Health Concerns of Adolescents and Adults With Spina Bifida

Due to advancements in medical care, people with spina bifida (SB) are surviving well into adulthood, resulting in a growing number of patients transitioning to an adult sector unequipped to care for people with chronic rehabilitative and medical needs. The Transitional and Lifelong Care (TLC) program is a multidisciplinary clinical service that compensates for this gap, providing comprehensive, coordinated care to adolescents, and adults with SB. As a relatively new clinical service, objective data about the patients using the service and their needs is scant. This study sought to identify the most common health concerns among TLC patients with SB at initial clinical consultation. A retrospective chart review of 94 patient charts was performed. Following data extraction, descriptive analyses were completed. The mean age of the sample was 29.04 ± 13.8 years. One hundred individual concerns and 18 concern categories were identified. On average, patients or care providers identified nine health concerns across various spheres of care, with care coordination being the most prevalent concern identified (86%). Patients also commonly had concerns regarding neurogenic bladder (70%), medications (66%), assistive devices (48%), and neurogenic bowel (42%). The numerous and wide-ranging health concerns identified support the need for individualised, coordinated care and a “medical home” for all adolescents and adults with SB during and following the transition to adult care. Health care providers caring for this population should continue to address well-documented health concerns and also consider raising discussion around topics such as sexual health, mental health, and bone health. Further research is required to understand how best to address the complex medical issues faced by adults with SB to maximise health and quality of life and improve access to healthcare

Weights, resistance bands, and rest days are best for tendinopathy. [NIHR Alert]

This NIHR alert is a plain English summary of an original research article, PAVLOVA, A.V., SHIM, J.S.C., MOSS, R., MACLEAN, C., BRANDIE, D., MITCHELL, L., GREIG, L., PARKINSON, E., ALEXANDER, L., BROWN, V.T., MORRISSEY, D., COOPER, K. and SWINTON, P.A. 2023. Effect of resistance exercise dose components for tendinopathy management: a systematic review with meta-analysis. British journal of sports medicine [online], 57(20), pages 1327-1334. Available from: https://doi.org/10.1136/bjsports-2022-105754

Factors in Patient Responsiveness to Directional Preference-Matched Treatment of Neck Pain With or Without Upper Extremity Radiation

Purpose: Patient-related predictive factors in responsiveness to directional preference therapy for neck pain with or without upper extremity radiation (NP/R) have not been reported. A directional preference is any neck movement that, when performed repeatedly to end range, results in centralization and/or alleviation of NP/R. It was hypothesized that patient compliance with a prescribed, directional preference-matched home exercise program would improve positive responsiveness to NP/R treatment. Methods: Patient-related factors thought to affect responsiveness to care were collected retrospectively from charts and de-identified for patients with NP/R who underwent chiropractic treatment at a multispecialty spine clinic from January 2014 through June 2015. Responsiveness was measured by calculating the percentage change in Neck Bournemouth Questionnaire (NBQ) scores over treatment time. Multiple linear regression was used to identify factors associated with positive responsiveness. Results: Mean percentage change in patient NBQ score from initial intake to discharge was 50% (standard deviation: 32%). Of 104 patients meeting study inclusion criteria, 86 (83%) reported experiencing improvement after the first treatment session. Bivariate analysis of patient characteristics by compliance with directional preference-matched exercise indicated that compliant patients (n = 95, 91%) demonstrated significantly greater responsiveness to care than did noncompliant patients, at 55% versus 25% change in NBQ score, respectively (P = 0.0041). Four factors were statistically significant predictors of patient responsiveness to directional preference therapy for NP/R: patient compliance with directional preference-matched exercise (P = 0.0023), patient age (P = 0.0029), condition chronicity (P < 0.0001), and whether the patient reported improvement of symptoms following initial treatment session (P = 0.0003). Conclusions: The results of this study suggest that patient compliance with directional preference exercise is associated with patient responsiveness to conservative treatment of NP/R, as are age, chronicity and report of immediate symptom improvement

Qualitative Methods of Road Traffic Crash Research in Low- and Middle-income Countries: A Review

Road traffic crashes are rapidly becoming one of the leading causes of injury and death globally. It is predicted that by 2030 crashes will become the fourth leading cause of disability-adjusted life years (DALYs) (Mathers & Loncar, [11]) and the seventh leading global cause of death (World Health Organization [WHO], [26]). The global death toll due to crashes has already escalated by 46% over the past two decades (The World Bank, [21]). Low- and middle-income countries (LMICs) are acutely affected by this \u27hidden epidemic\u27 (Balch, [ 1]). Ninety per cent of the world\u27s crash-related deaths occur in LMICs where only 54% of its motor vehicles are registered (WHO, [25]). Furthermore, the economic toll of crashes in LMICs is concerning because nearly one half of all health care expenditures in LMICs is used to treat injuries related to motor vehicle crashes (Zakeri & Nosratnejad, [28]). This epidemic deserves urgent attention (Lin, [10]). Research on the epidemiology of crash problems in LMICs is increasing but these research efforts predominantly report statistics. There is a paucity of qualitative research that could help to explain the statistics. Qualitative exploration has the potential to enhance crash research by describing and explicating the contexts and social processes surrounding crashes, such as the antecedents, the environments in which crashes occur and injuries are produced, and the behaviours of people which make crashes more likely (Roberts, [14]; Rothe, [16]). Qualitative research methods can spark and mobilize the ideas and efforts of affected community members, thereby optimizing crash prevention interventions. Additionally, incorporating local citizens\u27 perspectives on the nature, causes and potential solutions of traffic problems in their locale increases the likelihood that proposed solutions will be effective, wanted and beneficial (Roberts, Smith, & Bryce, [15]). This article will review the literature to assess the extent to which qualitative methods have been implemented to research road traffic crashes in LMICs and to inform future methodological decision-making

Learning Communities for Graduate Students: Supporting Scholarly Teaching

Mid-career graduate students have unique needs related to developing their pedagogical skills and their knowledge of classroom-based research. Participants in this panel session will gain insights into the benefits of participating in a graduate student learning community and learn ways to incorporate aspects of such a program into their mentoring repertoire

A mitochondrial-focused genetic interaction map reveals a scaffold-like complex required for inner membrane organization in mitochondria.

To broadly explore mitochondrial structure and function as well as the communication of mitochondria with other cellular pathways, we constructed a quantitative, high-density genetic interaction map (the MITO-MAP) in Saccharomyces cerevisiae. The MITO-MAP provides a comprehensive view of mitochondrial function including insights into the activity of uncharacterized mitochondrial proteins and the functional connection between mitochondria and the ER. The MITO-MAP also reveals a large inner membrane-associated complex, which we term MitOS for mitochondrial organizing structure, comprised of Fcj1/Mitofilin, a conserved inner membrane protein, and five additional components. MitOS physically and functionally interacts with both outer and inner membrane components and localizes to extended structures that wrap around the inner membrane. We show that MitOS acts in concert with ATP synthase dimers to organize the inner membrane and promote normal mitochondrial morphology. We propose that MitOS acts as a conserved mitochondrial skeletal structure that differentiates regions of the inner membrane to establish the normal internal architecture of mitochondria

Adverse effects of pegaspargase in pediatric patients receiving doses greater than 3,750 IU

BackgroundIncreased toxicities have been identified with higher doses of pegaspargase (PEG‐ASP) in adults. This has led to routine use of a dose cap of 3,750 IU for adult acute lymphoblastic leukemia (ALL) patients in most institutions. In pediatric ALL patients, PEG‐ASP is not capped. There is concern at our institution that larger doses may result in increased rates of adverse effects and that increased monitoring may be warranted in pediatric patients receiving doses greater than 3,750 IU. The objective of this study is to quantify the difference in the rates of PEG‐ASP‐associated adverse events between pediatric patients who received doses greater than 3,750 IU and less than or equal to 3,750 IU.MethodsRetrospective chart review of patients 1–21 years old with pre‐B‐cell ALL who received PEG‐ASP between 2007 and 2014 at an academic medical center.ResultsOf 183 patients included in the analysis, 24 received PEG‐ASP doses higher than 3,750 IU and 159 received doses less than or equal to 3,750 IU. The incidence of venous thromboembolism (VTE) was significantly higher for patients in the group that received more than 3,750 IU compared with those who received 3,750 IU or less (20.8 vs. 1.89%, respectively; P = 0.0011). The incidence of pancreatitis (P = 0.0306) and hyperglycemia (P = 0.0089) were also higher in the group that received more than 3,750 IU.ConclusionsPEG‐ASP doses higher than 3,750 IU are associated with higher rates of VTE, pancreatitis, and hyperglycemia in pediatric patients with pre‐B‐cell ALL. Patients receiving more than 3,750 IU should have increased monitoring, and larger, multicenter trials are needed to determine if monitoring, VTE prophylaxis, and potential dose capping recommendations should be added to clinical trial protocols.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138220/1/pbc26555_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138220/2/pbc26555.pd

Choice of randomisation time-point in non-inferiority studies of reduced treatment duration: experience from the SCOT study

No abstract available

The influence of diet and physical activity on bone density of children aged 5-7 years: The Belfast HAPO family study

ObjectiveOsteoporosis is a global health issue, and modifiable behavioural factors need to be identified in childhood to reduce the risk of osteoporosis in later life. The aim of this study was to investigate the influence of diet and physical activity on bone density of children aged 5–7 years participating in the Belfast Hyperglycaemia and Adverse Pregnancy Outcome (HAPO) Family study.Design and methodsPregnant women were recruited to the Belfast centre of the HAPO study at 24–32 weeks gestation. Offspring were followed up at 5–7 years as part of the Belfast HAPO Family Study. Heel bone mineral density (BMD) and bone mineral apparent density (BMAD) were measured and calculated, respectively. Physical activity in the offspring was measured by accelerometery and dietary intakes were measured using a 4-day food diary.ResultsResults from 793 offspring were analysed. Mean age of the offspring ± standard deviation was 6.4 ± 0.5 years. A mean of 48.3 ± 22.4 min each day was spent in moderate to vigorous physical activity (MVPA). Median (interquartile range) dietary calcium and vitamin D intakes were 844 (662–1073) mg/day and 1.7 (1.1–2.5) μg/day, respectively. Neither dietary vitamin D nor calcium intakes were significantly associated with offspring heel BMD or BMAD in multiple regression. However, controlling for confounders, a 30-min greater MVPA was associated with significantly larger heel BMD (0.018 g/cm2 in boys and 0.010 g/cm2 in girls) and BMAD (0.005 g/cm3 in boys and 0.003 g/cm3 in girls).ConclusionPhysical activity was associated with better BMD and BMAD in 5–7-year-old children. Dietary calcium and vitamin D were not predictive of BMD and BMAD