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Fatigue, a common complaint in individuals with postpolio syndrome (PPS), is defined as an overwhelming sustained feeling of exhaustion and diminished capacity for physical and mental work. A comprehensive medical work-up is needed to rule out all other causes of fatigue. A sleep study should be considered for individuals with PPS who complain of fatigue. Self-reported outcome measures, such as the Fatigue Severity Scale, are reliable and valid tools to measure fatigue in this population. Fatigue management consists of individualized treatment of underlying medical conditions, energy conservation, pacing techniques, and lifestyle modifications.

Background Literature indicates that individuals with long-term residual lower extremity (LE) weakness after polio have decreased bone mineral density (BMD) deficiencies related to muscle weakness. Where weakness is asymmetrical, bone densitometry (BDt) measured only on the stronger LE may misclassify BMD. Objective To determine (1) whether femoral neck BMD differed from side to side in individuals with asymmetrical LE muscle weakness, and (2) the proportion of individuals at risk for underdiagnosis of low bone density or osteoporosis given unilateral assessment of the femoral neck. Design Retrospective study. Setting Outpatient postpolio center. Participants Patients >18 years old with complete relevant data. Main Outcome Measures BDt T scores, BMD categories based on standard T-score ranges, and side of LE weakness determined by a strength score. Results Forty-three subjects had at least 1 femoral neck T score and bilateral LE strength scores. Fourteen (32.5%) had BDt only on their weaker LE and 14 (32.5%) had BDt only on their stronger LE. Of the 15 subjects with BDt done on both femoral necks, T scores (mean [standard deviation]) were lower in the weaker LE (–1.73 [1.09]) than the stronger LE (–0.88 [1.0]) (P = .001). Classification of low bone density or osteoporosis was more frequent based on T scores taken on a weaker LE (48.3% and 24.1%, respectively) than from T scores from a stronger LE (41.4% and 6.9%, respectively). Conclusions In this small sample, using strong-limb T scores resulted in fewer individuals categorized as having low bone density or osteoporosis than when weak-limb T scores were used. Underestimating BMD loss may lead to undertreatment and increased risk of morbidity, mortality, and costs associated with femoral neck fractures in this high-fall-risk group. Level of Evidence III

This chapter describes the Community Health Worker Core Consensus (C3) Project carried out from 2014 to 2018. The focus of the C3 Project was to develop an updated contemporary list of CHW core roles and competencies (skills and qualities) common in the United States, using the National Community Health Advisor Study (NCHAS, 1994–1998) as a baseline. This chapter outlines the process of undertaking the Project and the methods incorporated to maximize CHW voice and leadership in the process. The chapter closes with a presentation of the C3 Project’s updated CHW core roles and competencies. Of those roles or areas of CHW scope of work, three were newly identified since the NCHAS. They are implementing individual and community assessments; conducting outreach; and participating in evaluation and research. These and the other seven roles named by the C3 Project serve as the foundation for the organization of the ten roles highlighted in this book. Skills newly identified or refined in the same time frame include individual and community assessment skills; outreach skills; professional skills and conduct; and evaluation and research skills. Finally, qualities embraced by the C3 Project are noted; these are based on previous research in the field. The most prominent is the quality of CHWs’ “connection to the community served.”

Bayer Pharma AG; Bristol-Myers SquibbBristol-Myers Squibb; Pfizer Alliance; DaiichiSankyo Europe GmbHDaiichi Sankyo Company Limited

The core role of providing coaching and social support includes four sub-roles: providing individual support and coaching; motivating and encouraging people to obtain care and other services; supporting self-management of disease prevention and management of health conditions (including chronic disease); and planning and/or leading support groups. In this chapter, two teams describe the role of community health workers (CHWs) in providing coaching and social support in New York City, New York, and Chicago, Illinois. The first team explores the work of Cure Violence (CV) Credible Messengers, CHWs, to implement a neighborhood-based, public health approach to gun violence reduction. The history, trends, and disparities in community gun violence across New York City are highlighted to illustrate the landscape in which CV CHWs work. This section also describes a shift in how local government agencies work to prevent gun violence, largely in response to the work done by these CHWs. The second team shares the stories of a team of CHWs who work at Sinai Urban Health Institute (SUHI), serving some of the poorest and most disadvantaged neighborhoods in Chicago. By providing social support and utilizing effective coaching techniques, this team of CHWs moves their clients toward the ultimate goal of “thriving in health,” a key component of SUHI’s mission. The stories and lessons contained herein will support others interested in more effectively utilizing CHWs in providing social support and coaching.

Meckel's diverticulum (MD) is a well-defined diagnosis in children presenting with either bleeding or obstruction. Although anecdotally adult patients may present with complications from MD, their presentation seems to be different, with a reported predominance of non-bleed-related presentations. Reports in this population, however, are limited, and little is known of the epidemiology of MD in older patients. We performed a retrospective analysis of the Agency of Healthcare Research and Quality National Inpatient Sample of all US hospital discharges from 2012 to 2016. We identified patients with a primary discharge diagnosis of MD. Data were abstracted as raw numbers and population weighted rates of discharge with age group, income level, length of stay (LOS) and hospital charges as additional information. On average, 2030 individuals were discharged annually; most (71.1%) were adults (>18 years). Although MD was predominant in males in all age groups, the gender ratio decreased with older age categories from 3.5:1.0 (1-17 years) to 1.6:1.0 (65-84 years). LOS averaged 5.3 days with no clear relationship to other parameters. Median income category, however, closely correlated (R2=0.9996) with diagnosis in older age categories. MD may be significantly more prevalent in adult patients than was previously understood. Differences in gender preponderance suggest that gender may influence the pattern of presentation. Diagnosis in older individuals is closely associated with income or socioeconomic status but not hospital charges or LOS.

BACKGROUND People with spinal cord injury (SCI) are less likely to be physically active and have higher chronic disease risk than those in the general population due to physical and metabolic changes that occur postinjury. Few studies have investigated approaches to promote increased physical activity (PA) for people with SCI despite evidence that they face unique barriers, including lack of accessible transportation and exercise equipment. To address these obstacles, we adapted an evidence-based phone-delivered intervention that promoted increased PA among people with SCI into a web-based platform, titled the Workout on Wheels internet intervention (WOWii). The adapted program provides participants with weekly skill-building information and activities, basic exercise equipment, and ongoing support through weekly group videoconferencing. OBJECTIVE This pilot study was conducted to assess the feasibility of using a web-based and virtual format to deliver the WOWii program in a randomized controlled trial. METHODS We assessed the feasibility of the web-based program by delivering an abbreviated, 4-week version to 10 participants with SCI. Rates of weekly videoconference attendance, activity completion, and exercise activity as tracked by an arm-based activity monitor were recorded for all participants. RESULTS Participants averaged 3.3 of 4 (83%) weekly group videoconferences attended, 3.4 of 4 (85%) web-based module activities completed, and 2.3 of 4 (58%) weeks of using the arm-based activity monitor. The majority of the sample (9/10, 90%) synced their arm-based PA monitor at least once, and overall engagement as an average of each component across the 4 weeks was 75%. CONCLUSIONS The intervention had sufficiently high levels of engagement to be used in a full randomized controlled trial to test its effectiveness in improving levels of PA among people with SCI. The knowledge we gained from this pilot study informed improvements that were made in the full randomized controlled trial.

Although community health workers (CHWs) continue to gain credibility and recognition in the health care and public health sectors, there is still a need to expand workforce identity and development efforts, including identifying best practices for assessing CHW skill proficiencies. During this qualitative study, we interviewed 32 CHWs, trainers, and supervisors to understand current practice, perspectives, and perceived importance in assessing CHW skills and guiding principles for CHW skill assessment. Results from these interviews can be used to inform CHW workforce development to enhance efforts among those who are actively building CHW programs or who are considering improvements in strategies to assess CHW skill proficiencies.

BACKGROUND People with spinal cord injury (SCI) are at higher risk for numerous preventable chronic conditions. Physical activity is a protective factor that can reduce this risk, yet those with SCI encounter barriers to activity and are significantly less likely to be active. Limited evidence supports approaches to promote increased physical activity for those with SCI. OBJECTIVE Building upon our previous theory- and evidence-based approach to increase participation in regular physical activity for those with SCI, this study aimed to use a participatory action research approach to translate a theory-based intervention to be delivered via the Web to individuals with SCI. METHODS A total of 10 individuals with SCI were invited to participate in consumer input meetings to provide the research team with iterative feedback on an initial website designed as a platform for delivering a theory-based exercise intervention. RESULTS A total of 7 individuals with SCI whose average age was 43.6 years (SD 13.4) and lived an average age of 12.5 years (SD 14.9) with SCI met on 2 occasions to provide their feedback of the website platform, both on the initial design and subsequently on the revamped site. Their iterative feedback resulted in redesigning the website content, format, and functionality as well as delivery of the intervention program. CONCLUSIONS The substantially redesigned website offers an easier-to-navigate platform for people with SCI with greater functionality that delivers information using a module format with less text, short video segments, and presents more resources. Preliminary testing of the site is the next step.

Context: Proliferation of the use of psychopharmacologic drugs for the treatment of individuals with attention and behavior disorders has promoted discussion of the illicit use of such drugs to enhance academic performance. Previous research has focused on the use of such drugs by undergraduate students; however, inquiry into the nonmedical use of prescription stimulants by medical students is warranted because of the unique qualities of the medical school environment (including academic pressure, stress, and competition with peers) and the demographic characteristics common to many medical students. Objective: To examine the nonmedical use of prescription stimulants among osteopathic medical students, focusing on such key associated variables as academic stress, social network connections, and use of other substances. Methods: In 2012, first- and second-year students at a large osteopathic medical school were surveyed on the nonmedical use of prescription stimulants, stress, social networks, perceptions of drug use, and related topics. Data were compared with national data and assessed using analysis of variance and χ2 statistical tests. Results: A total of 380 students completed the survey. Of those, 56 (15.2%) reported using prescription stimulants nonmedically to help them study in medical school. This percentage is significantly higher than the national estimated rate of diagnosis of attention-deficit/hyperactivity disorder in similar populations (t=3.72, PF=14.89, P2=18.00, P Conclusion: In contrast with research on undergraduate populations, addressing academic stress and feelings of competitiveness may not be viable strategies for mitigating nonmedical use of stimulants among medical students.

BackgroundPeople with spinal cord injury (SCI) are at higher risk for numerous preventable chronic conditions. Physical activity is a protective factor that can reduce this risk, yet those with SCI encounter barriers to activity and are significantly less likely to be active. Limited evidence supports approaches to promote increased physical activity for those with SCI.ObjectiveBuilding upon our previous theory- and evidence-based approach to increase participation in regular physical activity for those with SCI, this study aimed to use a participatory action research approach to translate a theory-based intervention to be delivered via the Web to individuals with SCI.MethodsA total of 10 individuals with SCI were invited to participate in consumer input meetings to provide the research team with iterative feedback on an initial website designed as a platform for delivering a theory-based exercise intervention.ResultsA total of 7 individuals with SCI whose average age was 43.6 years (SD 13.4) and lived an average age of 12.5 years (SD 14.9) with SCI met on 2 occasions to provide their feedback of the website platform, both on the initial design and subsequently on the revamped site. Their iterative feedback resulted in redesigning the website content, format, and functionality as well as delivery of the intervention program.ConclusionsThe substantially redesigned website offers an easier-to-navigate platform for people with SCI with greater functionality that delivers information using a module format with less text, short video segments, and presents more resources. Preliminary testing of the site is the next step.

This article discusses Mann's model of power and its application to the sociology of gender. The model is used in a cross-national study of gender power in Poland and in the United States. It is demonstrated that the collective power of American men and their distributive power over women have been higher than the power of Polish men. Moreover, the power of American men has been diffused and extensive, while that of Polish men has been authoritative and intensive throughout most of the period since World War II. The nature of gender power is shown to influence the levels of sex segregation in higher education. Sex segregation in the Polish system of higher education was lower than in the American system in 1965 and in the 1970s, but it was slightly higher in the 1980s. These results are interpreted as reflecting historical changes in both countries: the increase in the collective power of American women and shifts in the reach of political and ideological power in Poland.

This article presents a comparative case study of the manifestation of sex segregation in higher education in the United States and in Poland from the end of the 19th century to the 1930s. The study is guided by a theoretical framework, which is organized around a concept of power and derived from The Sources of Social Power by Michael Mann (1986). In the United States, well-developed capitalism, democracy, and the ideology of separate spheres underlay the high collective power of men, their distributive power over women and—consequently—high levels of sex segregation in higher education. Contrastly, in Poland, weak capitalism and lack of democracy meant less collective and distributive power of men, which produced lower levels of educational sex segregation.

Setting: Outpatient rehabilitation clinic. Patient: A 47-year-old man with a history of polio and paralysis of his right arm. Case Description: The patient complained of numbness and tingling in his left hand both with activity and at night. His 2-point discrimination was 3 to 4mm, grasp strength was 70lb, lateral pinch was 22lb, and tip pinch was 15lb. Nerve conduction studies (NCSs) revealed an absent left median sensory nerve action potential (SNAP) and a prolonged motor nerve action potential (MNAP) equal to 6.1ms with a normal amplitude. The patient refused electromyography and was diagnosed with median neuropathy at the wrist, which appeared to be severe given the limited testing. A surgical consultation was recommended, but the patient refused, and conservative treatment was initiated. Treatment included lifestyle modifications, anti-inflammatory medications, vitamin B supplements, and a nocturnal wrist splint. He also began to use voice-activated software, speakerphone, large grip pen, and reduced-tension car steering. Assessment/Results: A repeat NCS was done at 6-month follow-up and it showed significant improvement of his left median neuropathy. The SNAP was present but prolonged at 4.7ms (normal