Physical Activity Promotion in North Carolina: a Reassessment of Public Park and Recreation Directors.

Regular physical activity is widely considered by public health and parks and recreation professionals as a key determinant of individual and community health and well-being. Prior research has shown that building sustainable health partnerships with community organizations can help parks and recreation departments meet many US health challenges. This descriptive study examined the perceptions of North Carolina public parks and recreation directors regarding physical activity and health partnership practices in their communities. The study was also a 15-year follow-up to a study and examined whether park and recreation director perceptions of health partnerships had changed given the many social, economic, and health events that have occurred since the original survey. Directors from two hundred seventy-five North Carolina city and county parks and recreation departments were surveyed in the Spring of 2022 to determine 1) directors' effort allocation in promoting physical activity toward vulnerable populations, 2) challenges associated with promoting community physical activity, and 3) differences in effort allocation, future priorities, and partnership among varying director and departmental demographics. Results were compared to findings from a 2007 study of NC perceptions of health partnerships, upon which the present study was based. One hundred twenty-three completed questionnaires were returned, resulting in a response rate of 45%. Directors in 2022 allocated similarly higher levels of effort toward older adults, families, and people with low income as did directors in 2007, while youth and adults with disabilities and people with chronic health conditions received lower allocations of effort from directors in 2022. Barriers such as lack of staff knowledge on how to promote physical activity, lack of citizen and political support, and lack of knowledge of under-represented groups' physical activity preferences were less pronounced in 2022 compared to 2007. Several distinct differences were revealed between female and male directors' rankings of effort and future priorities, as well as their perceptions of physical activity opportunities for women and people with disabilities. Partnerships with county health departments are being reported more in counties with the highest health disparities compared to more healthy counties, indicating that partnerships are being targeted and implemented in areas where resources are most needed. This study represents a meaningful extension of research conducted prior to the 2008 Great Recession and COVID-19 pandemic and provides recommendations for public parks and recreation departments to consider promoting physical activity and building community resilience in the face of future economic and health challenges.

Bilateral Ischial Tuberosity Stress Fractures in an Adolescent Football Player: A Case Report.

ABSTRACT: Pelvic stress fractures are rare, making up an estimated 1% to 7% of all stress fractures with the primary locations being the pubic rami, pubic symphysis, and sacrum. Two cases of stress fractures of the ischium have been previously described in the literature, with both occurring in the ischial body. In this case, a 17-year-old high school American football player presented with nonspecific pelvic pain and bilateral point tenderness on deep palpation of the ischial tuberosities. Advanced imaging identified bilateral ischial tuberosity stress fractures. This report outlines the diagnosis and management of the first reported case of bilateral ischial tuberosity stress fractures. We report how ischial tuberosity stress fractures present clinically, potential management strategies, and highlight the use of computed tomography imaging for pelvic stress fractures. Knowledge of unusual stress fracture locations may improve early diagnosis, limit complications, reduce healthcare costs, and promote an accelerated recovery time.

Myocarditis Following COVID-19 Vaccination: A Systematic Review of Case Reports.

Introduction: COVID-19, the infectious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), often presents with a spectrum of symptoms at varying levels of severity, ranging from asymptomatic patients to those with fatal complications, such as myocarditis. With increased availability of COVID-19 vaccines, the awareness of possible side effects has expanded as reports surface. This study reviewed cases of myocarditis following COVID-19 vaccination and with existing literature on COVID-19 infection-induced myocarditis to compare clinical courses and analyze possible mechanisms of action. Methods: A systematic review of literature was conducted to identify published case reports (as of February 3, 2022) pertaining to the development of myocarditis following COVID-19 vaccination with either Pfizer or Moderna for an in-depth analysis. Additional subgroup analyses were conducted based on age, past medical history, vaccine manufacturer, and dose number. Results: There were 53 eligible case reports that were included in this study. Patients were mostly male with a median age of 24 years, and the most reported symptom upon presentation was chest pain. Seventy percent of the cases involved the Pfizer vaccine with a majority of myocarditis developing subsequent to second dose. Resolution of symptoms was achieved in all but one patient. Clinical severity, as measured primarily by left ventricular ejection fraction, appeared to be worse among adult patients than pediatric, as well as for patients with comorbidities. Conclusion: This study revealed an observable association between COVID-19 vaccines and myocarditis. However, the clinical course and prognosis seem favorable and less prevalent than those conferred from natural infection.

Empowering Patients and Providers With More and Better Data: Innovative Concepts in Type 2 Diabetes Management.

IN BRIEF In this article, the authors discuss several innovative concepts UnitedHealth Group Research & Development is exploring to help patients manage their type 2 diabetes. The article focuses on efforts to use remote support programs and wearable technology to empower patients to take more active roles in managing their health and to foster more interactive patient-provider conversations. Additionally, the authors reflect on how such efforts could particularly benefit medically underserved communities. They offer observations from claims data about current health outcomes and costs in underserved areas.

Prevalence and treatment of dyslipidemia in Canadian primary care: a retrospective cohort analysis.

BACKGROUND: Dyslipidemia is an important modifiable risk factor for cardiovascular disease (CVD). Studies suggest that dyslipidemia is underdiagnosed and undertreated in Canada. OBJECTIVE: The objective of this study was to describe dyslipidemia prevalence, patient characteristics, and lipid-lowering treatment (LLT) patterns in a cohort representing Canadian primary care practice. METHODS: In this retrospective cohort analysis, the Southwestern Ontario database (which comprises data from >150,000 adult patients in rural and urban primary care practices) was used as the data source. Male and female patients with data available from 4 physician visits were included; data were captured quarterly between April 2000 and December 2003 and included demographic and lifestyle information, CVD risk factors, and cardiovascular drug treatments. Data gathered included clinical diagnoses at each visit, symptoms corroborating the diagnoses, clinical data (eg, blood pressure, smoking status, height, weight, fitness level), medications (including name, dose, duration, and quantity prescribed), and diagnostic test results and laboratory analyses. For the purposes of this study, a patient was considered to have dyslipidemia if >/=1 of the following conditions was met: (1) physician-diagnosed hyperlipidemia or hypercholes terolemia; (2) at least 1 measurement of low-density lipoprotein cholesterol (LDL-C) or total cholesterol: high-density lipoprotein cholesterol (TC:HDL-C) ratio greater than the recommended targets based on 10-year coronary artery disease (CAD) risk; and/or (3) at least 1 prescription for a lipid-lowering drug. RESULTS: A total of 49,667 patients were included in the study cohort. Dyslipidemia was identified in 6961 (14.0%) patients. Of patients with dyslipidemia, more were untreated (63.2%) than treated (36.7%) with LLTs, with women receiving treatment less often than men (P < 0.001). Of those treated, 47.2% had disease that was not adequately controlled, with fewer treated women having controlled disease than treated men (P < 0.017). Patients with dyslipidemia fell mostly into very-high-risk (45.7%) or low-risk (31.1 %) categories for CAD. A total of 73.0% of treated patients were prescribed monotherapy with a 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitor (statin); of starin prescriptions, most were for atorvastatin (51.8%) or simvastatin (29.4%). Initial LDL-C levels and initial TC:HDL-C ratios were statistically similar between patients prescribed atorvastatin and those prescribed simvastatin. CONCLUSION: Based on the results of this retrospective cohort analysis, dyslipidemia prevalence in Canadian primary care is high, and despite clinical evidence and treatment guidelines, dyslipidemia is largely untreated in family practice, suggesting a gap in care.

Falsely elevated international normalized ratio values in patients undergoing anticoagulation therapy: a descriptive evaluation.

BACKGROUND: Elevated international normalized ratio (INR) values have been linked to bleeding complications; however, elevated INR values are not always physiologic and can be falsely increased. This study describes the rate of falsely elevated INRs and characteristics predictive of falsely elevated INRs. METHODS: This cross-sectional study was conducted among adult patients receiving anticoagulation therapy monitored by a centralized anticoagulation service during January 2000 through December 2004 (n = 29,536). Prevalence rates of all elevated (ie, value >/= 10), falsely elevated, and truly elevated INRs were calculated. Multivariate logistic regression was performed to identify predictors of falsely elevated INRs among elevated INRs. RESULTS: Of the 556,998 INRs included in the analysis, 793 INRs (prevalence, 0.14%; 95% confidence interval [CI], 0.10 to 0.19%), 53 INRs (prevalence, 0.01%; 95% CI, < 0.01 to 0.03%), and 740 INRs (prevalence, 0.13%; 95% CI, 0.09 to 0.18%) were elevated, falsely elevated, and truly elevated, respectively. The strongest independent predictor of a falsely elevated INR was a patient undergoing hemodialysis at the time of the elevated INR (adjusted odds ratio, 9.60; 95% CI, 4.96 to 18.58; p < 0.001). A low target INR was the only other factor found to be an independent predictor of a falsely elevated INR. CONCLUSIONS: Although INR values >/= 10.0 occur infrequently, patients presenting with such values can present a challenge to the anticoagulation provider. Anticoagulation providers should be particularly vigilant for falsely elevated INRs when monitoring patients undergoing hemodialysis.

Prevalence, treatment, and control of hypertension in primary care: gaps, trends, and opportunities.

Since most cases of hypertension are managed in family practice, estimates of the prevalence, treatment, and control in the primary care population are needed to adequately address the burden of hypertension in Canada as it has in other countries. The authors used a large primary care research database to determine the prevalence of hypertension between 2000 and 2003. Blood pressure recordings were used to estimate the rates of prevalence, treatment, and control of hypertension for the overall population and for important subgroups. The prevalence of hypertension was 17.3%, most patients had untreated hypertension (68.6%), and only 15.8% had blood pressure treated and controlled. Higher rates of treatment and control were observed among older adults, those with type II diabetes, and those with a previous myocardial infarction. Odds of achieving target blood pressure were significantly better when combination therapy vs monotherapy was used. The prevalence of hypertension in primary care is high and most patients remain untreated; however, increased risk appears to lead to better treatment and control.

Exercise-induced transcription of the muscle glucose transporter (GLUT 4) gene.

We studied the effects of exercise on GLUT4 gene transcription in several lines of transgenic mice expressing the chloramphenicol acyltransferase (CAT) reporter gene, driven by various lengths of the human GLUT4 promoter (2400, 1600, 895, and 730 bp). In all transgenic lines examined, endogenous GLUT4 mRNA increased in response to exercise (19-90%, P < 0.05). Exercise increased CAT mRNA (51-83%, P < 0.05) in mice when the transgene was driven by at least 895 bp of the promoter but showed no effect in mice in which the transgene was driven by only 730 bp. These results suggest that the exercise-induced increase in the transcriptional activity of the human GLUT4 gene is mediated, at least in part, by element(s) within -895 bp of the promoter. These observations reveal a striking similarity to the time course and regional promoter requirements of AMPK-induced GLUT4 gene expression, providing further evidence that AMPK may be mediating the effects of exercise on GLUT4 expression.