Selective Tibial Neurotomy Outcomes for Spastic Equinovarus Foot: Patient Expectations and Functional Assessment.

BACKGROUND: Spastic equinovarus foot (SEF) is a common dysfunctional foot posture after stroke that impairs balance and mobility. Selective tibial neurotomy (STN) is a simple but underutilized surgical option that can effectively address critical aspects of SEF and thereby provide enduring quality of life gains. There are few studies that examine both functional outcomes and patient satisfaction with this treatment option. OBJECTIVE: To elucidate the patient goals that motivated their decision to undergo the procedure and compare subjective and objective changes in balance and functional mobility as a consequence of surgery. METHODS: Thirteen patients with problematic SEF who had previously failed conservative measures were treated with STN. Preoperative and postoperative (on average 6 months) assessments evaluated gait quality and functional mobility. In addition, a custom survey was conducted to investigate patient perspectives on STN intervention. RESULTS: The survey showed that participants who opted for STN were dissatisfied with their previous spasticity management. The most common preoperative expectation for STN treatment was to improve walking, followed by improving balance, brace comfort, pain, and tone. Postoperatively, participants rated the improvement in their expectations and were, on average, 71 on a 100-point scale, indicating high satisfaction. The gait quality, assessed with the Gait Intervention and Assessment Tool, improved significantly between preoperative and postoperative assessment (M = -4.1, P = .01) with a higher average difference in stance of -3.3 than in swing -0.5. Improvement in both gait endurance (M = 36 m, P = .01) and self-selected gait speed (M = .12 m/s, P = .03) was statistically significant. Finally, static balance (M = 5.0, P = .03) and dynamic balance (M = 3.5, P = .02) were also significantly improved. CONCLUSION: STN improved gait quality and functional mobility and was associated with high satisfaction in patients with SEF.

Understanding virtual primary healthcare with Indigenous populations: a rapid evidence review.

BACKGROUND: Virtual care has become an increasingly useful tool for the virtual delivery of care across the globe. With the unexpected emergence of COVID-19 and ongoing public health restrictions, it has become evident that the delivery of high-quality telemedicine is critical to ensuring the health and wellbeing of Indigenous peoples, especially those living in rural and remote communities. METHODS: We conducted a rapid evidence review from August to December 2021 to understand how high quality Indigenous primary healthcare is defined in virtual modalities. After completing data extraction and quality appraisal, a total of 20 articles were selected for inclusion. The following question was used to guide the rapid review: How is high quality Indigenous primary healthcare defined in virtual modalities? RESULTS: We discuss key limitations to the delivery of virtual care, including the increasing cost of technology, lack of accessibility, challenges with digital literacy, and language barriers. This review further yielded four main themes that highlight Indigenous virtual primary healthcare quality: (1) limitations and barriers of virtual primary healthcare, (2) Indigenous-centred virtual primary healthcare, (3) virtual Indigenous relationality, (4) collaborative approaches to ensuring holistic virtual care. DISCUSSION: For virtual care to be Indigenous-centred, Indigenous leadership and users need to be partners in the development, implementation and evaluation of the intervention, service or program. In terms of virtual models of care, time must be allocated to educate Indigenous partners on digital literacy, virtual care infrastructure, benefits and limitations. Relationality and culture must be prioritized as well as digital health equity. CONCLUSION: These findings highlight important considerations for strengthening virtual primary healthcare approaches to meet the needs of Indigenous peoples worldwide.

Psychological distress in children with developmental coordination disorder and attention-deficit hyperactivity disorder.

This study explored whether or not a population-based sample of children with developmental coordination disorder (DCD), with and without comorbid attention deficit/hyperactivity disorder (ADHD), experienced higher levels of psychological distress than their peers. A two-stage procedure was used to identify 244 children: 68 with DCD only, 54 with ADHD only, 31 with comorbid DCD and ADHD, and 91 randomly selected typically developing (TD) children. Symptoms of depression and anxiety were measured by child and parent report. Child sex and caregiver ethnicity differed across groups, with a higher ratio of boys to girls in the ADHD only group and a slightly higher proportion of non-Caucasian caregivers in the TD group. After controlling for age, sex, and caregiver ethnicity, there was significant variation across groups in both anxiety (by parent report, F(3,235)=8.9, p<0.001; by child report, F(3,236)=5.6, p=0.001) and depression (parent report, F(3,236)=23.7, p<0.001; child report, F(3,238)=9.9, p<0.001). In general, children in all three disorder groups had significantly higher levels of symptoms than TD children, but most pairwise differences among those three groups were not significant. The one exception was the higher level of depressive symptoms noted by parent report in the ADHD/DCD group. In conclusion, children identified on the basis of motor coordination problems through a population-based screen showed significantly more symptoms of depression and anxiety than typically developing children. Children who have both DCD and ADHD are particularly at heightened risk of psychological distress.

Risk factors for campylobacteriosis in two washington state counties with high numbers of dairy farms.

Campylobacteriosis is a frequently reported, food-borne, human bacterial disease that can be associated with ruminant reservoirs, although public health messages primarily focus on poultry. In Washington State, the two counties with the highest concentrations of dairy cattle also report the highest incidences of campylobacteriosis. Conditional logistic regression analysis of case-control data from both counties found living or working on a dairy farm (odds ratio [OR], 6.7 [95% confidence interval [CI], 1.7 to 26.4]) and Hispanic ethnicity (OR, 6.4 [95% CI, 3.1 to 13.1]) to have the strongest significant positive associations with campylobacteriosis. When the analysis was restricted to residents of one county, Hispanic ethnicity (OR, 9.3 [95% CI, 3.9 to 22.2]), contact with cattle (OR, 5.0 [95% CI, 1.3 to 19.5]), and pet ownership (OR, 2.6 [95% CI, 1.1 to 6.3]) were found to be independent risk factors for disease. Campylobacter jejuni isolates from human (n = 65), bovine (n = 28), and retail poultry (n = 27) sources from the same counties were compared using multilocus sequence typing. These results indicated that sequence types commonly found in human isolates were also commonly found in bovine isolates. These findings suggest that, in areas with high concentrations of dairy cattle, exposure to dairy cattle may be more important than food-borne exposure to poultry products as a risk for campylobacteriosis.

Cerebellar vermis volume in major depressive disorder.

The vermis is located in the midline of the cerebellum and is involved in the regulation of affect and cognitive processes. Although changes in vermis size have been reported in several psychiatric disorders such as schizophrenia and bipolar disorder, no volumetric studies have been conducted on samples of patients with major depressive disorder (MDD). One-hundred and five adult subjects were recruited: 35 patients who were presenting for first treatment (FT; 22 females), 35 patients with known previous treatment (PT; 22 females), and 35 healthy controls (NC; 22 females), matched for age and gender. We compared the volumes of the total vermis, the anterior lobe (V1), the superior-posterior lobe (V2), and the inferior-posterior lobe (V3), among these study groups. Anterior vermis (V1) was larger in patients with MDD with a long history of antidepressant treatment compared to healthy controls. This finding was evident only in men [F(2, 36) = 9.23, p = .001]. Patients in the FT group did not differ from healthy controls in any vermian region. We found no correlations between vermian subregional volumes and clinical variables such as illness duration or age at onset of illness. We speculate that the larger anterior vermis volumes might arise from abnormalities in connectivity or as compensatory responses to the prefrontal dysfunction noted in patients with MDD but confirmation of this hypothesis awaits further studies.

Farm animal contact as risk factor for transmission of bovine-associated Salmonella subtypes.

Salmonellosis is usually associated with foodborne transmission. To identify risk from animal contact, we compared animal exposures of case-patients infected with bovine-associated Salmonella subtypes with those of control-patients infected with non-bovine-associated subtypes. We used data collected in New York and Washington, USA, from March 1, 2008, through March 1, 2010. Contact with farm animals during the 5 days before illness onset was significantly associated with being a case-patient (odds ratio 3.2, p = 0.0008), after consumption of undercooked ground beef and unpasteurized milk were controlled for. Contact with cattle specifically was also significantly associated with being a case-patient (odds ratio 7.4, p = 0.0002), after food exposures were controlled for. More cases of bovine-associated salmonellosis in humans might result from direct contact with cattle, as opposed to ingestion of foods of bovine origin, than previously recognized. Efforts to control salmonellosis should include a focus on transmission routes other than foodborne.

Vibrio mimicus infection associated with crayfish consumption, Spokane, Washington, 2010.

We report a cluster of severe diarrheal disease caused by Vibrio mimicus infection among four persons who had consumed leftover crayfish the day after a private crayfish boil. Gastrointestinal illness caused by Vibrio mimicus has not been reported previously in Washington State. Three cases were laboratory confirmed by stool culture; using PCR, isolates were found to have ctx genes that encode cholera toxin (CT). Two of the cases were hospitalized under intensive care with a cholera-like illness. The illnesses were most likely caused by cross-contamination of cooked crayfish with uncooked crayfish; however, V. mimicus was not isolated nor were CT genes detected by PCR in leftover samples of frozen crayfish. Clinicians should be aware that V. mimicus can produce CT and that V. mimicus infection can cause severe illness.

A staged approach for identifying children with developmental coordination disorder from the population.

The purpose of this study was to describe the motor, attention and intellectual characteristics of a population-based sample of children first screened for motor impairment and to discuss the recruitment and identification methods employed. A two stage cross-sectional, school-based survey was conducted to screen for children with motor coordination difficulties and to identify children with an existing diagnosis of attention deficit hyperactivity disorder/attention deficit disorder (ADHD/ADD). The identified children, and a random sample of typically developing children, were assessed to confirm or rule out the presence of developmental coordination disorder (DCD). Six thousand four hundred and seventy five children were invited to participate; 2943 children, with parental consent, completed the initial screening process. Two hundred eighty four children with possible motor impairment were identified. The parents of 113 children consented to a full assessment. Sixty eight children of the 113 children met diagnostic criteria for DCD, and 26 also had ADHD. Twenty eight of the 55 children who screened in with a diagnosis of ADHD were subsequently found to have DCD. The total number of children with confirmed characteristics of DCD was reduced after application of DCD diagnostic criteria. This study differs from others with regard to the additional screening for children with ADHD/ADD. The second stage assessment notably increased the number of children identified with both ADHD and DCD.

Adults with mood disorders have an increased risk profile for cardiovascular disease within the first 2 years of treatment.

OBJECTIVES: People with bipolar disorder (BD) and major depressive disorder (MDD) are at risk for premature death from various physical illnesses. A large component of this risk may be accounted for by an elevated risk of metabolic syndrome (MeS) and coronary heart disease (CHD). The objective of our study was to examine patients' physical health prior to first treatment and over 2 years of follow-up. METHODS: Ten-year risk for CHD and incidence of MeS were calculated for newly diagnosed patients with MDD (n = 30) and BD (n = 24) at baseline and over a 2-year follow-up. Age and sex-matched control subjects were obtained from the National Health and Nutrition Examination Survey III dataset. RESULTS: At baseline, 11.2% of patients met diagnostic criteria for MeS and this increased to 16.8% at follow-up. Women had higher rates of MeS but rates were similar across diagnosis. There was a significant increase within all MeS criteria. The 10-year CHD risk was low for patients at baseline and follow-up but increased across the follow-up period. Changes in CHD and MeS risk were not associated with a specific type of pharmacotherapy, as all medication classes appeared to increase risk. CONCLUSION: Prior to treatment, MeS and CHD risk rates for patients were similar to the general population, but their risk of CHD increased appreciably.

Increased subgenual prefrontal cortex size in remitted patients with major depressive disorder.

Bilateral reductions in the volume of the anterior cingulate cortex have been reported in patients with major depressive disorder (MDD) when compared with findings in healthy controls. We compared regional brain volumes in the subgenual prefrontal cortex (SGPFC; Brodmann area (BA) 24(sg)), subcallosal gyrus (BA25) and paracingulate gyrus (BA32) in healthy control subjects and a large and well-characterized sample of patients with recurrent MDD, all of whom had received extensive antidepressant therapy. Patients with a remitted episode of MDD had SGPFC volumes larger than those of healthy controls, while those in an active illness episode did not differ from controls. There were no differences in subcallosal gyrus and paracingulate gyrus volumes between patients with MDD and healthy controls, with the exception that women with MDD had smaller paracingulate volumes than their sex-matched controls. This effect was not related to duration of illness, number of previous episodes, age at illness onset, or age at the time of scanning. Our findings demonstrate SGPFC volume increases in association with long-term antidepressant therapy and suggest that this result may be linked to positive clinical response.

Posterior hippocampal volumes are associated with remission rates in patients with major depressive disorder.

BACKGROUND: The hippocampus (HC) is smaller in patients with recurrent major depressive disorder (MDD), but few longitudinal studies have examined whether volume is associated with clinically meaningful outcomes such as response to treatment. METHODS: We compared regional (head and body/tail) HC volumes in 46 patients with MDD, 14 of whom remitted after 8 weeks of first treatment to HC volumes of 32 patients who were not in remission after 8 weeks. RESULTS: Patients who remitted had larger pretreatment hippocampal body/tail volumes bilaterally compared with those who were not in remission at 8 weeks. This difference was not apparent in either the right or left hippocampal head. CONCLUSIONS: These findings extend a small number of previous reports, suggesting that regional brain volumes might be associated with rate and extent of clinical response to antidepressant medication.

Life experiences of young adults who have coordination difficulties.

BACKGROUND: Little is known about the impact of developmental coordination disorder (DCD) during adolescence and young adulthood. PURPOSE: This study explored the lived experiences of a nonclinical sample of nine university students who reported having significant coordination difficulties. METHODS: A phenomenological approach was used that included two in-depth interviews asking participants to recall retrospectively their experiences throughout adolescence. Transcripts were coded to identify themes, and member-checking supported the credibility of findings. FINDINGS: Strong pathways of resilience were found with participants who employed cognitive and behavioural strategies to manage their motor differences. Key themes emerged related to managing coordination differences including avoidance/withdrawal/adaptation, seeking compatible activities, using humour, and persevering. As adolescents matured, changing social contexts affected their self-efficacy and others' perceptions of them. IMPLICATIONS: The findings of this study challenge occupational therapists to move beyond impairment-based interventions to ecological interventions that facilitate social and community participation.

Anterior cingulate volumes in never-treated patients with major depressive disorder.

The anterior cingulate cortex (ACC) is implicated in the cognitive and affective abnormalities observed in mood disorders. Bilateral ACC volume reductions have been reported in patients with major depressive disorder (MDD) when compared to healthy controls. We compared regional brain volumes in the subgenual prefrontal cortex (SGPFC; Brodmann area (BA) 24(sg)), subcallosal gyrus (BA25), and paracingulate gyrus (BA32) in 65 patients receiving a first course of treatment for MDD and 93 healthy control subjects. Patients with more than three episodes of untreated MDD had smaller subcallosal gyrus volumes than healthy controls, while those with three or fewer past untreated episodes did not differ from controls. We also found preliminary evidence that medication-exposed patients had smaller SGPFC volumes than patients with no exposure to medication and healthy controls. There was no evidence that these effects related to mood state, duration of untreated illness, or to patient age. No differences were apparent in paracingulate gyrus volumes between patients and controls. These findings confirm the presence of ACC volume reductions in untreated patients with MDD and suggest that illness burden and short-term medication exposure mediate this change.

Increased rates of obesity in first-presentation adults with mood disorders over the course of four-year follow-up.

BACKGROUND: Patients with mood disorders have higher rates of obesity than the general population. With respect to this, little is known regarding how patient look like prior to treatment or the rates of change. OBJECTIVE: To identify changes in the rates of obesity in never-treated patients with mood disorder over 4 years of follow-up. METHODS: Sixty-six never-treated patients with mood disorders were evaluated via clinical interview, symptom assessment and body mass index (BMI). Patients were followed 4 years. Population attributable risk (PAR%) was calculated. RESULTS: Patients in underweight and normal weight groups fell by nearly 29%, with a corresponding increase in patients entering overweight and obese groups. Rates of PAR% increased to 16.0, a significant 5-point increase over baseline. LIMITATIONS: This study had a small sample size and the population was ethnically homogenous. BMI was used as a maker of weight and not waist circumference. CONCLUSIONS: Over 4 years there was a significant increase in BMI and the risk conferred by obesity. Shift from normal weight to overweight and obese is a significant risk for patients with a mood disorder and clinical programs should consider interventions that might ameliorate risk of this shift early in the course of the illness.

Bilateral hippocampal volume increase in patients with bipolar disorder and short-term lithium treatment.

Most previous magnetic resonance imaging (MRI) studies of patients with bipolar disorder (BD) report similar hippocampus (HC) volumes across patients and controls, but because patients studied were heterogeneous with respect to course of illness variables and medication status, the conclusions of these studies remain equivocal. Lithium (Li) is the reference-standard drug for BD and its role as an important agent in neuroprotection and neurogenesis has been documented in human and in animal studies. We compared the volume of the HC, hippocampal head (Hh), and body/tail (Hbt) in three groups with no history of medication use before entry into this study: (a) a group of patients treated with Li for 1-8 weeks and then scanned; (b) a group comprised of patients who were unmedicated at the time of scan; and (c) a group of patients treated with either valproic acid or lamotrigine. Healthy age- and sex-matched comparison subjects were also scanned. HC volumes did not differ between the unmedicated and healthy comparison groups. There was a bilateral increase in volumes of HC and Hh in the Li-treated group compared to the unmedicated group, an effect that was apparent even over a brief treatment period. Our study provides further confirmation that Li can exert structural effects on the HC, which are detectable in vivo. The study emphasizes the need to control for even brief exposure to medication in volumetric studies of the HC.

Bilateral hippocampal volume increases after long-term lithium treatment in patients with bipolar disorder: a longitudinal MRI study.

RATIONALE: The majority of volumetric magnetic resonance imaging (MRI) studies of the hippocampus in patients with bipolar disorder (BD) show no differences in hippocampal volume between patients and healthy controls. Significant variability, however, exists in the medication status of patients included in these studies. In particular, treatment with lithium may exert long-term effects on hippocampal volume, influencing cognitive outcomes in BD patients. OBJECTIVES: To our knowledge, no longitudinal volumetric study has been performed in patients with BD, which would allow for an examination of whether lithium therapy used to treat BD can exert a long-term effect on hippocampal volume. MATERIALS AND METHODS: We examined the effects of lithium on hippocampal volumes and recollective memory performance over a period of 2 to 4 years in 12 patients with BD who had never received pharmacotherapy before lithium initiation. RESULTS: We found bilateral increases in volume of the hippocampus over time. We also found some evidence of improvement in verbal memory performance over the 4-year measurement period as assessed by the California Verbal Learning Test. CONCLUSIONS: Consistent with preclinical literature supporting the neuroprotective effects of lithium, long-term treatment is associated with preservation of recollective memory function and increased hippocampal size in vivo.

The elimination of raccoon rabies from Wolfe Island, Ontario: animal density and movements.

During 1996 to 1998, an average of 52% to 55% of the raccoon (Procyon lotor) population on Wolfe Island, Ontario was vaccinated against rabies during proactive trap-vaccinate-release (TVR) operations. However, during 1999, the percent of the population vaccinated declined to 39% and an outbreak (6 cases) of raccoon rabies occurred on the island from December 1999 to January 2000. The raccoon population on Wolfe Island declined dramatically (71% reduction) from 1,067 raccoons (mean density = 8.4/km(2) [6.4-12.4, 95% CI]) during 1999 to 305 raccoons (mean density = 2.4/km(2) [0.87-4.1, 95% CI]) in the spring of 2000. Raccoon density immediately following the outbreak was significantly lower in cells with rabies cases, suggesting that rabies had a negative effect on population size. However, raccoon density had doubled by 1 yr following the outbreak. Movement of raccoons on Wolfe Island was as great as 24 km. Male raccoons moved greater distances than females. Movements to surrounding islands were also noted for raccoons ear tagged on Wolfe Island which indicates the island could serve as a focus for greater geographic rabies spread. Point infection control (PIC) during 2000, TVR during 2001-02, and the aerial distribution of Vaccinia-Rabies Glycoprotein (V-RG) baits during 2000 and 2003-05 were used to eliminate rabies from Wolfe Island. No cases have been detected since late January 2000 (to February 2007).

Multidrug-resistant Salmonella typhimurium, Pacific Northwest, United States.

We compared human and bovine isolates of Salmonella enterica using antimicrobial-drug resistance profiles and pulsed-field gel electrophoresis. From 2000 through 2006, we observed an increase in a novel multidrug-resistant clone of S. Typhimurium with no recognized phage type. This clone may represent an emerging epidemic strain in the Pacific Northwest.

Course of illness, hippocampal function, and hippocampal volume in major depression.

Studies have examined hippocampal function and volume in depressed subjects, but none have systematically compared never-treated first-episode patients with those who have had multiple episodes. We sought to compare hippocampal function, as assessed by performance on hippocampal-dependent recollection memory tests, and hippocampal volumes, as measured in a 1.5-T magnetic resonance imager, in depressed subjects experiencing a postpubertal onset of depression. Twenty never-treated depressed subjects in a first episode of depression were compared with matched healthy control subjects. Seventeen depressed subjects with multiple past episodes of depression were also compared with matched healthy controls and to the first-episode patients. Both first- and multiple-episode depressed groups had hippocampal dysfunction apparent on several tests of recollection memory; only depressed subjects with multiple depressive episodes had hippocampal volume reductions. Curve-fitting analysis revealed a significant logarithmic association between illness duration and hippocampal volume. Reductions in hippocampal volume may not antedate illness onset, but volume may decrease at the greatest rate in the early years after illness onset.