High Proportion Of Respondents Research Articles

Cost-effectiveness and cost-utility of optimized mercaptopurine treatment versus placebo in ulcerative colitis patients: The randomized controlled OPTIC trial.

We assessed the cost-effectiveness and cost-utility of therapeutic drug monitoring (TDM)-guided mercaptopurine treatment compared with placebo in ulcerative colitis (UC) patients failing 5-aminosalicylates. Data were gathered alongside the randomized controlled OPTIC trial (EudraCT: 2015-005260-41). The evaluation was performed from a health care and societal perspective as cost-effectiveness and cost-utility analyses with a time horizon of one year. Volumes and costs of in-hospital care, out-of-hospital care, out-of-pocket expenses and productivity loss were assessed. The main outcomes were the extra costs per additional patient who achieved clinical remission and endoscopic improvement at 52weeks (responders) and extra costs per quality-adjusted life-year (QALY) gained. In total, 59 patients were randomized to the intervention (n=29) and control (n=30) group. Non-significant differences in costs were €63 (-€1267 to €1434; P=0.93) in favour of placebo from a health care perspective and -€742 (-€3683 to €2016; P=0.64) in favour of mercaptopurine from a societal perspective. The higher proportion of responders and a non-significant QALY difference of 0.0475 (-0.024-0.117) (P=0.184) favouring patients on mercaptopurine treatment resulted in €165 extra costs per additional responder and €1326 extra costs per QALY gained from a health care perspective. From a societal perspective, dominance over placebo was observed with cost savings of €1937 per additional responder and €15,621 per QALY gained. The probability of optimised mercaptopurine treatment being cost-effective was 0.80 at a willingness to pay per additional QALY of €20,000. TDM-based mercaptopurine treatment in UC patients failing 5-aminosalicylates is a cost-effective strategy from a societal perspective.

Methods used for caries detection and diagnosis in Ontario dental practices: a cross-sectional survey

BackgroundEarly detection of caries is essential for applying non-surgical treatment procedures and preventing the formation of cavitated lesions leading to unnecessary removal of tooth structure. Understanding dentists’ preferences for caries detection tools can inform stakeholders about their strategies and knowledge of contemporary, evidence-based caries management approaches. However, there is a lack of research exploring the detection methods of caries commonly used by dentists in Ontario, Canada. The objective of this study was to investigate the methods of caries detection and diagnosis preferred by dentists in Ontario.MethodsA 21-item self-reported survey was mailed to one thousand Ontario dental practices in the Winter of 2022. Descriptive and bivariate data analysis were performed to determine the associations between: demographics and professional practice characteristics (explanatory variables), and methods for detecting and diagnosing dental caries (outcome variables) using SPSS Statistics 29.0.ResultsA total of 325 dentists (33%) responded to the survey, with 274 answering all of the questions completely. The highest proportion of respondents were 35–44 years of age (32.8%) and male (53.4%). More than half of the respondents reported using a dental explorer to assess primary occlusal caries (57.6%), secondary caries (57.1%), and cervical caries (57.5%). Likewise, 57.9% of the participants reported using dental radiographs to diagnose proximal caries. Among additional caries detection tools, digital radiography (89.8%) and traditional radiography (84.7%) were the most used methods/modalities, while cone beam computed tomography was the least (12.8%). Most study participants did not use any caries classification system (77.7%) or caries risk assessment tool (85.3%).ConclusionsParticipants preferred conventional methods for caries detection, instead of contemporary visual-tactile caries lesions classification and/or caries risk assessment systems. These findings indicate a need for continuing dental education programs tailored to evidence-based caries management approaches.

A survey on the use of total intravenous anaesthesia in small animals by veterinary anaesthesiologists

ObjectiveTo describe the use of total intravenous anaesthesia (TIVA) in dogs and cats by veterinary anaesthesiologists. Study designA cross-sectional online, voluntary, anonymous survey. PopulationData from 153 answered questionnaires. MethodsAn anonymous questionnaire was sent via e-mail to diplomates, residents and residency-trained individuals from the American and European Colleges of Veterinary An(a)esthesia and Analgesia, to gather information on the use, perceived advantages, reasons for the use or not of TIVA and attitudes towards this technique in dogs and cats. Descriptive statistics and logistic regression analysis to detect significant associations were performed. The effect size was estimated using the odds ratio (OR) and 95% confidence interval (CI). A significance level of p < 0.05 was used. ResultsWe obtained 153/703 responses (66% diplomates, 34% residents; overall response rate of 21.7%). Although 99% and 94% of respondents used TIVA in dogs and cats, respectively, only 14% used it frequently (several times a week) in dogs, and < 1% in cats. Most respondents used propofol (97%, dogs) and alfaxalone (85%, cats), mostly combined with opioids. Reasons for not using TIVA more frequently included prolonged recovery (49%, dogs; 61%, cats), higher cost (46%, dogs) and concerns about drug accumulation (44%, cats). Frequent TIVA use was driven by clinical indications (100%) and greater haemodynamic stability (87%). A higher proportion of respondents using TIVA frequently reported the high stability of the anaesthetic plane (20%; OR = 5.0; 95% CI: 1.4–17.8; p = 0.013) and disagreed with using TIVA only when a specific clinical indication existed (OR = 3.3; 95% CI: 1.4–10.0; p = 0.013). Conclusions and clinical relevanceAlthough occasional, TIVA use is reported among veterinary anaesthesiologists. Clinical indications for TIVA are the most likely reason for its use, whereas factors such as a prolonged recovery or higher cost might limit its use.

Association Between Low Serum HDL Levels and Severity of Coronary Artery Disease Among Patients with Non-ST Elevated Myocardial Infarction

Introduction: Coronary artery disease is one of the leading causes of non-communicable diseases related deaths worldwide. Decreased serum high-density lipoprotein level are associated with an increased severity of coronary artery disease. Present study aims to evaluate the association between this low HDL level and the severity of coronary artery disease assessed by SYNTAX Score in patients with non-ST elevation Myocardial infarction. Materials &amp; Methods: This was a cross sectional study conducted in the Department of Cardiology at National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, from May 2020 to April 2021, on 170 admitted adult patients of non-ST elevated myocardial infarction undergoing coronary angiogram. Study population was divided in two groups; Group-I: Respondents with HDL level ≥ 40 mg/dl, Group-II: Respondents with HDL level &lt; 40 mg/dl. Transthoracic echocardiography was done before coronary angiography. All coronary lesions with diameter stenosis &gt; 50% in vessels &gt; 1.5 mm was scored, using the SYNTAX algorithm. A low score was defined as ≤ 22, an intermediate score as 23 to 32, and a high score as ≥ 33. To determine statistical significance, Chi-square test and independent sample t-test were considered according to applicability. P value of &lt; 0.05 was considered statistically significant. Results: Highest proportion of respondents were from age group 51 – 60 years, 48.2% and 43.5% for group-I and group-II respectively. Study population was male predominant, 88.2% among patients from group-I and 83.5% among patients from group-II. Smoking was the most prevalent risk factor for group-I patients at 58.8%. Hypertension was the most prevalent risk factor for group-II patients at 45.9%. Mean total cholesterol, low-density lipoprotein and high-density lipoprotein were higher among patients from group-I than group-II and these differences were statistically significant (p &lt; 0.05). Mean triglycerides was higher among patients from group-II than group-I and this difference was statistically significant (p &lt; 0.05). Triple vessel was more prevalent (36.5% vs 22.4%) among patients from group-II than group-I and this difference was statistically significant (p &lt; 0.05). Mean SYNTAX score (SS) was higher among patients from group-II than group-I, 17.4 ± 8.6 and 11.5 ± 8.4 respectively, and this difference was statistically significant (p &lt; 0.05). There was strong negative correlation between HDL level and Syntax score (r = - 0.299, p &lt; 0.05). Conclusion: Present study demonstrated significant negative correlation between low serum HDL levels with severity of coronary artery disease among patients with non-ST elevated myocardial infarction. Serum HDL levels can be used as a predictor for the severity of coronary artery disease among such patients. Bangladesh Heart Journal 2024; 39(2): 138-143

Choice of smoking cessation products among people with substance use problems in the US: Findings from the Population Assessment of Tobacco and Health (PATH) study Wave 6

ObjectiveThe aim of this study was to compare past 12-month use of cigarette smoking cessation aids (e.g., Food and Drug Administration (FDA)-approved cessation products or e-cigarettes for smoking cessation) among people with substance use problems (PWSUPs) who currently smoke to people without substance use problems (SUPs) who currently smoke cigarettes in a nationally representative US sample. MethodsWe used the Population Assessment of Tobacco and Health (PATH) Wave 6 Study [n = 30,516]. Our sample comprised adult (18+) established cigarette smokers (100+ lifetime-sticks with daily/non-daily use) [n = 5,895]. The independent variable was SUP status (no, moderate, and high). The dependent variables were past-year use of: nicotine replacement therapies (NRTs), cessation medications [i.e., varenicline or bupropion], or e-cigarettes [for cigarette cessation and reduction]. Weighted multivariable logistic regression models for each dependent variable examined the associations between SUP status and each cessation aid, adjusting for cigarette dependence, daily cigarette smoking, and demographic factors. ResultsAmong people who smoke, a higher proportion of respondents with high SUP severity used NRTs, cessation medications, and e-cigarettes for cigarette cessation, respectively (12.3%, 8.4%, 15.7%), compared to those with no/low SUP severity (9.8%, 6.0%, 8.9%). In the multivariable models, respondents with high SUPs had 63% (95% CI:1.16–2.29) higher odds of using e-cigarettes for cessation than those without SUPs. No significant differences were seen between high (vs. no/low SUPs) in the past-year use of NRTs and cessation medications. ConclusionOur findings indicate that cigarette smokers with high SUPs had higher odds of using e-cigarettes for cessation and reduction compared to smokers without SUPs.

Experience and level of confidence in the management of dental trauma among dental students and fresh graduate dentists

ABSTRACT Background: Dental trauma is one of the most serious and frequent oral problems in active children as well as adolescents worldwide. Anyone can be a victim. Hence, the level of competence in the management cannot be undermined. Aim: This study aims to evaluate the experience and confidence in the management of dental trauma among dental students and fresh graduate dentists in Benin City, Nigeria. Methodology: This questionnaire-based, analytical, and cross-sectional study utilized a self-administered questionnaire containing 15 closed- and open-ended questions to garner data from respondents. Data from 95 respondents were analyzed using the Statistical Package for the Social Studies software version 26.0 (IBM Corporation, Chicago, Illinois, USA.), and both univariate and bivariate analyses were used in this study. Results: A substantial proportion of respondents 73 (76.8%) had never managed any case of dental trauma. A relatively higher proportion of respondents were more confident in managing cases of enamel fracture 18 (18.9%), enamel infraction 17 (17.9%), and enamel-dentine fracture 12 (12.6%) as compared to other more complicated fractures. Conclusion: The experience and level of confidence in the management of dental trauma among dental students and fresh graduate dentists were found to be poor, and they were more confident in managing less complicated cases of dental trauma.

Understanding the burden of poor mental health and wellbeing among persons affected by leprosy or Buruli ulcer in Nigeria: A community based cross-sectional study.

Skin neglected tropical diseases including leprosy and Buruli ulcer (BU)are a group of stigmatizing and disability-inducing conditions and these aspects of the diseases could lead to poor mental health. The study was designed to assess the burden of poor mental health and wellbeing among persons affected by leprosy or BU in Nigeria. A community based cross-sectional study design was employed. The study involved persons affected by leprosy or BU. Ten local government areas with the highest number of notified leprosy or BU cases between 2014 and 2018 in southern Nigeria were purposively selected. Information were obtained using Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorders-7 (GAD-7), Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and OSLO Social Support Scale. Outcome measure was poor mental health/wellbeing and was determined by proportion of respondents who had depressive symptoms, anxiety disorder and poor mental wellbeing. A total of 635 persons affected by leprosy or BU participated in the study. The mean age of respondents was 43.8±17.0 years and highest proportion, 22.2% were in age group, 40-49 years. Majority of respondents, 50.7% were males. A higher proportion of respondents, 89.9% had depressive symptoms, 79.4% had anxiety disorders and 66.1% had poor mental wellbeing. Majority, 57.2% had poor mental health/wellbeing. Among the respondents, there was a strong positive correlation between depression and anxiety scores, (r = 0.772, p<0.001). There was a weak negative correlation between depression score and WEMWBS score, (r = -0.457, p<0.001); anxiety score and WEMWBS score, (r = -0.483, p<0.001). Predictors of poor mental health/wellbeing included having no formal education, (AOR = 1.9, 95%CI: 1.1-3.3), being unemployed, (AOR = 3.4, 95%CI: 2.2-5.3), being affected by leprosy, (AOR = 0.2, 95%CI: 0.1-0.4) and having poor social support, (AOR = 6.6, 95%CI: 3.7-11.8). The burden of poor mental health/wellbeing among persons affected by leprosy or BU is very high. There is need to include mental health interventions in the management of persons affected with leprosy or BU. Equally important is finding a feasible, cost-effective and sustainable approach to delivering mental health care for persons affected with leprosy or BU at the community level. Improving educational status and social support of persons affected by leprosy or BU are essential. Engaging them in productive activities will be of essence.

PD-L1 expression in pulmonary sarcomatoid carcinoma and response to immunotherapy.

8638 Background: Pulmonary sarcomatoid carcinoma (PSC) is a rare subtype of poorly differentiated non-small cell lung cancer (NSCLC) with poor prognosis. Outcomes to immune checkpoint inhibitors (ICIs) in patients with PSC have been incompletely examined, nor have they been compared to other NSCLC histologies. Methods: This retrospective study included two cohorts from MDACC and DFCI with metastatic NSCLC treated with ICI alone or with chemotherapy. Patients were categorized by histology as PSC, lung adenocarcinoma (LUAD), and lung squamous cell carcinoma (LUSC). We compared clinical and demographic characteristics between groups. Clinical progression-free survival (PFS), overall survival (OS), and best of response (BOR) were evaluated. BOR was further divided into responders (including partial and complete response) and non-responders (including stable and progressive disease). Results: A total of 1,515 patients from MDACC were included: 65 (4.3%) PSC, 1,138 (75.1%) LUAD, and 312 (20.6%) LUSC. PSC patients were more likely to be older and present with metastatic disease at diagnosis. PD-L1 expression was higher in PSC, with 71.7% having PD-L1 ≥50%. 19 out of 50 PSC patients (38%) treated with ICIs were responders, compared to 26.4% in LUAD and 21.8% in LUSC. In ICI-treated patients, median PFS (p=0.033) was 5.83 months (95%CI:2.9-22.67) in PSC, 7.5 (95%CI:6.97-8.17) in LUAD, and 6.13 (95%CI:5.23-7.23) in LUSC; median OS (p&lt;0.001) was 33.4 (months, 95%CI:15.4-NA) in PSC, 27.6 (95%CI:25.3-30.3) in LUAD, and 18.2 (95%CI:14.6-21.9) in LUSC. Subgroup analysis showed no significant difference among histologies for patients with PD-L1 high expression in either PFS (p=0.16) or OS (p=0.23). In PSC patients, chemotherapy treatment alone had worse outcomes than treatment with ICIs; when added to ICIs, however, there was no difference between ICI-mono and ICI-chemotherapy. The DFCI cohort included 1,405 patients treated with ICI-mono or ICI-chemotherapy: 41 (2.9%) PSC, 1,296 (92.2%) LUAD, and 68 (4.8%) LUSC. As above, PSC patients had higher PD-L1 expression (65.9% PD-L1≥50%) and higher response rate (45.6%). In PSC patients, median PFS was 5.4 (months, 95%CI:3.5-14.37) and median OS was 11.7 (months, 95%CI:7.7-35.9), without significant difference compared to LUAD and LUSC. Across cohorts, PSC tumors were enriched for KRAS, MET, and TP53 mutations. There was no significant difference across histologies in tumor mutational burden or tumor-infiltrating lymphocytes (TIL) in the DFCI cohort, where this data was available. Conclusions: PSC is associated with higher PD-L1 expression and higher proportion of responders when treated with immunotherapy, with similar PFS and OS compared to LUAD and LUSC. Further investigation of the immune profile in PSC is needed to explore predictive factors of immunotherapy to optimize patient selection in clinical practice.

Mexican physicians' knowledge and attitudes towards hereditary colorectal cancer risk management.

e22552 Background: Genetic cancer risk assessment (GCRA) has become an integral component of the management of patients with colorectal cancer (CRC). Understanding clinical criteria and interpreting screening tests to identify patients who should be prioritized for genetic testing is especially critical in resource-constrained settings such as Mexico, where access to genetic testing is limited. Methods: We designed a self-applicable survey consisting of 18 items, divided into three sections: 7 on knowledge, 5 on clinical approaches, and 6 on access to genetic testing. The aim was to assess the practice patterns of Mexican physicians in contact with patients at risk for hereditary CRC. Initially, the survey was piloted among oncology fellows to refine and improve its relevance and applicability. Following adjustments, it was disseminated using a QR code at the annual meeting of the Mexican Society of Oncology (SMeO) in September 2023. Descriptive statistics were performed using frequency and proportions for categorical variables and median and range for quantitative variables. Results: A total of 78 physicians completed the survey, with a median age of 37 years (range, 27-70). Among them, 47.2% were female, 82% were medical oncologists, with a median practice duration of 6 years (range, 1- 40). 52.6% practice in cancer community centers, 83.4% were employed in public primary care settings, and 60% were affiliated to academic centers. Referral criteria for GCRA was identified correctly in 66.7% who recognized age at CRC diagnosis &lt; 50 years, 57.7% synchronous or metachronous CRC, 50% deficient mismatch repair CRC, and 37.2% PREMM5 score of ≥2.5%. Lynch syndrome, Familial Adenomatous Polyposis (FAP), and Cowden syndrome were identified as syndromes with an increased CRC risk by 76.9%, 71.8% and 56.7% of respondents, respectively. Decision-making based on likely pathogenic and pathogenic variants was indicated by 26.9% and 69.2%, while 12.8% reported making decisions based on variants of uncertain significance (VUS). Regarding clinical approach, 74.4% inquired about a family history of cancer at the initial consultation, and 66.7% referred patients for genetic counseling. The primary obstacles to accessing GCRA were the cost of genetic testing (43.6%) and the absence of medical genetics services at their centers (39.7%). Only 23% reported the availability of cascade testing within their practice. Conclusions: The identification of patients at risk of hereditary CRC was suboptimal among Mexican physicians. A high proportion of respondents were not fully qualified to interpret correctly genetic testing results. These indicate a need for awareness and educational programs to improve providers’ knowledge on predisposition cancer syndromes.

Awareness, knowledge, and behaviors regarding trans unsaturated fatty acids in a sample of Lebanese adults.

Lebanon is a country in the Middle East that had been witnessing nutrition transition to a westernized diet high in trans fats (TFs) and saturated fatty acids (TFAs) that had been linked to cardiovascular diseases and many other health issues. This study examines TF-related awareness, knowledge, and self-reported behaviors among a sample of Lebanese adults aged between 18 and 64 years, as well as their association with sociodemographic factors and anthropometric measurements. Using a multicomponent questionnaire, a cross-sectional study was conducted online, across all Lebanese regions based on a convenience sampling method (n = 401). Factors associated with TF-related awareness, knowledge, and behaviors were examined by multivariate linear regression analysis. The study highlighted specific gaps in TF-related awareness, knowledge, and behavioral practices as well as differences by sociodemographic factors. Most of the participants (36%) had heard of partly hydrogenated oils (PHOs) rather than TFs (49%). A higher proportion of respondents (54%) said they understood a little about TFs, the majority had inadequate knowledge about the foods that contain TFs, and 44% said they would not give up eating their favorite snack even if they knew it contains TFs. Overall, consumers' awareness and knowledge about TFs are rather low and the majority had fair behavioral practices. In addition, being a woman and having higher education level were significantly associated with higher levels of TFs awareness, knowledge, and behavior scores. Higher behavior scores were shown in older participants, married, and those who had part-time jobs, whereas having higher income and normal weight were significantly associated with higher awareness scores. These findings offer valuable insight into TF-related awareness, knowledge, and behaviors in a sample of Lebanese adults and provide key information that could spur the development of evidence-based TFs reduction interventions specific to the Middle East.

The Relationship Between Eye Distance To The Computer And Computer Vision Syndrome (CVS) Complaints

The use of computers is now commonplace among individuals, ranging from students to professionals. Computers offer numerous advantages, leading to a high dependency on them, particularly among office workers, who incorporate computer usage into their daily activities. In general, the occupational setting necessitates prolonged computer usage, thereby leading to inadvertent exposure to the computer screen/monitor and subsequent development of eye-related complaints, including Computer Vision Syndrome (CVS). This study aimed to investigate the correlation between eye distance to the computer and the occurrence of CVS symptoms. This research employs an analytical observational study design with a cross-sectional approach. The study sample consists of employees from the Middle Type Customs and Excise Service Office (KPPBC TMC) in Malang. The sample selection was based on the prolonged duration of computer usage, averaging 6 hours per working day. The study findings indicated a significant correlation between the viewing distance to the computer screen and the occurrence of CVS complaints among the respondents. Among the total of 65 respondents, 66.2% experienced CVS complaints, with the most predominant symptom being tired eyes at 53.8%. A higher proportion of respondents (53.8%) had an eye distance from the computer of less than 50 cm, compared to those with an eye distance of more than 50 cm (46.2%). The majority of respondents in this study were in the age range of 25-29 years, comprising 40% of the sample. Among them, the majority were male, accounting for 57.7% of the respondents.

Energy drinks in Tamale: Understanding youth perceptions, consumption patterns, and related factors.

Energy drinks (EDs) have become a popular choice for young people seeking physical and cognitive boosts, with ingredients such as caffeine, taurine, and B vitamins aimed at improving academic, athletic, and alertness levels. However, the popularity of these drinks is also driven by low prices, taste, brand loyalty, and gendered marketing, with boys being more likely to consume them. Despite the supposed benefits, EDs have been associated with high-risk behaviours, deaths, and adverse health effects, especially those related to cardiovascular risk. Meanwhile, in Ghana, the use of EDs is on the rise. Hence, this study aimed to examine the prevalence and consumption patterns, perceptions, and factors associated with ED consumption among the youth of the Tamale Metropolis. The study was cross-sectional, consisting of 541 participants. The group consisted of 340 males and 201 females, between the ages of 15 and 45. A questionnaire was utilized to obtain data on the respondents' consumption patterns and perceptions of EDs, as well as their socio-demographic characteristics. The results of the study indicated that a large percentage of the respondents, 98.7%, had consumed EDs before, while 78.7% currently consume them. Respondents believed that EDs provided additional energy (81.00%) and reduced stress (62.30%). However, they also perceived side effects such as insomnia (60.60%) and restlessness (51.40%). Also, the highest proportion of respondents (83.4%) had poor knowledge of EDs. They were unaware of the classification of EDs and their ingredients, side effects, and benefits. Age, marital status, level of education, work intensity, EDs served at gatherings, and knowledge of EDs was significantly associated with ED consumption (p < .05). Consumption was higher among those aged 26 to 35 years, singles, individuals with no formal education, and those with high work intensity. The high consumption was also associated with low knowledge levels. It is recommended that public health and nutrition professionals engage in further advocacy efforts to improve the youth's knowledge and perception of EDs in a positive manner. In addition, lawmakers should use legislation to influence consumption rates and safeguard the health of consumers.

Contemporary Utilization and Outcomes of Resuscitative Endovascular Balloon Occlusion of the Aorta for Traumatic Noncompressible Torso Hemorrhage in Korea: A Retrospective Multi-Center Study

Purpose: This study aimed to evaluate the utilization and outcomes of resuscitative endovascular balloon occlusion of the aorta (REBOA) in managing noncompressible torso hemorrhage (NCTH) among trauma patients in Korea. The evolution of REBOA and its impact on patient survival was investigated as well as predictors of mortality.Methods: This retrospective study included 234 post-REBOA patients from 5 leading regional trauma centers across Korea between 2016 and 2021. Primary outcomes were in-hospital mortality, and secondary outcomes were various clinical parameters regarding REBOA, overall treatment flow, and complications. For comparative analyses, patients were dichotomized into in-hospital non-survivors or survivors. Then, generalized additive and linear regression models were used to evaluate the trend of in-hospital mortality.Results: The overall in-hospital mortality was 65.4%. The survivors had a higher proportion of responders following REBOA (87.7% vs 62.7%, &lt;i&gt;p&lt;/i&gt; &lt; 0.001). Key variables influencing outcomes included total occlusion time, red blood cell transfusion volume within the first 24 hours, revised trauma score, and systolic blood pressure gap. These factors significantly correlated with mortality rates in multivariate logistic regression.Conclusion: Over 6 years, survival rates for NCTH patients undergoing REBOA in Korea have shown improvement. Despite diverse REBOA protocols across institutions, the results underscore the need for continued research, standardized practices, and national quality control measures to further optimize patient outcome and establish more effective treatment protocols for NCTH.

Comparative-effectiveness study evaluating outcomes for transforaminal epidural steroid injections performed with 3% hypertonic saline or normal saline in lumbosacral radicular pain.

Transforaminal epidural steroid injections (TFESI) are commonly employed to treat lumbosacral radiculopathy. Despite anti-inflammatory properties, the addition of 3% hypertonic saline has not been studied. Compare the effectiveness of adding 0.9% NaCl (N-group) vs. 3% NaCl (H-group) in TFESI performed for lumbosacral radiculopathy. This retrospective study compared TFESI performed with lidocaine, triamcinolone and 0.9% NaCl vs. lidocaine, triamcinolone and 3% NaCl. The primary outcome was the proportion of patients who experienced a ≥ 30% reduction in pain on a verbal rating scale (VRS; 0-100) at 3 months. Secondary outcome measures included the proportion of patients who improved by at least 30% for pain at 1 and 6 months, and who experienced ≥15% from baseline on the Oswestry disability index (ODI) at follow-up. The H-group experienced more successful pain outcomes than the N-group at 3 months (59.09% vs. 41.51%; P = .002) but not at 1 month (67.53% vs. 64.78%; P = .61) or 6 months (27.13% vs 21.55%: P = .31). For functional outcome, there was a higher proportion of responders in the H-group than the N-group at 3 months (70.31% vs. 53.46%; P = .002). Female, age ≤ 60 years, and duration of pain ≤ 6 months were associated with superior outcomes at the 3-month endpoint. Although those with a herniated disc experienced better outcomes in general with TFESI, the only difference favoring the H-group was for spondylolisthesis patients. 3% hypertonic saline is a viable alternative to normal saline as an adjunct for TFESI, with randomized studies needed to compare its effectiveness to steroids as a possible alternative. Thai Clinical Trials Registry ID TCTR 20231110006.

Occupational and Return-To-Work Characteristics of Covid-19 Patients After Treated in Udayana University Hospital

Corona virus disease 2019 (COVID-19) is a new disease caused by severe acute respiratory syndrome corona virus 2 (SARS-COV-2). The COVID-19’s symptoms are fatigue, muscle pain, and psychological disorders. The purpose of this study was to describe the occupational characteristics and health conditions of COVID-19 patients who had recovered after being treated at Udayana University Hospital. This study is a descriptive study with a quantitative method and cross-sectional design. The research samples were 110 COVID-19 patients treated at Udayana University Hospital from June to August 2020 and taken using random sampling. The results showed that the highest proportion of respondents were aged between 24-44 years (44.5%), with almost equal proportions of women (50.1%) and men (49.09%). Most of them lived in Denpasar (46.36%). Most respondents work as private sector employees (24.55%), and 70% of them were using personal protective equipment (PPE) while working. Most respondents needed less than seven days to return to work after being declared “in recovery state” (60%), with the remaining 55.5% having a decreased work duration to be less than 8 hours per day. The proportion of respondents with comorbidities was 30.91%. As many as 27.27% were experiencing previously similar symptoms (fever, fatigue, cough) 4 to 5 months after being declared “cured.” COVID-19 patients who have recovered should be monitored for a longer period of time to evaluate the symptom reoccurrence and its impact on their occupational and health conditions.

Decision-making in women considering planned oocyte cryopreservation: decision satisfaction or regret?

Research question: Among women considering planned oocyte cryopreservation (OC), does decision regret differ among those that pursued planned OC vs. those that did not? Design: A survey was emailed to all women seen in consult for planned OC from January 2016–December 2021 using a secure REDCap platform. The survey comprised of questions on demographics, reproductive planning, and a validated decision regret scale (DRS). Univariable and multivariable models were fitted to examine decision regret in the group that pursued vs the group that did not pursue planned OC. A sentiment analysis was employed to characterize respondents’ emotional tone. Results: A total of 338 respondents met eligibility criteria, of which 178 (52.7%) underwent and 160 (47.3%) did not undergo planned OC. The groups were similar in age, race/ethnicity, and education. Respondents who underwent planned OC were more likely to be single, anticipate starting a family ≥39yo, and consider donor sperm acceptable. Those that did not undergo planned OC more frequently reported starting attempts at conception. A higher proportion of respondents that did not undergo planned OC experienced moderate-to-severe regret in their decision compared to those that underwent ≥1 cycle (50% vs. 13%, p<0.001). There was a correlation between decreasing number of cryopreserved oocytes and increasing DRS score (P<0.001). Conclusions: There is substantial decision regret among women considering planned OC who did not proceed with it. DRS score was highest among those that did not proceed with planned OC and those that underwent ≥1 cycle resulting in a low number of oocytes.

Prevalence and associated factors of last dental visit and teeth cleaning frequency in Bangladesh, Bhutan, and Nepal: Findings from nationally representative surveys.

This study evaluated the prevalence and frequency of teeth cleaning and last dental visits, along with associated socio-demographic factors, among residents of Bangladesh, Bhutan, and Nepal. The World Health Organization (WHO) STEPwise approach to surveillance (STEPS) survey data from Bangladesh (N = 8,164), Bhutan (N = 5,374) and Nepal (N = 5,371) were analyzed. After descriptive analysis, a multivariable multilevel logistic regression was conducted to identify the factors associated with oral hygiene. The following variables were considered as outcomes of interest: daily teeth cleaning frequency and visitation to the oral healthcare providers in the last six/twelve months at the time of data collection. Bangladesh had the highest proportion of respondents who cleaned their teeth at least once or twice a day, while Nepal had the lowest. Bhutan had the highest proportion of respondents who visited a dentist within the last six months (10.5%) or 12 months (16.0%). Almost 94.5% of Nepalese participants never visited a dentist. Participants of older age, who were females and had increased educational attainment, were more likely to follow oral hygiene measures. The populations of all the countries included in the study show poor adherence to oral hygiene practices. Health promotion programs should raise awareness regarding the advantages of regular teeth cleaning and dental check-ups.

Clinical Practice Trends in Otolaryngology for the Prevention of Ear Ventilation Tube Blockage

Abstract Context: Tympanostomy tube (TT) placement has become one of the most common surgical procedures performed in children. The tube drains fluid trapped behind the eardrum, thereby maintaining middle ear cavity ventilation and preventing hearing loss. One of the common postoperative complications is obstruction of the TT lumen. Aims: We aimed to identify common practices among general otolaryngologists (not subspecialized) and pediatric otolaryngologists for the prevention of middle ear TT blockage in children. Settings and Design: The design involves a cross-sectional, web-based survey. Subjects and Methods: The survey was conducted using Google Forms and delivered through e-mails to general and pediatric otolaryngologists between January and December 2022. Otolaryngologists of &gt;2 years’ experience were included in the study. Statistical Analysis Used: For the descriptive analysis of the data, frequency, percentages, and bar diagrams were used. For inferential analysis, the Chi-square test was used to study the relationship between two categorical variables. Results: Among the 196 otolaryngologists who participated in this survey, 78 (39.8%), 68 (34.7%), 44 (22.4%), and 6 (3.1%) were residents, consultants, specialists, and fellows, respectively. A majority of the practitioners were pediatric otolaryngologists (n = 140, 71.4%). A higher proportion of respondents (60.5%) with &lt;5 years of experience in ear, nose, and throat practice agreed that ear drops should be prescribed postoperatively, than respondents with &gt;5 years of experience (44.2%) (P = 0.029). Conclusions: This study identified the different practices used for managing ventilation tube blockage postoperatively. Further studies are required to determine optimal approaches for the prevention of postoperative tube blockage.

Awareness and perceptions of coral reef ecosystem use and management in ‘pseudo community’ and government-managed marine protected areas in Kwale county, Kenya

Both local ‘pseudo community’ and government-managed Marine Protected Areas (MPAs) are fundamental tools in the protection of coral reef ecosystems from human-driven threats globally. Inclusive decision-making between the local community and the government in co-management is vital to the success of MPAs. Consequently, understanding community awareness and perception of the coral reef ecosystem is an essential aspect for transformative change in the sustainable use of coral reef ecosystem services. This study aimed to assess and compare the community's awareness and perceptions of coral reef ecosystem benefits in the face of different management options between Diani Chale and Kisite-Mpunguti MPAs in south coast Kenya. We collected qualitative and quantitative data through 16 focus group discussions (n = 147) and household surveys (n = 412 in Diani Chale and n = 413 in Kisite-Mpunguti MPAs) on communities living in villages within 5 kilometers of the shoreline of the selected MPAs. The findings revealed that 77.6% (640/825) of the respondents were aware of coral reef ecosystems in their area. There was a higher awareness of coral reefs among respondents in government-managed Kisite-Mpunguti MPA (84.5%, 349/413) compared to pseudo-community-managed Diani Chale MPA (70.6%, 291/412). A higher proportion of respondents in Kisite-Mpunguti relied on coral reef resources for their livelihoods (p < 0.01). Moreover, a significantly higher percentage of respondents from Kisite-Mpunguti agreed or strongly agreed that local people derive economic benefits from the establishment of MPAs compared to Diani Chale (67.6% versus 52.2%, p < 0.001). Furthermore, more respondents from Kisite-Mpunguti expressed positive support for the establishment of more government-managed MPAs (55.69% versus 32%), and Locally Managed Marine Areas (53.9% versus 38.86%). Based on these findings, inclusive support by local communities towards coral reef conservation is recommended to increase their participation in positive environmental behaviors in Kenya and other countries in the Western Indian Ocean region. Additionally, improved political goodwill is required to support the creation of more and larger areas under marine protection, especially in the Diani Chale area.

Battlefield acupuncture for chronic musculoskeletal pain in cancer survivors: a novel care delivery model for oncology acupuncture.

Battlefield Acupuncture (BFA), a standardized auricular acupuncture protocol, is widely used for pain in the military but is not well-studied in oncology. This study examined cancer survivors who received BFA for pain. This is a secondary analysis of a randomized trial that compared the effectiveness of BFA and electroacupuncture vs. usual care for chronic musculoskeletal pain in cancer survivors. This study focused on participants randomized to BFA. Participants received 10 weekly treatments. Needles were placed until one of these stop conditions were satisfied: ten needles were administered; pain severity decreased to ≤1 out of 10; patient declined further needling, or vasovagal reaction was observed. Pain severity was assessed using Brief Pain Inventory. Responders were those with ≥30% pain severity reduction. We examined pain location, BFA stop reason, and pain reduction of participants during the first session. We also examined which factors predicted responder status after the first session (week 1) or the full treatment (week 12). Among 143 randomized to BFA, most common pain locations were lower back (30.8%) and knee/leg (18.2%). Of 138 who initiated treatment, 41 (30.0%) received ten needles; 81 (59.1%) achieved pain ≤1; 14 (10.2%) declined further needling; and 1 (0.7%) had vasovagal reaction. BFA reduced pain severity by 2.9 points (95% CI 2.6 to 3.2) after the first session (P < 0.001). After adjusting for baseline pain severity, responders at week 1 were 2.5 times more likely to be responders at week 12, compared to those who were non-responders at week 1 (AOR 2.5, 95% CI 1.02 to 6.11, P = 0.04). Among those who achieved pain ≤1, 74% were responders at week 12, a higher proportion compared to the proportion of responders among those who received ten needles (39.5%), those who declined further needling (50%), and those with vasovagal reaction (0.0%) (P = 0.001). Those with pain in proximal joints had a higher proportion of responders at week 12, compared to those with pain in distal joints (64.2% vs. 20%, P = 0.008). Specific factors may predict the likelihood of achieving meaningful pain reduction from BFA. Understanding these predictors could inform precision pain management and acupuncture delivery models.