Effectiveness of Robotic-Assisted Gait Training and Aquatic Physical Therapy in a Child With Long-Chain 3-Hydroxyacyl-CoA Dehydrogenase Deficiency: A Case Report.

PURPOSE: The purpose of this case study is to describe the outpatient rehabilitation program for a 15-year-old girl with long-chain 3-hydroxyacyl-CoA dehydrogenase deficiency (LCHADD). SUMMARY OF KEY POINTS: The child presented with sudden-onset muscle weakness and fatigue with resultant dependence for all mobility and self-care. After 12 months of therapy, which included aquatic interventions and robotic-assisted gait training, the patient demonstrated independence with transfers, ambulation with a rolling walker, and stair navigation. Functional mobility, gross motor skills, and participation in activities of daily living significantly improved per the Gross Motor Function Measure and the Pediatric Evaluation of Disability Inventory. STATEMENT OF CONCLUSION AND RECOMMENDATIONS FOR CLINICAL PRACTICE: This is the first case in the literature to outline an outpatient physical therapy treatment plan to address mobility deficits secondary to exacerbation of LCHADD. This patient's rehabilitative course will hopefully add to future research and provide patients with guidelines for their recovery.

Chronic environmental contamination: A narrative review of psychosocial health consequences, risk factors, and pathways to community resilience.

A body of psychological and social scientific evidence suggests that the experience of technological disaster or long-term exposure to environmental contamination can be psychologically stressful. Addressing the psychosocial impact in communities living with chronic contamination is therefore a vital part of improving their resilience. Guided by a synthetic theoretical model of the unique psychosocial impact of chronic environmental contamination (in contrast to natural and technological disasters, and background pollution), we undertook a narrative review to assess the current research on this important social problem. Relevant qualitative peer-reviewed studies and grey literature were examined to derive a model identifying likely factors increasing risk for distress in chronic contamination experience and actions that may be taken by public health professionals and local leaders to enhance community resilience and take health-protective actions. Based on our initial theoretical model and the literature reviewed, we emphasize the importance of considering both the material and social dimensions of chronic environmental contamination experience. For instance, our review of the qualitative literature suggests that individuals who attribute material health impacts to contamination, and who have the social experience of their concerns being delegitimized by responsible institutions, are most at risk for psychological stress. Psychological stress in the context of chronic contamination is an important potential public health burden and a key area for additional research.

Chronic environmental contamination: A systematic review of psychological health consequences.

We sought to undertake a systematic review to assess the current research and to provide a platform for future research on the psychological health impact of chronic environmental contamination (CEC). CEC is the experience of living in an area where hazardous substances are known or perceived to be present in air, water, or soil at elevated levels for a prolonged and unknown period of time. We employed a systematic review approach to assess the psychological health impact of CEC in literature from 1995 to 2019, and conducted a meta-analysis of available findings (k = 60, N = 25,858) on the impact of CEC on anxiety, general stress, depression, and PTSD. We also present a narrative synthesis of findings that suggest risk factors for the experience of psychological health impacts in the wake of CEC. Likely factors increasing risk for elevated psychological health impact from CEC experience are institutional delegitimization of community concerns and the real or perceived presence of health effects from CEC. The meta-analyses observed small-to-medium effects of experiencing CEC on anxiety, general stress, depression, and PTSD. However, there was also evident risk of bias in the data. Our review suggests that psychological health in the context of CEC is an important potential public health burden and a key area for future improved research.

Exploring Community Psychosocial Stress Related to Per- and Poly-Fluoroalkyl Substances (PFAS) Contamination: Lessons Learned from a Qualitative Study.

The purpose of this study was to qualitatively explore the per- and poly-fluoroalkyl substances (PFAS) exposure experience and associated stressors, to inform public health efforts to support psychosocial health and resilience in affected communities. Semi-structured interviews (n = 9) were conducted from July-September 2019 with community members and state public health department representatives from areas with PFAS-contaminated drinking water. Thematic analysis was completed and themes were described and summarized. Reported stressors included health concerns and uncertainty, institutional delegitimization and associated distrust, and financial burdens. Interviewees provided several strategies to reduce stress and promote stress coping capacity and resilience, including showing empathy and validating the normalcy of experiencing stress; building trust through visible action and sustained community engagement; providing information and actionable guidance; discussing stress carefully; fostering stress coping capacity and resilience with opportunities to build social capital and restore agency; and building capacity among government agencies and health care providers to address psychosocial stress. While communities affected by PFAS contamination will face unavoidable stressors, positive interactions with government responders and health care providers may help reduce negative stress. More research on how best to integrate community psychosocial health and stress coping and resilience concepts into the public health response to environmental contamination could be helpful in addressing these stressors.

Effectiveness of a Retention Program to Improve Performance During the First Semester of a Doctor of Physical Therapy Program.

BACKGROUND: To meet the expanding need for physical therapists universities are under increasing pressure to enroll, educate, and train physical therapists. Poor academic performance can result in student dismissal from a physical therapy program. The purpose of this study is to determine if implementation of a retention program would improve student academic performance in the foundational science curriculum in a physical therapy program. METHODS: A prospective observational cohort design was used. The retention program centered on three approaches: 1. Early identification of at-risk students. 2. Supplemental instruction in Human Anatomy. 3. Offering peer tutoring for the foundational science courses. RESULTS: A significant association existed between the implementation of the retention program and the reduction of dismissals from the Fall Semester of 2012 to the fall 2013 semesters. CONCLUSION: Implementation of a retention program had a beneficial effect on decreasing student dismissals in a physical therapy program.

Alkyl Mercury-Induced Toxicity: Multiple Mechanisms of Action.

There are a number of mechanisms by which alkylmercury compounds cause toxic action in the body. Collectively, published studies reveal that there are some similarities between the mechanisms of the toxic action of the mono-alkyl mercury compounds methylmercury (MeHg) and ethylmercury (EtHg). This paper represents a summary of some of the studies regarding these mechanisms of action in order to facilitate the understanding of the many varied effects of alkylmercurials in the human body. The similarities in mechanisms of toxicity for MeHg and EtHg are presented and compared. The difference in manifested toxicity of MeHg and EtHg are likely the result of the differences in exposure, metabolism, and elimination from the body, rather than differences in mechanisms of action between the two.

Student perceived competence in direct access to physical therapy in a doctor of physical therapy program at a historically black university.

Physical therapists provide care via direct access in many states. Greater perceived competence with direct access among graduating physical therapists is critical. The purpose of this study was to assess student physical therapists' perceived competence with direct access.A survey instrument was created to determine levels of perceived competence at three phases of the physical therapy curriculum. The Friedman two-way ANOVA by ranks was used to assess differences between year one, year two, and year three responses for each individual survey question and the overall survey score.Total survey score demonstrated significant increased student perceived competence with direct access to physical therapy care direct access from year one total to year two (p = .018), year one to year three (p = .005), and year two to year three (p = .016).More favorable attitudes among graduating physical therapists may have an influence on primary care for musculoskeletal conditions.

Critical biological pathways for chronic psychosocial stress and research opportunities to advance the consideration of stress in chemical risk assessment.

Emerging evidence suggests that psychosocial stress and toxicants may interact to modify health risks. Stress-toxicant interactions could be important in chemical risk assessment, but these interactions are poorly understood and additional research is necessary to advance their application. Environmental health research can increase knowledge of these interactions by exploring hypotheses on allostatic load, which measures the cumulative impacts of stress across multiple physiological pathways, using knowledge about physiological pathways for stress-related health effects, and evidence of common target pathways for both stress and toxicants. In this article, critical physiological pathways for stress-related health effects are discussed, with specific attention to allostatic load and stress-toxicant interactions, concluding with research suggestions for potential applications of such research in chemical risk assessment.

Risk factors for development of vancomycin-resistant enterococcal bloodstream infection in patients with cancer who are colonized with vancomycin-resistant enterococci.

Vancomycin-resistant Enterococcus faecium (VRE) is a common nosocomial isolate, especially among patients with cancer. VRE infections have substantial attributable mortality among patients with cancer. The purpose of this study was to identify risk factors for developing bloodstream infection with VRE in patients with cancer who are colonized with VRE. VRE colonization was prospectively identified in 197 patients with cancer during 4-year period, of whom 179 (91%) had complete records for evaluation. Of these 179 patients, 24 (13.4%) developed hospital-acquired VRE bloodstream infections. Risk factors for VRE bloodstream infection included vancomycin use (relative risk [RR], 1.98; 95% confidence interval [CI], 1.25-3.14), diabetes mellitus (RR, 3.91; 95% CI, 1.20-12.77), gastrointestinal procedures (RR, 4.56; 95% CI, 1.05-19.7), and acute renal failure (RR, 3.10; 95% CI, 1.07-8.93). Strategies for preventing VRE bloodstream infection in VRE-colonized patients with cancer should include limiting vancomycin use and, perhaps, gastrointestinal procedures.

Correlation of chlamydia pneumoniae infection and severity of accelerated graft arteriosclerosis after cardiac transplantation.

BACKGROUND: Chlamydia pneumoniae has been associated with atherosclerosis, although its role in the process is not clearly defined. Heart transplant recipients are known to have high titers of antibodies to C. pneumoniae, and the organism has been recovered from the coronary arteries of both transplant recipients and donors. This study evaluated association between C. pneumoniae infection and accelerated graft arteriosclerosis (AGA), also known as cardiac allograft vasculopathy (CAV), after cardiac transplantation. METHODS: A case-control study was performed with 54 heart transplant recipients at the Johns Hopkins Hospital. Severe cases had >50% luminal narrowing on cardiac catheterization, mild cases <50% narrowing, and controls were free of arteriosclerotic disease. Blood specimens were examined for C. pneumoniae serology and DNA detection by polymerase chain reaction (PCR) assays. RESULTS: For every twofold increase in geometric mean C. pneumoniae immunoglobulin (Ig)G titer, the odds ratio for severe AGA versus controls was 3.13 (P=0.03) and for mild AGA versus control patients was 1.61 (P=0.45). On Kaplan-Meier survival analysis there was a nonsignificant trend toward faster development of CAV in patients with higher C. pneumoniae antibody titers. Overall, 29% of heart transplant patients evaluated had evidence of circulating C. pneumoniae DNA by PCR, without a statistical difference between groups. CONCLUSIONS: C. pneumoniae IgG titer correlates with severity of allograft arteriosclerosis after cardiac transplantation. Circulating C. pneumoniae DNA is detectable by PCR in up to 30% of cardiac transplant recipients, but this does not correlate with severity of allograft vasculopathy.