The Effect of Iron Supplements on the Gut Microbiome of Females of Reproductive Age: A Randomized Controlled Trial

BACKGROUND

Iron deficiency is the most common nutritional deficiency worldwide, particularly for young children and females of reproductive age. Although oral iron supplements are routinely recommended and generally considered safe, iron supplementation has been shown to alter the fecal microbiota in low-income countries. Little is known about the effect of iron supplementation on the fecal microbiota in high-income settings.

OBJECTIVES

To assess the effect of oral iron supplementation compared with placebo on the gut microbiome in nonpregnant females of reproductive age in a high-income country.

METHODS

A 21-d prospective parallel design double-blind, randomized control trial conducted in South Australia, Australia. Females (18-45 y) were randomly assigned to either iron (65.7 mg ferrous fumarate) or placebo. Fecal samples were collected prior to commencing supplements and after 21 d of supplementation. The primary outcome was microbiota β-diversity (paired-sample weighted unique fraction metric dissimilarity) between treatment and placebo groups after 21 d of supplementation. Exploratory outcomes included changes in the relative abundance of bacterial taxa.

RESULTS

Of 82 females randomly assigned, 80 completed the trial. There was no significant difference between the groups for weighted unique fraction metric dissimilarity (mean difference: 0.003; 95% confidence interval: -0.007, 0.014; P = 0.52) or relative abundance of common bacterial taxa or Escherichia-Shigella (q > 0.05).

CONCLUSIONS

Iron supplementation did not affect the microbiome of nonpregnant females of reproductive age in Australia. This trial was registered at clinicaltrials.gov as NCT05033483.

Building Community and Identity Online: A Content Analysis of Highly Viewed #Autism TikTok Videos

Background

TikTok is a popular social media site for connecting with others online where many users also access and share health-related information. Previous studies have characterized information shared about specific disabilities on TikTok, but descriptions of autism-related content are lacking. Understanding the information shared about autism on TikTok is important to understanding health communication in this space, the lived experiences of autistic people, and the role that social media platforms play in building community through connection, understanding, and inclusion.

Methods

We used an open-source data scraper to identify and download videos with at least 1 million views and that used the hashtag #autism from TikTok. Using a joint inductive and deductive approach, we performed a content analysis of videos. We identified six content topics that described video content (e.g., positive social interactions and features of autism), and three categories that described video purpose (e.g., educational, experiential, and observational). We used descriptive statistics to describe characteristics of who was in the TikTok videos.

Results

We analyzed n = 678 videos. The most common content topic of TikTok videos was features of autism (39.7%), followed by marginalization (25.4%). Most videos were categorized as experiential (61.4%) or observational (31.4%) rather than educational (7.2%). Approximately 65.5% of videos featured an autistic adult and 22.6% featured an autistic child. Among videos featuring an autistic person (n = 594), most autistic people were perceived to be White (87.0%) with similar numbers of feminine (52.9%) and masculine (44.8%) presenting autistic people.

Conclusions

Highly viewed #autism TikTok videos primarily share autistic people's individual experiences rather than providing general education about autism. However, autistic Black, Indigenous, and people of color may have difficulty finding others that represent them along both disability and racial dimensions. Future research should investigate autistic people's motivations for using TikTok, and how #autism content shapes social discourse about autism.

Cervical Spinal Cord Stimulation for Failed Neck Surgery Syndrome

PURPOSE OF REVIEW

Cervical spine pain with or without radicular symptoms is a common condition leading to high utilization of the healthcare system with over 10 million medical visits per year. Many patients undergo surgical interventions and unfortunately are still left with neck and upper extremity pain, sometimes referred to as "Failed Neck Surgery Syndrome." When these options fail, cervical spinal cord stimulation can be a useful tool to decrease pain and suffering as well as reduce prescription medication use.

RECENT FINDINGS

Spinal cord stimulation is a well-established therapy for chronic back and leg pain and is becoming more popular for neck and upper extremity pain. Recent studies have explored cervical spinal cord stimulation with successful outcomes regarding improved pain scores, functional outcomes, and reduction of prescription medication use. Continued research into cervical spinal cord stimulation is essential for maximizing its therapeutic potential for patients with chronic neck and upper extremity pain. This review highlights the importance of cervical spinal cord stimulation as an option for patients with failed neck surgery syndrome.

The Effect of Iron Supplements on the Gut Microbiome of Non-pregnant Women of Reproductive Age: A Randomized Controlled Trial

Objectives

Blanket iron supplementation during pregnancy is not recommended in Australia. However, many women take iron as part of a prenatal supplement, often at doses >60 mg/day. Iron supplementation may negatively affect the maternal intestinal microbiome by increasing the abundance of pathogenic bacteria and decreasing commensal bacteria. It is not known if iron supplements alter the microbiome of pregnant women. Here we aim to determine if iron supplementation alters the gut microbiome of non-pregnant women of childbearing age.

Methods

In this two-arm parallel design, double-blind, randomized controlled trial, women (18–45 y) were randomized to take an iron supplement (60 mg elemental iron) or a placebo capsule for 21 days. The primary outcome was microbiota beta-diversity (paired-sample weighted UniFrac dissimilarity) between iron and placebo groups in stool samples collected at baseline and 21 days. A secondary outcome was to determine the effect of iron on Escherichia-Shigella genus relative abundance.

Results

Eighty-two women were randomized, 40 and 42 to iron and placebo groups, respectively. Attrition was < 3% (n = 2) and 97% of women took >80% of their study supplements. On Day 21, there was no difference in mean (95% CI) weighted UniFrac between iron and placebo groups [0.003 (−1.4, 0.7) P = 0.52]. There was no difference in the relative abundance of Escherichia-Shigella after 21 days between groups.

Conclusions

For the outcomes we assessed, we did not find an effect of iron supplementation on the microbiome in non-pregnant women. Studies should be carried out in pregnant women, particularly in settings where water and sanitation are poor, and the natural abundance of pathogenic bacteria is higher.

Funding Sources

South Australian Health and Medical Research Institute, Seed Funding Grants for Early/Mid-Career Researchers.

Estrogen May Enhance Toll-Like Receptor 4-Induced Inflammatory Pathways in People With HIV: Implications for Transgender Women on Hormone Therapy

Background

Transgender women (TW) are at increased risk for both human immunodeficiency virus (HIV) and cardiovascular disease (CVD). Antiretroviral therapy-treated HIV has been associated with a two-fold increased risk of CVD, potentially due to dysregulated Toll-like receptor (TLR)-induced immune activation. Use of estrogens in feminizing hormone therapy (FHT) may enhance inflammatory responses and the risk of cardiovascular mortality in TW. Despite this, the immunomodulatory effects of estrogen use in TW with HIV have been inadequately explored.

Methods

As an in vitro model for FHT, cryopreserved PBMCs (cryoPBMCs) from HIV negative (HIV-), HIV+ ART-suppressed (HIV+SP), and HIV+ ART-unsuppressed (HIV+USP) cisgender men were cultured overnight in the presence of 17-β estradiol or 17-α ethinylestradiol with and without the TLR4 agonist LPS or the TLR8 agonist ssPolyU. Monocyte activation (CD69, HLA-DR, CD38) was assessed by flow cytometry. Cytokine levels (IL-6, TNF-α, IL-1β, and IL-10) were measured in cell culture supernatants by Legendplex. Levels of phosphorylated TLR signaling molecules (JNK, MAPK p38) were assessed by Phosflow. Plasma levels of immune activation biomarkers (LPS-binding protein, monocyte activation markers sCD14 and sCD163, and inflammatory molecules IL-6 and TNF-α receptor I) were measured by ELISA.

Results

PBMCs from people with HIV (PWH) produced greater levels of inflammatory cytokines following exposure to LPS or ssPolyU compared to levels from cells of HIV- individuals. While estrogen exposure alone induced mild changes in immune activation, LPS-induced TLR4 activation was elevated with estrogen in cisgender men (CM) with HIV, increasing monocyte activation and inflammatory cytokine production (IL-6, TNF-α). Interestingly, testosterone inhibited LPS-induced cytokine production in CM regardless of HIV status. Plasma markers of immune activation and microbial translocation (e.g., sCD14, sCD163, LPS-binding protein) were generally higher in PWH compared to HIV- CM, and these markers were positively associated with in vitro responsiveness to estrogen and LPS in CM with HIV.

Conclusions

Our in vitro data suggest that estrogen exposure may enhance innate immune activation in PWH. Further examination is needed to fully understand the complex interactions of FHT, HIV, and CVD in TW, and determine optimal FHT regimens or supplementary treatments aimed at reducing excess immune activation.

Considering Domain-Specific Experiential Learning: Self-Efficacy in Pediatric Physical Therapy Education

BACKGROUND

Variability exists in pediatric training in physical therapy programs. Little is known about educator implementation of curriculum recommendations. Few options exist for evaluating student outcomes following pediatric instruction.

PURPOSE

The purposes of this study are to describe the pediatric curriculum of a physical therapy program, quantify changes in self-efficacy following pediatric instruction, and define relationships between self-efficacy, prior experience, and interest in future pediatric practice.

METHODS

A prospective cohort study included 48 students. Measures were pediatric content hours, the Pediatric Communication and Handling Self-Efficacy Scale, prior experience, and self-reported interest in future pediatric practice.

RESULTS

Pediatric content hours followed published recommendations. There was a significant increase in self-efficacy after pediatric instruction. Prior experience and interest in future pediatric practice were significantly related to self-efficacy.

CONCLUSIONS

Our results indicate that physical therapy programs reaching the recommended content hours for pediatric instruction support growth in student communication and handling self-efficacy.

The Need for OT in Promoting Sexual Health for Individuals With Intellectual and Developmental Disabilities (IDD): A Sexually Transmitted Infections (STI) Prevalence Study

Date Presented 04/04/19

A cross-sectional analysis of billing records for privately insured individuals with and without IDD from across the US was conducted to determine the prevalence of STI and STI testing among individuals with IDD. Our results speak to the need for increased STI testing in this population. OT practitioners have a unique role in promoting sexual and reproductive health and safety for this population.

Primary Author and Speaker: Elizabeth Schmidt

Additional Authors and Speakers: Brittany Hand

Contributing Authors: Amy Darragh, Kit Simpson

Abstract 102: NIHSS Lacks Validity and Sensitivity in Postacute Stroke

Stroke remains a leading cause of disability, with those affected usually experiencing long-term motor deficits. The National Institutes of Health Stroke Scale (NIHSS) is commonly used to measure acute neurological status, but recently is being deployed in at least 29 chronic stroke trials as a secondary UE motor outcome despite a lack of evidence surrounding its validity in chronic stroke. The purpose of this secondary, retrospective analysis of randomized controlled, multicenter, trial data was to (a) determine the NIHSS’s association with the Stroke Impact Scale (SIS), a poststroke health status measurement, the upper extremity Fugl Meyer (UEFM) and the Arm Motor Ability Test (AMAT), measures of upper extremity (UE) impairment and functional limitation and (b) determine the NIHSS’s sensitivity to UE motor change over time . There was no association between total NIHSS scores and SIS physical dimension, overall perception of recovery, activity of daily living scores ( P = -.036, P = .782; P = -.039, P = .640; P = -.054, P 5.520, respectively) or functional limitation ( P; = –0.141; P; = 0.089 ). NIHSS and UE impairment associations were significant ( P; = –0.204; P; = 0.014 ) but explained less than 4% of the variance among UEFM scores. Subjects scoring a “zero” on the NIHSS exhibited discernible UE motor deficits and varied scores on the UEFM, AMAT, and SIS. A statistically significant sensitivity to change was found for the UEFM ( χ 2 (3) = 10.783, p = 0.013 ), but not for NIHSS ( X 2 (3) = 1.250, p = 0.741 ) or either AMAT functional ability or quality of movement scores ( χ 2 (3) = 3.953, p = 0.267; χ 2 (3) = 4.199, p = 0.241, respectively ). There was a significant weak, negative correlation between the NIHSS and UEFM ( r s (47) = -.325, p = .026 ), but nonsignificant weak, negative correlations between the NIHSS and either AMAT scores ( r s (47) = -.051, p = .740; r s (47) = -.103, p = .489, respectively ). While being increasingly used in postacute trials, the NIHSS’s weak correlation with measures of motor impairment, functional limitation, and health status measurements as well as its insensitivity to change suggest that its use be reserved to acute bedside status. Its utility as a predictor of real world UE motor outcomes has been purported and is currently under investigation as a next step.

Latent Constructs Underlying Sensory Subtypes in Autism: An Independent-Component Analysis

Date Presented 4/8/2016

The present study asserts a novel theoretical framework of three core sensory dimensions (sensory reactivity, multisensory integration, and perception) to guide future research and clinical practice on sensory features in autism spectrum disorder.

Primary Author and Speaker: Brittany Hand

Contributing Authors: Simon Dennis, Elysa Marco, Alison E. Lane

Discriminating Sensory Subtypes: A Multigroup, Multidimensional Item Response Theory Analysis

Date Presented 4/7/2016

Item Response Theory analyses revealed that some items on the Short Sensory Profile are highly informative in determining sensory subtypes. It may be possible to identify sensory subtypes using a reduced number of items, thereby improving the clinical utility of subtyping for assessing and describing sensory difficulties.

Primary Author and Speaker: Brittany Hand

Contributing Authors: Alison E. Lane, Elysa Marco, Paul De Boeck

Intervention Fidelity Measures in Rehabilitation: A Systematic Review

Date Presented 4/7/2016

A systematic review was conducted to elucidate the reliability and validity of existing rehabilitation intervention fidelity measures (RIFMs). Strengths and weaknesses of 6 RIFMs are discussed. The authors propose steps for the development of novel RIFMs.

Primary Author and Speaker: Brittany Hand

Contributing Authors: Amy R. Darragh, Andrew C. Persch

The implementation of problem-based learning: changing pedagogy in nurse education

Problem-based learning (PBL) employs approaches to teaching and learning in nurse education that develop meaningful links between theory and practice. The adoption of such approaches, however, may require changes in pedagogical beliefs and practices which reflect a student-centred approach to teaching and learning. This paper focuses on a group of volunteer nurse educators (n = 14) who attended a 7-month professional development programme centred on introducing pedagogical changes when adopting PBL. From this group, three nurse educators participated in an in-depth study which aimed to examine the processes of conceptual change associated with adopting PBL as part of alternative teaching strategies. These three participants held common concerns about the changes required to their current teaching practices when moving to a new pedagogical approach. On completion of the programme, varying degrees of change in existing instructional practices were evident. This change was found to result from engaging educators in reflection about practice, providing opportunities to implement the new approaches on a trial basis, and providing feedback and support throughout the change process.

Problem-based learning in nurse education: an Australian view

This paper addresses the need to adopt teaching-learning approaches in nursing education that develop links between theory and clinical practice in a meaningful way. Problem-based learning (PBL) is such an approach and is gaining popularity in tertiary nursing programmes in Australia. PBL, as an example of the constructivist philosophy, focuses on students' existing knowledge as a starting point for conceptual change teaching. The implications for the nurse educator's role when using PBL are discussed in terms of assumptions about the nature of teaching and learning; conceptual change teaching; ability to focus; the role of negotiation; and the ability to analyse student learning. These factors are seen to be critical components of the pedagogy necessary for nurse educators to utilize PBL approaches effectively.

Determination of Maltol and Ethyl Maltol in Apple Juice by Gas-Liquid Chromatography

The qualitative and quantitative analysis of maltol and ethyl maltol in apple juice is described. The compounds were extracted with ethyl acetate and, after the addition of 2,6-dimethoxyphenol as internal standard, they were analyzed by gas-liquid chromatography as such or as their trimethylsilyl derivatives. Recovery of maltol and ethyl maltol was dependent on the method of isolation and ranged from 92 to 97.5% in the method of choice