Gender minority (GM) populations encompass individuals who identify with a gender different from their sex assigned at birth. This includes transgender adults, which make up 0.6% of the U.S. population. Despite cardiovascular disease being the leading cause of morbidity and mortality worldwide, there is little research on the cardiovascular health of GM populations. GM adults may be at higher risk for myocardial infarction, coronary heart disease, and stroke compared to their cisgender peers due to minority stress and the impact of stigma on health. The Behavioral Risk Factor Surveillance System (BRFSS) is a federal survey administered by state health departments and the CDC. The BRFSS has offered an optional standardized Sexual Orientation and Gender Identity (SOGI) module with measures to identify transgender respondents since 2014 and 30 states included the module in 2019. Life’s Simple 7 criteria are used in preventive medicine and public health to describe ideal cardiovascular health. The seven associated risk factors are smoking, obesity, physical inactivity, poor dietary habits, high cholesterol, high blood pressure, and high blood glucose. The 2019 BRFSS included core modules related to each of the risk factors and therefore provides a unique opportunity to investigate the cardiovascular health of GM respondents. BRFSS data (N = 177,322) were used to determine prevalence rates of cardiovascular risk factors and disease among GM compared to cisgender adults. R was used to conduct weighted estimates and regressions comparing behavioral and clinical cardiometabolic risk factors and events by gender identity (cisgender male, cisgender female, transgender male-to-female, transgender female-to-male, and transgender gender nonconforming). On average, GM respondents were younger, more racially/ethnically diverse, less likely to have graduated college, less likely to be straight, and reported lower annual household incomes than cisgender males or females. After adjusting for age, race/ethnicity, education, income, and sexual orientation, gender nonconforming transgender adults were less likely than both cisgender males (adjusted odds ratio = 1.17, 95% confidence interval: (1.02, 1.34)) and cisgender females (1.15 (1.00, 1.32)) to report exercise in the last 30 days. Gender nonconforming transgender adults were less likely to report a diagnosis of diabetes than cisgender males (0.97 (0.94, 1.00)). No significant differences between gender minority and majority adults were detected for cardiovascular events after adjusting for demographic variables and Life’s Simple 7 risk factors. This may be due to the age difference between the cisgender and GM groups, since older adults have higher risk of cardiovascular disease. Analyses may have been underpowered due to small GM sample sizes, emphasizing the importance of all states including the optional standardized SOGI module.
ABSTRACT Background Wearable activity monitors offer clinicians and researchers accessible, scalable, and cost-effective tools for continuous remote monitoring of functional status. These technologies complement traditional clinical outcome measures by providing detailed, minute-by-minute remote monitoring data on a wide array of biometrics that include, as examples, physical activity and heart rate. There is significant potential for the use of these devices in rehabilitation after stroke; however, the perceptions of persons with stroke regarding the acceptance of these devices are not well understood. Objective In this study, we investigated the participant-reported acceptance of a wrist-worn wearable activity monitor (the Fitbit Inspire 2) for remote monitoring of daily activity and heart rate in persons with stroke. We also assessed potential relationships between reported acceptance and real-world device wear. Methods Sixty-five participants with stroke wore a Fitbit Inspire 2 for three months. We assessed the perceived acceptance of the devices using the Technology Acceptance Questionnaire (TAQ) and calculated metrics of adherence to device wear in the three weeks preceding TAQ administration. We then also performed Spearman’s correlations to assess relationships between responses on the TAQ and adherence metrics. Results In their responses to statements on the TAQ, most participants reported the device to be generally beneficial for their health, efficient for monitoring their health, easy to use and don/doff, and unintrusive to daily life; participants reported generally agreeable responses across all seven dimensions of the TAQ, indicating general acceptance of the device. Participants wore the Fitbit for an average of 80.0% of daily minutes (median: 91%, IQR: 22%) and had 78.0% valid wear days (median: 90%, IQR: 33%). Contrary to our hypothesis, TAQ responses showed no significant positive correlations with adherence metrics. Conclusions Our study highlights the perceived acceptance of the Fitbit Inspire 2 among persons with stroke, with participants reporting agreement across all seven TAQ dimensions and no significant concerns interpreted as being directly relatable to post-stroke motor impairment (e.g., minimal concerns about donning and doffing devices, using the device independently). These findings align with previous studies on wearable technology acceptance in other populations and support the potential for scalable implementation of these devices in stroke rehabilitation. However, monitoring of wearable device adherence is required despite the high reported acceptance, as perceived acceptance was not positively related with adherence to wearing the device. Accordingly, technologies capable of automated monitoring and management of device wear will be important for scalability of these technologies in larger clinical and research use cases. In summary, this study provides new insights into the perceived acceptance of wearable activity monitors among persons with stroke and their association with real-world adherence to device use.
Reaching and grasping are often completed while walking, yet the interlimb coordination required for such a combined task is not fully understood. Previous studies have produced contradictory evidence regarding preference for support of the lower limb ipsilateral or contralateral to the upper limb when performing a reaching task. This coordinative aspect of the combined task provides insight into whether the two tasks are mutually modified or if the reach is superimposed upon normal arm swinging. Collectively, 18 right-handed young adults walked slower, took shorter steps, and spent more time in double support during the combined task compared with walking alone. The peak grasp aperture was larger in walking reach-to-grasp trials compared with standing trials. There was not a strong trend for lower limb support preferences at the reach initiation or object contact. The participants could begin walking with either foot and demonstrated variability of preferred gait initiation patterns. There was a range of interlimb coordination patterns, none of which could be generalized to all young adults. The variability with which healthy right-handed young adults execute a combined walking reach-to-grasp task suggests that the cyclical (walking) and discrete (prehension) motor tasks may have separate motor control mechanisms, as proposed in the two primitives theory.
Abstract Introduction: To better understand and prevent research errors, we conducted a first-of-its-kind scoping review of clinical and translational research articles that were retracted because of problems in data capture, management, and/or analysis. Methods: The scoping review followed a preregistered protocol and used retraction notices from the Retraction Watch Database in relevant subject areas, excluding gross misconduct. Abstracts of original articles published between January 1, 2011 and January 31, 2020 were reviewed to determine if articles were related to clinical and translational research. We reviewed retraction notices and associated full texts to obtain information on who retracted the article, types of errors, authors, data types, study design, software, and data availability. Results: After reviewing 1,266 abstracts, we reviewed 884 associated retraction notices and 786 full-text articles. Authors initiated the retraction over half the time (58%). Nearly half of retraction notices (42%) described problems generating or acquiring data, and 28% described problems with preparing or analyzing data. Among the full texts that we reviewed: 77% were human research; 29% were animal research; and 6% were systematic reviews or meta-analyses. Most articles collected data de novo (77%), but only 5% described the methods used for data capture and management, and only 11% described data availability. Over one-third of articles (38%) did not specify the statistical software used. Conclusions: Authors may improve scientific research by reporting methods for data capture and statistical software. Journals, editors, and reviewers should advocate for this documentation. Journals may help the scientific record self-correct by requiring detailed, transparent retraction notices.
Many individuals with chronic stroke demonstrate contracture of the elbow flexors. The development of contracture may be attributable to underlying impairments such as weakness, flexion synergy, and hyperactive reflexes. This study explored differences in motor impairment and function between 17 individuals with clinically detectable elbow flexor contracture and 17 individuals with full passive range of motion. The groups did not differ in age (61.61 ± 7.99, 55.06 ± 12.48, p = 0.078), years post-stroke (12.92 ± 9.34, 10.60 ± 7.16, p = 0.423), or Fugl-Meyer Motor Assessment score (FMA, 26.35 ± 5.86, 26.47 ± 8.70, p = 0.963). The passive range limitation in the contracture group was 3 to 36° (11.65 ± 8.30°). Kinetics, kinematics, and EMG were used to quantify four motor impairments and reaching function. Shoulder abduction and elbow extension strength were measured isometrically and normalized to the unaffected side. Flexion synergy was quantified as a force-based measure assessing independent joint control. Flexor spasticity was quantified while reaching at 50% of maximum shoulder abduction as the change in biceps EMG from reach onset to peak angular velocity, normalized by maximal EMG activity. Reaching function was defined as maximum reaching distance against gravity and normalized by target distance (-10° of full extension). The groups differed in elbow extension strength (Contracture, 0.315 ± 0.129; No contracture, 0.559 ± 0.153; p < 0.001) and flexion synergy (0.146 ± 0.186, 0.397 ± 0.229, p = 0.009). The groups did not differ in shoulder abduction strength (0.500 ± 0.174, 0.615 ± 0.199, p = 0.080), flexor spasticity (0.079 ± 0.090, 0.056 ± 0.115, p = 0.523), or reaching function (0.501 ± 0.391, 0.714 ± 0.296, p = 0.082). The findings of this study suggest a relationship between elbow contracture and the concurrent presence of elbow extension weakness and flexion synergy. The quantitative measure of reaching function will likely differentiate individuals with and without contracture if the assessment is modified so that the standardized reaching target is located at 0° of elbow extension (normal range). Future research should use quantitative metrics to further explore the temporal recovery of impairments in order to prevent the development of contracture.
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