FORCE-SHARING BETWEEN TRICEPS SURAE MUSCLES DURING REHABILITATION EXERCISES FOR ACHILLES TENDINOPATHY

The purpose of this study was to determine individual muscle forces of the Triceps Surae during a range of rehabilitation exercises for Achilles tendinopathy. We used experimental data (N=4) and musculoskeletal modelling to estimate muscle force (dynamic optimization). We observed clear peak muscle force differences between exercises. In addition, the force-sharing strategies used by the participants (i.e., individual muscle contribution to the total force produced within the Triceps Surae) were different between exercises. These preliminary results could be helpful to objectively determine the progression in exercise loading throughout rehabilitation programs. Additionally, new information regarding the influence of the type of exercise on load distribution within the Triceps Surae may better orientate practitioners in the choice of exercise

Stress, Burnout, Compassion Fatigue, and Mental Health in Hospice Workers in Minnesota

Background: Working in hospice care is a highly challenging yet rewarding profession. However, the challenges of working with dying patients and their families can overwhelm even the most highly dedicated professional, leading to burnout, compassion fatigue, anxiety, and depression. Objective: The aim of this study was to better understand how stress affects the mental health of hospice workers in terms of burnout and compassion fatigue and how they cope with these issues. Methods: Data for this study are from Compassion Fatigue and You, a cross-sectional survey of hospice staff from across Minnesota. We surveyed 547 hospice workers throughout Minnesota to better understand the overall mental health of staff, including levels of stress, burnout, and compassion fatigue, and how they cope with these issues. The study was conducted in 2008 and 2009 through a private, not-for-profit research institute affiliated with a large Midwestern health plan. Results: Hospice staff reported high levels of stress, with a small but significant proportion reporting moderate-to-severe symptoms of depression, anxiety, compassion fatigue, and burnout. Staff reported managing their stress through physical activity and social support, and they suggested that more opportunities to connect with coworkers and to exercise could help decrease staff burnout. Conclusions: Poor mental health places staff at risk for burnout and likely contributes to staff leaving hospice care; this is a critical issue as the profession attempts to attract new staff to meet the expanding demands for hospice care

Indole-based perenosins as highly potent HCl transporters and potential anti-cancer agents

Prodigiosin is one of the most potent anion transporters in lipid bilayer membranes reported to date. Inspired by the structure of this natural product, we have recently designed and synthesised a new class of H+/Cl− cotransporters named 'perenosins'. Here we report a new library of indole-based perenosins and their anion transport properties. The new transporters demonstrated superior transmembrane transport efciency when compared to other indole-based transporters, due to favourable encapsulating efects from the substituents on the perenosin backbone. Anion transport assays were used to determine the mechanism of chloride transport revealing that the compounds function as 'strict' HCl cotransporters. Cell viability studies showed that some compounds specifcally trigger lateonset cell death after 72h with a unique correlation to the position of alkyl chains on the perenosins. Further investigations of cell death mechanism showed a mixture of cell cycle arrest and apoptosis was responsible for the observed decrease in cell viability

The Effects of Patient-Centered Depression Care on Patient Satisfaction and Depression Remission

Background: While health systems are striving for patient-centered care, they have little evidence to guide them on how to engage patients in their care, or how this may affect patient experiences and outcomes. Objective: To explore which specific patient-centered aspects of care were best associated with depression improvement and care satisfaction. Methods: Design - observational. Setting - 83 primary care clinics across Minnesota. Subjects - Primary care patients with new prescriptions for antidepressants for depression were recruited from 2007 to 2009. Outcome measures - Patients completed phone surveys regarding demographics and self-rated health status and depression severity at baseline and 6 months. Patient centeredness was assessed via a modified version of the Patient Assessment of Chronic Illness Care. Differences in rates of remission and satisfaction between positive and negative responses for each care process were evaluated using chi-square tests. Results: At 6 months, 37% of 792 patients ages 18–88 achieved depression remission, and 79% rated their care as good-to-excellent. Soliciting patient preferences for care and questions or concerns, providing treatment plans, utilizing depression scales and asking about suicide risk were patient centered measures that were positively associated with depression remission in the unadjusted model; these associations were mildly weakened after adjustment for depression severity and health status. Nearly all measures of patient centeredness were positively associated with care ratings. Conclusion: The patient centeredness of care influences how patients experience and rate their care. This study identified specific actions providers can take to improve patient satisfaction and depression outcomes

Clinician Burnout and Satisfaction with Resources in Caring for Complex Patients

Objective: To describe primary care clinicians\u27 self-reported satisfaction, burnout and barriers for treating complex patients. Methods: We conducted a survey of 1554 primary care clinicians in 172 primary care clinics in 18 health care systems across 8 states prior to the implementation of a collaborative model of care for patients with depression and diabetes and/or cardiovascular disease. Results: Of the clinicians who responded to the survey (n=709; 46%), we found that a substantial minority (31%) were experiencing burnout that was associated with lower career satisfaction (P\u3c.0001) and lower satisfaction with resources to treat complex patients (P\u3c.0001). Less than 50% of clinicians rated their ability to treat complex patients as very good to excellent with 21% rating their ability as fair to poor. The majority of clinicians (72%) thought that a collaborative model of care would be very helpful for treating complex patients. Conclusions: Burnout remains a problem for primary care clinicians and is associated with low job satisfaction and low satisfaction with resources to treat complex patients. A collaborative care model for patients with mental and physical health problems may provide the resources needed to improve the quality of care for these patients

Adolescent Healthcare Contacts in the Year Before Suicide: a case control study

Introduction: Suicide rates among adolescents have risen steadily since 2007, creating a dire need to expand prevention protocols. Healthcare systems have been identified as a key avenue for identification and intervention. To date, no comprehensive analysis has been done to understand adolescent-specific characteristics and healthcare utilization prior to suicide death. Methods: A case-control study was conducted using records from eight healthcare systems nationwide. Data from 450 subjects aged 10-24 who died by suicide between the years 2000-2013 was matched with 4500 controls based on health system and time period of membership. We examined past-year health diagnoses and patterns of visit types and frequency. Results: Adolescents who died by suicide were more likely to have at least one mental health disorder (52% vs 16%), as well as each individual disorder. Physical health disorders were also more likely among this group. Close to half (49%) and nearly all (89%) of youth who died by suicide had a health care visit in the month and year prior to their death, respectively. Outpatient visits were most common, with suicide decedents averaging 8 in the year before death. Conclusion: With nearly half (48%) of adolescents who died by suicide lacking a mental health diagnosis in the year prior to their death, it is no longer sufficient to rely on mental health services to capture at-risk youth. High rates of healthcare utilization among those who died by suicide indicate a strong need for improving identification of youth while they are seeking services, thereby preventing future deaths

The biomechanical fingerprint of hip and knee osteoarthritis patients during activities of daily living

Background: Osteoarthritis is a highly prevalent disease affecting the hip and knee joint and is characterized by load-mediated pain and decreased quality of life. Dependent on involved joint, patients present antalgic movement compensations, aiming to decrease loading on the involved joint. However, the associated alterations in mechanical loading of the ipsi- and contra-lateral lower limb joints, are less documented. Here, we documented the biomechanical fingerprint of end-stage hip and knee osteoarthritis patients in terms of ipsilateral and contralateral hip and knee loading during walking and stair ambulation. Methods: Three-dimensional motion-analysis was performed in 20 hip, 18 knee osteoarthritis patients and 12 controls during level walking and stair ambulation. Joint contact forces were calculated using a standard musculoskeletal modelling workflow in Opensim. Involved and contralateral hip and knee joint loading was compared against healthy controls using independent t-tests (p &lt; 0.05). Findings: Both hip and knee cohorts significantly decreased loading of the involved joint during gait and stair ambulation. Hip osteoarthritis patients presented no signs of ipsilateral knee nor contralateral leg overloading, during walking and stair ascending. However, knee osteoarthritis patients significantly increased loading at the ipsilateral hip, and contralateral hip and knee joints during stair ambulation compared to controls. Interpretation: The biomechanical fingerprint in knee and hip osteoarthritis patients confirmed antalgic movement strategies to unload the involved leg during gait. Only during stair ambulation in knee osteoarthritis patients, movement adaptations were confirmed that induced unbalanced intra- and inter-limb loading conditions, which are known risk factors for secondary osteoarthritis.</p