Enhancements to a Telewellness Program for People With Physical Disabilities: Mindfulness, Exercise, and Nutrition To Optimize Resilience (MENTOR 2.0).

Introduction: This study evaluated the National Center on Health, Physical Activity and Disability (NCHPAD) Mindfulness, Exercise, and Nutrition To Optimize Resilience (MENTOR) program for people with physical disabilities. Methods: This retrospective evaluation of MENTOR 2.0, an 8-week online group health promotion program, was based on improvements from its first implementation (MENTOR 1.0). Baseline and postassessments included the Godin Leisure-Time Exercise Questionnaire (GLTEQ), NCHPAD Wellness Assessment (NWA), Connor-Davidson Resilience Scale, and Mindfulness Attention Awareness Scale. Estimates and corresponding 95% CIs from linear mixed models were provided to compare baseline and postassessment scores and effect sizes using Cohen d. Results: Among 116 participants (mean age, 53 y; 63% female), postassessment scores increased significantly in the overall NWA and in all 15 NWA domains (effect size, 0.30-0.69). The overall NWA score was 7.59 (95% CI, 5.63-9.56) units higher at postassessment compared with baseline. Scores for GLTEQ health contribution increased significantly among participants with low baseline scores (31.37 [95% CI, 12.97-49.77]) (effect size, 0.50). Mindfulness and resilience scores both showed improvement (0.16 [95% CI, 0.01-0.31]; effect size, 0.15) and (0.72 [95% CI, -0.25 to 1.68]; effect size 0.09), respectively, but only the change in mindfulness was significant. Conclusion: MENTOR 2.0 advanced the evaluation of this online telewellness program for people with physical disabilities by demonstrating consistent results with MENTOR 1.0. We reported improvements in GLTEQ, especially among those with lower baseline scores; in multiple areas of wellness, including physical, mental, and emotional/spiritual health; and in mindfulness and resilience, although the improvements in these 2 constructs were small.

Do outcomes from a behavioral weight loss intervention differ in Alabama versus Colorado?

Background: There are well-established regional differences in obesity prevalence in the United States but relatively little is known about why or whether success in weight loss differs regionally. Objective: The objective of this study was to determine whether changes in body weight, engagement in physical activity (PA), and psychosocial factors differed in Alabama (AL) versus Colorado (CO) in response to a 16-week behavioral weight loss program. Design: This is an ancillary study to a weight loss intervention being conducted simultaneously in AL and CO with identical intervention content and delivery in 70 participants (n = 31 AL and n = 39 CO). Body weight, objective (accelerometry) PA, and responses to psychosocial questionnaires (reward-based eating, stress, social support) were collected at baseline and at Week 16. Results: There were no differences in percent weight loss between states (AL: 10.98%; CO: 11.675%, p = 0.70), and weights at Week 16 were not different for participants in AL and CO (AL: 101.54 ± 4.39 kg, CO: 100.42 ± 3.67 kg, p = 0.84). Accelerometry-derived step count, stepping time, and activity score were all greater at Week 16 for participants in AL compared to participants in CO. Hedonic eating scores were more favorable for participants in AL at baseline (AL: 24.08 ± 2.42; CO: 34.99 ± 2.12, p = 0.0023) and at Week 16 (AL: 18.62 ± 2.70; CO: 29.11 ± 2.19, p = 0.0023). Finally, participants in AL presented more favorable social support scores at Week 16 compared to participants in CO. Conclusions: Weight loss did not differ between states, suggesting that factors contributing to higher obesity rates in some regions of the United States may not be barriers to weight loss. Further, participants in AL experienced greater improvements in some factors associated with weight maintenance, indicating the need to study regional differences in weight loss maintenance. National Clinical Trial 03832933.

Prolonged casualty care: Extrapolating civilian data to the military context.

BACKGROUND: Civilian and military populations alike are increasingly faced with undesirable situations in which prehospital and definitive care times will be delayed. The Western Cape of South Africa has some similarities in capabilities, injury profiles, resource limitations, and system configuration to US military prolonged casualty care (PCC) settings. This study provides an initial description of civilians in the Western Cape who experience PCC and compares the PCC and non-PCC populations. METHODS: We conducted a 6-month analysis of an ongoing, prospective, large-scale epidemiologic study of prolonged trauma care in the Western Cape (Epidemiology and Outcomes of Prolonged Trauma Care [EpiC]). We define PCC as ≥10 hours from injury to arrival at definitive care. We describe patient characteristics, critical interventions, key times, and outcomes as they may relate to military PCC and compare these using χ 2 and Wilcoxon tests. We estimated the associations between PCC status and the primary and secondary outcomes using logistic regression models. RESULTS: Of 995 patients, 146 experienced PCC. The PCC group, compared with non-PCC, were more critically injured (66% vs. 51%), received more critical interventions (36% vs. 29%), and had a greater proportionate mortality (5% vs. 3%), longer hospital stays (3 vs. 1 day), and higher Sequential Organ Failure Assessment scores (5 vs. 3). The odds of 7-day mortality and a Sequential Organ Failure Assessment score of ≥5 were 1.6 (odds ratio, 1.59; 95% confidence interval, 0.68-3.74) and 3.6 (odds ratio, 3.69; 95% confidence interval, 2.11-6.42) times higher, respectively, in PCC versus non-PCC patients. CONCLUSION: The EpiC study enrolled critically injured patients with PCC who received resuscitative interventions. Prolonged casualty care patients had worse outcomes than non-PCC. The EpiC study will be a useful platform to provide ongoing data for PCC relevant analyses, for future PCC-focused interventional studies, and to develop PCC protocols and algorithms. Findings will be relevant to the Western Cape, South Africa, other LMICs, and military populations experiencing prolonged care. LEVEL OF EVIDENCE: Therapeutic/care management; Level IV.

Demographic and Health Profiles of People Living With Traumatic Spinal Cord Injury in the United States During 2015-2019: Findings from the Spinal Cord Injury Model Systems Database.

OBJECTIVE: To estimate the population profile of people living with traumatic spinal cord injury (TSCI) to help evaluate health care needs of this aging population. DESIGN: Cross-sectional study. SETTING: SCI Model Systems (SCIMS) centers in the United States. PARTICIPANTS: Individuals (N=20,437) who: (1) incurred a TSCI between 1972 and 2019, (2) were initially treated at one of the SCIMS centers, and (3) were alive during the period from 2015 to 2019. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographics, injury characteristics, health conditions, and social participation, as compared with previous estimates in 2008 and general population statistics in 2017. RESULTS: People living with TSCI during the period from 2015-2019 (mean years since injury, 18y; 79.4% male, and 62.5% White) were older (51.6 vs 45.0y) and had a higher percentage of C1-C4 (21.9% vs 17.0%) and American Spinal Injury Association Impairment Scale D injuries (31.5% vs 26.0%) compared with the 2008 TSCI population profile. Although the proportion of people with a bachelor's degree or higher was similar between the TSCI and general US populations (30.7% vs 32.0%), the employment rate was lower in the TSCI population (24.0% vs 59.5%). People are affected by various medical problems over time post TSCI. The prevalence of pain and urinary tract infection remained high over postinjury years, at 86.1% and 52.6%, respectively. Rehospitalization and depression were most common during the first year (34.9% and 22.3%, respectively), and pressure injury was more common among those 20 years or more postinjury (>30.0%). Health conditions declined with advanced age, including self-perceived health, diabetes, and institutional residence. People who survived TSCI for years, however, had relatively good degrees of independence and social participation. CONCLUSION: Study findings highlight the need for greater involvement of primary care providers and geriatricians in the continuity of care for SCI to promote healthy aging. Improvement in employment should also be the target in promoting social participation and quality of life.

An Exploratory Analysis of the Association Between Catechol-O-Methyltransferase and Response to a Randomized Open-Label Placebo Treatment for Cancer-Related Fatigue.

Previous studies have identified catechol-O-methyltransferase (COMT), as a key enzyme influencing sympathetic function. Although the COMT SNP rs4680 and rs4818, are well-studied, little is known about their influence on cancer-related fatigue (CrF) and placebo response. In this study, we examined whether genetic variation in COMT, at the functional SNP rs4680 and linked rs4818, influenced open-label placebo (OLP) responses found in cancer survivors reporting moderate to severe CrF. We randomized cancer survivors (N = 74) reporting moderate-to-severe CrF to receive OLP or to treatment-as-usual (TAU) and assessed if rs4680 and rs4818 were associated with changes in fatigue severity and fatigue-distressed quality of life. At the end of the initial 21 days, the treatments were crossed over and both groups were re-assessed. Participants with the rs4680 high-activity G-allele (G/G or G/A) or rs4818 C/G genotypes reported significant decreases in fatigue severity and improvements in fatigue-distressed quality of life. The COMT rs4818 findings replicated findings in a similar study of OLP in cancer fatigue. Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02522988.

Cost, Severity and Prevalence of Agricultural-Related Injury Workers' Compensation Claims in Farming Operations from 14 U.S. States.

(1) Background: There is no national surveillance of agricultural injuries, despite agricultural occupations being among the most hazardous in the U.S. This effort uses workers' compensation (WC) data to estimate the burden of agricultural injuries and the likelihood of experiencing an injury by body part involved, cause, and nature in farming operations. (2) Methods: WC data from 2010 to 2016 provided by a large insurance company covering small to medium-sized farm operations from 14 U.S. states was used. We investigated the associations between injury characteristics and WC costs and the risk of having a more severe versus a less severe claim. The proportion of costs attributable to specific claim types was calculated. (3) Results: Of a total 1000 claims, 67% were medical only. The total cost incurred by WC payable claims (n = 866) was USD 21.5 million. Of this, 96% was attributable to more severe claims resulting in disabilities or death. The most common body part injured was the distal upper extremity. Falling or flying objects and collisions were the most expensive and common causes of injury. (4) Conclusions: Characterizing the cost and severity of agricultural injury by key injury characteristics may be useful when prioritizing prevention efforts in partnership with insurance companies and agricultural operations.

The Effects of a Movement-to-Music (M2M) Intervention on Physical and Psychosocial Outcomes in People Poststroke: A Randomized Controlled Trial.

OBJECTIVE: To investigate the effects of a 12-week movement-to-music (M2M) intervention on physical and psychosocial outcomes in people poststroke. DESIGN: Two-arm randomized controlled trial. SETTING: A community-based fitness facility. PARTICIPANTS: Participants (N=47) with stroke between 18 and 65 years old were randomized to M2M (n=23) or waitlist control (n=24). INTERVENTIONS: Participants in M2M completed 3 60-minute exercise sessions per week for 12 weeks. Controls received biweekly educational newsletters via mail. MAIN OUTCOME MEASURES: Primary outcomes included Six-Minute Walk Test (6MWT, in meters), Five Times Sit-to-Stand Test (FTSST, in seconds) and Timed Up and Go (TUG, in seconds). Secondary outcomes were self-reported measures using Patient-Reported Outcomes Measurement Information System Fatigue and Pain Interference Short Form 8a. Outcomes were collected at baseline and postintervention. Analyses involved descriptive statistics and adjusted linear mixed models. RESULTS: Mixed models adjusted for the respective baseline values and demographic variables showed that M2M participants had longer 6MWT distance (least square mean difference [LSM], 14.5; 95% confidence interval [CI], -12.9 to 42.0), more FTSST time (LSM, 2.0; 95% CI, -4.5 to 8.5), and less fatigue (LSM, -3.0; 95% CI, -7.2 to 1.2) compared with controls postintervention. When controlling for baseline TUG and demographic variables, there was a larger increase in 6MWT distance (LSM, 37.9; 95% CI, -22.7 to 98.6), lower FTSST time (LSM, -6.1; 95% CI, -18.5 to 6.2), and decrease in fatigue (LSM, -6.5; 95% CI, -13.1 to 0.2) in the M2M group compared with controls. Moderate effect sizes were observed for improving 6MWT (d=0.6), FTSST (d=-0.6), and fatigue (d=-0.6). There was no group difference in change in TUG time and pain interference, with trivial effect sizes (d=-0.1). CONCLUSION: M2M may be a valuable exercise form for adults with stroke. Future studies are needed to determine optimal exercise doses for improving health and function in this population.

Analyzing Workers' Compensation Claims and Payments Made Using Data from a Large Insurance Provider.

BACKGROUND: All states in the USA have established Workers' Compensation (WC) insurance systems/programs. WC systems address key occupational safety and health concerns. This effort uses data from a large insurance provider for the years 2011-2018 to provide estimates for WC payments, stratified by the claim severity, i.e., medical only, and indemnity. METHODS: Besides providing descriptive statistics, we used generalized estimating equations to analyze the association between the key injury characteristics (nature, source, and body part injured) and total WC payments made. We also provide the overall cost burden for the former. RESULTS: Out of the total 151,959 closed claims, 83% were medical only. The mean overall WC payment per claim for the claims that resulted in a payment was $1477 (SD: $7221). Adjusted models showed that mean payments vary by claim severity. For example, among medical only claims, the mean payment was the highest for amputations ($3849; CI: $1396, $10,608), and among disability and death related claims, ruptures cost the most ($14,285; $7772, $26,255). With frequencies taken into account, the overall cost burden was however the highest for strains. CONCLUSIONS: Workplace interventions should prioritize both the costs of claims on average and the frequency.

Telehealth Use among Community Health Centers and Cardio-Metabolic Health Outcomes.

Public health interventions to manage the cardio-metabolic syndrome (CMS) have had modest success, necessitating the expansion of telehealth services to where people live. This effort analyzes the association between telehealth provision and the management of CMS-related quality measures (hypertension, diabetes, weight assessment and related counseling, lipid therapy for coronary artery disease, and antiplatelet therapy for ischemic vascular disease) using the Uniform Data System administrative database during the period 2016-2018. A total of 523, 600, and 586 community health centers (CHCs) were documented using telehealth, out of the 1367, 1373, and 1362 total CHCs, in the respective three years. Our primary analysis showed that there was no association between telehealth use and the outcomes. A difference in difference approach that compared the CHCs which transitioned from not using it to using it with those that did not use telehealth in two consecutive years also produced null results. However, among rural areas, the odds of better managing the outcomes were greater for certain outcomes. Our study provides limited support that the adoption of telehealth is potentially beneficial in improving certain outcomes in the CHCs setting that are based in rural areas. More specificity in data regarding the nature of telehealth implementation in the CHC setting could bring clarity in these associations.

A marginal structural model approach to analyse work-related injuries: an example using data from the health and retirement study.

BACKGROUND: Biases may exist in the limited longitudinal data focusing on work-related injuries among the ageing workforce. Standard statistical techniques may not provide valid estimates when the data are time-varying and when prior exposures and outcomes may influence future outcomes. This research effort uses marginal structural models (MSMs), a class of causal models rarely applied for injury epidemiology research to analyse work-related injuries. METHODS: 7212 working US adults aged ≥50 years, obtained from the Health and Retirement Study sample in the year 2004 formed the study cohort that was followed until 2014. The analyses compared estimates measuring the associations between physical work requirements and work-related injuries using MSMs and a traditional regression model. The weights used in the MSMs, besides accounting for time-varying exposures, also accounted for the recurrent nature of injuries. RESULTS: The results were consistent with regard to directionality between the two models. However, the effect estimate was greater when the same data were analysed using MSMs, built without the restriction for complete case analyses. CONCLUSIONS: MSMs can be particularly useful for observational data, especially with the inclusion of recurrent outcomes as these can be incorporated in the weights themselves.

A longitudinal study of work-related injuries: comparisons of health and work-related consequences between injured and uninjured aging United States adults.

BACKGROUND: Age may affect one's susceptibility to the myriad physical hazards that may pose risks for work-related injuries. Aging workers are not only at risk for work-related injuries but, also, at even higher risk for more severe health and work-related consequences. However, limited longitudinal research efforts have focused on such injuries among the aging workforce. This study aimed to investigate the association between physical work-related factors and injuries among United States (U.S.) workers, and then compare the injured and uninjured workers with regard to consequences including, functional limitations, and reduced working hours post injury. A cohort of 7212 U.S. workers aged 50 years and above from the U.S. Health and Retirement Study were retrospectively followed from 2004 to 2014. Data on exposures were lagged by one survey wave prior to the outcome of work-related injuries and consequences, respectively. Crude and adjusted incident rate ratios, and hazard ratios were estimated using generalized estimating equations and Cox models. RESULTS: Risk of experiencing a work-related injury event was over two times greater among those whose job had work requirements for physical effort, lifting heavy loads, and stooping/kneeling/crouching, compared to those who did not. Over time, injured compared to uninjured workers had higher risks of functional limitations and working reduced hours. CONCLUSIONS: The aging workforce is at a high risk of experiencing injuries. Further, injured adults were not only more likely to incur a disability prohibiting daily life-related activities, over time, but, also, were more likely to work reduced hours. It will be important to consider accommodations to minimize functional limitations that may impair resulting productivity.

Asthma among World Trade Center First Responders: A Qualitative Synthesis and Bias Assessment.

The World Trade Center (WTC) disaster exposed the responders to several hazards. Three cohorts i.e., the Fire Department of New York (FDNY), the General Responder Cohort (GRC), and the WTC Health Registry (WTCHR) surveyed the exposed responder population. We searched Pubmed and Web of Science for literature on a well-published association between the WTC exposures and asthma, focusing on new-onset self-reported physician-diagnosed asthma. The resulting five articles were qualitatively assessed for potential biases. These papers were independently reviewed by the co-authors, and conclusions were derived after discussions. While, the cohorts had well-defined eligibility criteria, they lacked information about the entire exposed population. We conclude that selection and surveillance biases may have occurred in the GRC and WTCHR cohorts, but were likely to have been minimal in the FDNY cohort. Health care benefits available to responders may have increased the reporting of both exposure and outcome in the former, and decreased outcome reporting in the FDNY cohort. Irrespective of the biases, the studies showed similar findings, confirming the association between WTC exposure and self-reported physician-diagnosed asthma among responders. This suggests that health data gathered under great duress and for purposes other than epidemiology can yield sound conclusions. Potential biases can, however, be minimized by having validated survey instruments and worker registries in place before events occur.

Exploring social and infrastructural factors affecting open burning of municipal solid waste (MSW) in Indian cities: A comparative case study of three neighborhoods of Delhi.

Open municipal solid waste (MSW)-burning is a major source of particulate matter emissions in developing world cities. Despite a legal ban, MSW-burning is observed ubiquitously in Indian cities with little being known about the factors shaping it. This study seeks to uncover social and infrastructural factors that affect MSW-burning at the neighborhood level. We couple physical assessments of the infrastructure provision and the MSW-burning incidences in three different neighborhoods of varying socio-economic status in Delhi, with an accompanying study of the social actors (interviews of waste handlers and households) to explore the extent to which, and potential reasons why, MSW-burning occurs. The observed differences in MSW-burning incidences range from 130 km-2 day-1 in low-income to 30 km-2 day-1 in the high-income areas. However, two high-income areas neighborhoods with functional infrastructure service also showed statistical differences in MSW-burning incidences. Our interviews revealed that, while the waste handlers were aware of the health risks associated with MSW-burning, it was not a high priority in the context of the other difficulties they faced. The awareness of the legal ban on MSW-burning was low among both waste handlers and households. In addition to providing infrastructure for waste pickup, informal restrictions from residents and neighborhood associations can play a significant role in restricting MSW-burning at the neighborhood scale. A more efficient management of MSW requires a combined effort that involves interplay of both social and infrastructural systems.