Careful Information Research Articles

Drug therapy safety during pregnancy and breastfeeding

The treatment of dermatological diseases during pregnancy and breastfeeding poses particular challenges for the therapist for medical and legal reasons. Maternal and fetal influencing factors must be taken into account and the special need for protection of the fetus, infant, and mother must be considered in the treatment decision, usually outside of the approval process. Due to the lack of or insufficient evidence for most therapies during pregnancy and breastfeeding, an individual risk-benefit assessment should always be carried out, which also takes into account the risk of nontreatment. In the case of difficult or potentially momentous decisions, information from relevant databases, intercollegiate consultation and, if possible, advice from aclinical ethics committee should be obtained. In any case, the parents, and in particular the mother, should be carefully informed and their consent should be obtained and documented. Recommendations can be made for common chronic inflammatory and infectious dermatoses, but these should be reviewed on acase-by-case basis. For other therapy situations, an individual analysis and decision-making process is necessary. Overall, however, it can be stated that digital data processing and availability, combined with careful analysis, empathetic consideration and information for those affected, enables asuccessful treatment decision to be made in the vast majority of cases.

Consensus paper on the assessment of adult patients with traumatic brain injury with Glasgow Coma Scale 13-15 at the emergency department: A multidisciplinary overview.

Traumatic brain injury (TBI) is a common reason for presenting to emergency departments (EDs). The assessment of these patients is frequently hampered by various confounders, and diagnostics is still often based on nonspecific clinical signs. Throughout Europe, there is wide variation in clinical practices, including the follow-up of those discharged from the ED. The objective is to present a practical recommendation for the assessment of adult patients with an acute TBI, focusing on milder cases not requiring in-hospital care. The aim is to advise on and harmonize practices for European settings. A multiprofessional expert panel, giving consensus recommendations based on recent scientific literature and clinical practices, is employed. The focus is on patients with a preserved consciousness (Glasgow Coma Scale 13-15) not requiring in-hospital care after ED assessment. The main results of this paper contain practical, clinically usable recommendations for acute clinical assessment, decision-making on acute head computerized tomography (CT), use of biomarkers, discharge options, and needs for follow-up, as well as a discussion of the main features and risk factors for prolonged recovery. In conclusion, this consensus paper provides a practical stepwise approach for the clinical assessment of patients with an acute TBI at the ED. Recommendations are given for the performance of acute head CT, use of brain biomarkers and disposition after ED care including careful patient information and organization of follow-up for those discharged.

Unravelling the connection between COVID-19 and Alzheimer's disease: a comprehensive review.

Currently, there exists a limited comprehension regarding the correlation between COVID-19 and Alzheimer's disease (AD). To elucidate the interrelationship and its impact on outcomes, a comprehensive investigation was carried out utilising time-unrestricted searches of reputable databases such as Scopus, PubMed, Web of Science, and Google Scholar. Our objective was to evaluate the impact of various medical conditions on severe COVID-19-related events. We focused on identifying and analysing articles that discussed the clinical characteristics of COVID-19 patients, particularly those pertaining to severe events such as ICU admission, mechanical ventilation, pneumonia, mortality and acute respiratory distress syndrome (ARDS) a serious lung condition that causes low blood oxygen. Through careful data analysis and information gathering, we tried to figure out how likely it was that people with conditions, like AD, would have serious events. Our research investigated potential mechanisms that link AD and COVID-19. The ability of the virus to directly invade the central nervous system and the role of ACE-2 receptors were investigated. Furthermore, the OAS1 gene served as the genetic link between AD and COVID-19. In the context of COVID-19, our findings suggest that individuals with AD may be more susceptible to experiencing severe outcomes. Consequently, it is crucial to provide personalised care and management for this demographic. Further investigation is required to attain a comprehensive comprehension of the intricate correlation between Alzheimer's disease and COVID-19, as well as its ramifications for patient outcomes.

Legal and Ethical Dimensions of AI in Education: Navigating New Frontiers

Objective: This study critically examines the legal aspects of using artificial intelligence (AI) in education, exploring the roles of chatbots, Chat GPT, chat-based plagiarism issues, educational simulations, and AI's impact on the labor market.
 Methods: Employing a variety of research methods, the study analyzes current legal norms and international laws relevant to AI in education. This includes considerations of intellectual property, data privacy, ethical standards, and liability.
 Results: The paper highlights the challenge of chat-based plagiarism, emphasizing the need for careful information use to maintain academic integrity. While students might misuse AI tools like chatbots and GPT models for plagiarism, these technologies also aid in plagiarism detection. The study also explores the use of machine learning and data analysis in developing personalized learning experiences, enhancing learning effectiveness and knowledge retention.
 Conclusion: AI's integration into education promises to improve quality and accessibility, but necessitates a robust legal framework. The article evaluates the effectiveness of various AI tools, including chatbots, which provide on-demand information, and Chat GPT, useful for textual material handling. It also discusses the role of learning simulations in personalizing education, using AI to analyze performance data and tailor individual learning paths.

Physical Education Teacher Perspective On Kurikulum Merdeka and Sport Education Model: A Rasch Model Analysis

Changes and implementations of the new curriculum require a careful preparation and information about the Independent Curriculum, known as Kurikulum Merdeka. The learning model used needs to be explored as an illustration of teacher understanding. This study aimed to examine teacher perspectives regarding their understanding of the Kurikulum Merdeka and the Sport Education Learning Model. The cross-sectional survey method was used to collect data. Data were collected using Google Form filled by 74 teachers. The research instrument was in a Likert scale form and consisted of 30 questions focused on exploring teacher understanding of the Kurikulum Merdeka, the Sport Education (SEM) Learning Model, the SEM Phases/Syntax, and the roles existing in the implementation of the SEM Model and the importance of understanding curriculum and learning models in school. Then, 15 open-ended questions related to models often used by teachers, training expectations to follow, and obstacles experienced during learning at school were given. The research data were processed using Winsteps 5.2.3 software. The Rasch Model analysis was used to analyze the instruments made and the results of the teacher understanding perspective. The results showed that the instrument was valid for use. Related to the results of the teacher perspective, 48.6% of physical education teachers had an understanding and belief in the importance of the Kurikulum Merdeka and the SEM model in elementary schools at a high level. Meanwhile, 12. 2% were at the moderate level and 39.2% were at the low level. These findings can be used as a reflection related to the teacher understanding of the Kurikulum Merdeka and the Sport Education Learning Model and as a reference in arranging training needed for Physical Education teachers in the field.

950-P: Factors Associated with Hyper-/Hypoglycemia Unawareness in People with Type 2 Diabetes

Background: Hyper-/hypoglycemia unawareness harvours one of the major issues to hamper good clinical practice in people with type 2 diabetes (T2DM). To unveil risk factors of hyper-/hypoglycemia unawareness, we investigated its relationship with actual glucose variability in people with T2DM using continuous glucose monitoring (CGM). Methods: Data were obtained from our prospective observational study comprising Japanese people with T2DM who underwent blinded professional CGM and the Diabetes Treatment Satisfaction Questionnaire (DTSQ). People with a time above range (TAR; >180 mg/dL) ≥25% and those who answered 0 (“never”) or +1 (“almost never”) for the frequency of hyperglycemia in the DTSQ were defined as having hyperglycemia unawareness. People with a time below range (TBR; <70 mg/dL) ≥4% with an answer of 0 or +1 for the frequency of hypoglycemia were labelled as having hypoglycemia unawareness. We extracted various clinical characteristics associated with the discrepancies between hyper-/hypoglycemia unawareness and TAR ≥25% / TBR ≥4% on a multivariate logistic regression analysis. Results: This analysis included 284 subjects. In subjects with a TAR ≥25% (n=115), 27 had hyperglycemia unawareness. The analysis showed that each of no insulin use, older age, and a history of stroke was correlated with hyperglycemia unawareness. Among subjects with a TBR ≥4% (n=45), 28 were unaware of their hypoglycemia. A low eGFR was an independent risk of hypoglycemia unawareness. Conclusions: We newly identified some clinical characteristics that were significantly associated with hyper-/hypoglycemia unawareness. In people with those characteristics, careful and intensive information sharing regarding asymptomatic hyper-/hypoglycemia using CGM may lead to better glucose management. Disclosure Y.Suzuki: None.

Tumescent local anaesthesia for the surgical therapy of congenital nevi in the first year of life.

The indication for surgical treatment of congenital nevi must be made after individual consideration of the expected benefit and risk and requires careful information of the parents as well as interdisciplinary psychological support. In addition to suspected malignancy, a relevant indication is the risk of stigmatization depending on the size and localization of the nevus. Objective was to show which size reduction of the congenital nevus can be achieved by surgical therapy under tumescent local anaesthesia (TLA) in infancy and how often complications of anaesthesia or surgery occur. All infants up to 12 months of age who underwent surgery for a congenital nevus under TLA at the University Dermatological Clinic Tuebingen between January 2015 and December 2021 were included; surgeries were performed using serial excisions (powerstretching technique), whereby the incisions were made inside the nevus and mobilization was strictly limited to the skin side without nevus. Overall, a cumulative total area of 38.65 cm2 could be removed on average within the first year of life (trunk: 67 cm2 , head: 21.2cm2 , legs: 21.6cm2 , arms: 13.2cm2 ). A cumulative maximum area reduction of 406.9cm2 could be achieved. We evaluated 363 surgical sites (123 children) on all body regions. The median age of the children at the first surgery was 3.5months (0.46-10.7months). Complications occurred in 2.3% (seven procedures). All these complications were reversible in the course of the operation and did not lead to a prolonged hospital stay. No anaesthesia-related complications occurred. We were able to show that a reduction of large areas of congenital nevi is possible in the first year of life with the combination of serial excisions using powerstretching technique, TLA, and intracutaneous butterfly sutures.

Role of the community in the granting of blue flag certification at Tombo beach (Guarujá, Brazil)

In 2009, Tombo Beach in Guarujá (Brazil) received Blue Flag Certification, an ecological seal granted to beaches that meet environmental conservation requirements. Tombo Beach’s certification was the third in the program’s history in Brazil. Started in 1987, the Blue Flag Program is one of the most critical ecological seals created for the sustainable development of beaches and marinas that adopt careful water quality treatment, environmental education and information, environmental management, security, and other services. Thus, the objective of this study was to evaluate the knowledge of the requirements above by visitors to Tombo Beach to determine their participation in maintaining certification. To this end, structured questionnaires were used in interviews carried out in April in Tombo Beach, resulting in 300 interviews. Analysis of the data obtained through interviews (n=300) indicated restricted knowledge on the part of attendees regarding the requirements set out in the Blue Flag Program, demonstrating critical deficiencies, especially about environmental education programs. Furthermore, we sought to discuss the benefits of certification in increasing the attraction of visitors to disseminate the culture of accreditation on Brazilian beaches.

Distinct clinicopathological features of ovarian endometriosis after long-term exposure to mifepristone.

Mifepristone has been used to treat endometriosis, but it can cause a constellation of endometrial alterations. Our study investigated the effects of long-term mifepristone on ovarian endometriosis. We retrospectively analyzed the clinicopathological changes of ovarian endometriosis in 11 Chinese patients after long-term low-dose mifepristone therapy and compared these alterations with those observed in eutopic endometrium and adenomyosis side-by-side. Immunohistochemistry was applied to investigate estrogen receptor (ER), progesterone receptor (PR), and Ki67 expression in eutopic and ectopic endometrium. Nearly all patients had a pelvic mass and elevated serum CA125 levels. The ovarian lesions were grossly solid, cystic-solid, or cystic. They had a grayish-reddish appearance and a fleshy, honeycomb-like cut surface. The ovarian lesions shared morphological features with the uterine endometrium, and they were characterized by dilated, crowding endometrial glands with non-physiological changes. Immunostaining revealed consistent staining for ER and PR and a low Ki67 index in both eutopic and ectopic endometrium. Our findings suggest that ovarian endometriosis can mimic an endometrioid borderline tumor after long-term mifepristone administration. Careful histological assessment and related clinical information are critical for the correct interpretation of these rare entities.

Motivational factors were more important than perceived risk or optimism for compliance to infection control measures in the early stage of the COVID-19 pandemic.

Compliance to infection control measures may be influenced both by the fear of negative consequences of a pandemic, but also by the expectation to be able to handle the pandemic's challenges. We performed a survey on a representative sample for Norway (N = 4,083) in the first weeks of the COVID-19 lock-down in March 2020. We had preregistered hypotheses to test the effect of optimism and perceived risk on compliance. Perceived risk had small effects on increasing compliance and on leading to more careful information gathering. The expected negative association between optimism and compliance was not supported, and there was instead a small positive association. We found a small effect that optimism was associated with seeing less risk from the pandemic and with a larger optimistic bias. Finally, an exploratory analysis showed that seeing the infection control measures as being effective in protecting others explained a substantial proportion of the variation in compliance. The study indicates that how we think about pandemic risk has complex and non-intuitive relationships with compliance. Our beliefs and motivations toward infection control measures appears to be important for compliance.

Towards a specialised digital monolingual Igbo dictionary on crop cultivation

The monolingual dictionary as an essential language compendium preserved culture specific ideas. In a technologically driven society where visual platform enhanced comprehension, monolingual dictionary presents careful and detailed information on the usage patterns of a given language. This promotes longevity of historic peculiarities for generational connect. Yet, there is a dearth of such dictionaries in the Igbo language. Therefore, this study sets to explore an e- monolingual dictionary model for the Igbo language on crop cultivation. Data were primarily sourced from field work whereas published literature and internet materials comprised the secondary sources of information. While the Function Theory of Lexicography was adopted for the pre-data compilation and presentation, the lexiquepro was used for the post compilation stage of the dictionary. This model avails researchers and learners the opportunity to globally access appropriate lexemes within the Igbo crop cultivation domain. Furthermore, Igbo children (at home and in diaspora) would have been provided with a visual platform to acquaint with specialised traditional Igbo farming practices, values and systems. Consequently, the longevity of the use of Igbo terms associated with traditional farming practices is revitalised among the younger ones. This study suggested that such platforms be provided for other areas of Igbo cultural practices such as pottery, health, blacksmithing, and performances to aid Translators, Terminologists and text writers appropriately convey their messages as well.

Avoidant Restrictive Food Intake Disorder (ARFID) and Body Image: a case report

BackgroundAvoidant Restrictive Food Intake Disorder (ARFID) is a relatively new eating disorder diagnosis, and there is need to better understand this disorder’s presentation. Diagnostic criteria for ARFID require that there are no body image distortions. People with ARFID symptoms may have body image concerns that require careful consideration and more information about the interplay of these is needed to help clinicians appropriately diagnose and manage ARFID.Case presentationThis clinical observation reports a case of ARFID in a nine-year-old with severe malnutrition who positively views her small size and values thinness. The patient reported that her own desire for thinness was influenced by social media beauty ideals and praise of thinness witnessed in social situations. Despite this, the motivation for avoidant and restrictive eating behaviors was low appetitive drive, fear of trying new foods, and fear of adverse consequences from eating.ConclusionsAlthough concerning, the patient’s body image was not of clinical significance as a motivating factor for the disordered eating behaviors. Body image dissatisfaction is common. The requirement to exclude body image distortions in the diagnostic criteria for ARFID may require consideration of the pervasiveness of societal body ideals to which young people are exposed.

Perception of genetic testing among patients with inherited retinal disease: Benefits and challenges in a Japanese population.

Inherited retinal disease (IRD) is clinically and genetically heterogeneous. Awareness of the importance of genetic testing for IRD in the clinical setting is increasing with the recent development of new therapeutic strategies, such as gene therapy. Here, the perception of genetic testing, including its benefits and potential challenges, among patients with IRD was investigated to establish strategies for IRD genetic testing and counseling practices that can meet the requirements of the patients in Japan. An anonymous self-administered questionnaire was distributed to 275 patients with IRD who underwent genetic testing after clinical consultation and genetic counseling to investigate the motivations for genetic testing, benefits, challenges, status of communication of results to family, and attitude to timing of genetic testing. In total, 228 (82.9%) responses were analyzed. Several major motivations for genetic testing were identified, including gaining information on future treatment options and clarification of the inheritance pattern, among others. No association was found between the sharing of results with family members and the results of genetic testing. Moreover, according to patients who received positive results, the benefits of genetic testing included information on the inheritance pattern, additional information on the diagnosis, and mental preparation for the future. Even patients who received negative or inconclusive (variant of uncertain significance) results reported certain informative and psychological benefits. Altogether, these findings suggest that provisions for genetic testing and genetic counseling are necessary within a certain period after clinical diagnosis and it is necessary to facilitate appropriate family communication about genetic testing results while paying attention to the background of family relationships. Moreover, the benefits of genetic testing can be influenced by the careful interpretation and information provided on the test results during genetic counseling and consultation.

Mere Nuisance or Growing Threat? The Physical and Economic Impact of High Tide Flooding on US Road Networks

High tide flooding (HTF) already affects traffic in many US coastal areas, but the issue will worsen significantly in the future. While studies show that large storm surge events threaten to be ever more costly, less damaging, but more frequent HTF events remain understudied and potentially carry a comparable economic impact. This study advances our understanding of the risks and impacts of HTF on vulnerable traffic corridors using hourly tide gauge water levels, sea-level rise projections, and link-level spatial analysis. It is the first study to estimate HTF economic impacts for varying levels of intervention, including reasonably anticipated driver-initiated rerouting and ancillary protection of adjacent property. The 2020 annual national-level costs of $1.3 to $1.5 billion will increase to $28 to $37 billion in 2050 and $220 to $260 billion in 2100 for medium to high greenhouse gas (GHG) emissions scenarios, respectively. Total costs over the century are $1.0 to $1.3 trillion (discounted 3%). Additional cost-effective protection by building sea walls or raising road surfaces could significantly reduce 2100 costs to $61 to $78 billion, but there remain many barriers to adopting least-cost adaptation decisions, and these gains may only be realized with careful planning and information sharing.

Breaking Masked Implementations with Many Shares on 32-bit Software Platforms

We explore the concrete side-channel security provided by state-of-theart higher-order masked software implementations of the AES and the (candidate to the NIST Lightweight Cryptography competition) Clyde, in ARM Cortex-M0 and M3 devices. Rather than looking for possibly reduced security orders (as frequently considered in the literature), we directly target these implementations by assuming their maximum security order and aim at reducing their noise level thanks to multivariate, horizontal and analytical attacks. Our investigations point out that the Cortex-M0 device has so limited physical noise that masking is close to ineffective. The Cortex-M3 shows a better trend but still requires a large number of shares to provide strong security guarantees. Practically, we first exhibit a full 128-bit key recovery in less than 10 traces for a 6-share masked AES implementation running on the Cortex-M0 requiring 232 enumeration power. A similar attack performed against the Cortex-M3 with 5 shares require 1,000 measurements with 244 enumeration power. We then show the positive impact of lightweight block ciphers with limited number of AND gates for side-channel security, and compare our attacks against a masked Clyde with the best reported attacks of the CHES 2020 CTF. We complement these experiments with a careful information theoretic analysis, which allows interpreting our results. We also discuss our conclusions under the umbrella of “backwards security evaluations” recently put forwards by Azouaoui et al. We finally extrapolate the evolution of the proposed attack complexities in the presence of additional countermeasures using the local random probing model proposed at CHES 2020.

An Adapted Model for Transition to Adult Care in Young Adults with Prader-Willi Syndrome.

Background: Prader–Willi syndrome (PWS) is a rare, neurodevelopmental, genetic disease caused by the lack of expression of paternal genes in chromosome 15. The typical characteristics, including hyperphagia, muscular hypotonia, abnormal body composition, hormonal deficiencies, cognitive disabilities, and behavioral problems, appear or worsen in young adults, and the development of comorbidities increases. The transition of care of young adults with PWS is a challenge due to the complexity of the disease and the vulnerability of the patients. Multidisciplinary transition clinics are optimal but difficult to implement in clinics with few transitions. Methods: The description of transition care meetings was limited to the pediatric and adult endocrinologists and nurses. The presentation of our checklist was developed to optimize the organization of the transition of young adults with PWS. Results: Two to four patients with PWS are transferred to adult care every year in our hospital. Transition with the adapted program was more comfortable for patients and identification of the individual patient’s comorbidities and special needs could clearly be addressed. Conclusions: In smaller settings, an adapted model including a proper introduction and presentation of the adult team and clinic, careful information about comorbidities and special needs, together with a checklist can optimize the transition of care to adult care.

Carbon footprint information, prices, and restaurant wine choices by customers: A natural field experiment

Growing evidence suggests that consumers should be involved in the solutions to climate change. To test the responsiveness of wine consumers to carbon footprint stimuli we set a natural field experiment in a restaurant modifying the choice architecture of wine decisions. We modified wine cards to provide different information and price incentives to consumers to test the effects of two policy interventions for reducing CO2 emissions. Specifically, we test the provision of carbon footprint information and an additional price for carbon emissions. We randomly assigned subjects to four different wine cards. Results show that carbon footprint information alone is not enough to affect wine choices, but its effect becomes significant when combined with a price change. A card showing the carbon footprint of wine bottles and proportionally higher wine prices was associated with choices leading to lower carbon emissions. However, when information about the additional price to offset wine carbon emissions was made explicitly visible to consumers on another card, an opposite effect of an increase in the choice of wines with higher carbon-emitting production processes was observed. This finding indicates that how the price increase is presented can affect wine choices, highlighting the importance of careful information policy design.

Managing a Pan-European Consortium on Late Effects among Long-Term Survivors of Childhood and Adolescent Cancer-The PanCareLIFE Project.

PanCareLIFE brought together European partners and is the largest study to have evaluated the issues of fertility impairment, hearing loss, and health-related quality of life in survivors of childhood and adolescent cancer. Successful delivery of the project aims did not evolve solely from scientific qualities. Organizational structure and careful information management were key components for its successful completion and are retrospectively assessed in this paper. PanCareLIFE used cohort studies, case-control studies, clinical evaluation of hearing, and genetic testing to study 32,000 survivors from 25 data providers. A management team implemented the organizational structures, was the decision making body, developed and maintained a communication plan, and supervised deadlines, and made timely decisions. A biostatistics support group and an ethical advisory board were established. A publication committee ensured quality and accuracy of publications and is jointly responsible for the sustainability of the project. The chosen management structure of PanCareLIFE can serve as a blueprint for the management of complex international projects. Apart from the survivors themselves, various target audiences like oncology researchers, health care providers, and policy makers can derive benefits from the project. The results can also be used in oncological frontline therapy to reduce toxicity.

Treatment decision satisfaction and regret after focal HIFU for localized prostate cancer

PurposeFocal therapies (FTs) are investigated within prospective studies on selected patients treated for localized prostate cancer (PCa). Benefits are preservation of genitourinary function and reduced complications, but follow-up is elaborate and is associated with uncertainty as cancer-free survival appears to be lower compared to standard radical treatments. The aim of this study was to analyse patient-reported acceptance of FT and evaluate factors associated with treatment decision regret.Methods52 patients who received focal high-intensity focused ultrasound for low- to intermediate-risk PCa between 2014 and 2019 within two prospective trials were eligible for a survey regarding PCa-related treatment regret and quality-of-life (Clark’s scale) and the following potential predictors: sociodemographic variables, Charlson Comorbidity Index, subjective aging (AARC-10 SF), and general health-related quality-of-life (SF-12). Cancer persistence/recurrence (multiparametric MRI and fusion biopsy after 12 months) and functional outcomes (EPIC-26 UI/UIO/S) data were also included in this study.ResultsThe overall survey response rate was 92.3% (48/52 patients). Median follow-up was 38 months (interquartile range = 25–50 months). In total, ten patients (20.8%) reported treatment decision regret. In univariable analyses, a clinically meaningful increase in urinary incontinence showed a significant association (OR 4.43; 95% CI 0.99–20.53; p = 0.049) with regret. Cancer recurrence (OR 12.31; 95% CI 1.78–159.26; p = 0.023) and general health worry as a domain of Clark’s scale (OR 1.07; 95% CI 1.03–1.14; p < 0.01) were predictors of regret in a multivariable logistic regression model (AUC = 0.892).ConclusionAcceptance of FT is comparable to standard treatments. Extensive follow-up including regular PSA testing does not cause additional regret but careful patient selection and information before FT is crucial.

Myelomeningocele: Medical Considerations and Stomatologic Aspects in the Dental Treatment.

The aim was to analyze systemic and oral aspects of patients with myelomeningocele (MMC), relevant for their dental treatment. Dental treatment of these individuals requires the dentist's extensive knowledge and careful information to determine the dental treatment plan. Thirty participants aged 3 to 16 years were divided into 2 groups: study group (15 MMC individuals) and control group (15 healthy subjects). All patients were evaluated for: systemic conditions, use of medications, sequela of the underlying pathology, oral hygiene, diseases, convulsion, cerebrospinal fluid (CSF), allergy, behavior, learning, and mouth physical examination to assess the oral conditions. The study group presented: higher percentage using drugs (P < 0.05), 40% had convulsions (P < 0.05), 86.67% using CSF shunt, 53.33% presented latex allergies (P < 0.05), 53.33% were classified as anxious and with cognitive deficit (P < 0.05), showed more gingivitis (P < 0.05). The MMC individuals, in the majority, have shown cognitive impairment and anxious behavior, use of controlled drugs, convulsion, CSF shunt use, and latex allergy. The presence of periodontal tissue damage was higher in patients with MMC.