Kinematic gait pattern in children with cerebral palsy and leg length discrepancy: Effects of an extra sole.

The gait pattern in children with cerebral palsy (CP) often differs from normal, with slow velocity, problem with foot clearance and increased stress on joints. Several factors, such as muscle tone, impaired motor control, muscle contractures, skeletal deformities and leg length discrepancy affect gait. Leg length discrepancy can be treated surgically or with elevation of the shoe on the short leg. The purpose of this study was to examine whether compensating for leg length discrepancy, with elevation of the sole, leads to a change in movement pattern during walking in children with spastic CP. RESULTS: Ten children with spastic CP, able to walk without aids, and 10 typically developing (TD) children aged between seven and 14 years were assessed with 3D gait analysis: 1) barefoot, 2) with shoes and 3) with an extra sole beneath the shoe for the shorter leg. All children with CP had a leg length discrepancy of more than or equal to 1.0cm. In the barefoot condition, the velocity was slower and the stride length was shorter, in children with CP compared with TD. The stride length and gait velocity increased in children with CP with shoes and shoe+sole and the stance time became more symmetrical. Among children with CP, there was more flexion in the longer leg relative to the short leg during barefoot walking. Differences in the kinematic pattern between the long and the short leg decreased with the extra sole.

Effectiveness of a partnership-based self-management programme for patients with mild and moderate chronic obstructive pulmonary disease: a pragmatic randomized controlled trial.

AIMS: To evaluate the effectiveness of a 6-month, partnership-based self-management programme for patients with mild and moderate chronic obstructive pulmonary disease. BACKGROUND: Self-management is a widely valued concept used to address contemporary issues of chronic health problems. Findings of self-management programmes for people with chronic obstructive pulmonary disease are inconclusive. DESIGN: Pragmatic randomized control trial. METHODS: Patients, 45-65 years old, with mild and moderate chronic obstructive pulmonary disease were invited with a family member. Experimental group (n = 48) participated in a 6-month, partnership-based self-management programme consisting of: (a) three to four conversations between nurse and patient-family member; (b) 6 months of smoking cessation; and (c) interdisciplinary team-patient-family member group meeting. Control group (n = 52) received usual care. Data were collected at months zero, six and 12. The trial lasted from June 2009-March 2013. RESULTS: Patients with mild and moderate chronic obstructive pulmonary disease who participated in the partnership-based self-management programme perceived less intrusiveness of the disease and its treatment than patients in the control group. Patients in the experimental group did not have better health-related quality of life, less anxiety or depression, increased physical activity, fewer exacerbations or better smoking status than patients in the control group. Patients in both groups found participation in the research useful and important. CONCLUSION: The partnership-based self-management programme had benefits concerning perception of the intrusiveness of chronic obstructive pulmonary disease and its treatment on lifestyles, activities and interests for young patients with the disease in its early stages. High satisfaction in control group, low family attendance and the relatively short treatment period may explain the less than expected benefits of the programme.

Dimensions of health-related lifestyle in young adulthood: results from a national population survey.

AIM: This study assessed the underlying structure of health-related behaviours among young adults in Iceland. A number of individual behaviours were considered, including both positive and negative health-related behaviours. A central question was whether distinct underlying health-related lifestyles can be identified in this age group. METHOD: The study was based on the data from a national health survey entitled 'Health and Living Conditions in Iceland'. The original survey comprised a random sample of 18-75 year olds drawn from the National Register (response rate 69%). The current study used a subsample from the survey, consisting of young adults, age: 18-24 (N = 348). A total of 37 variables pertaining to health-related behaviour were analysed. The 37 variables were factor-analysed using principal component (PC) factor analysis. RESULTS: The PC analysis yielded four underlying health lifestyle dimensions: (i) physical activity; (ii) unhealthy diet; (iii) substance use; and (iv) healthy diet. The four factors explained 35.3% of the total item variance. The mean Cronbach's alpha for the four factors was 0.69. Correlations between factors were generally weak. CONCLUSION: Distinct health-related lifestyle dimensions underlie the numerous health-related behaviours that young adults engage in. The analysis of positive and negative lifestyle dimensions helps identify vulnerable young adults disproportionally involved in unfavourable patterns of health-related behaviour. Weak factor correlations and high unexplained item variance suggests that individual health-related behaviours need consideration, albeit within a larger framework acknowledging interconnected and sometimes inconsistent behaviours.

Declining coronary heart disease mortality in Iceland: contribution by incidence, recurrence and case fatality rate.

OBJECTIVE: To analyse to what extent the recent decline in coronary heart disease mortality in Iceland is due to changes in incidence, recurrence and case fatality rates. DESIGN: A countrywide registration of myocardial infarction (MI) in people aged 25-74 was performed in Iceland during 1981-1999 according to the MONICA protocol. Possible cases were found by review of all hospital discharge records, autopsy records and death certificates. RESULTS: MI death rate declined by 63% in males and 51% in females, most in the youngest age groups in men (86%) and least in the oldest (49%). In women there was not a significant difference in age groups. Overall the age-adjusted reduction in MI death rate was 55.4% in both sexes combined; of this 23.1% was due to incidence reduction, 22.8% to recurrence reduction and 11.6% to case fatality reduction. In the youngest age groups the decline in incidence contributed most to the decline in MI death rate (62% in men and 71% in women), but thereafter the decline in case fatality in men. In the older age groups decline in recurrence rate has greater weight. CONCLUSION: The recent decline in MI mortality under the age of 75 years in Iceland is due to reduction in incidence and recurrence rate by about 40% each and to reduction in case fatality by 20%.