Nevin Manimala

BMC Oral Health. 2022 Jul 26;22(1):308. doi: 10.1186/s12903-022-02343-7.

ABSTRACT

BACKGROUND: Satisfaction with dental services can provide valuable insights into aspects of quality including access as well as changes in this over time. In the UK publicly funded dental services are ostensibly delivered by private sector general dental practitioners for whom private patients represent an opportunity cost to the provision of care to public patients. This study examined changes in satisfaction as economic circumstances and policy changed in Britain between 1998 and 2019.

METHODS: Data were taken from successive waves of the British Social Attitudes Survey a representative cross-sectional survey of the population between 1998 and 2019. Descriptive statistics and a series of logistic regression analyses were used to examine the relationships between satisfaction and a range of socio-demographic characteristics over time.

RESULTS: 37,328 usable responses were extracted from the survey spanning 21 years of data. Over the course of the survey approximately 71% of the sample was very satisfied, satisfied or neither satisfied nor dissatisfied with publicly funded dental services. Satisfaction fell at the outset of the study period but rose following the economic downturn from 2008 which coincided with increased use of publicly funded services. Differences were evident in satisfaction between older versus younger respondents, more affluent versus less affluent respondents and better educated versus less well-educated respondents. Satisfaction did not appear to change in response to policy changes.

CONCLUSION: Satisfaction is an important outcome of service provision. Policies aiming to improve satisfaction with publicly funded dental care in the UK must take account of the competing demands on dentists’ time from private patients. At times of economic expansion or when supply has been disrupted, these may be particularly acute and require specific interventions to improve access for those who depend on public services.

PMID:35883074 | DOI:10.1186/s12903-022-02343-7

BMC Health Serv Res. 2022 Jul 26;22(1):950. doi: 10.1186/s12913-022-08287-6.

ABSTRACT

BACKGROUND: Midwives have long workdays and work many weeks on call. There is a concern that these extended work schedules can negatively affect their intention to stay in the profession.

PURPOSE: This study provides evidence on Canadian midwives’ preferences for and experiences with policies and guidelines which limit the hours of work and weeks per year preferred to be on call, and examines the relationship between preferences and midwives’ intention to stay in the profession.

METHODS: Data come from our 2018 pan-Canadian survey of midwives. Descriptive statistics of 720 midwives’ preferences and experiences are provided. In the correlations followed by the OLS regressions, 596 midwives’ data are used to test the associations between preferences and intention to stay in the profession. STATA (version 15) is used. A thematic analysis of 274 midwives’ responses to the open-ended survey question is conducted to give voice to midwives on what can be done for retention.

RESULTS: Three quarters of the 720 respondents prefer policies and guidelines to limit hours of work in a 24-hour period, though less than half have policies and guidelines on hours of work. More than half prefer to have fewer on-call weeks or never to be on call, less than a third prefer same number of on-call weeks, and only 2% prefer more weeks to be on call. Midwives are currently working on average 33 weeks per year on call. OLS regression analysis shows that ‘met preference’ for hours of work and on-call weeks are positively associated with intention to stay. In responding to the open-ended survey question, midwives recommend limiting the consecutive hours of work and on-call weeks to manageable hours and weeks to retain them in the profession.

CONCLUSION: Midwives whose preferences are met are the ones intending to stay in the profession. There is, however, a large number of midwives with ‘unmet needs’ preferring to have policies and guidelines to limit the hours but do not have that currently, and would like to work fewer weeks on call than currently. These are the midwives who are not intending to stay in the profession.

PMID:35883071 | DOI:10.1186/s12913-022-08287-6

J Glaucoma. 2022 Jul 20. doi: 10.1097/IJG.0000000000002080. Online ahead of print.

ABSTRACT

PURPOSE: Early hypotony after non-valved glaucoma drainage device (GDD) implantation for complex glaucomatous eyes with labile aqueous production can lead to significant visual morbidity. We therefore sought to report the early post-operative outcomes of a novel surgical technique that allows atraumatic insertion of non-valved GDDs through a much smaller 25-gauge scleral track, to minimise entry site leakage and improve safety.

METHODS: Retrospective case series of fifteen consecutive cases undergoing non-valved GDD insertion into the anterior chamber using a previously unreported technique.

RESULTS: All eyes underwent successful GDD insertion using our novel technique, with no intra-operative complications. Mean intraocular pressures (IOP) pre-operatively, at day 1, week 1 and week 3 were 31.4, 22.4, 23.7 and 25.6 mmHg respectively. A statistically significant IOP reduction was achieved at day 1, week 1 and week 3 post-operatively (P<0.05) without any observed leakage at the scleral entry site. One eye (6.7%) with complex panuveitic glaucoma developed early hypotony (5 mmHg) with shallow choroidal detachments on day 1. This was successfully managed with one intracameral ophthalmic viscoelastic device injection given at the slit-lamp and no further intervention.

CONCLUSIONS: This novel single needle-docking intra-ocular insertion manoeuvre is an easily adoptable technique to make GDD insertion through a smaller 25-gauge water-tight scleral track more efficient and less traumatic. The technique reduces scleral distortion and therefore improves surgical safety particularly in eyes with complex secondary glaucoma.

PMID:35882037 | DOI:10.1097/IJG.0000000000002080

J Glaucoma. 2022 Jul 19. doi: 10.1097/IJG.0000000000002075. Online ahead of print.

ABSTRACT

PURPOSE: To understand the feasibility, utility and efficacy of a low-cost model for performing anterior chamber angle gonioscopy and micro-surgery on human corneo-scleral tissues in wet lab on resident skill enhancement.

METHODS: Post-keratoplasty residual corneo-scleral rims and/or the expired donor corneo-scleral buttons were included for the purpose of this study. Initially, inverted rims were used to demonstrate the basic angle anatomy on a slit lamp bio-microscope. Central hazy cornea was then replaced with an artificial cornea and an artificial anterior chamber to simulate indirect gonioscopy, direct gonioscopy, goniotomy and other angle-based surgeries. Direct gonioscopy and goniotomy exercises (as a means to simulate intra-operative gonioscopy and other angle-based surgeries respectively) were evaluated quantitatively, and the rest qualitatively.

RESULTS: A total of 65 residents were included in the exercise. The mean age was 26.69±1.74 years. Amongst these, 55 ophthalmology residents performed the basic examination, that is, slit lamp mounted angle anatomy examination (n=55) and artificial chamber mounted indirect gonioscopic examination through artificial cornea (n=55). In the second exercise, 10 glaucoma fellows performed the direct gonioscopic and the goniotomy exercises on artificial chamber. The fellows demonstrated a statistically significant improvement in interpretation and surgical skill enhancement concurrent with reduction in time taken with increasing number of attempts (P<0.05). In the third simulation exercise, micro-stent placement within the Schlemm’s canal, sub-conjunctival space, and the supra-choroidal space was re-produced successfully on multiple occasions.

CONCLUSIONS: The residual human corneo-scleral rims proved to be an important resource for teaching both the basic examination skills as well as those required for transitioning to advanced intraoperative gonioscopy and goniotomy skills. These low cost, easy to adapt models can be incorporated within the curriculum for improved glaucoma training of both the residents and the glaucoma fellows.

PMID:35882034 | DOI:10.1097/IJG.0000000000002075

Bol Med Hosp Infant Mex. 2022;79(3):161-169. doi: 10.24875/BMHIM.21000155.

ABSTRACT

BACKGROUND: Chronic lymphocytic thyroiditis or Hashimoto’s thyroiditis is the most frequent cause of acquired hypothyroidism in children. An association between low levels of 25-hydroxyvitamin D (25OH vitamin D) and the development of the disease have been detected. The aim of this study was to describe 25OH vitamin D levels in patients aged 5 to 18 years with a diagnosis of Hashimoto’s thyroiditis in three pediatric endocrinology outpatient centers in Medellín, Colombia.

METHODS: We conducted a cross-sectional observational study with retrospective data collection. We evaluated the sociodemographic characteristics, diagnoses, presence of comorbidities, and frequency of vitamin D deficiency.

RESULTS: Sixty patients were included. The 25OH vitamin D levels were sufficient in 65% of the cases according to the Institute of Medicine (IOM) criteria and in 10% of the cases according to the Endocrine Society criteria. Serum calcium and phosphorus values were normal in 53% and 45% of the patients, respectively. All patients had normal magnesium and parathyroid hormone levels. No differences were found in the exploratory analysis when comparing 25OH vitamin D levels, thyroid antibody levels, and thyroid volume.

CONCLUSIONS: In this chronic lymphocytic thyroiditis population, we did not find an increased prevalence of vitamin D deficiency according to IOM or the Endocrine Society criteria compared with previous data from the general population. No statistically significant differences were found in the exploratory analysis.

PMID:35882020 | DOI:10.24875/BMHIM.21000155

Neuroreport. 2022 Jul 5. doi: 10.1097/WNR.0000000000001807. Online ahead of print.

ABSTRACT

OBJECTIVES: 3-dimensional multiple object tracking (3D-MOT) and the useful field of view (UFOV) both claim to measure and train cognitive abilities, such as selective and divided attention implicated in driving safety. 3D-MOT is claimed to improve even young adult cognitive ability. If true, one would expect to observe the transfer of 3D-MOT training to UFOV performance mediated by way of shared underlying cognitive mechanisms.

METHODS: We test this notion by assessing whether ten 30-min sessions of 3D-MOT training spread across 5 weeks improves UFOV performance relative to an active control group trained on a visual task and a challenging puzzle game (participants aged between 23 and 33 years old).

RESULTS: The 3D-MOT training group exhibited significantly improved UFOV performance whereas the active control group exhibited only a small, statistically nonsignificant improvement in the task.

CONCLUSIONS: This suggests that 3D-MOT and UFOV performance are likely dependent on overlapping cognitive abilities and helps support the assertion that these abilities can be trained and measured even in young adults. Such training could have implications for improving driver safety in both young and older adults.

PMID:35882017 | DOI:10.1097/WNR.0000000000001807

J Pediatr Gastroenterol Nutr. 2022 Jul 25. doi: 10.1097/MPG.0000000000003569. Online ahead of print.

ABSTRACT

OBJECTIVES: Known as pediatric medical traumatic stress (PMTS), posttraumatic stress symptoms from medical experiences have not been explored in children with chronic gastrointestinal diseases. This cross-sectional study of children and adolescents with inflammatory bowel disease, chronic pancreatitis and cystic fibrosis, aimed to: 1) estimate the prevalence of medical potentially traumatic events (PTEs) and PMTS, 2) explore potential risk factors for PMTS, and 3) explore potential consequences of PMTS.

METHODS: This cross-sectional study used validated, self-report measures to evaluate PTEs and PMTS. Descriptive statistics and regression analyses were used to achieve study objectives.

RESULTS: Over two-thirds of children reported a medical PTE (91 of 132, 69%). Forty-eight had PMTS symptoms (36%). PMTS was associated with medication burden, emergency and intensive care visits, and parent posttraumatic stress disorder in multivariate analysis. Potential consequences associated with PMTS included school absenteeism, home opioid use, poor quality of life, and parent missed work.

CONCLUSIONS: A substantial portion of our cohort reported medical PTEs and PMTS. The exploratory analysis identified potential associations between PMTS and illness factors, parent posttraumatic stress disorder, and functional impairments. Further studies of PMTS detection, prevention and treatment are integral to optimizing these children’s health and quality of life.An infographic is available for this article at: http://links.lww.com/MPG/C881.

PMID:35881966 | DOI:10.1097/MPG.0000000000003569

Menopause. 2022 Jul 26. doi: 10.1097/GME.0000000000002007. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the effects of prasterone compared with hyaluronic acid on symptoms of mild to moderate urinary urgency in women with genitourinary syndrome of menopause.

METHODS: This is an observational prospective cohort study. A total of 58 postmenopausal women were enrolled (from December 2019 to May 2021). Overactive Bladder Screener questionnaire, Patient Global Impression of Improvement questionnaire, International Consultation on Incontinence Questionnaire-Short Form, and International Quality of Life questionnaire were used.

RESULTS: Fifty-eight women, 29 (50%) and 29 (50%), were treated with prasterone and hyaluronic acid for 12 weeks, respectively. At the end of the study, 26 (89.7%) versus 3 (10.3%) women reported an improvement (Patient Global Impression of Improvement score ≤3) of the symptoms in the prasterone versus hyaluronic acid group. According to the International Consultation on Incontinence Questionnaire-Short Form, no statistically significant difference was recorded before treatment between the prasterone and hyaluronic acid groups (median, 12 [6-12] vs 11 [8-12]; P = 0.8). Conversely, a statistically significant difference was recorded after treatment between the two groups (median, 8 [5-11] vs 10 [8-11]; P = 0.03). According to the International Quality of Life, a statistically significantly lower median score was recorded in the prasterone compared with the hyaluronic acid group, before (73 [interquartile range {IQR}, 55-81] vs 89 [IQR, 67-94]; P < 0.01) and after (78 [IQR, 65-86] vs 87 [IQR, 72-99]; P = 0.04) treatment.

CONCLUSIONS: The current observational study supports the hypothesis that prasterone might improve the severity of urinary urge incontinence in this set of women. However, these results need to be confirmed in further studies with a controlled design and a larger population.

PMID:35881944 | DOI:10.1097/GME.0000000000002007

Menopause. 2022 Jul 26. doi: 10.1097/GME.0000000000002000. Online ahead of print.

ABSTRACT

IMPORTANCE: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality for menopausal individuals. Flow-mediated dilation (FMD), a surrogate marker of CVD, improves with aerobic exercise training in healthy and nonhealthy cohorts. However, systematic evaluation and precise estimate of this effect for menopausal individuals are unknown.

OBJECTIVE: We conducted a systematic review with meta-analysis to evaluate the influence of exercise training on FMD in postmenopausal individuals.

EVIDENCE REVIEW: Studies were identified from systematic search of major electronic databases (PubMed, ScienceDirect, and Cochrane Library) from inception to February 2021. Healthy, postmenopausal individuals were included, following an aerobic exercise intervention assessing FMD. A random-effects meta-analysis was used to calculate a pooled effect size (mean difference [MD]) with 95% confidence interval. Heterogeneity was assessed using I2 statistics. Metaregression was used to assess the association between changes in FMD and physical characteristics (eg, blood pressure, age, baseline FMD) and intervention details (metabolic equivalents and change in maximal oxygen uptake [ΔV˙o2max]). For variables that significantly correlated, a multiple metaregression model was used to assess the accounted variance in between-study ΔFMD%. Study quality was assessed using the National Heart, Lung, and Blood Institute assessment tool.

FINDINGS: Nine studies, including 11 interventions (6 controlled interventions and 5 pre-post interventions; N = 182), with age range of 52 ± 4 to 64 ± 7 years underwent quantitative pooling of data. Exercise training significantly improved ΔFMD% (MD, 0.99; 95% confidence interval, 0.46-1.52; P < 0.001). Between-study heterogeneity was large and statistically significant (I2 = 93.8%, P < 0.001). Post hoc analysis based on study design identified significant heterogeneity in the MD in ΔFMD% between controlled and pre-post study interventions (P < 0.05). According to multiple metaregression, diastolic and systolic blood pressure and ΔV˙o2max significantly predicted ΔFMD% (Q = 15.74, df = 3, P < 0.01, R2 = 0.72).

CONCLUSIONS AND RELEVANCE: Aerobic exercise training improves FMD for postmenopausal individuals, and this observation was greater among controlled versus pre-post interventions. A higher resting blood pressure and the greatest ΔV˙o2max yielded the largest improvements in FMD.

PMID:35881939 | DOI:10.1097/GME.0000000000002000

Med Sci Sports Exerc. 2022 Jul 19. doi: 10.1249/MSS.0000000000003005. Online ahead of print.

ABSTRACT

PURPOSE: The objective of the present study was to evaluate the implementation of the program in real life and the evolution of the QoL in breast cancer patients after 3 months of supervised PA in real-life and to determine the factors associated with changes in various QoL dimensions.

METHODS: This prospective cohort study was carried out in female patients with breast cancer diagnosed within a maximum of 3 years. QoL and physical exertion intensity during the supervised PA sessions were assessed by the QLQ-C30 and Borg scale, respectively. Statistical analyzes comparing QoL scores between the start and the end of supervised PA program were assessed using paired Student’s t tests. Multivariate analysis was performed by linear regression with only variables with a p-value <0.15 in univariate model.

RESULTS: A total of 93 patients were included in the analyzes. There was a significant improvement of social functioning at T3 (∆ = 11.5; p < 0.001). The improvement of social functioning was significantly and independently associated to the BORG improvement (β = 2.66 ± 1.31, p = 0.046), chemotherapy (β = 11.03 ± 5.45, p = 0.046), hormone therapy (β = -13.91 ± 5.51, p = 0.013), social isolation (β = -14.81 ± 6.55, p = 0.026) and comorbidities (β = -15.32 ± 5.59, p = 0.007).

CONCLUSIONS: We observed a real enthusiasm and need among patients for practicing physical activity supervised by a sport trainer near their home. The increase in the intensity of exercise over time contributes to the improvement of the QoL, especially on the social functioning. These results, consistent with previous literature, reinforce the importance of exercise intensity on many dimensions of QoL. In addition, patients expressed great satisfaction with the supervised program, resulting in a strong desire to maintain long-term physical activity.

PMID:35881932 | DOI:10.1249/MSS.0000000000003005