Medical Literature in the Treatment of Clubfoot 1997 - 2021: The Emergence and Spread of the Ponseti Method Over 23 Years.

Background: The Ponseti method of treatment for clubfoot which utilizes serial manipulations and casting in order to achieve correction of the deformity has become increasingly popular due to its robust track record of success without the need for surgical intervention and is considered the gold standard for clubfoot treatment. Exposure of new technology in the scientific literature is associated with the diffusion and adoption of that technology in clinical practice. The aim of this study sought to identify tendencies in the thematic changes in medical literature regarding the treatment of congenital clubfoot over a period of twenty-three years, from 1997 to 2021. Methods: The Medline databases were searched for articles containing the keyword "clubfoot". Articles from 1997 to 2021 were identified and analyzed by institutions which published the articles, and whether treatment was with the Ponseti method or surgical interventions. We also observed in order the geographic diffusion of the Ponseti method. Results: 2067 articles were found in Pubmed referencing clubfoot, and in these publications 577 addressed the Ponseti method and 273 articles discussed surgical treatment. From 1997 - 2000, the only articles discussing the Ponseti Method were from Iowa,in the United States. The increasing number of publications about the Ponseti method and the decrease in publications about surgical treatment for clubfoot occurred after 2003. In 1997, only one country had a publication regarding the Ponseti method; by 2018, 24 countries published articles on the method. Conclusion: These results suggest a trend of dissemination of knowledge to additional countries, reflecting the more widespread usage of the method throughout the world, and global outreach as a result of the work of Ponseti International Association. Level of Evidence: II.

Disability, Hospital Care, and Cost: Utilization of Emergency and Inpatient Care by a Cohort of Children with Intellectual and Developmental Disabilities.

OBJECTIVE: To use medical claims data to determine patterns of healthcare utilization in children with intellectual and developmental disabilities, including frequency of service utilization, conditions that require hospital care, and costs. STUDY DESIGN: Medicaid administrative claims from 4 states (Iowa, Massachusetts, New York, and South Carolina) from years 2008-2013 were analyzed, including 108 789 children (75 417 male; 33 372 female) under age 18 years with intellectual and developmental disabilities. Diagnoses included cerebral palsy, autism, fetal alcohol syndrome, Down syndrome/trisomy/autosomal deletions, other genetic conditions, and intellectual disability. Utilization of emergency department (ED) and inpatient hospital services were analyzed for 2012. RESULTS: Children with intellectual and developmental disabilities used both inpatient and ED care at 1.8 times that of the general population. Epilepsy/convulsions was the most frequent reason for hospitalization at 20 times the relative risk of the general population. Other frequent diagnoses requiring hospitalization were mood disorders, pneumonia, paralysis, and asthma. Annual per capita expenses for hospitalization and ED care were 100% higher for children with intellectual and developmental disabilities, compared with the general population ($153 348 562 and $76 654 361, respectively). CONCLUSIONS: Children with intellectual and developmental disabilities utilize significantly more ED and inpatient care than other children, which results in higher annual costs. Recognizing chronic conditions that increase risk for hospital care can provide guidance for developing outpatient care strategies that anticipate common clinical problems in intellectual and developmental disabilities and ensure responsive management before hospital care is needed.

The Association between Household Food Insecurity and Body Mass Index: A Prospective Growth Curve Analysis.

OBJECTIVE: To examine the association between food insecurity and body mass index (BMI) from early adolescence to adulthood. STUDY DESIGN: Growth curve analyses were performed. Sex differences were examined by conducting the analyses separately by sex. Ten data points were examined over a 16-year period from age 15 to 31 years. Data were obtained from the Family Transitions Project, a longitudinal study of 559 adolescents and their families that was initiated in 1989 in the Midwest. Primarily rural, non-Hispanic whites were selected based on the economic farm crisis. We examined participants from adolescence to adulthood from 1991 through 2007. Measures included a 2-item food insecurity construct and BMI as indicated by self-reported height and weight from adolescence through middle adulthood. These associations were analyzed using prospective growth curve modeling. RESULTS: Our analyses indicated a general increase in BMI with age, whereas food insecurity declined over time. Higher levels of food insecurity at age 15 years led to a more rapid increase in BMI. Finally, a positive relationship was found between the changes in food insecurity and BMI over time. These associations held only for females. CONCLUSION: Our results argue for increasing access to food during key developmental periods such as early adolescence, which could help reduce the long-term implications for health, particularly BMI in girls.

Iowa stream nitrate and the Gulf of Mexico.

The main objective of this work was to quantify and update the U.S. Midwest agricultural state of Iowa's contribution of nitrate-nitrogen to the Mississippi River stream network against the backdrop of the ongoing problem of Gulf of Mexico hypoxia. To achieve this objective, we used stream nitrate and discharge data collected from 1999 until 2016 at 23 Iowa stream sites near watershed outlets, along with publicly-available data for sites downstream of Iowa on the Missouri and Mississippi Rivers. Our analysis shows that Iowa contributes between 11 and 52% of the long-term nitrate load to the Mississippi-Atchafalaya Basin, 20 to 63% to the Upper Mississippi River Basin, and 20 to 89% to the Missouri River Basin, with averages of 29, 45 and 55% respectively. Since 1999, nitrate loads in the Iowa-inclusive basins have increased and these increases do not appear to be driven by changes in discharge and cropping intensity unique to Iowa. The 5-year running annual average of Iowa nitrate loading has been above the 2003 level for ten consecutive years, implying that Gulf hypoxic areal goals, also based on a 5-year running annual average, will be very difficult to achieve if nitrate retention cannot be improved in Iowa. An opportunity exists for land managers, policy makers and conservationists to manifest a positive effect on water quality by targeting and implementing nitrate reducing-practices in areas like Iowa while avoiding areas that are less likely to affect Gulf of Mexico hypoxia.

Pesticide Exposure and Risk of Rheumatoid Arthritis among Licensed Male Pesticide Applicators in the Agricultural Health Study.

BACKGROUND: The occupation of farming has been associated with rheumatoid arthritis (RA); pesticides may account for this association, but there are few studies. OBJECTIVES: We investigated associations between RA and use of pesticides in the Agricultural Health Study. METHODS: The study sample was drawn from male pesticide applicators enrolled in 1993­1997 who provided questionnaire data at baseline and at least once during follow-up (over a median 18 y; interquartile range 16­19). Incident RA cases (n=220), confirmed by physicians or by self-reported use of disease-modifying antirheumatic drugs, were compared with noncases (n=26,134) who did not report RA. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression, adjusting for enrollment age, state, smoking pack-years, and education. We evaluated the association of RA with the use of 46 pesticides and across 4 levels (never use and tertiles) of lifetime days of use for 16 pesticides with OR≥1.2 for ever use. RESULTS: Incident RA was associated with ever use of fonofos (OR = 1.70; 95% CI: 1.22, 2.37), carbaryl (OR = 1.51; 95% CI: 1.03, 2.23), and chlorimuron ethyl (OR = 1.45; 95% CI: 1.01, 2.07) compared with never use. Statistically significant exposure­response trends in association with RA were observed for lifetime days of use of atrazine [ORtertile3= 1.62 (95% CI: 1.09, 2.40); ptrend=0.01] and toxaphene [ORtertile3= 2.42 (95% CI: 1.03, 5.68); ptrend=0.02]. Exposure­response was nonlinear for fonofos [ORtertile1= 2.27 (95% CI: 1.44, 3.57); ORtertile2= 0.98 (95% CI: 0.54, 1.80); ORtertile3= 2.10 (95% CI: 1.32, 3.36); ptrend=0.005] and suggestive for carbaryl (ptrend=0.053). CONCLUSIONS: Our results provide novel evidence of associations between exposure to some pesticides and RA in male farmers. https://doi.org/10.1289/EHP1013.

Modeling plant interspecific interactions from experiments with perennial crop mixtures to predict optimal combinations.

The contribution of plant species richness to productivity and ecosystem functioning is a longstanding issue in ecology, with relevant implications for both conservation and agriculture. Both experiments and quantitative modeling are fundamental to the design of sustainable agroecosystems and the optimization of crop production. We modeled communities of perennial crop mixtures by using a generalized Lotka-Volterra model, i.e., a model such that the interspecific interactions are more general than purely competitive. We estimated model parameters -carrying capacities and interaction coefficients- from, respectively, the observed biomass of monocultures and bicultures measured in a large diversity experiment of seven perennial forage species in Iowa, United States. The sign and absolute value of the interaction coefficients showed that the biological interactions between species pairs included amensalism, competition, and parasitism (asymmetric positive-negative interaction), with various degrees of intensity. We tested the model fit by simulating the combinations of more than two species and comparing them with the polycultures experimental data. Overall, theoretical predictions are in good agreement with the experiments. Using this model, we also simulated species combinations that were not sown. From all possible mixtures (sown and not sown) we identified which are the most productive species combinations. Our results demonstrate that a combination of experiments and modeling can contribute to the design of sustainable agricultural systems in general and to the optimization of crop production in particular.

Implementing Cardiopulmonary Resuscitation Training Programs in High Schools: Iowa's Experience.

OBJECTIVE: To understand perceived barriers to providing cardiopulmonary resuscitation (CPR) education, implementation processes, and practices in high schools. STUDY DESIGN: Iowa has required CPR as a graduation requirement since 2011 as an unfunded mandate. A cross-sectional study was performed through multiple choice surveys sent to Iowa high schools to collect data about school demographics, details of CPR programs, cost, logistics, and barriers to implementation, as well as automated external defibrillator training and availability. RESULTS: Eighty-four schools responded (26%), with the most frequently reported school size of 100-500 students and faculty size of 25-50. When the law took effect, 51% of schools had training programs already in place; at the time of the study, 96% had successfully implemented CPR training. Perceived barriers to implementation were staffing, time commitment, equipment availability, and cost. The average estimated startup cost was <$1000 US, and the yearly maintenance cost was <$500 with funds typically allocated from existing school resources. The facilitator was a school official or volunteer for 81% of schools. Average estimated training time commitment per student was <2 hours. Automated external defibrillators are available in 98% of schools, and 61% include automated external defibrillator training in their curriculum. CONCLUSIONS: Despite perceived barriers, school CPR training programs can be implemented with reasonable resource and time allocations.

Prevalence of oral cancer self-examination among elderly people treated under Brazil's Unified Health System: household health survey / Prevalência de autoexame bucal é maior entre idosos assistidos no Sistema Único de Saúde: inquérito domiciliar

The aim of this study was to examine the prevalence of oral cancer self-examinationamong the elderly and confirm whether prevalence was higher among users of the dental services provided by Brazil's Unified Health System (SUS, acronym in Portuguese). A transversal study of elderly people aged between 65 and 74 years living in a large-sized Brazilian municipality was conducted using simple random sampling. Logistic regression was conducted and results were corrected for sample design and unequal weighting using the SPSS(r) software. The study assessed 740 individuals. A total of 492 met the inclusion criteria, of which 101 (22.4%) reported having performed an oral cancer self-examination. Prevalence was higher among users of the dental services provided by the SUS, higher-income individuals, people with higher levels of education, individuals that used a removable dental prosthesis, and people who had not experienced discomfort attributed to oral condition, and lower among people who sought regular and periodic dental treatment and individuals who did not have a drinking habit. This type of self-care should be encouraged by public health policies which respond to the needs of the elderly, with emphasis on users of private and philanthropic services, and other services outside the public health network.

Este estudo objetivou identificar a prevalência do autoexame bucal entre idosos e constatar se essa prevalência foi maior entre usuários de serviços odontológicos prestados pelo Sistema Único de Saúde (SUS). Estudo transversal conduzido a partir de amostragem probabilística complexa por conglomerados, entre idosos (65-74 anos) de um município brasileiro de grande porte populacional. Foi realizada regressão logística binária, as estimativas foram corrigidas pelo efeito de desenho e por ponderações, utilizando-se o SPSS(r). Dentre os 740 avaliados, atenderam aos critérios de inclusão 492 idosos e, destes, 101 (22,4%) relataram a prática do autoexame bucal. Esta prática foi maior entre idosos usuários dos serviços odontológicos prestados no SUS, entre aqueles com maior renda per capita, os com maior escolaridade, aqueles que utilizavam prótese dentária removível e entre os que não tiveram impactos decorrentes das desordens bucais; foi menor entre os que usaram serviços odontológicos por rotina e os que não possuíam hábito etilista. A prevalência do autoexame bucal entre idosos foi baixa e maior entre aqueles usuários do SUS. O estímulo à adesão a este autocuidado deve ser considerado nas políticas de saúde do idoso vigentes, especialmente entre usuários de serviços particulares, supletivos e filantrópicos.

Modeling potential freshwater ecotoxicity impacts due to pesticide use in biofuel feedstock production: the cases of maize, rapeseed, salix, soybean, sugar cane, and wheat.

The inclusion of ecotoxicity impacts of pesticides in environmental assessments of biobased products has long been hampered by methodological challenges. We expanded the pesticide database and the regional coverage of the pesticide emission model PestLCI v.2.0, combined it with the impact assessment model USEtox, and assessed potential freshwater ecotoxicity impacts (PFEIs) of pesticide use in selected biofuel feedstock production cases, namely: maize (Iowa, US, two cases), rapeseed (Schleswig-Holstein, Germany), Salix (South Central Sweden), soybean (Mato Grosso, Brazil, two cases), sugar cane (São Paulo, Brazil), and wheat (Schleswig-Holstein, Germany). We found that PFEIs caused by pesticide use in feedstock production varied greatly, up to 3 orders of magnitude. Salix has the lowest PFEI per unit of energy output and per unit of cultivated area. Impacts per biofuel unit were 30, 750, and 1000 times greater, respectively, for the sugar cane, wheat and rapeseed cases than for Salix. For maize genetically engineered (GE) to resist glyphosate herbicides and to produce its own insecticidal toxin, maize GE to resist glyphosate, soybeans GE to resist glyphosate and conventional soybeans, the impacts were 110, 270, 305, and 310 times greater than for Salix, respectively. The significance of field and site-specific conditions are discussed, as well as options for reducing negative impacts in biofuel feedstock production.

Impaired decision-making after traumatic brain injury: the Iowa Gambling Task.

SUMMARY: The aim of the present study was to use the Iowa Gambling Task (IGT) to investigate differences in decision-making (DM) between patients who sustained TBI and healthy subjects, while controlling for age, education and gender. METHODS: A hundred and ten participants, half of whom had severe or mild TBI, completed the IGT. RESULTS: Differences between control participants and patients with TBI were found regarding total net score, block score, number of selections from each deck and classification of performance as impaired or unimpaired. No significant differences in IGT performance were found between patients with and without frontal lesions and between patients with mild and severe TBI. CONCLUSIONS: Results indicate poor DM on the IGT in patients with TBI, regardless of lesion location and severity. The instrument proved to be equally sensitive to both frontal and extrafrontal lesions and did not differentiate between patients with mild and severe TBI.

Which contributes more to childhood adiposity-high levels of sedentarism or low levels of moderate-through-vigorous physical activity? The Iowa Bone Development Study.

OBJECTIVE: To examine the relative importance of sedentarism and moderate-to-vigorous physical activity for adiposity development in children and adolescents. STUDY DESIGN: A total of 277 boys and 277 girls (95% white; two-thirds of parents with college graduation or higher education) from the Iowa Bone Development Cohort Study completed body fat and accelerometry measurement at examinations of 8, 11, 13, and/or 15 years of age (during 2000-2009). The main exposure was accelerometry-measured sedentary time, frequency of breaks in sedentary time, and moderate- to vigorous-intensity physical activity time. The outcome was dual energy x-ray absorptiometry-measured body fat mass. RESULTS: Adjusted for age, height, physical maturity, and sedentary time, growth models showed that high moderate-to-vigorous physical activity time was associated with low body fat mass in both boys (coefficient ß=-0.10±0.02) and girls (ß=-0.05±0.01; P<.01). However, sedentary time and frequency of breaks in sedentary time were not associated with body fat mass. CONCLUSIONS: This study does not support an independent effect of sedentarism on adiposity. The preventive effect of moderate- to vigorous-intensity physical activity on adiposity in children and adolescents remained strong after adjusting for the effect of sedentarism.

Engaging Latino farmworkers in the development of symbols to improve pesticide safety and health education and risk communication.

The working and living environments of farmworkers put them and their families at risk for pesticide exposure and, consequently, immediate and long-term health effects. In this study, visual materials for a pesticide toxicology safety and health curriculum were constructed by engaging farmworkers in various stages of symbol development. Twenty-seven farmworkers in two states participated in this descriptive case study through focused small group discussions and interviews. Our findings support the importance of vivid and realistic symbols, the effectiveness of a traffic-light symbol in communicating technical information to farmworkers, and the need to engage low-literacy end-users in the production of educational materials. This work informs the development of curricula for other vulnerable populations pertaining to a variety of health-related topics, as well as discussions surrounding regulatory proposals to revise the United States Worker Protection Standard.

Major chromosomal anomalies among very low birth weight infants in the Vermont Oxford Network.

OBJECTIVE: To examine prevalence, characteristics, interventions, and mortality of very low birth weight (VLBW) infants with trisomy 21 (T21), trisomy 18 (T18), trisomy 13 (T13), or triploidy. STUDY DESIGN: Infants with birth weight 401-1500 g admitted to centers of the Vermont Oxford Network during 1994-2009 were studied. A majority of the analyses are presented as descriptive data. Median survival times and their 95% CIs were estimated using the Kaplan-Meier approach. RESULTS: Of 539 509 VLBW infants, 1681 (0.31%) were diagnosed with T21, 1416 (0.26%) with T18, 435 (0.08%) with T13, and 116 (0.02%) with triploidy. Infants with T18 were the most likely to be growth restricted (79.7%). Major surgery was reported for 30.4% of infants with T21, 9.2% with T18, 6.4% with T13, and 4.8% with triploidy. Hospital mortality occurred among 33.1% of infants with T21, 89.0% with T18, 92.4% with T13, and 90.5% with triploidy. Median survival time was 4 days (95% CI, 3-4) among infants with T18 and 3 days (95% CI, 2-4) among both infants with T13 and infants with triploidy. CONCLUSION: In this cohort of VLBW infants, survival among infants with T18, T13, or triploidy was very poor. This information can be used to counsel families.

The 5-HTTLPR polymorphism, impulsivity and suicide behavior in euthymic bipolar patients.

BACKGROUND: Suicide behavior is very frequent in Bipolar Disorder (BD) and they are both closely associated with impulsivity. Furthermore they are, impulsivity, BD and suicide behavior, associated with serotonergic function, at least partially, under genetic determinism and somewhat associated with the serotonin transporter gene polymorphism, the 5-HTTLPR. We aimed to assess different impulsivity components in BD sub-grouped by suicidal attempt and healthy controls. We hypothesized that the non-planning/cognitive impulsivity, could be more closely associated with suicidal behavior. We further associated 5-HTTLPR genotypes with neuropsychological results to test the hypothesis that this polymorphism is associated with cognitive impulsivity. METHOD: We assessed 95 euthymic bipolar patients sub-grouped by suicidal attempt history in comparison with 94 healthy controls. All subjects underwent a laboratory assessment of impulsivity (Continuous Performance Test and Iowa Gambling Test). Furthermore the genotyping of 5-HTTLPR was performed in all subjects. RESULTS: We found that bipolar patients are more impulsive than healthy controls in all impulsivity dimensions we studied. Furthermore bipolar patients with a suicide attempt history have a greater cognitive impulsivity when compared to both bipolar patients without such a history as well when compared to healthy controls. No association was found between 5-HTTLPR genotypes and neuropsychological measures of impulsive behavior. LIMITATIONS: The sample studied can be considered small and a potentially confounding variable - medication status - was not controlled. CONCLUSION: A lifetime suicide attempt seems associated with cognitive impulsivity independently of the socio-demographic and clinical variables studied as well with 5-HTTLPR genotype. Further studies in larger samples are necessary.

Dengue fever among U.S. travelers returning from the Dominican Republic - Minnesota and Iowa, 2008.

In February 2008, a group of U.S. residents became ill with symptoms and clinical findings suggestive of dengue fever after returning from the Dominican Republic, where they had traveled to work as missionaries. Dengue is endemic in the Dominican Republic and most tropical and subtropical areas of the world, including the Caribbean, and represents a known health risk for U.S. residents traveling to or working in those areas. Subsequent investigation by the Minnesota Department of Health (MDH), the Iowa Department of Public Health (IDPH), and CDC determined that at least 14 (42%) of 33 missionaries traveling to the Dominican Republic met the case definition for dengue fever, and 12 had cases that were confirmed serologically. Of the 13 patients interviewed, all had weakness and fever, with 12 reporting chills and body or joint pain. Ten patients had noticed mosquitoes inside or outside their house in the Dominican Republic, but only three had used repellent. Before departing on their trip, none of the 13 ill travelers interviewed had been aware of dengue in the Dominican Republic, and only two had sought pre-travel medical advice. The Dominican Republic is a frequent destination for U.S. travelers providing missionary and humanitarian services and also for vacationers. These cases indicate a need to increase awareness of dengue prevention measures among U.S. travelers to areas where they might be at risk for dengue.

Childhood predictors of the metabolic syndrome in middle-aged adults: the Muscatine study.

OBJECTIVE: To investigate the association between components of the metabolic syndrome (MetS) measured during childhood/adolescence, and adult MetS. STUDY DESIGN: This investigation focused on members of the Muscatine Study Longitudinal Adult Cohort. Predictor variables were risk factor measurements obtained between 1970 and 1981 when cohort members participated in school survey examinations. Risk factor measurements obtained between 1982 and 2008 when cohort members participated in follow-up examinations as young and middle-aged adults were used for MetS classification. RESULTS: 33.0% (29.7% of 474 women; 37.0% of 384 men) of cohort members were classified as having the MetS. The initial MetS classification occurred at ages ranging from 23 to 52 years, with a mean age of 37.2 years (SD = 7.4). Cohort members with the MetS had significantly higher body mass index, systolic blood pressure, and triglycerides at the time they participated in the school survey examinations (P < .0001). Estimated probabilities of remaining MetS free at age 35 for those whose school survey body mass index and triglyceride measurements were both <50th vs >/=75th percentiles were strikingly different (0.94 vs 0.42). CONCLUSIONS: BMI is the strongest childhood predictor of adult MetS. Early identification of at-risk children may reduce the burden of atherosclerotic cardiovascular disease.

Physical activity augments bone mineral accrual in young children: The Iowa Bone Development study.

OBJECTIVES: This 3-year follow-up study examined associations between physical activity and bone mineral content (BMC) and whether physical activity augments BMC accrual. STUDY DESIGN: Participants were 370 children (mean age baseline 5.3 years, follow-up 8.6 years). Physical activity was measured using 4-day accelerometry. BMC was measured using dual energy x-ray absorptiometry. RESULTS: After adjustment for baseline BMC, age, and body size, mean physical activity predicted follow-up BMC at the hip, trochanter, spine, and whole body in boys and at the trochanter and whole body in girls. The variability in BMC explained by physical activity was modest (1% to 2%). However, based on a general linear model with adjustment for baseline BMC and body size, children who maintained high levels of physical activity accrued, on average, 14% more trochanteric BMC and 5% more whole-body BMC relative to peers maintaining low levels of physical activity. CONCLUSIONS: This study suggests that maintaining high levels of everyday physical activity contributes to increases in BMC in young children, particularly at the trochanter.