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Medicaid Price as well as Compensation pertaining to Low-Risk Prenatal Attention in the United States.
Meeting recommendations for vegetables & fruit, meat & alternatives, saturated fat, added sugar, and physical activity was associated with fewer ADHD diagnoses. Compared to children who met 1-3 recommendations, meeting 7-9 recommendations was associated with substantially lower incidence of ADHD and fewer physician visits related to ADHD (Hazard Ratio 0.42 [95%CI 0.28, 0.61]) (Rate Ratio0.38 [95%CI 0.22,0.65]). CONCLUSION Lifestyle recommendations exist to benefit development and physical health. Their promotion comes at no harm and may have benefits for ADHD. Experimental evidence is needed to clarify the potential bidirectional relationship between ADHD and adverse health behaviors.BACKGROUND Serological tests can distinguish recent (in the prior 12 months) from long-term HIV infection. Integrating recency testing into routine HIV testing services (HTS) can provide important information on transmission clusters and prioritize clients for partner testing. This study assessed the feasibility and utility of integrating HIV recency into routine testing. METHODS We conducted a multi-method study at fourteen facilities in Kenya, and key informant interviews with healthcare providers. We abstracted clinical record data, collected specimens, tested specimens for recent infection, returned results to participants, and conducted a follow-up survey for those recently infected. RESULTS From March to October 2018, we enrolled 532 clients who were diagnosed HIV positive for the first time. Of these, 46 (8.6%) were recently infected. Women aged 15- 24 years had 2.9 (95% CI, 1.46-5.78) times higher adjusted odds of recent infection compared to 15-24-year-old men and those tested within the past 12 months having 2.55 (95% CI .38-4.70) times higher adjusted odds compared to those tested ≥12 months previously. Fourteen of seventeen providers interviewed found the integration of receny testing into routine HTS services acceptable and feasible. Among clients who completed the follow up interview, majority (92%) felt that the recency results were useful. CONCLUSIONS Integrating recent infection testing into routine HTS services in Kenya is feasible and largely acceptable to clients and providers. More studies should be done on possible physical and social harms related to returning results, and the best uses of the recent infection data at an individual and population level.BACKGROUND Lack of organizational support in healthcare settings has been linked to high levels of clinician stress, burnout, and job dissatisfaction. Little research exists on organizational support for nurse practitioners. OBJECTIVE We investigated the relationship between organizational support and nurse practitioner outcomes, including job satisfaction, intent to leave, and quality of care. METHODS A cross-sectional survey design was used to collect survey data from nurse practitioners (n = 398) in primary care practices in New York State in 2017. Nurse practitioners completed mail surveys with validated measures of organizational support, job satisfaction, intent to leave, and quality of care. Information on participant demographics and work characteristics was also collected. Multilevel regression models assessed the relationship between organizational-level organizational support and resources measure and job satisfaction, intent to leave, and quality of care. RESULTS The organizational-level organizatdings are consistent with existing literature regarding the relationship between organizational support and clinician outcomes.BACKGROUND Death by suicide is the second leading cause of death among adolescents globally. Healthy People 2020 set a goal to reduce by 10% the rate of suicide attempts that required treatment and designated the Youth Risk Behavior Survey (YBRS) to measure this objective. OBJECTIVES This study used cross-sectional YBRS data (2009-2017) to investigate whether (a) gender moderates the linear time trend for the rate of depressive symptoms, suicidal ideation, and suicide attempts among high school students within the United States; (b) to estimate these same measures stratified by gender; and (c) to investigate whether the Healthy People 2020 goal for reduction in suicide attempts was met in 2017 for males and females. METHOD Secondary analysis of nationally representative high school students using YBRS data 2009-2017 were analyzed using R and the R survey package. Based upon Strengthening the Reporting of Observational Studies in Epidemiology guidelines, additive interactions using rate difference were compared to multiplicative interactions using odds ratios. RESULTS Additive interactions were identified between female gender and linear trends for depressive symptoms, suicidal ideation, and suicide attempts requiring treatment. Females, but not males, had positive linear trends for depressive symptoms, suicidal ideation, and suicide attempts requiring treatment. Suicide attempts requiring treatment among females was 36% higher in 2017 than in 2009 but decreased 13% in males during the same period. DISCUSSION The Healthy People 2020 goal to reduce suicide requiring treatment by 10% has not been met among females. The divergent trends by gender highlight the importance of surveillance measures by gender. Future research is needed to identify better suicide prevention strategies that address underlying factors and are gender specific.Exercise intolerance is an objective biomarker of the physiological dysfunction after sport-related concussion (SRC). Several trials have established the safety and clinical efficacy of subsymptom threshold aerobic exercise prescribed within 1 week of injury as treatment for SRC. Clinicians, however, may not be comfortable prescribing aerobic exercise after SRC. This article presents 3 methods of exercise prescription for patients with SRC. The first requires a graded exertion test plus a home-based exercise program requiring a heart rate (HR) monitor. The second requires a graded exertion test but no HR monitor for home-based exercise. EN4 mouse The third requires solely an HR monitor to safely progress through the home-based exercise prescription. Patients are encouraged to keep a symptom and exercise diary and return for re-evaluation every 1 to 2 weeks. Delayed recovery should prompt the clinician to evaluate for other potential symptom generators (eg, cervical, vestibular, oculomotor, mood, or migraine disorders).We present 2 cases where the initial history and examination were similar to a Morton's/interdigital neuroma. In both cases, however, diagnostic ultrasound revealed symptomatic snapping of the proper digital nerve of the fifth toe. The anatomy of the proper digital nerve of the fifth toe may predispose it to a snapping phenomenon. Clinical awareness of this atypical cause of forefoot pain can help guide the diagnosis and treatment in those patients with persistent and refractory lateral forefoot pain and paresthesias.OBJECTIVE To investigate the impact of pediatric mild traumatic brain injury (mTBI), using a broad parent-reported measure, and to determine whether parent-ratings of mTBI symptoms are higher among those with premorbid attention-deficit/hyperactivity disorder (ADHD) and females. DESIGN Retrospective case-control. SETTING Hospital-based sports medicine clinic. PARTICIPANTS The retrospective chart review included 1346 (age M = 13.11 years, SD = 2.6; 61.7% male) pediatric patients with (n = 209) and without (n = 1137) ADHD. INDEPENDENT VARIABLES Group membership (ADHD vs non-ADHD) and sex (male vs female). MAIN OUTCOME MEASURES Baseline and current Post-Concussion Symptom Inventory-Parent Report Form (PCSI-P) Physical, Emotional, Cognitive, and Fatigue subscale scores. This study used a retrospective chart review; therefore, the hypotheses reported for the current study were formed after data were collected. RESULTS Controlling for patient age and days from mTBI, patients with ADHD had significantly higher retrospective parent-reported pre-mTBI ratings of physical, emotional, and cognitive symptoms (ds = 0.17-0.62) and higher post-mTBI ratings across all 4 symptom domains (ds = 0.18-0.57) than those without ADHD. There was no group × time interaction for any of the PCSI-P subscales. Females overall had higher retrospective parent-reported pre-injury Fatigue and Emotional symptoms (ds = 0.13-0.19) and higher post-mTBI symptoms in all 4 PCSI-P symptom domains (ds = 0.23-0.35), relative to males. CONCLUSIONS Attention-deficit/hyperactivity disorder-related postinjury exacerbations in parent-reported symptoms can be explained, in part, by elevated retrospective parent-reported ADHD-related pre-mTBI ratings. These results highlight the importance of assessing a patient's baseline symptoms post-mTBI. These data also indicate that ADHD status and sex should be considered when interpreting mTBI symptom severity during clinical evaluation of concussion.OBJECTIVE To identify whether a single session of postrace dry needling can decrease postrace soreness and quantity of postrace leg cramps in half-marathon and full-marathon runners. DESIGN Single-blind, prospective, randomized, controlled trial. SETTING Finish line of 2018 Salt Lake City Marathon & Half-Marathon. PARTICIPANTS Runners aged 18 years or older who completed a marathon or half-marathon. INTERVENTIONS True or sham dry needling of the bilateral vastus medialis and soleus muscles within 1 hour of race completion by 2 experienced practitioners. MAIN OUTCOME MEASURES The primary outcome measure was numeric pain rating improvements for soreness on days 1, 2, 3, and 7 compared to immediately postrace. Secondary outcome measures included number of postrace cramps and subjective improvement of soreness. RESULTS Sixty-two runners were included with 28 receiving true and 34 receiving sham dry needling. Objective pain scores showed an increase in pain of the soleus muscles at days 1 and 2 (P ≤ 0.003 and P ≤ 0.041, respectively) in the dry needling group. No differences were seen in postrace pain in the vastus medialis muscles (P > 0.05). No association was seen between treatment group and presence of postrace cramping at any time point (P > 0.05). Subjectively, there was a nonsignificant trend for those receiving dry needling to feel better than expected over time (P = 0.089), but no difference with cramping (P = 0.396). CONCLUSIONS A single postrace dry needling session does not objectively improve pain scores or cramping compared to sham therapy.OBJECTIVE To determine the psychological impact of a cardiovascular disease (CVD) diagnosis identified during preparticipation screening (PPS) of masters athletes. DESIGN Cross-sectional study. SETTING Masters athletes diagnosed with CVD through the Masters Athletes Screening Study. PARTICIPANTS Sixty-seven athletes (89.6% male, mean age at diagnosis 60.1 ± 7.1 years, range 40-76) with diagnoses of coronary artery disease (CAD) (73.1%), high premature ventricular contraction burden (9.0%), mitral valve prolapse (7.5%), atrial fibrillation (AF) (3.0%), bicuspid aortic valve (3.0%), aortic dilatation (1.5%), coronary anomaly (1.5%), and rheumatic heart disease (1.5%). Three participants had multiple diagnoses. INTERVENTION Online survey distributed to masters athletes identified with CVD. MAIN OUTCOME MEASURES Assessment of psychological distress [Impact of Event Scale-Revised (IES-R)], perceptions of screening, and preferred support by CVD type. RESULTS The median total IES-R and subscale scores were within the normal range median [interquartile range (IQR)] total 2.
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