Care Strategies Research Articles

A randomized controlled trial comparing two antenatal care regimes in the management of mild to moderate gestational diabetes in a low-middle income country.

The prevalence of gestational diabetes mellitus (GDM) in the Indian subcontinent has increased exponentially, especially after new diagnostic criteria. Identifying women who need close monitoring is a challenge. Ultrasound has been used to guide therapy but its use in the management of GDM has been used indiscriminately due to paucity of information. The use of ultrasound to guide the number of antenatal visits for adequate glycemic control has not been researched adequately. There is also a need to contrive antenatal care strategies that can obtain optimal neonatal outcomes without burdening the health system in low-middle income countries (LMIC). Our study was to compare pragmatic standard management of GDM with an ultrasound-guided regime (USGR) to prevent neonatal complications to ensure optimal care. A randomized controlled trial was done in a tertiary hospital between May 2019 and September 2021 in South India. Five hundred and eighty-eight women were randomized to a standard regime or USGR. χ2 and t-test were used to compare outcomes. Maternal and neonatal outcomes between standard and ultrasound USGR showed no significant difference in outcomes. Fetuses in USGR with AC ≥ 70th centile had macrosomia (3.59% vs 26.67%, P < 0.001), increased severity of diabetes (2.97% vs 16.67%, P < 0.001), 3rd- and 4th-degree perineal tear (2.95% vs 27.27%, P < 0.001). The increased number of visits did not decrease adverse outcomes. This small well-designed study did not show any advantage with USGR as compared to the pragmatic simple standard regime, in the treatment of women with GDM.

ESTUDO DE EMERGÊNCIAS ONCOLÓGICAS EM PACIENTES PEDIÁTRICOS: REVISÃO OBSERVATÓRIA

Care activities in intensive care units and for cancer patients are guided by the humanization of care and contribute to hospital management, seen as a challenge to be faced in order to promote advances in the implementation of health policy in Brazil. In this way, it is feasible to analyze in this study a reflection on the humanization of care provided to critically ill patients, the strategies of humanization and care in the ICU and in patients under palliative care, in order to identify improvements in the care of critically ill patients in a humanized way. The aim of this study is to identify, through literature reviews, the interventions of nursing professionals in assisting patients in palliative care in the area of pediatric oncology. The methodology used is bibliographical research, based on articles available on the internet. In Brazil, a number of problems persist in health institutions on a daily basis, which are rooted in the system and make it difficult to achieve the principles of universality, comprehensiveness and equity, which are fundamental to the Unified Health System (SUS). To work in the Oncology Unit and provide palliative care. Thus, health professionals must have specialized and qualified training, including experience acquired throughout their careers, as well as personal and professional development.

Body Mass Index as a Determinant of Lower Limb Function and Community Well-Being in Older Adults: Analysis of 2020 National Older Korean Survey Data.

This epidemiological research investigated the relationship between body mass index (BMI) and lower limb function and community well-being among the older population (≥65 years old) in South Korea. Using the 2020 National Survey of Older Koreans (N = 10 097; Mage = 73.6 ± 6.63; MBMI = 23.6 ± 2.61), the study identified underweight (2.3%), normal (72.8%), and obese (24.9%) groups. Findings revealed significant associations between BMI and lower limb function, with underweight individuals facing greater physical challenges (P < .05-.01). Underweight participants were also found to live farther from key community locations, possibly reflecting social and environmental factors (P < .01) and expressed higher dissatisfaction with community environments (Ps < .05-.01). The study emphasizes the need for tailored community planning and health care strategies, focusing on the unique needs of the underweight older adults, considering South Korea's rapidly increasing older population.

Thriving or Striving: Comparing Intra-Uterine Growth Restricted, Low Birth Weight and Normal Birth Weight Piglets within the First 24 Hours.

This observational study explored the early-life challenges of intra-uterine growth restricted (IUGR), low birth body weight (LBW), and normal birth body weight (NBW) piglets. The aim was to understand the impact of birth weight and intra-uterine growth restriction phenotype on neonatal survival and behavior. Based on weight and phenotype, piglets were classified as IUGR (n = 32), LBW (n = 34), and NBW (n = 29) immediately after birth. The piglets were litter- and sex-matched. Vitality scores were assigned based on motor activity and breathing and complemented with an assessment of umbilical cord condition, rectal temperature, crown-rump length (CRL), time to reach the udder, time to suckle, colostrum intake, and weight gain over 24 h. Beyond the lower birth weight, reduced CRL, and higher mortality rate, IUGR piglets faced several other challenges compared with LBW and NBW piglets. Growth-impaired piglets often struggled to engage in early feeding behaviors and displayed consistently lower rectal temperatures at 1, 3 and 24 h after birth. IUGR piglets showed inadequate colostrum intake and weight loss, which were also observed for LBW counterparts. In contrast, no significant differences were observed in vitality scores and umbilical cord conditions across the groups. In conclusion, our findings underscore the impact of intra-uterine growth restriction on neonatal piglets, emphasizing the need for specialized care strategies to improve survival and health outcomes in IUGR.

Beyond cancer treatment: dermo-aesthetic and other wellness recommendations for breast cancer patients.

Breast cancer, a prevalent malignancy among women, has various physical and psychological impacts. This comprehensive review offers an in-depth look at multidisciplinary dermo-aesthetic intervention approaches, emphasizing the balance between oncological therapies and the management of these effects. The information presented spans specialties such as aesthetic medicine, plastic surgery, dermatology, physiotherapy, nutrition, odontology, and gynecology. This review, which serves as a clinical guide, aims to establish a safe protocol for non-medical interventions involving oncologists, physicians, and specialists from various areas in patients with breast cancer focused on improving their quality of life. This work offers personalized and integrative care strategies for the eradication of cancer. However, it is still necessary for patients to consult with their oncologist before undergoing any dermo aesthetic treatment. However, it is still necessary for patients to consult with their oncologist before undergoing any dermo aesthetic treatment.

A scoping review of health models for the community mental health needs of the United Arab Emirates: Nurturing the social determinants of mental health through social prescribing in the Middle East

Despite the growing interest in social prescribing the diversification of health and social care strategies to support the well-being of patients has remained entrenched with a focus on the hospital setting within the Middle East. The United Arab Emirates has commenced progressing community mental health care to lead changes in how care and treatment are delivered within the United Arab Emirates. The authors adopted the use of the framework of Arksey and O’Malley (2005) to provide a systematic approach to searching the literature and creating a comprehensive foundation to guide the review. This scoping review provides a better understanding of the compatibility, content and outcomes of a selection of health models. The scoping review findings will inform the proposed use of social prescribing as an actionable approach to create a focus on the need to include and empower the social determinants of mental health. This article proposes an evidence-based health strategy that supports and enhances recent additions to national legislation on the inclusion of the Mental Health Law within the United Arab Emirates to meditate and prevent inequities in addressing the mental health needs of citizens and residents within the nation’s diverse communities.

Group Reminiscence Therapy for Dementia to Improve Well-Being and Reduce Behavioral Symptoms.

The global increase in dementia cases highlights the urgent need for effective treatment and care strategies. The aim of this study was to evaluate the effects of group reminiscence therapy on cognitive function, subjective well-being, and behavioral and psychological symptoms of dementia (BPSD) in older adults with moderate to severe dementia. A pre-post comparative design was used, with 49 participants receiving eight group reminiscence therapy sessions over 4 weeks. Baseline, one-week, and one-month postintervention assessments were conducted using the Hasegawa Dementia Scale-Revised (HDS-R), the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH), and the Philadelphia Geriatric Center Morale Scale (PGC Morale Scale). The results showed no significant improvement in HDS-R scores, but significant improvements in PGC Morale Scale (p = 0.0417) and NPI-NH scores (p = 0.00226), indicating improved well-being and reduced BPSD. These findings suggest that group reminiscence therapy is effective in improving BPSD. Future research should focus on extending the duration of the intervention, including different populations, and combining group reminiscence therapy with other therapeutic approaches to fully determine its long-term benefits and mechanisms. Research on its cost-effectiveness and cultural applicability could further validate and improve the use of group reminiscence therapy in diverse care settings.

Visual Acuity Thresholds in Preterm Newborns: An Experimental Study.

Purpose: Visual acuity plays a role in mediating neurological development in infants by enabling the differentiation of shapes and discriminating objects. Given the rapid structural development of the brain in the first days of life, this aspect is particularly significant for preterm infants, who typically experience this developmental phase while hospitalized in the neonatal intensive care unit (NICU). Therefore, this study aimed to assess visual acuity thresholds in preterm infants during hospitalization and to evaluate possible correlations between visual acuity and clinical parameters. Methods: A cross-sectional study was conducted in an NICU in Northeast Brazil. The visual acuity thresholds were tested using the Teller Acuity Cards II, comprised of 17 gray cards, with one 4 mm diameter peephole at the center and presented with about 35% reflectance. Preterm infants were positioned supine, at 30° elevation on the laps of their caregivers. The evaluator presented both sides of the cards and observed the eye fixation and reactions on both sides. Results: A total of 42 preterm infants with corrected gestational age between 30 to 36 weeks and 6 days were included. Visual acuity ranged from 0.23 to 0.64 cycle per degree. The mean visual acuity threshold was 0.32 cycles per degree for preterm infants at around 32 weeks of corrected gestational age. The visual acuity was not correlated with gestational age (p = 0.18), and neither were birth weight (p = 0.83) or duration of respiratory support (p = 0.98). However, days of phototherapy were inversely correlated with visual acuity (p = 0.04). Conclusions: Despite the challenges of hospitalization, it was possible to carry out a psychophysical test to assess visual acuity in preterm infants. The visual acuity showed no correlation with clinical parameters such as gestational age, birth weight, and duration of respiratory support. However, there was an inverse correlation between the number of days in phototherapy and visual acuity. Understanding the visual acuity levels in preterm infants during their NICU stay can contribute to tailoring interventions and care strategies that specifically address their visual developmental needs. This knowledge may guide healthcare professionals in optimizing the NICU environment to provide appropriate visual stimuli that support neurological development.

Creating "a Safe Place to Go": Yarning With Health Workers About Stroke Recovery Care for Aboriginal Stroke Survivors-A Qualitative Study.

Stroke affects Aboriginal people at disproportionate rates compared to other populations in Australia. Aboriginal peoples are less likely to receive a timely stroke diagnosis, or timely culturally responsive treatment, as there are very few stroke resources and recovery plans that have been developed by Aboriginal peoples for Aboriginal peoples. Understanding how to develop and implement culturally responsive stroke care requires research approaches that are informed by and with Aboriginal people. A qualitative Indigenous research methodology including "yarning" was undertaken to understand the experiences of both Aboriginal and non-Aboriginal health workers from nine health services providing stroke rehabilitation and recovery support to Aboriginal people living within the participating communities. Data were analyzed using an inductive approach driven by an Indigenous research approach. Yarns revealed three themes: (i) the role of culturally safe health environments to support stroke survivors, their family, and health workers; and how (ii) complicated, under-resourced systems impede the capacity to support stroke survivors; and (iii) collaborative and adaptive practices prevent people "falling through the cracks." This study highlights the need to scrutinize the cultural safety of health care, current health systems, workforce, and culture and how these influence the capacity of health workers to provide care that is responsive to the individual needs of Aboriginal stroke survivors and their families. These learnings will inform the co-design of a culturally responsive stroke recovery care strategy to improve the recovery experience and health and well-being of Aboriginal people and their families living with stroke.

Analysis of Sexually Transmitted Infections during the COVID-19 pandemic in Brazil

Objective: To analyze the trend and impact that COVID-19 had on the notifications of STIs (HIV/AIDS, Syphilis, HBV, and HCV) in Brazil. Methods: This is an ecological study, analyzing the temporal trend of STIs notifications based on the detection rate of infections across the five geographical regions of Brazil from 2015 to 2021. The trend analysis from 2015 to 2021 was conducted using a linear regression model for historical series. To assess the impact of the pandemic, the expected cases were compared with the observed cases for the years 2015 to 2021. A significance level of 5% was established, with trend analyses conducted using the Joinpoint Regression Program, and the expected values were estimated using the R software. Results: The results demonstrate that there was a sharp decrease in the detection rates of mandatory notifiable STIs in Brazil during the COVID-19 pandemic period, and this trend was reflected across all regions of the country. Conclusion: During the COVID-19 pandemic, there was a reduction in STIs notifications. These results support the establishment of surveillance and health care strategies to minimize the impact of delays in the diagnosis and treatment of these infections.

PERCEPÇÃO DE ENFERMEIROS DO CAPS DURANTE A PANDEMIA DA COVID-19

Introduction: The current pandemic becomes a concern for the mental health of the population, because in addition to the fear of contracting the disease, COVID-19 has caused a feeling of insecurity in all aspects of life, from the collective to the individual perspective, the daily functioning of the society to changes in interpersonal relationships. One of the services that has been challenged are the Psychosocial Care Centers, which offer care to people in mental suffering. Objective: to describe the experience of CAPS nurses during the covid-19 pandemic and how much this can interfere with care in the sector Method: An interview was conducted with nurses who work at the Psychosocial Care Center in the municipality of São Sebastião do Paraíso. Thematic content analysis was used for data analysis. Results and discussion: According to the nurses, the perception of the pandemic in the sector was revealed with feelings of apprehension, fear, lack of security and preparation; professional performance in this period has been a challenge and involved changes in the routine of the place and changes in the physical and mental health of the interviewees and, at the same time, an appreciation of the professional and an improvement in human relations and the difficulties and challenges facing the pandemic in the CAPS are centered on physical and social distance, lack of PPE, fear of contamination, difficulty in socializing, sleep problems and the worsening of the mental health of patients in general, which is in line with most of the studies referring to this topic. Final Considerations: The COVID-19 pandemic is part of the crisis conditions that the population is experiencing, including CAPS users, family members and users, conditions that, despite the circumstances, require solid bonds and the creation of care strategies that can guarantee safe assistance at a time of extreme insecurity for everyone, it being important to promote important changes for the continuation of assistance in demand, as far as possible, bringing the need for work by sectors, emphasizing communication in partnership with other health services and of other public policies. It was evident that professionals feel the need for training, material, physical resources and also to overcome difficulties and challenges, mainly related to the pandemic and reflection on the subject to recreate ways in order to continue carrying out their work in the best possible way.

Risk Factors for Adverse In-Hospital Outcomes in Patients With Traumatic Blunt Thoracic Aortic Injuries Undergoing Thoracic Endovascular Aortic Repair (TEVAR): An Analysis of the US Nationwide Inpatient Sample.

Thoracic endovascular aortic repair (TEVAR) is a treatment for traumatic blunt thoracic aortic injury (BTAI) with good survival rates and safety. However, there is limited study on the risk factors for in-hospital mortality and complications. This study aimed to identify risk factors associated with poor in-hospital outcomes after TEVAR. This is a population-based, retrospective observational study. Data of adults ≥20 years admitted for BTAI who received TEVAR were extracted from the Nationwide Inpatient Sample (NIS) database 2005 to 2018. The primary outcome was in-hospital mortality, and the secondary outcomes were length of stay (LOS) and unfavorable discharge (ie, non-routine discharge, including nursing homes or long-term care facilities). Associations between study variables and in-hospital outcomes were determined using univariate and multivariable logistic and linear regression analyses. Data of 1095 participants (representing 5360 hospitalized patients in the United States) were analyzed. Multivariable analysis revealed that older age (adjusted odds ratio [aOR]=1.02) and having at least 1 perioperative complication (aOR=4.01) were significantly associated with increased risk for in-hospital mortality. Patients with at least 1 perioperative complication (aOR=11.19) had significantly increased odds for prolonged LOS. Risk for unfavorable discharge was significantly increased by older age (aOR=1.02), household income at quartile 2 (aOR=1.58), Charlson Comorbidity Index (CCI) 2 to 3 (aOR=1.66), and having at least 1 complication (aOR=3.94). Complications including perioperative cerebrovascular accident (CVA) (aOR=2.75), venous thromboembolism (VTE) (aOR=2.87), pneumonia (aOR=3.93), sepsis (aOR=4.69), infection (aOR=4.49), respiratory failure (aOR=4.55), mechanical ventilation (aOR=3.27), and acute kidney injury (AKI) (aOR=3.09) significantly predicted prolonged LOS. In adults with traumatic BTAI undergoing TEVAR, advanced age and perioperative complications are risk factors for poor in-hospital outcomes. Acute kidney injury, CVA, respiratory failure, and sepsis are strong predictors of prolonged LOS, unfavorable discharge, and in-hospital mortality. The study identifies advanced age and perioperative complications as key risk factors for poor in-hospital outcomes in patients undergoing TEVAR for BTAI. Clinicians should be vigilant in managing these patients, particularly those with comorbidities, to mitigate risks. The findings suggest a need for tailored perioperative care strategies to improve survival rates and reduce complications. This research highlights the critical importance of early identification and intervention in high-risk patients, offering an innovative approach to refining TEVAR protocols and enhancing patient outcomes in trauma care.

Analysis of readmission and hospitalization expenditures of patients with ischemic stroke suffering from different comorbidities

BackgroundThe comorbidities of ischemic stroke (IS) are increasing worldwide. This study aimed to quantitatively assess the effect of different types of comorbidity on readmission and hospitalization expenditures of patients with IS. MethodsA retrospective observational study was conducted from the basic insurance claims database of a large city in China, between January 1, 2018, and May 31, 2022. We identified patients with IS aged 18 years and over, who experienced the first episode of IS and had one-year follow-up records. This study divided eighteen different comorbid conditions into two categories (concordant comorbidity and discordant comorbidity) and the IS patients were further categorized into four groups. Multivariable logistic regression models and generalized linear models with log-link and gamma distribution were to estimate the effect of different comorbidity groups on one-year readmission rates and annual hospitalization expenditures. ResultsIn total, 99,649 adult patients with IS were identified. Approximately 94.0 % of patients with IS had at least one comorbidity, and 63.8 % reported concordant comorbidity only. Patients with IS had a readmission rate of 26.7 %, and the mean of annual hospitalization expenditure and annual hospitalization out-of-pocket expenditure (OOPE) were 28086.6 Chinese Yuan (CNY) and 8267.3 CNY, respectively. After adjustment for covariates, the concordant comorbidity-only group had the highest readmission rate, annual hospitalization expenditure, and OOPE compared with the other groups, furthermore, these results increased as the number of comorbidity increased and had statistically significant positive associations. ConclusionsThe readmission and annual hospitalization expenditures of patients with IS were associated with different comorbidities. Concordant comorbidity increased hospital readmission risk and health expenditures. To better manage the comorbidities of patients with IS, especially concordant comorbidities, it is necessary to establish a routine care strategy specifically for comorbid conditions.

Quality of life in SCN1A-related seizure disorders across the lifespan.

This cohort study aims to describe the evolution of disease features and health-related quality of life per life stage in Dravet syndrome and other SCN1A-related non-Dravet seizure disorders which will enable treating physicians to provide tailored care. Health-related quality of life and disease features were assessed cross-sectionally in participants with a SCN1A-related seizure disorder, categorized per age group for Dravet syndrome, and longitudinally over seven years follow-up (2015-2022). Data were collected from questionnaires, medical records, and semi-structured telephonic interviews. Health-related quality of life was measured with the Paediatric Quality of Life Inventory, proxy-reported for participants with Dravet syndrome and for participants with non-Dravet aged younger than 18 years old and self-reported for participants with non-Dravet over 18 years old. Associations between health-related quality of life and disease features were explored with multivariable regression analyses, cross-sectionally in a cohort of 115 patients with Dravet and 48 patients with generalized epilepsy with febrile seizures plus and febrile seizures (non-Dravet) and longitudinally in a cohort of 52 Dravet patients and 13 non-Dravet patients. In the cross-sectional assessment in 2022, health-related quality of life was significantly lower in Dravet syndrome, compared to non-Dravet and normative controls. Health-related quality of life in the School and Psychosocial domain was significantly higher in older Dravet age groups. A higher health-related quality of life was associated with fewer behavioural problems [β = -1.1; 95% confidence interval (CI), (-1.4 to -0.8)], independent walking (β = 8.5; 95%CI (4.2-12.8)), compared to the use of a wheelchair), and fewer symptoms of autonomic dysfunction (β = -2.1, 95%CI (-3.2 to -1.0)). Longitudinally, health-related quality of life was significantly higher seven years later in the course of disease in Dravet participants (Δ8.9 standard deviation (SD) 18.0, P < 0.05), mediated by a lower prevalence of behavioural problems (β = -1.2, 95%CI (-2.0 to -0.4)), lower seizure frequency (β = -0.1, 95%CI (-0.2 to -0.0)) and older age (β = 0.03, 95%CI (0.01-0.04)). In summary, health-related quality of life was significantly higher at older age in Dravet syndrome. This finding may reflect the benefits of an advanced care strategy in recent years and a ceiling of severity of disease symptoms, possibly resulting in an increased wellbeing of parents and patients. The strong association with behavioural problems reinforces the need to incorporate a multidisciplinary approach, tailored to the age-specific needs of this patient group, into standard care.

Efficacy of periodontal treatment modalities in Down syndrome patients: a systematic review and meta-analysis.

The systematic review aimed to review the existing evidence, to identify and appraise the effectiveness of periodontal prevention and treatment modalities in individuals diagnosed with Down syndrome (DS) and to determine the estimates of the effects of implemented periodontal prevention and treatment strategies compared to chromosomally normal (CN) individuals. The systematic review was conducted and reported in conformity with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. The study protocol was registered in the Open Science Framework. Electronic and manual searches, in accordance with PICO framework and delineated inclusion/exclusion criteria, were conducted in multiple databases. The initial search identified 11,704 studies. After removing duplicates, 9,048 remained. Title and abstract screening narrowed these to 281 for full-text review. Ultimately, 16 studies met the inclusion criteria, with 4 eligible for quantitative data synthesis. Results of the meta-analysis indicated that professional tooth cleaning in combination with oral hygiene reinforcement was less effective in the reduction of PPD in patients with DS compared to those without DS (Mean difference (MD): 0.23; 95% Confidence Interval (CI): 0.14 to 0.32; p < 0.001). These findings suggest that conventional periodontal treatment is less effective in managing periodontitis in patients with DS. Thus, tailored periodontal care strategies that address the specific needs of individuals with DS should be implemented to improve treatment outcomes for this population The presence of moderate to high risk of bias in the included studies underscores the need for rigorously designed research that minimizes bias through effective blinding, randomization, control of confounding factors, and inclusion of diverse treatment outcomes to further investigate these associations. Based on the best available evidence, professional tooth cleaning combined with oral hygiene instructions appears to be less effective in reducing pocket depths in individuals with DS compared to those without DS. https://doi.org/10.17605/OSF.IO/UXTCG.

Assessing oral and toothbrush microbial profiles among high-altitude individuals with and without periodontal disease: a case-control study

BackgroundPeriodontitis is the sixth-most common disease worldwide. The oral microbiome composition and its association with Periodontal disease (PD) have been largely explored; however, limited studies have explored the microbial profiles of both oral and toothbrushes in patients with PD. Thus, this study aimed to ascertain the oral and toothbrushes microbial composition in high-altitude populations, hypothesizing that their correlation with periodontal health would differ from those at lower altitudes, potentially indicating links between environmental factors, microbial colonization patterns, and periodontal health in distinct geographic contexts.MethodsIn the present study, we enrolled 35 individuals including 21 healthy and 14 diagnosed with PD from the Lhasa region of Tibet, China. Saliva and toothbrush samples were collected from each participant to assess the association between toothbrush usage and oral microbiome with PD using 16 S rRNA gene-specific V3-V4 regions sequencing. To assess the oral and toothbrush microbiome composition and diversity and its possible link to PD.ResultsSignificantly higher Alpha diversity (Shannon index) was observed between the PD group and PD toothbrushes (p = 0.00021) and between the PD group and Healthy toothbrushes (p = 0.00041). The predominant species were Proteobacteria, Bacteroidota, Firmicutes, Actinobacteria, and Fusobacteria, with genera Pseudomonas, Veillonella, Neisseria, Acinetobacter, and Haemophilus. In addition, PICRUST2 analysis unveiled 44 significant pathways differentiating the disease and healthy groups, along with 29 pathways showing significant differences between their respective toothbrush microbial profiles. The distinct oral and toothbrush microbial composition among high-altitude populations suggests potential adaptations to the challenges of high-altitude environments.ConclusionThis study emphasizes the importance of tailored dental care strategies, accounting for altitude and racial factors, to effectively manage periodontal health in these communities. Further research is warranted to investigate the specific microbial mechanisms and develop targeted interventions for optimizing oral health in populations across varying altitudes.

Social determinants of health and quality of life in children with chronic kidney disease: insights from Saudi Arabia

BackgroundSocial determinants of health (SDoH) are increasingly recognized as crucial factors affecting the well-being of pediatric chronic kidney disease (CKD) patients. This study explores the impact of SDoH on the quality of life (QoL) of children with CKD in Saudi Arabia.MethodsThis observational, descriptive, cross-sectional study included 50 participants with CKD stages three to five, as well as children with end-stage renal disease (ESRD) undergoing peritoneal dialysis (PD) or hemodialysis (HD) in Riyadh, Saudi Arabia. Data were collected from children and their caregivers using a validated Arabic-adapted version of the Pediatric Quality of Life Inventory (PedsQL) 3.0 and an SDoH survey.ResultsThe study revealed that access to education significantly affects pediatric QoL (H/Z score 2.825; P-value 0.005), and the lack of dietary recommendations was identified as a critical factor (H/Z score 1.441; P-value 0.029). ESRD patients on PD from larger families reported better QoL, whereas lower family income was associated with reduced QoL in PD patients (P-value 0.048). Compared to those in earlier stages of CKD, ESRD patients showed lower QoL (H/Z score 2.154; P-value 0.031).ConclusionOur study provides initial insights into the relationship between SDoH and the QoL of children with CKD in Saudi Arabia. It calls for a comprehensive approach that includes these determinants in care strategies to improve patient outcomes and QoL.

Healthcare utilisation and associated costs for methadone versus buprenorphine recipients: Examination of interlinked primary and secondary care electronic health records in England.

More evidence for patterns of healthcare utilisation and associated costs among people receiving opioid agonist therapy (OAT) is needed. We investigated primary and secondary healthcare usage and costs among methadone and buprenorphine recipients in England. We conducted a cohort study using the Clinical Practice Research Datalink GOLD and Aurum databases of patients who were prescribed OAT between 1 January 2007 and 31 July 2019. The cohort was linked to Hospital Episode Statistics admitted patient care, outpatient and emergency department data, neighbourhood- and practice-level Index of Multiple Deprivation quintiles and mortality records. Negative binomial regression models were applied to estimate weighted rate ratios (wRR) of healthcare utilisation. Total and mean costs were calculated using Unit Costs of Health and Social Care and the National Healthcare Service Payment by Results National Tariffs. Among 12,639 patients observed over 39,016 person-years, we found higher rate of hospital admissions (wRR 1.18; 1.08-1.28) among methadone compared with buprenorphine recipients. The commonest hospital discharge diagnoses among methadone patients were infectious diseases (19.2%), mental and behavioural disorders (17.0%) and drug-related poisoning (16.5%); the three commonest among buprenorphine patients were mental and behavioural diseases (21.5%), endocrine (13.8%) and genitourinary system diseases (13.1%). Methadone patients had similar mean costs compared with buprenorphine patients (cost difference: £539.01; 432.11-1006.69). Differences in healthcare utilisation frequency for methadone versus buprenorphine recipients were observed. The differences in associated costs were mainly driven by hospital admissions. These findings offer valuable insights for optimising care strategies and resource allocation for OAT recipients.

Effects of graphene oxide and graphene quantum dots on enhancing CPP-ACP anti-caries ability of enamel lesion in a biofilm-challenged environment

ObjectiveTo investigate the anticaries effects of graphene oxide (GO) and graphene quantum dots (GQDs) combined with casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on enamel in a biofilm-challenged environment. Material and methodsGO and GQDs were synthesised using citric acid. The antibiofilm and biofilm inhibition effects for Streptococcus mutans were evaluated by scanning electron microscopy (SEM), confocal laser scanning microscopy (CLSM), and colony-forming units (CFU). Remineralisation ability was determined by assessing mineral loss, calcium-to-phosphorus ratio, and surface morphology. To create a biofilm-challenged environment, enamel blocks were immersed in S. mutans to create the lesion and then subjected to artificial saliva/biofilm cycling for 7 days. Anticaries effects of GO, GQDs, GQDs@CPP-ACP, GO@CPP-ACP, and CPP-ACP were determined by broth pH and mineral changes after 7-day pH cycling. Biocompatibility was tested using a Cell Counting Kit-8 (CCK8) assay for human gingival fibroblasts (HGF-1). ResultsGQDs and GO presented significant antibiofilm and biofilm inhibition effects compared to the CPP-ACP and control groups (P < 0.05). The enamel covered by GQDs and GO showed better crystal structure formation and less mineral loss (P < 0.05) than that covered by CPP-ACP alone. After 7 days in the biofilm-challenged environment, the GO@CPP-ACP group showed less lesion depth than the CPP-ACP and control groups (P < 0.05). GO and GQDs showed good biocompatibility compared to the control group by CCK8 (P > 0.05) within 3 days. ConclusionGO and GQDs could improve the anti-caries effects of CPP-ACP, and CPP-ACP agents with GO or GQDs could be a potential option for enamel lesion management.Clinical Significance: GO and GQDs have demonstrated the potential to significantly enhance the anticaries effects of CPP-ACP. Incorporating these nanomaterials into CPP-ACP formulations could provide innovative and effective options for the management of enamel lesions, offering improved preventive and therapeutic strategies in dental care.

Visualizing Nursing Narratives: An Evaluation of Latent Dirichlet Allocation Topic Modeling for Care Reports.

The increasing volume of unstructured textual data in healthcare, particularly in nursing care reports, presents both challenges and opportunities for enhancing patient care and operational efficiency. This study explores the application of Latent Dirichlet Allocation (LDA) topic modeling to analyze free-text nursing narratives from inpatient stays in three different clinics, aiming to uncover the latent thematic structures within. Utilizing the R programming environment and the visualization tool LDAvis, we identified three main themes: "Patient Well-being," "Patient Mobility and Care Activities," and "Treatment and Pain Management," the latter combining two closely related but initially distinct topics due to their overlapping content. Our findings demonstrate the potential of LDA topic modeling in extracting meaningful insights from nursing narratives, which could inform patient care strategies and healthcare practices. However, the study also highlights significant challenges associated with the method, including the sensitivity to parameter settings, the lack of updates for key software packages, and concerns about reproducibility. These issues highlight the need for meticulous parameter validation and the exploration of alternative text analysis methodologies for future research. By addressing these methodological challenges and emphasizing the importance of comparative method analysis, this study contributes to the advancement of text analytics in healthcare. It opens avenues for further research aimed at developing more robust, efficient, and accessible tools for analyzing free-text data, thereby enhancing the ability of healthcare professionals to use unstructured data to improve decision making and patient outcomes.