Understanding Historical Trauma Among Urban Indigenous Adults at Risk for Diabetes.

Historical trauma has been posited as a key framework for conceptualizing and addressing health equity in Indigenous populations. Using a community-based participatory approach, this study aimed to examine historical trauma and key psycho-social correlates among urban Indigenous adults at risk for diabetes to inform diabetes and other chronic disease prevention strategies. Indigenous adult participants (n=207) were recruited from an urban area in California and were asked to identify whether their Indigenous heritage was from a group in the United States, Canada, or Latin America. Historical trauma was assessed using the Historical Loss (HLS) and Historical Loss Associated Symptoms (HLAS) scales. Nearly half (49%) of Indigenous participants from the United States or Canada endorsed thinking about one or more historical losses weekly, daily, or several times a day, compared to 32% for Indigenous participants from Mexico, Central America, and South America. Most participants (62%) reported experiencing one or more historical loss-associated symptoms, such as depression and anger, sometimes, often, or always. Ancestry from the United States or Canada, depression, and participation in cultural activities were associated with greater HLS and HLAS scores, indicating a greater number of losses and associated symptoms. Results suggest a need to consider historical trauma when designing diabetes prevention interventions and the need to further consider ancestry differences. As preventive efforts for Indigenous adults expand in urban environments, behavioral interventions must incorporate strategies that address community-identified barriers in order to succeed.

Emerging Concepts and Evidence in Telematics Novel Approaches or Treatments for Spasticity Management After Botulinum Injection.

There is a strong recommendation for the use of intramuscular botulinum toxin in patients with persistent or progressive spasticity affecting one or more joints and who have an identifiable therapeutic target. After a botulinum toxin injection, a stretching intervention improves the results of the treatment, and it should be performed by patients and/or caregivers after being trained by a therapist. Adherence to this recommendation remains low once the therapist stops following the patient. The COVID-19 pandemic has increased the use of telemedicine with different approaches to treat patients. There has been an increased use of motivational applications, with virtual reality software and real-life videos, which provide a gaming experience that increases adherence. There are programs with synchronous telehealth exercises guided by physical therapists or software with sensor-based technology that shows the range of motion (ROM) and strength of the muscles of a particular joint. These new approaches to patient follow-up appear to increase adherence to exercise because they need to be "watched and controlled" is achieved.

Effectiveness of Lymphedema Prevention Programs With Compression Garment After Lymphatic Node Dissection in Breast Cancer: A Randomized Controlled Clinical Trial.

Background: Patients with breast cancer who undergo axillary lymph node dissection (ALND) are at risk of developing lymphedema, which can negatively impact quality of life. Lymphedema prevention programs, which primarily consist of educational content and exercise, have been shown to reduce the incidence of lymphedema. The addition of compression garments (CG) may increase the effectiveness of these programs. Aim: We aimed to determine whether adding a compression garment to a conventional lymphedema prevention program could improve treatment effectiveness. Design: Randomized clinical trial. Methods: Seventy patients who had undergone ALND for breast cancer were randomized to receive conventional preventative therapy (control arm, n = 35) consisting of a 1-hour educational session and a 12-week exercise program or the same therapy plus upper limb CGs (experimental arm, n = 35). Patients in the experimental arm were instructed to wear the CG ≥ 8 h/day for the first 3 months after surgery and 2 h/day thereafter. Results: At 2-years, the overall incidence of lymphedema in the two groups was 12.3%, with no significant differences between the conventional and experimental arms (12.5 vs. 12.1%). In the experimental arm, the incidence of lymphedema was significantly lower (p = 0.02) in patients who used the CGs daily as recommended compared to patient who did not adhere to this treatment recommendation. Neither exercise (p = 0.518) nor education alone decreased the incidence of lymphedema. Adherence decreased over time. Conclusions: The findings of this RCT show that health education, preventive exercise programs, and patient adherence to therapeutic recommendations all play an important role in preventing lymphedema. Clinical Rehabilitation Impact: Our data demonstrated that the use of a compression garment during the first 3 months after axillary node dissection may reduce the likelihood of lymphedema in high-risk patients.