Epidemiology of Huntington's Disease in Latin America: A Systematic Review and Meta-Analysis.

BACKGROUND: Latin America has played a crucial role in advancing our understanding of Huntington's disease (HD). However, previous global reviews include limited data from Latin America. It is possible that English-based medical search engines may not capture all the relevant studies. METHODS: We searched databases in Spanish, Portuguese, and English. The names of every country in Latin America in English-based search engines were used to ensure we found any study that had molecular ascertainment and provided general epidemiological information or subpopulation data. Additionally, we contacted experts across the region. RESULTS: The search strategy yielded 791 citations; 24 studies met inclusion criteria, representing 12 of 36 countries. The overall pooled prevalence was 0.64 per 100,000 (prediction interval, 0.06-7.22); for cluster regions, it was 54 per 100,000 (95% CI, 34.79-84.92); for juvenile HD, it was 8.7% (prediction interval, 5.12-14.35), and 5.9% (prediction interval, 2.72-13.42) for late-onset HD. The prevalence was higher for Mexico, Peru, and Brazil. However, there were no significant differences between Central America and the Caribbean versus South America. CONCLUSION: The prevalence of HD appears to be similar across Latin America. However, we infer that our findings are underestimates, in part because of limited research and underdiagnosis of HD because of limited access to molecular testing and the availability of neurologists and movement disorders specialists. Future research should focus on identifying pathways to improve access to molecular testing and education and understanding differences among different ancestral groups in Latin America. © 2024 International Parkinson and Movement Disorder Society.

Home versus indoor trampoline park injuries: A four-year review of hospital admissions, associated costs, and impact on patients.

Hospital admissions for trampoline-related injuries are a metric of injury severity. The literature shows hospital admissions are more likely to occur from trampoline park injuries rather than home trampoline injuries. The purpose of this study was to investigate the demographics, injury characteristics, patient experiences, and economic impact of home versus trampoline park injuries requiring admission to hospital before and after two indoor trampoline parks opened in the catchment area of a Level II trauma centre. A case series research design was used. All patients who were admitted to hospital following a trampoline injury were contacted. For those who consented, clinical data was recorded from patients' charts and electronic health records. A subset of participants consented to a telephone interview wherein patient narratives were collected on the mechanism of injury, recovery process, and impact of the injury. During the study period, 15 patients required 17 hospital admissions. Twelve consented to participate in the study. Nine of the 12 required an operative intervention. Eight of the 12 were trampoline park injuries. Anatomical location of the injuries, injury type and severity scores, hospital stay, and median age were similar. The economic impact of home trampoline and trampoline park injuries varied. Overall, there were more hospital admissions and more operative interventions for trampoline park injuries during the four-year study period. Seven participants who consented to be interviewed provided additional insights into the injury experience and long-term outcomes. This study contributes to the literature on trampoline-related injuries, focusing on hospital admissions, economic impact, and adds the important perspective of patients in evaluating the effect of these injuries.

Predictors of farther mobilization on day of surgery and shorter length of stay after total joint arthroplasty.

BACKGROUND: Mobilization on the day of total joint arthroplasty (TJA) is associated with shorter length of stay. The question of whether incrementally farther mobilization on the day of surgery (POD0) contributes to shorter length of stay has not been widely studied. The purpose of this study was to determine if farther mobilization on POD0 led to shorter length of stay and to identify the predictors of farther mobilization and length of stay. METHODS: A retrospective chart review was undertaken using data for patients who had a primary TJA and mobilized on POD0. Patients were categorized into the following 4 mobilization groups: sat on the bedside (Sat), stood by the bed or walked in place (Stood), walked in the room (Room) and walked in the hall (Hall). The primary outcome was length of stay. Predictors of farther mobilization on POD0 and length of stay were identified using regression analyses. RESULTS: The sample comprised 283 patients. The Hall group had significantly shorter length of stay than all other groups. There were sex differences across the mobilization groups. Simultaneous regression analysis showed that farther mobilization was predicted by younger age, male sex, lower body mass index, spinal anesthesia and fewer symptoms limiting mobilization. Hierarchical regression showed that shorter length of stay was predicted by male sex, lower body mass index, lower American Society of Anaesthesiologists physical status classification score, less pain/stiffness and farther mobilization on POD0. CONCLUSION: Understanding the modifiable and nonmodifiable predictors of mobilization after TJA and length of stay can help identify patients more likely to mobilize farther on the day of surgery, which would contribute to better resource allocation and discharge planning. Focusing on symptom management could increase opportunities for farther mobilization on POD0 and thereby decrease length of stay.

CONTEXTE: La mobilisation le jour même d'une arthroplastie totale (AT) est associée à une durée d'hospitalisation réduite. Or, le lien entre l'ampleur de la mobilisation le jour de la chirurgie (jour postopératoire 0 [JPO0]) et la réduction de la durée d'hospitalisation n'a pas été largement étudié. La présente étude visait à déterminer si une mobilisation plus importante au JPO0 réduit la durée d'hospitalisation, de même qu'à repérer les facteurs prédictifs de mobilisation importante et de durée d'hospitalisation. MÉTHODES: Une analyse rétrospective a été menée à l'aide des dossiers de patients ayant subi une AT primaire et ayant été mobilisés au JPO0. Les patients ont été classés en 4 groupes en fonction de l'ampleur de leur mobilisation : assis au bord du lit (assis), debout à côté du lit ou marche sur place (debout), marche dans la chambre (chambre) et marche dans le couloir (couloir). Le principal résultat à l'étude était la durée d'hospitalisation. Les facteurs prédictifs de mobilisation importante au JPO0 et de durée d'hospitalisation ont été dégagés au moyen d'analyses de régression. RÉSULTATS: L'échantillon comprenait 283 patients. Le groupe couloir présentait une durée d'hospitalisation significativement plus courte que les autres. Des différences entre les sexes ont été observées dans tous les groupes. Selon une analyse de régression simultanée, les facteurs prédictifs de mobilisation importante étaient un jeune âge, le sexe masculin, un faible indice de masse corporelle, une anesthésie rachidienne et un nombre limité de symptômes nuisant à la mobilisation. Une analyse de régression hiérarchique a quant à elle montré que les facteurs prédictifs de durée hospitalisation réduite étaient le sexe masculin, un faible indice de masse corporelle, un faible score à la classification de l'état de santé physique de l'American Society of Anesthesiologists, une douleur ou des raideurs moindres, et une mobilisation importante au JPO0. CONCLUSION: La mise en évidence des facteurs prédictifs modifiables et non modifiables de mobilisation et de durée d'hospitalisation après une AT peut faciliter le repérage des patients susceptibles d'être davantage mobilisés, ce qui contribuerait à une meilleure allocation des ressources et faciliterait la planification des congés. Accorder une attention particulière au soulagement des symptômes pourrait accroître les occasions de mobilisation importante au JPO0 et, par conséquent, réduire la durée d'hospitalisation.

Authentic leadership in healthcare organizations: A study of 14 chief executive officers and 70 direct reports.

There is limited research on authentic leadership in senior leaders of healthcare organizations. The purpose of this study was to investigate authentic leadership from the perspectives of 14 healthcare Chief Executive Officers (CEOs) and 70 senior-level direct reports using the validated Authentic Leadership Questionnaire (ALQ) and one-on-one interviews. CEOs also completed a 20-hour leadership curriculum focusing on authentic leadership. Although CEOs rated themselves higher than their direct reports on the total ALQ, it only approached significance (P = .060). Ratings on the four component parts of the ALQ were also higher, but only one was significant (P = .025) with a trend toward significance on another (P = .61). The CEOs' scores were slightly higher after their self-directed study but only one component was significant (P = .040). Interviews with the CEOs and direct reports underscore how healthcare leadership and authentic leadership specifically is viewed depending on organizational roles.

Developing a surgeon-patient communication checklist for total knee arthroplasty.

BACKGROUND: Total knee arthroplasty (TKA) is a well-established surgical procedure with high rates of clinical success, yet up to 20% of patients are dissatisfied with their outcomes. Surgeon-patient communication is an important contributor to patient satisfaction, particularly in the area of setting or resetting postoperative expectations that are reasonable and achievable for individual patients. OBJECTIVE: The goal of the present research was to develop a communication checklist for surgeons to use with their patients, to enhance communication in order better to manage postoperative expectations and increase patient satisfaction with TKA. METHODS: Content analysis was used to identify a preliminary list of checklist items from audio-recorded interviews of eight patients who were between 6 weeks and 6 months of their recovery from TKA. Patients identified eight issues for which more information was desired. The proportion of mentions for each topic was calculated, and chi-square tests assessed the distribution and pattern of the categories mentioned across groups of patients. RESULTS: Certain topics were used significantly more often than others. Age and employment status, but not gender, affected which topics were mentioned more often. The final categories for the checklist included pain management, physiotherapy, medication and general outcome information. CONCLUSION: An in-depth analysis of patient experiences of recovering from TKA was the foundation of this research. The result was a checklist that creates a potential new avenue for increasing patient satisfaction by improving surgeon-patient communication. The research described here could extend to any other type of intervention in which understanding patient expectations and increasing patient satisfaction is the goal.

Total Knee Arthroplasty Communication Checklist Increases Patient Satisfaction.

BACKGROUND: Satisfaction with total knee arthroplasty (TKA) is correlated with the fulfillment of expectations. Good surgeon-patient communication impacts how expectations are formed and managed. The TKA communication checklist was developed to help surgeons better understand and manage patients' postoperative expectations in order to increase satisfaction with TKA. METHODS: In this prospective cohort study, mean satisfaction scores of a standard of care communication group and a checklist intervention group were compared. The duration of postoperative follow-up appointments was also assessed to determine whether the checklist took significantly more time in practice. RESULTS: Sixty patients received the checklist in TKA appointments with surgeons between 6 weeks and 6 months postoperatively and their satisfaction ratings were compared with 67 patients who had received the standard of care communication. The checklist group reported higher satisfaction on overall TKA satisfaction and expectations met (P = .02), care and concern shown by the surgeon (P = .01), surgeons' communication ability (P = .01), and satisfaction with time spent in follow-ups (P < .001). Satisfaction with relief from pain and return to function was not significant (P = .06). More time was spent in the checklist groups' follow-ups, with a mean difference of 1 minute, 51 seconds (P = .001). CONCLUSION: The TKA communication checklist significantly improved patients' satisfaction across multiple dimensions. This has practical significance because patient satisfaction is increasingly used as a key performance indicator for surgeons and healthcare institutions alike. Increased TKA satisfaction will benefit patients, surgeons, and the healthcare system overall.

Aging and orthopedics: how a lifespan development model can inform practice and research.

Orthopedic surgical care, like all health care today, is in flux owing to an aging population and to chronic medical conditions leading to an increased number of people with illnesses that need to be managed over the lifespan. The result is an ongoing shift from curing acute illnesses to the management and care of chronic illness and conditions. Theoretical models that provide a useful and feasible vision for the future of health care and health care research are needed. This review discusses how the lifespan development model used in some disciplines within the behavioural sciences can be seen as an extension of the biopsychosocial model. We posit that the lifespan development model provides useful perspectives for both orthopedic care and research. We present key concepts and recommendations, and we discuss how the lifespan development model can contribute to new and evolving perspectives on orthopedic outcomes and to new directions for research. We also offer practical guidelines on how to implement the model in orthopedic practice.

Comme tous les soins de santé, les soins orthopédiques sont en pleine évolution. En raison du vieillissement de la population et de la prévalence des maladies chroniques, un nombre accru de personnes sont en effet atteintes d'affections qui doivent être prises en charge pour le reste de leur vie. Résultat : une transition graduelle du traitement des maladies aiguës vers la prise en charge de maladies et d'affections chroniques. Il est donc essentiel de mettre au point des modèles théoriques offrant une vision utile et réaliste de l'avenir des soins de santé et de la recherche dans ce domaine. La présente revue examine en quoi le modèle développemental du cours de la vie utilisé par certaines disciplines des sciences du comportement peut être vu comme une extension du modèle biopsychosocial. Nous posons comme hypothèse que le modèle développemental du cours de la vie propose des perspectives utiles à la fois pour les soins orthopédiques et pour la recherche dans ce domaine. Nous présentons des concepts et des recommandations clés et nous nous penchons sur la contribution potentielle de ce modèle à l'apparition et à l'évolution de nouvelles perspectives quant aux résultats en orthopédie ainsi qu'à l'élaboration de nouvelles orientations de recherche. Enfin, nous formulons des lignes directrices sur l'implantation du modèle dans la pratique orthopédique.

Empathy and conversational enjoyment in younger and older adults.

UNLABELLED: BACKGROUND/STUDY CONTEXT: Investigations of empathy across adulthood have yielded mixed findings, yet its contribution to successful social interactions is clear. METHODS: Here, the authors investigate the relationship between empathy and self-reported conversation enjoyment in 144 young adults (M age = 19.50) and 120 older adults (M age = 68.75). Participants completed three empathy-related measures (Interpersonal Reactivity Index [IRI], Toronto Empathy Questionnaire [TEQ], and Affect Intensity Measure [AIM]), and rated their enjoyment of recalled conversations with diverse targets. RESULTS: On the IRI, older adults had higher scores than younger adults on Empathic Concern, but lower scores on the Personal Distress and Fantasy subscales. For younger adults, conversations with same-age acquaintances were most enjoyable and conversations with children and older adults were least enjoyable. Older adults reported similar enjoyment across all groups. However, the links between conversation enjoyment and empathy were stronger for older adults. CONCLUSION: These results highlight the importance of a multidimensional view of empathy, and the possibility that empathy influences conversational interactions differentially across the life span.