Tag: nevin manimala

J Dent Hyg. 2021 Apr;95(2):50-57.

ABSTRACT

Purpose: Legislative advocacy provides an avenue through which oral health disparities and alternative methods of delivering oral health care to underserved populations can be addressed. The purpose of this study was to assess advocacy knowledge, values, actions and perceived barriers of undergraduate and graduate students enrolled in a leadership course with a Legislative Advocacy Project (LAP).Methods: A pre-test/post-test online questionnaire was administered to a convenience sample of undergraduate and graduate dental hygiene students to measure advocacy knowledge, values, and actions resulting from participation in a LAP (n=38). Descriptive statistics assessed the average responses of perceived barriers. Two open-ended questions asked about participation in advocacy and providing feedback regarding the LAP.Results: Both groups (undergraduate, n=25; graduate, n=13) demonstrated a statistically significant change from the pre-test/post-test assessment of knowledge, values, and actions (p<0.001). No statistically significant differences were identified when comparing undergraduate and graduate level responses, pre-test and post-test scores and undergraduate and graduate level responses, and perceived barriers. The three greatest barriers were lack of time to participate in legislative activities, lack of comfort speaking to legislators and testifying before legislators. Responses to the open-ended questions suggested learning in the three lower levels of the affective domain.Conclusions: Knowledge, values, and actions were increased following the LAP. Strategies to address ongoing barriers should be implemented in advocacy curricula. The LAP was influential in integrating cognitive knowledge and changing receiving, responding, and valuing levels of the affective domain. An Affective Advocacy Model was developed based on the analysis of responses to the open-ended questions and current literature.

PMID:33875530

Diabetes Care. 2021 Apr 19:dc201794. doi: 10.2337/dc20-1794. Online ahead of print.

ABSTRACT

OBJECTIVE: Emerging data from animal and human pilot studies suggest potential benefits of glucagon-like peptide 1 receptor agonists (GLP-1RA) on lung function. We aimed to assess the association of GLP-1RA and chronic lower respiratory disease (CLRD) exacerbation in a population with comorbid type 2 diabetes (T2D) and CLRD.

RESEARCH DESIGN AND METHODS: A new-user active-comparator analysis was conducted with use of a national claims database of beneficiaries with employer-sponsored health insurance spanning 2005-2017. We included adults with T2D and CLRD who initiated GLP-1RA or dipeptidyl peptidase 4 inhibitors (DPP-4I) as an add-on therapy to their antidiabetes regimen. The primary outcome was time to first hospital admission for CLRD. The secondary outcome was a count of any CLRD exacerbation associated with an inpatient or outpatient visit. We estimated incidence rates using inverse probability of treatment weighting for each study group and compared via risk ratios.

RESULTS: The study sample consisted of 4,150 GLP-1RA and 12,540 DPP-4I new users with comorbid T2D and CLRD. The adjusted incidence rate of first CLRD admission during follow-up was 10.7 and 20.3 per 1,000 person-years for GLP-1RA and DPP-4I users, respectively, resulting in an adjusted hazard ratio of 0.52 (95% CI 0.32-0.85). For the secondary outcome, the adjusted incidence rate ratio was 0.70 (95% CI 0.57-0.87).

CONCLUSIONS: GLP-1RA users had fewer CLRD exacerbations in comparison with DPP-4I users. Considering both plausible mechanistic pathways and this real-world evidence, potential beneficial effects of GLP-1RA may be considered in selection of an antidiabetes treatment regimen. Randomized clinical trials are warranted to confirm our findings.

PMID:33875487 | DOI:10.2337/dc20-1794

J Dent Hyg. 2021 Apr;95(2):6-13.

ABSTRACT

Purpose: Dental hygienists perform precision instrumentation tasks repetitively throughout the workday, placing them at increased risk for developing a musculoskeletal disorder. The purpose of this pilot study was to determine differences in muscle activity and pinch force generation between the traditional scaling technique and a modified scaling technique.Methods: A convenience sample of dental hygienists (n=12) acted as their own controls in this counterbalance-designed pilot study. Muscle activity and pinch forces were assessed while participants performed traditional and modified scaling techniques with designated instruments on artificial calculus applied to the lower left quadrant of a typodont, for a period of five minutes. Surface electromyography was used to measure muscle activity; sensors attached to the instrument handle measured pinch forces. Participants were surveyed regarding the instruments used and scaling technique preferences at the conclusion of the session. Parametric and non-parametric tests were used to analyze the data. Descriptive statistics were used to analyze the exit survey.Results: The modified scaling technique required less muscle activity than the traditional technique while scaling, however results were not significant (p>0.05). The traditional scaling technique required greater overall pinch force during scaling (p=.00). Pairwise comparisons revealed significant differences between pinch force generation in the thumb for the two scaling techniques (Z = -2.401, p= 0.016) and in the index finger (Z = -2.223, p= 0.026). The traditional scaling technique generated more pinch force (thumb x=7.25±4.99, index finger x=2.86±2.14) when compared to the modified scaling technique (thumb x=4.52±2.32, index finger x=1.65±1.28). Participants had a slightly higher preference for the instrument utilized for the modified scaling technique in terms of balance, maneuverability, overall comfort and the associated scaling technique as compared to the instrument utilized for the traditional scaling technique.Conclusion: Use of a modified scaling technique may reduce muscle activity and pinch force generation as compared to the traditional lateral pressure scaling technique during instrumentation. Future research on ergonomic scaling techniques is needed to determine their efficacy and impact on musculoskeletal disorders.

PMID:33875524

J Dent Hyg. 2021 Apr;95(2):21-27.

ABSTRACT

Purpose: Individuals with intellectual and developmental disabilities (IDD) have a higher risk of oral disease and require assistance in performing oral self-care. The purpose of this study was to measure the impact of an oral health education program in improving caregivers’ oral health knowledge, attitudes, behavior, and self-efficacy in providing oral health care to clients with IDD, residing in intermediate care facilities.Methods: A non-probability sample of new hire caregivers (n=47) for clients with IDD residing in an intermediate care facility was used for this quasi-experimental study. A one-group repeated measures design was used to explore the effectiveness of an oral health education program. All variables were examined using summary statistics and evaluated for normality and statistical assumptions.Results: Forty-seven participants attended the oral health education program intervention and completed the pre- and post-intervention questionnaire. Seventy percent (n=33) completed the four-week post-questionnaire. A statistically significant (p=0.004) improvement in knowledge between the baseline questionnaire and four-week questionnaire was identified. Findings demonstrated slight increases in knowledge for caregivers with <1 year experience, and in those with previous medical training. No significant differences were found in behaviors or attitudes from baseline to the four-week follow up, however, there was a trend toward positive behavior changes.Conclusion: Increased knowledge alone is not adequate to bring about and maintain positive oral health behavior change. Longer-term caregiver interventions, in addition to on-site support for oral care, are warranted to evaluate outcomes for individuals with IDD with the goal of reducing the burden of oral disease.

PMID:33875526

Br J Gen Pract. 2020 Dec 9:bjgp20X713489. doi: 10.3399/bjgp20X713489. Online ahead of print.

ABSTRACT

BACKGROUND: For some common cancers, survival is lower in the UK than in comparable high-income countries.

AIM: To assess the effectiveness of a targeted postal intervention (to promote awareness of cancer symptoms and earlier help seeking) on patient consultation rates.

DESIGN AND SETTING: A two-arm randomised controlled trial was carried out on patients aged 50-84 years registered at 23 general practices in rural and urban areas of Greater London, Greater Manchester, and the North East of England.

METHOD: Patients who had not had a consultation at their general practice in the previous 12 months and had at least two other risk factors for late presentation with cancer were randomised to intervention and control arms. The intervention consisted of a posted letter and leaflet. Primary outcome was the number of consultations at the practice with patients randomised to each arm in the 6 months subsequent to posting the intervention. All patients with outcome data were included in the intention-to-treat analyses.

RESULTS: In total, 1513 patients were individually randomised to the intervention (n = 783) and control (n = 730) arms between Nov 2016 – May 2017; outcome data were available for 749 and 705 patients, respectively, with a statistically significantly higher rate of consultation in the intervention arm compared with the control arm: 436 versus 335 consultations (relative risk 1.40, 95% confidence interval = 1.11 to 1.77, P = 0.004). There was, however, no difference in the numbers of patients consulting.

CONCLUSION: Targeted interventions of this nature can change behaviour; there is a need to develop interventions that can be more effective at engaging patients with primary care. This study demonstrates that targeted interventions promoting both awareness of possible cancer symptoms and earlier health seeking, can change behaviour. There is a need to develop and test interventions that can be more effective at engaging the most at-risk patients.

PMID:33875418 | DOI:10.3399/bjgp20X713489

Diabetes Care. 2021 Apr 19:dc202877. doi: 10.2337/dc20-2877. Online ahead of print.

ABSTRACT

OBJECTIVE: Insulin icodec (icodec) is a novel once-weekly basal insulin analog. This trial investigated two approaches for switching to icodec versus once-daily insulin glargine U100 (IGlar U100) in people with type 2 diabetes receiving daily basal insulin and one or more oral glucose-lowering medications.

RESEARCH DESIGN AND METHODS: This multicenter, open-label, treat-to-target phase 2 trial randomized (1:1:1) eligible basal insulin-treated (total daily dose 10-50 units) people with type 2 diabetes (HbA_1c 7.0-10.0% [53.0-85.8 mmol/mol]) to icodec with an initial 100% loading dose (in which only the first dose was doubled [icodec LD]), icodec with no loading dose (icodec NLD), or IGlar U100 for 16 weeks. Primary end point was percent time in range (TIR; 3.9-10.0 mmol/L [70-180 mg/dL]) during weeks 15 and 16, measured using continuous glucose monitoring. Key secondary end points included HbA_1c, adverse events (AEs), and hypoglycemia.

RESULTS: Estimated mean TIR during weeks 15 and 16 was 72.9% (icodec LD; n = 54), 66.0% (icodec NLD; n = 50), and 65.0% (IGlar U100; n = 50), with a statistically significant difference favoring icodec LD versus IGlar U100 (7.9%-points [95% CI 1.8-13.9%]). Mean HbA_1c reduced from 7.9% (62.8 mmol/mol) at baseline to 7.1% (54.4 mmol/mol icodec LD) and 7.4% (57.6 mmol/mol icodec NLD and IGlar U100); incidences and rates of AEs and hypoglycemic episodes were comparable.

CONCLUSIONS: Switching from daily basal insulin to once-weekly icodec was well tolerated and provided effective glycemic control. Loading dose use when switching to once-weekly icodec significantly increased percent TIR during weeks 15 and 16 versus once-daily IGlar U100, without increasing hypoglycemia risk.

PMID:33875485 | DOI:10.2337/dc20-2877

Diabetes Care. 2021 Apr 19:dc202607. doi: 10.2337/dc20-2607. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the effects of alcohol abstinence on prevention of new-onset atrial fibrillation (AF) in patients with type 2 diabetes mellitus (T2DM).

RESEARCH DESIGN AND METHODS: A total of 1,112,682 patients newly diagnosed with T2DM between 2011 and 2014 were identified from the Korean National Health Insurance Service database. After excluding those with a history of AF, 175,100 patients were included. The primary outcome was new-onset AF.

RESULTS: During a mean follow-up of 4.0 years, AF occurred in 4,174 patients. Those with heavy alcohol consumption (alcohol intake ≥40 g/day) before T2DM diagnosis had a higher risk of AF (adjusted hazard ratio [aHR] 1.22; 95% CI 1.06-1.41) compared with patients with no alcohol consumption. After T2DM diagnosis, those with moderate to heavy alcohol consumption (alcohol intake ≥20 g/day) who abstained from alcohol had a lower risk of AF (aHR 0.81; 95% CI 0.68-0.97) compared with constant drinkers. Alcohol abstinence showed consistent trends toward lower incident AF in all subgroups and was statistically significant in men (aHR 0.80; 95% CI 0.67-0.96), those aged >65 years (aHR 0.69; 95% CI 0.52-0.91), those with CHA₂DS₂-VASc score <3 points (aHR 0.71; 95% CI 0.59-0.86), noninsulin users (aHR 0.77; 95% CI 0.63-0.94), and those with BMI <25 kg/m² (aHR 0.68; 95% CI 0.53-0.88).

CONCLUSIONS: In patients with newly diagnosed T2DM, alcohol abstinence was associated with a low risk of AF development. Lifestyle modifications, such as alcohol abstinence, in patients newly diagnosed with T2DM should be recommended to reduce the risk of AF.

PMID:33875486 | DOI:10.2337/dc20-2607

Cogn Sci. 2021 Apr;45(4):e12972. doi: 10.1111/cogs.12972.

ABSTRACT

A fundamental question in the study of human cognition is how people learn to predict the category membership of an example from its properties. Leading approaches account for a wide range of data in terms of comparison to stored examples, abstractions capturing statistical regularities, or logical rules. Across three experiments, participants learned a category structure in a low-dimension, continuous-valued space consisting of regularly alternating regions of class membership (A B A B). The dependent measure was generalization performance for novel items outside the range of the training space. Human learners often extended the alternation pattern–a finding of critical interest given that leading theories of categorization based on similarity or dimensional rules fail to predict this behavior. In addition, we provide novel theoretical interpretations of the observed phenomenon.

PMID:33873244 | DOI:10.1111/cogs.12972

Adv Nutr. 2021 Apr 19:nmab037. doi: 10.1093/advances/nmab037. Online ahead of print.

ABSTRACT

Numerous observational studies have investigated the role of the Dietary Inflammatory Index (DII®) in chronic disease risk. The aims of this umbrella review and integrated meta-analyses were to systematically synthesize the observational evidence reporting on the associations between the DII and health outcomes based on meta-analyses, and to assess the quality and strength of the evidence for each associated outcome. This umbrella review with integrated meta-analyses investigated the association between the DII and a range of health outcomes based on meta-analyses of observational data. A credibility assessment was conducted for each outcome using the following criteria: statistical heterogeneity, 95% prediction intervals, evidence for small-study effect and/or excess significance bias, as well as effect sizes and P values using calculated random effects meta-analyses. In total, 15 meta-analyses reporting on 38 chronic disease-related outcomes were included, incorporating a total population of 4,360,111 subjects. Outcomes (n = 38) were examined through various study designs including case-control (n = 8), cross-sectional (n = 5), prospective (n = 5), and combination (n = 20) study designs. Adherence to a pro-inflammatory dietary pattern had a significant positive association with 27 (71%) of the included health outcomes (P value < 0.05). Using the credibility assessment, Class I (Convincing) evidence was identified for myocardial infarction only, Class II (Highly suggestive) evidence was identified for increased risk of all-cause mortality, overall risk of incident cancer, and risk of incident site-specific cancers (colorectal, pancreatic, respiratory, and oral cancers) with increasing (more pro-inflammatory) DII score. Most outcomes (n = 31) presented Class III (Suggestive) or lower evidence (Weak or No association). Pro-inflammatory dietary patterns were nominally associated with an increased risk of many chronic disease outcomes. However, the strength of evidence for most outcomes was limited. Further prospective studies are required to improve the precision of the effect size.

PMID:33873204 | DOI:10.1093/advances/nmab037

J Am Acad Audiol. 2021 Apr 19. doi: 10.1055/s-0041-1722983. Online ahead of print.

ABSTRACT

BACKGROUND: Temporal resolution is essential to speech acoustic perception. However, it may alter in individuals with auditory disorders, impairing the development of spoken and written language. The envelope of speech signals contains amplitude modulation (AM) that has critical information. Any problem reducing the listener’s sensitivity to these amplitude variations (auditory temporal acuity) is likely to cause speech comprehension problems. The modulation detection threshold (MDT) test is a measure for evaluating temporal resolution. However, this test cannot be used for patients with poor cooperation; therefore, objective evaluation of MDT is essential.

PURPOSE: The main aim of this study is to find the association between the auditory steady-state response (ASSR) and psychoacoustic measurement of MDT at different intensity levels and to assess the amplitude and phase of ASSR as a function of modulation depth.

DESIGN: This was a correlational research.

STUDY SAMPLE: Eighteen individuals (nine males and nine females) with normal hearing sensitivity, aged between 18 and 23 years, participated in this study.

DATA COLLECTION AND ANALYSIS: ASSR was recorded at fixed AM rates and variable AM depths for carrier frequencies of 1,000 and 2,000 Hz with varying intensities. The least AM depth, efficient to evoke an ASSR response, was interpreted as the physiological detection threshold of AM. The ASSR amplitude and phase, as a function of AM depth, were also evaluated at an intensity level of 60 dB hearing level (HL) with modulation rates of 40 and 100 Hz. Moreover, the Natus instrument (Biologic Systems) was used for the electrophysiological measurements. An AC40 clinical audiometer (Intra-acoustic, Denmark) was also used for the psychoacoustic measurement of MDT in a similar setting to ASSR, using the two-alternative forced choice method. Pearson’s correlation test and linear regression model and paired t-test were used for statistical analyses.

RESULTS: A significant positive correlation was found between psychoacoustic and electrophysiological measurements at a carrier frequency of 1000 Hz, with a modulation rate of 40 Hz at intensity levels of 60 dB HL (r = 0.63, p = 0.004), 50 dB HL (r = 0.52, p = 0.02). A significant positive correlation was also found at a carrier frequency of 2000 Hz, with a modulation rate of 47 Hz at 60 dB HL (r = 0.55, p = 0.01) and 50 dB HL (r = 0.67, p = 0.002) and a modulation rate of 97 Hz at 60 dB HL (r = 0.65, p = 0.003). Moreover, a significant association was found between the modulation depth and ASSR amplitude and phase increment at carrier frequencies of 1,000 and 2000 Hz, with modulation rates of 40 and 100 Hz.

CONCLUSION: There was a significant correlation between ASSR and behavioral measurement of MDT, even at low intensities with low modulation rates of 40 and 47 Hz. The ASSR amplitude and phase increment was a function of modulation depth increase. The findings of this study can be used as a basis for evaluating the relationship between two approaches in the clinical population.

PMID:33873218 | DOI:10.1055/s-0041-1722983