Middle-age people with multiple sclerosis demonstrate similar mobility characteristics to neurotypical older adults.

BACKGROUND: Clinical trials often report significant mobility differences between neurotypical and atypical groups, however, these analyses often do not determine which measures are capable of discriminating between groups. Additionally, indirect evidence supports the notion that some mobility impaired populations demonstrate similar mobility deficits. Thus, the current study aimed to provide a comprehensive analysis of three distinct aspects of mobility (walking, turning, and balance) to determine which variables were significantly different and were also able to discriminate between neurotypical older adults (OA) and middle-aged people with multiple sclerosis (PwMS), and between middle-aged neurotypical adults and PwMS. METHODS: This study recruited 21 neurotypical OA, 19 middle-aged neurotypical adults, and 30 people with relapsing remitting MS. Participants came into the laboratory on two separate occasions to complete mobility testing while wearing wireless inertial sensors. Testing included a self-selected pace two-minute walk, a series of 180˚ and 360˚ turns, and a clinical balance test capturing a total of 99 distinct mobility characteristics. We determined significant differences for gait and turning measures through univariate analyses and a series of repeated measures analysis of variance in determining significance for balance conditions and measures. In determining discrimination between groups, the Area Under the Curve (AUC) was calculated for all individual mobility measures with a threshold of 0.80, denoting excellent discrimination. Additionally, a stepwise regression of the top five AUC producing variables was performed to determine whether a combination of variables could enhance discrimination while accounting for multicollinearity. RESULTS: The results between neurotypical OA and middle-aged PwMS demonstrated significant differences for three gait and one turning variable, with no variable or combination of variables able to provide excellent discrimination between groups. Between middle-age neurotypical adults and PwMS a variety of mean and variability gait measures demonstrated significant differences between groups; however, no variable or combination of variables met discriminatory threshold. For turning, five 360˚ turn variables demonstrated significant differences and furthermore, the combination of 360˚ mean turn duration and variability of peak turn velocity were able to discriminate between groups. Finally, the majority of postural sway measures demonstrated significant group differences and the ability to discriminate between groups, particularly during more challenging balance conditions where participants stood on a compliant surface. CONCLUSION: These results offer a comprehensive analysis of mobility differences and measures capable of discriminating between middle-age neurotypical adults and PwMS. Additionally, these results provide evidence that OA and middle-age PwMS display similar movement characteristics and thus a potential indicator of advanced aging from a mobility perspective.

Pregnant women lack accurate knowledge of their BMI and recommended gestational weight gain.

AIM: To investigate pregnant women's knowledge of their body mass index (BMI) and their knowledge of gestational weight gain guidelines. METHODS: Participants were recruited when attending their nuchal translucency scan at between 11 and 13 weeks, 6-days gestation in Dunedin or Christchurch, New Zealand. Recruitment staff measured participants' weight and height. By way of a self-administered, paper-based survey, participants were asked to identify their body size (including: underweight (BMI <18.5 kg/m2); normal weight (18.5-24.9); overweight (25-29.9); and obese (≥30)), and recommended gestational weight gain (including the 2009 Institute of Medicine guidelines for healthy weight gain in pregnancy, along with the options: "I should not gain any weight in my pregnancy", plus "It does not matter how much weight I gain"). Participant-measured BMI was compared to responses for perceived BMI and recommended gestational weight gain to assess accuracy. Demographic predictors of accuracy were also investigated. RESULTS: In total, 644 women were included. Sixty-six percent of these correctly identified their BMI category, however only 31% identified their correct gestational weight gain recommendation. Overweight and obese women were much more likely to underestimate their BMI than normal weight women (p<0.001 for both). Overweight and obese women were also more likely to overestimate their weight gain recommendation (OR=4, p<0.001; OR=18, p<0.001, respectively) while normal weight women were more likely to underestimate their weight gain recommendation (p<0.001). Independent of BMI, women of New Zealand European ethnicity were less likely to underestimate their recommended gestational weight gain compared to other women of non-Maori/non-Pacific Island ethnicity (p=0.001), whereas younger women (p=0.012) were more likely to underestimate recommended gestational weight gain. CONCLUSION: The present study indicates that New Zealand women, particularly those who are overweight and obese, lack accurate knowledge of their own body size, and this may lead to an under- or over-estimation of appropriate gestational weight gain, which may in turn lead to increased risk of poor health outcomes in pregnancy. Education strategies related to healthy weight gain in pregnancy are urgently required.

Does the addition of saline infusion sonohysterography to transvaginal ultrasonography prevent unnecessary hysteroscopy in premenopausal women with abnormal uterine bleeding?

This observational case series in 65 premenopausal women with abnormal uterine bleeding evaluated whether transvaginal ultrasound followed by saline infusion sonohysterography (SIS) prevented unnecessary hysteroscopy. Although SIS indicated that hysteroscopy was unnecessary in eight women, this benefit was offset by the invasive nature of the scan, the number of endometrial abnormalities falsely detected by SIS and the cost of the additional investigation.

Potential for Integrating Diffusion of Innovation Principles into Life Cycle Assessment of Emerging Technologies.

Life cycle assessment (LCA) measures cradle-to-grave environmental impacts of a product. To assess impacts of an emerging technology, LCA should be coupled with additional methods that estimate how that technology might be deployed. The extent and manner that an emerging technology diffuses throughout a region shapes the magnitude and type of environmental impacts. Diffusion of innovation is an established field of research that analyzes the adoption of new innovations, and its principles can be used to construct scenario models that enhance LCA of emerging technologies. Integrating diffusion modeling techniques with an LCA of emerging technology can provide estimates for the extent of market penetration, the displacement of existing systems, and the rate of adoption. Two general perspectives of application are macro-level diffusion models that use a function of time to represent adoption, and microlevel diffusion models that simulate adoption through interactions of individuals. Incorporating diffusion of innovation concepts complement existing methods within LCA to inform proactive environmental management of emerging technologies.

Weight and height measurement: potential impact in obstetric care.

AIM: To assess the accuracy of reported weight and height in a pregnant population. METHODS: Participants were recruited when attending their nuchal translucency scan if they attended with an 'antenatal screening for Down syndrome and other conditions' laboratory form (used for the maternal serum screening in the first trimester (MSS1) blood test) that had weight and/or height recorded. Participants' weight and height were measured by trained recruitment centre staff and body mass index (BMI) was calculated. Differences in reported (MSS1) and measured weight, height and BMI were analysed using Bland-Altman plots. RESULTS: 248 women participated. Only 23% (n=56) of participants had a weight recorded on the MSS1 laboratory form that was within plus or minus 0.5 kg of measured weight: 62% (n=155) had an under-reported weight, and 15% (n=37) an over-reported weight. 30% (n=74) of participants had a correctly reported height: 26% (n=63) an under-reported height, and 44% (n=107) an over-reported height. 6% (n=14) of participants had a correctly reported BMI: 69% (n=166) had an under-reported BMI, and 25% (n=60) an over-reported BMI. 17% of participants (n=40) were incorrectly classified by BMI category based on MSS1 data. CONCLUSION: Our study suggests that there are considerable inaccuracies in the recording of weight and height during pregnancy in New Zealand. This results in a false reduction in BMI in many women which can affect clinical care.