Promoting active transport in rural communities through infrastructural modifications: the PABEM needs assessment tool.

The design of the built environment in communities influences active transport and physical activity levels of citizens. Existing instruments for quantitatively assessing built environments were developed for use in urban areas and mainly by experts. Participative assessment of built environment modifications (PABEM) is a needs assessment tool that involves citizens and community decision-makers within a structured process for identifying needed changes to promote walking and cycling in rural areas. This article describes the development of the PABEM process and evaluates its initial use in three rural towns in Austria. PABEM consists of the following seven steps: (i) qualitative interviews; (ii) expert assessment of the built environment; (iii) citizen assessment of the built environment; (iv) social media interaction; (v) household questionnaire; (vi) participatory workshop; and (vii) evaluation and scoring workshop. The main modifications identified as necessary in rural towns were the revitalization of existing walking and cycling facilities and the construction of new barrier-free and safe sidewalks. In addition cycling routes to schools, to public transport facilities and to central public places as well as cleaner and inviting seating, a car-free school environment, speed reduction in town centres, more crosswalks and improved cleanliness in public places were also deemed necessary modifications. PABEM's provisions to ensure collaborative participation of citizens and local decision-makers fostered a continuous dialogue about the requirements of the built environment, user needs and opportunities for realization throughout the whole process.

The design of the built environment in communities influences active transport and physical activity levels of citizens. Existing instruments for quantitatively assessing built environments were developed for use in urban areas and mainly by experts. Participative assessment of built environment modifications (PABEM) is a needs assessment tool that involves citizens and community decision-makers within a structured process for identifying needed changes to promote walking and cycling in rural areas. This article describes the development of the PABEM process and evaluates its initial use in three rural towns in Austria. PABEM consists of the following seven steps: (i) qualitative interviews; (ii) expert assessment of the built environment; (iii) citizen assessment of the built environment; (iv) social media interaction; (v) household questionnaire; (vi) participatory workshop; and (vii) evaluation and scoring workshop.

The Experiences of Functioning and Health of Patients With Primary Sjögren's Syndrome: A Multicenter Qualitative European Study.

Objective: To identify a spectrum of perspectives on functioning and health of patients with primary Sjögren's syndrome (pSS) from the five European countries in order to reveal commonalities and insights in their experiences. Methods: A multicenter focus group study on the patients with pSS about their perspectives of functioning and health was performed. Focus groups were chaired by trained moderators based on an interview guide, audiotaped, and transcribed. After conducting a meaning condensation analysis of each focus group, we subsequently combined the extracted concepts from each country and mapped them to the International Classification of Functioning, Disability and Health (ICF). Results: Fifty-one patients with pSS participated in 12 focus groups. We identified a total of 82 concepts meaningful to people with pSS. Of these, 55 (67%) were mentioned by the patients with pSS in at least four of five countries and 36 (44%) emerged in all the five countries. Most concepts were assigned to the ICF components activities and participation (n = 25, 30%), followed by 22 concepts (27%) that were considered to be not definable or not covered by the ICF; 15 concepts (18%) linked to body structures and functions. Participants reported several limitations in the daily life due to a mismatch between the capabilities of the person, the demands of the environment and the requirements of the activities. Conclusion: Concepts that emerged in all the five non-English speaking countries may be used to guide the development and adaption of the patient-reported outcome measures and to enhance the provision of treatment options based on the aspects meaningful to patients with pSS in clinical routine.

A Preliminary Investigation of Social Justice Perceptions Among U.S. Speech-Language Pathologists: Clinical Implications.

Purpose The purpose of this survey research is to provide preliminary data regarding speech-language pathologists' (SLPs') perceptions of the role that social justice (SJ) plays in their work. As our professional organizations call us to advocate and communicate with regulatory agencies and legislative bodies to promote quality care for all individuals, this topic has become particularly important at this time. At present, there is a lack of data in peer-reviewed publications within the discipline of communication disorders on SJ and even less regarding the perceptions of SLPs on SJ. Method The survey was sent to American Speech-Language-Hearing Association (ASHA)-certified SLPs, identified by the ASHA ProFind database, across six U.S. geographic regions, including both urban and rural communities. Four themes were explored through the survey: (a) importance of SJ, (b) awareness of SJ, (c) current practices related to SJ, and (d) barriers to SJ implementation. Results The majority of respondents view SJ as important to the profession (91.2%) and value the work of creating equality among groups (96.0%). Many SLPs are actively involved in implementing SJ principles in their own practice by accepting Medicaid (40.7%), engaging in political outreach (55.0%), and providing transdisciplinary educational outreach (77.9%). Identified barriers to incorporating SJ include time (62.7%), resources (65.6%), and finances (70.0%). Conclusions Working for SJ is important to a majority of the respondents, and various efforts are implemented to create equal opportunities for service to clients. Barriers continue to exist that limit the degree to which SLPs can work toward SJ. A list of actions to be considered in order to promote SJ in the field is provided. Supplemental Material https://doi.org/10.23641/asha.16584044.

Potential Risk Factors Influencing the Formation of Postoperative Seroma After Breast Surgery - A Prospective Study.

BACKGROUND/AIM: This trial intended to identify patient- and therapy-specific risk factors influencing the genesis of seroma and the extent of its formation. PATIENTS AND METHODS: Within a prospective randomized controlled trial, 70 patients (n=35 TissuGlu®; n=35 drain) underwent a mastectomy with or without sentinel lymphonodectomy. Specific seroma-associated risk factors were recorded. Regular outpatient aftercare was performed during a 90-day postoperative follow-up. RESULTS: A statistically significant increase in the postoperative seroma rate was demonstrated for those with pre-adiposity compared to normal body weight (p=0.016), as well as for the state of health evaluated by the score of American Society of Anesthesiologists (ASA) (ASA III compared to I; p=0.046), the presence of diabetes mellitus (p<0.001) and the reduction of the length of the surgical procedure (p=0.044). CONCLUSION: A high body mass index, a poor state of health (ASA score), and diabetes mellitus, as well as a shorter duration of surgery, favor the incidence of postoperative seroma.

Impact of the Lysine-urethane Adhesive TissuGlu® on Postoperative Complications and Interventions After Drain-free Mastectomy.

BACKGROUND/AIM: The influence of a polyurethane-based tissue adhesive (TissuGlu®) on common complications following breast surgery was investigated. PATIENTS AND METHODS: Within a Randomized-Controlled-Trial 70 women (n=35 TissuGlu®, n=35 drain) underwent a mastectomy with or without sentinel lymph node excision (SLNE), followed by a 90-day postoperative follow-up. RESULTS: Postoperative interventions: Non-inferiority of the application of TissuGlu® was seen. Pain-Level/ Hospitalization: A statistically significant pain reduction from day four onwards (p<0.001) and a shorter hospitalization period (p<0.001) was observed. In contrast, the TissuGlu® group showed increased mean puncture incidence (p=0.013), and increased puncture volume (p=0.021). CONCLUSION: Application of the polyurethane-based tissue adhesive TissuGlu® after mastectomy, with or without SLNE, showed potential for improvement of the clinical outcome. In contrast, high intervention rates and increased puncture volume, caused by recurring seromas following application of the surgical adhesive TissuGlu®, have a negative impact on the patient-specific convalescence.

The Use of TissuGlu® Surgical Adhesive for Mastectomy With or Without Lymphonodectomy.

BACKGROUND/AIM: Using drains after breast surgery is a preventive, but invasive measure to reduce seroma formation. A polyurethane-based tissue adhesive (TissuGlu®) might facilitate drainage-free wound healing after mastectomy in a non-invasive manner. PATIENTS AND METHODS: Retrospectively, data from 84 patients (42 receiving TissuGlu®, 42 receiving a drainage) who underwent mastectomy, were collected (90 days postoperative follow-up). Study endpoints were defined as the number of fluid-related postoperative clinical interventions, cumulative volume of postoperative wound fluid, duration of hospitalization and postoperative complications. RESULTS: In the entirety of postoperative interventions, no significant difference could be demonstrated (p=0.298). The drainage arm showed significantly less seroma aspirations (p=0.024) and complications (p=0.012). A significantly reduced length of hospitalization (p<0.001) and less cumulative wound secretion volume (p<0.001) appeared in the TissuGlu® group. CONCLUSION: The polyurethane-based tissue adhesive is a less invasive alternative to drain use in mastectomy.

Assessing health-related quality of life in primary Sjögren's syndrome-The PSS-QoL.

OBJECTIVES: To develop a questionnaire for the assessment of health-related quality of life (HRQL) in primary Sjögren's syndrome (PSS), and to test its psychometric properties. METHODS: Based on the concepts of a previous qualitative study, a questionnaire for the assessment of HRQL in PSS (PSS-QoL) was developed. Psychometric testing of PSS-QoL was performed after revising the first draft with feedback of patients (n = 6) and clinicians (n = 4). Convergent construct validity was assessed by correlating the score with the EULAR Sjögren's Syndrome Patient Reported Index (ESSPRI), EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI) and Euro-QoL 5D (EQ-5D). Reliability was examined by asking patients to complete the questionnaire twice 1-2 weeks apart. An English Version of the PSS-QoL was developed by using standard methodology with forward and back translation. RESULTS: Out of the 75 PSS patients, 91% were female, mean (±SD) age was 58.5 ± 12.5 years. PSS-QoL consists of 25 questions and can be divided into two main categories: physical (discomfort and dryness) and psychosocial. The internal consistency of the PSS-QoL revealed a Crohnbach's α of 0.892. Strong and moderate correlations were found between the PSS-QoL and ESSPRI (corrcoeff = 0.755) and EQ. 5D-pain/discomfort (corrcoeff = 0.531). Reproducibility of the PSS-QoL was high, yielding an ICC of 0.958 (95% CI: 0.926-0.981). CONCLUSIONS: The PSS-QoL is the first specific tool for the assessment of patients' HRQL in PSS and showed good psychometric properties. It may serve as a novel patient-reported outcome measure in future clinical studies.

EULAR 'points to consider' for the conduction of workforce requirement studies in rheumatology.

OBJECTIVE: Current methods used for forecasting workforce requirements in rheumatology are disparate, as are the parameters incorporated into workforce projection studies. The objective of these European League Against Rheumatism (EULAR points to consider (PTC) is to guide future workforce studies in adult rheumatology in order to produce valid and reliable manpower estimates. METHODS: The EULAR Standardised Operating Procedures were followed. A multidisciplinary task force with experts including patients with rheumatic diseases from 11 EULAR countries and the USA was assembled. A systematic literature review (SLR) was conducted to retrieve workforce models in rheumatology and other medical fields. PTC were based on expert opinion informed by the SLR, followed by group discussions with consensus obtained through informal voting. The level of agreement with the PTC was voted anonymously. RESULTS: A total of 10 PTC were formulated. The task force recommends models integrating supply (=workforce available in rheumatology), demand (=health services requested by the population) and need (=health services that are considered appropriate to serve the population). In general, projections of workforce requirements should consider all factors relevant for current and future workload in rheumatology inside and outside of direct patient care. Forecasts of workforce supply should consider demography and attrition of rheumatologists, as well as the effects of new developments in healthcare. Predictions of future need/demand should take demographic, sociocultural and epidemiological development of the population into account. CONCLUSION: These EULAR-endorsed PTC will provide guidance on the methodology and the parameters to be applied in future national and international workforce requirement studies in rheumatology.

Workforce requirements in rheumatology: a systematic literature review informing the development of a workforce prediction risk of bias tool and the EULAR points to consider.

OBJECTIVE: To summarise the available information on physician workforce modelling, to develop a rheumatology workforce prediction risk of bias tool and to apply it to existing studies in rheumatology. METHODS: A systematic literature review (SLR) was performed in key electronic databases (1946-2017) comprising an update of an SLR in rheumatology and a hierarchical SLR in other medical fields. Data on the type of workforce prediction models and the factors considered in the models were extracted. Key general as well as specific need/demand and supply factors for workforce calculation in rheumatology were identified. The workforce prediction risk of bias tool was developed and applied to existing workforce studies in rheumatology. RESULTS: In total, 14 studies in rheumatology and 10 studies in other medical fields were included. Studies used a variety of prediction models based on a heterogeneous set of need/demand and/or supply factors. Only two studies attempted empirical validation of the prediction quality of the model. Based on evidence and consensus, the newly developed risk of bias tool includes 21 factors (general, need/demand and supply). The majority of studies revealed high or moderate risk of bias for most of the factors. CONCLUSIONS: The existing evidence on workforce prediction in rheumatology is scarce, heterogeneous and at moderate or high risk of bias. The new risk of bias tool should enable future evaluation of workforce prediction studies. This review informs the European League Against Rheumatism points to consider for the conduction of workforce requirement studies in rheumatology.

It's more than dryness and fatigue: The patient perspective on health-related quality of life in Primary Sjögren's Syndrome - A qualitative study.

OBJECTIVES: In Primary Sjögren's Syndrome (PSS), there is an apparent lack of data concerning the perspectives of patients, their needs, preferences and difficulties of daily life. This qualitative study was conducted to explore perspectives and needs of patients with PSS that influence health related quality of life (HRQL). METHODS: We recruited 20 PSS patients fulfilling the American-European consensus classification criteria out of the PSS cohort of the Medical University Graz, Austria. In total, 6 focus group sessions (with three to four patients per group) were performed. A modified meaning condensation procedure was used to analyse the data. RESULTS: The interview analysis resulted in 484 meaning units, 254 subconcepts and 86 concepts. The identified concepts were grouped into three dimensions: physical dimension, psychological & emotional challenges and social life & daily living. A dependency between the three categories was identified. The concepts most commonly reported by patients were related to the physical dimension: pain and dryness as well as complaints associated with/provoked by these symptoms. Patients also reported shortness of breath, fatigue und constipation. CONCLUSIONS: This qualitative study underpins that HRQL in PSS patients is affected by several factors. The problems are not limited to dryness, pain and fatigue while the complaints secondary to these symptoms are important to patients with PSS significantly affecting physical, psychological and social life components of HRQL. A disease-specific patient related outcome measures for clinical practice and trials should be developed considering the different aspects of HRQL in PSS.

Acute and chronic menisco-capsular separation in the young athlete: diagnosis, treatment and results in thirty seven consecutive patients.

PURPOSE: Menisco-capsular separation (MCS) is an avulsion type of injury of the medial and/or lateral meniscus and is defined as detachment of the meniscus from its capsular attachment. The aims of this study were to show the results of arthroscopic all-inside menisco-capsular repair in a large number of consecutive patients with acute or chronic MCS, emphasise the advantages of this safe treatment option and stress the superiority of the treatment on the basis of thorough physical examination of the knee joint over magnetic resonance imaging (MRI) diagnosis in MCS. METHODS: We evaluated data of patients treated between October 2011 and July 2012. Inclusion and exclusion criteria were defined and demographic variables evaluated. All patients were examined physically and with MRI. Knee arthroscopy was performed and the MCS repaired through all-inside menisco-capsular repair. Postoperative treatment was standardised. Patients were followed up for at least 24 weeks. RESULTS: Thirty-seven athletes (12 women, 25 men) were evaluated. Only in six patients was MCS detected on MRI. In all patients, MCS was diagnosed via physical examination. Arthroscopic treatment led to significant (p < 0.01) improvement. There were no complications reported postoperatively. CONCLUSION: Isolated MCS is not as rare a meniscus pathology after trauma in young athletes as could be expected after reviewing current literature. It is occult on MRI scans in most of the cases and should therefor be taken into consideration in patients with acute or chronic tenderness at the level of the joint line and negative MRI scans. Thorough physical examination has higher diagnostic value than MRI alone, as shown in this study. Treatment of MCS using all-inside nonabsorbable sutures, as described in this study using Ultra FasT Fix®, is effective if performed by an experienced surgeon.

Immediate effects of AAF devices on the characteristics of stuttering: a clinical analysis.

UNLABELLED: The present study investigated the immediate effects of altered auditory feedback (AAF) and one Inactive Condition (AAF parameters set to 0) on clinical attributes of stuttering during scripted and spontaneous speech. Two commercially available, portable AAF devices were used to create the combined delayed auditory feedback (DAF) and frequency altered feedback (FAF) effects. Thirty adults, who stutter, aged 18-68 years (M=36.5; SD=15.2), participated in this investigation. Each subject produced four sets of 5-min of oral reading, three sets of 5-min monologs as well as 10-min dialogs. These speech samples were analyzed to detect changes in descriptive features of stuttering (frequency, duration, speech/articulatory rate, core behaviors) across the various speech samples and within two SSI-4 (Riley, 2009) based severity ratings. A statistically significant difference was found in the frequency of stuttered syllables (%SS) during both Active Device conditions (p=.000) for all speech samples. The most sizable reductions in %SS occurred within scripted speech. In the analysis of stuttering type, it was found that blocks were reduced significantly (Device A: p=.017; Device B: p=.049). To evaluate the impact on severe and mild stuttering, participants were grouped into two SSI-4 based categories; mild and moderate-severe. During the Inactive Condition those participants within the moderate-severe group (p=.024) showed a statistically significant reduction in overall disfluencies. This result indicates, that active AAF parameters alone may not be the sole cause of a fluency-enhancement when using a technical speech aid. EDUCATIONAL OBJECTIVES: The reader will learn and be able to describe: (1) currently available scientific evidence on the use of altered auditory feedback (AAF) during scripted and spontaneous speech, (2) which characteristics of stuttering are impacted by an AAF device (frequency, duration, core behaviors, speech & articulatory rate, stuttering severity), (3) the effects of an Inactive Condition on people who stutter (PWS) falling into two severity groups, and (4) how the examined participants perceived the use of AAF devices.