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BackgroundMusculoskeletal complications of Down syndrome (DS) are common but infrequently reported. The combination of ligamentous laxity and low muscle tone contributes to increased risk of a number of musculoskeletal disorders and a delay in acquisition of motor milestones. The primary aim of this study was to describe musculoskeletal anomalies reported in a national cohort of children with DS.MethodsThis was an observational study. Children with DS, aged 0–21 years, were invited to attend a musculoskeletal assessment clinic conducted by a paediatric physician. Relevant musculoskeletal history and clinical findings were documented.ResultsOver an 18-month period, 503 children with DS were examined (56% male). The median age was 8.1 years (0.6–19.2). Pes planus was almost universal, occurring in 91% of the cohort. A range of other musculoskeletal anomalies were observed, with inflammatory arthritis (7%) and scoliosis (4.8%) occurring most frequently after pes planus. Delay in ambulation was common; the median age to walk was 28 months (12–84).ConclusionChildren with DS are at increased risk of a number of potentially debilitating musculoskeletal problems. These conditions can present in variable manners or be completely asymptomatic. Pes planus is common; therefore, early consideration of orthotics and lifelong appropriate supportive footwear should be considered. Delayed ambulation is frequently noted. A significant proportion of children with DS have arthritis; however, despite a high prevalence, it is often missed, leading to delayed diagnosis. An annual musculoskeletal assessment for all children with DS could potentially enable early detection of problems, allowing for timely multidisciplinary team intervention and better clinical outcomes.

Musculoskeletal disorders affect morbidity, quality of life and mortality, and represent an increasing economic and societal burden in the context of population aging and increased life expectancy. Improvement of quality of life should be one of the priorities of any interventions to prevent and treat musculoskeletal disorders in the ageing population. Two main approaches, namely generic and disease-specific instruments, can be applied to measure health-related quality of life. Among the generic tools available in scientific literature, the short form 36 questionnaire (SF-36) and the Euroqol five item questionnaire (EQ-5D) are two of the most popular questionnaires used to quantify the health related quality of life in people with musculoskeletal disorders. However, because generic tools may not always be able to detect subtle effects of a specific condition on quality of life, a specific tool is highly valuable. Specific tools improve the ability to clinically characterize quality of life in subjects with a specific musculoskeletal disorder, as well as the capacity to assess changes over time in the QoL of these subjects. The recent development of specific tools should help to validate preventive and therapeutic interventions in this field.

The analysis of bioelectrical signals continues to receive wide attention in research as well as commercially because novel signal processing techniques have helped to uncover valuable information for improved diagnosis and therapy. This book takes a unique problem-driven approach to biomedical signal processing by considering a wide range of problems in cardiac and neurological applications, the two \"heavyweight\" areas of biomedical signal processing. The interdisciplinary nature of the topic is reflected in how the text interweaves physiological issues with related methodological considerations. This book is suitable for a final year undergraduate or graduate course as well as for use as an authoritative reference for practicing engineers, physicians, and researchers.

Crouch gait is one of the most common gait abnormalities; it is usually caused by cerebral palsy. There are few works related to the modeling of crouch gait kinematics, crouch gait analysis, and visualization in both the workspace and joint space. In this work, we present a quaternion-based method to solve the forward kinematics of the position of the lower limbs during walking. For this purpose, we propose a modified eight-DoF human skeletal model. Using this model, we present a geometric method to calculate the gait inverse kinematics. Both methods are applied for gait analysis over normal, mild, and severe crouch gaits, respectively. A metric-based comparison of workspace and joint space for the three gaits for a gait cycle is conducted. In addition, gait visualization is performed using Autodesk Maya for the three anatomical planes. The obtained results allow us to determine the capabilities of the proposed methods to assess the performance of crouch gaits, using a normal pattern as a reference. Both forward and inverse kinematic methods could ultimately be applied in rehabilitation settings for the diagnosis and treatment of diseases derived from crouch gaits or other types of gait abnormalities.

In light of the current COVID-19 pandemic, and given the importance of diet to overall health and well-being, nutrients (macro and micro) deserve special attention.10 As a key micronutrient, vitamin D should be given particular focus—not as a ‘magic bullet’ to beat COVID-19, as the scientific evidence base is severely lacking at this time—but rather as part of a healthy lifestyle strategy to ensure that populations are nutritionally in the best possible place.11 Vitamin D is unique: it is a prohormone which is produced in the skin during exposure to sunlight (UVB radiation at 290–315 nm) with, usually, smaller amounts obtained from food. [...]in Manchester, UK (53.5N) the nadir of seasonal vitamin D status occurs in February, with sunlight exposure once again becoming effective for vitamin D synthesis in the skin only from March onwards.13 Relatively high prevalence of low vitamin D status globally has been reported over recent decades in a wide range of population groups,14 including those in low latitude areas (despite the abundance of sunlight) and not necessarily confined to winter.15 This may be due to environmental factors, such as air pollution, as well as cultural factors that lead to skin being covered and not subject to sunlight exposure.16 Older, housebound individuals are at particularly high risk of vitamin D deficiency.17 Vitamin D status is reflected by the level of the circulating metabolite 25-hydroxyvitamin D (25OHD), which is produced by hepatic hydroxylation of vitamin D coming from either skin or the gut from oral intake.18 If the 25OHD concentration is low (as defined in the UK by a 25OHD concentration of <25 nmol/L7 and in the USA and some other countries by a 25OHD concentration of <30 nmol/L),8 9 such as observed commonly during and towards the end of the winter, this indicates that stores are depleted and vitamin D-requiring functions may be impaired. Recent meta-analyses of randomised controlled trials (RCTs) concluded that the use of vitamin D supplements was associated with lower total mortality in elderly, mostly vitamin D-deficient participants.21 22 However, the most recent Vitamin D Assessment Study and the Vitamin D and Omega-3 Fatty Acid Study did not show a mortality effect in vitamin D-replete adults.23 24 Vitamin D and respiratory health It has been hypothesised that there is an association between seasonal URTIs and low vitamin D status because both occur in the winter months. Epidemiological studies in children have found a strong association between URTI and rickets.28 A large cross-sectional study of the US population reported that URTI infections were higher in those with lower vitamin D status, with the association being stronger in those with respiratory diseases such as asthma and chronic obstructive pulmonary disease.29 There is evidence that lower vitamin D status is associated with acute respiratory tract infections (ARTIs).30 In a recent systematic review and meta-analysis of individual participant data from vitamin D supplementation RCTs, vitamin D supplementation reduced the risk of ARTI, with the greatest benefit in those with vitamin D deficiency at baseline.31 However, it is important to note the limitations to this systematic review/meta-analysis;32 33 there was a high level of heterogeneity in the findings and concomitantly, the overall significant results in the meta-analysis of the 24 included trials was dependent on the inclusion of the two studies undertaken in developing countries:

ObjectivesPain is a very common symptom of juvenile idiopathic arthritis (JIA). Disease activity alone cannot explain symptoms of pain in all children, suggesting other factors may be relevant. The objectives of this study were to describe the different patterns of pain experienced over time in children with JIA and to identify predictors of which children are likely to experience ongoing pain.MethodsThis study used longitudinal-data from patients (aged 1–16 years) with new-onset JIA. Baseline and up to 5-year follow-up pain data from the Childhood Arthritis Prospective Study (CAPS) were used. A two-step approach was adopted. First, pain trajectories were modelled using a discrete mixture model. Second, multinomial logistic regression was used to determine the association between variables and trajectories.ResultsData from 851 individuals were included (4 years, median follow-up). A three-group trajectory model was identified: consistently low pain (n=453), improved pain (n=254) and consistently high pain (n=144). Children with improved pain or consistently high pain differed on average at baseline from consistently low pain. Older age at onset, poor function/disability and longer disease duration at baseline were associated with consistently high pain compared with consistently low pain. Early increases in pain and poor function/disability were also associated with consistently high pain compared with consistently low pain.ConclusionsThis study has identified routinely collected clinical factors, which may indicate those individuals with JIA at risk of poor pain outcomes earlier in disease. Identifying those at highest risk of poor pain outcomes at disease onset may enable targeted pain management strategies to be implemented early in disease thus reducing the risk of poor pain outcomes.

IntroductionLow back pain, and especially non-specific low back pain, is a common cause of presentation to the emergency department (ED). Although these patients typically report relatively high pain intensity, the clinical course of their pain and disability remains unclear. Our objective was to review the literature and describe the clinical course of non-specific low back pain after an ED visit.MethodsElectronic searches were conducted using MEDLINE, CINAHL and EMBASE from inception to March 2019. We screened for cohort studies or randomised trials investigating pain or disability in patients with non-specific low back pain presenting to EDs. We excluded studies that enrolled participants with minimal pain or disability scores at baseline. Two reviewers independently screened the full texts, extracted the data and assessed risk of bias and quality of evidence. Estimates of pain and disability were converted to a common 0–100 scale. We estimated pooled means and 95% CIs of pain and disability as a function of time since ED presentation.ResultsEight studies (nine publications) with a total of 1994 patients provided moderate overall quality evidence of the expected clinical course of low back pain after an ED visit. Seven of the eight studies were assessed to have a low risk of bias. At the time of the ED presentation, the pooled estimate of the mean pain score on a 0–100 scale was 71.0 (95% CI 64.2–77.9). This reduced to 46.1 (95% CI 37.2–55.0) after 1 day, 41.8 (95% CI 34.7 to 49.0) after 1 week and 13.5 (95% CI 5.8–21.3) after 26 weeks. The course of disability followed a similar pattern.ConclusionsPatients presenting to EDs with non-specific low back pain experience rapid reductions in pain intensity, but on average symptoms persisted 6 months later. This review can be used to educate patients so they can have realistic expectations of their recovery.

\"Provides consumer health information about structure and function of the musculoskeletal system; importance of healthy bones, muscles, and joints; common musculoskeletal disorders and conditions; and cancers of the musculoskeletal system, along with information about workplace musculoskeletal disorders and rehabilitation strategies. Includes index, glossary of related terms, and other resources\"--.

Daily intake of 57 g Jarlsberg cheese has been shown to increase the total serum osteocalcin (tOC). Is this a general cheese effect or specific for Jarlsberg containing vitamin K and 1,4-dihydroxy-2naphtoic acid (DHNA)? 66 healthy female volunteers (HV) were recruited. By skewed randomisation (3:2), 41 HV were allocated to daily intake of 57 g Jarlsberg (J-group) and 25-50 g Camembert (C-group) in 6 weeks. After 6 weeks the C-group was switched to Jarlsberg. The study duration was 12 weeks with clinical investigations every 6 weeks. The main variables were procollagen type 1 N-terminal propeptide (PINP), tOC, carboxylated osteocalcin (cOC) and the osteocalcin ratio (R ) defined as the ratio between cOC and undercarboxylated osteocalcin (ucOC). Serum cross-linked C-telopeptide type I collagen (CTX), vitamin K , lipids and clinical chemistry were used as secondary variables. PINP, tOC, cOC, R and vitamin K increased significantly (p<0.01) after 6 weeks in the J-group. PINP remained unchanged in the C-group. The other variables decreased slightly in the C-group but increased significantly (p≤0.05) after switching to Jarlsberg. No CTX-changes detected in neither of the groups.Serum lipids increased slightly in both groups. Switching to Jarlsberg, total cholesterol and low-density lipoprotein-cholesterol were significantly reduced (p≤0.05). Glycated haemoglobin (HbA1c), Ca and Mg were significantly reduced in the J-group, but unchanged in the C-group. Switching to Jarlsberg, HbA1c and Ca decreased significantly. The effect of daily Jarlsberg intake on increased s-osteocalcin level is not a general cheese effect. Jarlsberg contain vitamin K and DHNA which increases PINP, tOC, cOC and R and decreases Ca , Mg and HbA1c. These effects reflect increased bone anabolism and a possible reduced risk of adverse metabolic outcomes. NCT04189796.