Pushing through the Barriers: Peer Advice to Increase Physical Activity and Reduce Dementia Risk from Participants in a Massive Open Online Alzheimer's Focused Course.

BACKGROUND: Engagement in physical activity is associated with reduced dementia risk but insufficient physical activity is a global trend. OBJECTIVES: We aimed to explore what advice might be offered to others to increase physical activity and to identify enablers and barriers to physical activity for adults interested in dementia prevention and participating in a massive open online course. PARTICIPANTS: Two thousand, one hundred and thirty-two participants contributed to an online discussion forum. DESIGN: Analysis was conducted using Topic modelling analysis followed by thematic analysis. RESULTS: The themes generated from the discussion posts included time constraints, poor health and lack of motivation as barriers to physical activity, and social interaction, incidental activities, and dog ownership as enablers. Peer advice was frequently suggested around scheduling physical activity into the day and joining a friend or organised activity. CONCLUSION: This online discussion forum uniquely captured ideas from a large, diverse group of participants. Future research may benefit from further examining the role of discussion forums and peer advice in dementia risk reduction initiatives.

Sexually transmitted infections epidemiology and risk assessment at the main correctional facility in Malta (2017-2019).

BACKGROUND: Inmates suffer from mental and physical ailments combined with substance misuse and addiction which are often underreported or disregarded by sufferers, for fear of being stigmatized. This vulnerable group has complex medical and psychosocial needs and hence gathering data is essential for a holistic approach to care. OBJECTIVES: Understanding the interplay between sexually transmitted (STIs) and blood borne infections, substance misuse and mental health is essential to enable targeted interventions and outreach programmes. The aim was to analyse the occurrence of STIs, hepatitis and tuberculosis in inmates at the main custodial facility in Malta; to assess risk behaviours and vulnerabilities through an outreach programme; to offer treatment and referral and to develop recommendations for screening of prison inmates. METHODS: A mixed methodology study was used which involved analysis of health data pooled from the Genitourinary Clinic (GUC) and Corradino Correctional Facility (CCF) in Malta. RESULTS: In the study period, 206 inmates were tested for STIs, 67.9% males, aged between 14 and 72. Only 27% were not sexually active in the 6 months prior to testing. Among those sexually active, 31% had had sex with casual partners and 43% had never used condoms for sexual intercourse. Seventy-five percent admitted to drug use. The most common STI diagnosed was HPV (16.5%), followed by syphilis (5.8%). Genital dermatoses were also frequent (9.2%). The prevalence of Hepatitis C was high (24.5%), in relation to intravenous drug use. CONCLUSION: The authors advocate for more collaboration between sexual health clinics and prisons to address educational interventions and STIs' testing. Cultural and linguistic barriers should be considered when devising national health strategies and screening recommendations in custodial settings. Adequate follow-up should extend into the community setting once inmates leave the prison to ensure a continuum of care.

Bacterial contamination of platelet components not detected by BacT/ALERT®.

OBJECTIVES: To investigate the possible causes for false negative results in BacT/ALERT® 3D Signature System despite bacterial contamination of platelet units. BACKGROUND: The Northern Ireland Blood Transfusion Service (NIBTS) routinely extends platelet component shelf life to 7 days. Components are sampled and screened for bacterial contamination using an automated microbial detection system, the BacT/ALERT® 3D Signature System. We report on three platelet components with confirmed bacterial contamination, which represent false negative BacT/ALERT® results and near-miss serious adverse events. METHODS: NIBTS protocols for risk reduction of bacterial contamination of platelet components are described. The methodology for bacterial detection using BacT/ALERT® is outlined. Laboratory tests, relevant patient details and relevant follow-up information are analysed. RESULTS: In all three cases, Staphylococcus aureus was isolated from the platelet residue and confirmed on terminal sub-culture using BacT/ALERT® . In two cases, S. aureus with similar genetic makeup was isolated from the donors. CONCLUSION: Risk reduction measures for bacterial contamination of platelet components are not always effective. Automated bacterial culture detection does not eliminate the risk of bacterial contamination. Visual inspection of platelet components prior to release, issue and administration remains an important last line of defence.

The delayed presentation of atlantoaxial rotatory fixation in children: a review of the management.

AIMS: Although atlantoaxial rotatory fixation (AARF) is a common cause of torticollis in children, the diagnosis may be delayed. The condition is characterised by a lack of rotation at the atlantoaxial joint which becomes fixed in a rotated and subluxed position. The management of children with a delayed presentation of this condition is controversial. This is a retrospective study of a group of such children. PATIENTS AND METHODS: Children who were admitted to two institutions between 1988 and 2014 with a diagnosis of AARF were included. We identified 12 children (four boys, eight girls), with a mean age of 7.3 years (1.5 to 13.4), in whom the duration of symptoms on presentation was at least four weeks (four to 39). All were treated with halo traction followed by a period of cervical immobilisation in a halo vest or a Minerva jacket. We describe a simple modification to the halo traction that allows the child to move their head whilst maintaining traction. The mean follow-up was 59.6 weeks (24 to 156). RESULTS: Despite the delay in referral, the subluxation was successfully reduced in all children. Only two children required atlantoaxial fusion. CONCLUSION: The results of our study suggest that normal anatomy with restoration of movement may be achieved even in cases of AARF presenting late, obviating the need for fusion. We also show a simple modification to the halo traction that allows the child to move their head about while still maintaining traction. TAKE HOME MESSAGE: Prompt diagnosis and management with halo traction (with a simple modification as described) is associated with good results in patients with AARF who present late. Cite this article: Bone Joint J 2016;98-B:715-20.

Body Mass Index adjustment for sitting height for better assessment of obesity risks in Maltese women.

OBJECTIVE: This study is aimed to assess the influence of body shape on Body Mass Index (BMI) estimations by determining the Sitting Height to Standing height ratio. METHODS: The study population included 291 non-pregnant premenopausal Maltese women aged 20-54 years. These women were assessed using the following anthropometric measurements: Body weight (Kg), standing height (cm) and sitting height (cm). The Sitting-to-Standing Height (SH/S) ratio, the observed BMI (oBMI) based on the standing height, and the SH/S ratio-corrected BMI (cBMI) were calculated. The SPSS package version 18.0 was used for statistical calculations. RESULTS: The average SH/S ratio of the Maltese premenopausal women is 0.44. The mean oBMI is 25.06, while the mean cBMI is 34.49 (P value < 0.001). Applying the linear regression prediction model with either oBMI or cBMI as dependent variables and the SH/S ratio as independent variable proved that the sitting height is a significant predictor of both oBMI and cBMI (P value < 0.00001). CONCLUSIONS: The results suggest that the cohort of this study tend to have long legs relative to torso-length (low SH/S ratio). Thus, the oBMI will underestimate the actual BMI value. The correction of BMI for the sitting height in Maltese population will more correctly identify individuals at greater risk for chronic diseases.

Unstable extra-articular fractures of the distal radius: a prospective, randomised study of immobilisation in a cast versus supplementary percutaneous pinning.

We performed a prospective, randomised study on 57 patients older than 60 years of age with unstable, extra-articular fractures of the distal radius to compare the outcome of immobilisation in a cast alone with that using supplementary, percutaneous pinning. Patients treated by percutaneous wires had a statistically significant improvement in dorsal angulation (mean 7 degrees), radial length (mean 3 mm) and radial inclination (mean 3 mm) at one year. However, there was no significant difference in functional outcome in terms of pain, range of movement, grip strength, activities of daily living and the SF-36 score except for an improved range of movement in ulnar deviation in the percutaneous wire group. One patient developed a pin-track infection which required removal of the wires at two weeks. We conclude that percutaneous pinning of unstable, extra-articular fractures of the distal radius provides only a marginal improvement in the radiological parameters compared with immobilisation in a cast alone. This does not correlate with an improved functional outcome in a low-demand, elderly population.

Scrotal approach for inguinal hernia and hydrocele repair in boys.

PURPOSE: The scrotal approach to repairing inguinal hernias and hydroceles in boys is a relatively new approach, which offers the paediatric surgeon the choice of leaving a more cosmetically acceptable scar. This paper reports the experience of one centre using this approach. METHODS: 195 consecutive repairs in 176 boys were studied. The operative technique is described. RESULTS: With an average follow-up of 13 months, there was one recurrence. There were no wound infections. Testicular size was equal or larger than the contralateral testicle in all but two cases. All boys had an excellent cosmetic result. CONCLUSION: The scrotal approach for inguinal hernia or hydrocele repair is a safe procedure without added morbidity and with excellent cosmetic results.

Enhanced efficiency of electrostatically charged insecticide aerosols.

The bioefficacy of a standard domestic aerosol insecticide has been compared with that of a similar spray in which the droplets were electrostatically charged. The aerosol was charged without the need for an external power supply, by enhancing natural charge separation processes that occur during atomisation. The charge-to-mass ratio achieved was 1.1 x 10(-4) C kg-1, compared with 2.2 x 10(-5) C kg-1 for the standard aerosol. Efficiency was assessed for insects in free flight. A direct space-spray application method was used to study the bioefficacy of these aerosols on houseflies, Musca domestica, and an indirect space-spray method on houseflies and mosquitoes, Culex quinquefasciatus. Two levels of concentration of active ingredients were compared. At low concentrations of 1.57 g kg-1 of bioallethrin and 0.29 g kg-1 of bioresmethrin, the charged aerosol achieved a significant reduction in KDT50 (time at which 50% of the flies were knocked down), compared with the standard aerosol. In the direct spray application to houseflies, the KDT50 was reduced by 50%, while in the indirect spray the KDT50 was reduced by 40%. In the indirect spray of mosquitoes, the KDT50 was reduced by 22%. With higher active ingredient concentrations of 2.09 g kg-1 for bioallethrin and 0.39 g kg-1 for bioresmethrin, the charged aerosol also demonstrated faster knockdown than the standard, but the improvement was less marked. In the direct spray application to houseflies, the KDT50 was reduced by 21% compared with the standard aerosol, while in the indirect spray the KDT50 was reduced by 16%. In the indirect spray of mosquitoes, the KDT50 was reduced by 24%. The percentage mortality after 24 h was also increased with the charged aerosol. Charge carried by the droplets results in increased interception of the insecticide, as the droplets are attracted to the insects in flight and space charge effects within the aerosol could cause improved dispersion in the test chamber.

Recurrent instability of the elbow in the Ehlers-Danlos syndrome. A report of three cases and a new technique of surgical stabilisation.

We present three cases of recurrent instability of the elbow in association with the Ehlers-Danlos syndrome. The pattern of instability has not previously been reported. We describe our procedure for achieving stability using a bone graft to the olecranon fossa which gave a functional range of movement.

Characteristics in addition to size of the contralateral hand predict hand volume but are not clinically useful.

Traditionally, therapists who treat hand edema have used the volume of the contralateral hand to estimate normal or pre-injury hand volume. This presupposes that for the average person the difference in volumes between the two hands is so small that it is clinically insignificant. Left and right hand volumes, as well as a number of other hand characteristics, and health history were collected for a sample of 512 persons. Over 15% of the subjects had a measured volume difference of 30 ml or more. The difference in absolute and relative volumes between hands was minimally affected by gender, age, lifestyle, hand dominance, size of the largest hand, health problems, or previous hand injuries. Regression analysis uncovered a number of characteristics, including gender, handedness, and age, that predicted hand volume over and above the contralateral hand, but they boosted the proportion of variance explained only from 0.968 to 0.973, a clinically insignificant increase. It was concluded that the traditional methods of estimating pre-injury volume are still useful.

Familial myelodysplasia: progressive disease associated with emergency of monosomy 7.

Two brothers developed hypoplastic anaemia with the development in one of refractory anaemia with excess blasts (RAEB) accompanied by emergence of monosomy 7. Both brothers have a constitutional inversion of chromosome 1. Neither shows the increased chromosomal fragility of Fanconi's anaemia or its variants. This family is the third reported in which monosomy 7 has been found when leukaemic or preleukaemic transformation has occurred in patients with familial hypoplastic anaemia.