Unexplained Gait and Balance Changes: A Case Report of Myxoma Mitigation in a Breast Reduction Patient.

In Fall 2020, a female physical therapist (PT) developed mild changes in gait, infrapatellar tendon pain, and lateral patellar tracking. As a PT in good physical condition, she did not access her employer's occupational health clinic but instead she self-treated. Two months after symptom onset and self-treatment, she was diagnosed with an intramuscular myxoma within her left vastus lateralis, the largest muscle within the quadricep. The employee was at risk of slips, trips, and falls as the mass grew. Due to the location and increasing size of the mass, the employee required surgical treatment. Healthcare workers, particularly those who provide treatment, are likely to self-treat rather than seek assistance from the occupational health professional. The employee was seen by a plastic surgeon for an unrelated medical condition which is when the myxoma was diagnosed. Further delay may have led to occupational injury associated with the balance and gait disturbances. Opportunity exists for the occupational health professional to provide a review of services, including screening for musculoskeletal changes associated with occupational injury such as those described herein. This is especially important among those healthcare workers who tend to self-treat.

The effectiveness of digital health technologies for patients with diabetes mellitus: A systematic review.

Introduction: Diabetes mellitus (DM) is a leading cause of morbidity and mortality worldwide. At the same time, digital health technologies (DHTs), which include mobile health apps (mHealth) have been rapidly gaining popularity in the self-management of chronic diseases, particularly following the COVID-19 pandemic. However, while a great variety of DM-specific mHealth apps exist on the market, the evidence supporting their clinical effectiveness is still limited. Methods: A systematic review was performed. A systematic search was conducted in a major electronic database to identify randomized controlled trials (RCTs) of mHealth interventions in DM published between June 2010 and June 2020. The studies were categorized by the type of DM and impact of DM-specific mHealth apps on the management of glycated haemoglobin (HbA1c) was analysed. Results: In total, 25 studies comprising 3,360 patients were included. The methodological quality of included trials was mixed. Overall, participants diagnosed with T1DM, T2DM and Prediabetes all demonstrated greater improvements in HbA1c as a result of using a DHT compared with those who experienced usual care. The analysis revealed an overall improvement in HbA1c compared with usual care, with a mean difference of -0.56% for T1DM, -0.90% for T2DM and -0.26% for Prediabetes. Conclusion: DM-specific mHealth apps may reduce HbA1c levels in patients with T1DM, T2DM and Prediabetes. The review highlights a need for further research on the wider clinical effectiveness of diabetes-specific mHealth specifically within T1DM and Prediabetes. These should include measures which go beyond HbA1c, capturing outcomes including short-term glycemic variability or hypoglycemic events.

Eye Health, COVID-19, and the Occupational Health Professional: Round Table.

BACKGROUND: Eye health has garnered increased attention since the COVID-19 pandemic. This Round Table explored the impact mask wearing, delays in eye examinations, and increased screen time have on vision and ultimately the worker. METHODS: Leading experts in the areas of occupational health, risk management, eye health, and communication were identified and invited to participate in a Round Table discussion. Questions posed to experts were based on literature that addressed eye health, such as mask wearing, communication and managing expectations when accessing professional eye health appointments, and increased screen time. FINDINGS: Experts agreed that eye health considerations must be in place. These considerations should address not only clinical care of the patient but ways to protect workers from occupational injury associated with the eye. CONCLUSION/APPLICATION TO PRACTICE: The occupational health professional is a key resource for assessment and training that pertains to eye health.

The Low-Wage Essential Worker: Occupational Concerns and Needs in the COVID-19 Pandemic-A Round Table.

BACKGROUND: Planning occupational health and wellness services and support directed toward low-wage, essential workers in the COVID-19 pandemic has posed a number of challenges across work settings. This article explores the concerns and needs of low-wage essential workers as understood by experts in the field. METHODS: Leading experts in the areas of occupational health and safety, risk management, insurance, and professional education/training were identified and invited to participate in a Round Table discussion. Questions posed to experts were based on literature that addressed COVID-19, essential workers, low-wage workers, infection transmission, education/training, and social justice. FINDINGS: Experts agreed that special considerations must be in place to address the concerns and needs of the low-wage essential worker. These special considerations should address not only the worker's occupational experience but their family and home environment, fears and anxieties, and the economic impact of the COVID-19 restrictions and requirements. CONCLUSION/APPLICATION TO PRACTICE: The occupational health professional is a key resource to employers charged with addressing the concerns and needs of low-wage, essential workers during the COVID-19 pandemic.

Bariatric Space, Technology, and Design: A Round Table.

BACKGROUND: Planning and executing healthcare for the patient or resident living with obesity can be a challenging task that has implications to the occupational health professional. METHODS: Leading global experts in the areas of occupational health, ergonomics, bariatrics, technology, and patient care were identified and invited to participate in a round table discussion. Questions posed to experts were based on literature that addressed patient handling and mobility, architectural design recommendations, clinical care of the person with obesity, and ergonomic guidelines. FINDINGS: Experts agreed that special considerations must be in place to care for the person who is obese. These special considerations should address not only clinical care of the patient, but ways to protect workers from occupational injury associated with clinical care. Experts suggested that, in some situations, a bariatric training suit may be helpful in better understanding space and design challenges, as well as a better understanding of the physical limitations associated with a larger body habitus (although simulated). Further, experts agreed that insensitivities often stem from failure to have proper space, technology and design accommodations in place. Conclusions/Application to Practice: The occupational health professional is a key resource to teams charged with planning and executing healthcare for the patient or resident living with obesity. Interprofessional understanding and communication can lead to a more comprehensive approach to space, design and technology that not only addresses the patient, but the worker providing direct care.

Managing Care of Critically Ill Bariatric Patients.

Nearly 160 million Americans are overweight, obese, or morbidly obese. Morbid obesity and its numerous comorbidities are threats to a person's health. Moreover, hospitalized individuals living with adiposity-based chronic conditions are at risk for certain immobility hazards. Many individuals who are morbidly obese look to metabolic surgery as a means for achieving sustainable weight loss. This article addresses critical care needs of people living with excess weight or weight maldistribution, along with specific needs of those undergoing metabolic surgery.

Using the Socio-Ecological Model to Frame Agricultural Safety and Health Interventions.

The Socio-Ecological Model (SEM) is a conceptual framework depicting spheres of influence over human behavior that has been applied in public health settings for nearly five decades. Core principles of all variations of the SEM are the multiple influences over an individual's behaviors, the interactions of those influences, and the multilevel approaches that can be applied to interventions intended to modify behaviors. A project team modified the standard SEM to address interventions for protecting children from agricultural disease and injury. The modified SEM placed the "child in the farm environment" at the core with five interrelated levels (spheres) of influence over the child. This framework provides guidance on how a multifaceted, multilevel intervention can maximize the potential for impact on behaviors and decisions made by parents/adults responsible for the safety of children on farms. An example of how this model could work to safeguard youth operating tractors is provided.

News Reports and Their Role in Child Agricultural Injury Prevention.

OBJECTIVES: The news media can be important sources of health information. News reports of child agricultural injuries were examined to assess what was reported and to evaluate potential implications for health communication and surveillance efforts. METHODS: A content analysis was conducted of a convenience sample of 113 US news reports from 2012 to 2014 involving agricultural injuries to children less than 18 years of age. The data collection instrument included basic elements of injury surveillance, as well as variables related to injury causation and prevention. RESULTS: Law enforcement personnel were the main source of information on the injury event (79%). Severity, age, sex, injury mechanism, and source were reported more than 90% of the time. However, few news reports mentioned use or lack of protective equipment (12%) or a prevention message (6%). Recommended prevention messages from the research team included keeping young children out of the farm worksite (38%) and following guidelines for age-appropriate work and recreational activities (31%). CONCLUSIONS: This study shows that news reports provide a valuable and relatively inexpensive addition to other childhood agricultural injury data sources. They highlight current serious events and have potential to be an effective communication tool with respect to education, prevention, and framing the public's perception of injury risk. An important next step may be to partner with law enforcement to develop three to five prevention messages that can be shared with reporters to educate readers on risks and steps that can be taken to prevent similar injuries on farms and ranches.

Dysbiosis of the Fecal Microbiota in Cattle Infected with Mycobacterium avium subsp. paratuberculosis.

Johne's disease (JD) is a chronic, intestinal infection of cattle, caused by Mycobacterium avium subsp. paratuberculosis (MAP). It results in granulomatous inflammation of the intestinal lining, leading to malabsorption, diarrhea, and weight loss. Crohn's disease (CD), a chronic, inflammatory gastrointestinal disease of humans, has many clinical and pathologic similarities to JD. Dysbiosis of the enteric microbiota has been demonstrated in CD patients. It is speculated that this dysbiosis may contribute to the intestinal inflammation observed in those patients. The purpose of this study was to investigate the diversity patterns of fecal bacterial populations in cattle infected with MAP, compared to those of uninfected control cattle, using phylogenomic analysis. Fecal samples were selected to include samples from 20 MAP-positive cows; 25 MAP-negative herdmates; and 25 MAP-negative cows from a MAP-free herd. The genomic DNA was extracted; PCR amplified sequenced on a 454 Roche platform, and analyzed using QIIME. Approximately 199,077 reads were analyzed from 70 bacterial communities (average of 2,843 reads/sample). The composition of bacterial communities differed between the 3 treatment groups (P < 0.001; Permanova test). Taxonomic assignment of the operational taxonomic units (OTUs) identified 17 bacterial phyla across all samples. Bacteroidetes and Firmicutes constituted more than 95% of the bacterial population in the negative and exposed groups. In the positive group, lineages of Actinobacteria and Proteobacteria increased and those of Bacteroidetes and Firmicutes decreased (P < 0.001). Actinobacteria was highly abundant (30% of the total bacteria) in the positive group compared to exposed and negative groups (0.1-0.2%). Notably, the genus Arthrobacter was found to predominate Actinobacteria in the positive group. This study indicates that MAP-infected cattle have a different composition of their fecal microbiota than MAP-negative cattle.

Outbreak of Type C Botulism in Commercial Layer Chickens.

This report describes an outbreak of type C botulism in two organic, free-range commercial layer farms in the Midwest. Hens affected were 64-wk-old Hy-Line brown hens and 34-wk-old Hy-Line brown hens owned by the same company, but housed on different premises, with approximately 20,000 birds per house. Mortality over the 2 wk of investigation was estimated to be up to 8% and 2.8%, respectively, with birds acting listless, lethargic, and depressed. Clinical signs consisted of progressive paralysis, and severely affected birds were moribund and laterally recumbent. Hens had ruffled feathers that easily epilated, with loss of muscular tone in the neck, tail, and wings. Hens had closed eyes and were reluctant to move. There were no significant gross or histopathologic lesions. Intestinal samples were submitted to the University of Pennsylvania Botulism Diagnostic Laboratory for real-time PCR and were positive for Clostridium botulinum organisms containing the Type C neurotoxin gene. Speculations on the source of the botulinum toxins include poor mortality removal leading to cannibalism of decomposing carcasses, as well as birds on the farm having access to putrid carcasses in the compost pile from a hole in their outdoor access fence.

Career Paths of Recipients of a Master's Degree in Health Communication: Understanding Employment Opportunities, Responsibilities, and Choices.

A growing number of institutions offer a master's degree in health communication to prepare individuals for applied work in the field, but there is very little literature on the career paths graduates pursue. The current study reports the results of a national survey that targeted the alumni of five institutions that offer the degree. Of the 522 total graduates to whom the survey was sent, 398 responded (76.2% response rate). Results show that the degree recipients have found employment in a wide variety of organizations across the country, including jobs within very prestigious organizations, such as the National Cancer Institute. Common job titles include manager, coordinator, communication associate/specialist, and program/project director. The most common job responsibilities include research activities, the development of health communication materials, project/program management, communication management, and social media/website management. The results also include stories of graduates across programs that illustrate details of career paths. The discussion of the findings addresses implications for career preparation, curriculum development, and advising.

Major Adverse Events and Relationship to Nil per Os Status in Pediatric Sedation/Anesthesia Outside the Operating Room: A Report of the Pediatric Sedation Research Consortium.

BACKGROUND: Studies that have attempted to define the incidence of aspiration or pulmonary complications during sedation/anesthesia of children with respect to nil per os (NPO) status or other factors are difficult because of the relatively infrequent rate of these complications. METHODS: The Pediatric Sedation Research Consortium consists of 42 participating institutions with elective sedation services that submit consecutive patient encounter information to a central database. The authors evaluated aspiration episodes and a combined outcome of major adverse events (defined as aspiration, death, cardiac arrest, or unplanned hospital admission) with respect to NPO status, American Society of Anesthesiologists physical status, age, propofol use, procedure types, and urgency of the procedure. RESULTS: A total of 139,142 procedural sedation/anesthesia encounters were collected between September 2, 2007 and November 9, 2011. There were 0 deaths, 10 aspirations, and 75 major complications. NPO status was known for 107,947 patients, of whom 25,401 (23.5 %) were not NPO. Aspiration occurred in 8 of 82,546 (0.97 events per 10,000) versus 2 of 25,401 (0.79 events per 10,000) patients who were NPO and not NPO, respectively (odds ratio, 0.81; 95% CI, 0.08 to 4.08; P = 0.79). Major complications occurred in 46 of 82,546 (5.57 events per 10,000) versus 15 of 25,401 (5.91 events per 10,000) (odds ratio, 1.06; 95% CI, 0.55 to 1.93; P = 0.88). Multivariate adjustment did not appreciably impact the effect of NPO status. CONCLUSIONS: The analysis suggests that aspiration is uncommon. NPO status for liquids and solids is not an independent predictor of major complications or aspiration in this sedation/anesthesia data set.

Simulation in Nursing Education: iPod As a Teaching Tool for Undergraduate Nurses.

Most people with psychosis and schizophrenia experience auditory hallucinations, particularly the hearing of voices. A common cause of frustration and alienation for consumers is the lack of understanding by therapists, family members and caregivers, who find it difficult to relate to the consumers' experiences. The purpose of this study is to examine and evaluate whether students' participation in a simulated auditory hallucination will increase their understanding and knowledge about psychosis and auditory hallucinations. The design method consisted of a lecture on psychosis and schizophrenia disorders, followed by a simulation of auditory hallucinations using iPods. Students' knowledge and perceptions of psychosis and hallucinations was assessed using quasi-experimental pre-post matched-design questionnaires. The questionnaire was divided into two parts, the first comprised closed questions to assess students' knowledge, and the second part consisted of open-ended questions to collect information about students' perceptions of auditory hallucinations. The results confirmed that students' knowledge of psychosis and hallucination increased following the teaching session and simulation is a useful tool to prepare students for clinical placements in mental health practice.

Prevalence and Predictors of Adverse Events during Procedural Sedation Anesthesia-Outside the Operating Room for Esophagogastroduodenoscopy and Colonoscopy in Children: Age Is an Independent Predictor of Outcomes.

OBJECTIVES: Procedural sedation/anesthesia outside the operating room for a variety of procedures is well described with an overall low adverse event rate in certain settings. Adverse event associated with procedural sedation/anesthesia outside the operating room for gastrointestinal procedures have been described, albeit in small, single-center studies with wide variance in outcomes. Predictors of such outcomes are unclear. We aimed to estimate the prevalence of adverse event in children undergoing procedural sedation/anesthesia outside the operating room for esophagogastroduodenoscopy, colonoscopy, or both to identify predictors of adverse event. DESIGN/SETTING/PATIENTS: Retrospective analysis of Pediatric Sedation Research Consortium database, a large data repository of pediatric patients aged 21 years old or younger undergoing procedural sedation/anesthesia outside the operating room during September 2007 to November 2011. Twenty-two of the 40 centers provided data pertaining to the procedure of interest. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Primary outcome variable is any adverse event. Independent variables include: age (five groups), sex, American Societyof Anaesthesiologists status, procedure (esophagogastroduodenoscopy, colonoscopy, or both), provider responsible, medication used, location, and presence of coexisting medical conditions. Descriptive statistics used to summarize the data. Using multivariablelogistic regression model, odds ratio, 95% CI) were computed. A total of 12,030 procedures were performed (esophagogastroduodenoscopy, 7,970; colonoscopy, 1,378; and both, 2,682). A total of 96.9% of patients received propofol. Eighty-three percent were performed in a sedation unit. Prevalence of adverse event was 4.8%. The most common adverse event were persistent desaturations (1.5%), airway obstruction (1%), cough (0.9%), and laryngospasm (0.6%). No deaths or CPR occurred. Infants and children aged 5 years old or younger had a higher adverse event rate than older children (15.8%, 7.8% vs 4%). Regression analysis revealed age 5 years old or younger, American Society of Anaesthesiologists greater than or equal to 2, esophagogastroduodenoscopy ± colonoscopy, and coexisting medical conditions of obesity and lower airway disease were independent predictors of higher adverse event. CONCLUSIONS: Overall prevalence of any adverse event was 4.8%. Independent predictors of adverse events in procedural sedation/anesthesia outside the operating room in pediatric esophagogastroduodenoscopy/colonoscopy onoscopy were identified. Recognition of such risk factors may enable optimization of procedural sedation.

Results from a national survey of health communication master's degree recipients: an exploration of training, placement, satisfaction, and success.

The field of health communication has seen substantial growth in recent years, but existing health communication research literature contains little information on individuals who practice health communication in applied settings. This study reports the results of a national survey that targeted the alumni of 5 institutions that offer a master's degree in health communication. Of the 522 total graduates to whom the survey was sent, 398 responded. Survey results provided information in a number of areas including undergraduate education background; criteria used to determine what type of master's degree in health communication to pursue; strategies used to gain employment; employment sector of first job after graduation; salaries received after completion of a master's degree in health communication; satisfaction with career choice after completion of master's degree; satisfaction with type of master's degree in health communication received; satisfaction with career choice after completion of master's degree; and the degree to which respondents felt their master's program in health communication prepared them to meet core competencies in the field. These findings have significant implications for the health communication field and the programs that prepare individuals for a career as a health communication practitioner.

Course Offerings in the Fourth Year of Medical School: How U.S. Medical Schools Are Preparing Students for Internship.

The fourth year of medical school remains controversial, despite efforts to reform it. A committee from the Clerkship Directors in Internal Medicine and the Association of Program Directors in Internal Medicine examined transitions from medical school to internship with the goal of better academic advising for students. In 2013 and 2014, the committee examined published literature and the Web sites of 136 Liaison Committee on Medical Education-accredited schools for information on current course offerings for the fourth year of medical school. The authors summarized temporal trends and outcomes when available.Subinternships were required by 122 (90%) of the 136 schools and allow students to experience the intern's role. Capstone courses are increasingly used to fill curricular gaps. Revisiting basic sciences in fourth-year rotations helps to reinforce concepts from earlier years. Many schools require rotations in specific settings, like emergency departments, intensive care units, or ambulatory clinics. A growing number of schools require participation in research, including during the fourth year. Students traditionally take fourth-year clinical electives to improve skills, both within their chosen specialties and in other disciplines. Some students work with underserved populations or seek experiences that will be henceforth unavailable, whereas others use electives to "audition" at desired residency sites. Fourth-year requirements vary considerably among medical schools, reflecting different missions and varied student needs. Few objective outcomes data exist to guide students' choices. Nevertheless, both medical students and educators value the fourth year of medical school and feel it can fill diverse functions in preparing for residency.