Standard values of the upper body posture in healthy adults with special regard to age, sex and BMI.

In order to classify and analyze the parameters of upper body posture in clinical or physiotherapeutic settings, a baseline in the form of standard values with special regard to age, sex and BMI is required. Thus, subjectively healthy men and women aged 21-60 years were measured in this project. The postural parameters of 800 symptom-free male (n = 397) and female (n = 407) volunteers aged 21-60 years (Ø♀: 39.7 ± 11.6, Ø â™‚: 40.7 ± 11.5 y) were studied. The mean height of the men was 1.8 ± 0.07 m, with a mean body weight of 84.8 ± 13.1 kg and an average BMI of 26.0 ± 3.534 kg/m2. In contrast, the mean height of the women was 1.67 ± 0.06 m, with a mean body weight of 66.5 ± 12.7 kg and an average BMI of 23.9 ± 4.6 kg/m2. By means of video rasterstereography, a 3-dimensional scan of the upper back surface was measured when in a habitual standing position. The means or medians, confidence intervals, tolerance ranges, the minimum, 2.5, 25, 50, 75, 97.5 percentiles and the maximum, plus the kurtosis and skewness of the distribution, were calculated for all parameters. Additionally, ANOVA and a factor analyses (sex, BMI, age) were conducted. In both sexes across all age groups, balanced, symmetrical upper body statics were evident. Most strikingly, the females showed greater thoracic kyphosis and lumbar lordosis angles (kyphosis: Ø â™€ 56°, Ø♂ 51°; lordosis: Ø â™€ 49°, Ø♂ 32°) and lumbar bending angles (Ø â™€ 14°, Ø♂ 11°) than the males. The distance between the scapulae was more pronounced in men. These parameters also show an increase with age and BMI, respectively. Pelvic parameters were independent of age and sex. The upper body postures of women and men between the ages of 21 and 60 years were found to be almost symmetrical and axis-conforming with a positive correlation for BMI or age. Consequently, the present body posture parameters allow for comparisons with other studies, as well as for the evaluation of clinical (interim) diagnostics and applications.

Symmetrical dental occlusion blocking - changes of body sway and weight distribution in healthy subjects across 4 age decades.

OBJECTIVES: Symmetrical dental occlusion blocking is used in dentistry as a quick diagnostic tool to test for potential influences of the craniomandibular system on body sway and weight distribution. This study presents the changes of body sway and pressure distribution in healthy subjects, free of a temporomandibular dysfunction (TMD). Immediate effects between occlusal blocking and rest position on body sway and body weight distribution in general, as well as for both genders and for four age decades will be evaluated. MATERIALS AND METHODS: 725 (396f/329 m) subjects (neither subjective signs of TMD nor acute/chronic complaints in the musculoskeletal system) volunteered (21 to 60 years) while both genders were divided into four age groups according to decades. A pressure measuring platform was used. Body sway and weight distribution were recorded in two dental occlusion conditions (a) in rest position and (b) symmetrical blocking (bicuspid region) by cotton rolls. RESULTS: Both, the frontal sway and the sagittal sway reduced by 0.67 mm (t(724) = - 3.9 (p <  0.001)) and by 0.33 mm (t(724) = - 3.4 (p <  0.001)). The relative pressure under the left forefoot increased by 0.33% (t(724) = 2.88 (p <  0.001)) and the relative pressure overall under the forefoot increased by 0.67% (t(724) = - 3.4 (p <  0.001)). Gender-specific, age-specific and BMI-specific reactions could not be identified. CONCLUSIONS: Subjects, free of any TMD and with no complaints of the musculoskeletal system, show small changes of the body sway and weight distribution when biting symmetrically on a cotton roll. These changes are independent of age, gender or body mass index (BMI). Due to the relative large sample size, the presented results can also be seen as norm values when body sway is used as an additional assessment of a TMD.

Association between constitution, axiography, analysis of dental casts, and postural control in women aged between 41 and 50 years.

OBJECTIVES: The aim of this study was to investigate the relationship between anamnestic, axiographic and occlusal parameters and postural control in healthy women aged between 41 and 50 years. MATERIALS AND METHODS: A total of 100 female participants aged between 41 and 50 (45.12 ± 2.96) years participated in the study. In addition to completing a general anamnesis questionnaire, lower jaw movements were measured axiographically, dental occlusion parameters were determined using a model analysis and postural parameters were recorded using a pressure measurement platform. The significance level was 5%. RESULTS: An increasing weight and a rising BMI lead to a weight shifted from the rearfoot (p ≤ 0.01/0.04) to the forefoot (p ≤ 0.01/0.02). A limited laterotrusion on the right resulted in a lower forefoot load and an increased rearfoot load (p ≤ 0.01). Laterotrusion to the left (extended above the standard) showed a lower frontal sway (p ≤ 0.02) and a reduced elliptical area, height and width (p ≤ 0.01, 0.02, 0.03). Thus, the extent of deviation correlated with reduced right forefoot loading (p ≤ 0.03) and the extent of deflection correlated with increased left foot loading (p ≤ 0.01). The higher the extent of angle class II malocclusion, the larger the ellipse area (p ≤ 0.04) and the ellipse height (p ≤ 0.02) resulted. CONCLUSIONS: There is a connection between weight, BMI and laterotrusion, as well as between angle class II malocclusion and postural control in women aged between 41 and 50 years. Interdisciplinary functional examinations of mandibular movements treating possible limitations can be conducive for an improvement of postural control. CLINICAL RELEVANCE: Angle class II malocclusion has a negative influence on postural control.

Systematic changes of the static upper body posture with a symmetric occlusion condition.

BACKGROUND: Temporary occlusal changes and their influence on the upper body statics are still controversially discussed. Furthermore, concrete statements on whether age- or gender-specific differences in neurophysiological reactions exist are missing. Therefore, it is the aim of this study to evaluate the immediate effects of a symmetrical occlusion blocking on the upper body posture. These effects shall be investigated for both genders and for a larger age range. METHODS: In this study, 800 (407f/393 m) subjects volunteered aged from 21 to 60 years. Both genders were divided into four age groups according to decades. The three-dimensional upper body posture was measured by using the rasterstereography (ABW-Bodymapper). The habitual static posture was measured in two dental occlusion conditions (a) in rest position and (b) symmetrical blocking in the bicuspid region by cotton rolls. RESULTS: A significant reduction of the trunk length (0.72 mm; p <  0.001), an increase of the lumbar (0.30°; p <  0.001) and the thoracic bending angle (0.14°; p = 0.001), a reduction of the spinal forward decline (0.16°; p <  0.001) and a reduction of the scapular distance (0.36 mm; p = 0.001) was found. Gender-specific reactions can only be recorded in scapular distance, in that regard men reduce this distance while over all age groups women did not show a significant change. DISCUSSION: Slight gender- and age-independent reactions due to a symmetric occlusion blockade are shown: A gender independent reaction of the spinal related variables in the sagittal plane (thoracic and lumbar flexion angle, trunk length, spinal forward decline). In addition, a gender specific change of the shoulder blade distance could be observed, where men reduced the distance while female did not show a change. However, since these reactions are of a minimum amount, it can be concluded that neurophysiological compensation mechanisms work equally well regardless of age and sex, and the upper body posture of healthy people changes only very slightly due to a temporarily symmetrical altered bite position.

Effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia: A systematic review.

BACKGROUND: Hospital readmission soon after discharge is common and costly. To date, published studies of effectiveness of structured discharge process addressing reduction of hospital readmission have focused on patients with chronic conditions and complex needs, but not in adult patients with community acquired pneumonia. OBJECTIVES: To examine and synthesise the best available evidence related to effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia. INCLUSION CRITERIA: This review considered studies that included hospitalised adult patients diagnosed with community acquired pneumonia regardless of gender, ethnicity, severity, and co-morbidities.Structured discharge process related to early patient engagement, patient-caregiver dyad intervention, transitional care, coordinated care, and multidisciplinary team approach.The outcome measures included in this review were hospital readmission, emergency room visits, and unscheduled visits to healthcare provider.Randomised controlled trials (RCTs) and quasi-experimental studies were considered for inclusion. SEARCH STRATEGY: The search strategy aimed to find both published and unpublished studies in English language without date limits. A search of PubMed/MEDLINE, CINAHL, CINAHL Plus, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, Academic Search Premier, Health Source Nursing/Academic Edition and seven other databases was conducted. METHODOLOGICAL QUALITY: Studies were critically appraised by two independent reviewers using the Joanna Briggs Institute's standardised critical appraisal tool. DATA EXTRACTION: Data were extracted using the standardised Joanna Briggs Institute's data extraction instruments. DATA SYNTHESIS: Statistical pooling in meta-analysis was not appropriate. Findings are presented in a narrative form. RESULTS: Three articles were included in the review, two RCTs and one pseudo-randomised controlled clinical trial. Structured discharge process did not have a positive impact in reducing hospital readmission at 30, 90, and 180 days and in reducing emergency room visit at 30 days. The outcome measure of unscheduled visit to healthcare provider was not measured in any of the three studies. The incorporation of medication reconciliation with follow-up telephone calls either by an advanced practice nurse, care coordinator, or a clinical pharmacist were effective strategies in reducing hospital readmission in all three studies and in reducing emergency room visits in one of the studies. CONCLUSIONS: Medication reconciliation with the addition of follow-up telephone calls and incorporation of either an advanced practice nurse, care coordinator, or a clinical pharmacist using a multidisciplinary team approach may have implications in existing coordination of care of adult patients with community acquired pneumonia.This review recommends use of medication reconciliation with follow-up telephone calls either by an advanced practice nurse, care coordinator, or a clinical pharmacist as part of the structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia.Further research is needed in examining the effectiveness of structured discharge process in reducing hospital readmission of adult patients with community acquired pneumonia.

A pilot study to assess the use of megesterol acetate to promote weight gain in frail elderly persons residing in long-term care.

OBJECTIVE: The purpose of this pilot study was to determine the effectiveness of megesterol acetate (MA) for increasing body weight of frail older persons residing in long-term care settings. DESIGN: A retrospective study. SETTING: Two long-term care facilities in a large city in the southwestern US. PARTICIPANTS: Six white residents (five female, one male, mean age 87.8 years) of the facilities who had a sustained weight loss of 5% in 1 month or 10% in 6 months or longer. MEASUREMENTS: Weight gain or loss of participants receiving 480 milligrams of megesterol acetate for a minimum of 28 consecutive days. RESULTS: Five of the six subjects gained weight over a 2-month period after taking 480 milligrams of MA for 1 month or more. There was a delayed effect of non-fluid weight gain that was statistically significant 2 months after the end of treatment. One woman with diagnoses of stroke, arthritis, and hypertension lost weight despite taking MA continuously for 84 days. CONCLUSIONS: Results suggest that MA has been underutilized by geriatric health professionals as an intervention to ameliorate or reverse anorexia of aging after other nutritional efforts have failed. Using MA to prevent unintentional weight loss and malnutrition may significantly improve the health status of older patients. A prospective study using a larger sample and based on ideal weight should be carried out to evaluate the benefit of MA, with particular attention to weight gain that persists after 2 months. Future studies should also take into account the high dropout rate of participants and consider earlier intervention with MA.

Measuring the impact of advanced practice nursing on achieving cost-quality outcomes: issues and challenges.

This article describes the issues and challenges that are inherent in conducting cost-quality outcomes research related to the advanced practice nurse role. As consumers of this research, nurse administrators need to be aware of these issues in order to make informed, organizationally rational decisions. Following discussion of the issues, recommendations are offered for factors to consider when using results of published research findings.

A case control study of factors associated with congenital syphilis

Congenital syphilis now occupies a high priority as a public health concern. In 1994, a case control study was conducted to elucidate factors associated with congenital syphilis. Cases (n=61) were obtained from the Bustamante Hospital for Children, Victoria Jubilee Hospital and the University Hospital of the West Indies. Data collection was done by hospital records review. Results indicate that mothers of cases were more likely to be unmarried (p<0.005), unemployed and unskilled (p<0.03). The time of mother's first antenatal visit (p<0.03) and, the type of health care facility where antenatal service was sought were significantly associated with congenital syphilis (p<0.0001). Cases were predominantly from the parish of Kingston & St. Andrew and were more likely to have been of low birth weight, less than 2.5 kilograms (p<0.0001). As expected, cases were significantly associated with mothers who were positive for syphilis (p<0.0001). Recommendations are to develop strategies for reduction in the vulnerability of the "at risk" population as well as promotion of early antenatal attendance of pregnant females thereby facilitating early treatment of maternal syphilis (AU)

Apolipoprotein B mRNA editing is associated with UV crosslinking of proteins to the editing site.

Apolipoprotein (apo) B100 mRNA undergoes editing of C-6666 to a U residue, which generates a stop-translation codon and defines the carboxyl terminus of apoB48. To aid purification of the editing enzyme we have undertaken UV crosslinking of a 32P-labeled substrate for apoB mRNA editing in vitro to proteins in an enterocyte editing extract. Proteins of 60 (p60) and 43 (p43) kDa, prominent among crosslinking bands, were competed for by unlabeled substrate, but not by nonspecific RNA, and did not crosslink to antisense RNA. Editing in vitro and UV crosslinking were inhibited by NaCl and vanadyl ribonucleoside complexes and by chemical modification of sulfhydryl, imidazolium, and guanidinium groups on the protein. The editing activity copurified predominantly with p60. To define the binding site for p60 on the substrate RNA, a series of scanning and point mutant RNAs, previously used to define nucleotides 6671-6681 as essential for editing, were used in competition studies with wild-type substrate. Results demonstrated that p60 binding is centered on nucleotides 6671-6674. We suggest that p60 contains the RNA-recognition component of the apoB mRNA-editing enzyme.