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Category: Diabetes; Other Introduction/Purpose: Racial minorities, including African Americans, Indigenous Americans, Asian Americans, Hispanic/Latinos, and Pacific Islanders are more likely to develop Type II diabetes and experience associated microvascular complications. Amputation rates related to diabetes and/or peripheral arterial disease are three times higher for African Americans, suggesting that race, access, and/or mistrust of the medical community may contribute to adverse outcomes for certain minority groups. Determining where the breakdown along the care continuum occurs is fundamental for achieving equitable outcomes among minority groups. This retrospective study was designed to determine 1) the associations of race and living status with rates of referral to specialists for DFU treatment, and 2) the severity of DFU at time of initial presentation. Methods: Patients were identified from the medical record based on a diagnosis related to diabetic foot ulcers made between January 01, 2018, and June 01, 2023, in the family medicine clinic, endocrinology clinic, or emergency department at a Midwest Level 1 Academic Hospital. Referral incidence to specialty orthopaedic foot clinic, severity at onset based on the Wagner ulcer scale, patient demographics, and National Area Deprivation Index (ADI) were analyzed. Results: 597 patients were eligible for inclusion. Patients seen in the Orthopaedic Specialty Clinic (n=98, 16.4%) were significantly younger (56.5 ± 10.9 years vs.61.1 ± 12.5, p< 0.001). Race was not associated with lower referral rates (p = 1) or source of referral (p = 0.68) to specialty clinic. Ulcer severity upon initial presentation did not differ based on race (p=0.318), however, all patients who initially presented to the emergency department (ED) had more severe ulcers (p = 0.016). Patients referred from the ED had lower National ADI scores (p=0.03). No significant differences in referral source or ulcer severity at presentation were seen for sex, rural status, or marital status, suggesting minority patients with diabetic foot ulcers are referred to specialists equally compared to non-minority patients. Conclusion: Patient race was not associated with decreased referral rate to specialty clinic for diabetic foot complications and ulcer severity at initial presentation. Patients with lower socioeconomic status relied on referrals from the ED, as opposed to their Primary Care Providers. Ubiquitous application of these findings may be limited given the breakdown of ethnic groups in the Midwest, and including other regions in a multicenter study would provide further incite.

Background: Racial minorities are more likely to develop type 2 diabetes and experience associated microvascular complications. Non-Hispanic Blacks and Hispanics initially present with more severe diabetic foot ulcers (DFUs) and peripheral artery disease (PAD), with an associated 10-fold increase in risk for lower extremity amputation within the first year after diagnosis. This study was designed to determine if race is associated with a failure to refer to specialists for DFU treatment, and the severity of DFU at the time of initial presentation. Methods: Patients were identified from the medical record based on a diagnosis related to diabetic foot complications between January 1, 2018, and June 1, 2023, in the family medicine, endocrinology, orthopaedic, or emergency clinics at a Midwest Academic Hospital serving rural and urban populations. Patients self-reported race, demographics, severity of ulcer based on Wagner ulcer scale at time of referral, eventual amputation status, and measures of social determinants of health including the national Area Deprivation Index (ADI) and Rural-Urban Commuting Area (RUCA) codes were manually extracted and analyzed for correlations with referral status. Results: A total of 597 patients were eligible for inclusion. Race was not associated with lower referral rates (P > .99) or source of referral (P = .58) to specialty clinic and ulcer severity at initial examination (P = .34). Patients who initially presented to the emergency department had more severe ulcers (P = .016), and higher severity was significantly associated with lower limb amputation vs mild ulcers (odds ratio = 38.8, P = .02). No significant differences in referral source or severity of ulcer at presentation were seen for sex, age, marital status, insurance type, rural status, ADI, time from referral to appointment, or eventual amputation. Conclusion: In this study, we found that patient race was not associated with severity of DFU at presentation or subsequent referral to a Midwest academic specialty orthopaedic clinic for care. Level of Evidence: Level III, retrospective review.

Category: Trauma; Ankle Introduction/Purpose: Syndesmotic injuries occur in 10% of ankle fractures. Restoration and maintenance of the distal tibiofibular stability is crucial. The literature regarding time to weight bearing is scarce, with the majority recommending greater than 6 weeks of non-weight bearing. No studies examine whether early weight bearing as tolerated is safe in syndesmotic injuries, and current early weight bearing studies after ankle fractures typically exclude syndesmotic injuries. Purpose: The purpose of this randomized controlled trial is to measure differences between early weight bearing at 2 weeks and delayed weight bearing at 6 weeks in terms of outcomes, hardware failure, and loss of reduction at 1 year. Methods: All rotational ankle fractures in patients over 18 were enrolled preoperatively. Only those who received syndesmotic fixation were randomized post-operatively to early vs delayed weight bearing. No fracture types were excluded. All syndesmotic fixation utilized suture buttons. A total of 39 patients were enrolled. Primary outcome was maintenance of reduction at 1 year comparing post-operative and 1 year CT scan of both ankles. Secondary outcomes included pain scores, surgical experience (SSQ-8), AAOS Foot and Ankle, range of motion, and complications. Data was analyzed using unpaired t-test and Fishers exact. Statistical significance was set at p < 0.05. Results: 16 patients were randomized to early weight bearing and 23 patients to delayed. The early weight bearing group had a significantly higher pain score (4.69 ± 2.84 vs 2.87 ± 2.31, p = 0.039) at the baseline 2 week visit. At 1 year, dorsiflexion in the early weight bearing group was significantly higher (14.2° ± 3.97° vs 7.71° ± 4.46°) than the delayed group (p = 0.017). There was no significant difference in syndesmotic malreduction, loss of reduction, pain scores, PROs, development of arthritis or complication rates at any other timepoint. Conclusion: Early weight bearing is safe following syndesmotic fixation in ankle fractures, at least in those receiving suture button fixation.

Self-critical perfectionism and stress have been implicated as risk factors for maladaptive academic outcomes (i.e., decreased academic self-efficacy, decreased academic self-concept, and increased academic burnout). The present study investigated a vulnerability-stress model, testing whether self-critical perfectionism moderates the relationship between stressor severity (academic and interpersonal) and academic outcomes. Exploratory analyses replaced self-critical perfectionism with rigid perfectionism in the model. A sample of 384 postsecondary students (76.8% women, average age: 20.06) completed a cross-sectional survey involving questionnaires assessing the constructs of interest. Stressor severity (both academic and interpersonal) was negatively associated with academic self-efficacy and academic self-concept and positively associated with academic burnout, when controlling for perfectionism. Self-critical perfectionism was positively associated with academic burnout, and rigid perfectionism was positively associated with academic self-concept, when controlling for stressor severity. None of the interaction effects were statistically significant, failing to support a vulnerability-stress model. Findings suggest that stressor severity (both academic and interpersonal) and self-critical perfectionism are strongly associated with maladaptive academic outcomes and may serve as risk factors for poor academic functioning. The lack of interaction effects suggests a vulnerability-stress model may not explain why perfectionism is associated with maladaptive academic outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved) (Source: journal abstract)

As of March 31, 2023, more than 30,000 monkeypox (mpox) cases had been reported in the United States in an outbreak that has disproportionately affected gay, bisexual, and other men who have sex with men (MSM) and transgender persons (1). JYNNEOS vaccine (Modified Vaccinia Ankara vaccine, Bavarian Nordic) was approved by the Food and Drug Administration (FDA) in 2019 for the prevention of smallpox and mpox via subcutaneous injection as a 2-dose series (0.5 mL per dose, administered 4 weeks apart) (2). To expand vaccine access, an Emergency Use Authorization was issued by FDA on August 9, 2022, for dose-sparing intradermal injection of JYNNEOS as a 2-dose series (0.1 mL per dose, administered 4 weeks apart) (3). Vaccination was available to persons with known or presumed exposure to a person with mpox (postexposure prophylaxis [PEP]), as well as persons at increased risk for mpox or who might benefit from vaccination (preexposure mpox prophylaxis [PrEP]) (4). Because information on JYNNEOS vaccine effectiveness (VE) is limited, a matched case-control study was conducted in 12 U.S. jurisdictions, including nine Emerging Infections Program sites and three Epidemiology and Laboratory Capacity sites, to evaluate VE against mpox among MSM and transgender adults aged 18-49 years. During August 19, 2022-March 31, 2023, a total of 309 case-patients were matched to 608 control patients. Adjusted VE was 75.2% (95% CI = 61.2% to 84.2%) for partial vaccination (1 dose) and 85.9% (95% CI = 73.8% to 92.4%) for full vaccination (2 doses). Adjusted VE for full vaccination by subcutaneous, intradermal, and heterologous routes of administration was 88.9% (95% CI = 56.0% to 97.2%), 80.3% (95% CI = 22.9% to 95.0%), and 86.9% (95% CI = 69.1% to 94.5%), respectively. Adjusted VE for full vaccination among immunocompromised participants was 70.2% (95% CI = -37.9% to 93.6%) and among immunocompetent participants was 87.8% (95% CI = 57.5% to 96.5%). JYNNEOS is effective at reducing the risk for mpox. Because duration of protection of 1 versus 2 doses remains unknown, persons at increased risk for mpox exposure should receive the 2-dose series as recommended by the Advisory Committee on Immunization Practices (ACIP), regardless of administration route or immunocompromise status.

The first U.S. case of COVID-19 attributed to the Omicron variant of SARS-CoV-2 (the virus that causes COVID-19) was reported on December 1, 2021 (1), and by the week ending December 25, 2021, Omicron was the predominant circulating variant in the United States.* Although COVID-19-associated hospitalizations are more frequent among adults, COVID-19 can lead to severe outcomes in children and adolescents (2). This report analyzes data from the Coronavirus Disease 19-Associated Hospitalization Surveillance Network (COVID-NET) to describe COVID-19-associated hospitalizations among U.S. children (aged 0-11 years) and adolescents (aged 12-17 years) during periods of Delta (July 1-December 18, 2021) and Omicron (December 19, 2021-January 22, 2022) predominance. During the Delta- and Omicron-predominant periods, rates of weekly COVID-19-associated hospitalizations per 100,000 children and adolescents peaked during the weeks ending September 11, 2021, and January 8, 2022, respectively. The Omicron variant peak (7.1 per 100,000) was four times that of the Delta variant peak (1.8), with the largest increase observed among children aged 0-4 years. During December 2021, the monthly hospitalization rate among unvaccinated adolescents aged 12-17 years (23.5) was six times that among fully vaccinated adolescents (3.8). Strategies to prevent COVID-19 among children and adolescents, including vaccination of eligible persons, are critical.*.

In mid-June 2021, B.1.671.2 (Delta) became the predominant variant of SARS-CoV-2, the virus that causes COVID-19, circulating in the United States. As of July 2021, the Delta variant was responsible for nearly all new SARS-CoV-2 infections in the United States.* The Delta variant is more transmissible than previously circulating SARS-CoV-2 variants (1); however, whether it causes more severe disease in adults has been uncertain. Data from the CDC COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance system for COVID-19-associated hospitalizations, were used to examine trends in severe outcomes in adults aged ≥18 years hospitalized with laboratory-confirmed COVID-19 during periods before (January-June 2021) and during (July-August 2021) Delta variant predominance. COVID-19-associated hospitalization rates among all adults declined during January-June 2021 (pre-Delta period), before increasing during July-August 2021 (Delta period). Among sampled nonpregnant hospitalized COVID-19 patients with completed medical record abstraction and a discharge disposition during the pre-Delta period, the proportion of patients who were admitted to an intensive care unit (ICU), received invasive mechanical ventilation (IMV), or died while hospitalized did not significantly change from the pre-Delta period to the Delta period. The proportion of hospitalized COVID-19 patients who were aged 18-49 years significantly increased, from 24.7% (95% confidence interval [CI] = 23.2%-26.3%) of all hospitalizations in the pre-Delta period, to 35.8% (95% CI = 32.1%-39.5%, p<0.01) during the Delta period. When examined by vaccination status, 71.8% of COVID-19-associated hospitalizations in the Delta period were in unvaccinated adults. Adults aged 18-49 years accounted for 43.6% (95% CI = 39.1%-48.2%) of all hospitalizations among unvaccinated adults during the Delta period. No difference was observed in ICU admission, receipt of IMV, or in-hospital death among nonpregnant hospitalized adults between the pre-Delta and Delta periods. However, the proportion of unvaccinated adults aged 18-49 years hospitalized with COVID-19 has increased as the Delta variant has become more predominant. Lower vaccination coverage in this age group likely contributed to the increase in hospitalized patients during the Delta period. COVID-19 vaccination is critical for all eligible adults, including those aged <50 years who have relatively low vaccination rates compared with older adults.In mid-June 2021, B.1.671.2 (Delta) became the predominant variant of SARS-CoV-2, the virus that causes COVID-19, circulating in the United States. As of July 2021, the Delta variant was responsible for nearly all new SARS-CoV-2 infections in the United States.* The Delta variant is more transmissible than previously circulating SARS-CoV-2 variants (1); however, whether it causes more severe disease in adults has been uncertain. Data from the CDC COVID-19-Associated Hospitalization Surveillance Network (COVID-NET), a population-based surveillance system for COVID-19-associated hospitalizations, were used to examine trends in severe outcomes in adults aged ≥18 years hospitalized with laboratory-confirmed COVID-19 during periods before (January-June 2021) and during (July-August 2021) Delta variant predominance. COVID-19-associated hospitalization rates among all adults declined during January-June 2021 (pre-Delta period), before increasing during July-August 2021 (Delta period). Among sampled nonpregnant hospitalized COVID-19 patients with completed medical record abstraction and a discharge disposition during the pre-Delta period, the proportion of patients who were admitted to an intensive care unit (ICU), received invasive mechanical ventilation (IMV), or died while hospitalized did not significantly change from the pre-Delta period to the Delta period. The proportion of hospitalized COVID-19 patients who were aged 18-49 years significantly increased, from 24.7% (95% confidence interval [CI] = 23.2%-26.3%) of all hospitalizations in the pre-Delta period, to 35.8% (95% CI = 32.1%-39.5%, p<0.01) during the Delta period. When examined by vaccination status, 71.8% of COVID-19-associated hospitalizations in the Delta period were in unvaccinated adults. Adults aged 18-49 years accounted for 43.6% (95% CI = 39.1%-48.2%) of all hospitalizations among unvaccinated adults during the Delta period. No difference was observed in ICU admission, receipt of IMV, or in-hospital death among nonpregnant hospitalized adults between the pre-Delta and Delta periods. However, the proportion of unvaccinated adults aged 18-49 years hospitalized with COVID-19 has increased as the Delta variant has become more predominant. Lower vaccination coverage in this age group likely contributed to the increase in hospitalized patients during the Delta period. COVID-19 vaccination is critical for all eligible adults, including those aged <50 years who have relatively low vaccination rates compared with older adults.

Infants aged <6 months are at increased risk for severe COVID-19 disease but are not yet eligible for COVID-19 vaccination; these children depend upon transplacental transfer of maternal antibody, either from vaccination or infection, for protection. COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) data were analyzed to estimate COVID-19-associated hospitalization rates and identify demographic and clinical characteristics and maternal vaccination status of infants aged <6 months hospitalized with laboratory-confirmed COVID-19. During October 2022-April 2024, COVID-NET identified 1,470 COVID-19-associated hospitalizations among infants aged <6 months. COVID-19-associated hospitalization rates among young infants were higher than rates among any other age group, except adults aged ≥75 years, and are comparable to rates among adults aged 65-74 years. The percentage of hospitalized infants whose mothers had been vaccinated during pregnancy was 18% during October 2022-September 2023 and decreased to <5% during October 2023-April 2024. Severe outcomes among infants hospitalized with COVID-19 occurred frequently: excluding newborns hospitalized at birth, approximately one in five young infants hospitalized with COVID-19 required admission to an intensive care unit, nearly one in 20 required mechanical ventilation, and nine infants died during their COVID-19-associated hospitalization. To help protect pregnant persons and infants too young to be vaccinated, prevention for these groups should focus on ensuring that pregnant persons receive recommended COVID-19 vaccines.

A global outbreak of clade II mpox associated with sexual contact, disproportionately affecting gay, bisexual, and other men who have sex with men (MSM), has been ongoing since May 2022. Information on types of contact most associated with transmission is limited. This report used data from a multijurisdictional vaccine effectiveness case-control study of sexually active persons aged 18-49 years who identified as MSM or transgender, collected during August 2022-July 2023. Odds of mpox associated with selected types of intimate and nonintimate close contact with a person with mpox were estimated. Among 457 case-patients and 1,030 control patients who met minimum data requirements, 150 (32.8%) case-patients and 57 (5.5%) control patients reported close contact with a person with mpox and were included in this analysis. Adjusted odds of mpox were 5.4 times as high among those who reported having condomless receptive anal sex with a person with mpox, compared with participants who reported close contact with a person with mpox and no condomless receptive anal sex with that person (OR = 5.4; p = 0.031). Although the mpox vaccine is highly effective, vaccination coverage remains low; a multifaceted approach to prevention remains important and should include vaccination promotion, safer sex practices, and increasing awareness that mpox continues to circulate.