Category: Nevin Manimala

Aust J Prim Health. 2021 Apr 1. doi: 10.1071/PY20262. Online ahead of print.

ABSTRACT

Health assessments (HAs) are available for community-dwelling older people to receive annually from general practitioners (GPs), but have low uptake. Little is known regarding the views of GPs and practice nurses (PNs) towards older person HAs and whether this might contribute to the low uptake. The objective of this study was to explore the attitudes of GPs and PNs towards older person HAs. Fifty-eight participant responses to an online questionnaire were analysed through descriptive statistics and content analysis. Most participants (77%) found older person HAs to be useful. Participants felt HAs identified health problems that may otherwise be missed (n=21). The main barriers to delivery of HAs were patient refusal (n=25) and insufficient practitioner time (n=19). The most requested change to HAs was increased patient education and public awareness regarding older person HAs (n=10). Health professionals felt increased patient education and public awareness, particularly to address patient misconceptions regarding older person HAs, may improve HA uptake.

PMID:33789076 | DOI:10.1071/PY20262

Can J Ophthalmol. 2021 Mar 28:S0008-4182(21)00088-0. doi: 10.1016/j.jcjo.2021.02.039. Online ahead of print.

ABSTRACT

INTRODUCTION: As mandated by the Accreditation Council for Graduate Medical Education (ACGME), residency programs are required to have parental leave policies. A lack of standardized requirements leads to a lack of uniformity among programs. We discuss resident and program director attitudes toward parental leave and examine the range of policies on parental leave and breastfeeding within ophthalmology residency programs.

METHODS: Two electronic surveys assessing perceptions toward parental leave during residency and breastfeeding on return to clinical duties were created individually for completion by ophthalmology residents or residency program directors, respectively, with responses collected over 4 weeks.

RESULTS: Of residents who took parental leave, 23 (87%) denied taking time off without pay. The most commonly reported effects on training by residents were missed surgical training and impact on research. Nearly 60% of residents (N = 26) reported receiving negative feedback or actions prior to or after the leave. The majority of residents felt program directors and coresidents were supportive (53.8%, 48.1%, respectively), but parental leave negatively affected their coresidents (46.2%). Twenty-five program directors reported that there are written parental leave policies in place at their institution. Gender disparities were noted, with program directors reporting more negative impacts on surgical training in female residents (p = 0.035). There was no statistically significant difference between program director attitudes on clinical training, well-being, or burnout by resident gender. All program directors were supportive of breastfeeding; half reported an institutional breastfeeding policy.

CONCLUSION: A national discussion on standardizing parental leave and breastfeeding policies over all ophthalmology residency programs is warranted.

PMID:33789088 | DOI:10.1016/j.jcjo.2021.02.039

Dent Med Probl. 2021 Mar 31. doi: 10.17219/dmp/127028. Online ahead of print.

ABSTRACT

BACKGROUND: Extractions of third molars constitute about 90% of the scheduled surgical procedures performed by oral surgeons. Wisdom tooth surgery is associated with complications, such as the lingual and inferior alveolar nerve damage, bleeding, tooth/jaw fractures, tooth displacement into the adjacent anatomical spaces, trismus, infections, and other.

OBJECTIVES: The aim of the study was to analyze complications after wisdom tooth extraction in patients treated at the Department of Oral Surgery of Jagiellonian University Medical College in Kraków, Poland, in the years 2016-2018.

MATERIAL AND METHODS: A retrospective analysis of the medical records of 339 patients treated in the outpatient setting was performed. The inclusion criterion comprised a single extraction of a third molar. The exclusion criteria were multiple extractions, comorbidities and pregnancy. No antibiotic prophylaxis was used. The incidence of post-extraction complications, such as oroantral communication, postoperative hematoma, acute inflammation of the surrounding tissues, trismus, and transient paresthesia in relation to patient gender and age, the developmental stage and location of the removed tooth as well as the type of surgery were studied.

RESULTS: Perioperative complications occurred in 51 (15.0%) cases, and comprised the acute inflammation of the surrounding tissues in 31 patients, trismus after the removal of 13 lower third molars, oroantral communication after the extraction of 5 upper wisdom teeth, and hematoma as well as a transient sensory alteration of the lingual nerve in 1 case each. Complications were more common in patients who had a surgical extraction of a wisdom tooth with root separation and in cases of lower third molar extractions. No statistically significant correlation was found between the patients’ age or gender, the developmental stage of the extracted tooth and the number of observed complications.

CONCLUSIONS: Lower third molars and the necessity of surgical extraction with root separation are risk factors for postoperative complications in patients who require wisdom tooth removal. Complications after the removal of third molars are most often inflammatory.

PMID:33789003 | DOI:10.17219/dmp/127028

Dent Med Probl. 2021 Mar 31. doi: 10.17219/dmp/130088. Online ahead of print.

ABSTRACT

BACKGROUND: In the past 20 years, several studies and clinical trials have reported similar results for transmucosal implants as compared to submerged implants. Several advantages of immediate loading have been pointed out, such as the reduction of treatment time, trauma reduction, and immediate esthetic and functional improvements.

OBJECTIVES: The main objective of this study was to clinically evaluate the implant survival rate in patients with total rehabilitation via implants that underwent immediate loading in the past 5 years.

MATERIAL AND METHODS: A cross-sectional, descriptive, observational analysis was conducted. The implant survival rate for an edentulous maxilla or mandible was assessed with regard to the loading protocol by means of a questionnaire and clinical observation. The study included 103 patients with edentulous jaws rehabilitated with fixed prostheses on implants. Each patient received 4-6 implants. In total, 474 implants were placed. Factors such as the implant survival rate as well as biological and prosthetic complications were evaluated and analyzed statistically.

RESULTS: Of the 474 implants initially placed, 458 were considered osteointegrated and 16 were considered lost, which corresponds to a 96.62% implant survival rate. The most common types of failure were prosthetic fractures (46.2%), peri-implantitis (23.1%) and unscrewing (11.5%) in the first 5 years.

CONCLUSIONS: The rate of osseointegration for implants placed under immediate loading was extremely high, in accordance with the previously published studies, which led us to conclude that currently, this is a surgical procedure with a high rate of success and high predictability.

PMID:33789002 | DOI:10.17219/dmp/130088

Cardiovasc Res. 2021 Mar 31:cvab127. doi: 10.1093/cvr/cvab127. Online ahead of print.

ABSTRACT

AIMS: Atrial fibrillation (AF) has been associated with intracellular calcium disturbances in human atrial myocytes, but little is known about the potential influence of sex and we here aimed to address this issue.

METHODS AND RESULTS: Alterations in calcium regulatory mechanisms were assessed in human atrial myocytes from patients without AF or with long-standing persistent or permanent AF. Patch-clamp measurements revealed that L-type calcium current (ICa) density was significantly smaller in males with than without AF (-1.15±0.37 vs. -2.06±0.29 pA/pF) but not in females with AF (-1.88±0.40 vs. -2.21±0.0.30 pA/pF). In contrast, transient inward currents (ITi) were more frequent in females with than without AF (1.92±0.36 vs. 1.10±0.19 events/min) but not in males with AF. Moreover, confocal calcium imaging showed that females with AF had more calcium spark sites than those without AF (9.8±1.8 vs. 2.2±1.9 sites/µm2) and sparks were wider (3.0±0.3 vs. 2.2±0.3 µm) and lasted longer (79±6 vs. 55±8 ms), favoring their fusion into calcium waves that triggers ITIs and afterdepolarizations. This was linked to higher ryanodine receptor phosphorylation at s2808 in women with AF, and inhibition of adenosine A2A or beta-adrenergic receptors that modulate s2808 phosphorylation was able to reduce the higher incidence of ITI in women with AF.

CONCLUSION: Perturbations of the calcium homeostasis in AF is sex-dependent, concurring with increased spontaneous SR calcium release-induced electrical activity in women but not in men, and with diminished ICa density in men only.

TRANSLATIONAL PERSPECTIVE: Statistical analysis taking into account confounding effects of concurrent disease, risk factors and treatments revealed differential sex-dependent alterations of the calcium homeostasis in AF. The analysis suggests that suppression of calcium release-induced membrane depolarizations with adenosine receptor antagonists may be efficient in women with AF only while therapies aiming to restore L-type calcium current may be more efficient in males with AF.

PMID:33788918 | DOI:10.1093/cvr/cvab127

Cancer Cytopathol. 2021 Mar 31. doi: 10.1002/cncy.22427. Online ahead of print.

ABSTRACT

BACKGROUND: The salivary gland neoplasm of unknown malignant potential (SUMP) category reflects the cytomorphologic overlap and complexity of reporting salivary gland cytology in the Milan system. It includes neoplasms for which a diagnosis of a specific entity cannot be made and, more importantly, for which a carcinoma cannot be entirely excluded. For risk stratification, the subcategorization of SUMP based on the predominant cell type is recommended. This study was aimed at evaluating the risk of neoplasm (RON) and the risk of malignancy (ROM) of the basaloid and oncocytic subtypes of the SUMP category.

METHODS: A retrospective analysis of 482 salivary gland fine-needle aspirations from 2012 to 2019 resulted in 48 SUMP cases. The cytology of these cases was reviewed and reclassified as the basaloid or oncocytic subtype. Surgical follow-up was available for 36 cases. The RON and ROM for each subtype were calculated.

RESULTS: The RON and ROM were 100% and 23%, respectively, for monomorphic basaloid tumors and 88% and 58.8%, respectively, for monomorphic oncocytic tumors. The ROM for basaloid tumors was 8.3% without matrix/with minimal matrix and 60% with an nonfibrillary matrix. The ROM for oncocytic tumors was 50% without a cystic background and 60% with a cystic or mucinous background. The difference was not statistically significant for either of the subgroups.

CONCLUSIONS: Even though statistically not significant in our study, the differential ROMs within the oncocytic and basaloid subgroups help in the risk stratification of SUMP cases. Further subcategorization based on the stroma and background helps in limiting the differential diagnosis but does not necessarily add to the value of the risk stratification.

PMID:33788998 | DOI:10.1002/cncy.22427

PLoS One. 2021 Mar 31;16(3):e0249391. doi: 10.1371/journal.pone.0249391. eCollection 2021.

ABSTRACT

BACKGROUND: Households are important sites for transmission of SARS-CoV-2 and preventive measures are recommended. This study aimed to 1) investigate the impact of living with a person infected with SARS-CoV-2; 2) understand how household members implemented infection control recommendations in their home; and 3) identify the information and support needs of household members.

METHODS: For this observational mixed-methods study, households with a person with confirmed SARS-CoV-2 infection were recruited via drive-through testing sites of Municipal Health Services, healthcare worker screening or hospital emergency visits in the University Medical Centre Utrecht, the Netherlands and via primary care physicians, hospital emergency visits or preoperative screening in the University Hospital of Antwerp, Belgium. We recorded household characteristics, including characteristics of all household members, together with their views on prevention measures. In a subset of households one adult household member was asked to participate in an interview investigating their views on preventive measures. Survey data were analysed using descriptive statistics and interview data by rapid framework analysis. A triangulation protocol was used to integrate findings.

RESULTS: Thirty-four households (120 household members) were included in the quantitative survey. Twenty-two households were invited to be interviewed, of which 18 completed an interview (response 81.8%). Survey data showed that almost all households implemented some preventive measures, the use of face masks being least frequently reported. Measures taken depended on what was physically possible, the perceived severity of illness of the index patient and to what extent household members were willing to limit social interaction. Respondents did not believe in the effectiveness of wearing face masks within the house, and from the interviews this was explained by media coverage of face masks, impracticality and the stigma associated with wearing masks. Interviewees reported that quarantine had a high emotional burden and wished to have more information about the exact duration of quarantine, their own COVID-19 status, symptoms and when to seek medical help.

CONCLUSION: People were willing to implement prevention measures, however actual adherence depended on perceived severity of illness and the perceived risk of becoming infected. Homes are social environments and recommendations for infection prevention should account for this context. Incorporating our findings into policy making could provide households with more relevant and actionable advice.

PMID:33788890 | DOI:10.1371/journal.pone.0249391

PLoS One. 2021 Mar 31;16(3):e0248755. doi: 10.1371/journal.pone.0248755. eCollection 2021.

ABSTRACT

Early palliative/supportive care (ePSC) is a medical intervention focused on patient’s needs, that integrates standard oncological treatment, shortly after a diagnosis of advanced/metastatic cancer. ePSC improves the appropriate management of cancer pain. Understanding the semantic and emotional impact of the words used by patients to describe their pain may further improve its assessment in the ePSC setting. Psycholinguistics assumes that the semantic and affective properties of words affect the ease by which they are processed and comprehended. Therefore, in this cross-sectional survey study we collected normative data about the semantic and affective properties of words associated to physical and social pain, in order to investigate how patients with cancer pain on ePSC process them compared to healthy, pain-free individuals. One hundred ninety patients and 124 matched controls rated the Familiarity, Valence, Arousal, Pain-relatedness, Intensity, and Unpleasantness of 94 words expressing physical and social pain. Descriptive and inferential statistics were performed on ratings in order to unveil patients’ semantic and affective representation of pain and compare it with those from controls. Possible effects of variables associated to the illness experience were also tested. Both groups perceived the words conveying social pain as more negative and pain-related than those expressing physical pain, confirming previous evidence of social pain described as worse than physical pain. Patients rated pain words as less negative, less pain-related, and conveying a lower intense and unpleasant pain than controls, suggesting either an adaptation to the pain experience or the role played by ePSC in improving patients’ ability to cope with it. This exploratory study suggests that a chronic pain experience as the one experienced by cancer patients on ePSC affects the semantic and affective representation of pain words.

PMID:33788893 | DOI:10.1371/journal.pone.0248755

PLoS One. 2021 Mar 31;16(3):e0248752. doi: 10.1371/journal.pone.0248752. eCollection 2021.

ABSTRACT

BACKGROUND: Despite a free access to public health services policy in most sub-Saharan African countries, households still contribute to total health expenditures through out-of-pocket expenditures. This reliance on out-of-pocket expenditures places households at a risk of catastrophic health expenditures and impoverishment. This study examined the incidence of catastrophic health expenditures, impoverishing effects of out-of-pocket expenditures on households and factors associated with catastrophic expenditures in Malawi.

METHODS: We conducted a secondary analysis of the most recent nationally representative integrated household survey conducted by the National Statistical Office between April 2016 to 2017 in Malawi with a sample size of 12447 households. Catastrophic health expenditures were estimated based on household annual nonfood expenditures and total household annual expenditures. We estimated incidence of catastrophic health expenditures as the proportion of households whose out-of-pocket expenditures exceed 40% threshold level of non-food expenditures and 10% of total annual expenditures. Impoverishing effect of out-of-pocket health expenditures on households was estimated as the difference between poverty head count before and after accounting for household health payments. We used a multilevel binary logistic regression model to assess factors associated with catastrophic health expenditures.

RESULTS: A total of 167 households (1.37%) incurred catastrophic health expenditures. These households on average spend over 52% of household nonfood expenditures on health care. 1.6% of Malawians are impoverished due to out-of-pocket health expenditures. Visiting a religious health facility (AOR = 2.27,95% CI:1.24-4.15), hospitalization (AOR = 6.03,95% CI:4.08-8.90), larger household size (AOR = 1.20,95% CI:1.24-1.34), higher socioeconomic status (AOR = 2.94,95% CI:1.39-6.19), living in central region (AOR = 3.54,95% CI:1.79-6.97) and rural areas (AOR = 5.13,95% CI:2.14-12.29) increased the odds of incurring catastrophic expenditures.

CONCLUSION: The risk of catastrophic health expenditures and impoverishment persists in Malawi. This calls for government to improve the challenges faced by the free public health services and design better prepayment mechanisms to protect more vulnerable groups of the population from the burden of out-of-pocket payments.

PMID:33788900 | DOI:10.1371/journal.pone.0248752

PLoS One. 2021 Mar 31;16(3):e0249040. doi: 10.1371/journal.pone.0249040. eCollection 2021.

ABSTRACT

BACKGROUND: GPRC5A is associated with various cancer initiation and progression. Controversial findings have been reported about GPRC5A prognostic characteristics, and no meta-analysis has been conducted to assess the relationship between GPRC5A and cancer prognosis. Therefore, the objective of this meta-analysis is to evaluate the overall prognostic effectiveness of GPRC5A.

METHODS: We first conducted a systematic search in the PubMed, Embase, Web of Science, CNKI, Cochrane, and WangFang databases. The hazard ratio (HR) and odds ratios (OR) with 95% CI were then pooled to assess the associations between GPRC5A expression and overall survival (OS), disease-free survival (DFS), event-free survival (EFS), and clinicopathological characteristics. Chi-squared test and I2 statistics were completed to evaluate the heterogeneity in our study. A random-effects model was used when significant heterogeneity existed (I2>50% and p<0.05); otherwise, we chose the fixed-effect model. Subgroup analysis was stratified by tumor type, region, HR obtained measurements, and sample capacity to explore the source of heterogeneity.

RESULTS: In total, 15 studies with 624 patients met inclusion criteria of this study. Our results showed that higher expression of GPRC5A is associated with worse OS (HR:1.69 95%CI: 1.20-2.38 I2 = 75.6% p = 0.000), as well as worse EFS (HR:1.45 95%CI: 1.02-1.95 I2 = 0.0% p = 0.354). Subgroup analysis indicated that tumor type might be the source of high heterogeneity. Additionally, cancer patients with enhanced GPRC5A expression were more likely to lymph node metastasis (OR:1.95, 95%CI 1.33-2.86, I2 = 43.9%, p = 0.129) and advanced tumor stage (OR: 1.83, 95%CI 1.15-2.92, I2 = 61.3%, p = 0.035), but not associated with age, sex, differentiation, and distant metastasis.

CONCLUSION: GPRC5A can be a promising candidate for predicting medical outcomes and used for accurate diagnosis, prognosis prediction for patients with cancer; however, the predictive value of GPRC5A varies significantly according to cancer type. Further studies for this mechanism will be necessary to reveal novel insights into application of GPRC5A in cancers.

PMID:33788883 | DOI:10.1371/journal.pone.0249040