Discordance Between Insurance Coverage of Antiviral Medications and Nicotine Replacement Therapy Among Individuals With Human Immunodeficiency Virus Who Smoke.

INTRODUCTION: Tobacco contributes to the leading causes of morbidity and mortality among persons with human immunodeficiency virus (PWHs). Nonetheless, medications for tobacco use disorder are widely underused, particularly among PWHs. We sought to characterize the extent to which insurance barriers impacted access to medications for tobacco use disorder and, in comparison, to access to antiretroviral therapy (ART). METHODS: This is a secondary analysis of data on individuals enrolled in a randomized clinical trial to address tobacco use involving nicotine replacement therapy and, for some, additionally, varenicline or bupropion. Medication prescriptions are transmitted electronically from the clinic to neighborhood pharmacies. Data sources included participant assessments and intervention visit tracking forms. RESULTS: Of 93 participants enrolled from September 2020 to July 2021, 20 (22%) were unable to fill or had difficulty filling their nicotine replacement therapy (NRT) prescriptions because of insurance barriers. These fell into 2 broad categories: enrollment in a publicly insured managed care plan in which the pharmacy benefit manager excluded nonprescription NRT and lack of understanding by the pharmacy of the scope of coverage. Of these 20 participants, 5 (25%) were unable to obtain medications at all, and 3 of these participants dropped out of the study. One additional participant paid out-of-pocket to obtain NRT. No participant was denied coverage of ART, bupropion, or varenicline. CONCLUSIONS: Gaps in insurance coverage may result in PWHs receiving ART without simultaneous medical management of their tobacco use. This may undermine the efficacy of antivirals. Mandated insurance coverage of nonprescription NRT may improve the health of PWHs who smoke.

Indirect Effects of Forgiveness on Psychological Health Through Anger and Hope: A Parallel Mediation Analysis.

Forgiveness often discussed as a religious idea is also a popular topic in psychology. Empirical studies have shown that forgiveness decreases anger, anxiety, and depression and increases self-esteem and hopefulness for the future. However, research on the relationship between various outcomes of forgiveness is scarce. Thus, we aimed at examining the mediating roles of anger and hope in the relationship between forgiveness and psychological health outcomes. A sample of college students from a large non-profit university (N = 202) filled out self-report measures on forgiveness, anger, anxiety, depression, hope, and self-esteem. A parallel mediation analysis examining the role of anger and hope in the forgiveness-psychological health link was conducted. Results supported the indirect effect of forgiveness on psychological health through anger and hope, and the two mediators had a comparable size of magnitude. Implications, limitations, and future directions are discussed.

Does pathologically increased or decreased tibial torsion affect muscle activations during walking in typically developing adolescents?

A reduced capacity of plantar flexors and other muscles to extend the hip and knee during gait was shown in modelling studies when the tibial torsion angle is > 30° than normal. The aim of the current study was to determine if patients with increased or decreased tibial torsion show deviating muscle activations in knee and hip extensors in surface electromyography (EMG). Patients with CT confirmed increased tibial torsion (n = 19, ITT), decreased tibial torsion (n = 21, DTT) and age-matched healthy controls (n = 20) were included in this retrospective study. Additionally, kinematic and kinetic data were recorded during three-dimensional gait analysis. Surface EMG was recorded for vastus medialis and medial hamstrings. Statistical parametric mapping with a one-way ANOVA and post-hoc Bonferroni corrected two-sample t-tests were used to obtain differences in joint angles and moments. ITT and DTT showed an increased and decreased external foot progression angle, respectively. No additional muscle activations in vastus medialis and medial hamstrings were found in both patient groups compared to controls. DTT showed an increased hip flexion through parts of the gait cycle and both patient groups had a decreased knee extension moment in terminal stance. Our hypothesis of deviating muscle activation had to be rejected. It could be that in most orthopaedic patients the amount of exceeding tibial torsion is too low to cause substantial deviations in gait and muscle activation patterns.

Compensatory gait deviations in patients with increased outward tibial torsion pre and post tibial derotation osteotomy.

BACKGROUND: Tibial torsion describes the rotation between the proximal and distal joint axis along the shaft, which can be, as rotational deformity, pathologically increased or decreased. Some patients might increase hip internal rotation during walking to compensate increased outward tibial torsion. RESEARCH QUESTION: The aim of this study was to assess the effect of tibial derotation osteotomy on gait deviations in patients with increased outward tibial torsion. METHODS: Thirteen patients (13.5 ± 1.4 yrs, 22 limbs) with increased tibial torsion (CT confirmed 49.2 ± 4.8°) were analyzed pre and post tibial derotation osteotomy and compared with 17 typically developing children (TDC, 13.5 ± 2.3 yrs, 32 limbs). Kinematic and kinetic data were recorded. Subgroup analyses were performed whether patients showed compensatory hip internal rotation (Comp) or not (NoComp). Principal component (PC) analysis was used to achieve data transformation. A linear mixed model was used to estimate the main effect of PC-scores of retained PCs explaining 90% of the cumulative variance. RESULTS: Compensatory hip internal rotation (Comp, present in 45.5% of limbs analyzed) led to a lower external foot progression angle compared to patients without compensatory hip internal rotation (NoComp). In both patient groups foot progression angle was normalized after tibial derotation osteotomy. Post-operative NoComp had normalized frontal plane joint loadings, while Comp showed an increased hip and knee adduction moment. SIGNIFICANCE: Future studies should investigate if more time is needed for Comp to normalize gait patterns post-operative or if a pre and post-operative gait training might help. Otherwise the increased knee adduction moment might be clinically relevant due to previous studies reporting a possible association with knee osteoarthritis.

The impact of increased femoral antetorsion on gait deviations in healthy adolescents.

Increased femoral antetorsion leads to several gait deviations, and amongst others, an increased knee flexion was reported in mid and terminal stance. Therefore, the purpose of this retrospective study was to identify gait deviations caused by increased femoral antetorsion and to perform subgroup analyses based on sagittal knee kinematics. Patients with isolated, CT confirmed increased femoral antetorsion (n = 42) and age-matched typically developing children (TDC, n = 17) were included in this study. Patients were referred to gait analysis because of gait abnormalities going along with an increased femoral antetorsion ≥30°. Kinematic and kinetic data were recorded during 3D gait analysis and three valid gait cycles were analyzed. Principal component (PC) analysis was used to achieve data transformation. A linear mixed model was used to estimate the group effect of PC-scores of retained PCs explaining 90% of the cumulative variance. Group effects of PC-scores revealed that patients walked with more flexed hips and greater anterior pelvic tilt throughout the gait cycle. Knee flexion was increased in patients during mid and terminal stance. Increased frontal plane knee and hip joint moments were found for patients compared to TDC. Furthermore, dividing patients into two subgroups based on their sagittal knee kinematics showed that kinematic gait deviations were more pronounced in patients with higher femoral antetorsion, while deviations in joint moments were more pronounced in patients with lower femoral antetorsion. Increased femoral antetorsion showed alterations in all lower limb joints and may be not only a cosmetic problem. Therefore, 3D gait analysis should be used for clinical management and operative treatment should be considered depending on severity of gait deviations.

A review of web-based support systems for students in higher education.

BACKGROUND: Recent evidence suggests that there is an increasing need for accessible and anonymous services to support higher education (HE) students suffering from psychological and/or academic difficulties. Such difficulties can lead to several negative outcomes, including poor academic performance, sub-optimal mental health, reduced study satisfaction, and dropout from study. Currently, universities in the UK lack financial resources and the on-campus mental health services traditionally offered to students are increasingly economically unsustainable. Compounded by the perceived stigma of using such services, mental health providers have been driven to address the escalating needs of students through online services. METHODS: In this paper, we review online support systems identified through a literature search and a manual search of references in the identified papers. Further systems were identified through web searches, and systems still in development were identified by consultation with researchers in the field. We accessed systems online to extract relevant information, regarding the main difficulties addressed by the systems, the psychological techniques used and any relevant research evidence to support their effectiveness. CONCLUSION: A large number of web-based support systems have been developed to support mental health and wellbeing, although few specifically target HE students. Further research is necessary to establish the effectiveness of such interventions in providing a cost-effective alternative to face-to-face therapy, particularly in certain settings such as HE institutions.

Gait deviations and compensations in pediatric patients with increased femoral torsion.

Coxa antetorta describes an abnormal torsion of the femur. It is commonly considered a cosmetic problem and is treated surgically only in severe cases and the presence of physical complaints. The purpose of this study was to identify deviations in gait kinematics and kinetics in pediatric patients caused by coxa antetorta and to categorize these deviations into primary and secondary deviations. We conducted a retrospective, cross-sectional three-dimensional (3D) gait analysis study to detect gait deviations in adolescents (n = 18; age range 10.5-17.5 years) with coxa antetorta compared to age-matched healthy control subjects (n = 17). Principal component (PC) analysis was used for data reduction. Linear mixed models applied to PC-scores were used to estimate the main effects within retained PCs followed by a post-hoc subgroup analysis. Patients walked with smaller external foot progression angle, greater knee adduction, more internally rotated and flexed hips and greater anterior pelvic tilt. Subgroup analysis revealed that-depending on knee alignment-patients had higher knee and hip adduction moments. These deviations in joint kinematics and kinetics may be associated with physical complaints and accelerated development of osteoarthritis. Assessment of gait deviations related to coxa antetorta using 3D gait analysis may be an additional tool in individual clinical decision-making.