Tag: nevin manimala

Radiography (Lond). 2021 Dec 24:S1078-8174(21)00192-9. doi: 10.1016/j.radi.2021.12.001. Online ahead of print.

ABSTRACT

INTRODUCTION: The evolution of technology within healthcare is continuing at a rapid rate. Touchless technologies (i.e. those involving gestures and voice commands) are rapidly being integrated into daily life. The aim of this study was to investigate the potential role for such technologies within diagnostic radiography.

METHODS: An online survey was developed, piloted and deployed using SurveyMonkey as part of an online radiology congress. Eligible respondents were radiographers or radiologic technologists, including students. The survey covered ten themes relating to the potential role of touchless technologies within diagnostic radiography. Results were analysed using descriptive and inferential statistics.

RESULTS: 155 people completed the questionnaire. 100 (64.9%) were women and clinical experience ranged from 13.5 (0-40) years. The majority, 54 (35.1%), had a Bachelor’s degree with respondents being from 23 different countries (five continents). 34 (21.9%) respondents did not personally own nor intended to purchase touchless technologies. 89 (84.8%) respondents saw themselves using touchless technologies, if available on current imaging equipment. 25 (16.0%) respondents reported that they currently have access to touchless technologies within their workplace. 88 (81.5%) and 67 (65.0%) respondents reported that they saw voice and gesture controls as being key in improving exam efficiency.

CONCLUSION: Participants clearly perceived a role for touchless technologies within diagnostic radiography. Access to such technologies is not yet widely available within X-ray rooms. Voice activated technologies appear more appealing that gesture-based aids. The primary role for such technologies was defined by participants as focusing on improving examination efficiency.

IMPLICATIONS FOR PRACTICE: Touchless technologies have been identified and as important and potentially useful in diagnostic radiography. Collaboration between healthcare institutions, industry and academia is required to design and successfully implement these technologies into practice.

PMID:34961676 | DOI:10.1016/j.radi.2021.12.001

Dent Mater. 2021 Dec 24:S0109-5641(21)00356-0. doi: 10.1016/j.dental.2021.12.029. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate in vitro the mechanical, biological, and polymerization behavior of a flowable bulk-fill composite with fibers as a dispersed phase.

METHODS: EverX Flow™ (GC Corporation) (EXF), one conventional bulk-fill composite (Filtek™ Bulk Fill Posterior Restorative, 3 M (FBF)), and one flowable bulk composite without fibers (SDR® flow+, Dentsply (SDR)) were tested. Samples were characterized in terms of flexural strength (ISO 4049), fracture toughness (ISO 20795-1), and Vickers hardness. Polymerization stress and volumetric shrinkage were evaluated. The in vitro biological assessment was achieved on cultured primary Human Gingival Fibroblast cells (HGF). The cell metabolic activity was evaluated using Alamar Blue assay at 1, 3, and 5 days of contact to the 3 tested composite extracts (ISO 10993) and cell morphology was evaluated by confocal microscopy. Data were submitted to One-Way analysis of variance (ANOVA) and independent t-test (α = 0.05).

RESULTS: FBF showed statistically higher Vickers hardness and flexural modulus than EXF and SDR. However, EXF showed statistically higher K_IC than FBF and SDR. EXF had the statistically highest shrinkage stress values and FBF the lowest. Archimedes volumetric shrinkage showed significantly lower values for FBF as compared to the other two composites. Slight cytotoxic effect was observed for the three composites at day one. An enhancement of metabolic activity at day 5 was observed in cells treated with EXF extracts.

SIGNIFICANCE: EXF had a significantly higher fracture toughness validating its potential use as a restorative material in stress bearing areas. EXF showed higher shrinkage stress values, and less cytotoxic effect. Fiber reinforced flowable composite is mainly indicated for deep and large cavities, signifying the importance for assessing its shrinkage stress and biological behavior.

PMID:34961643 | DOI:10.1016/j.dental.2021.12.029

Genet Med. 2021 Nov 27:S1098-3600(21)05399-5. doi: 10.1016/j.gim.2021.11.019. Online ahead of print.

ABSTRACT

PURPOSE: The Mexican Jewish community (MJC) is a previously uncharacterized, genetically isolated group composed of Ashkenazi and Sephardi-Mizrahi Jews who migrated in the early 1900s. We aimed to determine the heterozygote frequency of disease-causing variants in 302 genes in this population.

METHODS: We conducted a cross-sectional study of the MJC involving individuals representing Ashkenazi Jews, Sephardi-Mizrahi Jews, or mixed-ancestry Jews. We offered saliva-based preconception pan-ethnic expanded carrier screening, which examined 302 genes. We analyzed heterozygote frequencies of pathogenic/likely pathogenic variants and compared them with those in the Genome Aggregation Database (gnomAD).

RESULTS: We recruited 208 participants. The carrier screening results showed that 72.1% were heterozygous for at least 1 severe disease-causing variant in 1 of the genes analyzed. The most common genes with severe disease-causing variants were CFTR (16.8% of participants), MEFV (11.5%), WNT10A (6.7%), and GBA (6.7%). The allele frequencies were compared with those in the gnomAD; 85% of variant frequencies were statistically different from those found in gnomAD (P <.05). Finally, 6% of couples were at risk of having a child with a severe disorder.

CONCLUSION: The heterozygote frequency of at least 1 severe disease-causing variant in the MJC was 72.1%. The use of carrier screening in the MJC and other understudied populations could help parents make more informed decisions.

PMID:34961661 | DOI:10.1016/j.gim.2021.11.019

J Pediatr Health Care. 2021 Dec 24:S0891-5245(21)00258-3. doi: 10.1016/j.pedhc.2021.10.008. Online ahead of print.

ABSTRACT

INTRODUCTION: Depression is a common diagnosis among adolescents. Routine screening for depression is recommended, yet standardization in screening and management is lacking. A care gap exists due to long wait times for referrals to counseling and other specialized care. Use of a written action plan demonstrated positive effects as an initial management tactic of elevated screening scores.

METHOD: A take-home action plan was provided to adolescents with elevated Patient Health Questionnaire-9 (PHQ-9) scores. Approximately 30 days after initiation, participants completed a post-intervention survey and a re-administration of the PHQ-9.

RESULTS: Pre-intervention and post-intervention PHQ-9 scores were compared, showing a statistically significant decrease in PHQ-9 score (p = .008), with a median decrease of 4.5 points. Additionally, 92% of participants were somewhat likely or very likely to endorse the use of the action plan to a peer or friend.

DISCUSSION: Using a written action plan is an effective strategy to bridge gaps in the care of adolescents with elevated depression screening scores.

PMID:34961628 | DOI:10.1016/j.pedhc.2021.10.008

Aten Primaria. 2021 Dec;53 Suppl 1:102217. doi: 10.1016/j.aprim.2021.102217.

ABSTRACT

OBJECTIVE: To analyse and compare the epidemiology of patient safety incidents reported in Primary Health Care, before and after the start of the COVID-19 pandemic.

DESIGN AND SETTING: Analytical descriptive study comparing reported incidents from March 1st 2019 to February 28th 2020, and from March 1st 2020 to February 28th 2021, notified through the TPSC Cloud™ platform accessible from the Intranet corporative in 25 Primary Health Care centres from Tarragona district, in Catalonia (Spain).

MEASUREMENTS: Data obtained from voluntary notifications, through electronic, standardized and anonymized forms.

VARIABLES: Centre, professional, incident type, risk matrix, causal factors and contributing factors, and avoidability.

STATISTICAL ANALYSIS: Every notification was included in descriptive analysis, and another one specifically for adverse events, comparing both periods.

RESULTS: 2231 incidents were reported. Comparing both periods, during the pandemic a reduction in the number of reported incidents was observed (only represented 20% of the total). However, the percentage of reported notifications from health care professionals and adverse events that required observation were increased. Causal factors related to attendance and diagnosis were incremented whereas the causal factors related to medication were decreased. In addition, an increase in contributing factors related to the professional was observed. Avoidability was high (>95%) in both periods.

CONCLUSIONS: During the pandemic, fewer patient safety incidents have been reported, but proportionally more adverse events, most of which are preventable. The professional himself becomes the main contributing factor.

PMID:34961580 | DOI:10.1016/j.aprim.2021.102217

Am J Prev Med. 2021 Dec 24:S0749-3797(21)00595-X. doi: 10.1016/j.amepre.2021.11.002. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aims to evaluate the trends in the impact of Medicaid expansion on the use of selected recommended clinical preventive services and examine the differences in use by income level over time.

METHODS: The data were obtained from the 2011-2019 Behavioral Risk Factor Surveillance System and were analyzed in 2021. This study conducted a difference-in-differences analysis of the association between Medicaid expansion and the use of 5 clinical preventive services, including colon/breast/cervical cancer screenings, HIV testing, and influenza vaccination. Annual percentage change was applied to assess the trends in the impact of Medicaid expansion on the use of clinical preventive services.

RESULTS: The use of all the 5 clinical preventive services varied over time. In almost every year, the use of 4 clinical preventive services (all but HIV testing) among Medicaid expansion states was higher than that among the nonexpansion states. People with lower income used 4 clinical preventive services (all but HIV testing) less frequently than those with higher income, regardless of their residence in expansion or nonexpansion groups. Among the lower-income group, the use of 5 clinical preventive services increased after Medicaid expansion almost every year, with the use of colon cancer screening and HIV testing reaching statistical significance and the impact of Medicaid expansion in the use of each clinical preventive service kept stable from 2014 to 2019.

CONCLUSIONS: These findings provide evidence that Medicaid expansion may be associated with sustainably increased use of the selected recommended clinical preventive services among the lower-income population and that Medicaid expansion to reduce financial barriers may be an effective strategy to improve population health.

PMID:34961626 | DOI:10.1016/j.amepre.2021.11.002

Trials. 2021 Dec 27;22(1):953. doi: 10.1186/s13063-021-05930-1.

ABSTRACT

BACKGROUND: Type 1 diabetes is a main health burden with several related comorbidities. It has been shown that endothelial function, vascular structure, and metabolic parameters are considerably disrupted in patients with type 1 diabetes. Omega-3 as an adjuvant therapy may exert profitable effects on type 1 diabetes and its complications by improving inflammation, oxidative stress, immune responses, and metabolic status. Because no randomized clinical trial has examined the effects of omega-3 consumption in children and adolescents with type 1 diabetes; the present study aims to close this gap.

METHODS: This investigation is a randomized clinical trial, in which sixty adolescents with type 1 diabetes will be randomly assigned to receive either omega-3 (600 mg/day) or placebo capsules for 12 weeks. Evaluation of anthropometric parameters, flow-mediated dilation (FMD) as an endothelial function marker, carotid intima-media thickness (CIMT) as a vascular structure marker, proteinuria, biochemical factors including glycemic and lipid profile, blood urea nitrogen (BUN), creatinine, high-sensitivity C-reactive protein (hs-CRP), and erythrocyte sedimentation rate (ESR), as well as blood pressure will be done at the baseline and end of the trial. Also, dietary intake and physical activity will be assessed throughout the study. Statistical analysis will be performed using the SPSS software (Version 24), and P < 0.05 will be considered statistically meaningful.

DISCUSSION: It is hypothesized that omega-3 supplementation may be beneficial for the management of type 1 diabetes and its complications by reducing inflammation and oxidative stress and also modulating immune responses and glucose and lipid metabolism through various mechanisms. The present study aims to investigate any effect of omega-3 on patients with type 1 diabetes.

ETHICAL ASPECTS: This trial received approval from Medical Ethics Committee of Iran University of Medical Sciences, Tehran, Iran (IR.IUMS.REC.1400.070).

TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20210419051010N1 . Registered on 29 April 2021.

PMID:34961564 | DOI:10.1186/s13063-021-05930-1

Trials. 2021 Dec 27;22(1):956. doi: 10.1186/s13063-021-05943-w.

ABSTRACT

BACKGROUND: Adolescents and youth living with HIV (AYAHIV) have worse HIV outcomes than other age groups, particularly in sub-Saharan Africa (SSA). AYAHIV in SSA face formidable health system, interpersonal- and individual-level barriers to retention in HIV care, uptake of ART, and achievement of viral suppression (VS), underscoring an urgent need for multi-component interventions to address these challenges. This cluster-randomized control trial (cRCT) aims to evaluate the effectiveness and monitor implementation of a community-informed multi-component intervention (“CombinADO strategy”) addressing individual-, facility-, and community-level factors to improve health outcomes for AYAHIV.

METHODS: This trial will be conducted in 12 clinics in Nampula Province, Northern Mozambique. All clinics will implement an optimized standard of care (control) including (1) billboards/posters and radio shows, (2) healthcare worker (HCW) training, (3) one-stop adolescent and youth-friendly services, (4) information/motivation walls, (5) pill containers, and (6) tools to be used by HCW during clinical visits. The CombinADO strategy (intervention) will be superadded to control conditions at 6 randomly selected clinics. It will include five additional components: (1) peer support, (2) informational/motivational video, (3) support groups for AYAHIV caregivers, (4) AYAHIV support groups, and (5) mental health screening and linkage to adolescent-focused mental health support. The study conditions will be in place for 12 months; all AYAHIV (ages 10-24 years, on ART) seeking care in the participating sites will be exposed to either the control or intervention condition based on the clinic they attend. The primary outcome is VS (viral load < 50 copies/mL) at 12 months among AYAHIV attending participating clinics. Secondary outcomes include ART adherence (self-reported and TDF levels) and retention in care (engagement in the preceding 90 days). Uptake, feasibility, acceptability, and fidelity of the CombinADO strategy during implementation will be measured. Trial outcomes will be assessed in AYAHIV, caregivers, healthcare workers, and key informants. Statistical analyses will be conducted and reported in line with CONSORT guidelines for cRCTs.

DISCUSSION: The CombinADO study will provide evidence on effectiveness and inform implementation of a novel community-informed multi-component intervention to improve retention, adherence, and VS among AYAHIV. If found effective, results will strengthen the rationale for scale up in SSA.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04930367 . Registered on 18 June 2021.

PMID:34961567 | DOI:10.1186/s13063-021-05943-w

Arch Public Health. 2021 Dec 27;79(1):232. doi: 10.1186/s13690-021-00762-6.

ABSTRACT

BACKGROUND: Disengagement from outdoor recreation may diminish the positive benefits on health and well-being in old age. The purpose of this study is to present a contextual, theoretical, and empirical rationale for an intervention, aiming to promote continued engagement in outdoor recreation for older adults in a Swedish context.

METHODS: The paper includes a contextualization of outdoor recreation in Sweden, a presentation of evidence on health benefits related to engagement in outdoor recreation, together with theoretical frameworks that may guide future intervention designs. To add empirical knowledge, a mixed methods approach was applied, including an empirical data collection based on a quantitative survey (n = 266) and individual semi-structured interviews with older adults (n = 12). Survey data were presented with descriptive statistics. Associations between disengagement from previously performed activities and age and gender was analyzed with Chi² tests. Transcripts and handwritten notes from the interviews were analyzed qualitatively to identify key themes, as well as patterns and disparities among respondents.

RESULTS: Outdoor recreation was rated as important/very important by 90% of respondents of the survey. The interviews highlighted that engagement in outdoor recreation aided respondents to keep fit but had also relevance in terms of identity, experiences, and daily routines. Outdoor recreation close to the place of residence was most common and walking was the most frequently reported activity. While 80% considered their health to be good/very good, disability and long-term diseases were common and during the previous year, more than half of all respondents had disengaged from activities previously performed. Reasons for disengagement were mainly related to health decline or that activities were too demanding but also due to social loss. The interviews indicated that continued engagement was important but challenging, and that disengagement could be considered as a loss or accepted due to changing circumstances.

CONCLUSIONS: In the design of an intervention aiming to promote engagement in outdoor recreation for older adults, the following features are proposed to be considered: person-centeredness, promoting functioning, addressing self-ageism, providing environmental support, promoting subjective mobility needs and adaptation to find new ways to engage in outdoor recreation.

PMID:34961546 | DOI:10.1186/s13690-021-00762-6

Trials. 2021 Dec 27;22(1):959. doi: 10.1186/s13063-021-05900-7.

ABSTRACT

BACKGROUND: Clustered or correlated outcome data is common in medical research studies, such as the analysis of national or international disease registries, or cluster-randomized trials, where groups of trial participants, instead of each trial participant, are randomized to interventions. Within-group correlation in studies with clustered data requires the use of specific statistical methods, such as generalized estimating equations and mixed-effects models, to account for this correlation and support unbiased statistical inference.

METHODS: We compare different approaches to estimating generalized estimating equations and mixed effects models for a continuous outcome in R through a simulation study and a data example. The methods are implemented through four popular functions of the statistical software R, “geese”, “gls”, “lme”, and “lmer”. In the simulation study, we compare the mean squared error of estimating all the model parameters and compare the coverage proportion of the 95% confidence intervals. In the data analysis, we compare estimation of the intervention effect and the intra-class correlation.

RESULTS: In the simulation study, the function “lme” takes the least computation time. There is no difference in the mean squared error of the four functions. The “lmer” function provides better coverage of the fixed effects when the number of clusters is small as 10. The function “gls” produces close to nominal scale confidence intervals of the intra-class correlation. In the data analysis and the “gls” function yields a positive estimate of the intra-class correlation while the “geese” function gives a negative estimate. Neither of the confidence intervals contains the value zero.

CONCLUSIONS: The “gls” function efficiently produces an estimate of the intra-class correlation with a confidence interval. When the within-group correlation is as high as 0.5, the confidence interval is not always obtainable.

PMID:34961539 | DOI:10.1186/s13063-021-05900-7