Evaluation of the effectiveness of the standard traditional Korean medicine-based health promotion program for disadvantaged children in South Korea.

BACKGROUND: Traditional Korean Medicine (TKM) is highly integrated with the modern health care system of South Korea and is actively used in the public health field. Since 2014, the Ministry of Health and Welfare of South Korea has supported the development of standard models for TKM-based health promotion programs. This study aimed to develop and evaluate a standard TKM-based health promotion program for disadvantaged children. METHODS: Using convenience sampling, we recruited 16 Community Children's Centers (CCCs) located in Busan and Yangsan, South Korea, which are welfare daytime facilities for children from socially disadvantaged families. The CCCs were divided into two groups of eight CCCs-intervention CCCs and control CCCs-through random allocation, and children in each group were selected as subjects for the study. For 12 weeks, the TKM-based health promotion program developed in this study along with the basic services of CCCs were applied to children in the intervention group, and only the basic services of CCCs were provided to children in the control group. Data were obtained through pre- and post-surveys with the legal representatives of the children prior to implementing the program and after the 12-week program, respectively. The outcome variables-the number of outpatient visits, absences, lateness/early leaves, infectious symptoms, and EuroQol-5D and EQ-visual analog scale scores-were measured and statistically compared between the groups by descriptive analysis, chi-square test, t-test, and difference-in-differences model with regression analysis. RESULTS: At baseline, there were 156 children in the intervention group and 153 children in the control group, among which 155 and 147 children, respectively, were included in the analysis. Results indicated that the number of outpatient visits was significantly lower (by 65%) in the intervention group than in the control group (p = 0.03), and this was similar in the sensitivity analysis. Regarding other outcome variables, the effects were not consistently significant. CONCLUSIONS: A standard TKM-based health promotion program has the potential to improve the health of disadvantaged children. In the future, studies with long-term interventions and a larger sample are needed to enhance the applicability of these programs in communities.

Effects of arch-support orthoses on ground reaction forces and lower extremity kinematics related to running at various inclinations.

While foot orthoses are commonly used in running, little is known regarding biomechanical risk potentials during uphill running. This study investigated the effects of arch-support orthoses on kinetic and kinematic variables when running at different inclinations. Sixteen male participants ran at different inclinations (0°, 3° and 6°) when wearing arch-support and flat orthoses on an instrumented treadmill. Arch-support orthoses induced longer contact time, larger initial ankle dorsiflexion, maximum ankle eversion, and knee sagittal range of motion (RoM) (p < 0.05). As incline slopes increased, vertical impact peak and loading rate, stride length, and ankle coronal RoM decreased, but contact time, stride frequency, initial ankle dorsiflexion and inversion, maximum dorsiflexion, initial knee flexion, and ankle sagittal RoM increased (p < 0.05). Furthermore, knee sagittal RoM was lowest when running at an inclination of 3°. The interaction effect indicated that in arch-support condition, participants running at 6° induced higher maximum ankle eversion than running at 0° (p < 0.05), while no differences were found in flat orthosis condition. These findings suggest that the use of arch-support orthoses would influence running biomechanics that is related to injury risks. Running at higher inclination led to more alterations to biomechanical variables than at lower inclination.

The effects of downhill slope on kinematics and kinetics of the lower extremity joints during running.

BACKGROUND: The purpose of this study was to investigate how lower extremity kinematics and kinetics change when running downhill. METHODS: Fifteen male recreational runners ran on an instrumented treadmill with three different slope conditions [level (0°), moderate (-6°), and steep (-9°)] at a controlled speed of 3.2 m/s. Ten consecutive steps were selected for analysis for each of the slope conditions and the order of slope conditions was randomized. Synchonized motion analysis and force plate were used to determine joint kinematics and kinetics. RESULTS: Compared to level running, participants demonstrated significantly larger knee flexion but smaller ankle plantar-flexion and hip flexion during downhill running (Ps < 0.05). Significantly smaller peak propulsive ground reaction forces and posterior impulses were found during downhill running (Ps < 0.05). Furthermore, participants experienced significantly larger extension moment and negative joint power at the knee (Ps < 0.05) but smaller plantar-flexion moment and negative joint power at the ankle during downhill running (Ps < 0.05). Negative net joint work increased for all joints with increased declinations and the knee joint showed the greatest increase in negative net joint work amongst the three joints (Ps < 0.05). SIGNIFICANCE: These findings indicate that runners modify their running mechanics resulting in greater kinetic demand on the knee during downhill running. Differences in lower extremity injury mechanisms with different running slopes may be linked to the changes in loading at the knee but further investigation using clinical trials is needed to support the potential relationship.

Evaluation of Outcomes of the Busan Community-based Palliative Care Project in Korea.

PURPOSE: This study aimed to evaluate the outcomes of a community-based palliative care project conducted in Busan city, Korea, from 2013 to 2015. METHODS: We selected four outcome indices based on the project's outcomes derived from a logic model and used a longitudinal and cross-sectional comparative design approach depending on the outcome index. RESULTS: The utilization rate of palliative care increased from 9.2% in 2012 to 41.9% in 2015. Regarding symptom changes in 65 patients receiving palliative care at 3 and 6 months (mean age = 72 years, standard deviation = 9.64, 55.4% women), pain, anxiety, and depression had improved. Quality of life was higher among palliative care patients compared with patients who did not receive palliative care (t = 2.09, p = .039). Regarding recognition of palliative care, civil servants at public health centers who participated in the pilot project (2013-2014) scored higher than those at public health centers who began participation in 2015 (t = 2.67, p = .008). CONCLUSION: This is the first study in Korea that systematically evaluated community-based palliative care. The Busan Community-based Palliative Care Project improved the quality of life of palliative care patients by providing services at an appropriate level and by raising the recognition of palliative care in the community. To increase the utilization ratio of palliative care and the quality of service, strategies should be developed to supplement medical support systems.

Understanding the impact loading characteristics of a badminton lunge among badminton players.

BACKGROUND: The rapid and repetitive badminton lunges would produce strenuous impact loading on the lower extremities of players and these loading are thought to be the contributing factors of chronic knee injuries. This study examined the impact loading characteristics in various groups of badminton athletes performing extreme lunges. METHODS: Fifty-two participants classified into male skilled, female skilled, male unskilled, and female unskilled groups performed badminton lunge with their maximum-effort. Shoe-ground kinematics, ground reaction forces, and knee moments were measured by using synchronised force platform and motion analysis system. A 2 (gender) x 2 (skill-level) factorial ANOVA was performed to determine the effects of different gender and different playing levels, as well as the interaction of two factors on all variables. RESULTS: Male athletes had faster approaching speed (male 3.87 and female 1.08 m/s), longer maximum lunge distance (male 1.47 and female 1.16 m), larger maximum (male 215.7 and female 121.65 BW/s) and mean loading rate (male 178.43 and female 81.77 BW/s) and larger peak knee flexion moment (male 0.75 and female 0.69) compared with female athletes (P < 0.001). Unskilled athletes exhibited smaller footstrike angle (skilled 45.78 and unskilled 32.35°), longer contact time (skilled 0.69 and unskilled 0.75 s), larger peak horizontal GRF (skilled 1.61 and unskilled 2.40 BW), smaller mean loading rate (skilled 150.15 and unskilled 110.05 BW/s) and larger peak knee flexion moment (P < .05; skilled 0.69 and unskilled 0.75 Nm/BW) than the skilled athletes. In addition, the interaction indicated greater peak GRF impact in female unskilled athletes compared with female skilled athletes (P < 0.001; female skilled 2.01 and female unskilled 2.95 BW), while there was no difference between male participants (P > 0.05; male skilled 2.19 and male unskilled 2.49 BW). CONCLUSIONS: These data suggested that male athletes and/or unskilled athletes experience greater impact loading rates and peak knee flexion moment during lunge compared with female and skilled athletes, respectively. This may expose them to higher risk of overuse injuries. Furthermore, female unskilled athletes seemed to be more vulnerable to lower extremity injuries.

Comparison of Proprioceptive Training and Muscular Strength Training to Improve Balance Ability of Taekwondo Poomsae Athletes: A Randomized Controlled Trials.

Maintaining balance while performing "Hakdariseogi" in Taekwondo, which involves standing on one leg, is a critical aspect of the Poomsae competition. The purpose of this study was to investigate the effect of proprioceptive training and lower-limb muscular strength training on the balance of Taekwondo Poomsae athletes over a 6-week period. Thirty Taekwondo Poomsae athletes were randomly assigned to three groups, namely, a proprioception training group, a lower-limb muscular strength training group, and a control group. Biomechanics data were collected using eight infrared cameras (Qualysis, Sweden) at 200 Hz and a force plate (Kistler, Switzerland) at 2,000 Hz while the participants performed "Hakdariseogi" before and after the 6-week intervention. Balance and stability variables were calculated using customized MATLAB R2014b software (Mathworks, Inc., USA). The medio-lateral (M/L) center of pressure (CoP) range, M/L CoP mean velocity, antero-posterior (A/P) CoP range, A/P CoP mean velocity, and the vertical ground reaction torque after the training were reduced at P1 in the PG groups (p < 0.05). A decrease in the A/P CoP range, A/P CoP mean velocity, and vertical ground reaction torque after the training were observed at P2 in the PG and SG groups (p < 0.05). The PG exhibited a smaller A/P CoP range and A/P CoP mean velocity, in comparison to CG (p < 0.05). The A/P CoP position at P1 was negatively correlated with the vertical ground reaction torque, A/P CoP range, and A/P CoP mean velocity at P2(r = -0.438, r = -0.626, r = -0.638). Based on the above results, this study determined that both proprioception training and lower-extremity muscle strength training resulted in an improvement of athletic performance. It was also desirable to move the CoP position through conscious effort forward at P2 in order to maintain the crane stance without sway.

Kinetics and perception of basketball landing in various heights and footwear cushioning.

BACKGROUND: The previous studies on basketball landing have not shown a systematic agreement between landing impacts and midsole densities. One plausible reason is that the midsole densities alone used to represent the cushioning capability of a shoe seems over simplified. The aim of this study is to examine the effects of different landing heights and shoes of different cushioning performance on tibial shock, impact loading and knee kinematics of basketball players. METHODS: Nineteen university team basketball players performed drop landings from different height conditions (0.45m vs. 0.61m) as well as with different shoe cushioning properties (regular, better vs. best-cushioned). For each condition, tibial acceleration, vertical ground reaction force and knee kinematics were measured with a tri-axial accelerometer, force plate and motion capture system, respectively. Heel comfort perception was indicated on the 150-mm Visual Analogue Scale. A 2 (height) x 3 (footwear) ANOVA with repeated measures was performed to determine the effects of different landing heights and shoe cushioning on the measured parameters. RESULTS: We did not find significant interactions between landing height and shoe conditions on tibial shock, impact peak, mean loading rate, maximum knee flexion angle and total ankle range of motion. However, greater tibial shock, impact peak, mean loading rates and total ankle range of motion were determined at a higher landing height (P < 0.01). Regular-cushioned shoes demonstrated significantly greater tibial shock and mean loading rate compared with better- and best-cushioned shoes (P < 0.05). The correlation analysis indicated that the heel comfort perception was fairly associated with impact peak and mean loading rate regardless of heights (P < 0.05), but not associated with tibial shock. CONCLUSIONS: Determination of shoe cushioning performance, regardless of shoe midsole materials and constructions, would be capable in order to identify optimal shoe models for better protection against tibial stress fracture. Subjective comfort rating could estimate the level of impact loading in non-laboratory based situations.

Do running speed and shoe cushioning influence impact loading and tibial shock in basketball players?

BACKGROUND: Tibial stress fracture (TSF) is a common injury in basketball players. This condition has been associated with high tibial shock and impact loading, which can be affected by running speed, footwear condition, and footstrike pattern. However, these relationships were established in runners but not in basketball players, with very little research done on impact loading and speed. Hence, this study compared tibial shock, impact loading, and foot strike pattern in basketball players running at different speeds with different shoe cushioning properties/performances. METHODS: Eighteen male collegiate basketball players performed straight running trials with different shoe cushioning (regular-, better-, and best-cushioning) and running speed conditions (3.0 m/s vs. 6.0 m/s) on a flat instrumented runway. Tri-axial accelerometer, force plate and motion capture system were used to determine tibial accelerations, vertical ground reaction forces and footstrike patterns in each condition, respectively. Comfort perception was indicated on a 150 mm Visual Analogue Scale. A 2 (speed) × 3 (footwear) repeated measures ANOVA was used to examine the main effects of shoe cushioning and running speeds. RESULTS: Greater tibial shock (P < 0.001; η2 = 0.80) and impact loading (P < 0.001; η2 = 0.73-0.87) were experienced at faster running speeds. Interestingly, shoes with regular-cushioning or best-cushioning resulted in greater tibial shock (P = 0.03; η2 = 0.39) and impact loading (P = 0.03; η2 = 0.38-0.68) than shoes with better-cushioning. Basketball players continued using a rearfoot strike during running, regardless of running speed and footwear cushioning conditions (P > 0.14; η2 = 0.13). DISCUSSION: There may be an optimal band of shoe cushioning for better protection against TSF. These findings may provide insights to formulate rehabilitation protocols for basketball players who are recovering from TSF.

Effects of forefoot bending stiffness of badminton shoes on agility, comfort perception and lower leg kinematics during typical badminton movements.

This study investigated whether an increase in the forefoot bending stiffness of a badminton shoe would positively affect agility, comfort and biomechanical variables during badminton-specific movements. Three shoe conditions with identical shoe upper and sole designs with different bending stiffness (Flexible, Regular and Stiff) were used. Elite male badminton players completed an agility test on a standard badminton court involving consecutive lunges in six directions, a comfort test performed by a pair of participants conducting a game-like practice trial and a biomechanics test involving a random assignment of consecutive right forward lunges. No significant differences were found in agility time and biomechanical variables among the three shoes. The players wearing the shoe with a flexible forefoot outsole demonstrated a decreased perception of comfort in the forefoot cushion compared to regular and stiffer conditions during the comfort test (p < 0.05). The results suggested that the modification of forefoot bending stiffness would influence individual perception of comfort but would not influence performance and lower extremity kinematics during the tested badminton-specific tasks. It was concluded that an optimisation of forefoot structure and materials in badminton shoes should consider the individual's perception to maximise footwear comfort in performance.

Does shoe heel design influence ground reaction forces and knee moments during maximum lunges in elite and intermediate badminton players?

BACKGROUND: Lunge is one frequently executed movement in badminton and involves a unique sagittal footstrike angle of more than 40 degrees at initial ground contact compared with other manoeuvres. This study examined if the shoe heel curvature design of a badminton shoe would influence shoe-ground kinematics, ground reaction forces, and knee moments during lunge. METHODS: Eleven elite and fifteen intermediate players performed five left-forward maximum lunge trials with Rounded Heel Shoe (RHS), Flattened Heel Shoe (FHS), and Standard Heel Shoes (SHS). Shoe-ground kinematics, ground reaction forces, and knee moments were measured by using synchronized force platform and motion analysis system. A 2 (Group) x 3 (Shoe) ANOVA with repeated measures was performed to determine the effects of different shoes and different playing levels, as well as the interaction of two factors on all variables. RESULTS: Shoe effect indicated that players demonstrated lower maximum vertical loading rate in RHS than the other two shoes (P < 0.05). Group effect revealed that elite players exhibited larger footstrike angle, faster approaching speed, lower peak horizontal force and horizontal loading rates but higher vertical loading rates and larger peak knee flexion and extension moments (P < 0.05). Analysis of Interactions of Group x Shoe for maximum and mean vertical loading rates (P < 0.05) indicated that elite players exhibited lower left maximum and mean vertical loading rates in RHS compared to FHS (P < 0.01), while the intermediate group did not show any Shoe effect on vertical loading rates. CONCLUSIONS: These findings indicate that shoe heel curvature would play some role in altering ground reaction force impact during badminton lunge. The differences in impact loads and knee moments between elite and intermediate players may be useful in optimizing footwear design and training strategy to minimize the potential risks for impact related injuries in badminton.

Dynamically adjustable foot-ground contact model to estimate ground reaction force during walking and running.

Human dynamic models have been used to estimate joint kinetics during various activities. Kinetics estimation is in demand in sports and clinical applications where data on external forces, such as the ground reaction force (GRF), are not available. The purpose of this study was to estimate the GRF during gait by utilizing distance- and velocity-dependent force models between the foot and ground in an inverse-dynamics-based optimization. Ten males were tested as they walked at four different speeds on a force plate-embedded treadmill system. The full-GRF model whose foot-ground reaction elements were dynamically adjusted according to vertical displacement and anterior-posterior speed between the foot and ground was implemented in a full-body skeletal model. The model estimated the vertical and shear forces of the GRF from body kinematics. The shear-GRF model with dynamically adjustable shear reaction elements according to the input vertical force was also implemented in the foot of a full-body skeletal model. Shear forces of the GRF were estimated from body kinematics, vertical GRF, and center of pressure. The estimated full GRF had the lowest root mean square (RMS) errors at the slow walking speed (1.0m/s) with 4.2, 1.3, and 5.7% BW for anterior-posterior, medial-lateral, and vertical forces, respectively. The estimated shear forces were not significantly different between the full-GRF and shear-GRF models, but the RMS errors of the estimated knee joint kinetics were significantly lower for the shear-GRF model. Providing COP and vertical GRF with sensors, such as an insole-type pressure mat, can help estimate shear forces of the GRF and increase accuracy for estimation of joint kinetics.

Medical practices and attitudes of dual-licensed medical doctors in Korea.

Unique dual medical system in Korea has resulted in the emergence of dual-licensed medical doctors (DLMDs) who have both traditional Korean medicine (KM) and Western medicine (WM) licenses. There have been few studies on DLMDs in spite of their growing number and importance within the medical system. We surveyed the current status and attitudes of DLMD to assess their role in integrative medicine. Questionnaires were administered to the members of the association of DLMD. Data from 103 DLMD were collected and statistically analyzed. 41.4% of DLMD were copracticing both WM and KM at a single clinic, preferring the WM approach for physical examinations, laboratory tests, and education for patients-and the KM approach for treatment and prescription. Musculoskeletal, gastroenterologic, and allergic diseases were considered to be effectively treated with co-practice. DLMD highly agreed on the efficiency of copractice for disease control and patients' satisfaction. On the other hand, they regarded the lack of health insurance coverage for copractice and increased medical expenditure as major problems in providing co-practice. To expand the role of DLMD as mediators of integration in primary health care, the effectiveness of their co-practice should be evaluated and a corresponding health insurance reimbursement system should be established.