Changes in multi-segment foot biomechanics with a heat-mouldable semi-custom foot orthotic device

<p>Abstract</p> <p>Background</p> <p>Semi-custom foot orthoses (SCO) are thought to be a cost-effective alternative to custom-made devices. However, previous biomechanical research involving either custom or SCO has only focused on rearfoot biomechanics. The purpose of this study was therefore to determine changes in multi-segment foot biomechanics during shod walking with and without an SCO. We chose to investigate an SCO device that incorporates a heat-moulding process, to further understand if the moulding process would significantly alter rearfoot, midfoot, or shank kinematics as compared to a no-orthotic condition. We hypothesized the SCO, whether moulded or non-moulded, would reduce peak rearfoot eversion, tibial internal rotation, arch deformation, and plantar fascia strain as compared to the no-orthoses condition.</p> <p>Methods</p> <p>Twenty participants had retroreflective markers placed on the right limb to represent forefoot, midfoot, rearfoot and shank segments. 3D kinematics were recorded using an 8-camera motion capture system while participants walked on a treadmill.</p> <p>Results</p> <p>Plantar fascia strain was reduced by 34% when participants walked in either the moulded or non-moulded SCO condition compared to no-orthoses. However, there were no significant differences in peak rearfoot eversion, tibial internal rotation, or medial longitudinal arch angles between any conditions.</p> <p>Conclusions</p> <p>A semi-custom moulded orthotic does not control rearfoot, shank, or arch deformation but does, however, reduce plantar fascia strain compared to walking without an orthoses. Heat-moulding the orthotic device does not have a measurable effect on any biomechanical variables compared to the non-moulded condition. These data may, in part, help explain the clinical efficacy of orthotic devices.</p

Comparison of foot orthoses made by podiatrists, pedorthists and orthotists regarding plantar pressure reduction in The Netherlands

BACKGROUND: There is a need for evidence of clinical effectiveness of foot orthosis therapy. This study evaluated the effect of foot orthoses made by ten podiatrists, ten pedorthists and eleven orthotists on plantar pressure and walking convenience for three patients with metatarsalgia. Aims were to assess differences and variability between and within the disciplines. The relationship between the importance of pressure reduction and the effect on peak pressure was also evaluated. METHODS: Each therapist examined all three patients and was asked to rate the 'importance of pressure reduction' through a visual analogue scale. The orthoses were evaluated twice in two sessions while the patient walked on a treadmill. Plantar pressures were recorded with an in-sole measuring system. Patients scored walking convenience per orthosis. The effects of the orthoses on peak pressure reduction were calculated for the whole plantar surface of the forefoot and six regions: big toe and metatarsal one to five. RESULTS: Within each discipline there was an extensive variation in construction of the orthoses and achieved peak pressure reductions. Pedorthists and orthotists achieved greater maximal peak pressure reductions calculated over the whole forefoot than podiatrists: 960, 1020 and 750 kPa, respectively (p < .001). This was also true for the effect in the regions with the highest baseline peak pressures and walking convenience rated by patients A and B. There was a weak relationship between the 'importance of pressure reduction' and the achieved pressure reduction for orthotists, but no relationship for podiatrists and pedorthotists. CONCLUSION: The large variation for various aspects of foot orthoses therapy raises questions about a consistent use of concepts for pressures management within the professional groups

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Preference in the use of full childhood immunizations in Ethiopia: the role of maternal health services

Nigatu Regassa,1,2 Yelena Bird,2 John Moraros2 1Hawassa University, Hawassa, Ethiopia; 2School of Public Health, University of Saskatchewan, Saskatoon, Canada Background: Immunizations represent a successful and cost-effective public health strategy in preventing common childhood diseases. Ethiopia has made remarkable progress in increasing its full immunization coverage, but significant gaps remain. This study aims to measure the preference in the use of full immunizations for children aged 12&ndash;23&nbsp;months in Ethiopia and examine the role of key maternal health services.Methods: This is a cross-sectional study and uses data from a nationally generalizable survey, the Ethiopian Demographic and Health Survey, 2016. It includes a representative sample of 2,168 children aged 12&ndash;23&nbsp;months. The main outcome was full immunization, measured based on the WHO guidelines (Bacillus Calmette&ndash;Gu&eacute;rin [BCG], diphtheria, tetanus, and pertussis [DPT], polio, and measles vaccines). The main exposure variables were provision of three key maternal health services (antenatal care, delivery services, and tetanus vaccine) as well as other sociodemographic factors. Descriptive statistics and multivariate logistic regression analyses were conducted.Results: This study found the overall full immunization coverage in Ethiopia to be much lower (39%) than the WHO-recommended rate (&ge;90%). There were distinctive differences in the preference in the use of full immunization coverage for various vaccines (BCG 70.0%, polio 56.5%, measles 55.3%, and DPT 53.9%). The maternal health service variables (antenatal care, delivery services, and tetanus vaccine) were significantly associated with the full immunization of children aged 12&ndash;23&nbsp;months (P&lt;0.001). In the full model, the maternal health service variables remained significant, along with other socioeconomic predictors of full immunization, including sex of the household head (P&lt;0.001), maternal education (P&lt;0.05), wealth index (P&lt;0.01), and religion (P&lt;0.001).Conclusion: Full immunization coverage has been identified as a critical factor in the prevention of morbidity and mortality from childhood diseases. Future progress in the provision of key maternal health services can have a positive impact in narrowing the gap in immunization coverage. Keywords: Africa, Ethiopia, childhood immunizations, maternal health service

Ethno-specific preferences of cigarette smoking and smoking initiation among canadian immigrants &ndash; A multi-level analysis

Yelena Bird, Killian Forbeteh, Chijioke Nwankwo, John Moraros School of Public Health, University of Saskatchewan, Saskatoon, Canada Background: Cigarette smoking is the leading cause of preventable morbidity and mortality worldwide. Over the last decade, increased immigration has significantly shifted Canada&rsquo;s demographic profile. According to a 2011 National Household Survey, approximately 20.6% of the Canadian population was immigrants, the highest among the G8 countries. It is estimated that by 2031, one-in-three Canadian&rsquo;s will be an immigrant. This study examined the ethno-specific preference of cigarette smoking and smoking initiation among Canadian immigrants.Methods: This study used data from the 2013 to 2014 combined cycles of the Canadian Community Health Survey. This was a nationally generalizable, telephone-based survey that included a total of 130,000 respondents, aged 12 years or older. Ethnic differences in the preference of cigarette use among Canadian immigrant groups were determined. A three-level mixed effects logistic regression model was used to estimate the effect of ethnicity on the likelihood of smoking initiation after migration to Canada.Results: In our study, 82% of respondents were native-born Canadians (one group), while the rest were immigrants (six groups=18%). Results of the logistic regression analysis revealed statistically significant differences in the number of cigarettes smoked daily (P=0.0001), age of smoking onset (P=0.0001), and smoking initiation (P=0.0001) between Canadian-born and immigrant participants. Immigrant smokers in Canada were significantly more likely to be younger, single, Caucasian, females with high income and post-secondary education (P=0.0001).Conclusion: The results of our study suggest that Caucasian female immigrants in Canada initiated smoking at a younger age and smoked more cigarettes than any other immigrant group or native-born Canadians. This is a particularly interesting finding as Caucasian female immigrants may not be considered a vulnerable or at-risk population. To be effective, tobacco strategies specifically tailored for this overlooked population would require increased awareness, culturally appropriate initiatives, and gender-specific interventions. Keywords: cigarette smoking, initiation, ethnicity, immigrants, Canad

Examining the association between diabetes, depressive symptoms, and suicidal ideation among Aboriginal Canadian peoples living off-reserve: a cross-sectional, population-based study

Rasha Elamoshy,1 Yelena Bird,1 Lilian Ulrica Thorpe,2 John Moraros1 1School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada; 2Community Health and Epidemiology Department, University of Saskatchewan, Saskatoon, SK, Canada Background: Diabetes is a prevalent chronic condition that has been linked to depression and suicidal behavior. The Aboriginal peoples of Canada are known to suffer from significant health disparities and higher burden of physical and mental illnesses. The purpose of this study was to assess whether diabetes is associated with higher depressive symptoms and lifetime suicidal ideation among Aboriginal Canadian peoples living off-reserve.Methods: Data were obtained from the Aboriginal Peoples Survey, 2012. Depressive symptoms were evaluated by a modified version of the previously validated K-10 scale, while diabetes and suicidal ideation were self-reported. A secondary analysis was conducted on a weighted sample of 689,860 participants for depressive symptoms (9.25% diabetics) and 694,960 for suicidal ideation (9.39% diabetics). Descriptive statistics and multiple logistic regression analysis were conducted.Results: Our study found that the prevalence of depressive symptoms was higher among diabetics (17.53%) compared with nondiabetics (11.12%; OR =1.70, 95% CI: 1.22&ndash;1.61). After adjusting for sociodemographic variables, smoking/alcohol use/drug use, anxiety disorders, and other chronic illnesses, diabetes was still significantly associated with depressive symptoms (aOR =1.46, 95% CI: 1.03&ndash;2.07). Additionally, diabetics (23.86%) were more likely to report suicidal ideation compared with nondiabetics (18.71%; OR =1.36, 95% CI: 1.05&ndash;1.77). Controlling for the effect of sociodemographics and health-related behaviors, diabetes was still associated with higher risk of reporting suicidal ideation (aOR =1.40, 95% CI: 1.05&ndash;1.88).Conclusion: Our results suggest that the Aboriginal Canadian diabetic patients living off-reserve are at higher risk of depressive symptoms and suicidal ideation. Culturally appropriate co-screening strategies need to be implemented in primary health care settings to provide the supports necessary for this vulnerable population. Further research is needed to fully elucidate the nature of these associations in order to develop effective intervention and treatment approaches. Keywords: aboriginal, Canada, diabetes, depression, depressive symptoms, suicidal ideatio

The association between depression, anxiety and substance use among Canadian post-secondary students

Sarvenaz Esmaeelzadeh,1 John Moraros,1 Lilian Thorpe,2 Yelena Bird1 1School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada; 2Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada Purpose: This study aims to examine the association between depression, anxiety and substance use among Canadian post-secondary students.Methods: This study used data from the spring 2016, American College Health Association &ndash; National College Health Assessment II (ACHA-NCHA II) survey. It includes 43,780 college students from 41 Canadian post-secondary institutions. The exposure variables of interest were alcohol, cannabis and tobacco use, and the outcome variables of interest were diagnosis or treatment for depression and/or anxiety. Descriptive statistics, univariate and multivariate logistic regression models were used to analyze our data. Results: Our study found that 14.7% of post-secondary students were diagnosed or treated for depression and 18.4% for anxiety within the past 12 months. Among current (past 30 days) substance use, it was reported that alcohol (69.3%), cannabis (17.9%) and tobacco (11%) were the most common. There was a significant association between depression and current tobacco use (OR =1.36, 95% CI: 1.22&ndash;1.52, P&lt;0.001) and current cannabis use (OR =1.17, 95% CI: 1.05&ndash;1.31, P&lt;0.001). There was also a gender-specific association between anxiety and female alcohol users (OR =1.41, 95% CI: 1.24&ndash;1.62, P&lt;0.001).Conclusion: The results of this study found significant associations between depression, tobacco use and cannabis use, and anxiety and alcohol use among post-secondary students. These conditions should be screened concurrently for improved outcomes among this vulnerable population. Keywords: depression, anxiety, alcohol, cannabis, tobacco, post-secondary student

Primary nonadherence to chronic disease medications: a meta-analysis

Mark Lemstra,1 Chijioke Nwankwo,2 Yelena Bird,2 John Moraros2 1Alliance Health Medical Clinics, Moose Jaw, Regina and Saskatoon, Saskatchewan, Canada; 2School of Public Health, University of Saskatchewan, Saskatoon, Saskatchewan, Canada Background: Medication nonadherence is a global problem that requires urgent attention. Primary nonadherence occurs when a patient consults with a medical doctor, receives a referral for medical therapy but never fills the first dispensation for the prescription medication. Nonadherence to chronic disease medications costs the USA ~$290 billion (USD) every year in avoidable health care costs. In Canada, it is estimated that 5.4% of all hospitalizations are due to medication nonadherence. Objectives: The objective of this study was to quantify the extent of primary nonadherence for four of the most common chronic disease medications. The second objective was to identify factors associated with primary nonadherence to chronic disease medications. Materials and methods: We conducted an extensive systematic literature review of eight databases with a wide range of keywords. We identified relevant articles for primary nonadherence to antihypertensives, lipid-lowering agents, hypoglycemics, and antidepressants. After further screening and assessment of methodologic quality, relevant data were extracted and analyzed using a random-effects model. Results: Twenty-four articles were included for our meta-analysis after full review and assessment for risk of bias. The pooled primary nonadherence rate for the four chronic disease medications was 14.6% (95% CI: 13.1%&ndash;16.2%). Primary medication nonadherence was higher for lipid-lowering medications among the four chronic disease medications assessed (20.8%; 95% CI: 16.0%&ndash;25.6%). The rates in North America (17.0%; 95% CI: 14.4%&ndash;19.5%) were twice those from Europe (8.5%; 95% CI: 7.1%&ndash;9.9%). The absence of social support (20%; 95% CI: 14.4%&ndash;26.6%) was the most common sociodemographic variable associated with chronic disease medication primary nonadherence. Conclusion: Evidence suggests that a considerable percentage of patients do not initially fill their medications for treatable chronic diseases or conditions. This represents a major health care problem that can be successfully addressed. Efforts should be directed toward proper medication counseling, patient social support, and clinical follow-up, especially when the indications for the prescribed medication aim to provide primary prevention. Keywords: primary nonadherence, chronic disease medication, initial nonadherence, prescribed medications, predictors of primary nonadherenc

Substance use preferences and sexually transmitted infections among Canadian post-secondary students

Nway Mon Kyaw Soe,1 Yelena Bird,1 Michael Schwandt,2 John Moraros1 1School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada; 2Fraser Health Authority, Surrey, BC, Canada Background: In Canada, substance use is one of the key predisposing factors that may lead to risky sexual behaviors among post-secondary students. There is considerable economic burden and significant public health concern posed by substance use and sexually transmitted infections (STIs). The purpose of this study was to examine the prevalence of substance use preferences (alcohol, cannabis, and other drugs) and its association with STIs among Canadian post-secondary students. Materials and methods: This is a cross-sectional study using data from the National College Health Assessment II, Spring 2016 survey conducted by the American College Health Association. There were 31,642 sexually active participants, representing 41 post-secondary institutions in Canada. Descriptive analysis and logistic regression were conducted to estimate the effect of substance use preferences on STIs. Results: This study found that participants reported being current users of alcohol (80%), cannabis (23%), and other drugs (8%). Additionally, 3.96% of the participants self-reported being diagnosed or treated for an STI in the last 12 months. Multivariate logistic analysis revealed current cannabis use to be significantly associated with self-reported STIs (aOR, 1.34; 95% CI, 1.12&ndash;1.6). There was a significant association between current drug use and STIs among male (aOR, 3.04; 95% CI, 2.27&ndash;4.06) and female participants (aOR, 1.87; 95% CI, 1.52&ndash;2.30). Having multiple sexual partners, a history of sexual assault, being homosexual, Black, and &gt;21 years old were also found to have a significant association with self-reported STIs (P-value &lt;0.001). Conclusion: In this study, significant associations were found between cannabis and other drug use and STIs among post-secondary students in Canada. The results of this study can help inform institutions of higher learning and public health professionals in the design, implementation, and evaluation of substance use and STI policies and effective school-based health programming. Keywords: substance use, alcohol use, cannabis use, drug use, sexually transmitted infections, post-secondary student