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Background Maternal and child mortality remains a global public health challenge. Thus, countries, including Tanzania, have adopted different cost-effective models, especially antenatal care (ANC) to improve maternal and child health (MCH). Despite the early timing of ANC visits having a great implication for ensuring improved MCH services, Tanzania has disproportionately experienced late ANC visits among pregnant women. This has entailed conducting an institutional-based study in Western Tanzania, Kasulu Town Council (KTC) to ascertain whether demographic socio-economic and maternal characteristics imply the persistence of late ANC visits using robust methods. Methods An institutional cross-sectional study design was conducted in KTC, Kigoma Region using an embedded mixed-method approach from March-April 2020. Quantitative data was collected from 320 women with children aged 0–6 months attending postnatal services. A total of 40 participants were involved in the qualitative study through in-depth interviews with healthcare providers and focus group discussions held with pregnant women and women with children aged 0–6 months. Descriptive statistics and multivariate binary logistic regression were used to determine the characteristics associated with the timing of ANC visits among pregnant women. Furthermore, thematic analysis was used to generate themes triangulated with quantitative results. Results Findings revealed that 32.2% of pregnant women attended ANC visits in the first trimester. Early ANC was associated with maternal age (AOR = 1.839, 95% Cl: 1.023, 3.303), being accompanied by a partner (AOR = 2.165, 95% Cl: 1.256, 3.733), and awareness of the danger signs (AOR = 2.079, 95% Cl: 1.172, 3.687) and parity (AOR = 2.164, 95% Cl: 1.091, 4.291). Little association was noted in the knowledge of ANC timing (AOR = 0.564, 95% Cl: 0.320, 994) and household income (AOR = 0.529, 95% Cl: 0.281, 0.995). Qualitative data indicated that low rate of early ANC initiation was attributed to a lack of support from partners and accompanied to ANC visits, insufficient knowledge of the timing of early ANC visits, and socio-cultural beliefs. Conclusion Results confirmed that early ANC visit in KTC is low. Revealed associated factors act as a bridge to improve maternal and newborn health and contribute to achieving Sustainable Development Goal no 3, which targets maternal mortality of less than 70 deaths per 100,000 live births and neonatal mortality of 12 per 1000 live births by 2030. Proposed integrated interventions can potentially ensure that women, regardless of pregnancy status, are encouraged to receive early ANC utilisation during the first trimester to receive antenatal care before delivery to improve maternal and newborn health.

Category: Hindfoot Introduction/Purpose: Subtalar arthritis is a common consequence following calcaneal fracture, and its development is related to the severity of the fracture at the posterior facet. Previous calcaneus fracture models have demonstrated altered contact characteristics when a step-off is created in the posterior facet articular surface. A biomechanical model involving a fracture gap without step-off through the posterior facet has not been developed. In this study, a primary calcaneal fracture line is created to simulate fracture gap displacement without step-off, and to evaluate the resulting contact pressure changes across the posterior facet. Methods: The contact characteristics (peak pressure, area of contact, and centroid of pressure) of the posterior facet of the subtalar joint in six cadaveric below the knee specimens were determined. Contact pressures were measured using Tekscan pressure sensors in five foot positions (neutral, dorsiflexion, plantarflexion, inversion, and eversion) with an axial load of 50% of the cadaveric total body weight. Contact pressures were first determined in the intact foot in all positions in a modified MTS frame. A calcaneal osteotomy was made using a 1 mm osteotome from the posteromedial tuberosity to the anterolateral facet, exiting the facet to simulate a Sanders IIA fracture. The contact characteristics were measured before and after the osteotomy. The simulated fracture was fixed with two 6.4 mm steel dowels. The contact characteristics were then determined with the posterior facet anatomically reduced followed by an incremental increase in fracture gap displacement of 1, 2, and 4 mm. Results: In the intact foot, there was no significant difference in the peak pressures among the five foot positions (p=0.33). The area of contact was significantly less with the foot in inversion compared with neutral (p=0.002), dorsiflexion (p=0.010) or eversion (p=0.033). Peak pressure on the medial fragment (Table 1A) was significantly less with a 4 mm gap compared to a 1 mm gap (p=0.026), a 2 mm gap (p=0.031) or reduced (p=0.030). On the lateral fragment (Table 1B), the peak pressure was significantly increased with a 4 mm gap compared to a 1 mm gap (p=0.026) or a 2 mm gap (p=0.011). Measurements of the contact area and location of the pressure centroids did not show a significant difference on post-hoc testing. Conclusion: The forces across the posterior facet of the subtalar joint were significantly altered after a simulated calcaneal fracture involving gap displacement without step-off. A posterior facet gap of 2 mm did not significantly alter the contact characteristics of the subtalar joint in this study. Significant differences in peak pressure were demonstrated between 4 mm and 2 mm of gap displacement. The peak pressures with 4 mm of gap displacement were significantly increased on the lateral fragment of the posterior facet and decreased on the medial fragment. Changes in posterior facet contact characteristics have not been previously characterized for calcaneal fracture gap without step-off.

ObjectiveTo assess the prevalence and clinical implications of persistent or exertional cardiopulmonary symptoms in young competitive athletes following SARS-CoV-2 infection.MethodsThis observational cohort study from the Outcomes Registry for Cardiac Conditions in Athletes included 3597 US collegiate athletes after SARS-CoV-2 infection. Clinical characteristics, advanced diagnostic testing and SARS-CoV-2-associated sequelae were compared between athletes with persistent symptoms >3 weeks, exertional symptoms on return to exercise and those without persistent or exertional symptoms.ResultsAmong 3597 athletes (mean age 20 years (SD, 1 year), 34% female), data on persistent and exertional symptoms were reported in 3529 and 3393 athletes, respectively. Persistent symptoms >3 weeks were present in 44/3529 (1.2%) athletes with 2/3529 (0.06%) reporting symptoms >12 weeks. Exertional cardiopulmonary symptoms were present in 137/3393 (4.0%) athletes. Clinical evaluation and diagnostic testing led to the diagnosis of SARS-CoV-2-associated sequelae in 12/137 (8.8%) athletes with exertional symptoms (five cardiac involvement, two pneumonia, two inappropriate sinus tachycardia, two postural orthostatic tachycardia syndrome and one pleural effusion). No SARS-CoV-2-associated sequelae were identified in athletes with isolated persistent symptoms. Of athletes with chest pain on return to exercise who underwent cardiac MRI (CMR), 5/24 (20.8%) had probable or definite cardiac involvement. In contrast, no athlete with exertional symptoms without chest pain who underwent CMR (0/20) was diagnosed with probable or definite SARS-CoV-2 cardiac involvement.ConclusionCollegiate athletes with SARS-CoV-2 infection have a low prevalence of persistent or exertional symptoms on return to exercise. Exertional cardiopulmonary symptoms, specifically chest pain, warrant a comprehensive evaluation.

Purpose: Vitamin D is a concern for individuals who live at higher latitudes due to seasonality of sun exposure and intensity. Previous studies have shown that poor vitamin D status is associated with muscle weakness in test animals and the elderly. Supplementation has been shown to reverse vitamin D associated muscle weakness. Studies suggest that athletes are at risk of developing poor vitamin D status and thus may be at risk of skeletal muscle weakness. Hypothesis: We believe that Vitamin D supplementation will improve physical performance in healthy, college-age athletes that have poor vitamin D status. Methods: 25 subjects from the Buffalo, NY area were screened for cardiovascular disease risk and entry requirements (Serum 25(OH) Vitamin D between 10-30ng/mL and VO2max in the upper 50th percentile). 13 subjects were enrolled in a double blind, placebo controlled parallel arm design with 4 visits. Each test visits consisted of Vertical Jump, Wingate, 3RM Bench Press, and 5x6sec Repeated Sprint tests. After visit 2, subjects received either a 60,000IU dose of vitamin D (n=7) or placebo (n=6). Serum vitamin D and calcium were measured throughout for safety. Results: 12 subjects completed all of the visits (1 subject withdrew due to scheduling conflicts). Vitamin D status rose in significantly in the test group (9ng/mL), while the control group saw no significant change. A Two Way Repeated Measures ANOVA showed that there was no effect after supplementation on any of the measures of physical performance (p>0.05). Conclusion: Our findings suggest that there may be no effect of vitamin D on skeletal muscle function in young, healthy individuals.

Men infected with HIV are often faced with caregiving responsibilities of aging, ill parents, while simultaneously looking for support from their parents in dealing with their own health problems. Unfortunately, the reciprocal roles of HIV-positive adult sons and aging mothers as caregivers have not been examined. To address this gap in the literature, HIV-positive men (n = 118) answered open-ended questions about the support they exchanged with their mothers, completed the Depth of Relationships Inventory, and rated the importance of health-related assistance between themselves and their mothers. The men viewed themselves as important providers of both instrumental and emotional support to their mothers. Men perceived their mothers to be significant providers of emotional support but only moderately important in providing instrumental support. About a third of the men responded that the help they provided and received from the mothers in managing each other’s health and staying healthy was extremely important. Men regarded their relationships with their mothers as one of their most important social relationships. Non-White men rated the quality of their mother–son relationships more highly, exchanged more instrumental support, and provided more emotional support to their mothers than White men. Men who disclosed their HIV-positive status to their mothers rated the importance of the help they received from their mothers in managing their illnesses higher than men who had not disclosed.