracted from a complaint log, including solicited patient surveys, complaints, and clinician reports, and corroborated by medical records. AEs were independently graded 1-5 based on severity (1-mild, 2-moderate, 3-severe, 4-life-threatening, 5-death). Among 960,140 SMT sessions for 54,846 patients, 39 AEs were identified, two were grade 3, both of which were rib fractures occurring in women age > 60 with osteoporosis, while none were grade ≥ 4, yielding an incidence of grade ≥ 3 AEs of 0.21 per 100,000 SMT sessions (95% CI 0.00, 0.56 per 100,000). There were no AEs related to stroke or cauda equina syndrome. The sample size was insufficient to identify predictors of grade ≥ 3 AEs using multiple logistic regression. In this study, severe SMT-related AEs were reassuringly very rare.

Physical Activity Level of Physically Independent Older Adults in a Densely Populated City.

The aim of this study was to estimate older adults' physical activity level in all types and categories of physical activities and calculate their total physical activity level. This cross-sectional descriptive study estimated the physical activity level of older adults on a quota sample of 500 physically independent older adults living in a densely populated city (in this case, Hong Kong). It used the Physical Activity Questionnaire (Hong Kong version) to assess participants' physical activity level. Based on the frequency, duration, and intensity of each type of physical activity being performed by the participants, their physical activity level in terms of energy expenditure (in kilocalories per day) for all types and categories of physical activities and the total physical activity level were calculated. Independent t test or analysis of variance, whatever appropriate, was used to examine the difference in the total physical activity level between participants with different individual characteristics. Linear regression analysis was conducted to determine the contribution of individual characteristics to the total physical activity level (p < .05). Results indicated that the participants mostly engaged in leisurely sitting, watching television, listening to radio, and leisurely walking. They spent the greatest amount of energy on the category of "leisure activity" (710.77 kcal/day). Their total physical activity level was 1,727.09 kcal/day, which was much less than previously reported. Linear regression indicates that age accounted for 3.1% of the variance of the total physical activity level (p = .001) with senior older adults warranting additional support. Future research is suggested to confirm the role of specific neighborhood-level factors on the physical activity performance of older adults.

Caring for Older People during and beyond the COVID-19 Pandemic: Experiences of Residential Health Care Workers.

Older people and health care workers in residential care homes are particularly vulnerable to the adverse impacts of the COVID-19 pandemic. As COVID-19 has been spreading around the world for more than two years, the nature of care delivery has been substantially transformed. This study aims at understanding the long-term and ongoing impacts of COVID-19 on the delivery of care in residential care homes. It investigates how the delivery of care has been transformed by the COVID-19 pandemic and how health care workers adapted to these changes from the perspectives of frontline health care workers. Semi-structured interviews were conducted from February to December 2021 with a purposive sample of 30 health care workers from six residential care homes in Hong Kong. Thematic analysis identified three themes, including (1) enhancing infection prevention and control measures; (2) maintaining the psychosocial wellbeing of residents; and (3) developing resilience. Discussions and implications were drawn from these findings.

Cervical Spondylosis as a Hidden Contributing Factor to Fibromyalgia: A Case Report.

The present case study describes the long-term symptomatic remission in a patient with fibromyalgia (FM) after multimodal spinal manipulation. A 44-year-old woman presented with a chronic headache, severe neck pain, shoulder pain, and back pain lasting for 2 years after experiencing domestic violence. She had sleep disorders, fatigue, and depressive mood. Her primary care physician diagnosed her with FM and comorbid depression. Despite treatment with non-steroidal anti-inflammatory drugs, muscle relaxants, anti-depressants, anti-epileptics, acupuncture, and aqua-therapy, she experienced no appreciable relief from her symptoms. The patient then sought a chiropractic evaluation and potential treatment for her symptoms. At presentation, widespread tenderness was palpable over the neck, shoulder, back, anterior chest, abdominal wall, and buttock. Radiographs showed loss of cervical lordosis, widespread degenerative spondylosis, and osteitis pubis. Surface electromyography (sEMG) revealed neck and thoracic paraspinal muscular spasms. The patient was diagnosed with FM based on the American College of Rheumatology diagnostic criteria and the associated comorbidities. Multimodal chiropractic approaches, which consisted of spinal manipulation, massage, and intermittent motorized cervical traction, were used twice weekly to relieve soft-tissues and intervertebral joints and stretch core musculatures. The patient's physical and mental complaints were mostly resolved near the end of 9 months of treatment. Her symptom alleviation was associated with corresponding change in normalized sEMG signal and cervical spine realignment at the 16th- and 26th-month follow-ups. Widespread pain in FM can lead to confused thinking and a lack of awareness of cervical spondylosis. In this example, it is assumed that the noxious cervical inputs triggered an ongoing FM process. Chiropractic treatment blocked noxious inputs coming from pain sources, corrected pain thresholds, and lowered excitability, thereby eradicating FM symptoms.

Chiropractic Management of Neck Pain Complicated by Symptomatic Vertebral Artery Stenosis and Dizziness.

BACKGROUND Vertebrobasilar insufficiency (VBI) is most often caused by vertebrobasilar atherosclerosis, often presenting with dizziness and occasionally neck pain. Little research or guidelines regarding management of neck pain in affected patients exists. CASE REPORT A 62-year-old male hypertensive smoker presented to a chiropractor with a 13-year history of insidious-onset neck pain, dizziness, and occipital headache with a Dizziness Handicap Inventory (DHI) of 52%. The patient had known VBI, caused by bilateral vertebral artery plaques, and cervical spondylosis, and was treated with multiple cardiovascular medications. The chiropractor referred patient to a neurosurgeon, who cleared him to receive manual therapies provided manual-thrust cervical spinal manipulative therapy (SMT) was not performed. The chiropractor administered thoracic SMT and cervicothoracic soft tissue manipulation. The neck pain and dizziness mostly resolved by 1 month. At 1-year follow-up, DHI was 0%; at 2 years it was 8%. A literature search revealed 4 cases in which a chiropractor used manual therapies for a patient with VBI. Including the present case, all patients had neck pain, 60% had dizziness, and all were treated with SMT either avoiding manual cervical manipulation altogether or modifying it to avoid or limit cervical rotation, yielding positive outcomes. CONCLUSIONS The present and previous cases provide limited evidence that some carefully considered chiropractic manual therapies can afford patients with VBI relief from concurrent neck pain and possibly dizziness. Given the paucity of research, cervical SMT cannot be recommended in such patients. These findings do not apply to vertebral artery dissection, for which SMT is an absolute contraindication.

Living in a Region With a Low Level of COVID-19 Infection: Health Belief Toward COVID-19 Vaccination and Intention to Receive a COVID-19 Vaccine in Hong Kong Individuals.

INTRODUCTION: Vaccination is vital for controlling the COVID-19 pandemic. Individuals' vaccination intention is a good predictor of vaccine uptake and is influenced by individuals' health belief toward vaccination. Regions with different levels of pandemic severity may present varying effects. This study aimed to determine the influence of health belief on COVID-19 vaccination intention in a region with a low level of COVID-19 infection. METHODS: This cross-sectional telephone survey was conducted on a quota sample of 800 adults in Hong Kong before the commencement of the local COVID-19 vaccination program. The Health Belief Model Scale-COVID-19 was developed to assess health belief toward COVID-19 vaccination. The contribution of health belief on explaining intention to receive the COVID-19 vaccine was assessed using logistic regression. RESULTS: The subjects demonstrated moderate levels in all aspects of health belief. Only 28.9% of the subjects indicated an intention to receive a COVID-19 vaccine. After controlling for age, educational level, marital status, and high risk status, the logistic regression analysis indicated that perceived benefits of vaccination (OR = 1.615; CI 95%: 1.443-1.807; P < .001), perceived susceptibility to COVID-19 (OR = 1.130; CI 95%: 1.032-1.237; P = .008), cues to action toward vaccination (OR = 1.212; CI 95%: 1.108-1.326; P < .001), and perceived barriers to vaccination (OR = .696; CI 95%: .641-.756; P < .001) were associated with intention to receive a COVID-19 vaccine. CONCLUSION: Vaccination campaigns in regions with good control of the pandemic should promote the benefits of vaccination, emphasizing how it can help individuals regain a sense of normalcy in their daily lives and stop the spread of COVID-19. Although the COVID-19 pandemic affects countries worldwide, this study highlights the importance of adopting specific vaccination promotion strategies for regions with different levels of pandemic severity.

Chiropractic care for low back pain, gait and posture in a patient with Parkinson's disease: a case report and brief review.

Parkinson's disease (PD) is a progressive neurological disorder with cardinal motor features of tremor, bradykinesia, muscle rigidity, impaired gait and posture. Muscular pain or arthralgia is a common non-motor symptom in PD. The PD-related pain is probably attributed to a combination of altered posture, abnormal muscle tone, and truncal dystonia. A 59-year-old male taxi-driver with PD treated with levodopa for 18 months complained of progressive low back pain and gait difficulties that prevented him from normal activities in the past 2 months. Magnetic resonance imaging showed degenerative disc disease with multiple levels of bulging discs in the lumbar spine. After 35 chiropractic sessions, there was a significant improvement in various aspects of well-being, including pain resolution measured by a numeric rating scale, physical and mental improvement measured by the Parkinson's Disease Questionnaire, gait stability depicted by gait cyclogram, and better postural alignment and stability assessed by radiographic parameters. The current study may serve as an example of spinal manipulation showing the potential to address gait and posture problems associated with pain in a patient with PD. Aging changes in the muscles, bones and joints may accompany PD. Although PD itself is an incurable neurodegenerative disease, functional capacity of the musculoskeletal system can be enhanced by different types of manual therapy, by means of improving muscle strength, joint mobility, and postural balance. The actual duration in sustaining improved outcomes following a course of manipulative intervention remains to be determined.

Examining social context and the pathways to mental wellness in young adults during social movement: A parallel mediation analysis.

BACKGROUND: Good family relationships are important for mental health. However, the mechanism linking family perceptions to mental wellness during political and social turmoil remains unclear. This study aimed to examine whether psychological and social factors could protect university students from detrimental mental health conditions in a time of social chaos. METHODS: Participants included young adults (n = 1874, mean age = 22.19 years) who had been enrolled in Hong Kong local tertiary intuitions during Hong Kong's 2019 social movement. An online survey assessing various conditions, including family satisfaction, social support, personal resilience, negative moods, sense of school belonging, and mental health conditions before and during the movement, was administered to these students. Mediation analyses were performed to examine the role of negative affect, support from family, and school belongingness as mediators of the association between family satisfaction and mental health condition during the movement overall and by resilience subgroups. RESULTS: Higher levels of satisfaction with family relationships before the onset of movement was associated with lower levels of negative affect and higher levels of support from family and school belongingness during the movement, in turn benefiting the student's mental health. The links of family satisfaction and school belongingness with mental wellness were particularly strong among low-resilient students. LIMITATIONS: Mediation analysis using retrospective survey data CONCLUSIONS: Family conditions would interact with personal resilience to influence mental health status during social turmoil. The findings underscore the importance of early interventions particularly for those students facing family difficulties to enhance their social chaos and emergency preparedness.

Reuse of face masks among adults in Hong Kong during the COVID-19 pandemic.

BACKGROUND: During the COVID-19 pandemic, over 99% of adults in Hong Kong use face masks in public. With the limited supply of face masks in the market and the uncertainty about the future development of COVID-19, reusing face masks is a legitimate way to reduce usage. Although this practice is not recommended, reusing face masks is common in Hong Kong. This study aimed to examine the practice of reusing face masks among adults in Hong Kong during the COVID-19 pandemic and its association with their health beliefs toward this health crisis. METHODS: A cross-sectional descriptive study was conducted. A quota sample of 1000 adults was recruited in Hong Kong in April 2020. Guided by the Health Belief Model, the subjects were invited to answer questions on their practice of reusing face masks and health beliefs toward COVID-19 through telephone interview. Their practice on reuse, storage, and decontamination of used face masks were summarized by descriptive statistics. The difference in health beliefs between the subjects who reused and did not reuse face masks was examined by conducting an independent t test. The association between health beliefs and reuse of face masks was determined by conducting a logistic regression analysis. RESULTS: One-third (n = 345, 35.4%) of the subjects reused face masks in an average of 2.5 days. Among them, 207 subjects stored and 115 subjects decontaminated their used face masks by using various methods. The subjects who reused face masks significantly perceived having inadequate face masks (t = 3.905; p <  0.001). Having a higher level of perception of having inadequate face masks increased the likelihood of reusing face masks (OR = 0.784; CI 95%: 0.659-0.934; p = 0.006). CONCLUSION: Despite having 90 face masks in stock, the adults who reused face masks significantly perceived that they had inadequate face masks. Concerted effort of health care professionals, community organizations, and the government will improve individuals' practice in use of face masks and alleviate their actual and perceived feeling of having inadequate face masks, which lead them to reuse.

Craniocervical instability associated with rheumatoid arthritis: a case report and brief review.

Rheumatoid arthritis (RA) is an autoimmune disease that affects the synovial tissue which lines joints and tendons. The craniocervical junction is made up exclusively of synovial joints and ligaments and especially vulnerable to the inflammatory process of RA. The chronic inflammation of RA leads to loss of ligamentous restriction and erosion of the bony structures and results in craniocervical instability (CCI). This is a case report of an 80-year-old woman who had been diagnosed with seropositive RA two decades ago presented with head dropping and losing balance while walking for several months. Radiographic images of the cervical spine showed RA-related features of instability in the form of atlantoaxial instability, cranial settling and subaxial subluxation. Since physical therapy and acupuncture previously failed to provide a substantial, long-lasting outcome, the patient sought chiropractic care for her condition. The chiropractic regimen consisted of upper thoracic spine mobilization/adjustment, electrical muscle stimulation of the cervical extensors, home exercises and neck bracing. She regained substantial neck muscle strength, gaze angle and walking balance following a 4-month chiropractic treatment, although cervical kyphosis persisted. The current study aims to provide basic knowledge of CCI associated with RA and ability to modify a treatment program to accommodate the needs of patients with coexisting red flags.

Practice and technique of using face mask amongst adults in the community: a cross-sectional descriptive study.

BACKGROUND: The proper use of face mask comprises the correct practice and wearing technique and is important in preventing the spread of respiratory infections. Previous studies have addressed only the aspect of practice and failed to provide a detailed account of face mask usage amongst community-based populations. This study examined the practice and technique of using face mask amongst adults. METHODS: A cross-sectional descriptive design was adopted. A quota sample of 1500 adults was recruited in Hong Kong during a nonepidemic state between January and February 2017. The participants' practice of using face mask in five given situations was assessed using a questionnaire. Their technique in using face mask, including 12 steps, was assessed using an observation checklist. Statistical tests were used to compare the differences in practice and technique amongst adults of different gender and age groups. RESULTS: Findings revealed that the performance of the participants in both categories was unsatisfactory. In terms of practice, less than one-fifth of the participants reported that they always wore face mask when taking care of family members with fever (14.7%) or respiratory infections (19.5%). Male adults and those aged 55-64 reported low frequency in using face mask during required situations. In terms of technique, none of the participants performed all the required steps in using face mask correctly. More than 90% of the participants did not perform hand hygiene before putting on (91.5%), taking off (97.3%), or after disposing (91.5%) face mask. Adults aged 55 and above performed poorer than adults in the younger age groups. CONCLUSION: Compared with previous findings obtained during an epidemic, the performance of the participants during a nonepidemic state was less satisfactory. The possibility of developing fatigue after exposure to repeated epidemics was discussed. This study contributes to a comprehensive understanding of the use of face mask in a community and reveals the underperformed areas. Effort is required to enhance the proper practice of using face mask, convey the message that hand hygiene is an essential step in wearing and taking off a face mask and increase the public's general concern in the value of using face mask.

Sleep quality of middle-aged Tai Chi practitioners.

AIM: This study aimed to assess the association between Tai Chi and sleep quality in middle-aged Tai Chi practitioners. METHODS: This cross-sectional descriptive study recruited a convenience sample of 250 middle-aged Tai Chi practitioners. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI). Descriptive statistics such as frequency and percentage were used to describe the demographic characteristics of the subjects. Pearson's product-moment correlation was used to determine the relationship between sleep quality and duration of practicing Tai Chi. anova was used to compare difference in sleep quality among subjects practicing different styles of Tai Chi. Linear regression was conducted to determine the contribution of duration of practicing Tai Chi and the style of Tai Chi being practiced to explaining sleep quality. RESULTS: Subjects had practiced Tai Chi for 4.7 years. They reported a global PSQI score of 5.3. Among the subjects, 156 were classified as good sleepers (PSQI score, <5). No significant relationship was reported between sleep quality and duration of Tai Chi practice (P = 0.175). No significant differences in sleep quality were found among subjects who practiced different styles of Tai Chi (P = 0.876). Linear regression analysis indicated that the duration of practicing Tai Chi and the style of Tai Chi being practiced did not make a significant contribution to sleep quality. CONCLUSION: The present study represented an initial attempt to investigate the sleep quality among middle-aged Tai Chi practitioners. It serves to generate hypotheses for future testing.

Job stress among nurses in China.

Job stress is a well-known situation for nurses, especially for those working in the clinical environment. The purpose of this descriptive study was to examine the job stress level and stressors among nurses in a Zhuhai hospital. Ninety-three nurses were recruited for the study. Findings were that nurses had a relatively high level of stress, with "Working Environment and Resources" and "Workload and Time" identified as the major stressors. This study provided preliminary insights on relieving job stress among nurses in China.

Using the Roy adaptation model to develop an antenatal assessment instrument.

The utility of a nursing model as a framework to understand and explain a health phenomenon is fundamental to guide nursing practice. In this article, the authors aim to provide an examination of the Roy adaptation model as a basis for the development of an instrument used for assessing the health needs of pregnant women. With the congruence between the concepts in the Roy adaptation model and antenatal practice, an antenatal assessment instrument is developed. The assessment areas focus on pregnant women's behaviors in the four adaptation modes. The current experience is valuable for nurses who are involved in instrument development and midwifery practice.