Preference Measures Research Articles

Quantifying Patient Preferences and Expectations About Diabetic Retinopathy Monitoring.

Diabetic retinopathy (DR) is the leading cause of blindness among adults in the US. The US Centers for Disease Control and Prevention recommends annual DR monitoring for all individuals with diabetes, yet monitoring rates remain below 70%. To evaluate how patient preferences and expectations about DR monitoring are associated with expected monitoring adherence behaviors. In this survey study, a web-enabled survey instrument was developed and implemented with a discrete-choice experiment to characterize patient preferences for outcomes of DR monitoring and graded-pair questions to quantify patients' expectations about the impact of DR monitoring on blindness risk. The survey was conducted through ResearchMatch, a US National Institutes of Health-developed online platform, among adults with self-reported, physician-diagnosed diabetes. Recruitment occurred between September 15, 2023, and October, 17, 2023, and data analysis occurred between October 2023 and December 2023. Results from the 2 tasks were combined to derive patients' expected monitoring behavior following a recently proposed treatment adherence framework. The survey instrument was pretested in cognitive interviews and validated for the purposes of this study. Survey-based discrete-choice experiment and graded-pair questions. Participants' relative preferences for DR-related blindness risk reductions, monitoring time, and out-of-pocket monitoring costs were quantified, as well as the degree to which participants expected adherence to monitoring to affect the risk of blindness. By combining how much participants valued specific reductions in blindness risk (relative to monitoring costs) and their expected risk reduction through monitoring, the rate at which patients would maximize the benefit of monitoring appointments was assessed. The survey was completed satisfactorily by 304 respondents of 542 individuals invited to participate. Mean (SD) respondent age was 40.5 (11.2) years, and 169 respondents (56.1%) were female. Reductions in blindness risk were valuable to participants. Participants required a 3.87 (95% CI, 1.91-5.88) percentage-point reduction in 5-year blindness risk to be fully adherent to an annual 53-minute monitoring visit with a $26 co-payment, but respondents expected DR monitoring to reduce the 5-year blindness risk by 0.71 (95% CI, 0.21-1.28) percentage points. In this online survey study among adults with diabetes, measurement of patient preferences and expectations about DR monitoring with properly validated instruments offered an opportunity to assess patient health behaviors. The association between preferences and monitoring expectations was generally consistent with monitoring nonadherence among adults with diabetes and offers insights that may help address inconsistent DR monitoring.

Measurement of non-invasive rectal and ear temperature in inpatients ≥ 18 years old: A cross-sectional comparative study.

Body temperature measurement is a fundamental requirement for clinical decisions in nursing care, medical diagnosis, and treatment. Therefore, it is pivotal that body temperature measurements are accurate and precise. To test the diagnostic accuracy of an ear temperature screening procedure among adult hospitalized patients. Further aims were to test the precision of the measurements being carried out by trained registered nurses compared with daily routine practice and to investigate patients' preferences for different measurement methods. In Aalborg University Hospital, 274 patients were included in a cross-sectional comparative study. Each patient had four temperature measurements and responded to a survey regarding their preference for measurement. Bland-Altman analysis was used to evaluate the difference between ear- and rectal measurements. Sensitivity and specificity were evaluated at different cut-off points. The ear temperature was 0.1 to 0.2 °C lower than rectal temperature. At a cut-off point at 37.5 °C an ear thermometer is accurate and can be used for screening, while higher cut-off points risk missing patients with fever. There was no significant difference in the mean temperature measured by a trained registered nurse or other staff members and patients. Patients preferred ear measurements to rectal measurements. The tested ear thermometer is accurate for screening fever in an adult population during hospital admission. Using ear measurement as a screening tool can contribute to a less resource-demanding care activity and a more convenient alternative to rectal measurements in hospitalised patients.

Remote monitoring of social attention in neurogenetic syndromes and idiopathic neurodevelopmental disability.

Social attention is a key aspect of neurodevelopment and is significantly altered in neurodevelopmental genetic syndromes and many individuals with idiopathic autism spectrum disorder (ASD). The primary aim of the present study was to examine the psychometric properties of webcam-collected social attention measurements, including four new specific aspects of social attention, in three genetic syndromes (PTEN Hamartoma Tumor Syndrome-PHTS; Malan Syndrome-NFIX; and SYNGAP1-related disorder-SYNGAP1), a mixed group of other neurodevelopmental genetic syndromes (Other NDGS), and individuals with a range of idiopathic neurodevelopmental disorder (NDD). The secondary aim was to evaluate the construct validity of these social attention measurements, including evaluating known-groups validity across study groups and concurrent validity for separating ASD and non-ASD cases. Participants (N = 467, age 3-45; PHTS n = 102, NFIX n = 23, SYNGAP1 n = 42, other NDGS n = 63, idiopathic NDD n = 53, neurotypical siblings n = 71, and unrelated neurotypical controls n = 113) completed a 4-min online-administered social attention paradigm that includes a variety of distinct stimuli at three timepoints (baseline, 1-month, and 4-month follow-up). Social attention measures had good scale and test-retest reliability, with the exception of measures of non-social preference and face-specific processing. Unique patterns of social attention emerged across study groups, with near neurotypical levels in PHTS and weaker social attention in NFIX and SYNGAP1 relative to controls. Global social attention had good accuracy in detecting ASD within NDGS participants. Remote monitoring social attention, including distinct aspects of social attention, may be useful for characterizing phenotypic profiles and tracking the natural history of distinct NDGS and idiopathic NDD as well as identifying ASD within NDGS. Given their reproducibility and stability, global social attention and several distinct social attention measures may be useful outcomes for future clinical trials.

Veterans' Experiences of and Preferences for Patient-Centered, Measurement-Based PTSD Care.

Up to 50% of veterans drop out of trauma-focused evidence-based psychotherapies (TF-EBP) without completing treatment or recovering; evidence suggests this is in part because their posttraumatic stress disorder (PTSD) care is insufficiently patient-centered. There is also evidence that measurement-based care (MBC) for mental health should be personalized to the patient, yet this is not common practice in VA PTSD care. To explore veterans' experiences and preferences for aligning measurement-based PTSD care with their own treatment goals. Qualitative interviews were conducted with veterans (n=15) with PTSD who had received at least 2 sessions of a TF-EBP. Survey on the administration of outcomes questionnaires and demographics and an interview about their most recent TF-EBP episode. Half of veterans had symptom-focused goals and half did not; all had at least one treatment goal that was not symptom-focused. They typically met their goals about functioning and coping skills but not their symptom reduction goals. We found veterans overall were receptive to MBC but preferred patient-reported outcomes measures about functioning, wellbeing, coping skills, and understanding their trauma more than the commonly used PTSD symptom scale (the PCL-5). Many veterans in this sample disliked the PCL-5 because it reinforced their maladaptive cognitions. Such veterans might be more receptive to MBC if offered patient-report outcomes measures that better align with their functional and wellbeing goals. For many goal/outcome areas, psychometrically sound measures exist and require better implementation in PTSD care. For some areas, scale development is needed.

South African occupational therapists' orthotic management of trigger finger and factors influencing their decision regarding splinting type

Background: Orthotic management of trigger finger refers to the use of splints to immobilise affected joints. The prevalence of trigger finger and the management and treatment practices utilised by occupational therapists for this affliction in South Africa, are not yet documented. Aim: To explore occupational therapists' orthotic management for clients with trigger finger in KwaZulu-Natal, and the factors influencing the therapists' decisions when prescribing orthoses. Methods: A quantitative cross-sectional study design was implemented with a sample size of 102 via a stratified random sampling approach. A survey questionnaire was administered. Data were coded using frequencies and then descriptively analysed using SPSS. Results: Findings indicated that trigger finger is common in clinical settings and the majority (99%) of the occupational therapists use splints when managing trigger finger and as a first line of treatment (69.9%). The joint-blocking splint is preferred by 96.6% of the participants with the MCP joint-blocking splint being favoured by 55.0%. The most considered factors when deciding on the splint type are clinical presentation (99.1%) and the client's occupation (92.4%), and the most preferred measures of the effectiveness of treatment are pain (97.1%) and range of motion (97%). Conclusion: The study has demonstrated that the inconsistencies noted in global research also apply in KwaZulu-Natal. Therefore, further investigation on the effectiveness of splinting and a guide on deciding on splint type as well as appropriate outcome measures, are necessary to ensure that cclients receive optimal care through evidence-informed practice. Implications for Practice: This study informs further understanding of the current assessment ptior to splinting and treatment practices that occupational therapist in the South African context provide for their clients with trigger-finger. The study demonstrates that irrespective of the participant's level of experience and their clinical settings, the considerations when deciding on splint types remain the same. The results are consistent with available literature, particularly with which splint type to use. However, the development for a guide regarding the orthotic management of trigger finger covering aspects like the splint regime and the recommendations of exercises is vital, as discrepancies emerged largely fro these areas. The type of exercises, stages at which they may be introduced, duration and requenccy should be considered for deeper engagement. the development of this protocol will ensure consistency of treatment and evidence-informed practice.

Explicit and Implicit Preference for Symmetry Across Object Categories

Symmetry affects aesthetic judgements, and it has been extensively studied at least for faces and abstract objects. We examined the role of bilateral symmetry on aesthetic judgements across different types of stimuli. It is important to test if symmetry is equally effective in the context of objects expected to be symmetrical, e.g., faces, and objects that are almost never symmetrical, e.g., landscapes. We used the following categories: angular shapes, smooth shapes, landscapes, flowers, female faces, and male faces. We selected these image categories considering their differing degrees of curvature, familiarity to the viewer, and tendency to be perceived as ensembles, as opposed to standalone objects. We also included blobs, manipulating landscapes into blurry tessellated patterns featuring patches of color, to remove familiarity while preserving the appearance of ensembles. For each item in these categories, images were modified to obtain perfect bilateral symmetry. We collected both explicit ratings and implicit measures of symmetry preference. For landscapes, there was a clear preference for the non-symmetrical (original) version. We observed a dissociation between explicit and implicit measures. Implicit measures demonstrated positive associations for all categories.

The fertility gap and economic freedom

AbstractThe difference between desired fertility and achieved fertility is called the fertility gap. This paper investigates the relationship between economic freedom and the fertility gap across the United States since greater economic freedom may empower individuals to choose work more compatible with their family goals. We test this hypothesis using individual measures of fertility preferences from a nationally representative survey of reproductive‐aged women (2020–2024) and find evidence that women are more likely to achieve their family goals in states with greater economic freedom. This effect is strongest when focusing on variation in labor market freedom.

Understanding drought adaptation mechanisms from a gender perspective in modogashe ward, Kenya

Droughts have severely affected the pastoral production system resulting in hunger, massive loss of livestock, acute water shortages, and drought-related conflicts. This study aimed to understand the drought adaptive mechanisms from a gender perspective in Modogashe Ward, Kenya. To achieve this, the study investigated the impacts of droughts and the various ways in which men and women cope and adapt to the impacts. Due to the homogeneousness in sociocultural and economic activities in the Ward data was obtained from 60 respondents comprising 30 males and 30 females through a stratified random sampling method. One respondent, either the husband or wife, was chosen per household. Both men and women rely on pastoralism as the main source of livelihood. Thus, the impacts and adaptation mechanisms were similar for both genders. However, due to the attachment of men to livestock, the impacts and adaptation mechanisms revolved around environmental factors while those of women revolved around the provision of household basic needs. Furthermore, the study area had limited adaptation mechanisms options resulting in similar coping and adaptation strategies among men and women but with minor variations in the preferred strategies. The variations in the preferred strategies were a reflection of the existing gender roles within the social construct of the community. Men were inclined toward measures that promote livestock keeping while women preferred measures that enhanced the provision of household basic needs. The findings from this study highlight the significant role of gender dimensions driven by the local socio-cultural settings in influencing the uptake of drought adaptation practices and strategies among communities.

Statewide Outbreak of Neisseria meningitidis Serogroup Y, Sequence Type 1466 - Virginia, 2022-2024.

Invasive meningococcal disease (IMD) is a severe illness that can have devastating effects; outbreaks are uncommon in the United States. Vaccination is the preferred control measure for IMD outbreaks when a defined population at risk (e.g., college students or persons experiencing homelessness) can be identified. In August 2022, the Virginia Department of Health (VDH) began investigating an IMD outbreak in Virginia's Eastern Health Planning Region, prompted by the detection of four confirmed cases within 8 weeks. Clinical isolates available from three cases were characterized as Neisseria meningitidis serogroup Y, sequence type 1466. A subsequent statewide investigation identified 36 genetically related cases, including seven deaths (case fatality rate=19.4%) as of March 1, 2024. A majority of patients (63.9%) were in an age group (30-60 years) not generally considered at increased risk for IMD; 78.0% were non-Hispanic Black or African American. No common exposures, affiliations, or risk factors were identified, and a defined population could not be identified for vaccination. VDH recommended quadrivalent (serogroups A, C, W, and Y) meningococcal conjugate vaccination of a subset of close contacts of patients based on IMD risk factors and age range similar to that of patients with identified cases. IMD outbreaks might affect populations without established IMD risk factors. Lack of a well-defined population at risk might prompt exploration of novel control strategies, such as selective vaccination of close contacts.

Correlation between postdialysis blood pressure assessed at different time points and home blood pressure monitoring

Abstract Background Hemodialysis patients undergo blood pressure (BP) measurements during the predialysis, intradialytic and postdialysis (POSBP) periods at the dialysis sessions. However, there is no consensus regarding the time point when POSBP measurement should be performed. Purpose This study investigated the relationship of POSBP measurements performed at different time points with home blood pressure monitoring (HBPM). Methods This prospective study included 98 long-term dialysis patients (67% men; age=59.4 ±17.7 years; 79% using antihypertensive medications). During one week, POSBP measurements were obtained in sitting patients by trained health staff using oscillometric BP monitors lodged in the dialysis machines at all dialysis sessions in three different periods: 1) immediately after the dialysis period ended (POSBP1); 2) after returning the patient's blood (POSBP2) and 3) after hemostasis of the fistula or catheter sealing (POSBP3). In the same week, HBPM was performed using validated devices and was calculated as the mean of BP measurements obtained on six consecutive days, comprising three readings in the morning and in the evening after at least 3 min of rest, before antihypertensive medications were taken, with the patients seated. Abnormal BP was defined as HBPM≥135/85 mmHg. Based on the optimal cut-point values derived from ROC curves analysis, we built cutoffs for POSBP1 (143/79 mmHg), POSBP2 (153/78 mmHg) and POSBP3 (151/80 mmHg) corresponding to HBPM values of 135/85 mmHg. Results The values of POSBP1, POSBP2, POSBP3 and HBPM were 138±21/72±13, 143±24/73±13, 142±22/72±13 and 128±19/76±13 mmHg, respectively. Systolic HBPM showed greater correlation with systolic POSBP3 (r=0.71), followed by POSBP1 (r=0.68), POSBP2 (r=0.67), while diastolic HBPM showed greater correlation with diastolic POSBP2 and POSBP3 (both r=0.56), followed by POSBP1 (r=0.49) (all p<0.05). The POSBP3 cutoff showed the highest association (odds ratio [95% CI]= 8.06 [3.21, 20.27]), accuracy (area under the curve [95% CI]= 0.74 [0.65, 0.83]) and concordance (kappa coefficient=0.47) to identify elevated BP at HBPM in comparison with the POSBP1 and POSBP2 cutoffs (Figure). Conclusion(s) POSBP3 exhibited the strongest correlation with HBPM and had the highest accuracy to detect elevated HBPM in dialysis patients and may be a potentially preferable POSBP measurement in clinical practice.

Picture communication symbols and voice symbols: iconicity and preference among healthy older adults in Taiwan

Purpose: Unaided (e.g., speech and gestures) and aided (e.g., symbol corpuses) communication modes facilitate older adults’ expression and comprehension. Adults aged 65 years and above constituted 18.27% of Taiwan’s total population in 2023; hence, prioritizing high-quality healthcare for older adults becomes critical. Commercial symbol corpuses, such as Picture Communication Symbols (PCS) and Voice Symbols (VS), play a vital role in aiding older adults with expression and comprehension in Taiwan. Previous studies on iconicity and preference of symbol corpuses have primarily been conducted in Western and South Asian cultural communities. However, these findings may not apply to all Asian communities. Hence, studies investigating these aspects in specific communities are needed. Through quantitative nonexperimental observations, we explored the iconicity of and preference for PCS and VS among 30 healthy older adults in Taiwan. Materials and Methods: A total of 12 practice words and test words each, familiar to the participants and socially and culturally validated, were selected for the developed VS–PCS iconicity and preference measurement. Verbal choices were made to select one line drawing in both measurements. Results & Conclusions: The findings revealed that VS is significantly more transparent and preferred than PCS. Accounting for the iconicity of and preferences for symbol corpuses is pivotal for symbol selection.

Second Victims Among Austrian Nurses (SeViD-A2 Study).

Background: The Second Victim Phenomenon (SVP) significantly impacts the well-being of healthcare professionals and patient safety. While the SVP has been explored in various healthcare settings, there are limited data on its prevalence and associated factors among nurses in Austria. This study investigates the prevalence, symptomatology, and preferred support measures for SVP among Austrian nurses. Methods: A nationwide, cross-sectional, anonymous online survey was conducted September to December 2023 using the SeViD questionnaire (Second Victims in German-speaking Countries), which includes the Big Five Inventory-10 (BFI-10). Statistical analyses included binary logistic regression and multiple linear regression using the bias-corrected and accelerated (BCa) bootstrapping method based on 5000 bootstrap samples. Results: A total of 928 participants responded to the questionnaire with a response rate of 15.47%. The participants were on average 42.42 years old and were mainly women (79.63%). Among the respondents, 81.58% (744/912) identified as Second Victims (SVs). The primary cause of becoming an SV was aggressive behavior from patients or relatives. Females reported a higher symptom load than males, and higher agreeableness was linked to increased symptom severity. Notably, 92.47% of SVs who sought help preferred support from colleagues, and the most pronounced desire among participants was to process the event for better understanding. Conclusions: The prevalence of SVP among Austrian nurses is alarmingly high, with aggressive behavior identified as a significant trigger. The findings emphasize the necessity for tailored support strategies, including peer support and systematic organizational interventions to mitigate the impact of SVP on nurses and to improve overall patient care. Further research should focus on developing and implementing effective prevention and intervention programs for healthcare professionals in similar settings.

Leadership Preferences, Minimum Acceptable Nationalist Demands, and Duration of Ethno-territorial Civil Wars

In standard conflict bargaining models, internal ethno-territorial dispute outcomes should be influenced not only by status quo conditions and relative military power, but also by leadership preferences. Since direct, large-sample measures of leadership preferences on both sides of conflicts have not hitherto been available, statistical research typically diverges from case study research in omitting leadership preferences. This paper utilizes a database that measures the ideological nationalist dimension of variation in state and ethnic minority group leadership preferences by examining and ranking leaders’ minimum acceptable nationalist demands. Controlling for the impact of other factors, more extreme minimum nationalist demands, on both the state and the rebel group sides, are robust predictors of longer war duration.

Possibilities of music preferences measures in younger school age children

The musical-preference framework of a child at younger school age is gradually formed and shaped. The study outlined the possibilities of measuring musical taste at a younger school age and draws attention to the real specifics that this entails. We verified the newly created instrument - Musical Preference Questionnaire of Younger Pupils - MPQ-YP on 84 pupils (n=84) aged from 6 to 10 years (Mage=8.23). The 3-factor solution, which divides MPQ-YP into 3 categories of music genres - reflective and unconventional music; energetic and rhythmic music; optimistic and complex music, turned aout to be satisfactory. Psychometric properties are adequate, MPQ-YP seems to be sufficiently valid (construct and content validity) and reliable (measure of internal consistency and split-half reliability). Pilot descriptive results of younger schoolchildren's musical taste provide information about recognized musical genres and their preferences. The findings can be applied to the practice of music educators, music philetics and music therapists.

Patients with low prognosis in ART: a Delphi consensus to identify potential clinical implications and measure the impact of POSEIDON criteria

BackgroundCurrently, there is no consensus on the optimal management of women with low prognosis in ART. In this Delphi consensus, a panel of international experts provided real-world clinical perspectives on a series of literature-supported consensus statements regarding the overall relevance of the POSEIDON criteria for women with low prognosis in ART.MethodsUsing a Delphi-consensus framework, twelve experts plus two Scientific Coordinators discussed and amended statements and supporting references proposed by the Scientific Coordinators (Round 1). Statements were distributed via an online survey to an extended panel of 53 experts, of whom 36 who voted anonymously on their level of agreement or disagreement with each statement using a six-point Likert-type scale (1 = Absolutely agree; 2 = More than agree; 3 = Agree; 4 = Disagree; 5 = More than disagree; 6 = Absolutely disagree) (Round 2). Consensus was reached if > 66% of participants agreed or disagreed.ResultsThe extended panel voted on seventeen statements and subcategorized them according to relevance. All but one statement reached consensus during the first round; the remaining statement reached consensus after rewording. Statements were categorized according to impact, low-prognosis validation, outcomes and patient management. The POSEIDON criteria are timely and clinically sound. The preferred success measure is cumulative live birth and key management strategies include the use of recombinant FSH preparations, supplementation with r-hLH, dose increases and oocyte/embryo accumulation through vitrification. Tools such as the ART Calculator and Follicle-to-Oocyte Index may be considered. Validation data from large, prospective studies in each POSEIDON group are now needed to corroborate existing retrospective data.ConclusionsThis Delphi consensus provides an overview of expert opinion on the clinical implications of the POSEIDON criteria for women with low prognosis to ovarian stimulation.

The effects and mechanism of discounting unit price

PurposeSupermarket promotions typically use a standard label, which displays the regular price, discounted price and discounted unit price. Visits to supermarkets across multiple countries found that none used a price label that also contains the regular (i.e. pre-discounted) unit price. This study aims to investigate the effectiveness of a dual unit-price label that includes the regular unit price as a reference price, and what underpins its efficacy in enhancing promotion attractiveness.Design/methodology/approachThe authors executed four studies, supported by three supplemental studies. Study 1 established external validity through a natural instore experiment. Studies 2 and 3 tested the dual unit-price label with different pack sizes and assortment sizes, respectively. Finally, Study 4 tested the underpinning mechanism of the efficacy of the dual unit-price label.FindingsIn Study 1, daily sales records over four weeks showed that dual unit-price label promotions had larger sales volume than standard-label promotions. Study 2 showed a larger pack size, a heuristic cue for greater economy and increased preference for dual unit-price label promotions. Study 3 similarly found that the dual unit-price label was preferred more as cognitive load was increased by assortment size. Finally, Study 4 demonstrated the dual processing of the dual unit-price label, using a conscious preference measure (information provided) and an unconscious implicit attitude test.Research limitations/implicationsUnit-price research has mainly considered a cognitive process. The authors demonstrated the importance of considering a heuristic process.Practical implicationsSupermarkets can use this simple and yet effective tool to improve promotion effectiveness.Originality/valueThis study demonstrates that the dual unit-price label is a new and easy tool to enhance sales promotions, which academic research and managerial practice had never considered previously.

Smartphone app-based approximation of time spent with atrial fibrillation and symptoms in patients after catheter ablation: Data from the TeleCheck-AF project.

Reduction of atrial fibrillation (AF) burden is the preferred outcome measure over categorical AF rhythm recurrence after AF ablation. In this sub-analysis of the TeleCheck-AF project we tested the feasibility of smartphone app-based approximation of time spent with AF and/or symptoms. Patients scheduled for at least one teleconsultation during the 12-month follow-up after AF ablation were instructed to use a smartphone photoplethysmography (PPG)-based application for simultaneous symptom and rhythm monitoring 3-times daily for 1 week. Proxies of time spent with AF and/or symptoms (%-recordings, load, %-days), temporal aggregation of AF and/or symptoms (density), and symptom-rhythm correlation (SRC) were assessed. In total 484 patients (60% male, 62±9.9 years) were included. Adherence, motivation and patient satisfaction were high. %AF-recordings, AF load and %AF-days (rs= 0.88-0.95) and %symptom-recordings, symptom load, %symptom-days (rs= 0.95-0.98) showed positive correlations. The SRC correlated negatively with time spent with symptoms (rs=-0.65--0.90) and with time spent with AF (rs=-0.31--0.34). In patients with paroxysmal AF before ablation and AF during the monitoring period, 87% (n=39/44) had a low-density score <50% ("paroxysmal AF pattern") while 5% (n=2/44) had a high-density score >90% ("persistent AF pattern"). Corresponding numbers for patients with persistent AF before ablation were 48% (n=11/23) and 43% (n=10/23), respectively. On-demand, app-based simultaneous rhythm and symptom assessment provides objective proxies of time spent with AF and/or symptoms and symptom-rhythm correlation, which may assist in assessing AF and symptom outcomes after AF ablation.

Non-pharmacological interventions for reducing dental anxiety in pediatric dentistry: a network meta-analysis

BackgroundChild dental anxiety is a prevalent issue in the field of pediatric dentistry. At present, several non-pharmacological interventions are employed to mitigate anxiety during dental treatments for children. The objective of this study is to assess the effectiveness of diverse non-pharmacological interventions in reducing dental anxiety, as well as enhancing heart rate during pediatric dental treatments. To achieve this, we conducted a systematic review and a network meta-analysis (NMA) to compare the efficacy of various outcome indicators.MethodsA thorough search was conducted in the databases of PubMed, Embase, Web of Science, Cochrane Library, Scopus, APA PsycInfo, CINAHL, and AMED to identify all eligible randomized controlled trials (RCTs) from the beginning of the databases up to August 1, 2024. The quality assessment was carried out using the Cochrane Collaboration’s bias risk tool. The two outcome measures under consideration were dental anxiety and heart rate. Network graphs, league tables and SUCRA were constructed using R 4.2.3 software and Stata 16 software. This study is registered in PROSPERO under the registration number CRD42023467610.ResultsThe study examined 12 different non-pharmacological approaches, drawing from a pool of 61 research studies involving 6,113 participants aged 4 to 16 years. The results of the network meta-analysis revealed that music (SUCRAs: 93.60%) proved to be the most effective measure in mitigating dental anxiety, followed by aromatherapy (SUCRAs: 78.58%) and game (SUCRAs: 70.99%). Moreover, hypnosis (SUCRAs: 98.80%), music (SUCRAs: 79.58%), and relaxation (SUCRAs: 72.41%) were identified as the top three interventions for decreasing heart rate.ConclusionIn this NMA, when contemplating dental anxiety outcomes, music is recommended as a priority. For heart rate outcomes, hypnosis may be a preferred measure. However, owing to the limited number of articles, the conclusion of this study still requires additional confirmation or correction through more high-quality primary studies in the future.

Lipoprotein(a) and risk-weighted apolipoprotein B: a novel metric for atherogenic risk

BackgroundRetention of apolipoprotein B (apoB)-containing lipoproteins within the arterial wall plays a major causal role in atherosclerotic cardiovascular disease (ASCVD). There is a single apoB molecule in all apoB-containing lipoproteins. Therefore, quantitation of apoB directly estimates the number of atherogenic particles in plasma. ApoB is the preferred measurement to refine the estimate of ASCVD risk. Low-density lipoprotein (LDL) particles are by far the most abundant apoB-containing particles. In patients with elevated lipoprotein(a) (Lp(a)), apoB may considerably underestimate risk because Mendelian randomization studies have shown that the atherogenicity of Lp(a) is approximately 7-fold greater than that of LDL on a per apoB particle basis. In subjects with increased Lp(a), the association between LDL-cholesterol and incident CHD (coronary heart disease) is increased, but the association between apoB and incident CHD is diminished or even lost. Thus, there is a need to understand the mechanisms of Lp(a), LDL-cholesterol and apoB-related CHD risk and to provide clinicians with a simple practical tool to address these complex and variable relationships. How can we understand a patient’s overall lipid-driven atherogenic risk? What proportion of this risk does apoB capture? What proportion of this risk do Lp(a) particles carry? To answer these questions, we created a novel metric of atherogenic risk: risk-weighted apolipoprotein B.MethodsIn nmol/L: Risk-weighted apoB = apoB - Lp(a) + Lp(a) x 7 = apoB + Lp(a) x 6. Proportion of risk captured by apoB = apoB divided by risk-weighted apoB. Proportion of risk carried by Lp(a) = Lp(a) × 7 divided by risk-weighted apoB.ResultsRisk-weighted apoB agrees with risk estimation from large epidemiological studies and from several Mendelian randomization studies.ConclusionsApoB considerably underestimates risk in individuals with high Lp(a) levels. The association between apoB and incident CHD is diminished or even lost. These phenomena can be overcome and explained by risk-weighted apoB.

Critical Success Factors for Adopting Corporate Social Responsibility in the Malaysian Hotel Industry

Corporate social responsibility (CSR) is becoming more highly regarded in the hotel sector as a strong weapon in promoting sustainable economic development and addressing ethical concerns. Nevertheless, there is a limited knowledge of the notion of CSR in the hotel business, as well as how to effectively implement it. This study seeks to understand the views and recommendations of experts regarding the key elements of that are essential for the effective implementation of CSR in the hotel industry. This study uses the NGT method as the main method of the study. A panel of ten highly skilled Malaysian industry practitioners and academics was convened. The data were descriptively collected and analyzed, and they were weighted according to ranking (1-3, lowest to highest priority) of domain. The rationale for the choices were analyzed thematically. The domain of "financial resources," "top management support," "employees’ education and training on CSR," and " managerial or internal skills on CSR” was recommended as the preferred measure of time period over which the domains were rated. The adoption of these recommendations will help standardize approaches to improving the CSR practices particularly in the Malaysian hotels.