A new tool for assessing the risk of fall in children with severe disability: development of the ALICE scale.

Introduction: It is known in the literature that the main cause of physical impairment in children with severe disabilities is falling, which can worsen their already compromised condition. There are no specific scales for this population in the literature, neither in Italian nor in other languages. We created and validated a scale for assessing the risk of falling in children with severe disabilities. Study design: Observational prospective study. Methods: We enrolled children (inpatients or day-hospital) admitted to the "Santa Maria Bambina Centre" of the "Fondazione Onlus Sacra Famiglia" in Cesano Boscone, Milan; the Content Validity Index of the Scale was calculated to assess the content validity of a new scale (ALICE). Cronbach's alpha coefficient (α) was used to examine internal consistency, Spearman's rho coefficient to test inter-rater reliability. Sensitivity, specificity, positive and negative predictive values were calculated. Results: Out of 48 patients enrolled, 14 fell (29.2%). The ALICE scale, with cut-off set at 16, showed a sensitivity of 100%, a specificity of 88.2%, a positive predictive value of 77.8% and a negative predictive value of 100%. The Content Validity Index of the Scale (=0.93), inter-rater reliability (rho=0.91, p<0.001) and Cronbach's alpha (=0.72) were satisfactory. Conclusions: The ALICE scale seems reliable and valid in the disabled population and can be applied by nurses. Further studies with larger samples and a multicentre design are needed.

Conservative vs. surgical approach for degenerative meniscal injuries: a systematic review of clinical evidence.

OBJECTIVE: Analyzing the available evidence by comparing the role of arthroscopic surgery and conservative treatment in the management of degenerative meniscopathy. MATERIALS AND METHODS: A literature search was carried out on the PubMed, EMBASE, Scopus, and PEDro databases in May 2019 to identify all the randomized controlled trials (RCTs) comparing arthroscopic surgery to conservative management of painful but stable degenerated menisci. The quality of the RCTs was assessed using the Cochrane Risk of Bias Assessment. RESULTS: A total of 10 studies, including 1525 patients and dealing with conservative treatment vs. arthroscopic surgery were included in this review. In eight studies the effectiveness of exercise therapy was compared to surgery; in one study the effectiveness of intra-articular steroid injection was compared to surgery; in one study the effectiveness of placebo surgery was compared to partial meniscectomy. In all studies, no significant inter-group difference in terms of knee pain and knee function were observed at any follow-up evaluation. CONCLUSIONS: Degenerative meniscal tears, without symptoms of locking and catching, can be successfully managed by a proper regimen of physical therapy as a first line treatment. Surgical approach might be considered in case of poor response after conservative treatment.

[The evaluation of workplace visual characteristics and ophthalmologic requirements to define fitness to work]. / Valutazione delle esigenze visive del posto di lavoro e requisiti oftalmologici per l'idoneità alla mansione specifica.

It's necessary to proceed to an evaluation of visual function to define principal ophthalmologic requirements and fitness to work in relation of workplace characteristics. We also have to consider the effects of age on visual function, the specific work risks on eyes and sight care especially for near sight. The evaluation of these parameters permits to verify the compatibility between the psychophysics characteristics of workers and the requests of tasks and then to define fitness to its work. Moreover to the visual functions we have to consider organic visual conditions like conjunctivitis, blepharitis, stenosis of lacrimal gland, dacriocystitis, retinic diseases, muscular motility alteration of the eyes, glaucoma. Our study shows the relation between ophthalmologic requirements of workers and some job groups like professional drivers, technical clerks, precision work, height level workers and proposes a standard method to define fitness to work. Our standard method permits a specific and homogeneous evaluation of fitness to work.

Long-term refractive and phoric changes in visual display unit (VDU) operators.

PURPOSE: This study assessed the phoric and refractive changes possibly caused by visual display unit (VDU) activity. METHODS: In a longitudinal trial nearly 6000 VDU operators received two ophthalmological examinations at intervals ranging from 34 to 43 months. The findings from the two examinations were correlated to VDU work (hours daily and years of VDU work), age and sex. RESULTS: Changes in the refractive state seemed to be mainly age-related. There was a slight tendency toward hyperopia (imbalance of latent hyperopia). CONCLUSIONS: In the analysis of ocular motility, the results show no worsening capable of causing a definitive change from heterophoria to heterotropia. Heterophoric subjects, however, tend to improve both with regular office work and with additional VDU activity.