Exploration of parental rewards in incentivizing children's physical activity.

The purpose of this study was to explore the prevalence, varieties, and motivations behind parent-selected incentivization for children's physical activity (PA). Parents (n = 90; 30.0 ± 8.5 years) of children (8.7 ± 2.1 years) completed a web-based survey that included items regarding the use of PA rewards, children's moderate-to-vigorous PA (MVPA, min·week-1), access to electronic devices, and demographic characteristics. Open-ended questions were used to determine the type of activity rewarded, type of reward given, and parents' reasoning for not using PA rewards. Independent sample t-tests were used to determine differences between reward groups (reward and no reward) and parent-reported children's MVPA. Open-ended responses underwent thematic analysis. Over half (55%) of the respondents provided PA rewards. There was no difference between reward groups for MVPA. Parents reported their children having access to various technology modes, including TV, tablets, video game systems, computers, and cellphones. Most of the parents (78.2%) reported restricting their child's technology time in some capacity. Rewarded PAs were thematized as "children responsibilities", "non-sport activity", and "sport". Two themes regarding types of rewards included "tangible" and "nontangible". Two underlying themes as to why parents did not give rewards were deemed "built-in-habit" and "enjoyment". Rewarding children's PA is prevalent among this sample of parents. Substantial variety exists regarding the type of PA incentivized and the type of reward provided. Future studies should explore whether parents use reward structures and how they conceptualize nontangible, electronics-based rewards versus tangible rewards to incentivize children's PA to promote lifelong behavior.

Meningeal Melanomatosis with a Spinal Meningeal Melanocytoma Trigger by an in vitro Fertilization.

Meningeal melanomatosis is an infrequent tumor originating from the melanocytes in the leptomeninges and one of the recognized primary melanocytic tumors of the central nervous system. The average survival has known to be about 5 months. It can be associated with solid tumors, such as meningeal melanocytomas. The patient we present was diagnosed of a meningeal melanomatosis that developed two solid tumors related to an in vitro fertilization. The clinical course was rapidly fatal. Although the use of comprehensive diagnostic procedures, usually the final diagnosis of primary diffuse meningeal melanomatosis is postmortem, it would be advisable for the appropriate management of the patient to make a differential diagnosis and to be aware of the behavior of the tumor.

Determining Perceptions to Electronically-Delivered, Personally-Adaptive, Multimedia Exercise Prompts for Middle-Age Adults.

Due to high interaction rates, smart devices are being utilized for mobile health (mHealth) interventions. Multimedia capabilities may be leveraged to improve mHealth exercise interventions. Our purpose was to explore individuals' perceptions of multimedia exercise prompts tailored to their immediate mental/physical states. Using electronic surveys, respondents provided in-the-moment ratings of emotional state, energy, fatigue, physical discomfort, and thirst, with higher scores reflecting a higher "readiness to exercise" (i.e., if a person is currently in a pleasant mood with high energy and low discomfort, he/she is likely to have a greater capacity for a larger dose of exercise). They were then provided with an exercise prompt designed to match their readiness to exercise, demonstrated via text and graphic interchange format (GIF) showing a research member completing the recommended activity. Survey data regarding GIF quality, self-efficacy, and methodological feedback were then collected and analyzed using a combination of parametric statistics and thematic analysis of open-ended feedback. Respondents (N=204; 47±10 years; BMI 29±6 kg/m2) indicated GIFs loaded quickly (5.29±1.2, scale 0-6), were clear (5.36±1.1), and easily understandable (5.43±1.1). High task self-efficacy scores (9.34±1.62, scale 0-10) and statistically significant differences in coping self-efficacy (i.e., how well a person would be able to complete the recommended activity when feeling mentally/physically worse or better; F=3.229, p<.01) were found. Five themes relating to the exercise prompt were noted: improve attractiveness, limiting factors, exercise clarification, liked/understandable/doable, and disliked/unwilling to complete. Further refinement of these methods is warranted prior to using multimedia prompts to elicit actual exercise performance.

Interchangeability of the EQ-5D and the SF-6D, and comparison of their psychometric properties in a spinal postoperative Spanish population.

OBJECTIVE: EuroQol-5D (EQ-5D) and Short-Form Six-Dimensions (SF-6D) are widely used to calculate quality-adjusted life-years in cost-utility analysis. The choice of the instrument could influence the results of cost-utility analysis. Our objective was to compare the psychometric properties of the EQ-5D and SF-6D in a postoperative Spanish population, as well as assess their interchangeability in a cost-utility analysis. DESIGN: Ambispective study. SETTING: Tertiary public hospital. PARTICIPANTS: 275 Spanish patients who had undergone surgery for lumbar disc herniation. INTERVENTION(S): Patients completed EQ-5D-3L and Short-Form 36 (SF-36v2) questionnaires. Internal consistency, floor and ceiling effects, agreement, and construct validity (convergent validity, including dimension-to-dimension correlations, and "known groups" validity) were assessed. The Spanish tariffs were applied. MAIN OUTCOME MEASURE(S): Cronbach's α coefficient, Spearman's rank correlation coefficient, Lin's concordance correlation coefficient, intraclass correlation coefficient and Bland-Altman plot. RESULTS: Main findings were: (a) lack of agreement between EQ-5D and SF-6D utilities (Lin's concordance correlation coefficient: 0.664 [95% CI: 0.600-0.720]; the Bland-Altman plot showed a mean difference of 0.0835 and wide limits of agreement [- 0.2602-0.4272]). (b) Lack of correlation between domains that theoretically measure similar aspects of quality of life, with the exception of "pain" domain. CONCLUSIONS: The preference-based EQ-5D and SF-6D instruments showed valid psychometric properties to assess generic outcome in a Spanish population who had undergone surgery for lumbar disc herniation; however, utility scores derived from the measures were different. Thus, these two instruments cannot be used interchangeably to perform a cost-utility analysis, and they should both be included in sensitivity analyses.

Cost-utility Analysis for Recurrent Lumbar Disc Herniation: Conservative Treatment Versus Discectomy Versus Discectomy With Fusion.

STUDY DESIGN: This study was an ambispective long-term cost-utility analysis with retrospective chart review and included the prospective completion of health questionnaires by patients. OBJECTIVE: This was a cost-utility analysis, comparing conservative treatment, discectomy, and discectomy with spinal fusion for patients with recurrent lumbar disc herniation after a previous discectomy. SUMMARY OF BACKGROUND DATA: Lumbar disc herniation is an important health problem, with recurrence rates ranging from 5% to 15%. Management of recurrences is controversial due to a lack of high-level evidence. Cost-effectiveness analyses are useful when making clinical decisions. There are economic assessments for first herniations, but not in the context of recurrent lumbar disc herniations. MATERIALS AND METHODS: Fifty patients with disc herniation recurrence underwent conservative treatment (n=11), discectomy (n=20), or discectomy with fusion (n=19), and they completed the Short-Form 36, EuroQol-5D, and Oswestry Disability Index.Baseline case quality-adjusted life year (QALY) values, cost-utility ratios, and incremental cost-utility ratios were calculated on the basis of the SF-36. Direct health costs were calculated by applying the health care system perspective. Both QALY and costs were discounted at a rate of 3%. One-way sensitivity analyses were conducted for uncertainty variables, such as other health surveys or 2-year follow-up. RESULTS: Cost-utility analysis of conservative treatment versus discectomy showed that the former is dominant, mainly because it is significantly more economical (&OV0556;904 vs. &OV0556;6718, P<0.001), while health results were very similar (3.48 vs. 3.18, P=0.887). Cost-utility analysis of discectomy versus discectomy with fusion revealed that discectomy is dominant, showing a trend to be both more economical (&OV0556;6718 vs. &OV0556;9364, P=0.054) and more effective (3.18 vs. 1.92 QALY, P=0.061). CONCLUSIONS: This cost-utility analysis showed that conservative treatment is more cost-effective than discectomy in patients with lumbar disc herniation recurrence. In cases of recurrence in which conservative treatment is not feasible, and another surgery must be performed for the patient, discectomy is a more cost-effective surgical alternative than discectomy with fusion. LEVEL OF EVIDENCE: Level II.

Psychometric Properties Study of the Oswestry Disability Index in a Spanish Population With Previous Lumbar Disc Surgery: Homogeneity and Validity.

STUDY DESIGN: Evaluation of the psychometric properties of a questionnaire. OBJECTIVE: To assess the psychometric properties of the Spanish version of the Oswestry Disability Index (ODI) in a Spanish population with previous lumbar disc surgery. SUMMARY OF BACKGROUND DATA: ODI is frequently used for measuring disability in spinal disorders. In 1995, ODI was translated and transculturally adapted into the Spanish context; its content and apparent validity, internal consistency and test-retest reliability were demonstrated for a Spanish population with lumbar pain. However, this score has not been tested in terms of discriminative capacity (floor and ceiling effects) and construct validity. METHODS: Two hundred seventy-five patients who had previously undergone surgical treatment for disc lumbar herniation completed the ODI, Short-Form 36 (SF36), EuroQol-5D (EQ5D), and Numerical Rating Scale for Back Pain. Internal consistency, floor and ceiling effects and construct validity (convergent, divergent, and "known-groups" validities) were assessed. RESULTS: Spanish ODI showed a very good internal consistency: Cronbach-α coefficient for ODI score was 0.928; Cronbach-α coefficient, if the item was deleted, did not increase by more than 0.1 for each item; and Item-total correlations ranged from strong to very strong. There was floor effect for both ODI score and for all individual items. There was no ceiling effect. Spanish ODI showed very good construct validity because 88% (7/8) of the hypotheses about convergent, divergent and "known-groups" validities were supported. Concerning convergent validity, ODI was strongly correlated with the Numerical Rating Scale for Back Pain (0.717; P < 0.001), SF36-Utility (rho = -0.786; P < 0.001), Physical Component Summary score SF36 (rho = -0.787; P < 0.001), Mental Component Summary score SF36 (rho = -0.605; P < 0.001), EQ5D-Utility (rho = -0.833; P < 0.001) and some EQ5D physical components. CONCLUSION: Spanish ODI showed good psychometric properties (internal consistency and construct validity), similar to others validation studies. Spanish ODI is a valid instrument for the measurement of disability in Spanish patients with previous lumbar disc surgery, specifically in patients with moderate/intense disability. LEVEL OF EVIDENCE: 4.

Irrigation with Liquid Sevoflurane and Healing of a Postoperative, Recurrent Epidural Infection: A Potential Cost-Saving Alternative.

BACKGROUND: The general inhalation anesthetic sevoflurane can be used for the topical treatment of complicated wounds. It is applied in liquid form and may be used to irrigate the inside of cavities. Sevoflurane also exhibits in vitro antimicrobial activity. Therefore, sevoflurane may be used as an alternative to typical antibiotic or surgical treatment of complicated, localized infections. CASE DESCRIPTION: The case of a 61-year-old male patient who suffered a cranioencephalic trauma 18 years previously is presented. The patient underwent surgeries related to the trauma on numerous occasions. To date, he has suffered various recurrent epidural abscesses, which have been treated with surgical cleaning and antibiotic treatment. In the most recent episode, he presented a frontal epidural abscess 25 mm in diameter with fistulization of the skin. The patient gave written informed consent to be treated with sevoflurane irrigation, and the Pharmacy Service authorized the off-label use. Sevoflurane was applied via a catheter placed inside the cavity during weekly outpatient procedures. The procedures began 8 weeks after the clinically and radiologically verified recovery of the abscess. By avoiding surgery and the associated hospital admission, this novel alternative may prevent patient morbidity and, furthermore, may produce important economic savings. CONCLUSIONS: The treatment of complicated wounds with liquid sevoflurane may be an effective and economically efficient clinical alternative for some patients.

Neurofibromatosis segmentaria fronto temporo orbitaria: reporte de un caso: Revisión de la literatura / Fronto temporo orbitary segmental neurofibromatosis: Report of one case

Objective. To report a case of segmental neurofibromatosis located in the fronto temporal orbitary region. Description. A 54 year-old patient with a right progressive exoftalmos due to a tumor inside the orbit. He was operated 18 years ago with an histopatology diagnosis of neurofibroma. He recovered well from the surgery, but 3 years ago the right exoftalmos reappeared. The MRI shows multiple subgaleal tumors located in the right fronto temporal area, inside and outside the orbit. Intervention. A right fronto orbitary craniotomy was performed with the resection of soft non encapsulated subgaleal lesions. Conclusion. Segmental neurofibromatosis is a rare affection wich is very difficult to deal with, because of the high incidence of recurrence of the neurofibromas. Despite this, in cases like this one a surgical treatment is highly recommended to prevent not only visual defects but also cosmetic alterations.

Subluxación atlanto-axial anterior secundaria a osteoartritis: reporte de un caso / Anterior atlanto-axial subluxation secondary to osteoarthritis: a case report

Objetivo. Describir un caso de subluxación atlantoaxial anterior secundaria a una osteoartritis. Descripción. Un paciente masculino de 60 años de edad con una tetraparesia moderada, rápidamente progresiva, piramidalismo y trastornos sensitivos superficiales y profundos, de cuatro meses de evolución. Las radiografías de columna cervical frente y perfil muestraron una subluxación atlanto-axial anterior. La resonancia magnética mostró un tejido patológico periodontoideo con extensión a articulares y mielomalacia compresiva a nivel C1-C2 a expensas de elementos posteriores por la subluxación. Las radiografías del resto de la columna, manos, rodillas y hombros mostraron cambios degenerativos artrósicos. Se realiza una interconsulta con el servicio de reumatología que, luego del analizar los resultados serológicos, clínicos y radiológicos, arribó al diagnóstico de osteoartritis. Intervención. Consistió en un abordaje posterior, con apertura del foramen magno, laminectomía de C1 y osteosíntesis occipitocervical con la colocación de injertos óseos autólogos. Conclusión. La osteoartritis es una causa infrecuente de subluxación atlantoaxial anterior. Más allá de la patología causal, sabemos que el tratamiento quirúrgico es fundamental en los pacientes sintomáticos.

Objetive. To describe a new case of an anterior atlanto-axial suluxation caused by osteoarthritis. Dewscription. A 60-year-old male patient presented a 4 month history of progressive cuadriparesis, bipyramidalism and deep and superficial hipoestesia. The anterior and lateral radiographs showed an anterior C1-C2 subluxation and the magnetic resonance periodontoidal tissue mass that caused a compressive myelopathy. Intervention. Through a posterior approach, we openned theforamen magnum and performed a C1 laminectomy. After the decompression we performed an occipitocervical arthrodesis with an "Y" plate implant and autologous bone grafts. Conclusion. Osteoarthritis is an unusual cause of anterior atlantoaxial subluxation, that must be treated surgically in symptomatic patients.

Quiste aracnoide espinal: presentacion de un caso / Spinal arachnoidal cyst: case presentation

Objective: to present a case of an extradural arachnoid dorsal cyst in a 30 year-old woman. Description: a patient (30 years, female) who refers eight-months history of radicular pain and progressive right leg weakness, with exacerbations and remissions. On examination the patient had righ hemihypesthesia with T-10 sensitive level and right leg 4/5 palsy. Magnetic resonance imaging showed an extradural cystic lesion in T11-T12 hypointense in T1 and hyperintense en T2, without contrast enhancement. The cyst contained fluid tha demonstrated the same signal as cerebrospinal fluid. Intervention: After laminectomy of T-10 and T-11 the cystic lesion was exposed. The cyst was filled with CSF-fluid like. A surgical resection of the cyst wall was made. A small dural defect that allowed communication between the cyst and the subarachnoid space was revealed during the surgery, and a closure was made with a suture. Histopathological examination confirmed a cystic lesion with a single-cell lining of meningothelial cells, that contained no neural tissue neither ganglion cells. Conclusion: extradural arachnoid cysts showed characteristic images in the MRI in the preoperative stage. There was no need to use other invasive methods such as myelography or mielotomography to decide the indication for surgery or the surgical technique. Definitive diagnosis is based on the free comunication with the subarachnoidal space and the lack of neural tissue in the histopatological examination, which allowed us to distinguish between extradural arachnoid cysts and Tarlov cysts (AU)

Quiste aracnoide espinal: presentacion de un caso / Spinal arachnoidal cyst: case presentation

Objective: to present a case of an extradural arachnoid dorsal cyst in a 30 year-old woman. Description: a patient (30 years, female) who refers eight-months history of radicular pain and progressive right leg weakness, with exacerbations and remissions. On examination the patient had righ hemihypesthesia with T-10 sensitive level and right leg 4/5 palsy. Magnetic resonance imaging showed an extradural cystic lesion in T11-T12 hypointense in T1 and hyperintense en T2, without contrast enhancement. The cyst contained fluid tha demonstrated the same signal as cerebrospinal fluid. Intervention: After laminectomy of T-10 and T-11 the cystic lesion was exposed. The cyst was filled with CSF-fluid like. A surgical resection of the cyst wall was made. A small dural defect that allowed communication between the cyst and the subarachnoid space was revealed during the surgery, and a closure was made with a suture. Histopathological examination confirmed a cystic lesion with a single-cell lining of meningothelial cells, that contained no neural tissue neither ganglion cells. Conclusion: extradural arachnoid cysts showed characteristic images in the MRI in the preoperative stage. There was no need to use other invasive methods such as myelography or mielotomography to decide the indication for surgery or the surgical technique. Definitive diagnosis is based on the free comunication with the subarachnoidal space and the lack of neural tissue in the histopatological examination, which allowed us to distinguish between extradural arachnoid cysts and Tarlov cysts