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PubMedDate not supplied

Discreet products for children and teenagers with continence problems.

The National Service Framework for Children, Young People and Maternity Services (Department of Health, 2004a) estimates that 'at least 500,000 children suffer from nocturnal enuresis, and a significant number with daytime wetting and faecal incontinence'. The NSF also acknowledges that 'incontinence is distressing for children and young people; it can lead to bullying at school and cause emotional and behavioural problems'.

Absorbent Pads↗

PubMed1994

Casting in sport.

Attempts by sports medicine professionals to return high school athletes with hand and wrist injuries to competition quickly and safely have been the source of confusion and debate on many playing fields around the country. In addition to the differing views regarding the appropriateness of playing cast usage in high school football, a debate exists among sports medicine professionals as to which material is best suited for playing cast construction. Materials used in playing cast construction should be hard enough to provide sufficient stabilization to the injured area and include adequate padding to absorb blunt impact forces. The purpose of the biomechanical portion of this investigation was to attempt to determine the most appropriate materials for use in constructing playing casts for the hand and wrist by assessing different materials for: 1) hardness using a Shore durometer, and 2) ability to absorb impact using a force platform. Results revealed that RTV11 and Scotchcast were the "least hard" of the underlying casting materials and that Temper Stick foam greatly increased the ability of RTV11 to absorb impact. Assessment of the mechanical properties of playing cast materials and review of current developments in high school football rules are used to aid practitioners in choosing the most appropriate materials for playing cast construction.

Journal Article↗

PubMed1986

Use of a new sample-collection device (Macroduct) in anion analysis of human sweat.

We compared concentrations of chloride and sulfate in sweat obtained by use of the Macroduct capillary-coil collection device with results obtained by the conventional absorbent filter pad technique. Samples obtained with the device weighed less than those obtained conventionally, but sweat chloride concentrations were not significantly different. To assess analysis of trace anions, we used inorganic sulfate as a prototype. Background contamination, a problem with the filter pads, was negligible with the Macroduct collector. However, with the Macroduct device, sulfate concentrations were nominally higher than with the conventional pads (105 +/- 6 vs 88 +/- 5 mumol/L) and showed no dependence of sulfate concentration on sweat rate. Subtraction of the significant "background" SO4 concentration obtained with blanks (i.e., unused filter pads) is a likely source of error in the conventional method. We consider the Macroduct device useful for study of trace constituents of human sweat.

Adolescent↗

PubMedDate not supplied

The brittle bone: how to save women from osteoporosis.

For a woman, the risk of suffering an osteoporotic fracture during her lifetime is higher than the combined risk of breast, endometrial, and ovarian cancer. It is important to reduce the number of osteoporosis-related fractures. Therefore, it is necessary to emphasize various interventions and attitudes which will decrease both the risk of falling and that of breaking bones. Strategies should be followed to reach adulthood with an optimal bone mass through improved diet and exercise during childhood. Programs that identify women with the lowest bone mass at the time of menopause may be useful, since prophylactic measures against osteoporosis such as hormone replacement therapy (HRT) can be offered to them. Identification of women at risk can be achieved through bone densitometry; a decrease of each standard deviation of bone mineral mass below mean values predicts a doubling of the fracture risk. Some data suggest that physicians are more willing to prescribe HRT specifically to women with the lowest bone mass, and that the latter are more likely to stay on therapy for longer periods of time. The decision to use HRT should be taken by the patient after proper information of all benefits (diminished climacteric symptoms, decrease of cardiovascular risk) and potential risks (possible enhanced breast cancer risk, appearance of side effect). In women who do not want to take HRT, or for whom contraindications exist, alternative medications, such as calcium, vitamin D and biphosphonates can be considered, depending on fracture risk. For older and institutionalized women, programs should be developed to decrease the risk of falling. Likewise, it may be possible to reduce the consequences of a fall, for instance by promoting the development of energy-absorbing hip pads, which reduce fracture risk.

Bone Density↗

PubMed2006

Coloured chlorhexidine cotton pads may help to identify cerebrospinal fluid during epidural or spinal anaesthesia.

BACKGROUND: During complicated technical conditions in epidural or spinal anaesthesia, it may be difficult to safely identify the epidural space. The confirmation or exclusion of the presence of cerebrospinal fluid (CSF) during the procedure of regional anaesthesia is helpful to determine the position of the epidural needle in order to proceed with the anaesthetic block. METHODS: We have examined how CSF and different anaesthetic solutions change the colour of yellowish phenol red absorbed in cotton pads. RESULTS: Sodium chloride and local anaesthetic agents do not change the colour of yellowish phenol red. However, CSF immediately changes the colour from yellow to pink or red. Letting a drop of fluid from the epidural/spinal needle fall on to the cleaning pads filled with phenol red will enable the anaesthesiologist to immediately confirm the presence or absence of CSF. The higher pH of CSF relative to that of sodium chloride and local anaesthetic agents explains the different colour reaction. CONCLUSION: This colour reaction quickly identifies the presence of CSF and thus the intradural space during the procedure of spinal or epidural anaesthesia.

Absorbent Pads↗

PubMed1998

Variations in heel pad mechanical properties variation between children and young adults.

The purpose of this study was to compare the mechanical properties of the heel pads of adults and children, using ultrasound to assess the responses of the heel pad during compression. Thirty volunteers without heel problems, aged from 4 to 36 years, were recruited. There were 10 children (< 15 years old) and 20 adults (> 18 years old). A 7.5-MHz linear array ultrasound transducer was incorporated into a specially designed device to measure the thickness of the heel pad under different loads. The load on the heel pad was increased serially in increments of 0.5 kg, to a maximum of 3 kg, and then reduced sequentially. The load-displacement curve of the heel pad during a loading-unloading cycle was then plotted. Mechanical properties of the heel, including unloaded heel-pad thickness (UHPT), compressibility index, elastic modulus, and energy dissipation ratio (EDR), were calculated from the load-displacement curves. The average UHPT was 1.53 +/- 0.09 cm in children and 1.76 +/- 0.20 cm in adults (p < 0.001). The EDR, which represents the shock absorbency of the heel pad, was 13.5 +/- 2.0% in the children and 23.7 +/- 6.9% in adults (p < 0.001). The average compressibility index and elastic modulus were also higher in adults than in children, although the differences were not statistically significant. These findings suggest that the mechanical properties of the heel pad change from childhood to adulthood. Less energy is absorbed in the heel pad of children, which may partially explain why children tend to have fewer heel problems than adults.

Adolescent↗

PubMed2004

Mechanical energy and effective foot mass during impact loading of walking and running.

The human heel pad is considered an important structure for attenuation of the transient force caused by heel-strike. Although the mechanical properties of heel pads are relatively well understood, the mechanical energy (Etot) absorbed by the heel pad during the impact phase has never been documented directly because data on the effective foot mass (Meff) was previously unavailable during normal forward locomotion. In this study, we use the impulse-momentum method (IMM) for calculating Meff from moving subjects. Mass-spring-damper models were developed to evaluate errors and to examine the effects of pad property, upper body mass, and effective leg spring on Meff. We simultaneously collected ground reaction forces, pad deformation, and lower limb kinematics during impact phase of barefoot walking, running, and crouched walking. The latter was included to examine the effect of knee angle on Meff. The magnitude of Meff as a percentage of body mass (M(B)) varies with knee angle at impact and significantly differs among gaits: 6.3%M(B) in walking, 5.3%M(B) in running, and 3.7%M(B) in crouched walking. Our modeling results suggested that Meff is insensitive to heel pad resilience and effective leg stiffness. At the instant prior to heel strike, Etot ranges from 0.24 to 3.99 J. The combination of video and forceplate data used in this study allows analyses of Etot and Etot as a function of heel-strike kinematics during normal locomotion. Relationship between Meff and knee angle provides insights into how changes in posture moderate impact transients at different gaits.

Computer Simulation↗

PubMed1988

Significance of heel pad confinement for the shock absorption at heel strike.

Shock absorption (SA) is a simple way to reduce the body load and can be used in the prevention and treatment of injuries. The heel pad is the most important shock absorber in the shoe heel complex. The purpose of this study was to investigate whether the SA at heel strike can be increased by heel support in people and shoes with high or low SA. The impact forces at heel strike were measured on an AMTI (R) force platform. Fourteen legs were tested in seven persons (nine with normal and five with low heel pad SA) in gait analysis and in human drop tests. The tests were performed barefooted, and in a soccer and a running shoe (selected by shoe drop test), with and without the distal 2 cm of the heel counter. The heel pad confinement produced by the heel counter (the heel counter effect) increased the SA in both shoe types significantly in both impact situations. The mean increase in SA was 8.8% (range 5.8%-15.5%). The heel counter effect was in all situations significantly higher in persons with low heel pad shock absorbency (LHPSA) than in those with normal heel pads. The barefoot impact peak force per kg body weight was significantly higher (6% mean) on the side with LHPSA. The running shoe provided the significantly greatest SA compared with the soccer shoe. It is concluded that the shock absorbency at heel strike can be increased significantly by heel support, with highest effect in persons with LHPSA, both in shoes with high and low SA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

PubMed1995

Intraoperative blood loss during radical retropubic prostatectomy: epidural versus general anesthesia.

OBJECTIVES: There are conflicting reports on the influence of different anesthetic techniques, such as regional versus general anesthesia, on intraoperative blood loss. The purpose of this study was to elucidate the effects of anesthetic technique on intraoperative blood loss in men undergoing radical retropubic prostatectomy (RRP). METHODS: One hundred patients undergoing RRP for prostate cancer were randomly assigned to receive either epidural anesthesia (EA), combined epidural and general anesthesia (EG), or general anesthesia alone (GA). Intraoperative blood loss was calculated by using a formula that accounted for the volume and hematocrit of the fluid suctioned from the surgical field, blood absorbed on surgical pads, and the patient's hematocrit. RESULTS: Mean blood loss in the EA group (1490 +/- 90 mL; mean +/- SEM) was significantly less than mean blood loss in both the EG group (1810 +/- 100 mL) and the GA group (1940 +/- 130 mL) (P = 0.01). Blood loss was not different between the EG and the GA groups (P = 0.7). Significantly less blood was transfused during surgery in the EA group (730 +/- 50 mL) compared with the EG (960 +/- 60 mL) and GA (950 +/- 70 mL) groups (P = 0.02). CONCLUSIONS: Similar blood loss in patients receiving general anesthesia, either alone or when combined with epidural anesthesia, implies that epidural anesthesia did not reduce bleeding, but, rather, that general anesthesia increased blood loss.

Anesthesia, Epidural↗

PubMed2003

Prevalence and outcomes of continence surgery in community dwelling women.

PURPOSE: Published outcomes of continence surgery are based largely on cohort studies and a smaller number of randomized trials. There is no consensus on the outcomes that should be considered and patient reported outcomes have not always been included. We determined the prevalence of continence surgery as well as patient reported outcomes in community dwelling women. MATERIALS AND METHODS: We performed a 2-stage national cross-sectional mailed survey. A short questionnaire used to identify women with a history of continence surgery was sent to 45,000 representative American households. Eligible women with a history of continence surgery received a followup questionnaire to assess patient reported outcomes, including current symptom frequency, bother and overall satisfaction. RESULTS: Of the 24,581 women 967 (4%) had a history of continence surgery, including 73% who currently reported incontinence in the preceding month, 58% who reported incontinence in the preceding week and 53% who reported current use of pads or other absorbent material. Of those who reported incontinence 83% reported current stress incontinence symptoms, including 62% with stress and urge symptoms. A third of the women had been treated with surgery in the last 5 years. The proportion of women satisfied with the results of surgery decreased from 67% who recalled initial satisfaction to 45% who reported current satisfaction. CONCLUSIONS: Almost 4% of women had undergone continence surgery and continence rates were lower than most published figures. However, some women reported satisfaction with surgery even when they did not achieve continence. Patient satisfaction and other patient reported outcomes might be considered with continence rates when determining surgical success rates.

Adult↗

PubMed2005

Hindfoot containment orthosis for management of bone and soft-tissue defects of the heel.

BACKGROUND: Bone, soft-tissue, and nerve deficits of the weightbearing surface of the foot are frequent sequelae from foot trauma or diabetes mellitus and present challenging treatment issues. Injury to the specialized, shock-absorbing, heel-pad tissue containing spirally arranged fat chambers is particularly difficult to manage. Appropriate footwear modifications and shoe inserts for protection of this skin are essential to the long-term management of bone and soft-tissue defects of the heel. This study evaluated the performance of a new custom total contact foot orthosis (Hindfoot Containment Orthosis, HCO) which was designed to contain the soft tissues of the heel, reduce shear forces, redistribute weightbearing load, and accommodate bone or soft-tissue deformity of the heel. METHODS: Twenty-two patients treated with HCO were retrospectively reviewed. Followup averaged 26 months. The effectiveness of the orthosis was assessed by how well the integrity of the soft tissue was maintained (e.g. the number of ulcerations since dispensing the orthosis), the number of refabrications of the orthosis that were required, and whether or not revision surgery was required. RESULTS: Ten patients had superficial ulcerations. No patient required revision surgery. A total of 62 refabrications of the orthoses in 22 patients were required over a 2-year period. Overall results were good in 17 (77%) patients, fair in four (18%), and poor in one. CONCLUSIONS: The HCO is effective for preservation of soft-tissue integrity of the heel pad after bony or soft-tissue injury. Important factors in achieving success with the HCO are patient compliance and periodic monitoring for refabrication of the orthosis to accommodate skeletal growth, change in foot size or shape, and compression or wear of insert materials.

Adult↗

PubMed2000

Sitting biomechanics, part II: optimal car driver's seat and optimal driver's spinal model.

BACKGROUND: Driving has been associated with signs and symptoms caused by vibrations. Sitting causes the pelvis to rotate backwards and the lumbar lordosis to reduce. Lumbar support and armrests reduce disc pressure and electromyographically recorded values. However, the ideal driver's seat and an optimal seated spinal model have not been described. OBJECTIVE: To determine an optimal automobile seat and an ideal spinal model of a driver. DATA SOURCES: Information was obtained from peer-reviewed scientific journals and texts, automotive engineering reports, and the National Library of Medicine. CONCLUSION: Driving predisposes vehicle operators to low-back pain and degeneration. The optimal seat would have an adjustable seat back incline of 100 degrees from horizontal, a changeable depth of seat back to front edge of seat bottom, adjustable height, an adjustable seat bottom incline, firm (dense) foam in the seat bottom cushion, horizontally and vertically adjustable lumbar support, adjustable bilateral arm rests, adjustable head restraint with lordosis pad, seat shock absorbers to dampen frequencies in the 1 to 20 Hz range, and linear front-back travel of the seat enabling drivers of all sizes to reach the pedals. The lumbar support should be pulsating in depth to reduce static load. The seat back should be damped to reduce rebounding of the torso in rear-end impacts. The optimal driver's spinal model would be the average Harrison model in a 10 degrees posterior inclining seat back angle.

Automobile Driving↗

PubMed1998

Validation of a laboratory method of measuring postpartum blood loss.

Laboratory methods give more accurate measurement of blood loss in the postpartum period than visual estimation. In order to evaluate a laboratory method used to quantify blood loss postpartum, blood lost at gynecological operations was collected in a measuring bottle. The measured amount of blood (50-1,000 ml) was then poured onto absorbent paper towels and sanitary pads, in order to mimic conditions when measuring blood loss in clinical trials in the postpartum period. The amount of blood absorbed onto the absorbent paper and sanitary pads was measured by a rapid method of automatic extraction and photometric measurement of alkaline hematin. The study shows that the method provides a reliable and accurate means of measuring blood loss. The error in each case was less than 10% with an intraclass correlation coefficient of almost 1.

Analysis of Variance↗

PubMed1995

Energy-shunting hip padding system attenuates femoral impact force in a simulated fall.

Recent studies suggest that hip padding systems reduce the incidence of hip fractures during falls. However, no data exist on the force attenuating capacity of hip pads under realistic fall impact conditions, and thus it is difficult to compare the protective merit of various pad designs. Our goal is to design a comfortable hip padding system which reduces femoral impact force in a fall below the mean force required to fracture the elderly cadaveric femur. In pursuit of this objective, we designed and constructed a hip pad testing system consisting of an impact pendulum and surrogate human pelvis. We then developed a hip pad containing a shear-thickening material which allows for shunting of the impact energy away from the femur and into the surrounding soft tissue. Finally, we conducted experiments to assess whether the surrogate pelvis accurately represents the impact behavior of the human female pelvis in a fall, and to determine whether our energy-shunting pad attenuates femoral impact force in a fall more effectively than seven available padding systems. We found the surrogate pelvis accurately represented the human female pelvis in regional variation in soft tissue stiffness, total effective stiffness and damping, and impact force attenuation provided by trochanteric soft tissues. We also found that our padding system attenuated femoral impact force by 65 percent, thereby providing two times the force attenuation of the next best system. Moreover, the energy-shunting pad was the only system capable of lowering femoral impact force well below the mean force required to fracture the elderly femur in a fall loading configuration. These results suggest that the force attenuating potential of hip pads which focus on shunting energy away from the femur is superior to those which rely on absorbing energy in the pad material. While these in-vitro results are encouraging, carefully designed prospective clinical trials will be necessary to determine the efficacy of these approaches to hip fracture prevention.

Accidental Falls↗

PubMed1999

Responses of contralateral SI and SII in cat to same-site cutaneous flutter versus vibration.

The methods of (14)C-2-deoxyglucose ((14)C-2DG) metabolic mapping and optical intrinsic signal (OIS) imaging were used to evaluate the response evoked in the contralateral primary somatosensory receiving areas (SI and SII) of anesthetized cats by either 25 Hz ("flutter") or 200 Hz ("vibration") sinusoidal vertical skin displacement stimulation of the central pad on the distal forepaw. Unilateral 25-Hz stimulation consistently evoked a localized region of elevated (14)C-2DG uptake in both SI and SII in the contralateral hemisphere. In contrast, 200-Hz stimulation did not evoke elevated (14)C-2DG uptake in the contralateral SI but evoked a prominent, localized region of increased (14)C-2DG uptake in the contralateral SII. Experiments in which the OIS was recorded yielded results that complemented and extended the findings obtained with the 2DG method. First, 25-Hz central-pad stimulation evoked an increase in absorbance in a region in the contralateral SI and SII that corresponded closely to the region in which a similar stimulus evoked increased (14)C-2DG uptake. Second, 200-Hz stimulation of the central pad consistently evoked a substantial increase in absorbance in the contralateral SII but very little or no increase in absorbance in the contralateral SI. And third, 200-Hz central-pad stimulation usually evoked a decrease in absorbance in the same contralateral SI region that underwent an increase in absorbance during same-site 25-Hz stimulation. Experiments in which the OIS responses of both SI and SII were recorded simultaneously demonstrated that continuous (>1 s) 25-Hz central-pad stimulation evokes a prominent increase in absorbance in both SI and SII in the contralateral hemisphere, whereas only SII undergoes a sustained prominent increase in absorbance in response to 200-Hz stimulation to the same central-pad site. SI exhibits an initial, transient increase in absorbance in response to 200-Hz stimulation and at durations of stimulation >1 s, undergoes a decrease in absorbance. It was found that the stimulus-evoked absorbance changes in the contralateral SI and SII are correlated significantly during vibrotactile stimulation of the central pad-positively with 25-Hz stimulation and negatively with 200-Hz stimulation. The findings are interpreted to indicate that 25-Hz central-pad stimulation of the central pad evokes spatially localized and vigorous neuronal activation within both SI and SII in the contralateral hemisphere and that although 200-Hz stimulation evokes vigorous and well maintained neuronal activation within the contralateral SII, the principal effect on the contralateral SI of a 200-Hz stimulus lasting >1 s is inhibitory.

Animals↗

PubMed1994

Evaluation of vaginal and perineal area during the use of external sanitary protection throughout the menstrual cycle.

A clinical study evaluated potential external genital effects associated with the use of sanitary protection. The subjects used either a pad with traditional cellulose absorbent core or one containing cellulose and absorbent gelling material. Assessments included objective (transepidermal water loss, vaginal pH) and semi-quantitative subjective--methods (skin irritation grading, gynaecological inspection). No statistical or clinical significant differences for any of the parameters evaluated between the groups using the two pads, or compared to the non-pad control period, were found. The parameters used to study the effects on the genital area of an external sanitary product appear appropriate. No significant changes were observed for either of the two pads during daily use for two menstrual cycles.

Adult↗

PubMed1998

Comparison of the mechanical properties of the heel pad between young and elderly adults.

OBJECTIVE: To compare the mechanical properties of the human heel pad between young and aged adults. DESIGN: A 7.5-MHz linear-array ultrasound transducer was incorporated into a specially designed device to measure the thickness of the heel pad under different loads. The heel pad was compressed with serial increments of 0.5kg to a maximum of 3kg and then relaxed sequentially. Then the load-displacement curve of the heel pad during a loading-unloading cycle was plotted. PARTICIPANTS: Convenience sample of 33 volunteers without heel problems, aged 18 to 78 years, were divided into young (less than 40 years) and elderly (older than 60 years) groups. MAIN OUTCOME MEASURES: Unloaded heel-pad thickness, compressibility index, stiffness, and energy dissipation ratio were calculated from the load-displacement curves. Student's t-test was used to compare the mechanical properties of the heel between these two groups. RESULTS: The average unloaded heel-pad thickness was 1.76+/-.20cm in the young group and 2.01+/-.24cm in the elderly group (p < .001). The average compressibility index was 53.3%+/-7.7% in the young group and 61.3%+/-5.5% in the elderly group (p < .001). Energy dissipation ratio representing shock absorbency of the heel pad, was 23.7%+/-6.9% in the young group and 35.3%+/-10% in the elderly group (p < .001). CONCLUSION: Unloaded heel-pad thickness, compressibility index, and energy dissipation ratio of the heel pad were significantly increased in the elderly group, indicating loss of the elasticity of the heel pad. The loss of elasticity may be responsible for the higher incidence of heel injury in elderly individuals.

Adolescent↗

PubMed1997

Improving the performance of small incontinence pads: a study of "wet comfort".

PURPOSE: The wet comfort of small, disposable incontinence pads has been found to correlate strongly with overall acceptability. This study examined the relationship between pad properties (absorption capacity, strike-through, and wetback) and wet comfort. DESIGN: A group of women with light incontinence were asked to report on the wet comfort of a series of experimental pads made up to the same design geometry but in different combinations of materials. METHODS: Three different pad variants were selected, and two experiments were conducted. Experiment 1 used a single-blind design in which 20 testers were supplied with a random mix of the three unlabeled pad variants. All pads were saved for weighing and scored for overall performance, wet comfort, and absorbency. In experiment 2, subjects used each pad variant in turn for 1 week and at the end of each week compared that pad with the one used the previous week. MAIN OUTCOME MEASURES: Absorption capacity, wetback, and strike-through properties for each pad variant were measured in the laboratory setting, and wet comfort was measured by a written tool completed by participants during clinical trials. RESULTS: Data analysis from experiment 1 revealed statistically significant differences among pad variants, particularly when assessed for absorbency. Differences for wet comfort were less marked and only achieved significance when those with ratings of good or OK for wet comfort were compared with those with a score of poor. In experiment 2, no statistically significant differences were found for wet comfort. CONCLUSIONS: Overall, the improvement in wet comfort achieved by a substantial increase in absorption capacity and reduction in wetback were disappointing. The relatively small sample and the design specifications of the pad may have masked differences. Cost considerations mean that more evidence is needed to justify the inclusion of more expensive materials and production stages in the manufacture of small pads.

Adult↗