Intra-rater reliability of hip abductor isometric strength testing in a standing position in older fallers and non-fallers

Background

Reduced hip muscle strength has been shown to be a major factor related to falls in older persons. However, comprehensive assessment of hip abduction strength in the clinical setting is challenging. The aim of this study was to investigate the feasibility and intra-rater reliability of a quick and simple hip abductor strength test in a functional standing position.

Methods

Individuals over 65 years of age were recruited from the geriatric department of a university hospital and an outpatient clinic. Thirty-two older subjects, including 16 fallers (≥1 fall during the last 12 months) and 16 non-fallers were included. Maximum voluntary isometric strength (MVIS) and rate of force generation (RFG) of the hip abductors of the right leg were evaluated in a standing position using a hand-held dynamometer. Two test-sessions were carried out. All hip strength values were normalized to participants’ weight. Reliability was determined using the intra-class correlation coefficient agreement (ICC_agreement), the standard error of measurement (SEM) and a Bland and Altman analysis (BA).

Results

All participants completed the strength tests, which took a mean 2.47?±?0.49 min (one limb). Intra-rater reliability was higher for MVIS (0.98_{[0.95–0.99]}) than RFG (ICC?=?0.93_{[0.87–0.97]}) for the entire sample. In the non-fallers, ICC was 0.98_{[0.95–1.00]} (SEM?=?0.08 N.kg^??1) for MVIS and 0.88_{[0.75–0.96]} for RFG (SEM?=?1.34 N.kg^-1.s^-1). In the fallers, ICC was 0.94_{[0.89–0.98]} (SEM?=?0.11 N.kg^??1) for MVIS and 0.93_{[0.84–0.98]} (SEM?=?1.12 N.kg^??1.s^??1) for RFG. The BA plot showed that the MVIS and RFG values did not differ across test-sessions, showing that no learning effect occurred (no systematic effect). The mean differences between test-sessions were larger and the LOA smaller in the fallers than in the non-fallers.

Conclusion

Assessment of hip strength in a standing position is feasible, rapid and reliable. We therefore recommend this position for clinical practice. Future studies should investigate the diagnostic value of hip abductor strength in standing to discriminate between fallers and non-fallers, and to determine if change in strength following a falls prevention program reduces the risk of falls.

     

An alternative method for evaluating stationarity in transition models

Transition models are an important framework that can be used to model longitudinal categorical data. A relevant issue in applying these models is the condition of stationarity, or homogeneity of transition probabilities over time. We propose two tests to assess stationarity in transition models: Wald and likelihood-ratio tests, which do not make use of transition probabilities, using only the estimated parameters of the models in contrast to the classical test available in the literature. In this paper, we present two motivating studies, with ordinal longitudinal data, to which proportional odds transition models are fitted and the two proposed tests are applied as well as the classical test. Additionally, their performances are assessed through simulation studies. The results show that the proposed tests have good performance, being better for control of type-I error and they present equivalent power functions asymptotically. Also, the correlations between the Wald, likelihood-ratio and the classical test statistics are positive and large, an indicator of general concordance. Additionally, both of the proposed tests are more flexible and can be applied in studies with qualitative and quantitative covariates.     

Effects of minor household interventions to block draughts on social housing temperatures: a before and after study

Half of New Zealand’s renters report damp or mould problems with their homes, which can have negative health implications. Tenants in a newly upgraded social housing complex complained of being cold. Sealing strips around doors and baffles in rangehoods were installed. This exploratory study’s objectives were to determine: (1) whether the interventions influenced indoor temperature, (2) the extent to which indoor temperature changed and (3) benefits to the tenants. The before-and-after rapid response study was conducted in five social housing units. Indoor temperature was subjectively and objectively measured. Using multivariate normal linear regression, units were found to be on average 1.36°C warmer post-intervention after adjusting for outdoor temperature. Tenants’ daily diary entries also claimed units were warmer post-intervention. Simple minor interventions to block draughts made a relatively big difference to indoor temperature and comfort of those living there. Such interventions are worthwhile, especially when housing is tenanted by vulnerable populations.     

Global and local tests to assess stationarity of Markov transition models

We present global and local likelihood-based tests to evaluate stationarity in transition models. Three motivational studies are considered. A simulation study was carried out to assess the performance of the proposed tests. The results showed that they present good performance with the control of the type-I error, especially for ordinal responses, and control of the type-II error, especially for the nominal case. Asymptotically they are close to the classical test performance. They can be executed in a single framework without the need to estimate the transition probabilities, incorporating both categorical and continuous covariates, and used to identify sources of non-stationarity.     

Sex Partner Type,Drug Use and Condom Use Self-Efficacy Among African Americans from Disadvantaged Neighborhoods: Are Associations with Consistent Condom Use Moderated by Gender?

Gender inequalities in sexual behavior are explored from the perspective of the theory of gender and power. This study focused on the effect of sex partner type (steady versus casual), drug use, and condom use self-efficacy regarding consistent condom use (CCU) among a community-based sample of adults. The sample included 1,357 African American men and women (M age 37.0, SD 13.1 years; 44% women, 66% men) from 61 disadvantaged census block groups in Atlanta, GA as part of a study of individual and neighborhood characteristics and HIV risk-taking. Having a steady partner decreased the odds of CCU, while higher condom use self-efficacy increased the odds of CCU. Among non-drug users, having a drug-using partner was associated with decreased odds of condom use for women only. Women with drug-using partners, especially a steady partner, were least likely to report CCU. Therefore, interventions intended to empower CCU among women need to expand beyond acknowledging the reduced control that women who use drugs demonstrate to also consider those who have drug-using sexual partners.     

Resolution of Delusional Parasitosis within Complicated Grief Group Therapy: A Case Analysis

In this article, the authors present the case of a 71-year-old female suicide survivor in our Complicated Grief Group Therapy research study who presented with delusional parasitosis (DP) that resolved over the course of treatment. The authors describe Complicated Grief Group Therapy for survivors of suicide and the effect of therapy on her DP symptoms. The unique treatment elements of Complicated Grief Group Therapy addressed the trauma features of her grief, her relationship with her deceased son, her social isolation, health care adherence, and progression to a healthy grief process.     

Nation,Migration, Identity: Learning from the Cross‐Strait Context

It has been argued that globalization, with its flexible landscapes of production, consumption and mobility, has favoured the emergence of new forms of belonging that are not necessarily built on such principles of the nation state. In this article, we argue that this process is more likely to happen when movements occur between states that are not in conflictual relations with each other. When the relations between two nations are shaped by conflicts, for instance due to disputes about sovereignty over a territory, nationalism may remain a crucial factor shaping the identification and belonging of those who move between the two territories. In this article, by looking at the case of migrants moving between China and Taiwan, we will shed light on how the issue of “unresolved sovereignty” may eventually lead these actors to reinforce nationalist ideals and identities in their daily narratives, instead of favouring the generation of hybrid identities.     

Predictors and Moderators of Sexually Related Distress in Women with Persistent Genital Arousal Disorder

Abstract

The degree of general distress reported by women with Persistent Genital Arousal Disorder (PGAD) varies greatly, which might relate to their level of anxiety or depression. A variety of medical problems also has been associated with PGAD symptoms. The current study sought to determine the most significant predictor of sexually related distress and examine possible moderators. Participants were 51 women who met the criteria for PGAD and completed an online survey. Hierarchical regression determined depression significantly predicted sexually related distress, but anxiety and stress measures did not. Erotophobia and perceived partner support did not moderate the relationship between depression and sexually related distress. Greater numbers of concomitant medical diagnoses were significantly correlated with sexually related distress. The results indicate that PGAD is experienced by women as sexually distressing. As we continue to learn more about PGAD, a biopsychosocial treatment approach to PGAD, including psychotherapy would seem warranted.