Nevin Manimala

Nurs Open. 2021 Dec 4. doi: 10.1002/nop2.1135. Online ahead of print.

ABSTRACT

AIM: To explore the mediating role of depression in older people receiving haemodialysis on social support and the attitude of participants towards death.

DESIGN: A cross-sectional questionnaire survey.

METHODS: Data were collected from older people undergoing dialysis (N = 209) at two regional hospitals in the north of Taiwan. Confirmatory factor analysis with structural equation model was used to clarify the strength of relationships and intermediary effects of three scales in which with 5,000 bootstrap samples using LISREL 9.31.

RESULTS: The final model provided a good fit for the data. Social support and depression have statistically significant effects on dialysis older person’ negative death attitudes. The direct effect of social support on depression was the strongest (p<.001). Overall, depression completely mediates social support and positive death attitudes. Depression partially mediates social support and negative death attitude.

PMID:34863049 | DOI:10.1002/nop2.1135

Orthod Craniofac Res. 2021 Dec 4. doi: 10.1111/ocr.12553. Online ahead of print.

ABSTRACT

INTRODUCTION: Patients with Class II subdivision malocclusion present skeletal and dental asymmetries. The purpose of this study is to assess those asymmetries by 3D mirroring and colormap quantification.

METHODS: This study analyzed 50 initial CBCTs divided in two groups: Class I (control group) and Class II subdivision (study group) malocclusion patients. CBCTs were oriented and full skull was segmented generating a 3D model. The right side of the 3D models was mirrored, using a midsagittal plane as reference, resulting in a perfectly symmetric skull based on two right sides. Original and mirrored models were superimposed on the unchanged right half, and differences were quantified using a colormap. Eight regions of interest were assessed: gonion, mandibular front, maxillary front, zygomatic process, maxillary and mandibular canine and molar areas.

RESULTS: Statistically significant differences using the Mann Whitney test were found in six of the eight evaluated areas when comparing the control to the study group. The maxillary areas did not show any difference between the groups.

CONCLUSIONS: Patients with Class II subdivision malocclusion show true skeletal and dental asymmetries when comparing right and left sides. The maxilla showed no significant skeletal asymmetry, but the maxillary teeth were positioned more mesially on the Class II side. The maxillary canine on the Class II side was also more bucally positioned. The mandible showed significant asymmetries with both skeletal and dental areas in the Class II side more distally and bucally positioned.

PMID:34863033 | DOI:10.1111/ocr.12553

Am J Med Genet A. 2021 Dec 4. doi: 10.1002/ajmg.a.62587. Online ahead of print.

ABSTRACT

Children with Down syndrome (DS) show delayed acquisition of cognitive and functional skills compared to typically developing children. The objective of this study was to accurately describe early development of infants and young children (children hereafter) with DS based on a large recent sample. We carried out repeated measure analysis of the global development quotient (GDQ) and developmental age using data from the Assessment of Systematic Treatment with Folinic Acid and Thyroid Hormone on Psychomotor Development of Down Syndrome Young Children (ACTHYF) study (NCT01576705). Because there was no statistically significant difference in the primary endpoint between active treatment and placebo, data from all treatment groups were pooled for post-hoc analysis. Data of 141 children with DS aged 6-18 months at inclusion were analyzed. Mean GDQ decreased over the study period, especially in the youngest age classes ([6-9] and [9-12] months), indicating that acquisition of skills occurred at a slower pace compared to typically developing children. Strongest deficits were observed for motor and hearing and language skills. Only GDQ at baseline correlated significantly with evolution of GDQ. Future studies should aim at elucidating the mechanisms underlying motor and language development. Early pharmacological interventions together with early childhood therapies might be necessary to improve the developmental trajectory of children with DS.

PMID:34863019 | DOI:10.1002/ajmg.a.62587

J Eur Acad Dermatol Venereol. 2021 Dec 4. doi: 10.1111/jdv.17857. Online ahead of print.

ABSTRACT

BACKGROUND: A large discrepancy between physician-diagnosed and self-reported HS exists. Knowledge regarding incidence and remission rates of self-reported HS is missing, but may help bridge the gap in understanding between these two phenotypes.

OBJECTIVES: To determine the incidence and remission rates of self-reported HS, and to what degree these are affected by sex, smoking and BMI.

METHODS: A prospective cohort of 23,930 Danish blood donors. Information on self-reported HS, symptom-localization, sex, age, BMI and smoking status was collected at baseline and study termination. Self-reported HS fulfilled clinical obligatory diagnostic criteria. Cox proportional hazards regression analyses were conducted for both incidence and remission rates providing a hazard ratio (HR) of risk for each variable in the regression.

RESULTS: incidence rate of self-reported HS was 10.8/1,000 person-years (95% CI: 9.9-11.7), decreasing as a function of numbers of areas affected. Female BMI points above 25 (HR=1.11, 95% CI: 1.09-1.13), male BMI points above 25 (HR=1.07, 95% CI: 1.04-1.11) , active smoking (HR=1.72, 95% CI: 1.15-2.57), male sex (HR=0.55, 95% CI: 0.45-0.67) and years of age above 25 (HR=0.97, 95% CI: 0.96-0.97) were all statistically associated with the development of self-reported HS. Remission rate of self-reported HS was 256.7/1,000 person-years (95% CI: 223.9-292.6), decreasing as a function of numbers of affected areas. Symptoms in ≥3 areas (HR=0.54, 95% CI: 0.34-0.85), active smoking (HR=0.49, 95% CI: 0.32-0.76) and female weight loss (every percentage drop in BMI: HR=1.07, 95%CI: 1.05-1.11) all significantly affected the remission rate.

CONCLUSIONS: Both incidence and remission rates of self-reported HS are high, indicating that many with self-reported HS are unlikely to be diagnosed, as they to a higher degree experience mild transient HS symptoms.

PMID:34862994 | DOI:10.1111/jdv.17857

Biometrics. 2021 Dec 4. doi: 10.1111/biom.13609. Online ahead of print.

ABSTRACT

Complementary features of randomized controlled trials (RCTs) and observational studies (OSs) can be used jointly to estimate the average treatment effect of a target population. We propose a calibration weighting estimator that enforces the covariate balance between the RCT and OS, therefore improving the trial-based estimator’s generalizability. Exploiting semiparametric efficiency theory, we propose a doubly robust augmented calibration weighting estimator that achieves the efficiency bound derived under the identification assumptions. A nonparametric sieve method is provided as an alternative to the parametric approach, which enables the robust approximation of the nuisance functions and data-adaptive selection of outcome predictors for calibration. We establish asymptotic results and confirm the finite sample performances of the proposed estimators by simulation experiments and an application on the estimation of the treatment effect of adjuvant chemotherapy for early-stage non-small cell lung patients after surgery. This article is protected by copyright. All rights reserved.

PMID:34862966 | DOI:10.1111/biom.13609

Int J Gynaecol Obstet. 2021 Dec 4. doi: 10.1002/ijgo.14060. Online ahead of print.

ABSTRACT

OBJECTIVE: To study the association between precipitous labor (less than 3 hours) and the onset of transient tachypnea in singleton fetuses in cephalic presentation with term vaginal deliveries.

METHODS: This cohort study included women delivered from 2013 through 2017 in our French tertiary university hospital maternity unit. Inclusion criteria were vaginal delivery of liveborn singleton fetus in cephalic presentation and at term. We compared women with precipitous labor and those with longer labor. The principal endpoint was the rate of transient tachypnea of the newborn (TTN). We investigated risk factors for TTN besides duration of labor.

RESULTS: Comparison of 2644 women with precipitous labor and 7571 with longer labor showed a lower TTN rate in the precipitous labor group (1.6 vs 2.7%; P=0.003). The association was no longer significant after adjustment for the risk factors identified in the univariate analysis (adjusted OR 0.99, 95% CI 0.64-1.54). Risk factors identified for TTN were non-clear amniotic fluid, shoulder dystocia, umbilical cord encirclement, birth weight less than 2500 g, use of cervical ripening and operative vaginal delivery.

CONCLUSION: Precipitous labor, lasting less than 3 hours, is not associated with a higher risk of transient tachypnea in term newborns after vaginal delivery.

PMID:34862963 | DOI:10.1002/ijgo.14060

Ophthalmol Ther. 2021 Dec 4. doi: 10.1007/s40123-021-00413-7. Online ahead of print.

ABSTRACT

INTRODUCTION: To compare the long-term effect after modified CO₂ laser-assisted sclerectomy surgery (MCLASS) and conventional trabeculectomy (TRAB) in medically uncontrolled Chinese primary open-angle glaucoma (POAG) patients. This was a retrospective comparative study.

METHODS: A total of 87 patients were reviewed, including 45 in the MCLASS group and 42 in the TRAB group. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), and use of supplemental medical therapy were retrospectively compared at baseline, and until 36 months postoperatively.

RESULTS: Patients in both groups achieved a significant IOP decrease from baseline (P < 0.001); postoperative IOP in the MCLASS group was significantly lower than that in the TRAB group at 24 and 36 months. The reduced use of medication was statistically significant in both groups, and the number of postoperative medications was significantly more in TRAB group at 24 and 36 months. At 24 and 36 months, the complete success rate was 60% and 53.3% for MCLASS versus 66.7% and 59.5% for TRAB, and the qualified success rate was 91.1% and 88.9% for MCLASS versus 83.3% and 80.9% for TRAB, respectively. BCVA deterioration post TRAB was clinically more serious than that post MCLASS at 24 and 36 months, although the difference was not statically significant at any time point postoperatively. Compared with MCLASS, more complications occurred postoperatively in the TRAB group.

CONCLUSIONS: MCLASS is an effective surgical option for Chinese POAG patients. Compared to TRAB, eyes undergoing MCLASS experience a comparable success rate, a greater IOP reduction, fewer medications, and a lower risk of complications up to 36 months.

PMID:34862960 | DOI:10.1007/s40123-021-00413-7

Ultrasound J. 2021 Dec 4;13(1):47. doi: 10.1186/s13089-021-00247-1.

ABSTRACT

BACKGROUND: Traditional anatomy teaching methods are based on the models and cadaveric dissections, providing fixed views of the anatomical structures. However, in the last few years, the emerging concept of ultrasound-based teaching in anatomy has started to gain ground among medical curricula. This study aims to evaluate the integration of ultrasound as an adjunct tool to traditional anatomy teaching methods and explore students’ perceptions of whether ultrasound-based teaching enhances their interest and knowledge of anatomy. A cross-sectional study was carried out among the students of the 6-year undergraduate entry (MD) and 4-year graduate entry (MBBS) program of the University of Nicosia. A questionnaire was distributed to them after the delivery of several twenty minutes ultrasound sessions by an expert in the field during anatomy practicals. The data were analyzed utilizing SPSS software, and the statistical significance was determined as p value < 0.05.

RESULTS: 107 MD and 42 MBBS students completed the questionnaire. Both groups agreed that their ultrasound-based learning experience was good or excellent (79.4% MD students; 92.9% MBBS students), that it enhanced their knowledge of anatomy (68.2% MD students; 90.5% MBBS students) and boosted their confidence regarding their examination skills practice (69.2% MD students; 85.7% MBBS students). Although most students desired more time allocated to the ultrasound station (72% MD students; 85.7% MBBS students), they believed that ultrasound-based teaching is a necessary adjunct to the traditional teaching methods of anatomy (89.7% MD students; 92.9% MBBS students).

CONCLUSIONS: Overall, MBBS students were more confident about the benefits of ultrasound-based teaching. Most of the students agreed that cross-sectional sessions of traditional teaching and ultrasound-based teaching strengthened their knowledge of anatomy and enhanced their confidence concerning their clinical examination skills. Medical schools should embrace the advantages that ultrasound-based teaching offers in order future doctors to be qualified to utilize ultrasound for procedural and diagnostical purposes.

PMID:34862937 | DOI:10.1186/s13089-021-00247-1

Skeletal Radiol. 2021 Dec 4. doi: 10.1007/s00256-021-03951-0. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess prevalence of CT imaging-derived sarcopenia, osteoporosis, and visceral obesity in clinically frail and prefrail patients and determine their association with the diagnosis of frailty.

MATERIALS AND METHODS: This cross-sectional study was constructed using our institution’s pelvic trauma registry and ambulatory database registry. The study included all elderly pelvic trauma patients and ambulatory outpatients between May 2016 and March 2020 who had a comprehensive geriatric assessment and CT abdomen/pelvis within 1 year from the date of the assessment. Patients were dichotomized in prefrail or frail groups. The study excluded patients with history of metastatic disease or malignancy requiring chemotherapy.

RESULTS: The study cohort consisted of 151 elderly female and 65 male patients. Each gender population was subdivided into frail (114 female [75%], 51 male [78%]) and prefrail (37 female [25%], 14 male [22%]) patients. CT-imaging-derived diagnosis of osteoporosis (odds ratio, 2.5; 95% CI: 1.2-5.5) and sarcopenia (odds ratio, 2.6; 95% CI: 1.2-5.6) were associated with frailty in females, but did not reach statistical significance in males. BMI and subcutaneous adipose tissue at L3 level were statistically lower in the frail male group compared to the prefrail group. BMI showed strong correlation with the subcutaneous area at the L3 level in both genders (Spearman’s coefficient of 0.8, p < 0.001). Hypoalbuminemia and visceral obesity were not associated with frailty in either gender.

CONCLUSION: This proof-of-concept study demonstrates the feasibility of using CT-derived body-composition parameters as a screening tool for frailty, which can offer an opportunity for early medical intervention.

PMID:34862921 | DOI:10.1007/s00256-021-03951-0

Arch Gynecol Obstet. 2021 Dec 4. doi: 10.1007/s00404-021-06336-9. Online ahead of print.

ABSTRACT

OBJECTIVE: The COVID-19 pandemic restricting clinical practice and exacerbating the lack of medical staff. There is currently a lack of young residents who are deciding on further training in gynecology and obstetrics.

DESIGN: review and prospective, cross-sectional study.

SETTING: the aim of this study was to investigate if structured mentoring programs can counteract this deficiency.

POPULATION: medical students took part from Germany in the clinical phase.

METHODS: An anonymous questionnaire was developed and distributed to students from January to October 2020. Epidemiological data, questions about mentoring experiences, necessity and their expected influence on career planning were collected and statistically evaluated.

MAIN OUTCOME MEASURES: structured mentoring-programs can influence the choice of subject. In particular, men are still underrepresented. Research on the topic of mentoring during in the field of gynaecology and obstetrics is completely lacking.

RESULTS: A representative number of 927 medical students took part in the survey. 22% (170/906) of the students had already participated in a mentoring program with a significantly higher proportion of men (69%; 117/170; p < 0.001). Of these, 94% (453/170) said this was helpful. 6% (55/906) wanted to pursue a career in gynecology and obstetrics. When asked about their appreciation for structured mentoring programs in gynecology and obstetrics, 95% (880/906) would participate and 94% agreed (871/906) that this could have an impact on their choice of specialist and career planning.

CONCLUSIONS: An active provision of mentoring programs and more content can be a way of counteracting the shortage of residents in gynecology and obstetrics.

PMID:34862919 | DOI:10.1007/s00404-021-06336-9