Index Scale Research Articles

Pharmacopuncture therapy for adhesive capsulitis: A pragmatic randomized controlled pilot study

BackgroundAlthough several studies have reported the effectiveness of acupuncture treatment for adhesive capsulitis (AC), research on pharmacopuncture therapy for AC remains limited. We compared the effectiveness and safety of pharmacopuncture and physiotherapy for AC. MethodsThis pragmatic, randomized, controlled, parallel-group pilot study enrolled patients with limitations of shoulder movement and a numeric rating scale (NRS) score for shoulder pain ≥5 randomized (1:1) to the pharmacopuncture therapy (PPT) and physiotherapy (PT) groups. Treatment sessions were administered twice weekly for 6 weeks, and the participants were followed up for 13 weeks after randomization. The primary outcome was the NRS score for shoulder pain, and the secondary outcomes were the visual analog scale (VAS), Shoulder Pain and Disability Index (SPADI), range of motion (ROM), patient global impression of change (PGIC), EuroQol 5-Dimension 5-Level (EQ-5D-5L), and Short Form 12 Health Survey (SF-12) scores. The intention-to-treat (ITT) analysis was set as the primary analysis. ResultsAmong 50 participants, for the primary endpoint (week 7) the PPT group showed a significantly superior improvement in NRS, VAS, SPADI, ROM for flexion, ROM for abduction, and EQ-5D-5L scores. The ROM for extension, ROM for adduction, physical component summary, and patient global impression of change were significantly better in the PPT than in the PT group, and these effects were sustained until week 13. ConclusionIn this pilot study, PPT showed better effects than PT, confirming the feasibility of a follow-up main study. Trial registrationClinicaltrials.gov (NCT05292482) and cris.nih.go.kr (KCT0007198).

Surgical outcomes of robotic-assisted percutaneous fixation for thoracolumbar fractures in patients with ankylosing spondylitis

BackgroundSpinal fractures in patients with ankylosing spondylitis (AS) mainly present as instability, involving all three columns of the spine, and surgical intervention is often considered necessary. However, in AS patients, the significant alterations in bony structure and anatomy result in a lack of identifiable landmarks, which increases the difficulty of pedicle screw implantation. Therefore, we present the clinical outcomes of robotic-assisted percutaneous fixation for thoracolumbar fractures in patients with AS.MethodsA retrospective review was conducted on a series of 12 patients diagnosed with AS. All patients sustained thoracolumbar fractures between October 2018 and October 2022 and underwent posterior robotic-assisted percutaneous fixation procedures. Outcomes of interest included operative time, intra-operative blood loss, complications, duration of hospital stay and fracture union. The clinical outcomes were assessed using the visual analogue scale (VAS) and Oswestry Disability Index (ODI). To investigate the achieved operative correction, pre- and postoperative radiographs in the lateral plane were analyzed by measuring the Cobb angle.ResultsThe 12 patients had a mean age of 62.8 ± 13.0 years and a mean follow-up duration of 32.7 ± 18.9 months. Mean hospital stay duration was 15 ± 8.0 days. The mean operative time was 119.6 ± 32.2 min, and the median blood loss was 50 (50, 250) ml. The VAS value improved from 6.8 ± 0.9 preoperatively to 1.3 ± 1.0 at the final follow-up (P < 0.05). The ODI value improved from 83.6 ± 6.1% preoperatively to 11.8 ± 6.6% at the latest follow-up (P < 0.05). The average Cobb angle changed from 15.2 ± 11.0 pre-operatively to 8.3 ± 7.1 at final follow-up (P < 0.05). Bone healing was consistently achieved, with an average healing time of 6 (5.3, 7.0) months. Of the 108 screws implanted, 2 (1.9%) were improperly positioned. One patient experienced delayed nerve injury after the operation, but the nerve function returned to normal upon discharge.ConclusionPosterior robotic-assisted percutaneous internal fixation can be used as an ideal surgical treatment for thoracolumbar fractures in AS patients. However, while robot-assisted pedicle screw placement can enhance the accuracy of pedicle screw insertion, it should not be relied upon solely.

Cortical Mechanisms Underlying Effects of Repetitive Peripheral Magnetic Stimulation on Dynamic and Static Postural Control in Patients with Chronic Non-Specific Low Back Pain: A Double-Blind Randomized Clinical Trial.

Patients with chronic non-specific low back pain (CNLBP) often experience impaired postural control, contributing to pain recurrence. Although repetitive peripheral magnetic stimulation (rPMS) combined with core muscle training (CMT) could improve postural control, its neural mechanism remains unclear. This study aims to investigate the postural control-related cortical mechanism of the effect of rPMS on patients with CNLBP. This unicentric, prospective, randomized, double-blind, controlled trial was conducted in a public hospital from May to December 2023. A total of 40 patients (27 females and 13 males, mean age 29.38±7.72) with CNLBP were randomly assigned to either the rPMS group (real rPMS with CMT) or the sham-rPMS group (sham-rPMS with CMT) for 12 sessions over 4weeks. The rPMS was applied to the lumbar paravertebral multifidus muscle on the painful side. Pain and disability were quantified using the visual analog scale (VAS) and Oswestry dysfunction index (ODI) pre- and post-intervention. Furthermore, the sway area and velocity of the center of pressure (COP) were measured using a force platform. The cortical activities in 6 regions of interest during 4 tasks (standing with eyes open/closed on a stable/unstable plane) were recorded by functional near-infrared spectroscopy (fNIRS) pre- and post-intervention. The repeated measure ANOVA was applied for statistical analysis. Spearman's correlation was used to determine the relationships between variables. After the intervention, the rPMS group showed decreased pain intensity (p=0.001) and sway area (unstable eyes-closed task) (p=0.046) compared to the sham-rPMS group. Additionally, the rPMS group exhibited increased activation in left primary motor cortex (M1) (p=0.042) and reduced in left supplementary motor area (SMA) (p=0.045), whereas the sham-rPMS group showed no significant changes. The increased activation of left M1 was negatively correlated to the reduction of pain intensity (r=-0.537, p=0.018) and sway area (r=-0.500, p=0.029) under the static balancing task. Furthermore, there was a positive correlation between sway velocity and VAS (r=0.451, p=0.046) post-rPMS intervention. Repetitive peripheral magnetic stimulation combined with core muscle training demonstrated better analgesic effects and postural control improvements, compared to sham-stimulation. This may be attributed to the increased activation of the left primary motor cortex. The trial was registered on ClinicalTrials.gov (ChiCTR2300070943).

Effects of chronic neck pain on grip strength and psychomotor skills in adults.

It can be challenging to perform activities of daily living in patients with chronic neck pain. As the severity of the pain increases, the quality of the movements decreases. Not only the neck, but also the shoulder, elbow, grip strength and psychomotor skills are affected by these pains. In this study, it was aimed to investigate the effect of neck pain on grip strength and psychomotor skills in adults diagnosed with chronic neck pain. A cross-sectional study was conducted to examine the effect of pain on grip strength and psychomotor skills in patients with chronic neck pain. This study was planned to be carried out between October 2019 and May 2020 at the Private Yaşam Medical Center in Adana, with the official permission of the institution manager, but this period was carried out between October 2019 and November 2020 due to the fact that sufficient number of patients could not be reached due to the COVID-19 global epidemic. A total of 80 individuals, including 40 control and 40 patients, were included in the study. Forty adult patients who applied to the clinic with a diagnosis of chronic neck pain and 40 healthy adults without a diagnosis of chronic neck pain were included in the study. Conducted with 80 adults between the age of 19 and 74 years old. Individuals were divided into Group 1-control group (n = 40) and Group 2-patient group (n = 40). Information such as age, height, body weight and occupation of the groups were noted. Visual analogue scale and Neck Disability Index were applied to both the groups; hand grip strength with a Jamar hydraulic hand dynamometer, finger lateral grip strength with a pinchmeter and psychomotor skills with the Purdue Pegboard test were evaluated. In the study, hand grip strength (p < .05), finger lateral grip strength (p < .05), psychomotor skills (p < .01) showed a statistically significant decrease in the patient group compared to the control group. It is thought that in addition to the routine treatments for neck pain in the treatment plan of patients with chronic neck pain, exercises to improve the functionality and psychomotor skills in daily living activities can be included in the direction of increasing the grip strength and will guide future studies.

Factors associated with self-rated health in people with late-stage parkinson’s and cognitive impairment

PurposeTo investigate the contributors to self-rated health in people with late-stage Parkinson’s disease (PD) and cognitive impairment.MethodsA secondary analysis of baseline data from the international Care of Late-Stage Parkinsonism (CLaSP) cohort study was conducted. Participants with PD and either dementia or mild cognitive impairment or MMSE < 24/30 in the absence of major depression were included if they had completed the EQ-5D-3L assessment (n = 277). Factors associated with self-rated health (EQ-5D-3L Index and Visual Analogue Scale) were investigated through multivariable linear regression.ResultsMore severe PD (motor and non-motor) was associated with worse self-rated health. The EQ-5D-3L dimensions of Mobility, Self-Care and Usual Activities were almost universally affected; the latter two particularly severely. Being unable to perform usual activities or having moderate to extreme anxiety or depression were significantly associated with EQ-5D-3L Visual Analogue Scale, suggesting these are particularly valued. Worse motor impairment and function and the non-motor symptom domains of mood, perception, sexual function, and miscellaneous (e.g., pain) were associated with worse self-rated health, whereas greater burden of gastrointestinal symptoms was associated with better self-rated health in multivariate analysis. Better self-rated health was associated with recent PD nurse consultation, and higher doses of dopaminergic medication.ConclusionImprovement of activities of daily living, mood and anxiety should be prioritised in clinical practice, with consideration of perception and sexual function in this population. Recent nurse consultations and higher antiparkinsonian doses are associated with better self-rated health, suggesting there is no room for a therapeutic nihilism in this population of people within a complex phase of PD.

Cost-Effectiveness and Clinical Outcomes of Lateral Lumbar Interbody Fusion With Tricalcium Phosphate and Iliac Bone Graft Compared With Posterior Lumbar Interbody Fusion With Local Bone Graft in Single-Level Lumbar Spinal Fusion Surgery in Thailand.

Nowadays, minimally invasive lateral lumbar interbody fusion (LLIF) is used to treat degenerative lumbar spine disease. Many studies have proven that LLIF results in less soft tissue destruction and rapid recovery compared with open posterior lumbar interbody fusion (PLIF). Our recent cost-utility study demonstrated that LLIF was not cost-effective according to the Thai willingness-to-pay threshold, primarily due to the utilization of an expensive bone substitute: bone morphogenetic protein 2. Therefore, this study was designed to use less expensive tricalcium phosphate combined with iliac bone graft (TCP + IBG) as a bone substitute and compare cost-utility analysis and clinical outcomes of PLIF in Thailand. All clinical and radiographic outcomes of patients who underwent single-level LLIF using TCP + IBG and PLIF were retrospectively collected. Preoperative and 2-year follow-up quality of life from EuroQol-5 Dimensions-5 Levels and health care cost were reviewed. A cost-utility analysis was conducted using a Markov model with a lifetime horizon and a societal perspective. All enrolled patients were categorized into an LLIF group (n = 30) and a PLIF group (n = 50). All radiographic results (lumbar lordosis, foraminal height, and disc height) were improved at 2 years of follow-up in both groups (P < 0.001); however, the LLIF group had a dramatic significant improvement in all radiographic parameters compared with the PLIF group (P < 0.05). The fusion rate for LLIF (83.3%) and PLIF (84%) was similar and had no statistical significance. All health-related quality of life (Oswestry Disability Index, utility, and EuroQol Visual Analog Scale) significantly improved compared with preoperative scores (P < 0.001), but there were no significant differences between the LLIF and PLIF groups (P > 0.05). The total lifetime cost of LLIF was less than that of PLIF (15,355 vs 16,500 USD). Compared with PLIF, LLIF was cost-effective according to the Thai willingness-to-pay threshold, with a net monetary benefit of 539.76 USD. LLIF with TCP + IBG demonstrated excellent radiographic and comparable clinical health-related outcomes compared with PLIF. In economic evaluation, the total lifetime cost was lower in LLIF with TCP + IBG than in PLIF. Furthermore, LLIF with TCP + IBG was cost-effective compared with PLIF according to the context of Thailand. LLIF with less expensive TCP + IBG as bone graft results in better clinical and radiographic outcomes, less lifetime cost, and cost-effectiveness compared with PLIF. This suggests that LLIF with TCP + IBG could be utilized in lower- and middle-income countries for treating patients with degenerative disc disease.

The effect of reiki on fatigue and sleep quality in individuals with multiple sclerosis: a randomised controlled study

The aim of the study is to investigate the effect of the application of Reiki on fatigue and sleep quality in people with MS. The study is a randomised controlled study. A total of 60 people (control group = 30, intervention group = 30) participated in this study. Personal Information Form, Piper Fatigue Scale (PFS) and Pittsburg Sleep Quality Index (PSQI) were used to collect data. It was found that the PFS and PSQI total and subcomponent scores of the intervention group decreased after Reiki compared to the control group and this was statistically significant (p < 0.05). The study showed that Reiki was significantly effective in improving fatigue and sleep quality in people with MS. As Reiki is a simple, inexpensive and accessible method, it was suggested that its use in the management of MS should be encouraged and maintained in nursing practice.

Is larger always lekker? A comparative analysis of South Africa's water user associations (WUAs) and catchment partnerships (CPs) and their impact on water, energy, and food (WEF) security

Complexities in water, energy, and food (WEF) governance provide varied systems and pathways that shape welfare outcomes. The biggest question relates to the scale and complexities in resource management and governance, which reaches a certain equilibrium to achieve maximum welfare benefits. This is a proposition that is assessed in this study which sought to compare the WEF welfare outcomes of jurisdictions under Water User Associations (WUAs) and Catchment Partnerships (CPs). The study used a multi-stage purposively sampled cross-sectional survey of 1184 households from Greater Taung and Magareng Local Municipalities (Vaalharts Water User Association) and Matatiele Local Municipality (uMzvimvubu Catchment Partnership) in South Africa. The Household Water Insecurity Experiences, Household Multi-Dimensional Energy Poverty Index and Household Food In-Access Scale, Min-Max normalization and Propensity Score Matching were used to analyze the data. There was association between jurisdiction and the level of WEF security. Households under the jurisdiction of a WUA experienced 13.8%, 6.8% and 9.3% higher levels of water, energy, and food insecurity, respectively. The study concludes that households under the jurisdiction of a CP had higher levels of WEF security, with complexities or lack thereof resulting in higher welfare outcomes. Therefore, larger is not always lekker. The study recommends either (i) scaling down of WUA to CP and/or (ii) diversifying by increasing the breadth and scope of stakeholders within WUA. The governance systems should be integrated in an evaluation to ascertain any impact on the welfare outcomes.

10-Year Heterogeneity of Minimal Important Change and Patient Acceptable Symptom State After Lumbar Fusions.

Cohort study. To evaluate heterogeneity (fluctuation) in minimal important change (MIC) and patient acceptable symptom state (PASS) for patient-reported outcomes (PROMs) through 10 years after lumbar fusion. PROMs have become key determinants in spine surgery outcomes studies. MIC and PASS were established to aid PROM interpretations. However, their long-term stability has not yet been reported. A consecutive series of elective lumbar fusions were followed-up using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) for pain. Improvement was rated by a 4-point Likert scale into "improved" or "non-improved". Satisfaction-to-treatment was rated by the patients' willingness to undergo surgery again. Receiver operating characteristics (ROC) curve analysis estimated MIC (95% confidence interval, CI) as the PROM change that best predicted improvement at distinct time-points. PASS (CI) was estimated as the lowest PROM score at which the patients were still satisfied. Heterogeneity across thresholds was evaluated using the DeLong algorithm. MIC for ODI represented heterogeneity across 10-years, ranging from -21 (-24 to -16) at 2-years to -8 (-7 to -4) at 5-years, P <0.001. The areas under the ROC curves (AUCs) (0.79-0.85) indicated acceptable to excellent discrimination. Heterogeneity was not significant in the MICs for the pain scores. At 1-year, MIC for back pain was -24 (-38 to -15), AUC 0.77, and for leg pain it was -26 (-44 to -8), AUC 0.78. No significant heterogeneity was observed in 10-year PASS scores. At 1-year, PASS for ODI was 22 (15 to 29), AUC 0.85. Similarly, 1-year PASS for back pain was 38 (20 to 56), AUC 0.81, and for leg pain it was 49 (26 to 72), AUC 0.81. MIC for ODI fluctuated over 10-years after lumbar fusions. PASS values for all PROMs seemed most stable over time. Caution is needed when generic MIC values are used in long-term studies. Therapeutic Level III.

Morbidity and mortality of elderly patients with pancreaticobiliary disease according to age and comprehensive geriatric assessment: A prospective observational study

BackgroundThis study was designed to analyze the influence of age and comprehensive geriatric evaluation on clinical results of pancreaticobiliary disease management in elderly patients. MethodsA prospective observational study has been undertaken, including 140 elderly patients (over 75 years) with benign pancreaticobiliary disease. Patients were divided according to age in the following groups: group 1: 75–79 years old; group 2: 80–84 years old; group 3: 85 years and older. They underwent a comprehensive geriatric assessment with different scales: Barthel Index, Pfeiffer Index, Charlson Index, and Fragility scale, at admission and had been follow-up 90 days after hospital discharge to analyze its influence on morbidity and mortality. ResultsOverall, 140 patients have been included (group 1=51; group 2=43 and group 3=46). Most of them, 52 cases (37.8%), had acute cholecystitis, followed by 29 cases of acute cholangitis (20.2%) and acute pancreatitis with 25 cases (17.9%). Significant differences has been observed on complications in different age groups (p=0.033). Especially in patients with a Barthel Index result ≤60, which suggests that these less functional patients had more severe complications after their treatment (p=0.037). The mortality rate was 7.1% (10 patients). ConclusionsNo significant differences were found between age, morbidity and mortality in elderly patients with pancreaticobiliary disease. Comprehensive geriatric scales showed some utility in their association with specific complications.

Assessment of Nasal Aesthetic Parameters in Patients with Unilateral Cleft Lip and Palate – A Retrospective Study

Objectives To assess and compare the deviating nasal cephalometric parameters of patients with unilateral cleft lip and palate (UCLP) with a control group. The study also aims to correlate the deviating cephalometric parameters with two aesthetic scoring systems. Design A retrospective study. Setting Dental college and hospital. Participants Pre-treatment lateral cephalograms and extra oral photographs of 20 adult patients with repaired UCLP presenting for orthodontic treatment. 20 patients with age and type of malocclusion matched control were selected. Main Outcome The nasal cephalometric parameters of patients with UCLP and a control group were compared. The nasolabial region of patients with cleft lip and palate (CLP) was scored using Asher McDade Aesthetic Index (AMAI) and Cleft Aesthetic Rating Scale (CARS). The scoring was done by six different groups assessors to study their perception of the nasolabial region. Correlation between cephalometric parameters and the aesthetic scores was done. Results The study found significant differences in nasal length ( P = .003) and depth ( P &lt; .001) between UCLP and the non-cleft control group. In the aesthetic assessment, orthodontist gave the least scores, while layman group scored the highest. The CARS nose aesthetic scores showed statistically significant high, negative correlation with the nasal length ( P = .01). Conclusion The cephalometric parameters and the aesthetic indices can be aid the orthodontists in the assessment of nasolabial aesthetics and additionally refer for further definitive rhinoplasty to improve the patient's overall facial aesthetics.

From Distraction to Action: Elevating Situation Awareness with Visual Assistance in Level 3 Autonomous Driving

This study examines the impact of visual assistance and cognitive load on situation awareness (SA) during takeover events in Level 3 (L3) autonomous driving, where drivers are permitted to engage in Non-Driving Related Tasks (NDRTs). Utilizing a driving simulator, the research explores how different NDRTs, occupying various sensory channels, influence drivers’ SA under two visual assistance conditions: full marking and key marking. Results from the Situation Awareness Global Assessment Technique (SAGAT) and NASA Task Load Index (NASA-TLX) scales, along with eye-tracking data, demonstrate significant interactions between visual assistance conditions and tasks, highlighting key marking’s superior effectiveness in enhancing SA across all NDRTs. The study reveals that cognitive workload, largely arising from NDRTs rather than road attention, remains unaffected by visual assistance conditions. Findings suggest that drivers’ strategies for allocating attention are consistent, regardless of the visual task presence. This research contributes to understanding SA in autonomous driving takeovers, offering valuable insights for developing Human-Machine Interface (HMI) designs to improve SA and takeover performance in autonomous driving systems.

Revealing inconsistencies between Epworth scores and apnea-hypopnea index when evaluating obstructive sleep apnea severity: a clinical retrospective chart review.

A common practice in clinical settings is the use of the Epworth Sleepiness Scale (ESS) and apnea-hypopnea index (AHI) to demonstrate the severity of obstructive sleep apnea (OSA). However, several instances were noted where there were discrepancies in the reported severity between Epworth scores and AHI in our patient sample, prompting an investigation into whether OSA severity as demonstrated by AHI or predicted by ESS quantification of sleepiness is primarily responsible for inconsistencies. Discrepancies were examined between Epworth scores and AHI by categorizing patients into two categories of inconsistency: individuals with either ESS < 10 and AHI ≥ 15 events/h or ESS ≥ 10 and AHI < 15 events/h. The potential influence of sex on these categories was addressed by assessing whether a significant difference was present between mean Epworth scores and AHI values for men and women in the sample. We investigated BMI both by itself as its own respective variable and with respect to the sex of the individuals, along with a consideration into the role of anxiety. Furthermore, we tested anxiety with respect to sex. In the first category of inconsistency the average ESS of 5.27 ± 0.33 suggests a normal level of daytime sleepiness. However, this contrasts with the average AHI of 32.26 ± 1.82 events/h which is indicative of severe OSA. In the second category the average ESS of 14.29 ± 0.47 suggests severe daytime sleepiness, contradicting the average AHI of 9.16 ± 0.44 events/h which only indicates mild OSA. Sex, BMI (both as a variable by itself and with respect to sex), and anxiety (both as a variable by itself and with respect to sex) contributed to observed inconsistencies. The findings of our study substantiate our hypothesis that Epworth scores should be de-emphasized in the assessment of OSA and a greater importance should be placed on measures like AHI. While Epworth scores offer insights into patients' daytime sleepiness levels and the perceived severity of their OSA, the inconsistencies highlighted in our results when compared to AHI-based OSA severity underscore their potential inaccuracy. Caution is advised when utilizing Epworth scores for evaluating OSA severity in clinical settings.

Comparison of clinical and functional outcomes of physical therapy alone versus additional intraarticular injection of platelet rich plasma in treatment of frozen shoulder in Indian population

Background: Frozen shoulder (adhesive capsulitis) involves significant restriction of shoulder motion due to an inflammatory process and typically follows stages of pain, stiffness, and recovery over 2-3 years. This study explores the efficacy of platelet-rich plasma (PRP) injections, alongside conventional physiotherapy, as a non-operative treatment to enhance recovery in patients with adhesive capsulitis. Methods: This prospective, randomized, open, blinded, single-center clinical study involving 50 patients with adhesive capsulitis, comparing intra-articular PRP injections and physical therapy with physical therapy alone over 24 weeks. Primary outcomes were assessed using the shoulder pain and disability index (SPADI) and visual analog scale (VAS), with follow-ups at 6, 12, and 24 weeks to evaluate pain, function, and patient satisfaction. Results: In adhesive capsulitis (AC), intra-articular platelet-rich plasma (IA-PRP) injections with physical therapy (PT) provided superior pain relief, functional improvement, and higher treatment satisfaction after 24 weeks compared to PT alone. The IA-PRP group also showed better VAS scores and reduced acetaminophen use, indicating more effective pain management. Conclusions: In AC, IA-PRP injections showed greater pain relief and improved shoulder mobility compared to PT alone after 12 weeks. PRP's effectiveness highlights its potential, especially when corticosteroids are unsuitable, though longer-term studies are needed to confirm these results.

The Relationship Between Academic Stress, Sleep Quality, and Psychological Wellbeing in Pasifika and New Zealand European Students at the University of Otago

Abstract Background Pasifika students in New Zealand are overrepresented in poor academic outcomes, and their academic challenges may potentially influence their wellbeing. We aim to: 1) compare the academic stress, sleep quality, and psychological wellbeing of Pasifika and New Zealand European (NZE) anatomy students at the University of Otago, and 2) determine if academic stress mediates the association between their psychological wellbeing and sleep quality. Methods We launched a brief online survey to Pasifika and NZE students in our department. The survey included basic demographics, Perception of Academic Stress Scale, Pittsburgh Sleep Quality Index, Hospital Anxiety and Depression Scale, a short loneliness scale, a reduced morningness-eveningness scale, and the Epworth Sleepiness Scale. Results Perceived academic stress were comparable between NZE and Pasifika students, but Pasifika students reported poorer sleep quality than NZE students (t(113) = 14.41, P &lt; .001). In addition, Pasifika students reported more loneliness (t(119) = 8.933, P &lt; .001), less anxiety symptoms (t(120) = 2.469, P = .015), and less of a morning person (t(121) = 2.618, P = .010) than NZE students, but they had comparable depressive symptoms and daytime sleepiness. After controlling for age, ethnicity and gender, we found that academic stress fully mediated the relationship between anxiety or depressive symptoms and poor sleep quality. Furthermore, academic stress partially mediated the relationship between loneliness and poor sleep quality in our cohort. Conclusion Our findings highlight the importance for academic institutions to support students’ wellbeing, including ethnic minority students such as Pasifika students in New Zealand.

Analysis of Spatial and Temporal Distribution and Changes in Extreme Climate Events in Northwest China from 1960 to 2021: A Case Study of Xinjiang

Xinjiang, as a climate-sensitive region in Northwest China, holds significant importance in studying extreme climate events for agricultural production and socioeconomic development. Using data spanning from 1960 to 2021 from 52 meteorological stations across Xinjiang, encompassing 23 indices of extreme climate events, the 5-year moving average, linear trend fitting, and inverse distance weighting (IDW) are used to analyze the distribution patterns and temporal changes in extreme climatic phenomena within the region. The results indicate that, over the period from 1960 to 2021, the Amplitude Temperature Index, Heat Index, and Warm Spell Duration Index in Xinjiang exhibited a marked increasing trend, whereas the Cold Index and Cold Spell Duration Index displayed a significant decreasing trend. The range of changes in the extreme temperature indices from 1990 to 2021 is higher than that of 1960 to 1989. The areas with high values of amplitude temperature extreme indices are primarily concentrated in the southern part, while the areas with high values of cold indices are mainly distributed in the northern part. The upward/downward trends all account for over 80.00% of the entire region. The precipitation scale indices, precipitation day indices, intense precipitation index, and extreme precipitation index all showed a significant growth trend from 1960 to 2021, and the range of change in the extreme precipitation indices from 1990 to 2021 was lower than that from 1960 to 1989. Furthermore, areas with high precipitation values and regions with high trend values of climate tendency are predominantly concentrated in the northern and western parts of Xinjiang, with over 71.00% of the entire region experiencing an upward trend. The research results provide theoretical foundations for formulating climate risk strategies in the northwest region of China.

Investigation of the applicability of internet-based approach to subjective tinnitus

Background To ensure that subjective tinnitus patients develop positive attitudes toward tele-audiology. Aims/objectives This study investigates the appropriateness of the internet-based software in patients with subjective tinnitus. Material and methods Patients between the ages of 19 and 59 applying to the clinic with the subjective tinnitus filled in Tinnitus Handicap Index (THI) and Coronavirus Anxiety Scale (CAS). Visual Numeric Scale (VNS) was applied to the patients to complaint of tinnitus. Parameter measurements related to hearing and tinnitus were performed clinically. After the evaluations, 54 participants were divided into two groups to receive the ‘Basic Information Material Service’ (BIMS) face-to-face and online. Afterwards, THI and VNS were used to determine the current status. Results There was no significant difference between the groups that received BIMS with 2 different methods (p > .05). A significant difference was found in the scores before and after BIMS in terms of THI and VNS (p < .05). A strong negative correlation was found between the duration of tinnitus and the change in THI. In addition, there is a stronger-negative relationship between the number of centers consulted and the informational benefit revealed by the scales. Conclusions and significance Online intervention is as effective as face-to-face interaction in the management of tinnitus.

The Effects of Longer Use of Teriparatide on Clinical and Radiographic Outcomes after Spinal Fusion in Geriatric Patients.

Background: Teriparatide is an anabolic agent for osteoporosis and is believed to improve the bone healing process. Previous studies showed that teriparatide could enhance not only fracture healing but also spine fusion. It has been reported that use of teriparatide could promote the spine fusion process and decrease mechanical complications. However, there was no consensus regarding optimal treatment duration. The purpose of this study was to compare surgical outcomes between short-duration and long-duration teriparatide treatment after lumbar fusion surgery in elderly patients. Materials and Methods: All consecutive patients older than 60 years who underwent 1-level lumbar fusion surgery for degenerative diseases between January 2015 and December 2019 were retrospectively reviewed. Based on the duration of teriparatide treatment (daily subcutaneous injection of 20 µg teriparatide), patients were subdivided into two groups: a short-duration (SD) group (<6 months) and a long-duration (LD) group (≥6 months). Mechanical complications, such as screw loosening, cage subsidence, and adjacent vertebral fractures, were investigated. Postoperative 1-year union rate was also evaluated on computed tomography. Clinical outcomes were recorded using visual analog scale (VAS) and Oswestry Disability Index (ODI). Between-group differences for these radiographic and clinical outcomes were analyzed. Results: Ninety-one patients were reviewed in this study, including sixty patients in the SD group and thirty-one patients in the LD group. Their mean age was 72.3 ± 6.2 years, and 79 patients were female. Mean T-score was -3.3 ± 0.8. Cage subsidence (6.7% vs. 3.2%), screw loosening (28.3% vs. 35.5%), and adjacent vertebral fracture (6.7% vs. 9.7%) were not significantly different between the SD and LD groups. Union rate at 1-year postoperative was 65.0% in the SD group and 87.1% in the LD group (p = 0.028). Both groups showed improvement in VAS and ODI after surgery. However, the differences of VAS from preoperative to 6 months and 1 year postoperative were significantly higher in the LD group. Conclusions: Longer teriparatide treatment after lumbar fusion surgery resulted in a higher union rate at 1-year postoperative than the shorter treatment. Also, it could be more beneficial for clinical outcomes.

Prospects for Use of Botulinum Toxin Type A for Prevention of Hypertrophic and Keloid Scars after Surgeries (Meta-analysis)

Abstract Objective To evaluate the possibility of improving and preventing the formation of postoperative hypertrophic and keloid scars using botulinum toxin type A (BTA). Materials and Methods Scientific articles published in English have been systematically screened in PubMed/MEDLINE database over the entire period. The following information about the studies was analyzed: first author surname; year of publication; number of patients; average age; scar location; dosage of the drug administered; follow-up duration; scar assessment methods; results, incidence of hypertrophic and keloid scars formation. The odds ratio and 95% confidence interval were calculated for each of the estimated parameters. The statistical heterogeneity of publications assessed using the criteria of chi-square test and I 2. The differences were considered significant at p &lt; 0.05. Results A total of 18 prospective randomized studies were selected for evaluation, containing data on the use of BTA in 363 cases. Patients receiving botulinum toxin had a lower Vancouver scar scale index, higher visual analog scale index, and higher Stony Brook scar evaluation scale score. The use of BTA reduces the risk of perceptible scar formation, the incidence of hypertrophic and keloid scars. Conclusion The use of BTA to obtain imperceptible scar and prevent hypertrophic and keloid postoperative scars demonstrates good prospects. However, there is no consensus regarding the pathophysiological mechanisms underlying the positive effect of BTA on the prevention of hypertrophic and keloid scars.

Development and validation of a social alienation predictive model for older maintenance hemodialysis patients based on latent profile analysis—a cross-sectional study

BackgroundSocial alienation refers to the state of feeling isolated, helpless, and unsatisfied due to maintaining distance from others or avoiding social interaction and activities. This phenomenon is caused by a lack of social skills, social anxiety, physical health problems, and other reasons. Older maintenance hemodialysis patients are exposed to a higher risk of social alienation. However, previous studies have been performed using the total score of the scale, which does not allow the identification of the characteristics of various patient groups with different levels of social alienation. In contrast, latent profile analysis can classify individuals into different categories based on continuous observational indicators, which improves accuracy and provides a more objective assessment by accounting for the uncertainty of variables. Given the concealed nature of social alienation and the differences in characteristics and treatment measures between different profiles, developing a predictive model for social alienation in older maintenance hemodialysis patients holds significance.ObjectiveTo explore the latent profile analysis of social alienation in older maintenance hemodialysis patients and to develop and validate a predictive model for social alienation in this population.MethodsA total of 350 older maintenance hemodialysis patients were selected as the study subjects using convenience sampling. A cross-sectional survey was conducted using a general information questionnaire, the Generalized Alienation Scale, and the Self-Perceived Burden Scale. Based on the results of the Generalized Alienation Scale, a latent profile analysis was performed, followed by univariate analysis and multinomial logistic regression to develop a predictive model. The effectiveness of the predictive model was evaluated in terms of its authenticity, reliability, and predictive ability.ResultsThree hundred nineteen valid questionnaires were collected. The social alienation of older maintenance hemodialysis patients based on latent profile analysis were divided into three profiles, which were named the low/medium/high-symptom groups, comprising 21%, 38.9%, and 40.1% of participants, respectively. Based on male, monthly social activity hours, Age-Adjusted Charlson Comorbidity Index, dialysis age, and Self-Perceived Burden Scale, a predictive model of social alienation for older maintenance hemodialysis patients was developed, and the Hosmer–Lemeshow tests showed no statistical significance (P > 0.05). The model has high predictive efficiency in authenticity, reliability and predictability.ConclusionOlder maintenance hemodialysis patients exhibited moderate to high levels of social alienation. The latent profile analysis based method was used to divide patients into low/medium/high-symptom profiles, and the predictive model demonstrates excellent authenticity, reliability, and predictability.