Pearson's Chi-square Test Research Articles

Comparing the effects of Mycozin and Clotrimazole 1% creams on vaginal candidiasis: a triple-blinded randomized controlled trial

Clotrimazole 1% and Mycozin vaginal cream have been reported to be effective in relieving the symptoms of vulvovaginitis caused by Candida. The resistance to azole compounds, and the side effects of chemical drugs have been reported following azole therapy. It was hypothesized that Mycozin is at least as effective as Clotrimazole in treating vaginal candidiasis. This equivalent, triple-blinded, randomized clinical trial was conducted on 126 patients who complained of vaginal itching referred to Al-Zahra Teaching Hospital, Tabriz, Iran between September 2023 and May 2024. Participants were divided into two groups, i.e., Mycozin (n = 64) and Clotrimazole 1% (n = 62), using the block randomization method. The patient's complaints, clinical signs, the pH and culture of the secretions was recorded before and after treatment. The patient's improvement, level of satisfaction, and side effects were recorded. The data were analyzed using Pearson chi-square test, ANCOVA, and Mann–Whitney U test. There was no statistically significant difference between the two groups regarding the mean pH (Adjusted mean difference: 0.01; 95% Confidence Interval (CI): −0.20 to 0.21, P = 0.965), and microscopic evaluation (Odds Ratio (OR): 0.61; 95% CI; 0.28 to 1.36, P = 0.230). After the treatment the frequency of itching in the Clotrimazole group (N = 13; 22.0%) was lower than that of the Mycozin group (N = 26; 43.3%) (OR: 0.37; 95% CI: 0.17 to 0.82; P = 0.013). There was no statistically significant difference in other symptoms and signs before and after the treatment (P > 0.05). Also, there was no statistically significant difference between the two groups in the level of satisfaction (P = 0.056) and patient improvement (P = 0.074). The side effects of treatment with Mycozin and Clotrimazole were observed in eleven and five patients, respectively. Considering the efficacy of Mycozin vaginal cream in eliminating most of the symptoms and signs associated with vaginal candidiasis and its positive effect in negating the results of culture, it can be used as a suitable alternative in the treatment of vaginal candidiasis in patients interested in herbal medicines and resistant to azole compounds.Trial registration: Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N77. Date of registration: 20/05/2023; URL: https://irct.behdasht.gov.ir/user/trial/68718/view; Date of first registration: 31/05/2023.

Serology and histology in Sjögren's syndrome diagnosis: a retrospective accuracy study.

Sjögren's syndrome (SS) presents complex diagnostic challenges due to its multi-organ involvement, often leading to misdiagnosis, which can result in unnecessary treatments, elevated healthcare costs, and significant impacts on patient quality of life. Accurate diagnosis is therefore critical, utilising ACR/EULAR criteria that include both labial minor salivary gland (LMSG) biopsy and anti-SSA antibodies. This retrospective study analysed medical records of 87 adults suspected of primary SS, who underwent both anti-SSA serology and LMSG biopsy. We evaluated the diagnostic accuracy of these tests under existing ACR/EULAR criteria and a newly proposed 'modified ACR/EULAR criteria-ClinDx'. Statistical analysis included Pearson's chi-square test for the association between test results and disease status and receiver operating characteristic (ROC) curves to assess the sensitivity and specificity of the diagnostic models. Utilising ACR/EULAR criteria, 40 patients were diagnosed with SS, while 47 were categorised as non-diseased. The ClinDx criteria application resulted in 32 SS diagnoses and 55 non-diseased classifications, highlighting discrepancies in patients with low anti-SSA titers (< 200 MFU). Statistical analysis confirmed a significant association (p < 0.001) between test results and disease status, indicating the robustness of the modified criteria in enhancing diagnostic accuracy. This study underscores the utility of integrating serological tests and histological biopsies in diagnosing SS. While anti-SSA antibodies provide a good preliminary screening tool, the specificity of LMSG biopsies is indispensable. Refining both serological and histological assessments per ClinDx criteria can improve diagnostic accuracy, aiding in better management of SS and reducing healthcare burdens.

Is intraoperative neuromonitoring the standard of care for pedicle screw placement surgery? A survey of neurosurgeons' practices.

Spine surgery is highly litigious; misplaced screws and intraoperative neuromonitoring frequently feature in lawsuits. Intraoperative neuromonitoring aims to prevent injury but its standards are debated, and literature suggests its benefits are mixed. We surveyed its use among neurosurgeons from the Congress of Neurological Surgeons with Pearson's chi-square test applied to analyse data within R. Among 188 respondents, 39.9% worked in private practice or academic institutions. Usage rates were 50.5% always, 27.7% never and 21.8% sometimes. Opinions on intraoperative neuromonitoring necessity varied, with 55% disagreeing and 32% agreeing. No differences were noted by practice type or location. Among intraoperative neuromonitoring users, 47% found it sensitive and specific, while 45% used it for medico-legal reasons. Of non-users, 26% preferred other technologies. Overall, the usage of intraoperative neuromonitoring is nuanced and opinions leaned more heavily toward its implementation not being a current standard of care in pedicle screw placement surgery.

The association of seizure control with neuropathology in dementia.

Seizures in people with dementia (PWD) are associated with faster cognitive decline and worse clinical outcomes. However, the relationship between ongoing seizure activity and postmortem neuropathology in PWD remains unexplored. We compared post-mortem findings in PWD with active, remote, and no seizures using multicentre data from 39 Alzheimer's Disease Centres from 2005 to 2021. PWD were grouped by seizure status into active (seizures over the preceding one year), remote (prior seizures but none in the preceding year), and no seizures (controls). Baseline demographics, cognition, mortality, and postmortem findings of primary and contributing(co-pathologies) Alzheimer's Disease(AD), Frontotemporal lobar degeneration(FTD), Lewy body, vascular pathologies and neurodegeneration were compared among the groups using Pearson's Chi-squared test, fisher's exact test, t-test, and ANOVA tests. Of 10,474 deceased PWD, active seizure participants suffered the highest mortality among the groups(proportion deceased among the groups: active=56%remote=35%, controls=34%, p<0.001). Among 6085 (58.1% of deceased) who underwent autopsy, 294 had active, 151 had remote, and 5640 had no seizures. PWD and active seizures died at a younger age (Active=75.8, remote=77.9, controls: 80.8 years, p <0.001) and had more severe dementia (CDR-Global: active=2.36, remote=1.90, controls=1.69, p<0.001). In post hoc analyses, those with primary postmortem diagnosis of AD with active seizures had more severe and later stages of AD pathology and ATN (amyloid, tau, and neurodegeneration) as evidenced by Braak stage for neurofibrillary(tau) degeneration and CERAD score density of neuritic(amyloid) plaques than remote seizure participants and controls. Active seizure participants had more neurodegeneration, evidenced by cerebral atrophy, hippocampal atrophy, and locus coeruleus hypopigmentation than controls. Among participants with primary postmortem diagnosis of non-AD, in posthoc analyses, active seizure participants had worse AD co-pathology evidenced by higher Braak stages than remote seizures and controls and a higher thal phase of beta-amyloid plaques than controls. Neurodegeneration (cerebral/hippocampal atrophy) and LC hypopigmentation were comparable among the groups. In both primary postmortem AD and non-AD diagnoses, FTD (co)pathology was less prevalent among active seizure participants than controls, while vascular pathology, Circle of Willis atherosclerosis, Lewy body pathology, lobar atrophy, and substantia nigra hypopigmentation were comparable among the three groups. This study shows that active, compared to remote seizures, are associated with earlier death and postmortem evidence of more severe ATN pathology. Active seizures are associated with more advanced AD pathology in AD and worse AD co-pathology in non-AD dementias. Therefore, clinicians should be vigilant in detecting ongoing seizures as this could reflect a worse prognosis in PWD.

Food and Housing Insecurity, Resource Allocation, and Follow-up in a Pediatric Emergency Department

Introduction: Food and housing insecurity in childhood is troublingly widespread. Emergency departments (ED) are well positioned to identify and support food- and housing-insecure children and their families. However, there is no consensus regarding the most efficient screening tools or most effective interventions for ED use. Objective: In this cross-sectional study we aimed to investigate the implementation of a food/ housing insecurity screening tool and resource referral uptake in a pediatric ED. Methods: During the study period (March 1–December 9, 2021), there were 67,297 ED visits at the study institution, which is a freestanding children’s hospital. Caregivers of patients presenting to the ED were approached for participation in the study; 1,908 families participated (2.8% of all ED visits during the study period) and were screened for food and housing insecurity. Caregiver surveys included demographic, food and housing insecurity, caregiver/patient health status, and healthcare utilization questions. Caregivers who screened positive for food and/or housing insecurity received printed materials with food and/or housing resources. We analyzed data using descriptive statistics, one-way analysis of variance, and the Pearson chi-squared test. Results: A total of 1,908 caregivers were surveyed: 416 (21.8%) screened positive for food and/or housing insecurity. Of those who screened positive, 147/416 completed follow-up surveys. On follow-up, 44 (30.0%) no longer screened positive for food and/or housing insecurity, while 15 (10.2%) reported using at least one resource referral. The most frequently reported referral utilization barrier was loss or reported non-receipt of the referral. Conclusion: This study demonstrates high food- and housing-insecurity rates among families presenting to a pediatric ED, emphasizing the urgency and necessity of screening and intervening in this environment. The food and housing insecurity change between baseline and follow-up reported here and the overall low resource uptake highlights challenges with ED-based screening and intervention efficacy.

Decentralized worker-centred occupational management in health care: nationwide survey and alpha testing.

Occupational stress among healthcare workers negatively impacts job satisfaction and patient care quality, jeopardizing healthcare system sustainability. Traditional employer-driven approaches often fail to address these challenges comprehensively, leading to persistent gaps in work condition transparency and well-being. To elucidate the working conditions of health workers and introduce a worker-centred, technology-based strategy moving beyond traditional practices and entrenched medical culture. A nationwide survey of Belgian medical residents evaluated occupational conditions and perceptions of management practices. Additionally, the alpha version of a decentralized mobile application was tested to gather user satisfaction and feedback on its usability. The data were surveyed using Pearson's chi-squared and Kruskal-Wallis rank sum tests to assess associations between categorical and ordinal variables, respectively. Alpha-testing results were evaluated using descriptive statistics. The nationwide survey, involving 257 participants, revealed significant associations between medical specialty, work choices and compensation. Notably, 91% of participants expressed strong interest in our proposed open, decentralized solution. In the alpha testing phase, 12 testers reported high satisfaction regarding time-tracking accuracy and payroll verification, though challenges related to administrative burden were also identified. The findings underscore the need for innovative, worker-centred occupational management solutions. The proposed solution shows promise in improving autonomy and transparency, potentially enhancing healthcare delivery and sustainability.

Disease features at diagnosis and changes in disease course severity among commercially insured patients with childhood-onset compared with adult-onset systemic lupus erythematosus.

Systemic lupus erythematosus (SLE) causes widespread inflammation and damage in affected organs. Severity is determined by the type of organ systems affected and the extent of involvement. SLE occurs in childhood or adulthood and disease severity varies according to age of onset. We compared disease features and changes in disease severity over time between childhood-onset (cSLE) and adult-onset SLE (aSLE). Patients 0-64years old, newly diagnosed with SLE during 2014-2020 were identified using the MarketScan® database. A validated algorithm was used to assess disease severity. Improving severity versus baseline was defined as a transition from a higher (severe) to a lower (mild/moderate) disease state during each evaluation period. Group comparisons were made using the Pearson chi-square test for categorical and t test for continuous measures. A total of 10,912 patients were included. Most (89.9%) were female with a mean age of 14.2 versus 44.6years for cSLE and aSLE groups, respectively. Patients with cSLE were more likely to have severe disease at diagnosis (38.3% vs 10.7%; p < .0001) versus aSLE. The largest reduction in SLE severity occurred during 6 to <12months post-index with cSLE experiencing the greatest improvement (36.7% vs 19.9%; p < .0001) compared with aSLE. However, despite improvements observed over time in cSLE, this group was still more likely to have severe disease at 0 to <6months (26.4% vs 10.5%) and 6 to <12 months (14.4% vs 8.6%) post-index compared with aSLE patients (p < .01, all). For aSLE, the proportions of patients experiencing either an improvement or deterioration in symptoms was similar during 0 to <6months and 6 to <12months. However, during 12 to <24months, nearly twice as many patients in this group experienced a deterioration in symptoms (30.1%) compared to improvement (15.6%). Children with SLE present with greater symptom severity compared with adults. Although children were more likely to experience improvements following treatment, they had more active disease over time than aSLE patients. Disease severity remained stable for aSLE patients until the second year of follow-up, when more patients experienced a deterioration rather than improvement in symptoms.

The Impact of Marriage Contract Type on Divorce Likelihood: Evidence from Rivers State, Nigeria

This study investigated the impact of marriage contract type (statutory and customary) on divorce likelihood in Rivers State, Nigeria. Data consisting of demographic, socio-economic and treatment related variables were collected from judiciary high court and customary court for a period of 10 years for the analysis. The factors estimated using survival analysis techniques were: Age at Marriage of Husband and Wife, Presence of Children, Duration of Marriage, Employment Status of Husband and Wife, Educational Level of Husband and Wife, Number of Counseling Sessions and Court Sittings Attended, as well as Marriage Type. The Cox PH model revealed that marriage type does not influence the rate of divorce among couple in Rivers State. For statutory marriages, significant determinants of divorce include: duration of marriage (p = 0.000), employment status of husband (p = 0.028), and presence of children (p = 0.045). For customary marriages, significant determinants of divorce include: presence of children (p = 0.018) and number of court sittings (p = 2.83e-06). Ironically, the result revealed that the presence of children increases the risk of statutory marriage divorce by 72% and reduces the risk of customary marriage divorce by 41%. The findings of this study using Pearson chi-square test for independence between the two types of marriage showed that chi-square statistic value χ2 = 0.0066 and the p-value = 0.936, which indicates that divorce is independent of the type of marriage contracted. This means that there is no relationship between the type of marriage contracted in Rivers State and the likelihood of divorce. Overall, this study contributed to the understanding of divorce likelihood in Nigeria, highlighting the complexity of factors influencing marital stability. The study thereby recommended among others that policymakers should focus on addressing socio-economic factors influencing marital stability.

Comparison of Partial Endoscopic vs Surgical Fundoplication after Hiatal Hernia Repair.

The concomitant hiatal hernia repair with endoscopic fundoplication (c-TIF) is a novel anti-reflux procedure that addresses the hiatus and the gastro-esophageal flap valve for surgical candidates with GERD. We aim to compare the outcomes of a hiatal hernia repair with endoscopic fundoplication (TIF) vs surgical partial fundoplication (anterior and posterior) with regards to quality-of-life scores at 12 months after surgery. Following IRB approval, a prospectively maintained anti-reflux database was retrospectively reviewed to identify patients who underwent a c-TIF procedure or a surgical hiatal hernia repair with partial fundoplication. The primary endpoint was QoL scores at 2, 6, and 12 months from surgery with attention to bloating and dysphagia scores. Secondary endpoints were PPI use, 30-day outcomes, OR time and costs, re-operation within 1 year. The three groups were compared using analysis of variance for continuous variables and Pearson's Chi-square test for categorical variables. P-values < 0.05 were considered indicative of statistical significance. Demographics between groups were similar except for age, PPI use, and presenting symptoms. There was no difference between the three groups with regards to post-operative QoL scores, PPI use, dysphagia, or bloating. All three types of fundoplication are associated with significant improvement of all symptom types and 65-80% of patients are no longer using a PPI at 12 months. There are no differences in outcomes between the c-TIF and a surgical partial fundoplication. QoL scores significantly decrease with all partial fundoplications and there are no differences in dysphagia or bloating between the three types of fundoplication. Long term data is necessary to see if either technique provides superior control of symptoms while minimizing dysphagia and bloating.

Mental health risk in human services work across Europe: the predictive role of employment in various sectors

BackgroundHuman services occupations are highly exposed to mental health risks, thus psychosocial risk management is critical to assure healthy and safe working conditions, promote mental health and commitment, and prevent fluctuation of employees. However, still little is known about prominent psychosocial risk factors in various human services work.ObjectivesTo identify prominent psychosocial risk factors of mental health in human services occupations and to explore their individual and organizational correlates in 19 European countries.MethodsCross-sectional survey using data from the European Union's Labor Force Survey among 379,759 active employees in 19 European countries. First, a descriptive analysis was carried out to establish the prevalence of mental health risk factors. Then sociodemographic correlates of occupational mental health risk factors were assessed by means of Pearson's chi-squared test. Finally, correlations were explored between perceived psychosocial risk factors and human vs. non-human services occupations, as well as contextual variables by applying multilevel logistic and multinomial regression analyses.ResultsThe prevalence of mental health risk was 45.1%. Work overload (19.9%), dealing with difficult clients (10.2%), and job insecurity (5.8%) were the most prevalent mental health risk factors among European employees. We identified significant differences in the prevalence of mental health risks and specific mental health risk factors among employees according to sex, age, and educational attainment. The prevalence of mental health risks was significantly higher among women (47.0%, man: 43.3%), workers aged 35–50 years (47.5%, &amp;gt;50: 44.4%, &amp;lt;35: 42.3%), and those with the higher level of education (51.9%, secondary with diploma: 42.6%, elementary: 36.2%). Employees working in healthcare in Northern Europe were most likely to be exposed to mental health risks (AME = 0.717). Working in healthcare in Northern Europe was the strongest predictor of reporting work overload (AME = 0.381). Working in social care in Central and Eastern Europe was the strongest predictor of reporting dealing with difficult clients (AME = 0.303) as the most prevalent mental health risk factor.ConclusionUnderstanding the impact of employment in specific human services occupations on mental health and its specific occupational stressors are vital to improve mental health and safety at work and maintain high quality services.

A comparison of risk factors for canine leptospirosis and seropositivity in New South Wales, Australia.

This study aimed to identify and compare risk factors associated with canine leptospirosis and Leptospira seropositivity in New South Wales, Australia. Seventy-nine canine cases of confirmed leptospirosis (clinical cases) and 16 healthy dogs seropositive to Leptospira (seropositive cases) were included in the study; these were separately compared to 394 healthy dogs seronegative to Leptospira (controls) in at-risk areas. A questionnaire investigated rat contact, stagnant water, dog park access and household number of dogs and cats. Associations between these factors, signalment and risk of leptospirosis or Leptospira seropositivity were screened using Pearson Chi-Square test and logistic regression was used to estimate odds ratios of association. Significantly associated with both leptospirosis risk and seropositivity risk was rat contact (P < 0.01) which increased the risk 4.3- and 4.5-fold, respectively. Other factors significantly associated with leptospirosis risk were breed (P < 0.01) and age (P < 0.01). Being a herding dog or Terrier increased leptospirosis risk 27.2-fold and 8-fold, respectively and being a young adult dog increased leptospirosis risk 3.9-fold. Frequenting dog parks decreased leptospirosis risk (OR 0.12). In contrast, no other significant risk factors were identified for seropositivity risk. Exposure to Leptospira through contact with reservoir hosts resulted in seropositivity as well as clinical leptospirosis. However, host factors like breed and age seem to be important factors in determining if exposure results in clinical disease. Increased urbanisation and landscape fragmentation could result in increased exposure to reservoir hosts. Environmental sampling is needed to identify sources of infection. Risk mitigation includes reducing contact with reservoir hosts and contaminated environments and increased pest control.

Epistaxis Versus Nonepistaxis Bleeding in Anticoagulated Patients With Atrial Fibrillation: Results From the ENGAGE AF-TIMI 48 Trial.

Epistaxis is common with antithrombotic therapy and is often troublesome to patients, yet its frequency, severity, and outcomes are poorly characterized. Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation-Thrombolysis in Myocardial Infarction 48 (ENGAGE AF-TIMI 48) randomized 21 105 patients with atrial fibrillation and CHADS2 risk score ≥2 to higher-dose edoxaban regimen (60 mg daily, dose-reduced to 30 mg), lower-dose edoxaban regimen (30 mg, dose reduced to 15 mg, daily), or warfarin. Bleeds were adjudicated using International Society on Thrombosis and Haemostasis criteria. Patients with intracranial hemorrhage during follow-up were excluded; those with >1 bleeding event were categorized according to their most severe event. The safety cohort with interval censoring during drug interruption was analyzed. Proportions were compared using Pearson's chi-square test and treatment arms were compared using a Cox proportional hazards model. Among 5247 patients with a bleeding event, 1008 (19.2%) had epistaxis and 4239 (80.8%) had nonepistaxis bleeding. Epistaxis events were less severe than nonepistaxis bleeds (International Society on Thrombosis and Haemostasis major: 3.2% versus 20.7%; clinically relevant nonmajor: 64.7% versus 60.1%; minor: 32.1% versus 19.2%; P<0.001). Permanent drug discontinuation was similar following epistaxis versus nonepistaxis bleeding in patients with major (59.4% versus 53.6%; P=0.52) or clinically relevant nonmajor (32.5% versus 33.3%; P=0.70) bleeding but was significantly higher in patients with minor epistaxis versus other minor bleeds (33.3% versus 23.9%; P=0.001). Compared with warfarin, higher-dose edoxaban regimen had similar risk of epistaxis (hazard ratio [HR], 1.09 [95% CI, 0.95-1.26]), whereas lower-dose edoxaban regimen conferred reduced risk (HR, 0.73 [95% CI, 0.62-0.86]). Epistaxis was frequent, and despite being overall less severe than nonepistaxis bleeding, was associated with similar rates of anticoagulant discontinuation. Compared with warfarin, lower-dose edoxaban regimen reduced the risk of epistaxis by 27% whereas higher-dose edoxaban regimen had no effect. URL: https://clinicaltrials.gov; Unique Identifier: NCT00781391.

Service evaluation of 'GP at Door' of accident and emergency services in Eastern England.

We describe activity, outcomes, and benefits after streaming low urgency attenders to General practice services at Door of Accident and Emergency departments (GDAE). Many attendances to A&Es are for non-urgent health problems that could be better met by primary care rather than urgent care clinicians. It is valuable to monitor service activity, outcomes, service user demographics, and potential benefits when primary care is co-located with A&E departments. As a service evaluation, we describe and analyse GDAE users, reasons for presentation, wait times, outcomes, and co-located A&E wait times at two hospitals in eastern England. Distributions of outcomes, wait times, reasons for attendance, deprivation, and age groups were compared for GDAE and usual A&E attenders at each site using Pearson chi-square tests and accelerated time failure modelling. Performance in a four-hour key performance indicator was descriptively compared for co-located and similar emergency departments. Each GDAE saw about 1025 patients per month. Wait times for usual accident and emergency (A&E) care are relatively short at only one site. Reattendances were common (about 11% of unique patients), 75% of GDAE attenders were seen within 1 hour of arrival, 7% of patients initially allocated to GDAE were referred back to A&E for further investigations, and 59% of GDAE patients were treated and discharged with no further treatment or referral required. Pain, injury, infection, or feeling generally unwell each comprised > 10% of primary reasons for attendance. At James Paget University Hospital, 4.3%, and at Queen Elizabeth Hospital, 16.1% of GDAE attendances led to referral to specialist health services. GDAE attenders were younger and more socially deprived than attenders to co-located A&Es. Patients were seen quickly at both GDAE sites, but there were differences in counts of specialist referrals and wait times. Process evaluation could illuminate reasons for differences between study sites.

Disparities in Operative Fixation for Acromioclavicular Joint Injuries: An Analysis of Insurance Status.

Acromioclavicular (AC) joint injury management has historically been guided by the severity and grade of the injury. However, recent debates have emerged regarding the role of surgical intervention for these injuries. Insurance-based disparities in surgical treatment have been well-documented across various orthopedic conditions. This study seeks to determine whether insurance coverage influences the likelihood of undergoing surgical fixation for AC joint dislocation. We conducted a retrospective analysis of the National Readmissions Database (NRD) spanning from 2016 to 2021. Using International Classification of Diseases, Tenth Revision (ICD-10) codes, we identified patients with isolated AC joint dislocation and determined whether they received surgical intervention based on ICD-10 procedural codes. A total of 5,654 cases of AC joint dislocation were identified, of which 219 (3.9%) underwent operative management. Statistical analysis was conducted via univariate analysis using Pearson's chi-square test, followed by multivariable logistic regression to assess the significance of demographic and socioeconomic factors on likelihood of operative intervention. Results were presented as odds ratios (ORs) and 95% confidence intervals. After adjusting for demographic and socioeconomic variables including age, sex, income quartile, and medical comorbidities, patients with Medicaid insurance were significantly less likely to receive surgical intervention for AC joint dislocation compared to those with private insurance (OR 0.51; 95% CI 0.34-0.76; p < 0.01). Furthermore, individuals residing in areas with the highest income quartile by ZIP code exhibited the greatest likelihood of undergoing surgery (OR 1.91; 95% CI 1.27-2.89; p < 0.01), in contrast to those in lower-income areas. This study suggests that patients insured by Medicaid are less likely to undergo surgery for acromioclavicular joint injury compared to those with private insurance. Additionally, patients from higher-income areas were more likely to receive operative treatment. These findings emphasize the need for more standardized treatment guidelines, particularly as the controversy surrounding operative versus nonoperative management of these injuries persists, and no definitive gold standard surgical technique exists. Surgeons must remain vigilant of these biases that may influence clinical decision-making.

Pear-Shaped Disc as a Risk Factor for Postoperative Sclerotic Modic Changes After Transforaminal Lumbar Interbody Fusion.

Pear-shaped disc could increase the risk of intraoperative end-plate injury, which may lead to postoperative sclerotic Modic Changes (MCs). However, there are no studies on the relationship between pear-shaped disc and postoperative sclerotic MCs. Therefore, this study investigates the risk factors for postoperative sclerotic MCs following transforaminal lumbar interbody fusion (TLIF). Specifically, the study focuses on the impact of pear-shaped disc on the occurrence of postoperative sclerotic MCs and evaluates its influence on clinical outcomes. A total of 411 patients undergoing TLIF between January 2018 and January 2022 were included. Among them, 50 developed postoperative sclerotic MCs, while 361 did not. The two groups were matched based on various parameters. Clinical and radiographic evaluations, including visual analogue scale (VAS), Oswestry disability index (ODI), lumbar X-ray, CT, and MRI, were performed. Statistical analysis included independent sample t test, Pearson's chi-square test, and binary logistic regression analysis. After pairing, a total of 100 patients were included, including 50 patients in postoperative sclerotic MCs group and 50 patients in non-MCs group. There were 27 pear-shaped discs in the postoperative sclerotic MCs group, significantly higher than 7 in the non-MCs group (p < 0.001). Besides, BMI, endplate injury, and cage subsidence in the postoperative sclerotic MCs group were significantly higher than those in the non-MCs group, but the fusion rate was significantly lower than that in the non-MCs group. The postoperative and follow-up SL and surgical corrections of SL in postoperative sclerotic MCs group were significantly higher than those in non-MCs group. The independent risk factors identified for postoperative sclerotic MCs include pear-shaped disc and higher BMI. Pear-shaped disc and higher body mass index (BMI) as independent risk factors for postoperative sclerotic MCs. Patients with sclerotic MCs exhibited a lower fusion rate, increased cage subsidence, and poorer symptom improvement compared to those without MCs.

Association of Social Vulnerability Index With Declining Recommended Surgical Treatment in Head and Neck Cancer Patients.

To investigate the impact of county-level social vulnerability on patients' decision to refuse recommended surgical treatment. Retrospective cohort analysis conducted on HNSCC cases documented in the latest available SEER databases from 2000 to 2020; various demographic, including county of residence, and disease-related variables were collected. CDC's Social Vulnerability Index (SVI) was assigned based on patients' county of residence, and patients were subsequently categorized into four SVI quartiles. Pearson chi-square tests and binomial logistic regression was conducted to determine the impact of variables on patients' refusal of surgical treatment. Among 83,184 patients, 2.6% (2,165) refused surgical intervention recommended by their physician as part of treatment. Social vulnerability (higher SVI), male sex, older age, more advanced disease stage, belonging to non-Hispanic Black or Native Hawaiian/Asian Pacific Islander Race and Origin, and single marital status were associated with higher likelihood of refusing surgery. SVI is a significant factor in the refusal of recommended surgical treatment in HNSCC patients. Advanced disease stages and social vulnerability appear to interplay, influencing treatment decisions. Culturally competent care and support for socially vulnerable patients may mitigate disparities in treatment acceptance, potentially improving survival outcomes. 3 Laryngoscope, 2025.

Assessing Gaps in Integrated HIV and STI Testing Among New York State-Funded Providers by Pre-Exposure Prophylaxis Status: Implications for Status-Neutral Programming.

In the United States, up to 75% of primary care patients go untested for HIV each year, and nearly two-thirds of adults report never having been tested for HIV. Integrated HIV and STI testing, combining these tests into a single visit, is recommended as a status neutral approach to prevention. Over 200 New York State Department of Health-funded primary care clinics, hospitals, health centers and community-based organizations funded to conduct integrated screening. We analyzed weekly testing data from December 2022 to January 2024 to prospectively evaluate whether integrated HIV and STI testing events and results occurred within 30 days of each other. We also assessed group differences in integrated testing by sex at birth, gender, race/ethnicity, risk, organization type, and pre-exposure prophylaxis (PrEP) status using Pearson's Chi-square tests and calculated prevalence ratios using log binomial models stratified be PrEP usage. Analyses were restricted to individuals with an HIV-negative status. Integrated testing was completed for 69% for individuals on PrEP and 39% for those not taking PrEP, with significant differences observed across all client-specific categories at p < 0.001. Except for age group, variations in integrated screening levels by client characteristics were similar by PrEP status. Individuals who identified as female at birth, as non-Hispanic Black, without an elevated risk, and those tested in non-hospital settings were significantly less likely to experience integrated screening. HIV-test reactivity was 0.04% among integrated testers and 0.15% for HIV-only testers. STI-test reactivity was 4.9% among integrated testers and 7.8% for STI-only testers. A significant gap was identified in integrated testing among providers specifically funded to perform it, resulting in missed opportunities for identification of HIV and other sexually transmitted infections. Integrating HIV and STI testing at a systems level will require significant changes to the perceived individual- and provider-level risks and benefits associated with testing.

Implementation of the STEM education model in a law school

Introduction. STEM education is based on processes based on the integration of fields of knowledge in science, technology, engineering and mathematics. The use of STEM education allows you to prepare specialists who are in demand in the labor market and have the skills of the 21st century. The purpose of the study is to develop and verify the effectiveness of the STEM education model in the preparation of university students. Materials and methods. The following methods were used in the research: analysis of scientific and methodological literature, pedagogical experiment (ascertaining, forming and control stages), method of mathematical processing of results (Pearson's chi-squared test – χ 2 ), modeling of the pedagogical process. 97 students of the Faculty of Extra-budgetary Education of the Perm Institute of the Federal Penitentiary Service (Russian Federation) took part in the pedagogical experiment. Results. On the basis of competence-based, transprofessional and synergetic approaches and principles of consistency, projectedness, independence and interdisciplinarity, a model for the implementation of STEM education in the preparation of university students throughout the entire period of study has been developed in classroom classes in various disciplines, during extracurricular and independent work. STEM elements are considered as certain areas that give a new look at the learning process at a law school: science – the totality and integrativity of knowledge acquired by students in the study of various disciplines; technology – the use of information technologies with various software for conducting judicial and other examinations; engineering – the possession of legal technology and its effective application; mathematics – the application of mathematical methods in legal activity. Interdisciplinary STEM projects based on the facts of real professional activity were used as elements or the basis of a lesson, options for short-term, medium- term or long-term homework, an element or the basis of extracurricular work. The level of competence formation (χ 2 = 8.46; p=0.05) increased significantly after the formative experiment. Conclusion. The interrelation of STEM elements with the content of legal education has been established, a set of techniques and methods aimed at the formation of professionally important competencies, including those of the 21st century, has been selected.

Profile of care for children and adolescents at a gender-affirming outpatient clinic within the Brazilian National Health System in São Paulo, Brazil, between 2009 and 2020.

To describe the profile of transgender children and adolescents receiving care at a gender affirming outpatient clinic within the Brazilian National Health System (Sistema Único de Saúde - SUS) in São Paulo. This was a descriptive study involving 555 participants, who received care between 2009 and 2020, in tertiary care services of the SUS. Data were analyzed using Pearson's chi-square test and standard deviation, considering gender, age, and origin. Between 2009 and 2020, there was an increase among males (2009, 0%; 2020, 83.3%) and a decrease among females (2009, 100%; 2020, 16.6%), with an average age of 13.7 and 14.3 years. The majority (93.7%) of consultations was performed in the Southeast region. Over the two decades analyzed, there was an increase in healthcare demand from male transgender children and adolescents, while there was a proportional reduction among females. Care for children and adolescents was concentrated in the Southeast region.

Reaching Syrian migrants through Dutch municipal registries for hepatitis B and C point-of-care testing.

Undetected chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections can lead to cirrhosis and liver cancer. Syrian migrants are the largest non-European migrant group in the Netherlands with HBV and HCV prevalence rates above 2%. This study aimed to reach Syrian migrants for HBV and HCV testing using point-of-care tests (POCT). A multifaceted strategy was employed to reach Syrian migrants aged ≥16 years from two Dutch municipalities for free-of-charge HBsAg and anti-HCV POCT using finger prick blood at the regional Public Health Service. All were personally invited by the Public Health Service by postal mail, based on municipal registry data. Respondents' medical history data were analysed descriptively and data on age, sex, and municipality were compared with non-participating invitees, using Pearson's Chi-square test. Of the study population (N = 832), 32.3% (n = 269) attended the testing. The mean age of participants was 36 years (range 16-70), 59.1% were men, and 66.5% were unemployed. Non-participation was higher in the younger age groups (<30 years) (p < .001). The POCT using finger prick blood was well received. None tested HBsAg or anti-HCV positive. With approximately one-third of participation, this study demonstrated relatively high reach of Syrian migrants for testing, compared to studies with similar recruitment methods. However, while the reach could be considered successful, testing failed to demonstrate new infection in this key population. Thereby, other methods may be preferred to identify new HBV and HCV infections, such as opportunistic testing within existing care processes.