A Finite Element Model (FEM) of the young adult human cervical spine has been developed as a first step in studying the process of spondylotic degeneration. The model was developed using normal geometry and material properties for the lower cervical spine. The model used a three-zone composite disc annulus to reflect the different material properties of the anterior, posterior, and lateral regions of the annulus. Nonlinear ligaments were implemented with a toe region to help the model achieve greater flexibility at low loads. The model was validated against experimental data for normal, nondegenerated cervical spines tested in flexion and extension, right and left lateral bending, and right and left axial rotation at loads of 0.33, 0.5, 1.0, 1.5, and 2.0 Nm. The model was within in vitro experimental standard deviation corridors 100% of the load range for right and left lateral bending. The model was within 80% of the load response corridors for extension and flexion with a deviation <0.3 degrees from the SD corridors. For axial rotation, the model was within 70% of the SD corridors for left axial rotation within 83% of right axial rotation responses. The deviation from SD corridors for axial rotation was generally <0.2 degrees.
Introduction Incontinence affects a significant proportion of older adults who reside in care homes. Incontinence symptoms have been linked to comorbidities, an increased risk of infection and reduced quality of life and mental wellbeing of residents. However, continence care provision can often be poor for residents, further compromising the health and wellbeing of this vulnerable population. Method A systematic qualitative evidence synthesis and thematic analysis established the current evidence-base of barriers and facilitators for the provision of continence care in care homes. Results The evidence synthesis revealed complex barriers and facilitators at three influencing levels: macro (structural, societal and external influences), meso (organisational and institutional influences) and micro (day-to-day actions of individuals impacting care provision). Macro-level barriers included negative stigmas relating to incontinence, aging and working in the older adult social care sector, restriction of continence care resources such as containment products (i.e. pads), short staffing in care facilities, shortfalls in the professional education and training of care home staff and the complex health and social care needs of older adult residents. Meso-level barriers included task-centred organisational cultures, ageist institutional perspectives regarding old age and incontinence, inadequate care home management and poor communication and teamwork among care staff. Micro-level barriers included both staff and residents’ poor knowledge of continence care and negative attitudes towards incontinence symptoms, management and treatment. Conclusions These findings help to outline the complexities of continence care provision in older adult care homes. Macro, meso and micro level influences demonstrate problematic and interrelated barriers across international contexts, indicating that improving continence care in this setting is extremely challenging due to the multiple levels at which care provision, services and individuals are impacted. Older adult social care policy-makers, researchers and service-providers must recognise this complexity in any intervention that aims to improve continence care in care homes.
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