Can Dance Improve Turning in People With Parkinson's Disease?

Objective: To investigate the effects of a dance intervention on selected functional parameters during the 180° turning phase of the Timed Up & Go (TUG) test in people with Parkinson's Disease (PwPD). Methods: Fifteen adults clinically diagnosed with idiopathic PD were allocated into dance intervention (DIG; n = 7 ; age 73 ± 2 years) and control (CG; n = 8; age 64 ± 5 years) groups. The dance intervention lasted for 3 months (1 hour, twice a week). At baseline, all participants completed the Unified PD Rating Scale-part III, the International Physical Activity Questionnaire-short form, and the Hoehn & Yahr scale. Pre- and post-intervention, the primary outcomes were measured (number of steps and time to complete the 180° turning phase of the TUG test) at 2 speeds (comfortable walking and as quickly and safely speed) while using the Xsens® 3D motion suit. The secondary outcome (girdle dissociation) was assessed by calculating the difference between pelvis and affected shoulder orientation in the transverse plane (dissociation angles) at each data point during the TUG test's 180° turning phase. Results: At participant's comfortable walking speed, the functionality during the 180° turning remained unaffected following the dance intervention. However, at participant's fast speed, the dance intervention group significantly reduced the number of steps with a large effect size, and the total time taken to complete the 180° turning with a medium effect size. Post-intervention, most participants in the dance intervention group reduced the affected shoulder and pelvic girdle dissociation and turned more "en bloc." Conclusion: Dance can improve selected functional parameters during the 180° turning at fast speed in PwPD. The current results should be considered in rehabilitation programs.

A quality improvement initiative to reduce the time to initial maternal visit in the neonatal intensive care unit.

OBJECTIVE: We aimed to reduce the time interval between an infant's admission to the Neonatal Intensive Care Unit (NICU) and first maternal interaction. METHODS: We identified three key drivers: 1. Collaboration with Labor and Delivery, 2. Education of staff and parents, and 3. Improved documentation of maternal presence. We measured the time interval from NICU admission to the initial maternal presence. We followed length of stay as a balancing measure to assay whether use of remote televisitation impeded efficient parental teaching and delayed discharge. RESULTS: We reduced the time interval from an average of 19.7 h in February 2020 to 12.3 h in June 2021. We expanded an already existing televisitation program as a surrogate to in-person interaction during COVID-19 pandemic. Televisitation did not affect in-person parental presence or LOS. CONCLUSION: Our multidisciplinary efforts resulted in a significantly accelerated time to initial maternal presence and did not prolong LOS.

Force plate coverings significantly affect measurement of ground reaction forces.

The purpose of this study was to carry out a material test to investigate the effect of different force plate coverings on vertical and horizontal ground reaction force and derived parameters. Four surface conditions were analysed; bare plate, vinyl, sportflex, and astroturf on a Kistler force plate. Vertical data were collected by dropping a 2 kg rigid, textured medicine ball from a low (61 cm) and a high (139 cm) height. Horizontal data were collected using a custom-built, rigid, metal pendulum device. A one-way ANOVA revealed a significant main effect of surface on peak force and rate of force development for high height, low height, and horizontal force conditions (all p<0.001), with effect sizes in the post-hoc analysis being mostly large to very large. Interestingly, sportflex yielded the highest vertical but the lowest horizontal ground reaction forces. This study showed the use of current force platform coverings had a significant effect on peak force and rate of force development measurements during a standardised testing procedure. Future research should try to obtain rate of force development values that more closely replicate aspects of human performance during standardised testing procedures. Also further investigate the effect of the different surfaces on ground reaction forces during human movement.

Spinal Counts, Impact, and Partnering Movements in Ballet, Modern, and Hip Hop dance: A YouTube Video Analysis Study.

INTRODUCTION: Dancers have self-reported a link between spinal extension movements and low back pain (LBP). Researchers have not reported the total number or frequency that spinal movements occur in ballet, modern, or hip-hop dance classes or performances. The purpose of this study was to report the number of spinal movements dancers are exposed to in different dance environments. MATERIALS AND METHODS: We analyzed 65 dance videos on YouTube.com for dance movements within 7 dance environments: ballet class and performance, modern class and performance, and hip-hop breaking, ciphers (large groups), and battles ("1v1s"). Two reviewers recorded counts of spinal (spinal flexion, extension, lateral flexion, and rotation), impact (jumps, leaps, and falls), and partnering movements (lifts, catches, and leans). Data analyses were processed in Jamovi (the jamovi project, Sydney, Australia). We reported movement totals, percentages, frequency, ranges, means with standard deviations (SD), and medians with interquartile range (IQR). We calculated significant differences using Mann-Whitney U tests. RESULTS: Video length ranged from 3 to 141 minutes (mean ± SD: 38.4 ± 38.3, range: 138). the average spinal extension movements ranged from 2 ± 0.8 to 7 ± 9.6 movements per minute across genres. Modern dance class had the most spinal flexion (89 ± 53.6), rotation (60 ± 40.8), and lateral flexion (74 ± 20.7) movements. Ballet performance had the most spinal extension movements (77 ± 69.8), jumps (74 ± 48), and leaps (19 ± 18.2). Hip-hop breaking had the highest number of falling movements (2 ± 2.3). Partnering movements were only present in ballet performance, modern dance performance, and hip-hop breaking environments. CONCLUSIONS: Movements that increase LBP occur often in all 3 dance genres. Dancers can expect frequent exposure to spinal extension movements; therefore, we recommend strengthening back and core musculature for all dancers. We recommend that ballet dancers also strengthen their lower extremity muscles. For modern dancers, we recommend strengthening their obliques. For hip-hop dancers, we recommend increasing muscular power and muscular endurance.

Perceived Severity and Management of Low Back Pain in Adult Dancers in the United States.

INTRODUCTION: Low back pain (LBP) lifetime prevalence in dancers reportedly ranges from 17% to 88%. Low back pain can have negative secondary consequences on dancers' lives and careers. Still, how LBP impacts dancer function and medical care-seeking behaviors and whether these issues differ across dance genres, is understudied.
Materials and Methods: Two hundred and eight-nine ballet, modern, and hip-hop dancers and teachers (median age: 20.3 years; range: 18 to 69 years) in the United States completed an online 24-question survey assessing LBP related self-reported injury history, impact on their lives, and management strategies. We defined LBP as occurrence of acute or chronic pain in the lumbar or sacral regions of the back.
Results: Two hundred and fifty-seven participants (88.9% of 289 total) reported at least one instance of LBP during their lifetime and 220 participants reported LBP in the prior 4 weeks. Of these 220, 72 (32.7%) had LBP severe enough to limit their activities of daily living. Of the 213 who had LBP and danced during that time, 89 (41.8%) reported that LBP limited their dancing. Pain intensity (median: 4 on a 0 to 10 scale, IQR: 3.0) and LBP prevalence were similar across dance genres. Dancers sought multiple medical professionals, most often chiropractors (n = 94, 33.8%), medical doctors (n = 77, 27.7%), and physiotherapists (n = 60, 21.6%). Ninety dancers (35.0% of those with LBP) never sought medical care. Dancers who did seek care reported higher pain intensities (median: 4, IQR: 3.8) than those who did not (median: 3, IQR: 3.0).
Conclusion: Overall, most participants did suffer from LBP. Low back pain negatively impacts dancers' everyday activities and dancing. Pain intensity and loss of function may impact care-seeking. Our findings highlight the need for all dance stakeholders to educate dancers about their health, provide resources for dancer health care, and proactively create an environment that supports injury reporting behaviors in dancers.

Key Healthcare Leadership Competencies: Perspectives from Current Healthcare Leaders.

The healthcare system is complex and requires effective leaders who can navigate team, organizational and system dynamics. The objectives of this study were to explore competencies required to lead emerging healthcare challenges and identify strategies for developing successful leaders. Semi-structured interviews were conducted with 12 healthcare leaders from the government, hospitals and in consulting. This study unpacks competencies such as communication and change management and draws attention to the significance of emotional intelligence and working with data that have not traditionally been identified as key competencies. These findings can inform curriculum and modernization initiatives in healthcare leadership programs.

This is Me: Evaluation of a boardgame to promote social engagement, wellbeing and agency in people with dementia through mindful life-storytelling.

Receiving a dementia diagnosis is a difficult experience for most people and often affects their wellbeing negatively. To support people's wellbeing, in a therapeutic context, life-storytelling, reminiscence and mindfulness are used with people with dementia. In an everyday context, traditional games are used as a resource for stimulating memory, cognition and social activity. While an increasing number of creative strategies are available to support people with dementia, the area of board games design and their effect on wellbeing is underexplored. This paper reports on the evaluation of the This is Me (TIM) mindful life-storytelling board game by the European project MinD. Using a co-design methodology, TIM was developed with and for people with mild to moderate dementia to support their wellbeing by enhancing self-empowerment and social engagement. A focus group methodology was used to evaluate TIM with 50 people with dementia and 19 carers across four countries. TIM was evaluated with regard to the usability and experience of the design as well as people's emotional wellbeing, social engagement and agency. The thematic analysis demonstrated that the combination of life-storytelling and mindfulness allowed players to engage in meaningful social interaction and, as a result, they reported enjoyment, learning, more acceptance of the past and present situation, and that they perceived looking forward into the future together with others as helpful. The study demonstrates that design can be a useful means to support people with dementia in aspects of emotional wellbeing, social engagement and a sense of agency.

Assessing the generalisability of a multicentre qualitative dementia research: the experience and challenges faced by the MinD project in Europe.

Background: Generalisation of findings is an important aspect of research and essential for evidence-based practice. While generalisation is common in quantitative research, there is a lack of generalisability in qualitative research. This paper presents the experience and challenges faced by the Designing for People with Dementia (MinD) project in meeting the requirements to strengthen the generalisation of findings on the lived experience of people living with dementia and their engagement to co-create designs to empower their everyday living.   Methods: Polit and Beck (2010)'s strategies to generalise qualitative findings were applied: (1) replication in sampling; (2) replication of studies; (3) meta-synthesis of findings; (4) reflexivity and conceptualization; (5) immersion with the data; and (6) thick description. Results: While it is possible to increase the generabilisabilty of qualitative evidence through the replication of the sampling to attain a large, heterogeneous sample in different and multiple contexts and environments; implementation of sound and robust research; conducting in-depth analysis and interpretation collaboratively for emergent themes; and meeting the thick description requirement, there are challenges that the project team faced in implementing some of the Polit and Beck's strategies because of the condition, namely dementia, that our participants are having. Other challenges faced were: the language and cultural diversity in the team; diverse  work and organisational procedures; and the inter-disciplinary differences relating to the methods of enquiry, approaches and techniques to conduct research. These challenges will need to be identified and addressed at the start of the project with a strong leadership to ensure a seamless journey to complete the project successfully. Trust between the researchers and participants, and time to build this trust are critical to recruitment and participation in the study; these factors are of utmost important in research involving participants with condition such as dementia.

LOW BACK PAIN AND INJURY IN BALLET, MODERN, AND HIP-HOP DANCERS: A SYSTEMATIC REVIEW.

BACKGROUND: Low back pain is believed to be a common complaint among dancers; however, a comparison across recent research is needed to support or disprove this assertion across genres. PURPOSE: To determine the prevalence of low back pain and low back injury in ballet, modern, and hip-hop dancers through a systematic literature review. A secondary goal was to identify trends amongst dance genres, level of mastery, gender, and age, if possible. STUDY DESIGN: Systematic Review of the Literature. METHODS: PRISMA search strategy of terms relating to dance and low back pain was conducted within the Pubmed, MEDLINE, SPORTDiscus, Web of Science, and the archives of the Journal of Dance Medicine and Science databases between November 2017 and March 2018. Inclusion criteria were published articles that addressed low back pain or injury in ballet, modern, or hip-hop dance population. Exclusion criteria included studies relating to specific pathologies or studies that did not report specific dance genre. All included articles were assessed for quality using a modified grading evaluation and a Modified Newcastle-Ottawa Risk of Bias assessment. RESULTS: Twenty-five ballet articles, five modern, and three hip-hop articles met the inclusion criteria, for a total of 33 articles. Twenty-five of the 33 studies relied on a questionnaire to gather data. Risk of bias results ranged from 3-7/10 and quality of studies ranged from Good I to Limited III. Prevalence of low back pain seems relatively high in ballet dance (range: 20.3%-79% of total dancers are affected). Little research exists on the prevalence of back pain in modern or hip-hop dancers, but hip-hop dancers also seem likely to have low back pain (range: 46.6%-85.7% of total dancers are affected). Low back injuries are also present in ballet (range: 2.1%-88% of total injuries), modern (range: 8.6%-21.6% of total injuries), and hip-hop (range: 26.3%-69.6%). CONCLUSION: Ballet dancers seem to be at risk for low back pain or injury independent of gender, age or level of mastery; however, there is not enough evidence to draw any conclusions about modern dancers or hip-hop dancers and their risk for low back pain/injury currently. Future higher-level studies are needed with reduced risk of bias. LEVEL OF EVIDENCE: 2a.

Impacts of Overweight and Obesity in Older Age on the Risk of Dementia: A Systematic Literature Review and a Meta-Analysis.

BACKGROUND: It is unclear whether overweight and obesity in older age reduces or increases the risk of incident dementia. OBJECTIVE: To assess the impacts of overweight and obesity in older age on incident dementia. METHODS: We searched cohort studies reporting body weight measured in older age and dementia through PubMed, Embase, Medline, PyschInfo, and Cochrane library until July 2016. Sixteen articles were identified for the review. We pooled data from them and a new unpublished study from China, to calculate relative risk (RR) of incident dementia in relation to body mass index (BMI) and waist circumference (WC). RESULTS: All 16 cohort studies were undertaken in high income countries, with follow-up periods ranging between 3 to 18 years. Thirteen studies showed an inverse association between BMI and dementia, and three studies demonstrated a positive association. Pooled RR of dementia in relation to continuous BMI from 14 studied populations, including the new Chinese data, was 0.97 (95% CI 0.95-1.00); in those followed up <9 years it was 0.95 (0.93-0.96) while in ≥9 years follow-up it was 1.03 (0.96-1.11). In five studied populations examining categorical BMI, RR of dementia in older people classified as overweight and obese was 0.98 (0.54-1.77) and 1.17 (0.65-2.10) respectively, in comparison with other weights. The pooled WC data showed no association between increased WC and reduced risk of dementia. CONCLUSION: The current evidence did not support a paradox on beneficial impacts of overweight and obesity in older age on incident dementia. More studies with long term follow up are needed to clarify the association of body weight in older age with dementia risk.

Association between fish consumption and risk of dementia: a new study from China and a systematic literature review and meta-analysis.

OBJECTIVE: To assess the association of fish consumption with risk of dementia and its dose-response relationship, and investigate variations in the association among low-, middle- and high-income countries. DESIGN: A new community-based cross-sectional study and a systematic literature review.SettingsUrban and rural communities in China; population-based studies systematically searched from worldwide literature. SUBJECTS: Chinese adults aged ≥60 years in six provinces (n 6981) took part in a household health survey of dementia prevalence and risk factors. In addition, 33 964 participants from eleven published and eligible studies were included in the systematic review and meta-analysis. RESULTS: In the new study in China, 326 participants were diagnosed with dementia (4·7 %); those who consumed any amount of fish in the past two years v. those who consumed no fish had reduced risk of dementia (adjusted OR=0·73, 95 % CI 0·64, 0·99), but the dose-response relationship was not statistically significant. The meta-analysis of available data from the literature and the new study showed relative risk (RR) of dementia of 0·80 (95 % CI 0·74, 0·87) for people with fish consumption; the impact was similar among countries with different levels of income. Pooled dose-response data revealed RR (95 % CI) of 0·84 (0·72, 0·98), 0·78 (0·68, 0·90) and 0·77 (0·61, 0·98) in people with low, middle and high consumption of fish, respectively. Corresponding figures for Alzheimer's disease were 0·88 (0·74, 1·04), 0·79 (0·65, 0·96) and 0·67 (0·58, 0·78), respectively. CONCLUSIONS: Greater consumption of fish is associated with a lower risk of dementia. Increasing fish consumption may help prevent dementia worldwide regardless of income level.

Effects of Body Mass Index on Bone Loading Due to Physical Activity.

The aim of the current study was to compare bone loading due to physical activity between lean, and overweight and obese individuals. Fifteen participants (lower BMI group: BMI < 25 kg/m2, n = 7; higher BMI group: 25 kg/m2 < BMI < 36.35 kg/m2, n = 8) wore a tri-axial accelerometer on 1 day to collect data for the calculation of bone loading. The International Physical Activity Questionnaire (short form) was used to measure time spent at different physical activity levels. Daily step counts were measured using a pedometer. Differences between groups were compared using independent t-tests. Accelerometer data revealed greater loading dose at the hip in lower BMI participants at a frequency band of 0.1-2 Hz (P = .039, Cohen's d = 1.27) and 2-4 Hz (P = .044, d = 1.24). Lower BMI participants also had a significantly greater step count (P = .023, d = 1.55). This corroborated with loading intensity (d ≥ 0.93) and questionnaire (d = 0.79) effect sizes to indicate higher BMI participants tended to spend more time in very light activity, and less time in light and moderate activity. Overall, participants with a lower BMI exhibited greater bone loading due to physical activity; participants with a higher BMI may benefit from more light and moderate level activity to maintain bone health.

Defining instances and limbs during performance of the standing turn.

Conventions have been reported to describe walking and turning gait. No such descriptions appear for the 180° standing turn and as such there are inconsistencies in the literature reporting on this movement. The complexity of explaining the standing turning motion, variation in number of steps when turning, and differing strategies used means conventions will make research reporting easier to comprehend and less likely for errors in interpretation. We propose definitions of the 180° standing turning motion and steps used to complete a turn for able-bodied and pathological populations to encourage consistency in reporting. It is recommended that the definitions be applied in future research on standing turns.

The Use of Recovery Strategies Among Participants of the BUPA Great North Run: A Cross-Sectional Survey.

OBJECTIVE: To investigate half-marathon runners' frequency of use of recovery strategies, perceptions regarding the most beneficial recovery strategy, and reasons for using recovery strategies. DESIGN: Cross-sectional survey. PARTICIPANTS: 186 participants of the 13.1 mile BUPA Great North Run 2013. METHODS: A questionnaire was developed which required participants to indicate how frequently they used 12 different recovery strategies, identify which recovery strategy they believed to be most beneficial, and rank 6 reasons for using recovery strategies in order of importance. Data were analyzed using a Friedman nonparametric ANOVA and additional nonparametric tests. RESULTS: All participants used recovery strategies. Stretching was the most commonly used recovery strategy (P < .001), whereas the use of nutritional supplements was the most commonly selected most beneficial recovery strategy. More than 50% of respondents indicated that they never used strategies such as kinesio tape (80%), hydrotherapy (78%), or ice baths (71%). A significant difference was observed between reasons for using recovery strategy (χ2 (5) = 292.29, P < .001). Reducing muscle tightness (rank 4.87) and reducing injury (rank 4.35) were the most frequently chosen most important reasons for using recovery strategies. Minor sex and age differences in the responses were identified. CONCLUSION: Recovery strategy usage appears to be widespread among half-marathon runners; however, disparities exist between the frequency of use and perceived effectiveness of different recovery strategies. Further research in this area is needed to facilitate the development of recovery strategy guidelines which are both evidence-based and practically relevant.

Selecting, Adapting, and Implementing Evidence-based Interventions in Rural Settings: An Analysis of 70 Community Examples.

OBJECTIVE: This paper explores how communities translate evidence-based and promising health practices to rural contexts. METHODS: A descriptive, qualitative analysis was conducted using data from 70 grantees funded by the Federal Office of Rural Health Policy to implement evidence-based health practices in rural settings. Findings were organized using The Interactive Systems Framework for Dissemination and Implementation. RESULTS: Grantees broadly interpreted evidence-based and promising practices, resulting in the implementation of a patchwork of health-related interventions that fell along a spectrum of evidentiary rigor. The cohort faced common challenges translating recognized practices into rural community settings and reported making deliberate modifications to original models as a result. CONCLUSION: Opportunities for building a more robust rural health evidence base include investments to incentivize evidence-based programming in rural settings; rural-specific research and theory-building; translation of existing evidence using a rural lens; technical assistance to support rural innovation; and prioritization of evaluation locally.

Hospitals in rural or remote areas: An exploratory review of policies in 8 high-income countries.

Our study reviewed policies in 8 high-income countries (Australia, Canada, United States, Italy, Spain, United Kingdom, Croatia and Estonia) in Europe, Australasia and North America with regard to hospitals in rural or remote areas. We explored whether any specific policies on hospitals in rural or remote areas are in place, and, if not, how countries made sure that the population in remote or rural areas has access to acute inpatient services. We found that only one of the eight countries (Italy) had drawn up a national policy on hospitals in rural or remote areas. In the United States, although there is no singular comprehensive national plan or vision, federal levers have been used to promote access in rural or remote areas and provide context for state and local policy decisions. In Australia and Canada, intermittent policies have been developed at the sub-national level of states and provinces respectively. In those countries where access to hospital services in rural or remote areas is a concern, common challenges can be identified, including the financial sustainability of services, the importance of medical education and telemedicine and the provision of quick transport to more specialized services.

Three-dimensional analysis of a lofted instep kick by male and female footballers.

There is a paucity of data describing the lofted instep kick and little information on the kinematic differences between male and female footballers. This study provides a preliminary investigation into the differences in motion patterns between the sexes. A four-camera motion analysis system videoed 13 amateur footballers (7 female and 6 male) attempting a standardised task that represented a lofted instep kick of approximately 35 m. Footballers performed 20 kicks, with the three trials categorised closest to the standardised distance retained for statistical analysis. Three-dimensional motion patterns for kicks of 35 m illustrated that female footballers produced greater fluctuation in movement patterns for pelvic, hip joint and thoracolumbar spine motion in the frontal plane; thorax and hip joint transverse rotation; and ankle dorsiflexion/plantarflexion motion. Peak hip extension (P = 0.018), impact hip abduction (P = 0.032), impact ankle plantar flexion (P = 0.030) and resultant ball velocity (P = 0.004) differed significantly between sexes. Principle component analysis highlighted associations between kinematic variables related to ball velocity and sex including a reduced hip abduction and increased internal rotation approaching impact, and greater peak knee flexion, respectively. In summary, increased variation in direction of segment motion, increased backswing and formation of a tension arc by females compared to males, may be related to anthropometric, strength and muscle activation differences. Specifically, this exploratory study indicates future research would benefit from exploring trunk, pelvis and hip kinematics and kinetics, and whether training the trunk, pelvis and hip musculature assists female footballers.

Experimental manipulation of breakfast in normal and overweight/obese participants is associated with changes to nutrient and energy intake consumption patterns.

The effect of breakfast and breakfast omission on daily food intake in normal and overweight participants was investigated. 37 participants were recruited for this experimental study and assigned to one of four groups on the basis of their body mass index (BMI) (normal weight BMI <25 kg/m(2) or overweight/obese BMI >25 kg/m(2)) and breakfast habits (breakfast eater or breakfast omitter). All participants were requested to eat breakfast for an entire week, and then following a washout period, omit breakfast for an entire week, or vice versa. Seven-day food diaries reporting what was consumed and the timing of consumption were completed for each breakfast condition. Overall more energy was consumed during the breakfast than the no breakfast week. The present study revealed significant effects of timing on energy intakes; more energy was consumed during the afternoon in the no breakfast week compared to the breakfast week. Overweight participants consumed greater amounts of energy than normal weight participants in the early evening. Breakfast omitters consumed more than did breakfast eaters later in the evening. All groups consumed significantly less energy, carbohydrate and fibre in the no breakfast week; however, overweight participants increased their sugar intakes. Consumption of the micronutrients iron and folate was reduced in the no breakfast week. The findings highlight that the timing of food intake and habitual breakfast eating behaviour are important factors when investigating why breakfast consumption may be associated with BMI.