The profile of people undergoing lower limb amputations at Groote Schuur Hospital.

Background: The annual incidence of lower limb amputations (LLA) at Groote Schuur Hospital is rising gradually. However, little is known about the sociodemographic and clinical profiles of people undergoing these limb amputations. Objectives: To collect and analyse data to describe the sociodemographic, health and amputation profiles of people who have undergone LLA at Groote Schuur Hospital. Method: A descriptive retrospective chart review was conducted using a sample of 107 participants who had undergone LLA at Groote Schuur Hospital between January 2019 and July 2020. A customised assessment tool was used to extract data on the sociodemographic, health and amputation profiles of patients who had LLA. Data were analysed descriptively. Results: Sixty per cent of the patients who had undergone LLA at Groote Schuur Hospital were women. Most of the patients were over the age of 60 years and had not completed school and were pensioners or unemployed, with very low income and multiple co-morbidities including poorly controlled diabetes. Conclusions: Complications because of uncontrolled diabetes were the primary indication for LLAs at Groote Schuur Hospital. Therefore, health literacy projects are indicated to address chronic diseases of lifestyle, which, in turn, may reduce the overall burden of LLA, particularly on the South African under-resourced healthcare system. Contribution: The results of this study may help us identify key factors that predispose patients to LLAs. Consequently, this may help us identify key areas for prevention and better management of diseases that can result in complications that indicate the need for amputation.

The effect of self-reported balance confidence on community integration after brain injury: an observational study.

OBJECTIVE: To evaluate the correlation between self-reported balance confidence and community integration related to home management for community-dwelling adults with acquired brain injury (ABI). METHODS: This is a study of 141 participants over the age of 18 with a history of ABI, living in the community, who completed an online survey. The survey included a series of demographic questions followed by the Activities-Specific Balance Confidence Scale (ABC) and the Home Integration subscale of the Community Integration Questionnaire (CIQ-H). RESULTS: Data from 119 completed surveys were included in the analysis. Significant positive correlations were found between the ABC and the CIQ-H total scores (rs = 0.241, p = 0.008). There was no significant difference between CIQ-H total scores in individuals by injury type (traumatic vs non-traumatic) or by level of severity (mild, moderate, severe) (p > 0.05). There was no significant difference between ABC total scores by injury type (p > 0.05). CONCLUSIONS: Higher levels of balance confidence may be associated with improved community integration related to home management for individuals with traumatic and non-traumatic BI. This study's results support future research to evaluate the integration of strategies to improve balance confidence as a component of interdisciplinary assessment and rehabilitation to maximize community integration in community-dwelling adults with ABI.

Measurement of improvement on repeat exercise intolerance testing for suspected dysautonomia in protracted concussion recovery: a retrospective cohort study.

BACKGROUND: Research has demonstrated concussion likely causes autonomic dysfunction leading to exercise intolerance. OBJECTIVE: To measure improvement in exercise intolerance due to suspected dysautonomia associated with protracted concussion recovery, using objective measurements on a Buffalo Concussion Treadmill Test (BCTT) following participation in a prescribed exercise program. METHODS: This is a retrospective cohort study of 101 patient charts post-concussion. Exercise intolerance was assessed using a BCTT to identify suspected dysautonomia and an exercise prescription was provided using guidelines for treating concussion-associated exercise intolerance. Patients without symptom improvement and/or inability to achieve 80-85% of age-expected maximum heart rate (HR) without symptom exacerbation received a repeat BCTT. RESULTS: Twelve patient charts met inclusion criteria and were included in data analysis. There were significant improvements from pre-intervention to post-intervention testing in: maximum BCTT stage mean scores (p = .02); maximum HR mean scores (p = .01); prescription HR (RxHR) mean scores (p = .01); and HR delta (HR δ) mean scores (p = .00). CONCLUSIONS: Maximum stage, HR threshold, RxHR, and newly identified HR delta (HR δ) are potential objective measurements of progress for dysautonomia treatment post-concussion. Future studies are indicated to create a tailored protocol in the management of protracted concussion-associated dysautonomia.

Salmonella enterica Serovar Dublin from Cattle in California from 1993-2019: Antimicrobial Resistance Trends of Clinical Relevance.

Salmonella enterica subsp. enterica serovar Dublin (S.Dublin) is a cattle-adapted pathogen that has emerged as one of the most commonly isolated and multidrug resistant (MDR) serovars in cattle. S.Dublin may be shed in feces, milk, and colostrum and persist in asymptomatic cattle, leading to spread and outbreaks in herds. Though infections with S.Dublin in humans are rare, they are frequently severe, with extraintestinal spread that requires hospitalization and antimicrobial therapy. To determine minimum inhibitory concentration (MIC) and antimicrobial resistance (AMR) patterns and trends in cattle in California, broth microdilution testing was performed on 247 clinical S. Dublin isolates recovered from cattle at the California Animal Health and Food Safety Laboratory System (CAHFS) over the last three decades (1993-2019). Mean MICs and classification of resistance to antimicrobial drugs using a clinical livestock panel and the National Antimicrobial Resistance Monitoring System (NARMS) Gram-negative drug panels were utilized to assess prevalence and trends in AMR. Findings indicate an increase in AMR for the years 1993 to 2015. Notably, compared to the baseline year interval (1993-1999), there was an increase in resistance among quinolone and cephalosporin drugs, as well as an increased number of isolates with an MDR profile.

Identifying Trends of Dysautonomia Signs and Symptoms Associated with Protracted Concussion Recovery during the Buffalo Concussion Treadmill Test: A Retrospective Study.

OBJECTIVE: To identify trends of provoked dysautonomia signs and symptoms during the Buffalo Concussion Treadmill Test (BCTT). SUBJECTS: This is a retrospective cohort study of 101 patient charts post-concussion who were screened for suspected dysautonomia. METHODS: Patients with suspected dysautonomia were assessed for exercise intolerance using a BCTT. Symptoms and rate of perceived exertion were recorded on a standardized form. Digital pulse oximetry was used to collect heart rate (HR) and oxygen saturation. Descriptive analyses were conducted on BCTT results. RESULTS: Of 101 patient charts, 57 were excluded from analysis, including four patients who completed the BCTT by asymptomatically reaching the target HR zone for their estimated HR max. The remaining 44 patients demonstrated: 35 (79.5%) poor HR stabilization defined as a drop or plateau in HR during exercise, 28 (63.8%) exacerbated concussion symptoms, 13 (29.5%) autonomic nervous system response such as hot flushed sensation, 12 (27.3%) rebound symptoms during recovery phases, and 8 (18.2%) desaturation of 90% or below. The mean delta (80% expected HR max â€" 80% achieved HR max) on the initial test was 80.66 (± 23.08) beats per minute. CONCLUSIONS: This study is the first to identify trends of signs and symptoms during the BCTT in an expanded population with suspected dysautonomia after concussion. Future studies are indicated to validate these findings and contribute to development of modified termination criteria for the BCTT in individuals with suspected dysautonomia associated with protracted concussion recovery.

Unapproved Pharmaceutical Ingredients Included in Dietary Supplements Associated With US Food and Drug Administration Warnings.

Importance: Over half of adults in the United States report consuming dietary supplements. The US Food and Drug Administration (FDA) has warned of numerous dietary supplements containing undeclared, unapproved pharmaceutical ingredients. These FDA warnings have not been comprehensively analyzed for recent years. Objective: To summarize trends across adulterated (containing unapproved ingredients) dietary supplements associated with a warning released by the FDA from 2007 through 2016. Design, Setting, and Participants: In this quality improvement study, data were extracted from the FDA's Center for Drug Evaluation and Research, Tainted Products Marketed as Dietary Supplements_CDER database from 2007 through 2016. Data from each warning were recorded unless multiple warnings were issued for the same product within a 6-month period. Date, product name, company, hidden ingredient(s), product category, source of sample, and warning document type were recorded for each included warning. Data analysis was conducted from February 2017 to June 2017. Results: From 2007 through 2016, 776 adulterated dietary supplements were identified by the FDA and 146 different dietary supplement companies were implicated. Most of these products were marketed for sexual enhancement (353 [45.5%]), weight loss (317 [40.9%]), or muscle building (92 [11.9%]), with 157 adulterated products (20.2%) containing more than 1 unapproved ingredient. The most common adulterants were sildenafil for sexual enhancement supplements (166 of 353 [47.0%]), sibutramine for weight loss supplements (269 of 317 [84.9%]), and synthetic steroids or steroid-like ingredients for muscle building supplements (82 of 92 [89.1%]). There were 28 products named in 2 or 3 warnings more than 6 months apart. Of these products, 19 (67.9%) were reported to contain new unapproved ingredients in the second or third warning, consistent with the assumption that the FDA found the product to be adulterated more than once. In recent years (2014-2016), 117 of 303 adulterated samples (38.6%) were identified through online sampling and 104 of 303 (34.3%) were identified through the examination of international mail shipments. Conclusions and Relevance: Active pharmaceuticals continue to be identified in dietary supplements, especially those marketed for sexual enhancement or weight loss, even after FDA warnings. The drug ingredients in these dietary supplements have the potential to cause serious adverse health effects owing to accidental misuse, overuse, or interaction with other medications, underlying health conditions, or other pharmaceuticals within the supplement.

Nonstandard work schedules and developmentally generative parenting practices: An application of propensity score techniques.

Data from the National Institute for Child Health and Human Development (NICHD) Study of Early Child Care (Phase I) and propensity score techniques were used to determine if working fulltime in a nonstandard schedule job during the child's first year predicted parenting practices over 3 years. Results indicated that women who worked fulltime in a nonstandard schedule job during the first year had poorer maternal sensitivity at 24 and 36 months. Modest differences in HOME scores were also observed at 36 months. The results provide strong evidence that fulltime maternal employment in nonstandard schedule jobs may interfere with the creation and maintenance of developmentally generative parenting practices.

Return to work, economic hardship, and women's postpartum health.

This study followed a sample of 217 new mothers in a North Carolina county as they returned to work full-time, measuring their mental and physical health-related quality of life through 16 months postpartum. In general, working mothers of infants had mental health scores that were comparable to the general population of U.S. women, and physical health that was slightly better than women in general. Using ANCOVA and controlling for important demographic characteristics, health-related quality of life was compared between mothers experiencing low and high levels of economic hardship. Across the study period, women with high economic hardship, who constituted 30.7% of the sample, had levels of mental and physical health below those of women with low economic hardship. Mothers with high economic hardship also had less stable health trajectories than mothers with low economic hardship. The findings highlight the importance of reconsidering the traditionally accepted postpartum recovery period of six weeks and extending benefits, such as paid maternity and sick leave, as well as stable yet flexible work schedules.

Breast milk expression and maintenance in mothers of very low birth weight infants: supports and barriers.

The study objective was to identify patterns of factors that supported or hindered initiation of breast milk expression and maintenance of breast milk production after the birth of a very low birth weight (VLBW) infant in a sample of US women with varied prenatal infant feeding intentions. In-depth interviews were conducted 1 to 6 months after delivery in 32 women who initiated breast milk expression after encouragement from hospital staff. Pregnancy complications, anxiety regarding their infant's health, and lack of privacy interfered with initiation of milk expression. After hospital discharge, using manual or small electric breast pumps, travel to the neonatal intensive care unit, return to work, and difficulty with time management interfered with maintenance of breast milk production. Family support, positive attitudes toward pumping, and anticipation of breastfeeding supported maintenance of breast milk production. From these data emerge points of intervention where additional support could improve mothers' experiences and increase duration of breast milk feeding.

Individual and job-related variation in infant feeding practices among working mothers.

OBJECTIVE: To document working mothers' infant feeding practices and delineate factors that may shape infant feeding. METHODS: Cross-sectional data were obtained from a community sample of working women with 8-month old infants (n=199). RESULTS: Nearly all working mothers used commercially prepared foods like infant cereals, fruits, and vegetables. Approximately one-fifth fed infants french fries, sweetened beverages, and sweetened desserts. Unhealthy infant feeding was elevated among unmarried mothers, those with less education, and those with a nonstandard work schedule. CONCLUSIONS: Working mothers use commercially prepared foods for infant feeding. Socially disadvantaged working mothers' infant feeding may pose health and developmental risks.

Characteristics of mother-provider interactions surrounding postpartum return to work.

BACKGROUND: Many mothers with infants work full-time, yet little is known about communication between women and health care providers regarding returning to work (RTW). METHODS: Survey data were obtained from a community-based sample of mothers returning to full-time employment within 4 months postpartum. Bivariate analyses (chi(2) and independent sample t tests) and multivariate logistic regressions were specified. RESULTS: Eighty-three percent of mothers believed prenatal providers should discuss RTW, yet only 60% had such a discussion; 58% discussed RTW with their infants' provider. Black women (odds ratio, 2.6) and women in poverty (odds ratio, 3.6) more often reported having an RTW discussion with a prenatal provider whereas mothers with college degrees or higher (odds ratio, 2.7) more often had RTW discussions with their infant's provider. RTW discussions occurred < or =3 times and were felt to be only somewhat useful. RTW discussions infrequently centered on maternal health (19.5%) or infant health or development (35.5%). CONCLUSIONS: Women want providers to initiate RTW discussions. Providers should be aware that race, poverty status, and level of maternal education impact a mother's odds of having an RTW discussion. Additional research is required to further delineate the content of RTW discussions and to determine the clinical value of RTW discussions.

Nonstandard maternal work schedules during infancy: implications for children's early behavior problems.

This paper examines the associations between maternal nonstandard work schedules during infancy and children's early behavior problems, and the extent to which infant temperament may moderate these associations. Hypothesized associations were tested using data from the National Institute of Child Health and Human Development (NICHD) Study of Early Child Care (Phase I). Analyses focused on mothers who returned to work by the time the child was 6 months of age, and who worked an average of at least 35h per week from 6 through 36 months. At 24 and 36 months, children whose mothers worked a nonstandard schedule had higher internalizing and externalizing behaviors. Modest, albeit inconsistent, evidence suggests that temperamentally reactive children may be more vulnerable to maternal work schedules. Maternal depressive symptoms partially mediated associations between nonstandard maternal work schedules and child behavior outcomes.