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BACKGROUND There is limited information about sexual knowledge and behaviours in adults with complex care needs, including those with 22q11.2 deletion syndrome (22q) which represents a group predisposed to intellectual disabilities. METHODS We conducted sexual health assessments with 67 adults with 22q, examining whether those with knowledge deficits and a history of engaging in sexual activities with others would be more likely to engage in high-risk behaviours. RESULTS The majority (65.7%) of adults with 22q were sexually active with others; most (70.1%) had sexual knowledge deficits. Those with intellectual disabilities were more likely (p = .0012) to have deficits in certain topics. In the sexually active subgroup, most (81.8%) engaged in high-risk sexual behaviours, regardless of intellectual disability or knowledge deficits. CONCLUSION The results suggest a need for increased dialogue, repeated education, genetic counselling and preventive healthcare measures related to sexuality in 22q and potentially in other complex care conditions.

BACKGROUND: Research into oral health care for older people has shown that dental care in general decreases with increasing age and frailty and, therefore, oral health care provision may be complex. The aim of this study is to identify the oral health care dentists provide to community-dwelling older people and which barriers they experience in doing this.METHODS: In this cross-sectional study, a representative sample of dentists in the Netherlands was asked to prospectively select one older patient and describe this patient using a specially developed registration form; the patient was requested to fill out a questionnaire. The relationship between experienced barriers in providing oral health care to older patients and characteristics of the dentists and the patients was studied by means univariate and multivariate logistic regression analysis.RESULTS: In total, 923 dentists were asked to participate in the study. Data were available for 39.4% dentist-patient pairs. In most cases (87.4%), oral health care was focussed on conservation of the dentition. In all, 14.0% of the dentists experienced barriers in providing oral health care for older people. Some patient factors increase the risk of experiencing barriers, eg, the more difficult behaviour of older patients and the greater disease burden.CONCLUSIONS: Oral health care was mostly focussed on conservation of the dentition, and dentists especially experience barriers in oral health provision to older patients if they are already frail.

BACKGROUND: Some older people stop visiting the dentist when they get older. This study aims to identify the characteristics and oral health status of older people who do visit community dental practices.METHODS: In this exploratory cross-sectional study, the oral health of Dutch community-dwelling older people was assessed. A random sample of general dental practitioners and older people who visit the dental practice was drawn. The dentists were asked to prospectively select one older patient and describe this patient using a specially developed registration form; the patient was requested to complete a questionnaire. Data were described for 3 distinct groups of older people. Statistical measures for distribution and dispersion were used to describe the oral health of community-dwelling older patients in relation to the age.RESULTS: A total of 373 (40.4%) dentist registration forms and 372 (40.3%) patient questionnaires were returned. Data were available for 364 (39.4%) dentist-patient couples. Amongst the patients, 52.8% were female and most had a high socioeconomic status. About 65.7% had one or more problems related to general health, and 75.2% used medication. Regarding the overall oral health status, the average number of teeth was 20, 3.5% were edentulous. Oral health problems were more common in the older patient group (aged 75+), in whom frailty was also most common.CONCLUSIONS: Older people who visit community dental practices are still relatively healthy, non-frail, and highly educated. Even in this group, there is a turning point in both general and oral health from the age of 75.

Background The impact of pancreatic and periampullary cancer treatment on health-related quality of life (HRQoL) is unclear. Methods This study merged data from the Netherlands Cancer Registry with EORTC QLQ-C30 and -PAN26 questionnaires at baseline and three-months follow-up of pancreatic and periampullary cancer patients (2015-2018). Propensity score matching (1:3) of group without to group with treatment was performed. Linear mixed model regression analyses were performed to investigate the association between cancer treatment and HRQoL at follow-up. Results After matching, 247 of 629 available patients remained (68 (27.5%) no treatment, 179 (72.5%) treatment). Treatment consisted of resection (n=68 (27.5%)), chemotherapy only (n=111 (44.9%)), or both (n=40 (16.2%)). At follow-up, cancer treatment was associated with better global health status (Beta-coefficient 4.8, 95% confidence-interval 0.0-9.5) and less constipation (Beta-coefficient -7.6, 95% confidence-interval -13.8--1.4) compared to no cancer treatment. Median overall survival was longer for the cancer treatment group compared to the no treatment group (15.4 vs. 6.2 months, p Conclusions Patients undergoing treatment for pancreatic and periampullary cancer reported slight improvement in global HRQoL and less constipation at three months-follow up compared to patients without cancer treatment, while overall survival was also improved. Larger studies should confirm these findings and investigate whether the observed improvement in HRQoL is clinically relevant.

Aims and objectives The holistic care dependency concept can be applied to gain comprehensive insights into individuals' care needs in the end-of-life (EoL) phase. This study was carried out to measure and characterise the "care dependency" phenomenon in this phase and to obtain deeper knowledge about this phenomenon. Background The end of a human life is often characterised by a physical decline, often implying that a high amount of care is needed. Non-malignant diseases can develop unpredictably; therefore, it is difficult to detect the onset of the EoL phase. Design Data were collected in a cross-sectional multicentre study, using the Austrian Nursing Quality Measurement 2.0. Methods Descriptive and multivariate statistical methods were used. Care dependency was measured with the Care Dependency Scale (CDS). The study follows the STROBE guideline. Results Ten per cent (n = 389) of the sample (N = 3589) were allocated to "a pathway for management of patients at the end of life." The patients and residents in the EoL phase are significantly older and more often diagnosed with dementia, and circulatory system and musculoskeletal system diseases. Of these patients, 60% were care dependent completely or to a great extent. Dementia and age represent main influencing factors that affect the degree of care dependency at the end of life. Conclusion Our results show that the "typical" EoL patient or resident is female, old and affected by dementia and/or circulatory system diseases. Dementia and age were identified as main factors that contribute to very high care dependency. Relevance to clinical practice The measurement of care dependency may support the identification of special care needs in the EoL phase. Gaining deeper knowledge about the care dependency phenomenon can also help healthcare staff better understand the needs of patients with non-malignant conditions in their last phase of life.

This paper proposes and implements a compact wireless motor drive using orthogonal bipolar coils for the coordinated operation of robotic arms. The key is to orthogonally integrate two bipolar coils to form a compact magnetic coupler (CMC), while each CMC serves as the transmitting coil and receiving coil, respectively. Instead of adopting the one-to-many coil structure and operating at multiple frequencies, in this paper, two bipolar coils in the CMC are mutually decoupled and separately energized to drive two permanent magnet DC (PMDC) motors. As such, the wireless and selective motor drives can be achieved via the shared power-transfer channel at a single resonant frequency. All controls and switches are concentrated at the transmitter so that the receiver is entirely sealable. Accordingly, the coordinated operation of robotic arms can be realized with the high integration and no electrocution. Theoretical calculations and experimental results are given to validate the flexibility and feasibility of the proposed system.

Summary Background Diabetes leads to a wide range of established vascular and metabolic complications that has resulted in the implementation of diverse prevention programmes across high-income countries. Diabetes has also been associated with an increased risk of a broader set of conditions including cancers, liver disease, and common infections. We aimed to examine the trends in a broad set of cause-specific hospitalisations in individuals with diabetes in England from 2003 to 2018. Methods In this epidemiological analysis, we identified 309 874 individuals 18 years or older with diabetes (type 1 or 2) in England from the Clinical Practice Research Datalink linked to Hospital Episode Statistics inpatient data from 2003 to 2018. We generated a mixed prevalent and incident diabetes study population through serial cross sections and follow-up over time. We used a discretised Poisson regression model to estimate annual cause-specific hospitalisation rates in men and women with diabetes across 17 cause groupings. We generated a 1:1 age-matched and sex-matched population of individuals without diabetes to compare cause-specific hospitalisation rates in those with and without diabetes. Findings Hospitalisation rates were higher for all causes in persons with diabetes than in those without diabetes throughout the study period. Diabetes itself and ischaemic heart disease were the leading causes of excess (defined as absolute difference in the rate in the populations with and without diabetes) hospitalisation in 2003. By 2018, non-infectious and non-cancerous respiratory conditions, non-diabetes-related cancers, and ischaemic heart disease were the most common causes of excess hospitalisation across men and women. Hospitalisation rates of people with diabetes declined and causes of hospitalisation changed. Almost all traditional diabetes complication groups (vascular diseases, amputations, and diabetes) decreased, while conditions non-specific to diabetes (cancers, infections, non-infectious and non-cancerous respiratory conditions) increased. These differing trends represented a change in the cause of hospitalisation, such that the traditional diabetes complications accounted for more than 50% of hospitalisation in 2003, but only approximately 30% in 2018. In contrast, the proportion of hospitalisations due to respiratory infections between the same time period increased from 3% to 10% in men and from 4% to 12% in women. Interpretations Changes in the composition of excess risk and hospitalisation burden in those with diabetes means that preventative and clinical measures should evolve to reflect the diverse set of causes that are driving persistent excess hospitalisation in those with diabetes. Funding Wellcome Trust.

Background/purpose In 1906, there was a dental treatment room established in the department of surgery of Taipei Hospital to introduce modern dental services to Taiwan. It is undoubtedly the earliest hospital dentistry in Taiwan. This study tried to assess the dental manpower and treated dental diseases in Taipei Hospital, and hence to explore the appearance of Taiwan's early hospital dentistry. Materials and methods This study utilized the secondary data analysis to evaluate the dental manpower and treated dental diseases of dental outpatients in the 27th Annual Report of Taipei Hospital (Taisho 12th year or 1923). Results Our results found that there were 3 dentists and one dental technician in the dental department of Taipei Hospital in 1923. These 3 dentists totally treated 3 inpatients and 1759 outpatients with 4511 outpatient visits (1959 for male patients and 2552 for female patients) in that year. Dental caries and retained root were the two most common dental diseases in Japanese and Taiwanese dental outpatients, and followed in a descending order by missing tooth, pulp necrosis, and pulpitis for Japanese outpatients as well as pulpitis, suppurative periodontitis, and acute or chronic periodontitis for Taiwanese outpatients. Conclusion We conclude that the dentistry of Taipei Hospital in 1923 does have a modern form of dentistry with 3 dentists and one dental technician. Its dental patients are mainly Japanese and minorly Taiwanese. Moreover, the treated dental diseases are mainly tooth diseases for Japanese outpatients and both tooth and periodontal diseases for Taiwanese outpatients.

Objectives: To evaluate the experienced barriers of care for treatment-seeking trans individuals (TSTG) in three large European clinics. Methods: An online follow-up questionnaire was filled out by 307 TSTG individuals as part of the research protocol of the European Network for the Investigation of Gender Incongruence (ENIGI). Data was collected during follow-up in 2017/2018, around 5 years after participants had their initial clinical appointments in Ghent (Belgium), Amsterdam (the Netherlands), or Hamburg (Germany). Background characteristics, country, treatment characteristics and mental health were analyzed in relation to experienced barriers of care (EBOC, measured though agreement with statements). Results: The majority of participants reported various EBOC, oftentimes more than one. The most-frequently reported EBOCs pertained to the lack of family and friends’ support (28.7%, n = 88) and travel time and costs (27.7%, n = 85), whereas around one-fifth felt hindered by treatment protocols. Also, a significant share expressed the feeling that they had to convince their provider they needed care and/or express their wish in such way to increase their likelihood of receiving care. A higher number of EBOCs reported was associated with more mental health problems, lower income and female gender. Conclusions: A substantial number of TSTG individuals within three European health care systems experiences EBOCs. EBOCs relate to both personal and systemic characteristics. These findings can help health care providers and centers to improve care. More research must be done to better understand the diversity among TSTG individuals and the corresponding barriers experienced. Supplemental data for this article is available online at https://doi.org/10.1080/26895269.2021.1964409.

Objectives:To explore and compare the experiences of care home visits during the pandemic in the UK and the Netherlands.Design:Qualitative semi-structured interview studiesSetting and Participants:Family carers of relatives residing in care homes in the UK and the Netherlands were interviewed remotely.Methods:Family carers were asked about their experiences of care home visits during the pandemic, and specifically in the Netherlands after care homes had reopened. Transcripts were analyzed in each country separately in the native language using thematic analysis, before discussing findings at multiple analysis meetings.Results:Across 125 interviews, we developed four themes: (1) different types of contact during lockdown; (2) deterioration of resident health and well-being; (3) emotional distress of both visitors and residents; and (4) compliance to guidelines and regulations. Visiting in both the UK and the Netherlands was beneficial, if possible in the UK, yet was characterized by alternative forms of face-to-face visits which was emotionally distressing for many family carers and residents. In the Netherlands, government guidance did enable early care home visitation, while the UK was lacking any guidance leading to care homes implementing restrictions differently.Conclusions and Implications:Early and clear guidance, as well as communication, is required in future pandemics, and in this ongoing pandemic, to enable care home visits between residents and loved ones. It is important to take learnings from this global pandemic to reimagine long-term care, highlighting the value of socializing for care home residents.

The present study is a retrospective study of medico-legal autopsies conducted in the Department of Forensic Medicine and Toxicology MMIMSR Mullana, Ambala, India, from Jan 2016 to December 2020. During this period, 793 cases of medico-legal autopsies were done in the mortuary of MMIMSR, Mullana, Ambala. The majority of victims were male 670 (84.48 %) cases and female 123 (15.52%) cases. A maximum number of post mortem done in the age group 20-40 years was 385(48.56 %) cases and minimum in age group 0-10 year were 18 (02.26%) cases. In our study, 601 (75.78%) were married, 169 (21.31%) unmarried, and unknown 23 (02.99%) cases. Hindus were 660 (83.22%), Muslim 50(06.30%), and Sikh 83 (10.48%) cases. The total number of deaths from rural areas was 406(51.20%) cases, which is slightly higher than urban area 387 (48.80%) cases. Manners of death due to natural causes were 38 (04.97%) cases and unnatural 755 (95.20%) cases. In unnatural, (accidents 551 (69.44%), Suicides 186 (23.44%) and homicides 18 (02.24%) cases). A maximum number of death due to Head injury were 235 (29.64%), shock and hemorrhage 188 (23.70%), poisoning 124 (15.64%), others-skeleton and visceral injuries 81 (10.22%), hanging 44 (05.54%), heart attack 38(04.78%), Drowning 23(02.90%), Electrocution 14 (01.76%), strangulation 13(01.64%), burns 11(1.38%), alcoholic 10(01.26%), septicemia 10(01.26%) and snake bite 2(00.26%)cases. A maximum number of deaths occurring between 0-6 hrs of injury was 395(49.82%) cases, and a minimum number of deaths in 24-48 hrs of injury was 22(02.77%) cases.

Introduction Lifestyle factors are associated with musculoskeletal pain and metabolic chronic diseases. To date, intensive lifestyle medicine programs have predominantly targeted metabolic rather than musculoskeletal conditions. Objective To assess the feasibility of an intensive interprofessional lifestyle medicine program for patients with musculoskeletal conditions. Design Prospective observational feasibility study. Setting Tertiary academic medical center. Patients Adults diagnosed with musculoskeletal condition(s) and lifestyle-related chronic disease(s) who previously completed standard-of-care musculoskeletal treatments, enrolled from 2018-2020. Interventions Patients enrolled in an intensive interprofessional lifestyle medicine program led by a physiatrist, with options to interface with an acupuncturist, dietician, massage therapist, psychologist, physical therapist, and smoking cessation specialist. The physiatrist engaged in shared decision making with patients to establish program goals related to function, overall health, and required lifestyle changes. Bi-monthly interprofessional team conferences facilitated communication between treatment team and patients. Main outcome measures Feasibility was measured by patient participation and goal attainment. Secondary outcomes included changes from program enrollment to discharge in patient anthropometric, metabolic lab, sleep apnea risk, and Patient-Reported Outcomes Measurement Information System (PROMIS) function, pain, and behavioral health measures. Results Twenty-six patients enrolled in the program (18 (69%) female, mean age 59 (SD 14.5) years, baseline HbA1c 6.0% (0.8%), hs-CRP 7.7 (12.1) mg/dL, 25-hydroxy Vitamin D 32.0 (14.2) ng/mL). Of 21 (81%) patients who completed the program, 13/21 (62%) met their goal. On average, program completers presented for 26.2 (10.6) total visits over 191 (88) days. By discharge, program completers achieved clinically meaningful improvement in PROMIS Anxiety (mean difference -3.5 points 95% CI (-6.5-.5), p=.035), whereas non-completers did not (p>.05). Conclusions An intensive interprofessional lifestyle medicine program for patients with musculoskeletal conditions is feasible. With training in lifestyle intervention, physiatrists are well-suited to lead interprofessional teams aimed at assisting patients in making lifestyle changes to achieve personalized function- and health-related goals. This article is protected by copyright. All rights reserved.

Objectives: This study explores the effects of the Active Plus intervention aiming to decrease loneliness among older adults (>65 years) with chronic diseases. Methods: A randomized controlled trial (RCT) was performed (N = 585; age: M = 74.5 years, SD = 6.4), assessing loneliness at baseline, 6 months and 12 months. Outcome measures in the multilevel linear regression analyses were total, social and emotional loneliness. Results: At 12 months, significant decreases in total ( B = −.37, p = .01) and social loneliness ( B = −.24, p = .02) were found. Age was a significant moderator for total and social loneliness; however, the intervention was effective only for participants aged 80 years and older. Discussion: The Active Plus intervention showed a significant decrease in total and social loneliness and was especially beneficial for the vulnerable age group of 80 years and older. A more comprehensive tool for measuring social activity and mobility impairments, and using a longer time frame to detect loneliness changes, may form interesting future research.

Near-peer teaching (NPT) has been identified as a contemporary and valued pedagogical approach in higher education health programs, and it has recently gained momentum in paramedicine education. The objective of this study was to investigate the perceived experience of student paramedics involved in a near-peer teaching program over two academic trimesters. A cross-sectional study design was utilised in the form of an online questionnaire. The questionnaire contained a variety of questions that related to the experience of student paramedics involved in paramedicine near-peer programs. Of the 65 students enrolled, 34 completed the questionnaire (52.3% response rate). The results indicated that NPT was overwhelmingly considered a valuable and positive pedagogical method for use in paramedicine education.

The King Cobra, Ophiophagus hannah (Cantor 1836), is the longest venomous snake in the world; it is globally threatened and has been categorized as Vulnerable (VU) on the IUCN Red List. Herein we describe distribution, habitats, and nesting behavior of the King Cobra in Trashigang Forest Division, Bhutan. We recorded a total of 18 King Cobras during the one-year survey period. The elevational distribution was 650–2,057 m but most sightings were at lower elevations. King Cobras did not appear to prefer or avoid any particular habitat type but most records were from areas where human disturbances were at a minimum. We monitored a nest containing 37 eggs that was actively guarded by a female. This study was the first of its kind in Trashigang Forest Division and we hope that the information obtained will help formulate appropriate conservation strategies for this globally threatened species.

Postgraduate training of dental technicians is their right and obligation, to meet the expectations of patients and dentists in the provision of health care. On May 31, 2019, the Bulgarian Association of Dental Technicians was established. It is still unable to organize its activities in the direction - organization and control of postgraduate education. Our purpose is to find out if teachers are willing to participate in continuing education for practicing dental technicians, the directions in which they have the opportunity to do this and who should organize it. To achieve this purpose we used the following methods: study of literature sources, documents, sociologically, graphic and descriptive analysis to present the results. We found that, according to a large part, continuing education should be organized by Bulgarian Association of Dental Technicians, the second place is assigned to Bulgarian Association of Dental Technicians jointly with the colleges, and the third place is represented by the manufacturing companies of materials and devices. together with prominent specialists from the practice. Most of them are ready to participate in the postgraduate training of dental technicians, with the predominance of the respondents ready to organize courses in the field of modern methods and means for restoration of the defects of the dental crowns and dental rows with non-removable dental prosthetic structures. A small part of the teachers (27,78%) offer other additional courses, which will help practicing dental technicians: for development and management of practice; in the mentoring process; to create a publishing activity.

Accurate pancreatic and periampullary cancer staging with resectability assessment is vital to optimize surgical management and improve patient outcomes. The aim of this study is to assess the usefulness of a standardized reporting template.Retrospective review of all surgically managed patients with pancreatic or periampullary malignancy between January 2018 and June 2019. Pre-operative CT imaging report was anonymised and audited against a modified NCCN reporting template. The same imaging studies were re-reported by two experienced GI radiologists using the same template.Fifty-nine patients (37 male) with median age of 68 years (36-83) underwent surgery for suspected pancreatic/peri-ampullary malignancy. The median time between pre-operative CT scan and surgery was 56.5 days (14-225). The use of reporting template resulted in significant increase in number of reported key features (p 0.005), interobserver agreed features (p 0.005) and overall k-value assessed interobserver agreement (p 0.005). Template reports correlated closely with key intraoperative findings whilst primary free text reports did not (k-value 0.85-0.96 versus 0.20-0.46, p 0.05).The use of a reporting template resulted in a more complete and accurate pancreatic/peri-ampullary tumour evaluation, improved inter-observer relatability and correlation with intraoperative findings.

Introduction: Paramedic duties include assessing, treating, and maneuvering patients in physically challenging environments. Whether clinical skills and patient care are affected by these occupational demands is unknown. High-fidelity simulation affords the opportunity to study this in a controlled setting. Methods: Using a randomized crossover design, 11 regional paramedicine students and graduates (mean ± SD age = 23 ± 2 years) completed two, 20-minute high-fidelity simulations that included cardiopulmonary resuscitation (CPR) immediately after either an acute bout of occupational physical activity (OPA) or a rest period (REST). Heart rate, respiratory rate, and mean arterial pressure were measured throughout. Clinical performance was scored using the Global Rating Score and a patient care record. Measures of CPR efficacy were recorded in the manikin. Results: There were no significant differences in Global Rating Score (P = 0.07, ES = 0.03) or CPR efficacy between conditions. Patient care record accuracy was higher after the OPA versus REST simulations (mean ± SD = 61.8 ± 12.6% vs. 55.5 ± 12.0%, P = 0.03, ES = 0.5). Mean heart rate was higher during OPA simulations versus REST simulations (121 ± 14 vs. 84 ± 9 beats per minute, P < 0.01, ES = 3.1), as was mean respiratory rate (19 ± 3 vs. 16 ± 3 breaths per minute, P < 0.01, ES = 1.0). Mean arterial pressure was higher for OPA versus REST at simulation start (105 ± 11.3 vs. 95.8 ± 11.8 mm Hg, P = 0.01, Effect Size = 0.8), although not different after simulation. Conclusions: Paramedicine students including recent graduates performed as well, or better, in a simulated clinical scenario immediately after occupation-specific acute physical exertion compared with a REST, despite higher physiological exertion. Whether this is the case for more experienced but potentially less physically fit paramedics in the workforce warrants investigation.

The existence of street vendors (in Indonesian called Pedagang Kaki Lima/PKL), who are often shabby and disturb the visual image of the city, has become an issue raised in this community service program. This service program assists PKL Communities along Wahidin Sudirohusodo Street Yogyakarta (in front of the Duta Wacana Christian University Campus). The PKL Wahidin community has the intention to improve itself to organize street vendors that involve relevant stakeholders (according to the Yogyakarta City ‘gandeng-gendong’ program) it is hoped that it can become an identity for an image of a city in Yogyakarta. The process of designing street vendors tents using participatory design methods, community-based design with stages in the form of surveys, observations, interviews, Focus Group Discussion (FGD), and making tent design mockups. The participatory design method chosen was expected to make the community have a ‘sense of belonging’ to the arrangement of street vendors along Wahidin Street so that sustainability would be created. This tent design can later be moved (movable) and following user needs and because the location of the design sidewalks remains environmentally friendly to pedestrians.

A previously published model of avian electrocution risk, the “2014 model,” compared power poles that electrocuted birds (electrocution poles; including 21 golden eagle Aquila chrysaetos electrocutions) with poles not known to have electrocuted birds (comparison poles). The 2014 model produces pole-specific risk index scores between 0 and 1. The scores rank relative risk so electric utilities can maximize conservation benefits per dollar spent by focusing retrofitting on poles with greatest risk. Although the creation of the 2014 model encompassed a study population of birds and poles in southern California, the 2014 model has potential for use in managing a target population of raptors including golden eagles throughout the western United States. Use beyond southern California is only appropriate if the study population is similar enough to the target population for the 2014 model to predict risk effectively. To evaluate similarity, we examined five sources of evidence: 1) the relative consistency in electrical safety codes for power poles; 2) the body sizes of golden eagles in the study and target populations; and consistency in structure-specific factors associated with 3) golden eagle electrocutions in other studies, 4) other avian electrocutions, and 5) previously unreported golden eagle electrocutions. We found that although the study population in the 2014 model included relatively few golden eagles, data were sufficient to create a model that is applicable to a target population throughout the western United States. The model also can be useful in helping determine equivalencies between pole types if utilities seek to compare benefits of retrofitting small numbers of high-risk poles with large numbers of low-risk poles.

Recent studies have obtained inadequate data on the association between nutritional status, body composition, clinical parameters and tumor stage in patients withpancreatic and periampullary tumors. The purpose of this study was to assess the relationship between nutritional status (NS), body composition (BC) and selected clinical parameters in patients with pancreatic and periampullary cancer, as well as describe the differences between resection and non-resection groups. This is a prospective study of 76 patients with pancreatic and periampullary tumors. We evaluated NS, BMI, body mass loss (BML) and albumin, total protein, CRP, CEA, CA19-9, lipase, amylase, tumor stage, and BC using bioelectrical impedance (BIA). All subjects were divided into resection (n = 59) and non-resection (n = 17) groups. The non-resection group had a worse NS, as well as increased amylase and WBC, compared to the resection. The selected parameters of BC corresponded to BML albumin, TP, NS, age, BMI, Karnofsky, RBC, HCT and HGB. No associations were found between BC with tumor size, CRP, CA19-9, and CEA. We recorded the relationship between metastasis and NRS, as well as tumor size with SGA. The percentage of BML was positively correlated with age and CRP but negatively correlated with RBC, HGB, HCT and anthropometric measurements. We found many statistical correlations with NS and selected parameters, as well as differences between the resection and non-resection group. The detection of early prognostic factors of nutritional impairments would improve the quality of life and reduce the rate of postoperative complications.

Introduction Even with the benefits of vaccinations, some parents refuse vaccinations because of the influence of vaccine opponents. The purpose of this article is to identify common vaccine concerns on public forums and address these concerns with scientific evidence, thereby offering pediatric nurse practitioners (PNPs) information on how to respond. Method Six electronic databases were searched to identify parental concerns regarding vaccines and provide evidence-based responses to each concern. Results Some parents are concerned that health care providers do not obtain written informed consent before vaccinating their children. Another common concern is that pharmaceutical companies are solely motivated by financial profits when manufacturing vaccines. Parents also share concerns about vaccine manufacturers’ exemption from liability for those who suffer a vaccine-related injury. Discussion PNPs are responsible for addressing parents’ concerns regarding vaccines and providing the public with correct information. PNPs are in a prime position to influence parental vaccine decision-making positively.

Background Internationally increasing demand for emergency care is driving innovation within emergency services. The Alternative Pre-Hospital Pathway (APP) Team is one such Community Emergency Medicine (CEM) initiative developed in Cork, Ireland to target low acuity emergency calls. In this paper the inception of the APP Team is described, and an observational descriptive analysis of the APP Team’s service data presented for the first 12 months of operation. The aim of this study is to describe and analyse the APP team service. Methods The APP Team, consisting of a Specialist Registrar (SpR) in Emergency Medicine (EM) and an Emergency Medical Technician (EMT) based in Cork, covers a mixed urban and rural population of approximately 300,000 people located within a 40-min drive time of Cork University Hospital. The team are dispatched to low acuity 112/999 calls, aiming to provide definitive care or referring patients to the appropriate community or specialist service. A retrospective analysis was performed of the team’s first 12 months of operation using the prospectively maintained service database. Results Two thousand and one patients were attended to with a 67.8% non-conveyance rate. The median age was 62 years, with 33.0% of patients aged over 75 years. For patients over 75 years, the non-conveyance rate was 62.0%. The average number of patients treated per shift was 7. Medical complaints (319), falls (194), drug and alcohol related presentations (193), urological (131), and respiratory complaints (119) were the most common presentations. Conclusion Increased demand for emergency care and an aging population is necessitating a re-design of traditional models of emergency care delivery. We describe the Alternative Pre-Hospital Pathway service, delivered by an EMT and an Emergency Medicine SpR responding to low acuity calls. This service achieved a 68% non-conveyance rate; our data demonstrates that a community emergency medicine outreach team in collaboration with the National Ambulance Service offering Alternative Pre-Hospital Pathways is an effective model for reducing conveyances to hospital.

Purpose Knowledge about the most prevalent types of Kennedy classifications is of great value and will enlighten dental students, dental technicians, and practitioners regarding the treatment needs of their patients, ultimately leading to better treatment outcomes. The aim was to determine the prevalence of various Kennedy classifications among patients attending clinics at the College of Dentistry at King Saud bin Abdulaziz University for Health Sciences and King Abdulaziz Dental Center, National Guard Health Affairs, who were seeking treatment for partial edentulism. Methods An observational cross-sectional study was conducted by visualizing cast models for partially edentulous patients. Kennedy classification, age, gender, and treatment design were recorded from the lab request sheets that were attached to the casts in the labs at both the College of Dentistry at King Saud bin Abdulaziz University for Health Sciences and King Abdulaziz Dental Center, National Guard Health Affairs. The statistical analyses were performed with SPSS version 20.0 utilizing frequency and Pearson’s and Spearman’s correlation tests. Results Kennedy Class I (45.0%) was the most prevalent pattern in both dental arches, followed by Class III (26.2%). Next was Class II (23.3%), while Class IV was the least prevalent (5.4%). Conclusion Kennedy Class I was the most noted classification in our patient population. As age increases, there is an increased tendency toward Class I and II.

Objectives: To assess the prevalence of orthostatic hypotension (OH) and the association of OH with the risk of falls among community-dwelling older adults with a previous fall. Design: Longitudinal study. Setting and Participants: The subjects (n = 561) were participants in fall prevention conducted in western Finland. Methods: Blood pressure (BP) was measured in supine position and at 30 seconds and 3 minutes after standing. The participants were divided according to the consensus definition to an OH group (OHG) and a non-OH group (non-OHG). Falls were recorded by fall diaries during 12 months. Falls requiring treatment were gathered from health center and hospital registers during 12 and 36 months. Results: The prevalence of OH was 23.4% (30 seconds) and 7.3% (3 minutes). The 30-second measurement showed that the incidence of falls and that of falls requiring treatment were significantly higher in OHG compared with non-OHG during 12 months. After adjustments, the incidence of falls remained higher in all 5 adjusted models whereas that of falls requiring treatment remained higher only after adjustment for functional balance. The 3-minute measurement showed that the incidence of falls was higher in OHG compared with non-OHG during 12 months and remained higher after adjustments for functional balance and for age and functional balance. During the 36-month follow-up, OH measured at 30 seconds or 3 minutes after standing was not associated with the occurrence of falls leading to treatment. Conclusions and Implications: OH at 30 seconds or 3 minutes after standing is associated with a greater risk for falling within 12 months in older adults. The 30-second blood pressure measurement is more reliable to detect the risk than the 3-minute measurement. The results support the usability of 30-second measurement in determining OH and the risk for falling among older persons. (C) 2021 The Authors. Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.

In recent years, the number of dental technicians (DTs) in Japan has fluctuated around 35,000. However, this number is expected to decline dramatically in future, given the increase in the number of older DTs and marked decline in the number of younger DTs. This is a review of various reports analyzing the supply of and demand for DTs in Japan and a description of prospective measures to ensure a sufficient supply of DTs in future. Several previous reports have suggested that the number of DTs will fall more rapidly than the demand. However, there are only few quantitative assessments of the supply of and demand for DTs, and extensive investigation of how the decrease in numbers will affect the future of dental services is required. The role of each Japanese dental profession, that is, dentists, dental hygienists, and dental technicians, is well-defined; they are to provide dental services to the Japanese people. Therefore, it is necessary to maintain the required number of each dental profession in future. For clarity on the social situation of DTs and to help in taking immediate measures, it is important to analyze the supply and demand of DTs from various perspectives, such as region.

The paper presents statistical research results regarding the occurrence of which dangerous aviation events in 1919-2018. The source of the information about the events was the AviationSafetyNetwork website. With the use of Excel 2016 and Statistica v. 12 computer programs, five-time intervals were identified in which hazardous aviation incidents took place.Characterizing the distribution of these events in all periods, due to the technological advancement and capabilities of airplanes, the distribution of dangerous events in the last three periods was compared. The following tests were used to verify the statistical hypotheses: , Shapiro-Wilk, Brown-Forsythe, Kruskal-Wallis. When choosing the appropriate test, the following factors were taken into account: the type of measurement scale, the dependence/independence of samples, and their number. The standard significance level was assumed to be α = 0.05. The consequences and repeatability of aviation events in the identified time intervals were analyzed. The research questions that were posed were the following: in which seasons of the year, months, days of the month, and days of the week did the most dangerous events deaths occur? How often did dangerous events take place? Was the distribution of events similar in the identified periods? The results of the conducted research allowed to identify five periods in which hazardous events took place and demonstrate that in particular periods the distribution of hazardous air events in subsequent seasons, months, and days of the week was not the same.

INTRODUCTION: The impact of amyloid positron emission tomography (PET) imaging on patient health outcomes for individuals with dementia is unknown. In the present study, we explored the association between diagnostic outcome and clinician's level of certainty with quality of life (QoL) after [18F]flutemetamol PET results were disclosed in young onset dementia patients in a memory clinic cohort.METHODS: In 154 patients suspected of dementia, QoL was measured before and after [18F]flutemetamol PET results were disclosed. Multiple regression analyses were conducted with (changed) general and disease-specific QoL measures as dependent factors [QoL-Alzheimer disease (AD) and EQ-5D Dutch tariff] and etiological diagnosis and clinician's certainty as independent factors.RESULTS: (Change in) diagnosis of AD was associated to QOL in 2 of the 4 analyses (utility-based QoL β=0.15, P=0.010; disease-specific QoL β=2.0, P=0.037). Diagnostic certainty was associated to QOL in 1 of the 4 analyses (generic QoL β=0.002, P=0.028).DISCUSSION: The diverse results in this explorative analysis do not reflect a univocal association between diagnosis, certainty, and QoL. Nevertheless, this result could be interpreted as a possible potential for advanced diagnostic technologies for AD, which requires confirmation in future research.

As banking firms attempt to attract and retain customers, a default is to add technological services (most recent mobile banking), even though previous studies have found that bank tellers are most...

PurposeIn the context of early detection of frail older people, prior research found several risk factors of multidimensional frailty. The current study aims to validate these risk factors.Design/methodology/approachTwo data sets, Belgian Ageing Studies and Detection, Support and Care for older people: Prevention and Empowerment (BAS and D-SCOPE), in three Belgian municipalities (Ghent, Knokke-Heist and Thienen) were used and compared. The BAS data set (N = 1496) is a representative sample of community-dwelling older adults (60+), while the recruitment of the D-SCOPE sample (validation sample, N = 869) is based on risk factors (e.g. age, marital status, moved in the past 10 years). Frailty was measured with the comprehensive frailty assessment instrument (CFAI). The validity was examined by means of prevalence rates, distribution and the odds rates within both data sets.FindingsThe validation sample had an increase in the percentage of elderly who were mildly and highly frail for physical frailty (men: +17.0 percent point, women: +20.7 percent point), for psychological frailty (men: +13.4 percent point, women: +13.7 percent point), for social frailty (men: +24.8 percent point, women: +4.8 percent point) and environmental frailty (men: +24.2 percent point, women: +6.8 percent point). The present results indicate that the risk of being mildly or highly frail was higher in the validation sample in comparison with the BAS data.Originality/valueThe present study proved the validity of aforementioned risk factors. Selecting older people based on these risk factors proved to be an effective strategy for detecting frail older people.

BACKGROUND: Many frail older adults have an unhealthy dentition; unrestorable broken teeth and root remnants with open root canals, commonly accompanied by periapical and periodontal inflammation, are often seen. Improving oral health in the growing group of frail older adults with remaining teeth is a considerable challenge for dental care professionals. Dentists are often uncertain how to deal with root remnants and unrestorable broken teeth in frail older adults.METHODS: The authors aim was to provide recommendations to dentists to help in their clinical decision making about the extraction or retention of roots remnants and broken teeth in frail older adults.CONCLUSIONS: Decisions about the extraction or retention of root remnants should made on the basis of preventing pain and oral discomfort, preventing severe inflammation, and preventing additional decline in oral health. Both root-related and patient-related factors are considered.PRACTICAL IMPLICATIONS: Decision-making trees can help dentists decide whether to extract root remnants and unrestorable broken teeth in frail older adults.

Background Increasing hospitalization rates present unique challenges to manage limited inpatient bed capacity and services. Transport by paramedics to the emergency department (ED) may influence hospital admission decisions independent of patient need/acuity, though this relationship has not been established. We examined whether mode of transportation to the ED was independently associated with hospital admission. Methods We conducted a retrospective cohort study using the National Ambulatory Care Reporting System (NACRS) from April 1, 2015 to March 31, 2020 in Ontario, Canada. We included all adult patients (≥18 years) who received a triage score in the ED and presented via paramedic transport or self-referral (walk-in). Multivariable binary logistic regression was used to determine the association of mode of transportation between hospital admission, after adjusting for important patient and visit characteristics. Results During the study period, 21,764,640 ED visits were eligible for study inclusion. Approximately one-fifth (18.5%) of all ED visits were transported by paramedics. All-cause hospital admission incidence was greater when transported by paramedics (35.0% vs. 7.5%) and with each decreasing Canadian Triage and Acuity Scale level. Paramedic transport was independently associated with hospital admission (OR = 3.76; 95%CI = 3.74–3.77), in addition to higher medical acuity, older age, male sex, greater than two comorbidities, treatment in an urban setting and discharge diagnoses specific to the circulatory or digestive systems. Conclusions Transport by paramedics to an ED was independently associated with hospital admission as the disposition outcome, when compared against self-referred visits. Our findings highlight patient and visit characteristics associated with hospital admission, and can be used to inform proactive healthcare strategizing for in-patient bed management.

In the United States, 7,000-8,000 people are bitten by a venomous snake each year, out of which approximately 5 die. Although common practice is to treat any and all victims of envenomation with repeated doses of antivenom, this approach is not without its risks. The gold standard for treating venomous snakebites with severe symptoms is antivenom. Although a standardized approach to treating envenomation is needed, it cannot be developed without first delineating current practices. This article discusses the ways in which advanced practice emergency nurses should manage bites from a variety of venomous snakes. It is divided into 4 main sections: (1) the types of venomous snakes found in the United States, their habitat, and the effects of their venom; (2) priorities of care in treating venomous snakebites; (3) preparation and administration of antivenom; and (4) other considerations for the advanced practice emergency department nurse.

Background:After a first episode of psychosis, cognitive impairments present an important barrier to successful (re-)entry into work and education. We assessed whether cognitive remediation (CR) as an add-on to Individual Placement and Support (IPS) can improve participation in regular employment and education.Method:Participants with early psychosis (N = 73) were randomly assigned to receive IPS supplemented with computerized CR, or IPS plus an active control intervention (computer games). The primary outcome was the number of hours spent in competitive employment or regular education, which was assessed every month during the 18-month study period. Secondary outcomes included employment rate, cognitive functioning, mental health (assessed at baseline, 6 and 18 months), and job duration (assessed after 18 months). Both patients and assessors were blind to treatment.Results:Participants receiving IPS + CR showed greater improvement of competitive employment over time in terms of hours worked (during follow-up period: 38.5 vs. 19.6 h, B = 2.94; Wald χ2 = 5.39; P = .02) and employment rate (at T2: 62.1% vs. 25.9%, χ 2 = 7.39; df = 1; P = .008), compared with the IPS + control group, particularly in the longer term. The number of hours spent in regular education was lower in the IPS + CR group, with more participants having ended education for a positive reason. There was a significant beneficial effect of adjunctive CR for executive functioning, subjective cognitive functioning, and empowerment.Conclusions:Augmenting IPS with CR has a significant impact on competitive employment in people with early psychosis, with beneficial effects being more pronounced after 18 months.

Background Community paramedicine programs (i.e., physician-directed preventive care by emergency medical services personnel embedded in communities) offer a novel approach to community-based health care. Project Swaddle, a community paramedicine program for mothers and their infants, seeks to address (directly or through referrals) the physical, mental, social, and economic needs of its participants. The objective of this process evaluation was to describe women’s experiences in Project Swaddle. By understanding their experiences, our work begins to build the foundation for similar programs and future examinations of the efficacy and effectiveness of these approaches. Methods We completed 21 interviews with women living in Indiana (July 2019–February 2020) who were currently participating in or had graduated from Project Swaddle. Interviews were audio-recorded, transcribed, and analyzed using a six-phase approach to thematic analysis. Results Program enrollment was influenced by the community paramedics’ experience and connections, as well as information received in the community from related clinics or organizations. Participants viewed the community paramedic as a trusted provider who supplied necessary health information and support and served as their advocate. In their role as physician extenders, the community paramedics enhanced patient care through monitoring critical situations, facilitating communication with other providers, and supporting routine healthcare. Women noted how community paramedics connected them to outside resources (i.e., other experts, tangible goods), which aimed to support their holistic health and wellbeing. Conclusions Results demonstrate Project Swaddle helped women connect with other healthcare providers, including increased access to mental health services. The community paramedics were able to help women establish care with primary care providers and pediatricians, then facilitate communication with these providers. Women were supported through their early motherhood experience, received education on parenting and taking control of their health, and gained access to resources that met their diverse needs.

Background The COVID-19 pandemic has had an adverse effect on the mental health of population worldwide. This study was conducted to systematically review the existing literature to identify the individuals at higher risk of anxiety with a view to provide targeted mental health services during this outbreak. Methods In this study, the studies focusing on anxiety prevalence among the general population during the COVID-19 pandemic were searched in the PubMed, EMBASE, Scopus, Web of Science (WoS) and Google Scholar from the beginning of Covid-19 pandemic to February 2021. Results 103 studies constituting 140732 people included in the review. The findings showed that anxiety prevalence was 27.3% (95% CI, 23.7%; 31.2%) among general population while the prevalence in COVID-19 patients was 39.6% (95% CI, 30.1%; 50.1%). Anxiety was significantly higher among females and older adults (p≤0.05). In addition Europe revealed the highest prevalence of anxiety 54.6% (95% CI, 42.5%; 66.2%) followed by America 31.5% (95% CI, 19%; 47.5%) and Asia 28.3% (95% CI, 20.3%; 38%). In the general population the highest prevalence of anxiety was in Africa 61.8% (95% CI, 57%-66.4%) followed by America 34.9% (95% CI, 27.7%-42.9%), Europe 30.7% (95% CI, 22.8%-40%) and Asia 24.5% (95% CI, 20.7%-28.9%). Conclusion During the COVID-19 crisis, through identifying those who are more likely to be suffered from mental disorders at different layers of populations, it would be possible to apply appropriate supportive interventions with a view to provide targeted mental health services during the outbreak.

In this study was to determine knowledge of cardiovascular disease (CVD) risk factors and to explore related factors among adults with type 2 diabetes mellitus (DM) who have not been diagnosed with CVD. This descriptive study was conducted with 175 adults. Data were collected individual identification form and Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL) scale. A negative correlation was found between age and CARRF-KL score. A significant difference was found between educational status and CARRF-KL score. The individuals described their health status as good, managed their condition with diet and exercise, received information from nurses, adults with DM in their family and those with no DM complications had significantly higher scores in CARRF-KL. The knowledge of an individual with DM about CVD risk factors should be assessed, CVD risks should be identified at an early stage, and individuals at risk should be subjected to screening.

Background:In the care of people with intellectual disability, support staff apply restrictions to people with moderate intellectual disabilities (ID) in several domains of daily life, such as restrictions on bedtimes or on the amount of food intake. Support staff may experience moral dilemmas applying these restrictions. In this respect, moral case deliberation (MCD) is used as an instrument for support staff to jointly reflect on dilemmas in care and is considered a form of ethical support. MCD also seems to broaden the perspective of their participants.Specific Aims:This study examined to what extent MCD led to changes in support staff's perspectives with regard to daily life restrictions placed upon people with moderate ID. Consequently, this study examined to what extent support staff's perspectives on these restrictions were broadened as a result of their participation in the study.Method:Prior to and following a series of three MCD sessions on moral dilemmas commonly encountered in daily life care, interviews were held with 12 support staff across two teams. Participants were asked what they considered to be good care in the given dilemmas. To systematically compare all of the answers given in the interviews prior to and following the MCDs, the same interview-guide was used in both instances. Interviews were analyzed inductively.Findings:Following the MCD sessions, the respondents tended to hold onto their perspective to restrict clients to provide them with structure, clarity and rest, as expressed prior to the MCD. However, some respondents adapted their perspective on restrictions and were willing to provide people with moderate ID more freedom after the MCD.Discussion:This study contributed to the evidence underlying MCD in healthcare and in providing insights into MCD with regard to daily life restrictions in the care of people with moderate ID. Partly, MCD leads to a broadening of perspective on restrictions applied in the daily life of people with moderate ID.

Electrocution injuries are divided into high (HVI) and low voltage injuries (LVI). The aim of this study was to examine the sociodemographic data of cases where autopsy was performed because of dea...