Tag: pubmed

BMC Med Educ. 2024 Nov 4;24(1):1252. doi: 10.1186/s12909-024-06261-w.

ABSTRACT

BACKGROUND: The analytical rubric serves as a permanent reference for guidelines on clinical performance for undergraduate dental students. This study aims to assess the rubric system used to evaluate clinical class II composite restorations performed by undergraduate dental students and to explore the impact of gender on overall student performance across two academic years. Additionally, we investigated the relationship between cumulative grade point averages (CGPAs) and students’ clinical performance.

METHODS: An analytical rubric for the assessment of clinical class II composite restoration in the academic years of 2022/2023 and 2023/2024 was used by two evaluators. These two evaluators were trained to use the rubric before doing the evaluations. The scores were based on a 4-point scale for the evaluation of five major parameters for pre-operative procedures (10 points), cavity preparation (20 points), restoration procedures (20 points), and time management (4 points). At the same time, chairside oral exam parameter was 15 points based on a 5-point scale. Descriptive statistics were calculated for the different analytical rubric parameters, and the independent t-test was used to compare the scores between the student groups and the evaluators. Other tests, such as the Kappa test and Pearson’s correlation coefficient, were used to measure the association among CGPA, evaluators, and gender participants.

RESULTS: The overall score out of 69 slightly increased for females/males (61.28/59.42) and (61.18/59.49) in the 2022/2023 and 2023/2024 academic years, respectively, but the differences were not statistically significant. In the 2022/2023 academic year, female students scored significantly higher than male students in pre-operative procedures, as evaluated by both evaluators (p = 0.001), and in time management, as assessed by both evaluators (p = 0.031). The Kappa test demonstrated a moderate to substantial level of agreement between the two evaluators in both academic years. Strong and significant correlations were noted between students’ CGPA and some tested parameters (p = 0.000).

CONCLUSION: The overall performance was very good and high among both genders, but it was marginally higher among females than among males. This study found some differences in performance between male and female students and variability in the evaluations by the two raters ranging from moderate to substantial agreement and similar performances for students with different CGPA.

PMID:39497127 | DOI:10.1186/s12909-024-06261-w

Addict Sci Clin Pract. 2024 Nov 4;19(1):77. doi: 10.1186/s13722-024-00502-5.

ABSTRACT

BACKGROUND: Addiction medicine providers have a key role in HIV prevention amidst rising HIV incidence in persons who inject drugs (PWID). Pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) are vastly underutilized in this population. Inpatient hospitalization represents a potential touchpoint for initiation of HIV prophylaxis, though little research explores the role of addiction providers. Here we describe rates of PrEP/PEP delivery to hospitalized PWID seen by an Addiction Consult Service (ACS) at an urban, essential hospital.

METHODS: We performed a cross-sectional study of hospitalized patients who were seen by the ACS from January 1, 2020 to December 31, 2022 and had plausible injection drug use. We calculated the proportion of patients who received a new prescription for PrEP/PEP at discharge. We used descriptive statistics to characterize demographics, substance use, reason for admission, and indications for PrEP/PEP. Secondarily, we calculated the monthly proportion of all patients discharged from the hospital with PrEP/PEP who were seen by the ACS compared to those not seen by the ACS.

RESULTS: The average monthly proportion of ACS consults with plausible injection drug use who received PrEP/PEP was 6.4%. This increased from 4.2% in 2020 to 7.5% in 2022. Those seen by the ACS who received PrEP/PEP had high rates of opioid use disorder (97.5%), stimulant use disorder (77.8%), and homelessness (58.1%); over half were admitted for an injection-related infection. The indications for PrEP/PEP were injection drug use only (70.6%), followed by combined injection and sexual risk (20.2%); 71.9% of prescriptions were for PrEP and 28.1% for PEP. Overall, the ACS was involved in 83.9% of hospital-wide discharges with PrEP/PEP prescriptions (n = 242).

CONCLUSIONS: PWID who were seen by the ACS received PrEP/PEP prescriptions at rates exceeding national averages. The ACS was also involved with the care of the majority of admitted patients who received PrEP/PEP at discharge. While PrEP/PEP use for PWID remains low, the inpatient ACS represents a key resource to improve uptake by leveraging the reachable moment of an inpatient hospitalization.

PMID:39497126 | DOI:10.1186/s13722-024-00502-5

BMC Cancer. 2024 Nov 4;24(1):1352. doi: 10.1186/s12885-024-13126-4.

ABSTRACT

BACKGROUND: Primary screening for high-risk human papillomavirus (hrHPV) with cytological triage for women with non-16/18 hrHPV-positive status has become popular in China. However, cytology relies on the subjective judgment of pathologists, leading to inconsistent clinical performance.

METHODS: A total of 657 hrHPV-positive women aged 25-64 years were enrolled in this cross-sectional study. All participants underwent colposcopic biopsy after cytology triage, with cytology residual specimens undergoing DNA methylation testing. CIN2+ and CIN3+ sensitivity and specificity were compared between the different triage strategies (n=487): PAX1 methylation (PAX1^m) , Glycophorin C methylation (GYPC^m), cytology, and combinations between them or with HPV16/18.

RESULTS: The area under the receiver operating characteristic curves (AUCs) for PAX1^m and GYPC^m in detecting CIN2 or worse (CIN2+) were 0.867 (95% confidence interval [CI]: 0.796-0.937) and 0.873 (95% CI: 0.808-0.938), respectively. The sensitivities of PAX1^m and GYPC^m were consistent with those of cytology for both CIN2+ and CIN3+ detection. The relative specificities of PAX1^m and GYPC^m for CIN2+ detection compared to cytology were 2.83 (95% CI: 2.33-2.45) and 3.09 (95% CI: 2.40-3.98), respectively. The relative specificities of combining HPV 16/18 with PAX1^m and GYPC^m for CIN2+ detection compared to cytology were 3.38 (95% CI: 2.96-3.86) and 3.67 (95% CI: 3.15-4.27), respectively. Compared to low levels of DNA methylation, high levels of PAX1^m and GYPC^m resulted in odd ratios (ORs) of 57.66 (95% CI: 13.57-409.12, p < 0.001) and 23.87 (95% CI: 6.49-115.42, p < 0.001) for CIN3+, adjusted for HPV 16/18 and cytology results.

CONCLUSIONS: PAX1^m and GYPC^m demonstrated superior ability to identify cervical precancerous lesions and cervical cancer, with AUC values exceeding 0.85. For detecting CIN2+/CIN3+ in women with hrHPV-positive status, DNA methylation (combined with HPV 16/18) showed higher specificity than cytology (combined with HPV 16/18) and is a potential molecular biomarker for detecting cervical (pre)cancer.

PMID:39497123 | DOI:10.1186/s12885-024-13126-4

J Neuroeng Rehabil. 2024 Nov 4;21(1):196. doi: 10.1186/s12984-024-01497-5.

ABSTRACT

BACKGROUND: Physical exercise is an important method for both the physical and mental health of the senior population. However, excessive exertion can lead to increased risks of falls, severe injuries, and diminished quality of life. Therefore, simple and effective methods for fatigue monitoring during exercise are highly desirable, particularly in community settings. The purpose of this study was to explore the possibility of real-time detection of exercise-induced fatigue using surface Electromyogram (sEMG) features, including the kurtosis and skewness of the Probability Density Function (PDF) in the community settings to solve the issues of low sensitivity and high computational complexity of commonly used sEMG features.

METHODS: sEMG signals from six forearm muscles were recorded during hand grip tasks at 20% maximal voluntary contraction (MVC) task-to-failure contractions from 30 healthy community-dwelling elders at their respective community centers. PDF shape features of the sEMG, namely kurtosis and skewness, were computed from 25 s of non-fatigue stable phase and 25 s of fatigue data for comparison. Statistical tests were conducted to compare and test for the significance of these features. We further proposed a novel fatigue indicator, Temporal-Mean-Kurtosis (TMK) of channel-averaged kurtosis, to detect fatigue with relatively low computational complexity and adequate sensitivity in community settings. ANOVA and post-hoc analyses were performed to examine the performance of TMK.

RESULTS: Statistically significant differences were found between the non-fatigue period and the fatigue period for both kurtosis and skewness, with increasing values when approaching fatigue. TMK was shown to be sensitive in detecting fatigue with respect to time with lower computational complexity than the Sample Entropy.

CONCLUSION: This study investigated PDF shape features of sEMG signals during a handgrip exercise to identify muscle fatigue in older adults in community experiments. Results revealed significant changes in kurtosis upon fatigue, indicating that PDF shape features were suitable convenient detectors of muscle fatigue in community experiments. The proposed indicator, TMK, showed potential sensitivity in tracking muscle fatigue over time in community-based settings with limited computational complexity, highlighting the promise of sEMG’s PDF features in detecting muscle fatigue among the elderly.

PMID:39497122 | DOI:10.1186/s12984-024-01497-5

BMC Endocr Disord. 2024 Nov 5;24(1):235. doi: 10.1186/s12902-024-01766-3.

ABSTRACT

BACKGROUND: The prevalence of steatotic liver disease (SLD) in patients with type 2 diabetes (T2DM) exceeds 50%. This study aimed to investigate the clinical characteristics of SLD and liver fibrosis in Chinese patients with T2DM.

METHODS: Inpatients from 2021 to 2023 were included in the study. Fatty liver index (FLI) and fibrosis-4 (FIB-4) were calculated to assess hepatic steatosis and fibrosis respectively. Statistical analysis was completed by SPSS v25 and GraphPad Prism v8.0.1.

RESULTS: Of the 1466 participants, about one-third of the patients in T2DM-SLD group were diagnosed with liver fibrosis (LF), and the percentage of patients over 50 years old was 85.9%. Patients with SLD had higher levels of BMI, blood pressure, liver enzymes, fasting blood glucose (FBG), HbA1c, C-peptide, total cholesterol (TC) and triglyceride (TG) (P<0.05 for all). Patients with liver fibrosis had lower TC, TG, hemoglobin (Hb), erythrocyte count (RBC), leukocyte count (WBC) and platelet (PLT) levels (P<0.05 for all). Compared with simple T2DM and SLD-NLF (non-liver fibrosis) groups, for patients over 50 years old, the prevalence of coronary heart disease, stroke, tumor, and diabetic nephropathy was higher in patients with liver fibrosis. Liver fibrosis might be the risk factor of arterial stiffness, stroke, coronary heart disease and numbness based on multivariable logistic regression analysis.

CONCLUSION: Hepatic steatosis and fibrosis were common in patients with T2DM. Liver fibrosis was relevant to many macrovascular and microvascular diabetic complications.

PMID:39497118 | DOI:10.1186/s12902-024-01766-3

J Breath Res. 2024 Nov 4. doi: 10.1088/1752-7163/ad8e7c. Online ahead of print.

ABSTRACT

Oral malodor negatively impacts a person’s quality of life and may affect up to 50% of the population. The aim of this randomized, placebo and no-product controlled, evaluator-blind, proof-of-concept study was to evaluate the effectiveness and safety of the single use of two experimental lozenges containing the laccase enzyme and green coffee extract (with and without flavor) in reducing intrinsic oral malodor. Following 12 to 16 h of avoidance of oral hygiene,156 generally healthy subjects presented at screening and baseline visits with a mean organoleptic odor intensity (OI) score of ≥ 2 and an OralChroma^TMreading of ≥ 125 parts per billion (ppb) hydrogen sulfide (H2S) gas and were randomly assigned to receive either one of the two experimental lozenges, a placebo lozenge, or no-product. Following the supervised use of the assigned products, subjects’ oral malodor was evaluated using OI assessments and OralChroma^TMmeasurement for volatile sulfur compounds (VSCs) immediately following product use (approximately 5 min), and at 30 min, 1 h, 2 h, 3 h and 4 h. The two experimental lozenges, with and without flavor, showed significant reductions in OI scores compared with the placebo and no-product groups at all time points (p < 0.001). At 5 minutes post-product use, the experimental lozenges, with and without flavor, were significantly better than the no-product group in reducing the VSCs (p < 0.04). The results of individual VSC components (hydrogen sulfide, methyl mercaptan and dimethyl sulfide) were variable; both experimental lozenges notably reduced hydrogen sulfide and methyl mercaptan levels in most post-use assessments. Four minor adverse events were reported, none of which were directly linked to the product. In conclusion, the experimental lozenges, whether flavored or not, were safe and effective in reducing oral malodor over a span of 4 h, based on organoleptic OI scores.&#xD;NCT05950529.

PMID:39496199 | DOI:10.1088/1752-7163/ad8e7c

Acta Chir Orthop Traumatol Cech. 2024;91(5):276-281. doi: 10.55095/ACHOT2024/052.

ABSTRACT

INTRODUCTION: During the 20th century, the life expectancy increased by 30 years. At the same time, the number of people living longer than that has grown significantly. The aim of this study was to investigate whether total hip or knee arthroplasty (THA or TKA) in patients over 80 years of age does not reduce their life expectancy.

MATERIAL AND METHODS: The study examined the data of patients who had undergone THA or TKA between 1994 and 2002 and were older than 80 years at the time of surgery. The study group was divided into a group of patients in whom elective total hip or knee arthroplasty was performed for arthritis and into a group of patients who underwent the same procedure for proximal femur fracture. The investigated parameter was the real survival, which was compared with the life expectancy predicted by the Institute of Health Information and Statistics of the Czech Republic. We also monitored postoperative mortality and postoperative interval after which the life expectancy was no longer reduced.

RESULTS: The study included 547 patients. Of whom, 96 patients underwent elective surgery (36%) and 351 patients underwent surgery for intracapsular hip fracture (64%). In the elective surgery group, the survival was longer than the national average: In the 80-84-year group, the median survival was 6.0 years vs. median life expectancy of 5.6 years; in the 85-89-year group, the median survival was 6.3 years vs. median life expectancy of 3.9 years. The fracture surgery group showed a decrease in the life expectancy compared to the national average – in the 80-84-year group, the median survival was 3.5 years vs. median life expectancy of 5.6 years, and in the 85-89-year group, the median survival was 2.9 years vs. median life expectancy of 3.9 years. The likelihood of postoperative mortality was significantly higher in the fracture group than in the elective group (p = 0.05 vs. 0.01), with the difference being the highest in the first 8 weeks after surgery.

CONCLUSIONS: Correctly indicated THA or TKA in patients over 80 years of age improves the quality of life of these patients and does not reduce the life expectancy. Intracapsular femoral neck fractures in patients of that age can still be considered as an indication for surgical treatment as a life-saving procedure.

KEY WORDS: total hip arthroplasty, total knee arthroplasty, osteoarthritis, hip fracture, life expectancy.

PMID:39496193 | DOI:10.55095/ACHOT2024/052

Ann Intern Med. 2024 Nov 5. doi: 10.7326/ANNALS-24-00829. Online ahead of print.

ABSTRACT

BACKGROUND: Late career physicians (LCPs; physicians working beyond age 65 to 75 years) may be at higher risk for delivering unsafe care. To oversee LCPs, some health care organizations (HCOs) have adopted LCP policies requiring cognitive, physical, and practice performance screening assessments. Despite recent controversies, little is known about the content and implementation of such policies.

OBJECTIVE: To characterize key features of LCP policies and the perspectives of medical leaders responsible for policy development and implementation.

DESIGN: Mixed-methods study using content analysis and key informant interviews.

SETTING: 29 U.S. HCOs with LCP policies active in 2020.

PARTICIPANTS: 21 purposively sampled interviewees in physician leadership roles at 18 HCOs.

MEASUREMENTS: Descriptive statistics of policy features and content analysis of interviews.

RESULTS: Although policies had many commonalities-mandatory universal screening at a trigger age around 70 years, a strategy of screening followed by in-depth assessment of positive results, and commitment to patient safety as the key motive-they varied substantially in the testing required, funding, processes after a positive screening result, and decision making around concerning results. Policies prioritized institutional discretion in interpreting and responding to test results; many lacked clear language about appeals or other procedural protections for physicians. Leaders were generally satisfied with policies but reported preemptive retirements as physicians approached the screening age and cautioned that substantial investment in cultivating physicians’ buy-in was required for successful rollout.

LIMITATIONS: Sampled policies and interviews may not be representative of all HCOs. The analysis excluded the experiences of HCOs that tried and failed to implement LCP screening.

CONCLUSION: Policies about LCPs are considered successful by institutional leaders. Policy variations and early adopters’ implementation experiences highlight opportunities to improve physician acceptance and program rigor.

PRIMARY FUNDING SOURCE: The Greenwall Foundation.

PMID:39496180 | DOI:10.7326/ANNALS-24-00829

Ann Intern Med. 2024 Nov 5. doi: 10.7326/M23-3179. Online ahead of print.

ABSTRACT

BACKGROUND: Polycystic ovary syndrome (PCOS) is common in women of reproductive age and is associated with obesity. Clinical guidelines recommend weight loss, but the impact on the clinical manifestations of PCOS is unclear.

PURPOSE: To quantify the effect of weight loss interventions on clinical features of PCOS, compared with usual care.

DATA SOURCES: MEDLINE, Embase, PsycINFO, CINAHL, Cochrane, Web of Science, and trial registries were searched from inception through June 2024.

STUDY SELECTION: Randomized controlled trials comparing interventions aiming to reduce weight against usual care, including lower-intensity weight loss interventions in people with PCOS. Conversations with people with PCOS informed the outcomes.

DATA EXTRACTION: Pairs of independent reviewers screened studies, extracted data, and assessed risk of bias (RoB). Outcomes included glycemic control (Homeostasis Model Assessment for Insulin Resistance [HOMA-IR], fasting insulin and glucose), hormonal markers (free androgen index [FAI] and other sex hormones), menstrual frequency, hirsutism, and PCOS-related quality of life (QoL). Pooled mean differences were obtained from random-effects meta-analysis with Knapp-Hartung adjustment.

DATA SYNTHESIS: Primary analyses included 29 comparisons with 1529 participants: 13, 12, and 4 comparisons were judged as high, some, or low RoB, respectively. Twelve used behavioral interventions, 9 used glucagon-like peptide-1 (GLP1) agonists, and 8 used other weight loss medications. Weight loss interventions were associated with significantly greater improvements in HOMA-IR (mean difference, -0.45 [-0.75 to -0.15]; I ² = 24%), FAI (mean difference, -2.03 [-3.0 to -1.07]; I ² = 48%), and menstrual frequency (mean difference, 2.64 [0.65 to 4.63]; I² = 43%). There was no evidence that weight loss interventions were associated with clinically or statistically significant improvements in hirsutism, QoL, or other sex hormones, which may be due to the limited power of the available data.

LIMITATION: There was high statistical heterogeneity in the interventions, comparators, and outcomes, largely unexplained by sensitivity and subgroup analyses.

CONCLUSION: Weight loss interventions were associated with improvements in some important features of PCOS and should be considered as a routine treatment option for people with PCOS.

PRIMARY FUNDING SOURCE: National Institute for Health and Care Research School for Primary Care Research. (PROSPERO: CRD42022367488).

PMID:39496172 | DOI:10.7326/M23-3179

J Med Internet Res. 2024 Nov 4;26:e56386. doi: 10.2196/56386.

ABSTRACT

BACKGROUND: eHealth literacy is critical for evaluating abilities in locating, accessing, and applying digital health information to enhance one’s understanding, skills, and attitudes toward a healthy lifestyle. Prior research indicates that enhancing eHealth literacy can improve health behaviors such as physical activity (PA). Physical literacy (PL) refers to the ability to develop sustainable PA habits, taking into account various aspects of an individual. Notably, university students have shown a decline in PA and possess low PL levels. However, the connection between eHealth literacy and PL in this demographic has not been extensively studied, and it remains uncertain whether PA acts as a mediator between eHealth literacy and PL.

OBJECTIVE: This study examines the extent to which PA mediates the link between eHealth literacy and PL in Chinese university students and explores gender differences in these variables.

METHODS: In February 2022, a cross-sectional survey was administered to 1210 students across 3 universities in China. The instruments used were the Perceived PL Instrument, the International Physical Activity Questionnaire, and the Chinese version of the eHealth Literacy Scale. Correlations between eHealth literacy, PA, and PL were analyzed using Pearson product-moment correlation and multiple linear regression, while mediation models helped elucidate the interactions among the 3 variables.

RESULTS: The response rate for the study was 92.9% (1124/1210). In the mediation analysis, eHealth literacy showed a significant direct effect on PL, with a coefficient of 0.78 (β .75, SE 0.02; P<.001). Moderate to vigorous physical activity (MVPA) accounted for 2.16% of the total effect, suggesting that MVPA partially mediates the relationship between eHealth literacy and PL. Additionally, male students outperformed female students in terms of MVPA (t₆₃₆=4.94; P<.001) and PL (t₆₃₆=3.18; P<.001), but no significant differences were found in eHealth literacy (t₆₃₆=1.23; P=.22).

CONCLUSIONS: The findings indicate that MVPA serves as a mediator in the link between eHealth literacy and PL among university students. Students with low eHealth literacy or limited PA are less likely to be physically literate. Thus, eHealth literacy plays a crucial role in enhancing PL and PA, especially when interventions targeting PL are implemented. Our results also suggest a need for targeted health education interventions aimed at improving MVPA and PL among female students, while also recognizing that eHealth literacy is comparable across genders at universities.

PMID:39496161 | DOI:10.2196/56386