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Pediatric seizures commonly trigger emergency medical services (EMS) activation and account for approximately 5–15% of all pediatric 911-EMS calls. More than 50% of children with active seizure activity do not receive prehospital antiepileptic drugs, potentially because they are not recognized by EMS. The purpose of this study is to evaluate specificity and sensitivity of paramedic identification of pediatric seizures and to describe the characteristics of unrecognized seizures. This is an 18-month prospective cohort study at a single, pediatric emergency department (ED). EMS patients ≤15 years old with a prehospital provider impression of seizure were included. Upon ED arrival, a data collection form, which included the EMS verbal report and patient's clinical status, was completed by the attending emergency physician. The primary outcome was sensitivity and specificity of paramedic identification of active seizure. Secondary outcomes included characteristics of missed seizures, ED interventions, and disposition. Descriptive statistics, sensitivity, and specificity were computed. Patient characteristics and clinical outcomes were compared. Surveys were completed for 349 patients (Median 3, IQR = 3.4). Fifty-two of the patients (15%) were actively seizing upon arrival at the ED. Sensitivity was 54% and specificity was 96% for paramedic identification of active seizure. Common features of missed cases were abnormal vital signs (75%), gaze deviation (50%) and clenched jaw (33%). Of these, 37% required intubation and 53% were admitted to the intensive care unit. Paramedics were highly specific, but not sensitive in identifying active seizures on ED arrival. Patients with unrecognized seizures presented most commonly with abnormal vital signs and gaze deviation. [ABSTRACT FROM AUTHOR]

The American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care recommend ventilation rates of eight to ten breaths per minute or two ventilations every 30 compressions, and tidal volumes between 500–600 ml. However, compliance with these guidelines is mainly unknown. The objective of this study is to estimate the proportion of simulated adult OHCA cases that meet guideline-based ventilation targets. We conducted a blinded prospective observational study of standardized simulated cases of EMS-witnessed adult OHCA. During scheduled training sessions, resuscitations were performed by high-quality CPR trained EMS teams composed of four on-duty, full-time EMT/Paramedics from a large urban fire-based EMS agency. A high-fidelity simulation center allowed complete audio and video monitoring from a control room. Rescuers were unaware of the study, or that ventilation practices were being observed. All interventions, including airway and ventilation strategies, were at the discretion of the clinical team. A calibrated Laerdal SimMan 3 G manikin and associated Laerdal Debrief Viewer software recorded ventilation rate, tidal volume, and minute ventilation. Simulations achieving median ventilation rate 7–10 breaths/min, tidal volume 500–600 ml, and minute ventilation 3.5–6 liters/min were considered meeting guideline-based targets. A total of 106 EMS teams were included in the study. Only 3/106 [2.8% (95% CI: 0.6–8.0)] of the EMS teams demonstrated ventilation characteristics meeting all guideline-based targets. The median ventilation rate was 5.8 breaths/min (IQR 4.4–7.7 breaths/min) with 26/106 [24.5% (95% CI: 17.2–33.7)] between 7–10 breaths/min. The median tidal volume was 413.5 ml (IQR 280.5–555.4 ml), with 18/106 [17.0% (95% CI: 10.9–25.5)] between 500–600 ml. The median minute ventilation was 2.4 L/min (IQR 1.2–3.6 L/min) with 16/106 [15.1% (95% CI: 9.4–23.3)] between 3.5–6.0 L/min. During simulated adult OHCA resuscitation attempts, ventilation practices rarely met guideline-based targets, despite being performed by well-trained EMS providers. Methods should be developed to monitor and ensure high-quality ventilation during actual OHCA resuscitation attempts. [ABSTRACT FROM AUTHOR]

Early warning scores are clinical tools capable of identifying prehospital patients with high risk of deterioration. We sought here to contrast the validity of seven early warning scores in the prehospital setting and specifically, to evaluate the predictive value of each score to determine early deterioration-risk during the hospital stay, including mortality at one, two, three and seven- days since the index event. Methods: A prospective multicenter observational based-ambulance study of patients treated by six advanced life support emergency services and transferred to five Spanish hospitals between October 1, 2018 and December 31, 2019. We collected demographic, clinical, and laboratory variables. Seven risk score were constructed based on the analysis of prehospital variables associated with death within one, two, three and seven days since the index event. The area under the receiver operating characteristics was used to determine the discriminant validity of each early warning score. Results: A total of 3,273 participants with acute diseases were accurately linked. The median age was 69 years (IQR, 54–81 years), 1,348 (41.1%) were females. The overall mortality rate for patients in the study cohort ranged from 3.5% for first-day mortality (114 cases), to 7% for seven-day mortality (228 cases). The scores with the best performances for one-day mortality were Vitalpac Early Warning Score with an area under the receiver operating characteristic (AUROC) of 0.873 (95% CI: 0.81-0.9), for two-day mortality, Triage Early Warning Score with an AUROC of 0.868 (95% CI: 0.83-0.9), for three and seven-days mortality the Modified Rapid Emergency Medicine Score with an AUROC of 0.857 (0.82-0.89) and 0.833 (95% CI: 0.8-0.86). In general, there were no significant differences between the scores analyzed. Conclusions: All the analyzed scores have a good predictive capacity for early mortality, and no statistically significant differences between them were found. The National Early Warning Score 2, at the clinical level, has certain advantages. Early warning scores are clinical tools that can help in the complex decision-making processes during critical moments, so their use should be generalized in all emergency medical services. [ABSTRACT FROM AUTHOR]

This study evaluated the risk posed by attachment type in the development of anxiety or depression symptomatology in Mexican adults. This was case-control study in which anxiety and depression symptomatology levels were compared according to the attachment type reported by 3,666 participants. It was found that insecure attachment is a risk factor (p≤.001) for the development of severe levels of depression (OR = 2.12, CI 95%: 1.66–2.70) and anxiety symptomatology (OR = 1.52, 95% CI: 1.30–1.77). Findings are discussed based on their implications for psychiatric nursing practice. The findings of this study enable nurses to consider the empirical validity of attachment theory for studying psychosocial aspects of mental health and to design intervention strategies that promote secure attachment in populations without psychiatric diagnoses to prevent anxiety and depression symptomatology. [ABSTRACT FROM AUTHOR]

Trunk muscle endurance may be associated with balance and falls self-efficacy for people with osteoporosis. However, all previous studies have examined trunk muscle strength rather than endurance. To explore the relationships between trunk muscle endurance and standing balance and falls self-efficacy for women with vertebral fractures. This is an exploratory, secondary analysis of baseline data of a pilot randomized controlled trial in Ontario, Canada. Thirty-one women with osteoporosis, aged 65 years or older, with at least one vertebral fracture were included. The associations between balance (Balance Outcome Measure for Elder Rehabilitation) and trunk muscle endurance (Timed Loaded Standing Test) and falls self-efficacy (Falls Efficacy Scale International) and trunk muscle endurance were tested via Spearman rank order correlation with Fisher's z transformations. Trunk muscle endurance was correlated with better balance performance on the Balance Outcome Measure for Elder Rehabilitation [Spearman correlation coefficient, 0.71; 95% confidence interval: 0.47–0.85; p < 0.001], but not with falls self efficacy (Spearman correlation coefficient; –0.22; 95% confidence interval: –0.53 to 0.14; p = 0.23). Trunk muscle endurance was moderately associated with better standing balance performance but not falls self-efficacy, highlighting the importance of trunk muscle endurance for standing balance for older adults with osteoporosis and vertebral fractures. Older adults with osteoporosis and vertebral fractures who have better trunk muscle endurance may also have better standing balance. There was no association between trunk muscle endurance and how confident a person is that they will not fall while completing various activities of daily living. Trunk muscle endurance training could be included as part of a standing balance rehabilitation program for this population. [ABSTRACT FROM AUTHOR]

Objectives: To assess factors associated with HPV vaccine-related awareness and knowledge among caregivers of adolescents from five ethnic community groups in Utah. Design: For this community-based participatory research study, we surveyed N = 228 caregivers of teens aged 11–17 years from African American, African refugee, American Indian/Alaskan Native, Hispanic/Latino, and Native Hawaiian/Pacific Islander community groups in Utah about their HPV vaccine awareness and knowledge. Results: Participants exhibited high awareness of cervical cancer (71.05%), moderate awareness of HPV (53.95%), and low awareness of the HPV vaccine (46.49%). HPV vaccine-related knowledge was mostly worse, with fewer than half the participants reporting knowing that HPV can cause cervical cancer (46.93%), that most people are infected with HPV at some point in their lives (28.95%), that HPV is asymptomatic in females (36.40%) and males (37.28%), that the HPV vaccine is recommended for adolescent females (41.67%) and males (36.40%), and that the HPV vaccine requires more than one dose (27.19%). HPV vaccine-related awareness and knowledge were significantly associated with race/ethnicity, educational attainment, income, occupation, birthplace, parents' birthplace, English usage, health insurance coverage, type of health insurance, and child having a primary care provider (all p < 0.05). HPV vaccine-related knowledge (p < 0.05) and awareness (p < 0.05) of caregivers were associated with a child in the household receiving the HPV vaccine. Conclusion: Our findings indicate a need to develop educational interventions in collaboration with diverse communities in Utah. We underscore the importance of promoting knowledge about the existence of the HPV vaccine, as well as deeper HPV vaccine-related issues (e.g. HPV risks, treatment, and recommendations). [ABSTRACT FROM AUTHOR]

The aim was to examine the impact of high-risk alcohol consumption on health care service utilization and causes of death after ICU discharge. This retrospective cohort study included non-trauma admissions to ICU in 2014 in Oulu University Hospital, Finland. The National Institution for Health and Welfare provided the data of health care contacts and causes of death. There was a total of 715 ICU survivors, 234 (32.7%) in the alcohol group and 481 (67.3%) in the non-alcohol group. There were no differences between groups in the mortality, median number of primary health care visits, or hospital admissions, but alcohol- and trauma-related visits were more frequent in the alcohol group. 22.5% (vs 2.2%, p <.001) of the patients in the alcohol-group died due to traumas and 29.6% (vs 0.7%, p <.001) due to alcohol-related causes, whereas malignancies and cardiovascular causes (79.4% vs 35.2%, p <.001) were the most common causes in the non-alcohol group. One-third of the patients with high-risk alcohol consumption died due to alcohol-related causes and one-fifth due to traumas. High-risk consumption of alcohol did not have a significant impact on the health care resource use after ICU discharge. [ABSTRACT FROM AUTHOR]

Optimal care suggests that all moderate-high risk head and neck (H&N) cancer patients should receive speech pathology assessment, education and management when commencing radiotherapy. However this is not always feasible due to high patient numbers and limited staffing. The aim of this study was to investigate the implementation of a speech-language pathology assistant (SLP-A) role for swallowing screening and education in a multidisciplinary H&N treatment clinic. A detailed model of care and training module were developed to up-skill the SLP-A in the screening and education to be undertaken. A pre-test post-test design compared outcomes in two separate groups prior to and following SLP-A role implementation. Outcomes included: optimal care compliance, speech-language pathology time spent with complex patients, swallowing-related admissions and patient satisfaction. Twenty-six patients were included pre-implementation and 35 post-implementation, with 16 (46%) patients receiving SLP-A screening/education post-implementation. The proportion of eligible patients seen by speech-language pathology pre-implementation was 62%, compared to 94% seen by speech-language pathology or SLP-A post-implementation (p = 0.002). There was a (non-significant) increase in speech-language pathology time spent with complex patients post-implementation (total minutes per patient: mean 252, SD = 144 vs. 279, SD = 115). There was no increase in swallowing-related admissions, and a (non-significant) increase in patient satisfaction post-implementation, indicating no compromise to patient safety or satisfaction. Implementing a speech-language pathology assistant role for screening patients within the H&N treatment clinic allowed delivery of optimal care and increased time for speech-language pathologists to spend with complex patients, without compromising patient safety or satisfaction. [ABSTRACT FROM AUTHOR]

Pain researchers demonstrated that pain intensity is not the most reliable measure of the success of chronic-pain treatment. Several research groups have proposed "core outcome domains", such as measurements of disability, to assess the effect of an intervention in pain patients. Up till now, studies investigating the relation between pain intensity and disability in patients treated with spinal cord stimulation (SCS) are lacking. Therefore, the current objective is to examine which pain-reporting strategy, routinely used in pain research, associates best with the degree of disability in these patients. Eighty-one failed back surgery syndrome patients (37 males and 44 females, mean age 54.6 years), treated with high-dose spinal cord stimulation (HD-SCS) are recruited. Pain intensity was scored on an 11-point numerical rating scale (NRS) for leg and back pain, while disability was assessed with the Oswestry disability index (ODI). The association between both variables was investigated with Spearman's correlation and Cramér's V. Significant correlations (p < 0.001) are found between the absolute and relative differences of the ODI and NRS. Significant associations were found between reported cut-offs in literature (≤3, ≤5, and 50% pain relief) and the degree of disability. Finally, a significant association (p < 0.001) was found between the minimal clinical important difference. In this study, we showed that the degree of disability was strongly associated with the pain intensity as measured using different methods. The standard method for reporting pain intensity reduction (50%) seems to associate the strongest with the degree of disability. However, a low degree of disability does not always reflect a low pain intensity. The degree of disability reveals a good association with the reporting methods of pain intensity from the literature. The Oswestry disability index could serve as a valid tool to measure the effect of spinal cord stimulation on pain. Disability measures offer a better insight in the clinical profile of chronic pain patients than a pain intensity score. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether early postoperative pulmonary complications after abdominal surgery are associated with a lower performance in preoperative six-minute walk test. Methods: A cross-sectional cohort study of 50 participants who underwent elective abdominal surgery and performed the six-minute walk test within 48 hours prior to surgery were conducted. Postoperative pulmonary complications up to the seventh postoperative day were obtained from medical records. Results: Overall, 25 participants developed postoperative pulmonary complications. The mean (standard deviation) preoperative walked distances of the participants with and without postoperative pulmonary complications were, respectively, 444.8 (81.3) meters and 498.3 (63.7) meters (p =.013). The incidence of postoperative pulmonary complications was greater in the participants with walked distance < 400 meters. The multivariable logistic regression model revealed a significant association between postoperative pulmonary complications and preoperative walked distance (Odds ratio = 0.978, p =.010) in participants who underwent intestinal, stomach, or bile tract resection. Conclusions: This study found a high incidence of postoperative pulmonary complications in abdominal surgery participants and an association between lower preoperative physical capacity and the risk of postoperative pulmonary complications in participants who underwent intestinal, stomach, and biliary tract resection. [ABSTRACT FROM AUTHOR]

Purpose: To expose students to various public health roles and complement clinical experience using simulated encounters. Design: This exploratory study assessed students' performance of basic nursing tasks for three public health nurse roles. Methods: 15-guided questions were used to evaluate a convenience sample of 137 students' expected performance compared to their actual performance of basic nursing skills. Findings: Students' performed well in all nurse roles with some significant differences in completing a few critical tasks in the case manager and school nurse roles. Conclusion: Simulation can address gaps in nursing programs and expose student nurses to various public health roles using real-life scenarios. Clinical Evidence: Lack of clinical sites in public health limits students' experience to a myriad of nurse functions within communities. [ABSTRACT FROM AUTHOR]

The purpose of this study was to examine the association between institution-delivered sex education given under real-world conditions and sexually transmitted infection (STI) rates, STI fatalism, and prior STI testing among African American men aged 15–24 who have sex with women. Participants were tested at community venues for Chlamydia and gonorrhoea and undertook a survey to elicit history of sex education and sexual health information. Among 1196 participants, 73.0% reported having received institution-delivered sex education topics including STI information (90.5%), condoms (89.2%), pregnancy/birth (72.1%) and birth control (67.1%). Among a subset of participants asked about the quality of sex education, 85.7% reported it was 'very good' or 'OK'. The prevalence rate for Chlamydia and/or gonorrhoea was 10.5%. Those who received sex education were more likely to have lower STI fatalism (51.0% vs. 42.4%, p = 0.01) and more likely to report previous Chlamydia screening (44.1% vs. 31.6%, p < 0.01), but did not have a significantly lower rate of Chlamydia and/or gonorrhoea (9.9% vs. 12.4%, p = 0.20) compared to those who did not receive sex education. These findings suggest that institution-delivered sex education given under real-world conditions has beneficial effects on STI risk factors among young African American men. [ABSTRACT FROM AUTHOR]

Parental caregivers can expect to support their children with autism spectrum disorder (ASD) across the lifespan. Providing ongoing support for adult children with ASD who have difficulty performing activities of daily living (ADLs) independently can increase caregiver burden. This may be particularly challenging for compound caregivers (caring for at least one adult child with ASD and another care recipient). The present study investigated differences in relationships between caregiver burden and basic ADLs (BADLs) and instrumental ADLs (IADLs) between compound and noncompound caregivers. Using a nonexperimental correlational research design, 320 parental caregivers of adults with ASD completed a web-based survey. The quantitative analysis compared compound and noncompound caregivers on relationships between caregiver burden and ability to perform ADLs independently. Differences for caregiver burden, BADLs, and IADLs between compound and noncompound caregivers were statistically significant. However, comparison of correlations of caregiver burden and ADLs between the two groups was not significant. These findings provided support that caregiver burden was negatively impacted by the lack of independence in functional ability of their care recipients with ASD for both groups. Social workers and other professionals should offer relevant interventions, supports, and services that benefit compound and noncompound caregivers and their adult children with ASD. [ABSTRACT FROM AUTHOR]

Aerobic training can improve cardiorespiratory fitness in individuals after stroke. However, the effects of short-term and long-term detraining are not well known. To determine the effects of short-term (1-month) and long-term (6-month) detraining on cardiorespiratory fitness (VO2peak) of individuals after stroke, who participated in aerobic training. A cohort study was developed. Twenty adults (57 ± 11 years old) with stroke were included. After completing an outpatient aerobic training, participants were divided into gain group (VO2peak increase >1.3 ml.kg−1.min−1 from before to immediately after the training) or non-gain group (VO2peak change ≤1.3 ml.kg−1.min−1). Cardiorespiratory fitness (VO2peak), obtained by the cardiopulmonary exercise test was assessed one and 6 months after the end of the training (short- and long-term detraining, respectively), or collected retrospectively from patient chart (before and after the training). There was found a significant interaction effect (time*group) for VO2peak (F= 6.108;p < 0,001). Higher values in the VO2peak observed in the gain group with the aerobic training (F = 25.86; p<.001) were significantly reduced with short-term detraining, reaching values similar to that observed before the training and to that of the non-gain group (F = 14.81;p=.001). Both groups had similar VO2peak values within long-term detraining (F = 2.70;p=.12), with no significant differences from the values observed before the training and after short-term detraining (0.11 ≤ p≤ 1.00). Detraining on cardiorespiratory fitness of individuals after chronic stroke occurred within only 1 month. Therefore, it is important to maintain aerobic training throughout life. [ABSTRACT FROM AUTHOR]

Seizures are a common reason why emergency medical services (EMS) transports children by ambulance. Timely seizure cessation prevents neurologic morbidity, respiratory compromise, and mortality. Implementing recommendations from an evidence-based pediatric prehospital guideline may enhance timeliness of seizure cessation and optimize medication dosing. We compared management of pediatric prehospital seizures across several EMS systems after protocol revision consistent with an evidence-based guideline. Using a retrospective, cross-sectional approach, we evaluated actively seizing patients (0–17 years old) EMS transported to a hospital before and after modifying local protocols to include evidence-based recommendations for seizure management in three EMS agencies. We electronically queried and manually abstracted both EMS and hospital data at each site to obtain information about patient demographics, medications given, seizure cessation and recurrence, airway interventions, access obtained, and timeliness of care. The primary outcome of the study was the appropriate administration of midazolam based on route and dose. We analyzed these secondary outcomes: frequency of seizure activity upon emergency department (ED) arrival, frequency of respiratory failure, and timeliness of care. We analyzed data for 533 actively seizing patients. Paramedics were more likely to administer at least one dose of midazolam after the protocol updates [127/208 (61%) vs. 232/325 (71%), p = 0.01, OR = 1.60 (95% CI: 1.10–2.30)]. Paramedics were also more likely to administer the first midazolam dose via the preferred intranasal (IN) or intramuscular (IM) routes after the protocol change [(63/208 (49%) vs. 179/325 (77%), p < 0.001, OR = 3.24 (2.01–5.21)]. Overall, paramedics administered midazolam approximately 14 min after their arrival, gave an incorrect weight-based dose to 130/359 (36%) patients, and gave a lower than recommended dose to 94/130 (72%) patients. Upon ED arrival, 152/533 (29%) patients had a recurrent or persistent seizure. Respiratory failure during EMS care or subsequently in the ED occurred in 90/533 (17%) patients. Implementation of an evidence-based seizure protocol for EMS increased midazolam administration. Patients frequently received an incorrect weight-based dose. Future research should focus on optimizing administration of the correct dose of midazolam to improve seizure cessation. [ABSTRACT FROM AUTHOR]

Due to the coronavirus disease 2019 (COVID-19) pandemic, the state of Texas-limited elective procedures to conserve beds and personal protective equipment (PPE); therefore, between March 22 and May 18, 2020, admission to the epilepsy monitoring unit (EMU) was limited only to urgent and emergent cases. We evaluated clinical characteristics and outcomes of these patients who were admitted to the EMU. Nineteen patients were admitted (one patient twice) with average age of 36.26 years (11 female) and average length of stay 3 days (range: 2–9 days). At least one event was captured on continuous EEG (cEEG) and video monitoring in all 20 admissions (atypical in one). One patient had both epileptic (ES) and psychogenic non-epileptic seizures (PNES) while 10 had PNES and 9 had ES. In 8 of 9 patients with ES, medications were changed, while in 5 patients with PNES, anti-epileptic drugs (AED) were stopped; the remaining 5 were not on medications. Of the 14 patients who had seen an epileptologist pre-admission, 13 (or 93%) had their diagnosis confirmed by EMU stay; a statistically significant finding. While typically an elective admission, in the setting of the COVID-19 pandemic, urgent and emergent EMU admissions were required for increased seizure or event frequency. In the vast majority of patients (13 of 19), admission lead to medication changes to either better control seizures or to change therapeutics as appropriate when PNES was identified. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Early identification of neonates at risk of neurological impairment is particularly important for the bedside clinician. Clinical value of S100b and neuron-specific enolase in neonates has not been yet established. We investigated their kinetics and possible early clinical utility in neonatal encephalopathy (NE). STUDY DESIGN: 36 full-term neonates (13 with moderate/severe encephalopathy, 11 with mild encephalopathy, 12 controls) were enrolled and studied prospectively. Serum S100b and neuron-specific enolase (NSE) were measured serially on days(d) 1, 3, 9 and 18 of life. Brain MRI and long-term neurodevelopmental outcome were also assessed. RESULT: Neonates with moderate/severe encephalopathy had significantly increased S100b (d1) and NSE levels (d1, d3, d9) compared to controls. Neuron-specific enolase significantly correlated with the degree of encephalopathy, and a cutoff of 38.8 μg/l (d1) accurately predicted moderate/severe encephalopathy. S100b (d1) cutoff points of 1.6 μg/l and 11.4 μg/l prognosticated severe encephalopathy and death/cerebral palsy, respectively. Both biomarkers correlated well with neuroimaging and Bayley-III scores. CONCLUSION: Combined clinical, laboratory, imaging and neurodevelopmental data indicate that serum S100b and NSE can be useful biomarkers for the diagnosis and prognosis of neonatal brain injury, providing useful information to the bedside clinician. [ABSTRACT FROM AUTHOR]

To study the effect of the financial crisis in Greece, with a population of drug users approaching the Therapy Center for Dependent Individuals (KETHEA) between 2009 and 2014. It includes two different samples: 2,900 drug users who approached KETHEA in 2009 and 2,338 individuals in 2014. The analysis was based on the questionnaire "Treatment Demand Indicator" (TDI) which was filled out during drug users' first approach. There was a significant increase in the proportion of homeless people (from 8.7% to 16.8%), use of cannabinoids (from 13.2% to 31.8%) and a reduction in opioid use. IVU decreased significantly (from 33.2% to 24.4%). HIV/AIDS infection presented increasing trends. Psychological problems have increased. Risky sexual behaviors present very high rates (63.6%). It seems that the financial crisis has affected the morbidity rates of the population of drug users. It is, therefore necessary to reinforce Harm Reduction interventions in order to control the rates of HIV/AIDS infection and focus more on Palliative Care with regards to comorbidity. The financial crisis seems to have a disruptive effect on the economic and social structure of society with a direct and violent impact on the lives of citizens. [ABSTRACT FROM AUTHOR]

To determine prevalence, incidence and risk factors for foot pressure ulcers in ambulatory children with spina bifida. Retrospective cohort study of 72 ambulatory children (age range 0–23.9 years) with spina bifida treated at a pediatric tertiary care facility. Data on foot pressure ulcers were recorded and analyzed to determine prevalence, incidence and predictive factors. Foot pressure ulcers occurred in 50/143 limbs (35%) over 10.5 ± 3.5 years. Average incidence was 0.10 foot pressure ulcer incidents per person-year, and prevalence in years with complete follow-up was 8.8%. Prevalence was related to age [higher for ages 11–15 (17%), than ages 0–10 (5%) and 16+ years (7%), p < 0.0001], and varus/valgus foot deformities (p < 0.001) and brace use (0.32 risk difference, p = 0.01), but not with standing foot position, deformity rigidity, body mass index, spina bifida type, lesion level, ambulatory level or co-morbidities. Most common sites were the heel (21/96, 22%), lateral malleolus (12/96, 13%), and plantar 5th metatarsal head (11/96, 12%). Foot pressure ulcers occur in nearly 1 out of 10 ambulatory children with spina bifida, most often in pre-teens or young teen-agers with foot deformities, who use braces. This information can help direct skin care education and prevention to those most vulnerable. Foot pressure ulcers occur in children and adolescents with spina bifida, most commonly in those aged 11-15 years, with foot deformities and who use braces. Ulcer development was unrelated to stiffness of foot deformity, body mass index, lesion or functional level, or presence of comorbidities such as Arnold-Chiari malformation, syringomyelia or shunted hydrocephalus. Skin care education and preventative measures should be provided to all patients, but with particular emphasis for those with these risk factors. [ABSTRACT FROM AUTHOR]

Objective: Worldwide research trends on the prevalence of hearing loss within young rural populations are scarce. Current evidence suggests extended high-frequency audiometry could be a sensitive predictor to detect subclinical hearing loss. This study aimed to determine the prevalence of hearing loss through conventional pure tone (0.25-8 kHz) and extended high-frequency (9-20 kHz) audiometry tests in a group of adolescents aged 13 to 19 years old from two rural areas of Colombia. A sociodemographic and associated factor for hearing loss questionnaire was applied. Design: Cross-sectional study. Study Sample: Three hundred sixty-six adolescents aged 13 to 19 years old from two rural municipalities in Colombia: Soracá, and Palmas del Socorro. Results: Hearing loss prevalence assessed through pure tone audiometry was 3.28% in right ears and 3.83% in left ears while through extended high-frequency audiometry was 14.21% and 13.11%, respectively. Associated factors found by the logistic regression were age (OR: 1.36; CI 95% 1.13-1.64) and obesity (OR: 3.74; CI 95% 1.07-13.11). Conclusions: Using 15 dB as the normal hearing threshold parameter for audiometric frequencies, our results suggest that extended high-frequency hearing loss is already widespread among rural adolescents. This highlights the need for research on extended high-frequency audiometry in rural schoolaged children. [ABSTRACT FROM AUTHOR]

Post-stroke sitting balance is a known predictor of independence of gait after stroke. However, previous studies used only qualitative scales or measured static or dynamic sitting balance alone. To investigate whether quantitative parameters of sitting posturography at post-stroke 1 month can predict independent gait. In this prospective cohort study, we enrolled patients with first-ever stroke who could hold a sitting posture at post-stroke 1 month. Sitting balance was assessed using posturography at post-stroke 1 month. Independence of gait was assessed using functional ambulation categories at post-stroke 2 months. We predicted mobility independence at post-stroke 2 months according to sitting balance at post-stroke 1 month. We also assessed the correlation between sitting posturography parameters and clinical scales. We enrolled 27 patients. The limit of stability deviation predicted independent gait at post stroke 2 months (cutoff, 78.4%). Further, there was a high degree of correlation between sitting posturography parameters (weight-bearing distribution deviation and limit of stability deviation) and Berg Balance Scale (ρ = 0.763, ρ = 0.777; p <.001, respectively), Scale for Assessment and Rating of Ataxia (ρ = −0.853, ρ = −0.929; p <.001, respectively), and Fugl-Meyer Assessment scale (upper extremities: ρ = 0.520, ρ = 0.480 [p =.005, p =.011, respectively]; lower extremities: ρ = 0.744, ρ = 0.564 [p <.001, p =.002, respectively]) scores. Sitting posturography parameters is clinically useful because they can quantitatively assess post-stroke balance and neurological impairment and predict post-stroke independence of gait even when patients cannot reach their arms forward or stand upright. [ABSTRACT FROM AUTHOR]

Medical Amnesty/Good Samaritan (MAGS) policies, which eliminate legal charges when students call 9-1-1 for excessive drinking, have been implemented with the goal of reducing barriers to accessing Emergency Medical Services (EMS). This study investigated the impact of MAGS policy implementation on EMS calls on campus and if that EMS call volume could be used to measure policy success. The aim of this study was to compare the prevalence of alcohol-related EMS calls before and after MAGS implementation at a single large public university campus. Methods: A retrospective review of all 9-1-1 calls to on-campus locations was conducted using patient care records (PCRs) from a collegiate EMS agency responding exclusively to on-campus 9-1-1 calls. Calls were excluded if the PCR was marked "incomplete", were outside the 2015 CBEMS response zone boundaries, or if patient age was <15 or >25 years old to ensure analysis was targeting the on-campus student population. The incidence of alcohol-related 9-1-1 calls was compared between one academic year (AY) prior to (pre-MAGS, AY2015) and two years after MAGS implementation (post-MAGS, AY2016/17). An alcohol-related 9-1-1 call was defined as an EMS provider primary or secondary impression of "Alcohol, Alcohol Intoxication, or Alcohol Ingestion" or a call in which the patient explicitly admitted to alcohol use. Relative risk (RR) with 95% confidence intervals (CI) were used to describe the results. Results: Over the three-year study period, the collegiate EMS agency responded to 2440 calls of which 1283 met inclusion criteria. 58 calls were excluded for being incomplete, 227 were outside the original boundaries and 872 were outside the defined age range. Of those calls, 351 were pre-MAGS and 932 were post-MAGS. Of the total 9-1-1 calls, 127 (36.2%) were related to alcohol pre-MAGS and 327 (35.1%) were related to alcohol post-MAGS policy implementation. The relative risk of a 9-1-1 call being made for alcohol-related issues after MAGS implementation was RR = 0.97 (95% CI 0.83-1.14; P = 0.713). Conclusion: Implementation of a MAGS policy was not associated with a significant change in the number of alcohol-related EMS responses. It is unclear if these results reflect ineffective policy implementation or a general reduction in on-campus alcohol consumption. However, using EMS call volume as a marker for policy success and quality improvement offers an innovative tool through which EMS agencies can provide valuable feedback to other system stakeholders. [ABSTRACT FROM AUTHOR]

Problem: Opioid-related overdose deaths are a significant public health concern globally, and current recommendations to address chronic pain and opioid-related stigma in medical curricula may be accomplished using contact-based education. To assess the effectiveness of this technique in changing medical students' opioid use disorder (OUD) stigma and opioid-related postgraduate intentions, the authors implemented two curricular interventions – (1) a modified contact-based education panel and (2) a didactic lecture – at a medical school. Intervention: Medical students were randomized to a curricular intervention and completed pre- and post-assessments to measure opioid misuse knowledge, opioid-related postgraduate intentions, and OUD stigma. One group of participants attended a lecture on opioids and medication assisted treatment (MAT) developed by a clinical psychiatrist; a second group interacted with a 5-member panel of opioid content experts and an individual in recovery. We conducted Fisher's exact tests, paired t-tests, repeated-measures mixed ANOVAs, and logistic regression to examine changes in pre- and post-assessment responses. All first- and second-year (i.e., pre-clinical) medical students at a large, Midwestern medical school with three campuses were invited to participate in a two-arm, parallel educational study comparing the efficacy of two types of curricular interventions. Students at the main campus attended the modified contact-based education panel or the didactic lecture in person, while students at the two distance campuses attended the modified contact-based education or lecture remotely using the University's videoconferencing system. Impact: A total of 109 students participated in the study (average age 24.2 years (SD = 2.6), 64.2% female, 79.8% white, 56.0% second-year students, 67.9% attended on main campus, lecture = 52 participants, modified contact-based = 57 participants). Baseline responses were similar across groups. Following the session, participants in both interventions rated drug abuse (percent increase = 21.2%, p <.001) and prescription drug diversion (percent increase = 7.6%, p =.004) as more serious problems. Participants from both interventions expressed increased confidence in caring for patients with OUD (percent increase = 45.5%, p <.001) and increased interest in pursuing MAT training (percent increase = 21.5%, p =.04). Both curricular interventions were equally effective at reducing OUD stigma with a significant 8.2% decrease in total stigma scores and a large effect size (p <.001, ηp2 =.34). Lastly, participants with lower post-assessment OUD stigma scores were more likely to indicate that they would pursue additional training to provide MAT (p =.02). Lessons learned: Exposure to opioid-specific education with a focus on MAT and recovery, regardless of education type, positively affected opioid-related postgraduate intentions and reduced OUD stigma. Notably, these findings suggest that there are multiple efficacious techniques to reduce OUD stigma during preclinical training. [ABSTRACT FROM AUTHOR]

This case-controlled study determined the utility of the READMIT index to identify the risk for 30-day readmission of patients discharged from an urban community hospital psychiatric inpatient unit. Data was collected from 118 matched patient pairs from 2017 to 2018. Findings demonstrated the READMIT index did not effectively discriminate those patients who were likely to readmit within 30 days. However, the following factors were associated with likelihood of 30-day readmission: the inability to care for self, number of lifetime readmissions, the comorbidity of liver disease, as well as a history of substance abuse. [ABSTRACT FROM AUTHOR]

Human Papillomavirus (HPV) is responsible for 26,900 cancer cases yearly, including genital and oropharyngeal cancers. Despite providing nearly 100% protection against cancer-causing strains of HPV, only 68.9% of teenagers receive even one dose of the HPV9 vaccine. To increase HPV9 vaccine series initiation rates among 11–14 year-olds. Vaccine rates were examined before and after multi-modal protocol implementation at a nurse-run, walk-in immunization clinic. Initiation increased from 17.9% in 2017 to 35.5% in 2018. Use of same way/same day recommendation practices and inclusion of non-clinician staff could improve quality of care and decrease HPV-related disease. [ABSTRACT FROM AUTHOR]

This cross-sectional study assessed prenatal pertussis vaccination acceptance in Taiwan. A sample of pregnant women from five private clinics in Taiwan was recruited. Demographics, experience of prenatal vaccinations, key considerations, knowledge, and attitude about pertussis and its vaccination were measured. Among 505 participants, the vaccination rate, including planned vaccination, was 29.7%. Factors associated with acceptance included clinic location, primary caregiver of the newborn, newborns with siblings, previous influenza vaccination history, knowledge and attitude toward pertussis and its vaccination. Public health agencies should provide free vaccinations, clarify misinformation, and publicize prevention information, to improve prenatal pertussis vaccination acceptance. [ABSTRACT FROM AUTHOR]

Parents frequently experience challenges implementing daily routines important for consistent hearing aid management. Education that supports parents in learning new information and gaining confidence is essential for intervention success. We conducted a pilot study to test an eHealth program to determine if we could implement the program with adherence and affect important behavioural outcomes compared to treatment as usual. Randomised controlled trial. Parents of children birth to 42 months who use hearing aids. Eighty-two parents were randomly assigned to the intervention or treatment-as-usual group. Four parents assigned to the intervention group did not continue after baseline testing. The intervention was delivered successfully with low drop out (10%), high session completion (97%), and high program adherence. The intervention conditions showed significantly greater gains over time for knowledge, confidence, perceptions, and monitoring related to hearing aid management. Significant differences between groups were not observed for hearing aid use time. We found that we could successfully implement this eHealth program and that it benefitted the participants in terms of knowledge and confidence with skills important for hearing aid management. Future research is needed to determine how to roll programs like this out on a larger scale. [ABSTRACT FROM AUTHOR]

Aims: There are very few studies comparing epidemiology and outcomes of out-of-hospital cardiac arrest (OHCA) in different ethnic groups. Previous ethnicity studies have mostly determined OHCA differences between African American and Caucasian populations. The aim of this study was to compare epidemiology, clinical presentation, and outcomes of OHCA between the local Middle Eastern Gulf Cooperation Council (GCC) Arab and the migrant North African populations living in Qatar. Methods: This was a retrospective cohort study of Middle Eastern GCC Arabs and migrant North African patients with presumed cardiac origin OHCA resuscitated by Emergency Medical Services (EMS) in Qatar, between June 2012 and May 2015. Results: There were 285 Middle Eastern GCC Arabs and 112 North African OHCA patients enrolled during the study period. Compared with the local GCC Arabs, univariate analysis showed that the migrant North African OHCA patients were younger and had higher odds of initial shockable rhythm, pre-hospital interventions (defibrillation and amioderone), pre-hospital scene time, and decreased odds of risk factors (hypertension, respiratory disease, and diabetes) and pre-hospital response time. The survival to hospital discharge had greater odds for North African OHCA patients which did not persist after adjustment. Multivariable logistic regression showed that North Africans were associated with lower odds of diabetes (OR 0.48, 95% CI 0.25–0.91, p = 0.03), and higher odds of initial shockable rhythm (OR 2.86, 95% CI 1.30–6.33, p = 0.01) and greater scene time (OR 1.02 95% CI 1.0–1.04, p = 0.02). Conclusions: North African migrant OHCA patients were younger, had decreased risk factors and favourable OHCA rhythm and received greater ACLS interventions with shorter pre-hospital response times and longer scene times leading to better survival. [ABSTRACT FROM AUTHOR]

In Argentina, gestational diabetes mellitus (GDM) is diagnosed by the Latin American Diabetes Association (ALAD) diagnostic criterion. In this work, we investigated GDM prevalence according to the ALAD and IADPSG diagnostic criteria, evaluated maternal and fetal outcomes and assessed whether fasting glycemia between 92–99 mg/dL was associated with increased risk of macrosomia and maternal obesity/overweight in an Argentine cohort of pregnant women. GDM prevalence was 9.8% with the ALAD diagnostic criterion and 25% considering the IADPSG criterion. Increased prevalence of maternal obesity/overweight was observed in patients with fasting glycemia over 99 mg/dL. A population of high metabolic risk is identified by the ALAD criterion. [ABSTRACT FROM AUTHOR]

For parents of adult children with autism spectrum disorder (ASD), caregiving can be ongoing, beginning at diagnosis and continuing throughout adulthood. As parental caregivers age, many may be faced with additional caregiving responsibilities, such as caring for another loved one. This study examined differences in formal and informal social support used by caregivers providing care to more than one person with at least one being an adult child with ASD (compound caregivers) and those caring for a single adult child with ASD (noncompound caregivers). A nationwide sample of 320 parents (age 50 or older) of adult children with ASD completed a web-based survey to understand use of formal and informal social support. Fisher's exact probability tests were used to determine significant differences in the extent to which the services were used by the two groups of caregivers. Results indicated that 4 of the 12 formal and 2 of the 6 informal social support services differed significantly between compound and noncompound caregivers. Given that both groups of caregivers were aging, future research should focus on understanding what services are anticipated to be needed as these changes occur and as changes to future care plans are needed, to best support their care-recipients. [ABSTRACT FROM AUTHOR]

We aimed at clarifying correlations between lay etiologies, self-efficacy, and patient activation among cancer patients. Patients with different kinds of cancer answered a questionnaire on self-efficacy, lay etiology, and patient activation. 639 patients participated. Psychological reasons/stress (43.3%) and destiny (41.6%) were the most cited causes. Lay etiology was influenced by demographics, self-efficacy, and patient activation. Men, younger people, and active patients more often described internal causes of cancer, women and religious patients more often external causes. Patients with higher scores of self-efficacy were more often convinced of external cancer causes. By identifying individual disease theories, physicians may improve patient–physician communication. [ABSTRACT FROM AUTHOR]

In Australia, school-based immunisation programmes (SBIP) provide Human Papillomavirus (HPV) vaccinations to secondary school students. However, despite such free programmes, around 20% of girls and 25% of boys do not complete all doses. This formative study identified barriers and enablers to vaccine completion. Online surveys were conducted with senior school administrators and nurses from Western Australian secondary schools across all three school sectors. Year 8 students participated in focus group discussions. Parents participated in one-on-one interviews (n = 22). Administrators were supportive of vaccination and the SBIP. Nurses and administrators perceived lack of parental awareness, issues around consent and school absenteeism as the main barriers to completion. Parent and student knowledge concerning HPV, the HPV vaccine and immunisation in general were low. Despite this, students and parents were supportive of the SBIP and wanted the opportunity to learn more about HPV, the vaccination and immunisation in general. There are opportunities for targeted school-based work to increase awareness and provision of consent. [ABSTRACT FROM AUTHOR]

The predominance of literature on autism spectrum disorder (ASD) focuses on the diagnosis and needs of young children with ASD and their parental caregivers. Research that compares adults with ASD who were in extended public school programs and those who had either aged out of the programs or were not attending these programs and their service needs is lacking. The purpose of this study was to examine differences in caregivers' reported use of formal and informal social support services for adults with ASD in public educational systems and those who are not receiving services from the educational system. A national sample of 320 parents (age 50+) of an adult child (18+) diagnosed with ASD completed a web-based survey. Results of the study indicated that parental caregivers and adults with ASD were not accessing support services, especially after leaving or aging out of public schools. Social work practitioners and other healthcare professionals can play an important role in addressing the needs of parents and individuals with ASD as they transition into adulthood and age across the lifespan. Future research should investigate the need for services for adults with disabilities, specifically ASD. [ABSTRACT FROM AUTHOR]

Background: Upper extremity hemiparesis is one of the most common post-stroke disabilities requiring rehabilitation. Objective: To compare the effects of virtual and real boxing training in addition to neurodevelopmental treatment on the upper extremity, balance, and cognitive functions in hemiparetic stroke patients. Methods: Forty hemiparetic stroke patients were assigned to either real boxing group-RBG (n=20) or virtual boxing group-VBG (n=20), for a total of 24 sessions (3 sessions/week for 8 weeks). The primary outcome was upper extremity motor ability (Wolf Motor Function Test-WMFT). The secondary outcomes were arm-hand dexterity (Manual Dexterity Test-MMDT), goal-oriented performance (Video Boxing Analysis-VBA), balance functions (Fullerton Advanced Balance Scale-FAB-T), and cognitive functions (Addenbrooke's Cognitive Examination-Revised-ACE-R). Results: There was small treatment effect on ACE-R, small-medium effect for WFMT and MMDT and large effect on bilateral punching time [VBA (Cohen's d- VBG=0.83; RBG=0.95)] and balance [FAB-T (Cohen's d - VBG=0.89; RBG=0.82)] after treatment in both groups. No significant differences were found for training effects between the groups for upper extremity functions [WMFT (p=0.799; Cohen's d=-0.07), MMDT-PT (p=0.327; Cohen's d=-0.10), MMDT-THTPT (p=0.779; Cohen's d=-0.17) and VBA bilateral punch number (p=0.068; Cohen's d=0.15)], balance functions [FAB-T (p=0.602; Cohen's d=-0.19)] and cognitive functions [ACE-R total (p=0.947, Cohen's d=0.09)]. Conclusion: The study showed that virtual and real boxing training methods, in addition to neurodevelopmental treatment, are effective in improving upper extremity, balance, and cognitive functions in patients with hemiparetic stroke. The training effects were higher on bilateral punching time and balance functions for both groups. There was no superiority of either approach. [ABSTRACT FROM AUTHOR]

People with a mental illness may be exposed to stigma which, when internalised, negatively influences self-esteem, personal goal attainment and quality of life. However, people who are empowered may actively challenge stigma by engaging in meaningful opportunities, furthering their self-worth as they achieve control within their lives. People who are empowered through active treatment participation are more likely to reach recovery goals and experience the benefits of evidence-based practices. Hence, empowerment can be viewed as essential to the recovery and well-being of people with a mental illness. Participants in this quantitative study (N = 173) were diagnosed with a mental illness and were recruited via convenience sampling from mental health support groups in Australia. Internalised stigma was less common and empowerment more prevalent in this study than was found in previous studies. However high internalised stigma and low empowerment were present. The terms 'individual' and 'person with lived experience' which have been identified as the preferred terms in a previous study were highlighted as both empowering and recovery focussed. [ABSTRACT FROM AUTHOR]

Anxiety sensitivity (AS) is a multidimensional construct associated with the etiology and maintenance of panic disorder (PD) symptoms. However, only a few studies have evaluated whether cognitive-behavioral group therapy (CBGT) can modify the condition. The objective of this study was to evaluate the impact of CBGT on AS in patients with PD and to analyze AS and its dimensions as predictors of response to CBGT. In the present clinical trial, an intervention group (n = 37) attended 12 CBGT sessions, while a control group (n = 52) did not receive any intervention. The severity of symptoms and of AS were evaluated before and after CBGT in the intervention group and once in the control group. Significant improvement occurred in all specific PD symptoms and in general anxiety and depressive symptoms. Furthermore, AS scores reduced significantly after intervention. This study confirmed that AS is higher in patients with more severe PD. The effectiveness of CBGT for reducing the physical, cognitive, and social dimensions of AS was also observed, supporting the hypothesis of a positive impact of therapy. [ABSTRACT FROM AUTHOR]

The aim of this study was to qualitatively analyse physiotherapists' experiences and perspectives for delivering services directly, without prescription or referral, for clients with musculoskeletal pain or dysfunction. This was a qualitative study where data were collected from questionnaires given to 34 physiotherapists, 18 of them being in direct access for 6 years and 16 for 6 months. There were 15 structured questions and 3 open-ended ones. The answers were analysed with quantitative and qualitative methods. The data analysis of the open-ended questions showed that physiotherapists had positive experiences of direct access. This practice brought meaningfulness, including increased self-respect, to physiotherapists' work. Meaningfulness was interpreted as being constructed from a client perspective, a work perspective and a working community perspective. The self-respect was connected to experiencing the improvement of skills with their clients. In providing direct access practice, physiotherapists expressed a heightened sense of meaningfulness in their work, which was related to clients' satisfaction with being in the right place at the right time. They experienced improved competence, which was connected with their self-respect and cooperation with other health care professionals. For future research, we propose to explore of larger samples of physiotherapists, clients and other key stakeholders. [ABSTRACT FROM AUTHOR]

To investigate the postural instability and vestibular functions in children with severe inner ear malformations (IEMs). A prospective case-control study. The study group consisted of 10 children using unilateral auditory brainstem implant (ABI) with labyrinthine aplasia or rudimentary otocyst. The age-matched control groups consisted of 10 unilateral cochlear implant (CI) users with normal inner ear structures and 10 healthy peers. All tests were performed to implant users when the implants were off. All median VOR gains in the ABI group (median anterior, lateral, and posterior canal 0.15, 0.05, and 0.05, respectively, for the non-implanted sides) were significantly lower than those of the control groups (median VOR gains ≥ 0.90 in both control groups). There were no oVEMP and cVEMP responses in the study group. The mean BOT-2 balance scores of the ABI (3.70 ± 1.34) group was dramatically lower than those of the CI (9.40 ± 2.88) and healthy control (16.20 ± 4.16, p < 0.001). The postural instability in children with severe IEMs was higher than those in CI users with normal inner ear structures and healthy peers. The level of deficiency in the labyrinthine was more important for postural stability in children. [ABSTRACT FROM AUTHOR]

Objective: African Americans (AA) are often underrepresented and tend to lose less weight than White participants during the intensive phase of behavioral obesity treatment. Some evidence suggests that AA women experience better maintenance of lost weight than White women, however, additional research on the efficacy of extended care programs (i.e. continued contacts to support the maintenance of lost weight) is necessary to better understand these differences. Methods: The influence of race on initial weight loss, the likelihood of achieving ≥5% weight reduction (i.e. extended care eligibility), the maintenance of lost weight and extended care program efficacy was examined in 269 AA and White women (62.1% AA) participating in a 16-month group-based weight management program. Participants achieving ≥5% weight reduction during the intensive phase (16 weekly sessions) were randomized to a clustered campaign extended care program (12 sessions delivered in three, 4-week clusters) or self-directed control. Results: In adjusted models, race was not associated with initial weight loss (p = 0.22) or the likelihood of achieving extended care eligibility (odds ratio 0.64, 95% CI [0.29, 1.38]). AA and White women lost −7.13 ± 0.39 kg and −7.62 ± 0.43 kg, respectively, during initial treatment. There were no significant differences in weight regain between AA and White women (p = 0.64) after adjusting for covariates. Clustered campaign program participants (AA: −6.74 ± 0.99 kg, White: −6.89 ± 1.10 kg) regained less weight than control (AA: −5.15 ± 0.99 kg, White: −4.37 ± 1.04 kg), equating to a 2.12 kg (p = 0.03) between-group difference after covariate adjustments. Conclusions: Weight changes and extended care eligibility were comparable among all participants. The clustered campaign program was efficacious for AA and White women. The high representation and retention of AA participants may have contributed to these findings. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the methodology, interpretation, and perceived value of Spurling's test toward diagnosis/classification and treatment. Methods: An anonymous web-based survey was made available to physical therapist members of the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Based on video demonstrations of technique and symptom distribution, questions included preferred method, criteria for test interpretation, and perceived value of Spurling's test and other examination findings toward clinical decision-making. Professional profile data were also collected. Results: Among the 452 participants completing the survey, no method of testing was preferred by more than 37%, with ipsilateral lateral flexion, rotation, and extension with compression being most frequently preferred followed by ipsilateral lateral flexion with compression at 32%. Proximal provocation of symptoms only without distal symptoms was interpreted as a positive test by 67%. Participants rated Spurling's test of moderate to low value toward diagnosis/classification and treatment. Discussion: Inconsistency with methodology and interpretation of Spurling's test is suggested to be pervasive in physical therapist practice. While an optimal test methodology has yet to be identified, result interpretation does have a basis for clarification toward diagnosis/classification and reduction of unwanted variance in practice. [ABSTRACT FROM AUTHOR]

Background: The use of psychoactive substances constitutes one of the leading social problems confronting students. Some gender differences have been reported in the use of substances. Aim and objectives: To identify the gender differences in substance use among students in Nigeria. Methods: This was a cross-sectional study conducted among 763 students of Imo State University Owerri. A self-administered structured questionnaire was used to obtain the socio-demographic data and information on the reasons, and consequences of substance use. Results: A total of 763 students were studied. More males used substances compared to females (χ2 = 10.6, p˂0.01). More females used psychoactive substances out of curiosity (51.9%), and because a family member used psychoactive substance (55.7%). More males used psychoactive substances to be accepted by friends (χ2 = 7.33, p˂0.01), to make life more enjoyable (χ2 = 18.6, p˂ 0.01), to appear bold and strong (χ2 = 21.7, p <.01), and to cope with the stress (χ2 = 6.52, p˂0.01). Skipping classes regularly (χ2 = 6.98, p˂0.01) and being charged for sexual molestation (χ2 = 5.64, p˂0.02) were more among those who abused substances. Conclusion: There are differences in the rate and reasons for the use of psychoactive substances between the genders. In the design of preventive approaches in students, these should be borne in mind. [ABSTRACT FROM AUTHOR]

Background: In the West African sub-region, the recreational use of psychoactive substances has increased. Adolescent substance use is commonly found among students. This study was aimed at determining the prevalence and pattern of substance use among secondary school students in Ilorin, Nigeria. Methods: Using a multistage sampling technique, data from 2,001 students was analyzed. Instruments used were a sociodemographic questionnaire and a modified WHO Students' Drug Use Survey Questionnaire. Results: The overall lifetime use of substances was 83.7%, while overall current use was 62.4%. Non-prescription use of antibiotics and analgesics was prevalent (53% and 15.8%, respectively). The psychoactive substances most commonly used were stimulants, alcohol and organic solvents, with a current use of 7.1%, 3.5% and 3.5% respectively (N = 2001). The overall mean age at first use was 13.45 ± 1.49, while many organic solvent users started at age 10. Conclusions: The recreational use of psychoactive substances is common among school children in Ilorin. The age of onset is in early adolescence, or earlier for substances like organic solvents that are easily accessible. The prevalent use of alcohol, a gateway drug, is a call for action. [ABSTRACT FROM AUTHOR]

Background: Due to its progressive nature, substance use impacts the entire aspects of life, and can result in adverse repercussions on mental status. Accordingly, the current article seeks to compare the mental status of substance abusers with that of normal individuals.Methods: The study is a cross-sectional research. The study population is comprised of 50 methamphetamine users, 52 opium users, and 100 normal individuals referred to Farabi Psychiatric Hospital in Kermanshah, 2018, in Iran. The subjects were selected by convenience sampling method and matched in terms of demographic characteristics. Data collection was performed using Mental State Examination (MMSE) and demographic questionnaire.Results: The results showed that mean scores of orientation, attention, and mental status were significantly different between the normal and substance abusers (P <.05). However, the above-mentioned difference was not significant between methamphetamine abusers and opioid abusers (P >.05). In addition, the mean score of the language tests was statistically significant only among the normal and methamphetamine abusers (P <.05). Conclusions: Based on the obtained results, it can be concluded that the opium and methamphetamine users showed poorer performance in MMSE than the normal group. [ABSTRACT FROM AUTHOR]

Purpose: To study physical function perspectives in persons with spina bifida (SB) aged ≥50 years. In relation to this, we also wanted to survey participation perspectives, health issues and health services usage. Methods: We used predefined fixed questions to interview community-dwelling adults with SB in Norway. Physical function assessments included Timed Up and Go, the Six Minute Walk Test, and BMI was calculated. Descriptive statistics were used, and logistic regression was performed to study variables associated with community walking. Results: Eighteen women and twelve men, twenty-four of them without hydrocephalus, participated in the study. Their mean age was 57.5 years (range 51–76). The majority were well-functioning persons, with 53% employed. However, deterioration in ambulation started at a median age of 40 years in >80% of the participants. Higher odds for being a community walker were found for sacral SB, BMI < 30, and/or being more physical active per week. More than 60% of the study sample used antihypertensive medication, and 43% were obese (BMI ≥ 30). Pain was a commonly perceived health problem. About 50% had been through a comprehensive SB-specific health evaluation in adulthood. Conclusion: The striking results on obesity, hypertension, pain and deterioration in ambulatory function in middle-aged and elderly SB cases call for action. Our findings elucidate the importance of prevention and clinical follow-up throughout the lifespan, even in well-functioning SB cases. Weight-management and interventions to reduce hypertension are issues that need attention in follow-up and as part of secondary rehabilitation in spina bifida. Early deterioration in ambulatory function and pain in spina bifida are target areas for multidisciplinary secondary rehabilitation, and should adequately focus on maintaining or improving "real-life" functioning performance. Neurogenic bowel and fecal incontinence are important in relation to social participation in ageing spina bifida. Rehabilitation programs and research should take the level of cele and hydrocephalus into account. [ABSTRACT FROM AUTHOR]

We conducted an epidemiological study to identify the demographics and pre-operative characteristics of patients undergoing primary anterior cruciate ligament (ACL) reconstruction in a multi-ethnic Asian population. A retrospective study was performed on 696 patients who registered in our ACL reconstruction registry from January 2013 to August 2016. Important inter-ethnic differences were found. Indian patients were significantly older compared to Malay and Chinese patients. Malay and Indian patients were more likely to be male, overweight, and obese compared to Chinese patients. Soccer was the predominant sport involved, although ethnic predominance in specific sports exists. Novel findings from this study include increased prevalence of concomitant chondral injuries in the Chinese population compared to Malays and Indians, and significantly higher rates of concomitant intra-articular injuries in soccer and basketball compared to netball. Identification of these high-risk subgroups would serve useful in guiding the formulation of prevention strategies within our multi-ethnic community. [ABSTRACT FROM AUTHOR]

Purpose: The mortality rate of cardiovascular diseases in such developing countries as Iran is on the rise. Despite sufficient evidence pointing to its efficacy, cardiac rehabilitation (CR) approach is only employed to a limited extent. In the present study, barriers to participation in center-based cardiac rehabilitation programs and patients' attitude toward home-based cardiac rehabilitation model were examined. Methods: In this study, 204 eligible patients for CR visiting an academic hospital were examined during the first three months of 2017. Patients had either abandoned rehabilitation programs midway through or had not attended one in the first place. Data about perceived barriers were collected using the modified Cardiac Rehabilitation Barriers Scale. Also, Patients' attitude toward home-based CR was collected using a pre-validated researcher-made questionnaire. Results: The results revealed that the most effective barriers were transportation problems (70%), travel costs (70%), considerable distance to the rehabilitation center (67%), and lack of insurance coverage for rehabilitation costs (64%), respectively. Patients with longer than 30-minute drive time were less likely to attend in training sessions in the center. In addition, the important patient expectations about home-based CR programs included: communication with specialists, training before entering the rehabilitation program, and making periodic visits to maintain motivation and adhere to the home-based CR programs. Conclusions: The results revealed that logistical factors were the major barriers to participation in rehabilitation programs. Alternative models such as home-based CR programs, positively evaluated by the participants, can be used to overcome these barriers. [ABSTRACT FROM AUTHOR]

Stigma is one of the common problems of patients with bipolar disorders, which impedes their recovery. This is a quasi-experimental study on 76 hospitalized patients with bipolar disorder (38 in each group) in Iran. The intervention group received six sessions of psychoeducation in a period of 2 weeks. Internalized stigma was measured by the Internalized Stigma of Mental Illness scale. The education significantly reduced the scores of alienation, discrimination experience, stigma resistance and total score of stigma in the intervention group. Hence, this education can be used as an accessible technique in hospitals to reduce the internalized stigma. [ABSTRACT FROM AUTHOR]

To determine if exposure to organic solvents and noise is associated with audiometric results among workers from a printing press in Mexico City. Cross-sectional study. One hundred and seventy-six male workers at a printing press in Mexico City exposed to noise and organic solvents, including xylene, and 103 non-exposed male workers as reference group. Hearing thresholds were assessed with pure-tone audiometry. Poorer hearing thresholds were observed among printing workers than non-exposed controls, particularly among groups with over 5 years of exposure. Hearing thresholds differences were observed in the frequencies above 500 Hz, especially in 4000 Hz in all exposure groups compared to the reference. Adjusted models for age and previous exposure to noise and organic solvents showed worse hearing thresholds as years of seniority increased –β coefficients (95% CI): ≤5 years: 3.06 dB (0.01, 6.10); >5–10 years: 4.51 dB (1.13, 7.89); >10 years: 4.58 dB (1.20, 7.96). Further analyses showed no interaction between noise and organic solvents on hearing thresholds, considering both current and previous occupational exposures. Exposure to noise levels that were below recommended exposure limits and organic solvents were associated with poorer hearing thresholds than those observed among non-exposed study participants. This suggests that workers exposed to solvents should be included in hearing conservation programmes, even when noise exposures are below 85 dB. If only noise levels were taken into consideration in the risk assessment of this worker population, the risk of hearing effects could have been overlooked. [ABSTRACT FROM AUTHOR]

This study aimed to systematically investigate the ototoxic potential of cobalt in patients with a metal-on-metal (MoM) hip implant, using objective auditory and vestibular assessments and a questionnaire. The results of the objective evaluation were published previously, whereas the current study focused on the questionnaire outcome and its relationship to the blood cobalt level. Design and study sample: Twenty patients (33–65 years) with a primary MoM hip implant and 20 non-implanted control subjects, matched for age, gender, and noise exposure, received a questionnaire to evaluate the presence of several hearing and balance symptoms (part 1) and general neurological issues (part 2). Concerning part 1, the proportion of auditory-related symptoms in general (p = 0.022) and tinnitus (p = 0.047) was significantly higher in the MoM patient group, whereas no group difference was found for hyperacusis, increased listening effort, and decreased speech understanding. Concerning part 2, no significant group differences were detected. Within the MoM patient group, the questionnaire outcome was not significantly different between the low-exposure and high-exposure subgroups according to the blood Co level. In line with our previous study, these results potentially imply Co-induced impairment to the auditory system, despite the lack of a clear dose–response relationship. [ABSTRACT FROM AUTHOR]

This study assessed the association between sources of sexuality education, sexual beliefs and behaviour among Lebanese youth. 451 unmarried students at a private university, mean age 20.25 (±1.41) years, participated in the study. Main sources of information were teachers, mothers, internet and friends. Respondents wished for increased involvement of fathers and doctors in their sexuality education. There was a positive association between receipt of school classes on reproductive health and adoption of protective behaviour at first sexual experience (OR = 4.09, p < 0.05). A Sexual Belief Index (SBI) was calculated as a mean score on 18 items related to sexual permissiveness (Cronbach's alpha = 0.83). Sex and classes on reproductive health predicted a rise in SBI. The timing of classes, namely earlier introduction, and communication with family and religious figures predicted a decrease in SBI. The SBI was positively associated with sexual activity (OR = 3.68, p = 4.399e-07), first sex at <17 years (OR = 5.262, p = 0.0099) and engagement in one-night stands (OR = 4.195, p = 0.0001). Students who engaged in same-sex sexual experiences had higher odds of contracting STIs (OR = 12.7, p = 0.0001). Findings reveal the need to include sexual health in school curricula; train parents, physicians and teachers as information providers and moderators of SBI; and improve access to youth-friendly services. [ABSTRACT FROM AUTHOR]