Orthoses Effect on Radiographic Measurements of Hallux Abducto Valgus: A Systematic Review.

BACKGROUND: Hallux abducto valgus (HAV), commonly referred to as a bunion, is a prevalent foot deformity with multifactorial etiology, including genetic predisposition, biomechanical abnormalities, and footwear choices. HAV is often managed conservatively with orthotic devices aimed at reducing deformity progression and alleviating associated pain. However, the effectiveness of orthotics in altering radiographic measurements of HAV remains debated. This systematic review aims to evaluate the impact of orthotic interventions on radiographic parameters. METHODS: A comprehensive search of five electronic databases-PubMed, Cochrane Library, CINAHL, Medline, and EMBASE-was conducted, covering the period from inception to March 2021. The search included terms related to HAV and orthotic interventions. Studies were included if they provided pre- and post-treatment radiographic measurements of halux abductus angle (HAA), hallux valgus angle (HVA), or intermetatarsal angle (IMA) and involved the use of orthotics. A total of 523 references were initially identified, with five studies meeting the inclusion criteria for review. Data extraction focused on study characteristics, orthotic type, radiographic measurements, and follow-up duration. RESULTS: The systematic review found insufficient high-quality evidence to support the effectiveness of orthotics in slowing the progression of HAV deformity. Of the five studies included, results were mixed: two studies reported changes in radiographic measurements following orthotic use, though one of these involved toe spacers rather than traditional orthotics. The remaining studies found no significant impact of orthotics on HAA, HVA, or IMA. The heterogeneity in study design, population, and orthotic types limited the ability to draw robust conclusions. CONCLUSIONS: Current evidence does not conclusively support the use of orthotics for altering the radiographic progression of HAV. The reviewed studies highlight significant variability in outcomes and suggest that while orthotics may provide symptomatic relief, their role in deformity correction remains unclear. Whether and to what extent orthotics affect common radiographic measures of HAV deformity should be proven with further studies and investigation.

Long-term radon-222 (222Rn) and hydroclimatic dataset for a coastal estuary, Corpus Christi Bay, Texas.

The dataset features radon-222 (222Rn), a radioactive tracer naturally present and frequently employed to assess submarine groundwater discharge (SGD). This collection is part of a study aimed at refining SGD estimations in shallow estuaries through the prediction of 222Rn variations using accessible hydroclimatic parameters [1]. The dataset includes measurements of 222Rn in water gathered recurringly from Aug. 2019 to June 2021 at half-hour intervals, at a monitoring station near the shore in Corpus Christi Bay, TX, USA (n = 10,660). Additionally, the data set encompasses continuous, accessible hydroclimatic parameters (e.g., wind speed and direction, atmospheric pressure, water temperature, tide height, creek and river discharge rate, n = 35,088). These parameters were integrated into two machine learning models - Random forest (RF) and Deep Neural Network (DNN) - aiming to interpret the variations in 222Rn and forecast during the data gap. A generalized additive model (GAM) was utilized, focusing on interpreting the variability in 222Rn inventory, particularly influenced by windspeed and direction. The tools and data presented herein afford prospects to 1) forecast 222Rn inventories in areas with significant data voids using only publicly accessible hydroclimatic parameters, and 2) refine SGD estimations affected by wind, thereby offering valuable insights for the planning of field expeditions and the development of management strategies for coastal water and solute budgets.

Association of select psychiatric disorders with incident brain aneurysm and subarachnoid hemorrhage among veterans.

Background: Brain aneurysms represent a significant cause of hemorrhagic stroke. Prior research has demonstrated links between stress and stroke, including brain aneurysms. We aimed to determine relationships between select psychiatric disorders and aneurysms and aneurysmal SAH. Methods: We performed retrospective, case-control study of a National Veterans Affairs population with two experimental groups (aneurysm-only and aneurysmal SAH) and 10-fold controls per group matched by age, date, and clinical data source. The studied the presence of 4 psychiatric disorders: Posttraumatic stress disorder (PTSD), major depressive disorder (MDD), generalized anxiety disorder (GAD), and other mood disorders. Our main outcomes Unadjusted and multivariable adjusted ORs of PTSD, MDD, GAD, and mood disorders within aneurysm-only and aSAH groups. Results: In 6,320,789 US Veterans who were enrolled for at least 5 years in Medicare and/or the Veterans Health Administration, we identified 35,094 cases of aneurysm without SAH and 5,749 cases of aneurysm with SAH between 1/2005 and 12/2019. In analyses adjusted for sex, hypertension, and tobacco use, patients with aneurysm were more likely than matched controls to have a history of PTSD (OR 1.48), MDD (OR 1.33), GAD (OR 1.26), and other mood disorders (OR 1.34) (all p-values < 0.0001). Similarly, patients with aSAH were more likely than controls to have a history of PTSD (OR 1.35), MDD (OR 1.38), GAD (OR 1.18), and other mood disorders (OR 1.30) (all p-values < 0.0001). Conclusion: The study, the largest of its kind, further suggests links between psychiatric disorders and stroke. This is important as patients with aneurysms are not routinely screened for such psychiatric risk factors. Additional research on this topic could lead to novel strategies to improve stroke prevention.

Pretreatment stabilization increases completion of trauma-focused evidence-based psychotherapies.

OBJECTIVE: Veterans with posttraumatic stress disorder (PTSD) initiate and complete cognitive processing therapy (CPT) and prolonged exposure (PE) at low rates within Veterans Health Administration (VHA) despite substantial dissemination and training. This study investigated how trauma-informed, skills-based treatment ("stabilization") administered before CPT and PE was related to initiation and completion of trauma-focused evidence-based psychotherapies (TF-EBPs). METHOD: Data were extracted from the VHA electronic medical record to identify veterans who initiated outpatient treatment in the PTSD Clinical Team (PCT) at a Veterans Affairs Health Care System. Treatment initiation was defined as three or more PCT visits with no prior PCT care for at least 18 months (N = 341). Before initiation of TF-EBP, veterans received either no stabilization or received individual and/or group stabilization. RESULTS: Twenty-eight percent of veterans without stabilization (n = 115) initiated TF-EBP, compared with 34% of veterans who completed individual-only stabilization (n = 82), and 10% of veterans who completed group-only stabilization (n = 29, p = .050). Compared with those with no stabilization, individual stabilization was associated with significantly higher TF-EBP completion (93% vs. 50%, p < .001). CPT completion was also significantly higher for veterans who received individual-only stabilization (90% vs. 43%, p = .001). Results for PE followed the same relationship, but did not reach significance (100% vs. 67%, p = .090). CONCLUSIONS: Findings suggest that individual stabilization may improve delivery of TF-EBPs in VHA settings by increasing TF-EBP completion without reducing initiation, while pretreatment with group-only stabilization may reduce initiation of TF-EBPs. Results inform how models of care can improve TF-EBP retention and completion among veterans with PTSD. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Loneliness: An Overlooked Contributing Factor in Anorexia of Older Patients With End-Stage Renal Disease and Focal Point for Interventions to Enhance Nutritional Status-An Overview of Evidence and Areas of Suggested Research.

Although research has shown that loneliness can contribute to anorexia in older non-ESRD (end-stage renal disease) populations, and the benefits of its mitigation with improving appetite, nutrient, and caloric intake, its implications for older patients with ESRD have been overlooked. This article provides an overview of evidence on the potential contributing role of loneliness in anorexia of older patients with ESRD, and loneliness as a focal point for interventions to help improve nutritional status. Areas of needed research are suggested in the course of the analysis. With a 41%-83% projected rise in the prevalence of patients in the United States with ESRD by 2030, and demographic population trends showing that an ever-increasing number will be living alone, there is a long overdue need to better understand the implications of loneliness for this nutritionally vulnerable population. KEYWORDS: Chronic kidney disease; loneliness; anorexia; malnutrition; protein energy wasting.

Black pepper and vegetable oil-based emulsion synergistically enhance carotenoid bioavailability of raw vegetables in humans.

This study demonstrated the combination of black pepper and a canola oil-based emulsion synergistically enhanced carotenoid bioavailability of raw vegetables in humans. In a randomized crossover design, healthy young adults consumed (1) vegetable salad (control), (2) salad with canola oil emulsion (COE), (3) salad with black pepper (BP), and (4) salad with canola oil emulsion and black pepper (COE + BP). COE + BP led to a higher AUC0-10h of total plasma carotenoids (p < 0.0005) than the control (6.1-fold), BP (2.1-fold), and COE (3.0-fold). COE + BP increased AUC0-10h of plasma lutein, α-carotene, ß-carotene, and lycopene by 4.8, 9.7, 7.6, and 5.5-fold than the control, respectively (p < 0.0001). COE + BP produced a significant synergy in increasing both Cmax and AUC0-10h of total carotenoids, α-carotene, ß-carotene, and lycopene. Moreover, COE + BP produced a stronger enhancement on AUC0-10h of total carotenoids, α-carotene, ß-carotene, and lycopene in females than in males.

Podiatric Medical Resident Wellness: A Group Survey Study.

BACKGROUND: Burnout and medical resident well-being has become an increasingly studied topic in medical degree (MD) and doctor of osteopathic medicine (DO) fields and specialties, which has led to systemic changes in postgraduate education and training. Although an important topic to address for physicians of all experience levels and fields of practice, there is little research on this topic as it pertains specifically to the podiatric medical community. METHODS: A wellness needs assessment was developed and distributed to podiatric medical residents via electronic survey to assess overall wellness levels of residents and to highlight several subdomains of well-being in the training programs of the podiatric medical profession. RESULTS: A total of 121 residents completed the wellness needs assessment. Survey respondents indicated that they experienced high levels of professional burnout, with large numbers of them experiencing depression and anxiety. When analyzing the different subdomains of wellness, levels of intellectual and environmental wellness were high, and levels of financial and physical wellness were reported as low. In addition, free response answers were recorded in the survey regarding well-being initiatives that have been implemented in residency programs, and in many cases no such programs are reported to exist. CONCLUSIONS: Podiatric medical residents experience compromised well-being similar to their MD/DO counterparts. These exploratory survey group results are concerning and warrant further investigation as well as organizational introspection. Analyzing well-being and implementing changes that can support podiatric physicians at all levels of training could decrease the deleterious effects of burnout in all its forms.

Enhancing prolonged exposure therapy for PTSD among veterans with oxytocin: Design of a multisite randomized controlled trial.

Posttraumatic stress disorder (PTSD) is the most highly prevalent mental health disorder among U.S. military Veterans. Prolonged Exposure (PE) therapy is one of the most widely used evidence-based treatments for PTSD, but there is substantial room for improvement in outcomes and retention rates. Accumulating data suggest that oxytocin offers a promising pharmacological approach towards achieving this goal. Therefore, the primary objective of this two-site Phase II study is to examine the ability of oxytocin (vs. placebo) administration combined with PE therapy to (1) reduce PTSD symptom severity, (2) accelerate the rate of PTSD symptom improvement, and (3) improve PE adherence and retention rates. To accomplish these objectives, we will employ a randomized, double-blind, placebo-controlled trial and use standardized, repeated dependent measures of change at five time points (baseline, mid-treatment, end of treatment, and 3 and 6 month follow-up). Intranasal oxytocin (40 IU) will be administered directly prior to each PE therapy session. Findings from this study will provide critical new information regarding the efficacy of oxytocin to augment psychosocial treatment for PTSD, as well as information regarding the physiological mechanisms underlying PTSD and positive treatment response. ClinicalTrials.gov Identifier: NCT04228289.

Associations between food insecurity and psychotropic medication use among women living with HIV in the United States.

AIMS: Psychotropic prescription rates continue to increase in the United States (USA). Few studies have investigated whether social-structural factors may play a role in psychotropic medication use independent of mental illness. Food insecurity is prevalent among people living with HIV in the USA and has been associated with poor mental health. We investigated whether food insecurity was associated with psychotropic medication use independent of the symptoms of depression and anxiety among women living with HIV in the USA. METHODS: We used cross-sectional data from the Women's Interagency HIV Study (WIHS), a nationwide cohort study. Food security (FS) was the primary explanatory variable, measured using the Household Food Security Survey Module. First, we used multivariable linear regressions to test whether FS was associated with symptoms of depression (Center for Epidemiologic Studies Depression [CESD] score), generalised anxiety disorder (GAD-7 score) and mental health-related quality of life (MOS-HIV Mental Health Summary score; MHS). Next, we examined associations of FS with the use of any psychotropic medications, including antidepressants, sedatives and antipsychotics, using multivariable logistic regressions adjusting for age, race/ethnicity, income, education and alcohol and substance use. In separate models, we additionally adjusted for symptoms of depression (CESD score) and anxiety (GAD-7 score). RESULTS: Of the 905 women in the sample, two-thirds were African-American. Lower FS (i.e. worse food insecurity) was associated with greater symptoms of depression and anxiety in a dose-response relationship. For the psychotropic medication outcomes, marginal and low FS were associated with 2.06 (p < 0.001; 95% confidence interval [CI] = 1.36-3.13) and 1.99 (p < 0.01; 95% CI = 1.26-3.15) times higher odds of any psychotropic medication use, respectively, before adjusting for depression and anxiety. The association of very low FS with any psychotropic medication use was not statistically significant. A similar pattern was found for antidepressant and sedative use. After additionally adjusting for CESD and GAD-7 scores, marginal FS remained associated with 1.93 (p < 0.05; 95% CI = 1.16-3.19) times higher odds of any psychotropic medication use. Very low FS, conversely, was significantly associated with lower odds of antidepressant use (adjusted odds ratio = 0.42; p < 0.05; 95% CI = 0.19-0.96). CONCLUSIONS: Marginal FS was associated with higher odds of using psychotropic medications independent of depression and anxiety, while very low FS was associated with lower odds. These complex findings may indicate that people experiencing very low FS face barriers to accessing mental health services, while those experiencing marginal FS who do access services are more likely to be prescribed psychotropic medications for distress arising from social and structural factors.

Food insecurity is associated with anxiety, stress, and symptoms of posttraumatic stress disorder in a cohort of women with or at risk of HIV in the United States.

BACKGROUND: Food insecurity, which disproportionately affects marginalized women in the United States, is associated with depressive symptoms. Few studies have examined relations of food insecurity with other mental health outcomes. OBJECTIVE: The aim of this study was to investigate the associations of food insecurity with symptoms of generalized anxiety disorder (GAD), stress, and posttraumatic stress disorder (PTSD) in the Women's Interagency HIV Study (WIHS), a prospective cohort study of women with or at risk of HIV in the United States. METHODS: Participants were 2553 women with or at risk of HIV, predominantly African American/black (71.6%). Structured questionnaires were conducted during April 2013-March 2016 every 6 mo. Food security (FS) was the primary predictor, measured using the Household Food Security Survey Module. We measured longitudinal outcomes for GAD (GAD-7 score and a binary GAD-7 screener for moderate-to-severe GAD). Only cross-sectional data were available for outcomes measuring perceived stress (PSS-10 score) and PTSD (PCL-C score and a binary PCL-C screener for PTSD). We examined associations of FS with the outcomes through use of multivariable linear and logistic regression, including lagged associations with GAD outcomes. RESULTS: After adjusting for sociodemographic and health-related factors including HIV serostatus, current marginal, low, and very low FS were associated with increasingly higher GAD-7 scores, and with 1.41 (95% CI: 1.10, 1.80; P < 0.01), 2.03 (95% CI: 1.59, 2.61; P < 0.001), and 3.23 (95% CI: 2.43, 4.29; P < 0.001) times higher odds of screening positive for moderate-to-severe GAD, respectively. Low and very low FS at the previous visit (6 mo earlier) were independently associated with GAD outcomes at current visit. Associations of FS with PSS-10 and PCL-C scores exhibited similar dose-response relations. Very low FS was associated with 1.93 (95% CI: 1.15, 3.24; P < 0.05) times higher odds of screening positive for PTSD. CONCLUSIONS: Food insecurity may be associated with a range of poor mental health outcomes among women in the United States with or at risk of HIV.

Positive impact of IPS supported employment on PTSD-related occupational-psychosocial functional outcomes: Results from a VA randomized-controlled trial.

OBJECTIVE: Posttraumatic stress disorder (PTSD) has significant negative effects on occupational, interpersonal, and social functioning. Supported employment is highly effective in helping people with a diagnosis of PTSD obtain and maintain competitive employment. However, less is known about the impact of supported employment on functioning in work or school, social, and interpersonal areas as specifically related to the symptoms of PTSD. METHOD: The Veterans Individual Placement and Support Toward Advancing Recovery study was a prospective, multisite, randomized, controlled trial that compared Individual Placement and Support (IPS) supported employment with a stepwise vocational rehabilitation involving transitional work (TW) assignments with unemployed veterans with PTSD diagnoses (n = 541) at 12 Veterans Administration (VA) medical centers. This analysis focuses on the PTSD-related functional outcomes over the 18-month follow-up period. RESULTS: Compared with those randomized to TW, the PTSD Related Functioning Inventory (PRFI) total score significantly improved for participants randomized to IPS (LSMeans difference = -3.92, 95% CI [-7.49, -.36]; p = .03) over 18 months. When the Work/School subscale of the PRFI was removed from the analysis, the IPS group continued to show significant improvements compared with the TW group on the PRFI relationship and lifestyle domains (LSMeans difference = -2.37, 95% CI [-4.74, .00]; p = .05), suggesting a positive impact of IPS beyond work/school functioning. CONCLUSION: Compared with the usual-care VA vocational services for veterans with PTSD, IPS supported employment is associated with greater improvement in overall PTSD-related functioning, including occupational, interpersonal, and lifestyle domains. In addition to superior employment outcomes, IPS has a positive impact on occupational-psychosocial functioning outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Short-term influence of coal mine reclamation using coal combustion residues on groundwater quality.

Two full-scale coal mine reclamation projects using coal combustion residues (CCRs) were recently carried out at highwall pit complexes near the Conesville and Cardinal coal-fired power plants owned by American Electric Power. The environment impacts of the reclamation projects were examined by regularly monitoring the leaching characteristics of the backfilling CCRs and the water quality of the uppermost aquifers underlying the sites. With over five years of field monitoring, it shows that the water quality at both demonstration sites had changed since the reclamation began. By analyzing the change of the hydrogeochemical properties, it was concluded that the water quality impact observed at the Conesville Five Points site was unlikely due to the seepage of FGD material leachates. Reclamation activities, such as logging, grading, and dewatering changed the hydrogeological conditions and resulted in the observed water quality changes. The same hydrogeological effect on water quality was also found at the Cardinal Star Ridge site during the early stage of the reclamation (approximately the first 22months). Subsequent measurements showed the water quality to be strongly influenced by the water in the reclaimed highwall pit. Despite the changes to the water quality, the impacts are insignificant and temporary. None of the constitutes showed concentration levels higher than the regulatory leaching limits set by the Ohio Department of Natural Resources' Division of Mineral Resources Management for utilizing CCRs in mined land reclamation. Compared to the local aquifers, the concentrations of eleven selected constituents remained at comparable levels throughout the study period. There are four constituents (i.e., As, Be, Sb, and Tl) that exceeded their respective MCLs after the reclamation began. These detections were found shortly (i.e., within 2years) after the reclamation began and decreased to the levels either lower than the respective detection limits or similar to the background levels.

Prospective Study of the Mental Health Consequences of Sexual Violence Among Women Living With HIV in Rural Uganda.

The association between sexual violence and depression is well known, but the temporal aspects of the association have not been well established. We analyzed data from a cohort of 173 HIV-positive women in rural Uganda who were interviewed every 3 months for a median of 1.8 years of follow-up. The method of generalized estimating equations (GEE) was used to model the marginal expectation of depression symptom severity (Hopkins Symptom Checklist for Depression), mental health-related quality of life (MOS-HIV Mental Health Summary), and heavy drinking (Alcohol Use Disorders Identification Test) as a function of self-reported forced-sex victimization in the 3 months prior to interview. Estimates were adjusted for variables known to confound the association between victimization and mental health status. To assess any potential reciprocal relationships, we reversed the temporal ordering of the exposures and outcomes and refitted similar GEE models. In multivariable analyses, victimization was associated with greater depression symptom severity (b = 0.17; 95% CI = [0.02, 0.33]) and lower mental health-related quality of life (b = -5.65; 95% CI = [-9.34, -1.96]), as well as increased risks for probable depression (adjusted relative risk [ARR] = 1.58; 95% CI = [1.01, 2.49) and heavy drinking (ARR = 3.99; 95% CI = [1.84, 8.63]). We did not find strong evidence of a reciprocal relationship. Our findings suggest that forced sex is associated with adverse mental health outcomes among HIV-positive women in rural Uganda. Given the substantial mental health-related impacts of victimization, effective health sector responses are needed.

Are word-of-mouth communications contributing to a shortage of nephrology nurses?

Nephrology nurse shortages have historically been viewed as a subset of the overall nursing supply in the United States. Not-here-to-fore considered as a contributing factor are the effects of word-of-mouth and Internet-based word-of-mouth communications from nurses who have had disappointing work experiences in hemodialysis clinics. This article discusses the potential effects of word-of-mouse communications and posits that negative word-of-mouse communications may discourage new and experienced nurses from considering the specialty of nephrology nursing, thus contributing to a nephrology nursing shortage.

Moving the issue of renal dietitian staffing forward.

The day-to-day pragmatic work realities of dietitians who cover dialysis clinics are rarely the focus of discussion. This article highlights the points of convergence between these realities and the research literature. Focusing on the National Kidney Foundation Kidney Disease Outcomes Quality Initiative clinical practice guidelines for nutrition and the difficulties encountered with their full implementation, a seemingly pervasive problem of limited time is revealed. Given the evidence that renal dietitians can positively impact morbidity and mortality risks, when protein-energy malnutrition is primarily the byproduct of insufficient nutrient intake, it suggests that progress with enhancing the nutritional status of patients may be fundamentally contingent on increasing the time they have available, through improved staffing.

Adequacy of dialysis clinic staffing and quality of care: a review of evidence and areas of needed research.

Improving the quality of care delivered to patients receiving in-center dialysis treatment remains a perpetual concern with stakeholders. Quality indicators traditionally have focused on such items as adequacy of dialysis, anemia management, patient survival, and, most recently, the percentage using arteriovenous fistulas. Largely overlooked in the quest for improvement has been adequate consideration of dialysis clinic staffing levels. Staffing is important because it has been identified as a structural measure of quality. With 326,671 (93.1%) of all dialysis patients receiving in-center treatments, this is a potentially critical issue. This article reviews evidence related to inadequacies in clinic staffing and how they may be contributing to suboptimal care and outcomes. Focusing on nephrologists, nurses, patient care technicians, dietitians, and social workers, this article suggests areas of needed research.

Prevalence and correlates of forced sex perpetration and victimization in Botswana and Swaziland.

OBJECTIVES: We sought to identify correlates of forced sex perpetration among men and victimization among women in Botswana and Swaziland. METHODS: We surveyed a 2-stage probability sample of 2074 adults from the 5 districts of Botswana with the highest HIV prevalence rates and all 4 regions of Swaziland. We used multivariable logistic regression to identify correlates of forced sex victimization and perpetration. RESULTS: Lifetime prevalence rates of forced sex victimization of women were 10.3% in Botswana and 11.4% in Swaziland; among men, rates of perpetration were 3.9% in Botswana and 5.0% in Swaziland. Lifetime history of forced sex victimization was the strongest predictor of forced sex perpetration by men in Botswana (adjusted odds ratio [OR] = 13.70; 95% confidence interval [CI] = 4.55, 41.50) and Swaziland (adjusted OR = 5.98; 95% CI = 1.08, 33.10). Problem or heavy drinking was the strongest predictor of forced sex victimization among women in Botswana (adjusted OR = 2.55; 95% CI = 1.19, 5.49) and Swaziland (OR = 14.70; 95% CI = 4.53, 47.60). CONCLUSIONS: Sexual violence in Botswana and Swaziland is a major public health and human rights problem. Ending codified gender discrimination can contribute to fundamentally changing gender norms and may be an important lever for gender-based violence prevention in these countries.