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Objective: To analyze dental procedures and operating time provided to medically compromised and uncooperative pediatric patients under general anesthesia (GA). Method and materials: This cross-sectional retrospective study reviewed hospital records of pediatric patients treated under day-care GA at a Malaysian university hospital between January 2013 and December 2019. Dental procedures were categorized into preventive, restorative, pulp therapy, extraction, and surgical procedures. Age groups were categorized into < 6 years (primary), 6 to 12 years (mixed) and > 12 years old (permanent), to represent different dentitions. The treatment and operating times under GA were compared between age groups, sex, and medical conditions. Results: A total of 595 patients (455 uncooperative healthy and 140 medically compromised) were included in the study. The mean age of the patients was 5.7 years. Male patients (58.3%) outnumbered female patients (41.7%). The most frequently performed procedure was primary tooth extraction. A higher number of surgical procedures were performed on children aged > 12 years compared to younger age groups (P = .001). Children with medical problems had more preventive (mean 3.85 ± 3.65) than restorative treatments (mean 2.66 ± 2.80) and the results were reversed for healthy children. The mean operating time was 64.71 ± 27.89 minutes. Regardless of health status, children > 12 years old had longer operating times, and the mixed dentition group had the shortest treatment durations. Conclusions: Different types of dental treatment modalities are provided under GA for pediatric patients and operating time was associated with age group. Findings will be useful to improve efficiency of management of pediatric dental cases under day-care GA. [ABSTRACT FROM AUTHOR]

Objective: Bacteria entering the bloodstream through oral mucosa cause bacteremia, which can lead to septic or distant infections. The underlying factors and need for dental treatment in patients referred for oral examination because of septic infection were investigated. It was expected that general diseases and poor socioeconomic status of patients would increase the risk of bacteremia. Method and materials: This descriptive retrospective study included patients (N = 128) referred from medical clinics of the Helsinki University Hospital (HUH), during 2012 to 2017, to the Department of Oral and Maxillofacial Diseases due to bacteremia suspected to be of oral origin. Data were extracted from medical and dental records according to the World Health Organization International Classification of Diseases (ICD-10) for systemic or remote infections. Different groups were formed using modified Skapinakis classification for socioeconomic status (SES), from I (high) to V (low). Underlying medical conditions were retrieved according to McCabe classi- fication: healthy, nonfatal, ultimately fatal, and rapidly fatal diseases. The data were analyzed using the statistical software package SPSS (IBM). Results: Patients were referred most often from the Departments of Infectious Diseases and Internal Medicine. Because of infection, 12 patients needed aortic or mitral valve operations. Many of the patients were intravenous drug users. However, the majority of patients presented McCabe class I, indicating no systemic disease. The main SES was intermediate III. Tooth extraction was the principal mode of treatment. No demographic background variables were identified to explain increase of the risk for bacteremia except that most patients were men with untreated dental problems. Conclusions: Contrary to the authors' expectation, poor SES and underlying diseases did not seem to link to the outcome. However, untreated dental infections present an evident risk for life-threatening septic complications also in generally healthy individuals. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to analyze retrospectively the clinical reliability of complete-arch rehabilitations with screw-retained fixed prostheses supported by four dental implants inserted with a fully guided surgical protocol. Materials and Methods: All the implants were placed between December 1, 2015, and April 30, 2019. Digital implant surgical planning was performed for all the complete-arch rehabilitations, and then, fully guided surgery was performed. The fixed provisional prostheses were delivered the day of the surgery and replaced by definitive prostheses after the healing period. Patients were followed up to determine survival of the implants and success of the overall treatment. Results: A total of 160 implants were positioned in 37 patients, with three patients receiving rehabilitations in both arches. A total of 40 complete-arch rehabilitations were performed, 26 in the maxilla and 14 in the mandible. Only five implants failed, resulting in an overall implant survival rate of 96.9%. No definitive prostheses failed, resulting in a 100% prosthetic success rate. The failed implants were successfully replaced before definitive prostheses were made, resulting in an overall treatment success of 100%. Conclusion: Within the limitations of this study, digital planning and guided surgery to perform complete-arch rehabilitations on four dental implants seems to be a valid treatment option. However, several prospective studies with longer follow-up are needed to achieve more predictable results. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the long-term survival and success rates of dental implants placed with autogenous onlay block bone grafts harvested from the mandibular ramus. Materials and Methods: Patients treated with onlay bone graft from the mandibular ramus due to a severe vertical alveolar defect from 2001 to 2017 were included in this study. The marginal bone loss, success, and survival time of the implants were recorded and analyzed with clinical factors, such as time from bone graft to implant placement, type of implant prosthesis connection, history of periodontitis, and insertion depth. Results: Seventy-five implants in 40 onlay bone-grafted areas of 38 patients were included, with a mean follow-up period of 102 months (range: 14 to 192 months). Two grafts were removed before implant placement. Of the 75 implants, 11 implants were lost. History of periodontitis and marginal bone loss at 6 months after implant placement were significantly associated with implant success. The receiver operating characteristic curve showed that a marginal bone loss of 0.75 mm after 6 months of implant placement was related to implant success, with a sensitivity of 72.2% and specificity of 89.6%. Conclusion: Implants placed with onlay bone graft from ramal bone had more frequent biologic complications, and failures may be predicted by measuring the amount of implant bone loss after 6 months of placement. [ABSTRACT FROM AUTHOR]

Purpose: The objective of this study was to quantify the probability of implant failure over time from intrinsic patient factors using a population of patients from multiple private practices. Materials and Methods: The records for this retrospective, multicenter cohort study were randomly selected from eight private practices. The primary outcome variable was time to event (implant failure or last known follow-up). The included independent variables were age, sex, diabetes status, smoking status, and arch location. Analyses were performed with Cox proportional hazards on three models: univariate, full multivariate, and systemic factor multivariate. The probability of implant survival at 1, 5, and 10 years was calculated using univariate time-to-event modeling on log-normal distribution with 95% CIs and Cox proportional hazard tests for significance. The Kaplan-Meier survival curve was calculated for patients < 71 years of age. Results: Eight hundred thirty-five implant-level records from 378 patients were collected for analyses. The mean patient age was 60 years, and 48% were men, 15% reported a history of smoking, and 16% reported having diabetes. The follow-up time was as long as 17 years, with a mean of 23.1 months, and a median of 7 months. The hazard ratio (HR) for implant failure due to sex (HR = 1.18; 95% CI: 0.52 to 2.66), smoking (HR = 1.30; 95% CI: 0.49 to 3.46), diabetes (HR = 1.17; 95% CI: 0.35 to 3.86), and arch location (HR = 2.13 to 3.39) failed to reach the threshold within any Cox proportional hazards model (P > .05). Conclusion: The implant survival probability for patients = 70 years of age is 86.4% at 10 years in the course of routine private practice by experienced providers. Cautious interpretation of these results is critical, as the effects of known systemic risk factors are likely tempered by effective modifications in clinical decisions and protocols with short- and long-term follow-up maintenance. [ABSTRACT FROM AUTHOR]

Purpose: The SAC Assessment Tool is a clinical decision support system based on the foundations of the SAC Classification System in Implant Dentistry developed by the International Team for Implantology in 2009. It objectively classifies a patient’s rehabilitation with dental implants as straightforward, advanced, or complex, from both a surgical and restorative perspective. The aim of this research was to test the agreement between observers with different qualification levels and clinical experience when using this clinical decision support system as a method that mitigates risk. Materials and Methods: A total of 30 patients were randomly selected from clinical records, and diagnostic casts, intraoral and extraoral images, and panoramic radiographs were obtained. All data were analyzed with and without the SAC Assessment Tool by a dentist with advanced training and clinical experience in implant dentistry (control dentist) and compared with three colleagues (dentists 1, 2, and 3) with fewer qualifications and less clinical experience. All data were analyzed using statistical agreement tests (Fless kappa), interclass correlation, and agreement rate. The level of significance (α) was set at .05. Results: All patients included in this research presented 104 edentulous areas, which were subjected to surgical evaluation for possible placement of dental implants. Concerning the degree of risk evaluation for dental implant treatment, the results of this study found that the agreement rate of the control dentist without SAC and control dentist with SAC was excellent (81.7%); the agreement rate of the control dentist and dentists 1, 2, and 3 with the use of SAC was satisfactory (67.3% to 76.0%); the variable that presented a lower agreement rate (34.6%) was the comparison between dentists 1, 2, and 3 without use of the SAC Assessment Tool. Conclusion: The SAC classification seems to be a useful tool to assist dentists with less experience in implant dentistry with defining the complexity of the treatment and hence with patient selection. It helps in the collection and homogenization of important clinical data to assess the risk of implant-based rehabilitations, thus contributing to an increase in the agreement rate. [ABSTRACT FROM AUTHOR]

Purpose: High cardiorespiratory capacity is a key determinant of human performance and life expectancy; however, the underlying mechanisms are not fully understood. The objective of this pilot study was to investigate biochemical signatures of endurance-performance athletes using high-resolution nontargeted metabolomics. Methods: Elite long-distance runners with similar training and anthropometrical records were studied. After athletes' maximal oxygen consumption ( V ˙ O 2 max) was measured, they were divided into 2 groups: low V ˙ O 2 max (<65 mL·kg−1·min−1, n = 7) and high V ˙ O 2 max (>75 mL·kg−1·min−1, n = 7). Plasma was collected under basal conditions after 12 hours of fasting and after a maximal exercise test (nonfasted) and analyzed by high-resolution LC–MS. Multivariate and univariate statistics were applied. Results: A total of 167 compounds were putatively identified with an LC–MS-based metabolomics pipeline. Partial least-squares discriminant analysis showed a clear separation between groups. Significant variations in metabolites highlighted group differences in diverse metabolic pathways, including lipids, vitamins, amino acids, purine, histidine, xenobiotics, and others, either under basal condition or after the maximal exercise test. Conclusions: Taken together, the metabolic alterations revealed in the study affect cellular energy use and availability, oxidative stress management, muscle damage, central nervous system signaling metabolites, nutrients, and compound bioavailability, providing new insights into metabolic alterations associated with exercise and cardiorespiratory fitness levels in trained athletes. [ABSTRACT FROM AUTHOR]

Clinical records of patients who underwent implant-supported rehabilitation according to the biologically oriented preparation technique (BOPT) principles were retrospectively analyzed. Records of 189 nonconsecutive patients who received 502 implants were reviewed. At the last follow-up visit (occurring on average 5.11 years after prosthesis delivery), 466 (92.8%) implants had a Gingival Index of 0, and 491 (97.8%) presented no bleeding on probing. Four hundred eighty-nine crowns on as many implants (97.4%) showed no sign of gingival recession. Technical complications occurred with 10 implants (2.0%) and 6 patients (3.2%). Biologic complications were detected with 14 implants (2.8%) and 6 patients (3.2%). When the BOPT approach is applied to rehabilitate patients using implant-supported prostheses, excellent medium-term results concerning soft tissue health may be achieved. [ABSTRACT FROM AUTHOR]

Purpose: This nonrandomized, retrospective multicenter study aimed to evaluate success rates, peri-implant marginal bone loss, and clinical parameters around single implants with and without laser-microgrooved collars placed and loaded using different protocols after 7 to 10 years of function. Materials and Methods: A chart review was used to select patients treated at five private dental clinics with single dental implants with and without laser-microgrooved collars. Cumulative success rates, peri-implant marginal bone loss, probing depth, Plaque Index, bleeding on probing, and gingival recession were recorded at baseline examinations (ie, definitive restoration delivery) and at each year during the follow-up period. Results: Three hundred single implants (140 without laser-microgrooved collars and 160 with 1.7-mm laser-microgrooved collars) in 300 patients were selected. At the completion of the study period, 26 patients and 26 implants (17 with and 9 without a laser-microgrooved collar) were classified as "dropouts." Implants and restorations were categorized into two subgroups each for a total of four study groups: group 1, immediate implant placement; group 2, delayed implant placement; group 3, immediate nonocclusal loading of prostheses; and group 4, delayed loading of prostheses. Nineteen implants (6.9%) failed clinically (4 [2.7%] with and 15 [11.4%] without a laser-microgrooved collar). The difference in cumulative success rates was statistically significant (P < .05). Radiographically, at the end of the follow-up period, the laser-microgrooved group showed a mean peri-implant marginal bone loss of 0.64 mm compared with 1.82 mm for the non-laser-microgrooved group. At the same time point, a mean probing depth of 0.76 mm was observed for the lasermicrogrooved group compared with 2.75 mm for the non-laser-microgrooved group. A statistically significant difference in peri-implant marginal bone loss and probing depth between the two types of implant collars was evident (P < .05). No statistically significant correlation was noted between the types of implant placement/prosthetic restoration and clinical parameters. Conclusion: Implants with a laser-microgrooved collar appear to influence the peri-implant soft and hard tissue stability, reducing the probing depth levels and the peri-implant marginal bone loss by more than 50% after 10 years of function, regardless of the type of implant placement and loading protocol. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this preliminary study was to evaluate maxillary bone resorption with conventional dentures and implant-supported prostheses opposed by distal-extension removable partial dentures (RPDs). Materials and Methods: Fifteen patients (seven women and eight men) with totally edentulous maxillary ridges and partially edentulous mandibular ridges (Class I Kennedy classification) received maxillary fixed prostheses on four implants and mandibular distal-extension RPDs (study group). The control group consisted of 15 patients who received conventional maxillary dentures and distal-extension mandibular RPDs without any implant treatment but were matched to the study group and acted as a historical group. Evaluation of vertical maxillary bone resorption for both groups was made at the time of prosthesis insertion (T0) and 5 years later (T2) using the proportional area measurements made on digital panoramic radiographs for anterior and posterior areas. Results: The control group showed significantly higher vertical bone loss than the test group (P < .001). The control group had 0.270 higher maxillary bone loss than the test group. For both groups, anterior maxillary areas showed significantly higher bone loss than posterior areas (P < .003). Anterior maxillary areas had 0.122 higher bone loss compared with posterior areas. Women had 0.035 higher maxillary bone loss compared with men. Conclusion: Within the limitations of this study, implant-supported fixed prostheses for the edentulous maxilla opposed by remaining mandibular anterior teeth reduce maxillary anterior and posterior alveolar bone loss compared with conventional dentures. However, they do not prevent maxillary bone loss. [ABSTRACT FROM AUTHOR]

Purpose: To present functional and esthetic success of a well-defined protocol for rehabilitation with implant-supported complete-arch prostheses in the treatment of patients with maxillary edentulism. Materials and Methods: Medical records of patients treated from 1990 to September 2014 were reviewed. This clinic history should include clinical, anatomicalfunctional, and esthetic data for at least the first 5 years of follow-up. Results: Two hundred eighty-two implants were inserted into the pterygomaxillary-pyramidal region in 141 edentulous patients using cylindrical osteotomes to form bone sites and thereby minimize the use of drills in bone preparation. Also, 580 implants were inserted in the premaxilla using lyophilized bone of bovine origin as a graft material and platelet-rich plasma for repairing small bone defects around implants and as a volume-generating material to support perioral structures. Of the 282 implants placed in the pterygomaxillary-pyramidal region, 272 survived (96.1% survival rate). The 10 failures occurred after being subjected to functional load. Of the 580 implants placed in the premaxilla, 19 implants failed; thus, the survival rate was 96.7%. Moreover, from the results obtained in the study sample, it was observed that the retention and stability obtained with the implant-supported prosthesis helps improve the ability to speak, swallow, and chew, which improves patient comfort and satisfaction. Conclusion: The rehabilitation of total maxillary edentulism with an implant-supported complete-arch prosthesis achieves a high level of functional and esthetic success, which is reflected directly in oral health and patient satisfaction. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this retrospective study was to report the survival rate of a novel hybrid hydrophilic dental implant design for all bone types. Materials and Methods: This study evaluated the data collected from patients who received at least one implant to support a full-arch, partial, or single-crown dental rehabilitation in the maxilla or mandible. Implant survival rate was evaluated according to the clinical area and bone type, loading protocol, implant length and diameter, and placement torque. Results: A total of 453 tapered hybrid implants placed in 101 patients (mean age: 56.39 ± 12.98 years) were evaluated, and the survival rate was 99.6%. The follow-up period was up to 24 months. Regarding bone quality, types I, III, and IV presented a 100% survival rate, whereas type II presented a 99.3% survival rate. The vast majority of implants were immediately loaded (443 implants), which achieved placement torques between 32 and 60 Ncm or higher, and presented an implant survival rate of 99.5%. Conclusion: An overall survival rate of 99.6% was found for hydrophilic hybrid dental implants when placed in all bone types, and no statistically significant difference was observed between them. However, further studies should be necessary to confirm these preliminary results. [ABSTRACT FROM AUTHOR]

Purpose: Most pediatric physical activity and bone health research has focused on the period immediately around puberty; few have addressed bone structural strength outcomes. This study assessed the magnitude and consistency of the longitudinal relationships between device-measured vigorous-intensity physical activity (VPA) and structural bone strength outcomes across adolescence to emerging adulthood. Methods: Participants with 3 to 5 bone scans between the age of 11 and 19 years were studied (N = 439, 220 females, 1838 records). Dual-energy X-ray absorptiometry scans of the hip (hip structural analysis) and peripheral quantitative computed tomography scans of the tibia were obtained. Outcomes included femoral neck section modulus, femoral neck cross-sectional area, tibial Bone Strength Index, and tibial torsion strength (polar Strength Strain Index). Sex-specific bone mixed growth models were developed using biological age (chronological age − age at peak height velocity) as the time variable, and height, weight, and device-measured VPA as time-varying covariates. Models also included the VPA–biological age interaction. Results: Individual-centered VPA and the VPA–biological age interaction were significantly, positively associated (P <.05) with Bone Strength Index, polar Strength Strain Index, section modulus, and cross-sectional area in males and females, indicating accumulative effects of VPA throughout maturation and beyond. Conclusion: Bone remains responsive to the mechanical loading of physical activity throughout adolescence and into emerging adulthood. Attention should be placed on promoting bone-strengthening physical activity after the prepubertal years when adult exercise patterns are likely formed. [ABSTRACT FROM AUTHOR]

Purpose: Proton pump inhibitors (PPIs) are prescribed for the treatment of gastric reflux disease, but such medications might also influence bone metabolism. Therefore, the primary goal of this study was to determine if bone loss severity at dental implants could be associated with PPI use. Materials and Methods: Dental, medical, and radiographic history records of patients receiving dental implants at the University at Buffalo, School of Dental Medicine from 2000 to 2017 were reviewed in this retrospective clinical study. Bone loss around each implant was evaluated radiographically by direct measurement of crestal bone loss and by counting the number of radiographically evident exposed threads. PPI use was confirmed by medical record examination. The effects of systemic factors were assessed. Confidence intervals (CI) and P values of mean differences between PPI and non- PPI groups were computed via IBM SPSS Statistics v.25. Results: A total of 1,480 implants from 635 patients were used in this study. Greater crestal implant bone loss was associated with patients with a history of PPI medication use. Mean crestal bone loss of 1.60 mm was noted at implants from PPI patients, in contrast to 1.01 mm of crestal implant bone loss at implants from the non-PPI group (group difference = 0.59 mm, 58.40% increase, P = .024, CI [95%] = 0.08 to 1.09 mm). Following adjustment for systemic factors, those effects persisted, with crestal implant bone loss of 1.87 mm from PPI patients, in contrast to 1.04 mm from non-PPI patients (group difference = 0.83 mm, 79.80% increase, P = .028, CI [95%] = 0.09 to 1.56 mm). Similarly, 0.63 exposed threads per implant were found in the PPI group, in contrast to 0.38 supracrestal implant threads in the non-PPI patient group (mean difference = 0.25 exposed threads, 65.8% increase, P = .039, CI [95%] = 0.01 to 0.50 mm). After excluding systemic factors, a similar pattern was observed with 0.79 vs 0.36 threads exposed from subjects taking PPIs, compared with those not taking PPIs, respectively (mean difference = 0.43 exposed threads, 119.4% increase, P = .014, CI [95%] = 0.09 to 0.77 mm). Conclusion: The data suggest that PPI medications are related to more loss of crestal bone at implant sites. Patients receiving implant therapy might require more frequent periodontal maintenance. [ABSTRACT FROM AUTHOR]

This study's objective was to identify differences in risk for low energy availability and athletic clearance level by comparing scores on Female Athlete Triad Cumulative Risk Assessment (Triad CRA) and Relative Energy Deficiency in Sport Clinical Assessment Tool (RED-S CAT). A total of 1,000 female athletes aged 15--30 years participating in ≥4 hr of physical activity/ week for the previous ≥6 months completed an extensive survey assessing health, athletic history, family disease history, and specific Triad/RED-S risk factors. Retrospective chart review ascertained laboratory and bone mineral density measures. Triad CRA and RED-S CAT were used to assign each athlete's risk level (low, moderate, and high), and case-by-case comparison measured the level of agreement between the tools. We hypothesized that the tools would generally agree on low-risk athletes and that the tools would be less aligned in the specific elevated risk level (moderate or high). Most of the sample was assigned moderate or high risk for Triad CRA and RED-S CAT (Triad: 54.7% moderate and 7.9% high; RED-S: 63.2% moderate and 33.0% high). The tools agreed on risk for 55.5% of athletes. Agreement increased to 64.3% when only athletes with bone mineral density measurements were considered. In conclusion, Triad CRA and RED-S CAT provide consensus on the majority of athletes at elevated (moderate or high) risk for low energy availability, but have less agreement on the specific risk level assigned. [ABSTRACT FROM AUTHOR]

Purpose: To assess the pattern of bone loss in peri-implantitis in partially edentulous patients and relate patient and implant/site characteristics that may influence such patterns. Materials and Methods: In this retrospective study, the records of partially edentulous patients with dental implants were stratified according to sex, age, smoking, and diabetes. Implants were stratified according to site, number of years in function, presence of adjacent implants, diameter, bone-grafted site, and implant platform. All these variables were obtained from previous periodontal charts and radiographs. The implants were then classified into two main groups: (1) bone loss as defined by the presence of progressive marginal bone change found on radiographs at least 12 months following prosthesis placement compared to a baseline with a threshold ≥ 2 threads of bone loss; and (2) no bone loss as defined by no detected bone change or bone level change with a threshold < 2 threads. The bone loss group was further divided into three subgroups according to pattern: vertical, horizontal, and combined. Descriptive analyses were applied to assess the frequency of the pattern of bone loss (horizontal, vertical, and combined). A statistical regression model was used to find if there was a significant correlation between patient/implant characteristics and the pattern of bone loss. Results: A total of 304 charts with 540 implants met the inclusion criteria. One randomly selected implant per patient through Microsoft Excel software was included in this study. Of these, 157 (51.6%) of examined charts were men and 147 (48.4%) were women. The patients’ mean age was 63.9 ± 11.4 years (range: 27 to 85 years) at implant placement, and implants had been in function for 12 to 120 months (median: 37 months). The percentage of implants that had bone loss was 24.7% (75 out of 304). The pattern of bone loss was 65%, 22%, and 13% for vertical, horizontal, and combined, respectively. Implants that had been placed in surgically bone-grafted sites had increased odds of vertical bone loss with either narrow or wide implants (OR = 2.5 [P = .04] and 3.1 [P = .01], respectively). The presence of adjacent implants had significantly (P = .003) increased odds of horizontal bone loss (OR = 5.1). Conclusion: Approximately one-quarter of dental implants (24.7%) developed bone loss beyond normal physiologic remodeling. Vertical bone loss around single implants was the most common pattern (65%), particularly around implants placed in bone-grafted sites with odds ratio of 2.5 for narrow implants vs 3.1 for wide implants. In the presence of adjacent implants, the odds of horizontal bone loss was 5.1 (P = .003). [ABSTRACT FROM AUTHOR]

Introduction: The study evaluated the increased mortality risk within 14 days of coronavirus disease 2019 (COVID-19) diagnosis in dementia patients. Methods: This retrospective study was conducted from February to April 2020 using the COVID-19 patients' database from the Korea Disease Control and Prevention Agency. The risk factors for early death within 14 days were determined using generalized logistic regression performed in a stepwise manner. Dementia patients diagnosed with COVID-19 were used for the study. The propensity score-matched cohort was included as controls. The differences in mortality within 14 days after COVID-19 diagnosis between the dementia patients and controls were evaluated. Results: We enrolled 5,349 COVID-19 patients from the database; 224 had dementia as comorbidity. The mortality rate within 14 days after COVID-19 diagnosis in dementia patients and the controls was 23.7% versus 1.7%, respectively, before propensity score matching (PSM) (p < 0.001), and 23.7% versus 9.2% after PSM (p < 0.001). The hazard ratio (HR) for mortality within 14 days in COVID-19 patients with dementia was significant even after PSM (HR 5.104, 95% confidence interval 2.889–5.673, p < 0.001). The survival curve of dementia patients was steeply inclined within 14 days after COVID-19 diagnosis, resulting in 70.7% of all deaths in dementia patients. Conclusions: COVID-19 patients with dementia had a higher risk of early death within 14 days. Thus, prompt intervention is necessary for dementia patients after COVID-19 diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: To investigate associations between alcohol use, psychological treatment attendance, and clinical outcomes. Methods: We analysed electronic health records for N = 7,986 patients accessing psychological treatment for common mental disorders. Data were collected for pre‐treatment alcohol use (average units per week) and severity of dependence (SDS), number of therapy contacts attended, pre‐ and post‐treatment anxiety (GAD‐7), and depression (PHQ‐9) symptom severity. Hierarchical regression was used to examine associations between alcohol use/dependence and post‐treatment symptom severity controlling for intake severity and relevant confounders. Results: After controlling for confounders, alcohol use had significant nonlinear associations with pre‐treatment depression severity (R2 =.54, p <.01, cubic trend), and post‐treatment anxiety (R2 =.23, p <.01, quadratic trend). Alcohol use was not significantly associated with intake anxiety, post‐treatment depression or treatment duration. SDS was not significantly associated with depression severity, alcohol severity, or total contacts after controlling for confounders. Conclusion: Alcohol users are just as likely to engage in and benefit from evidence‐based psychological treatments for depression in primary care. A nonlinear association between alcohol use and anxiety treatment outcomes indicates that light‐to‐moderate drinkers have some shared characteristic that favours treatment response. Practitioner points: Depression and anxiety problems often co‐occur with alcohol use and dependence.Conventional wisdom in the field suggests that heavy alcohol users may not engage well or benefit from psychological therapies for depression and anxiety.We found no empirical support for the above assumptions in a large clinical sample.Alcohol consumption was not significantly associated with treatment attendance or depression treatment outcomes.A nonlinear association between alcohol use and anxiety outcomes suggests that moderate drinkers may have some shared characteristic that favours treatment response. [ABSTRACT FROM AUTHOR]

The present work empirically explores whether experts are trusted more or more persuasive than an "average Joe" when engaging in policy advocacy on public health topics. I conducted a 2 (topic: climate change vs. COVID-19) X 2 (source: expert vs. nonexpert) experimental study with an US adult sample (N = 486). Using Bayes factors to quantify evidence for null and alternative hypothesis, I find substantial evidence that at least under the conditions present in the study, experts are perceived to be higher in expertise, but equal in trustworthiness to the "average Joe". In turn, experts are equally persuasive to nonexperts on both topics. My work suggests that when engaging in policy advocacy on public health matters, the fact that an advocate is an expert on a topic can be acknowledged by audiences, but this may not necessarily help (nor necessarily harm) one's perceived trustworthiness or ability to persuade an audience. More research is needed to understand how experts can bolster their trustworthiness and persuasiveness when advocating for public health policies. [ABSTRACT FROM AUTHOR]

Purpose: Heavily T2-weighted 3D FLAIR (hT2w-3D-FLAIR) sequence with constant flip angle (CFA) has been reported as being more sensitive to low concentrations of gadolinium (Gd) enabling endolymphatic hydrops (EH) visualization. The purpose of this study was to compare signal-to-noise (SNR) ratio, detection rate of EH, and increased perilymphatic enhancement (PE) as well as diagnostic accuracy in diagnosing definite Menière's disease (MD), using 3D-SPACE FLAIR versus conventional 3D-TSE FLAIR. Methods: This retrospective study included 29 definite MD patients who underwent a 4-h delayed intravenous (IV) Gd-enhanced 3D-TSE FLAIR and 3D-SPACE FLAIR MRI between February 2019 and February 2020. MR images were qualitatively and quantitatively analyzed twice by 2 experienced head and neck radiologists. Qualitative assessment included grading of cochlear and vestibular EH and visual comparison of PE. Quantitative assessment of PE was performed by placing a region of interest (ROI) and ratio calculation in the basal turn of the cochlea and the brainstem. Results: The intra- and inter-reader reliability for grading of EH and PE was excellent (0.7 < kappa < 0.9) for 3D-SPACE FLAIR and exceeded the values for 3D-TSE FLAIR (0.5 < kappa < 0.9) The combination of EH and visual assessment of PE has the highest diagnostic accuracy in diagnosing definite MD on 3D-SPACE FLAIR with a sensitivity of 0.91 and a specificity of 0.98 resulting in a sensitivity raise of 6% compared to 3D-TSE FLAIR. Conclusion: Four-hour delayed IV Gd-enhanced 3D-SPACE FLAIR sequence has a higher sensitivity and reproducibility than 3D-TSE FLAIR for the visualization of EH and increased PE in definite MD patients. [ABSTRACT FROM AUTHOR]

Background: Heterogeneity of gliomas challenges the neuronavigated biopsy and oncological therapy. Diffusion and perfusion magnetic resonance imaging (MRI) can reveal the cellular and hemodynamic heterogeneity of tumors. Integrated positron emission tomography (PET)/MRI is expected to be a non-invasive imaging approach to characterizing glioma. Purpose: To evaluate the value of apparent diffusion coefficient (ADC), cerebral blood volume (CBV), and spatially co-registered maximal standard uptake value (SUVmax) for tissue characterization and glioma grading. Material and Methods: Thirty-seven consecutive patients with pathologically confirmed gliomas were retrospectively investigated. The relative minimum ADC (rADCmin), relative maximal ADC (rADCmax), relative maximal rCBV (rCBVmax), the relative minimum rCBV (rCBVmin), and the corresponding relative SUVmax (rSUVmax) were measured. The paired t- test was used to compare the quantitative parameters between different regions to clarify tumor heterogeneity. Imaging parameters between WHO grade IV and grade II/III gliomas were compared by t -test. The diagnostic efficiency of multiparametric PET/MRI was analyzed by receiver operating characteristic (ROC) curve. Results: The values of rSUVmax were significantly different between maximal diffusion/perfusion area and minimum diffusion/perfusion area (P < 0.001/ P < 0.001) within tumor. The values of rADCmin (P < 0.001), rCBVmax (P = 0.002), and corresponding rSUVmax (P = 0.001/ P < 0.001) could be used for grading gliomas. The areas under the ROC curves of rSUVmax defined by rADCmin and rCBVmax were 0.89 and 0.91, respectively. Conclusion: Diffusion and perfusion MRI can detect glioma heterogeneity with excellent molecular imaging correlations. Regions with rCBVmax suggest tissues with the highest metabolism and malignancy for guiding glioma grading and tissue sampling. [ABSTRACT FROM AUTHOR]

Background: Pulmonary infection is a major cause of morbidity and mortality in immunocompromised patients, in whom diagnostic yields of cone-beam computed tomography (CBCT)-guided percutaneous transthoracic needle biopsies (PTNBs) have not been evaluated so far. Purpose: To evaluate diagnostic yields and complications of CBCT-guided PTNBs in immunocompromised patients. Material and Methods: From January 2015 to January 2018, 43 patients (25 men, 18 women; mean age 54.1 ± 16.4 years) who were suspected of having pulmonary infections were included in this retrospective study. Electronic medical records and radiologic studies were reviewed, including the underlying medical status, information on target lesions, PTNB procedural factors, and pathologic results. Logistic regression was performed to explore factors related with post-PTNB complications. Results: Among 43 patients, specific causative organisms or family of organisms were identified by PTNBs in 16 patients (37.2%). The most common causative organism was fungus (10/16, 62.5%), while bacterial infection was pathologically proven only in one patient (6.3%). Clinically significant change in management occurred in 12 of 43 patients (27.9%). Post-PTNB complications developed in 12 patients (27.9%; pneumothorax [n = 6] and hemoptysis [n = 6]) without PTNB-related mortality. Lower lobar location (odds ratio [OR] = 0.07, P = 0.006) was related with post-PTNB pneumothorax, while lower platelet counts (≤127 × 103/µL) were associated with post-PTNB hemoptysis (OR = 9.82, P = 0.025). Conclusion: CBCT-guided PTNBs revealed microbiological pathogens in 37.2% of immunocompromised patients and led to subsequent clinical actions in 27.9% of patients. Post-PTNB complications occurred in 27.9% of patients, and it might be necessary to perform PTNBs more carefully in immunocompromised patients with lower platelet counts. [ABSTRACT FROM AUTHOR]

Objective: To describe the epidemiology of pediatric type 1 diabetes over 50 years in Canterbury, New Zealand. Further, to explore variation in case presentation according to age, gender, ethnicity, urban/rural character, socio‐economic deprivation and immunogenetic features. Research Design and Methods: Prospective ascertainment of cases commenced in 1982, and incident cases presenting 1970–1982 were ascertained retrospectively from clinical records. Eligibility criteria included diagnosis of type 1 diabetes by a physician and commencement of insulin therapy at diagnosis and age less than 15 years. Data collection included name, hospital number, date of birth, date of diagnosis, and date of initiation of insulin treatment. Full address at diagnosis was assigned an urban–rural classification, and a deprivation score. HLA‐DQ susceptibility alleles and diabetes associated autoantibodies were determined. Results: The incidence of type 1 diabetes increased more than 5‐fold (3.9% per annum) over 50 years for the entire cohort. The mean for 5‐year periods, starting from 1970, increased from 5.3 to 29.0 cases per 100,000 person years. Incidence was greatest in the 10–14 year age group. The cohort is predominantly European (89.4%), but there has been an increase in cases identifying as New Zealand Māori in the last three decades. Weak evidence was found for reduced incidence of type 1 diabetes in rural regions (adjusted IRR = 0.70, 95%CI 0.52 to 0.91, p = 0.011). Conclusions: The incidence of type 1 diabetes in children aged less than 15 years continues to increase with time. Incidence was significantly affected by age, ethnicity, and urban/rural characterization of address at diagnosis. [ABSTRACT FROM AUTHOR]

This article describes the rate of suicidal ideation (SI) across three timepoints among treatment-seeking patients recently discharged from psychiatric hospitalization—a group that is at ultrahigh-risk for suicide. Retrospective chart review was used to quantify the rate of SI in 252 consecutive patients discharged to a post-hospital mental health clinic. Data include patients' lifetime history of SI, SI at the time of hospital intake, and SI at post-hospital outpatient clinic intake, as well as demographics and diagnosis. Overall, 67% of the sample reported a lifetime history of SI, 49% reported SI during hospital intake, and 6% reported SI at post-hospital clinic intake. Age was the only variable associated with history of SI (p =.04), with younger patients more likely (OR = 1.85) to report a history of SI. These results may help inform the development of interventions for the population of ultrahigh-risk patients being discharged from hospital after psychiatric care. [ABSTRACT FROM AUTHOR]

Purpose: This retrospective cross‐sectional study aimed to evaluate oral health status (dental, periodontal, and functional) and oral health behavior in young German athletes including the comparison of competitive (CA) and amateur sports (AA). Methods: Data of CA (German national teams, perspective, and youth squads) and AA aged between 18 and 30 years with an available oral examination in 2019 were included. Clinical examination: caries experience (DMF‐T), non‐carious wear (erosion, BEWE), partially erupted wisdom teeth, gingival inflammation (PBI), plaque index, periodontal screening (PSI), and temporomandibular dysfunction (TMD) screening. Questionnaires: oral health behavior and periodontal symptoms. Results: 88 CA (w = 51%, 20.6 ± 3.5 years) of endurance sports and 57 AA (w = 51%, 22.2 ± 2.1 years) were included. DMF‐T was comparable (CA: 2.7 ± 2.2, AA: 2.3 ± 2.2; p = 0.275) with more D‐T in CA (0.6 ± 1.0) than AA (0.3 ± 0.7; p = 0.046; caries prevalence: CA: 34%, AA: 19%; p = 0.06). Both groups had low severity of erosion (BEWE about 3.5). CA had more positive TMD screenings (43% vs. 25%; p = 0.014). In both groups, all athletes showed signs of gingival inflammation, but on average of low severity (PBI <1). More CA needed complex periodontal treatment than AA (maximum PSI = 3 in 40% vs. 12%; p < 0.001). Oral health behavior was comparable (daily tooth brushing; regular dental check‐ups in >70%). Conclusions: Young German athletes (CA and AA) generally showed signs of gingival inflammation and needed to improve their oral health behavior. CA showed slightly increased oral findings (more D‐T, periodontal and TMD screening findings) than AA, but similar oral health behavior. This may imply an increased dental care need in competitive sports. [ABSTRACT FROM AUTHOR]

Background and Aims: In February 2014, the government of New South Wales (NSW), Australia, introduced new restrictions (known as the 'lockout laws') on the sale of alcohol in licensed premises in two of Sydney's most prominent entertainment districts, Kings Cross (KX) and the central business district (CBD). This study aimed to determine: (i) whether the introduction of the lockout laws was the point at which the time pattern of the assault series in the KX and CBD entertainment precincts changed; (ii) whether the apparent reduction in assault in these precincts persists when we control for common variations in assault across the entire state of NSW; (iii) whether the reduction in assault in the KX and CBD entertainment precincts resulted in a displacement of the assault problem into other areas; and (iv) whether there is a net reduction in assault after taking any spill‐over or displacement effects into account. Design Structural break analysis was used to determine the date at which the time pattern of assaults changed. Interrupted time series analysis with a rest‐of‐NSW comparator was used to assess the change in assault. Setting, cases and measurements: The monthly totals of incidents of non‐domestic assaults reported to the NSW Police between January 2009 and March 2019 (n = 123). Findings The structural break in assaults occurred in January 2014 rather than in February 2014, when the lockout laws were introduced. The reduction in assault persists even when we control for common influences across NSW as a whole. In particular, from January 2014 onwards, assaults fell immediately by 22% (a downward step) in KX (90% confidence interval [CI] = 15–28) and by 33% in the CBD (90% CI = 19–47). Assaults continued declining in KX (trend‐break coefficient = −0.094, 90% CI = −0.192 to 0.005). The reduction in assault in the KX and CBD precincts is associated with a rise in assault in areas surrounding these precincts. The net effect, nonetheless, remains a lower level of assault. In particular, we estimate that the net reduction over the three areas combined was 1670 assaults (i.e. 27 per month). Conclusion: Some of the initial reduction in assault in KX and the CBD of Sydney, Australia, previously attributed to the February 2014 introduction of lockout laws may have been a response to publicity surrounding recent deaths connected with alcohol‐related violence. [ABSTRACT FROM AUTHOR]

Purpose: Survival time after bisphosphonate use has been increasingly recognized to be associated with the incidence of medication-related osteonecrosis of the jaw (MRONJ); however, this has not been elucidated sufficiently in the literature. This study aimed to clarify the incidence of MRONJ and the corresponding survival rate of patients treated with zoledronic acid (ZA) for each type of cancer and obtain useful information for the oral/dental supportive care of cancer patients. Methods: We evaluated 988 patients who were administered ZA at our hospital; among them, 862 patients with metastatic bone tumors or myeloma were included. Results: The median survival time (MST) after ZA initiation was 35, 34, 8, 41, 12, and 6 months for patients with breast, prostrate, lung, myeloma, renal, and other cancers, respectively. Patients with cancers that had a short survival time (lung and other cancers [MST = 8 and 6 months, respectively] and cancers with MST < 10 months) did not develop MRONJ; this could be attributed to the shorter duration of ZA administration. The cumulative incidence of MRONJ in breast cancer, prostate cancer, and multiple myeloma was related to the frequency of anti-resorptive drug use and the increased risk over time. In renal cancer, the cumulative incidence of MRONJ increased early, although the MST was 12 months. Conclusion: For the dentists in charge of dental management, it is essential to be aware of prognosis-related factors, predict MRONJ risk for each cancer treatment, and use risk prediction in dental management planning, particularly for cancers with non-poor prognosis. [ABSTRACT FROM AUTHOR]

Purpose: A high score determined by SARC-F, a simple screening questionnaire for sarcopenia, has been reportedly associated with worse medical outcomes. However, information regarding whether high SARC-F scores are associated with a poor prognosis in patients with advanced cancer remains limited. We clarified whether a SARC-F score ≥ 4 predicts poor prognosis in patients with cancer receiving palliative care.Methods: We conducted a retrospective cohort study of patients with cancer who received palliative care at a university hospital between May 2019 and April 2020. Patient characteristics including age, sex, height, weight, cancer type, serum albumin level, C-reactive protein level, presence of edema, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS), SARC-F score, history of anticancer therapy, and clinical outcomes were collected from electronic medical records.Results: Of 304 patients, 188 had a SARC-F score < 4, and 116 patients had a SARC-F score ≥ 4. The overall survival of patients with a SARC-F score ≥ 4 was 40 days (95% CI 29-47), which was significantly worse than 121 days (95% CI 95-156) for patients with a SARC-F score < 4 (p < 0.001). SARC-F score ≥ 4 (hazard ratio: HR 1.56), edema (HR 1.94), head and neck cancer (HR 0.51), C-reactive protein (HR 1.05), ECOG-PS ≥ 3 (HR 1.47), and radiotherapy (HR 0.52) were associated with overall survival. The ability to climb stairs was a SARC-F sub-item significantly associated with mortality (HR 1.59).Conclusion: The SARC-F questionnaire is a useful predictor of prognosis for patients with cancer receiving palliative care because a SARC-F ≥ 4 score predicts worse overall survival. [ABSTRACT FROM AUTHOR]

Background: Immune checkpoint inhibitors (ICI) are increasingly used across multiple cancer types and stages and little is known about real-world outcomes. This study sought to determine healthcare utilization, costs, immune-related adverse events (irAEs), and all-cause mortality of single-agent versus combination ICI in the USA. Materials and methods: This is a retrospective study conducted with 2016–2018 data from the HealthCore Integrated Research Database, consisting of commercial and Medicare-insured adult patients with a cancer diagnosis using ICI in the USA. Outcomes were healthcare utilization, costs, and irAEs (FDA-recognized and others) up to 1-year post-index between patients using ICI monotherapy (mono, PD-1/PD-L1 inhibitor) and combination therapy (combo, PD-1/PD-L1 with CTLA-4 inhibitors). Results: In total, 9084 patients received monotherapy and 904 patients received combo therapy. Mean age 65 years for mono and 58 years for combo. Overall, the combo arm had higher rates of FDA-recognized irAEs (67.4% vs. 45.9%), especially endocrinopathies (27.7% vs 14.7%) and dermatitis (25.9% vs. 12.4%). All-cause mortality over 1-year follow-up was similar, 30.7% in mono vs 30.8% in combo arms. The combo group had higher rates of all-cause inpatient hospitalizations (55.4% mono vs 65.6% combo) and emergency department (ED) visits (33.7% mono vs 41.4% combo). IrAE-related hospitalizations were higher in combo (55.2% vs 42.1%). IrAE-related ED visits were 15.7% mono vs 22.7% combo. This increased toxicity and health care utilization was reflected in significant differences in healthcare costs. Stark differences were seen in all-cause medical costs as well as costs related to inpatient and ED utilization and costs attributed to irAEs. Conclusions: Higher rates of irAEs, healthcare utilization, and costs occur with combination immunotherapy. As further indications are approved for combination ICI, our study highlights the real-world tradeoffs involved with combination therapy regarding burdens of toxicity and increased healthcare utilization. [ABSTRACT FROM AUTHOR]

Purpose: In the last few decades, interest in palliative care and advance care planning has grown in Brazil and worldwide. Empirical studies are needed to reduce therapeutic obstinacy and medical futility in the end-of-life care of children with incurable cancer. The aim of this study was to investigate the effects of do-not-resuscitate-like (DNRL) orders on the quality of end-of-life care of children with incurable solid tumors at a cancer center in Brazil.Methods: A retrospective observational cohort study of 181 pediatric patients with solid tumors followed at the Pediatric Oncology Department of the Brazilian National Cancer Institute, Rio de Janeiro, Brazil, who died due to disease progression from 2009 to 2013. Medical records were reviewed for indicators of quality of end-of-life care, including overtreatment, care planning, and care at death, in addition to documentation of the diagnosis of life-limiting illness and the presence of a DNRL order. Data were summarized using descriptive statistics. Univariate and multivariate logistic regression analyses were used to examine associations between demographics, disease, treatment, and indicators of end-of-life care with a DNRL order.Results: A documented DNRL order was associated with lower odds of dying in the intensive care unit or emergency room (80%), dying within 30 days of endotracheal tube placement (80%), or cardiopulmonary resuscitation (CPR) administration at the time of death (96%).Conclusion: Placement of DNRL orders early in the disease process is critical in reducing futile treatment in pediatric patients with incurable cancer. [ABSTRACT FROM AUTHOR]

Purpose: Little is known about non-tobacco substance use (SU) and its treatment in cancer patients. National guidelines address tobacco only, and assessment of SU in cancer patients is not standardized. It is not clear how oncology clinicians assess, document, and follow-up on SU.Methods: We conducted an electronic health record review of patients enrolled in a smoking cessation trial at one large hospital site (N = 176). Chart review of oncology treatment notes assessed whether SU assessment was documented, the content of the documentation/assessment (e.g., frequency of use), and details about documentation (e.g., where/who documented).Results: Sixty-nine percent (121/176) of cancer patients had SU documented. Many patients (42%, 74/176) had only one substance documented; 66% (116/176) had alcohol use documented. For a substantial minority of patients (43/176; 24%), the provider did not specify the substance assessed (e.g., "drug use," "illicits"). SU was primarily documented by physicians (84%, 102/121), in routine progress notes (56%, 68/121), in the "social history" section of the note (84%, 102/121). Only 4 patients had a documented SU follow-up plan. When examining the subset of patients who reported problematic alcohol use (N = 27), the content of documentation was inconsistent (e.g., number of drinks/day vs. qualitative descriptors of use).Conclusions: About 1/3 of oncology patients did not have SU assessment documented. SU other than alcohol use was infrequently documented, many clinicians documented SU but did not specify substance type, and few clinicians documented a follow-up plan for problematic SU. Oncology settings should utilize standardized assessment and referral for SU treatment. [ABSTRACT FROM AUTHOR]

Aims and Objectives: The aim of this study was to evaluate the risk factors for lower urinary tract symptoms in prostate cancer patients underwent radical prostatectomy, thus providing therapeutic evidence for post‐operative nursing. Background: Prostate cancer is one of the most commonly diagnosed male malignancy in recent years. With surgical treatments, patients with prostate cancer indeed have satisfying survival rate. However, the presence of postprostatectomy lower urinary tract symptoms which affect quality of life significantly is more worthy of attention. Design: Patients underwent surgical therapies were followed up and the symptoms were recorded. Methods: A total of 65 prostate cancer patients underwent radical prostatectomy from January 2019 to October 2020, and pathologically diagnosed with prostate cancer were enrolled in our study. These patients were followed up 3 months after surgery and their medical records were retrospectively collected and analysed. Results were reported according to the STROBE Statement. Results: The incidence of post‐operative lower urinary tract symptoms at 3 months after surgery is similar to that of pre‐operation. Univariate and multivariate analyses revealed that the independent risk factor for postprostatectomy lower urinary tract symptoms is body mass index, whereas pelvic floor muscle exercise is a protective factor. Conclusions: The incidence of postprostatectomy lower urinary tract symptoms is non‐negligible, which significantly affects quality of life. Body mass index is found as an independent risk factor for postprostatectomy lower urinary tract symptoms, while pelvic floor muscle exercise is a strong protector. Relevance to clinical practice: Patients with prostate cancer would benefit from post‐operative pelvic floor muscle exercise. These findings contribute to tailor post‐operative nursing strategy. [ABSTRACT FROM AUTHOR]

Introduction: Avoidant and restrictive food intake disorder (ARFID) is characterized by restrictions in oral intake and does not include concerns related to body image. Despite the evidence-based medical and behavioral treatments, there is limited research as they apply to ARFID, but the extant research supports hospital-based behavioral therapy. Individuals with ARFID may have comorbidities that can affect treatment, which requires multidisciplinary treatment to provide effective care. Supplementary sources of nutrition may be required for individuals with this diagnosis to ensure they maintain proper nutritional status (eg, enteral feeding). Methods: A record review from 2015 to 2019 identified 16 participants admitted to an inpatient hospital. Of the sample, 75% of participants had a psychiatric diagnosis and 88% of participants experienced an acute event that preceded their feeding difficulties. Each participant received medical oversight, and instead of a standard treatment approach, behavioral treatment components were individualized based on each participants' presentation. Results: All participants met at least 80% of their admission treatment goals, and 92% of participants who completed their admission consumed 100% of their nutritional needs orally. Follow-up data indicate sustained progress for several months following discharge. Conclusion: Our results suggest that a multidisciplinary, medical, and behavioral treatment model is effective for a variety of clinical presentations of ARFID. More research is needed on triggering events that precede restricted food and liquid intake. In addition, the extent to which these treatment components are preferred should be assessed in an effort to maintain treatment gains after discharge. [ABSTRACT FROM AUTHOR]

Purpose: Hallux valgus is a disease that can be treated with many different surgical procedures. In our study, we aimed to compare patients with and without dorsal neutralization plate after distal metatarsal osteotomy and fixation with compression screws. Methods: The files of 59 patients with 89 feet operated with the diagnosis of moderate degree hallux valgus have been examined retrospectively. Hallux valgus angles, AOFAS, VAS and satisfaction scores, time to return to work of both groups were compared. The cases in which only screw fixation was performed were mobilized with the hallux valgus apparatus for 6 weeks postoperatively, while the cases in which dorsal neutralization plate was performed were immediately mobilized full weightbearing without using an additional apparatus. Patients with a minimum follow-up of 2 years were included in the study. Result: There was no statistically significant difference between the two groups in terms of being bilateral (p = 0.457), mean age (p = 0.105) and gender data (p = 0.105). There was no significant difference in the preop and postop second year hallux valgus angles, AOFAS, VAS and satisfaction scores of the patients. There was a significant difference in the time to return to work (p < 0.001) and the 6th week AOFAS (p < 0.001), VAS (p < 0.001) and postop satisfaction (p < 0.001) scores between the two groups. Conclusion: The dorsal neutralization plate performed in addition to the compression screw after distal metatarsal osteotomy can cause painless early postoperative results that do not require the use of an additional apparatus, and early good functional results. [ABSTRACT FROM AUTHOR]

Purpose: With rising healthcare costs and insurance push against non-emergent hospital admission, lower extremity fracture treatment is shifting toward outpatient procedures over inpatient hospitalizations. This study compares outcomes for fractures treated as inpatient versus outpatient. Methods: We conducted a retrospective review of lower extremity fracture patients. We collected demographics, injury information, hospital course, and complication data. Length of stay was categorized as "inpatient" and "outpatient" based a 24-h hospital stay cutoff. Data analysis included differences between cohorts with regards to readmissions and complications. Results: We identified 229 patients who met inclusion criteria. Inpatient versus outpatient status was predictive of in-hospital complications; however, inpatient versus outpatient status did not predict 1-year readmission. Conclusion: Outpatient surgery is safe and effective. As the population increases and ages, low-risk surgeries should be considered for outpatient rather than inpatient stays to lower costs, save resources, and reduce complications. [ABSTRACT FROM AUTHOR]

In France, the current recommendation is to perform a routine abdominopelvic ultrasound in any child under 2 years of age who is suspected to have been abused. We retrospectively studied the relevance of this practice in our center over the past fifteen years. This was a descriptive, retrospective study of all children under 2 years of age who had been subject to suspected abuse. Abdominal images and reports were reviewed and cross-referenced with possible clinical and biological signs. Four hundred and five children were included between 2006 and 2020, of whom 296 underwent abdominal imaging (2 initial abdominopelvic CT scans, 4 ultrasounds followed by CT scans, and 290 ultrasounds alone). Four examinations revealed traumatic abnormalities related to abuse. These four children all had clinical or biological anomalies. In the absence of clinical or biological signs, no imagery showed any abnormality related to abuse. [ABSTRACT FROM AUTHOR]

Background: Abusive head trauma (AHT) is a leading cause of death and disability in children and one of the most lethal forms of child abuse. Most known risk factors for AHT pertain to the infant's caregiver and limited research has assessed external influences beyond the familial or caregiver/infant dyad. Objective: Our primary objective was to determine if temperature patterns are associated with AHT events. Secondary outcomes included associations between AHT and specific days of the week, months, or seasons. Methods: This was a retrospective review of 198 patients under 24 months old who were diagnosed with AHT at Saint Louis Children's Hospital. Demographic information was obtained from the medical record for each patient. For each AHT incident, the date and zip code of the incident were recorded. Temperature on the date of incident was identified using the Midwestern Regional Climate Center (MRCC). Chi square tests were utilized to calculate differences in cases per year as well as temperature and seasonal variation. Results: Temperature was not associated with a statistically significant increase in cases of AHT. There was an increase in cases as temperatures rose, but no statistically significant associations between incidence of AHT and day of the week, month, or season. Conclusion: Our study suggests no significant association between AHT incidence and temperature or temporal patterns in this Midwest hospital. [ABSTRACT FROM AUTHOR]

Purpose: Non-operative management of aortic graft infection is usually only considered in a palliative context. We describe the safety, efficacy, and clinical outcomes of percutaneous drainage of aortic graft infections (AGI) following either open or endovascular repair of aneurysmal disease. Methods: Twelve consecutive patients (11 males, 1 female, mean age 72.7 ± 10.3 years, age range 52-88 years) between January 2010-July 2020 who underwent percutaneous drain insertion in either an infected aortic sac or periaortic abscess cavity following endovascular or open surgical graft repair were identified. Patient and procedural characteristics as well as clinical outcomes were determined. Results: Of the 12 patients who underwent percutaneous drain insertion, five (41.7%) had undergone open abdominal aneurysm repair, one (8.3%) open thoracoabdominal aneurysmal repair, and six (50%) endovascular abdominal aneurysm repairs. Drain size ranged from 10-20 French. All were inserted under ultrasound (US), computed tomography (CT), and/or fluoroscopic guidance. Median duration of drain placement was 55.2 days (range 3-174). Five patients (41.7%) had the drain in place as a stabilizing bridge until or after definitive surgical explantation and aortic reconstruction. Seven patients (58.3%) were managed with drain placement and antibiotic therapy without surgical intervention. Six (50%) were alive at the most recent time of follow-up (median, 732 days, range 166-1650 days). Three patients (25%) died during follow-up with causes including erosion of aortic reconstruction into sigmoid colon, unrelated chronic obstructive pulmonary disease exacerbation, and severe clostridium difficile colitis and pseudomonal pneumonia (median 1244 days, range 992-1597 days). Three (25%) patients were lost to follow-up. No drain-related complications were noted. Conclusion: Percutaneous drainage of AGI following endovascular or open aneurysm repair is a safe and viable management option either as a temporizing measure as a bridge to surgical graft explantation or as a non-surgical therapy for long term management. [ABSTRACT FROM AUTHOR]

Complementary and alternative medicine (CAM) has become widely popular in many countries, yet little is known about the actual training of CAM practitioners. This article employs ethnographic research methods to closely examine the meaning-making processes used in such training at a complementary and alternative medical college. It delineates how CAM practitioners in training, specialising in naturopathy, make sense of alternative medical knowledge and transform it into medical truth. The study indicates that the core of CAM training rests on overturning the biomedical epistemological hierarchy between the objectification of disease and the experience of illness through extended intersubjective sharing by instructors and students. This study therefore adds to the extensive CAM literature by carefully examining the way naturopathic knowledge is inculcated during practitioner training. The emerging insight is that introspection and the search for authenticity, a central narrative of modernity, have become powerful resources in CAM's construction of alternative medical truth. [ABSTRACT FROM AUTHOR]

Background: Ventricular assist device simulation-based mastery learning (SBML) results in better patient and caregiver self-care skills compared with usual training. Objective: The aim of this study was to evaluate the effect of SBML on driveline exit site infections. Methods : We compared the probability of remaining infection free at 3 and 12 months between patients randomized to SBML or usual training. Results : The SBML-training group had no infections at 3 months and 2 infections at 12 months, yielding a Kaplan-Meier estimate of the probability of remaining infection free of 0.857 (95% confidence interval [CI], 0.692-1.00) at 12 months. The usual-training group had 6 infections at 3 months with no additional infections by 12 months. Kaplan-Meier estimates of remaining infection free at 3 and 12 months were 0.878 (95% CI, 0.758-1.00) and 0.748 (95% CI, 0.591-0.946), respectively. Time-to-infection distributions for SBML versus usual training showed a difference in 12-month infection rates of 0.109 (P =.07). Conclusions: Ventricular assist device self-care SBML resulted in fewer 12-month infections. [ABSTRACT FROM AUTHOR]

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Background: Chronic pain affects 20% of the adult population, and pain-related consultations comprise a significant amount of all primary care visits. Objective: The purpose of this study was to describe health care utilization by primary care physicians for patients with a consultation for pain and to compare subsequent health care utilization and costs for a physician trained in the McKenzie method, or mechanical diagnosis and therapy (MDT), with a group of physicians that were not trained in MDT. Design, setting, and participants: This study was a single-center retrospective quality and cost metrics data analysis performed at a community regional health-care system; patients seen by primary care physicians for a consultation for pain had subsequent health care utilization and costs compared for a physician trained in MDT with a group of 19 physicians who were not trained in MDT. A total of 22,907 continuously eligible patients were seen during the 12-month period for a pain-related complaint; 1282 patients (6%) were seen by the physician trained in MDT, and 21,625 patients (94%) were seen by the group of physicians that were not trained in MDT (n = 19). Key results: The patients seen by the physician trained in MDT had a decreased likelihood of medication use including both opioids and non-opioid pain pills, diagnostic imaging, electromyography/nerve conduction velocity testing, specialty referrals, injections (joint and spinal injections), surgeries, emergency room visits, and inpatient admissions. Also, patients who were seen by the physician trained in MDT cost significantly less to the system ($3481 per member per year versus $4852, p < 0.001), despite being older and having more medical problems and pain complaints. Conclusions: Although further research is necessary to either support or refute these findings, these results may have important implications for health policy decisions for designing optimal primary care models and consideration of MDT in primary care. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study is to provide a deeper analysis characterizing the current health status of Tulane University School of Medicine's student-run free clinic patients. Only one prior study by Rebholz et al. (South Med J 106(3):217–223, https://doi.org/10.1097/SMJ.0b013e318287fe9a, 2013) has explored the demographics in this population. Ultimately, this study will allow for easy interpretation of the demographics of the student clinic system as a whole and for the individual clinics participating in this study. This information will allow clinics to better customize care for their respective populations and ultimately improve health outcomes. Subject and methods: Patient demographic data was collected from five preceptor-based clinics from December 2016 to May 2019 and submitted via a REDCap survey. Survey fields included patient age, sex, gender, race, ethnicity, insurance status, chief complaints, past medical history, social history, and medications. Gross data was analyzed in Excel and subsequently stratified by clinic for inter-clinic comparison. Results: A total of 772 patient responses were collected from five different student-run clinics; 56% were male and 44% were female. The three most common reasons for a clinic visit were complaint-free wellness visits (26%), musculoskeletal complaints (16%), and respiratory complaints (11%). The three most common comorbidities included smoking and/or tobacco abuse (28%), psychiatric conditions (19%), and illicit drug abuse (15%). Conclusion: Future applications derived from this study may include redistribution of resources for patient education, social services, medical inventory, and preventative health services based on patient clinical needs. [ABSTRACT FROM AUTHOR]

Background: An increasing number of breast cancer patients undergo immediate or secondary breast reconstruction, but the ideal method in terms of patient satisfaction remains ambiguous. We compared the 3 most common breast reconstruction techniques to determine patient satisfaction and objective outcomes. Methods: Retrospective study of 184 patients with breast cancer who underwent a reconstructive procedure between 1993 and 2011 at our institution. Procedures evaluated were implant-based reconstruction (IBR) alone, latissimus dorsi (LD) flap reconstruction with/without implant, and deep inferior epigastric perforator (DIEP) free flap reconstruction. A retrospective patient satisfaction questionnaire was sent to all women. Twenty patients from each subgroup were matched to conduct a standardized objective assessment of the sensitivity of their reconstructed breast. A blinded photographic evaluation was also performed by 3 independent observers to assess the esthetic aspect and symmetry. Results: DIEP obtained significantly higher average scores regarding the esthetic outcome, immediate reconstruction impact, and overall score in the questionnaire evaluation. The IBR had the best results in the somatosensory evaluation, with DIEP scoring better than LD. DIEP received higher scores on average than LD for the criteria of size and symmetry in the esthetic evaluation. No statistically significant differences were observed between IBR and DIEP. Conclusions: Good results were reported overall for all breast reconstruction procedures, with more reserved scores for LD. The DIEP reconstruction appeared to be the most satisfactory and best experienced reconstruction method for patients, despite the complexity of the intervention. Clinicians should be encouraged to consider DIEP as the principal choice for breast reconstruction. [ABSTRACT FROM AUTHOR]

Purpose Inadequate pain control after cardiac surgery increases postoperative morbidity. Increasing evidence suggests that perioperative intravenous (IV) methadone results in improved analgesia. This study evaluated the effect of intraoperative IV methadone on postoperative opioid requirements and surgical recovery. Methods A retrospective review of patients undergoing coronary artery bypass graft (CABG), valvular surgery or both between April 2017 and August 2018 was conducted. Patients were separated into a usual care cohort of those who received short-acting opioids (ie, IV fentanyl, hydromorphone, or morphine) alone or a methadone cohort of those who received IV methadone plus short-acting opioids. Opioid requirements were assessed within the first 24 hours of surgery (postoperative day [POD] 0) and 25 to 48 hours after surgery (POD 1) as oral morphine milligram equivalents (MME). Postoperative pain scores, adjunctive analgesia, time to extubation, use of noninvasive respiratory support (continuous positive airway pressure [CPAP] or bilevel positive airway pressure [BiPAP]), and intensive care unit (ICU) and hospital length of stay (LOS) were also evaluated. Results A total of 117 patients were evaluated (methadone cohort, n = 52; usual care cohort, n = 65). Median cumulative intraoperative opioid consumption was less in the methadone cohort (150 MME vs 314.1 MME; P < 0.0001). The methadone cohort required 44% fewer MME than the usual care cohort on POD 0 (median MME, 15.8 vs 36; P = 0.025), with low and not significantly different opioid use in both cohorts on POD 1 (15.5 MME vs 7.5 MME; P = 0.47). Weight-based methadone dosing ranged from 0.1 to 0.4 mg/kg (mean, 0.22 mg/kg). There were no significant differences in pain scores, time to extubation, use of CPAP or BiPAP, or ICU and hospital LOS. Conclusion Intraoperative IV methadone in cardiac surgery patients was safe and significantly reduced intraoperative and postoperative opioid requirements on POD 0. [ABSTRACT FROM AUTHOR]

Purpose. It is controversial whether donor-recipient sex mismatch is a risk factor associated with corneal graft failure. The purpose of this study was to investigate the effect of sex mismatch on corneal graft failure in high-risk and non-high-risk patients. Design. A retrospective study. Methods. The medical charts of patients who underwent corneal transplantations by one surgeon between 2012 and 2017 were reviewed. Patients were defined as high-risk for failure if they had glaucoma, ocular surface disease, or corneal vascularization. Graft failure rates were compared using the Kaplan–Meier survival curves between sex matched and mismatched subjects and between male-to-female grafting and other patients. Results. One hundred and thirteen patients with a minimum follow-up of 18 months were included. In 62 non-high-risk patients, graft failure rates were similar between the sex mismatched and the sex matched recipients (p = 0.645 , log-rank) and in male donor to female recipient transplantations and in the other transplantations (p = 0.496 , log-rank). Analysis of fifty-one eyes of 51 high-risk graft recipients (mean age of 73.4 ± 12.7 years, N = 26 females) showed that graft failure rates were significantly higher in the sex mismatched than sex matched recipients (p = 0.022 , log-rank) and in male donor to female recipient transplantations than in the other transplantations (p = 0.002 , log-rank). Conclusions. Sex matching for every patient bares logistic difficulties; however, in patients who are at high-risk for graft failure, it may be a simple way to improve outcomes and better utilize corneal grafts. [ABSTRACT FROM AUTHOR]

Background: The clinical and prognostic implications of anaplastic lymphoma kinase (ALK) status in resected lung cancers remain unclear. In this study we analyzed the prognostic and predictive significance of ALK‐positive among patients with completely resected lung adenocarcinoma. Methods: We retrospectively reviewed 197 patients with lung adenocarcinoma who underwent complete surgical resection and had been tested for their ALK status. We investigated the impact of an ALK‐positive status on the recurrence‐free survival (RFS) and overall survival (OS) and examined the predictive factors for an ALK‐positive status. Results: ALK positivity was noted in 36 (18%) out of 197 patients, and when limited to stage I patients, in 24 (19%) out of 124. In the pathological‐stage I population, while the OS exhibited no significant difference between ALK‐positive and ALK‐negative patients (5‐year OS rate, 81.2% vs. 89.8%, p = 0.226), the RFS of ALK‐positive patients was significantly worse than that of ALK‐negative patients (5‐year RFS rate, 55.9% vs. 78.8%, p = 0.018). A multivariate analysis showed that ALK‐positive status (hazard ratio [HR] 3.431, p = 0.009) was an independent prognostic factor for the RFS. Regarding the relationship between clinicopathological factors and an ALK‐positive status, a high‐grade histological subtype, including solid and micropapillary subtypes (odds ratio [OR] 5.464, p < 0.001), and never‐smokers (OR 4.292, p = 0.018) were associated with ALK‐positive. Conclusion: A high‐grade histological subtype and never‐smokers were associated with ALK positivity, and the RFS of ALK‐positive patients was worse than that of ALK‐negative patients among patients with completely resected stage I lung adenocarcinoma. [ABSTRACT FROM AUTHOR]

Introduction: Disparities in COVID-19 infection, illness severity, hospitalization, and death are often attributed to age and comorbidities, which fails to recognize the contribution of social, environmental, and financial factors on health. The purpose of this study was to examine relationships between social determinants of health (SDOH) and COVID-19 severity. Methods: This multicenter retrospective study included adult patients hospitalized with COVID-19 in Southwest Georgia, U.S. The primary outcome was the severity of illness among patients on hospital admission for COVID-19. To characterize the effect of biological and genetic factors combined with SDOH on COVID-19, we used a multilevel analysis to examine patient-level and ZIP code-level data to determine the risk of COVID-19 illness severity at admission. Results: Of 392 patients included, 65% presented with moderate or severe COVID-19 compared to 35% with critical disease. Compared to moderate or severe COVID-19, increasing levels of Charlson Comorbidity Index (OR 1.15, 95% CI 1.07-1.24), tobacco use (OR 1.85, 95% CI 1.10-3.11), and unemployment or retired versus employed (OR 1.91, 95% CI 1.04-3.50 and OR 2.17, 95% CI 1.17-4.02, respectively) were associated with increased odds of critical COVID-19 in bivariate models. In the multi-level model, ZIP codes with a higher percentage of Black or African American residents (OR 0.94, 95% CI 0.91-0.97) were associated with decreased odds of critical COVID-19. Conclusion: Differences in SDOH did not lead to significantly higher odds of presenting with severe COVID-19 when accounting for patient-level and ZIP code-level variables. [ABSTRACT FROM AUTHOR]

Introduction: Same-day referrals from primary care to mental health increase subsequent mental health treatment engagement. VA Primary Care-Mental Health Integration (PC-MHI) clinics offer integrated mental health services embedded in primary care clinics, providing a key entry point to mental health care. Although telehealth use expanded rapidly after the onset of COVID-19, the impact of telehealth on same-day primary care access among new PC-MHI mental health patients is unknown. To address this knowledge gap, we examined associations between telehealth use and same-day primary care access in VA PC-MHI. Methods: We examined electronic health record data to identify same-day primary care appointments among PC-MHI patients who initiated care during 3/1/2018 to 10/29/2021. We used logistic regression analyses to evaluate the effect of telehealth on same-day primary care access. Time, demographic characteristics, mental health diagnoses (PTSD and depression), and substance use disorder diagnosis were evaluated as covariates. Results: New PC-MHI patients who were seen via telehealth were less likely to receive same-day primary care access than patients seen in person (OR: 0.54; 95% CI: 0.41-0.71; P <.001). Conclusions: Despite the potential advantages of using telehealth to increase access, VA patients with an initial PC-MHI visit via telehealth were less likely than patients seen in person to be referred from primary care. Telehealth may adversely affect primary care referrals to mental health services, an outcome that could ultimately reduce specialty mental health care continuity. There is an urgent need to identify strategies to facilitate PC-MHI care coordination in the telehealth context. [ABSTRACT FROM AUTHOR]

Objective. A retrospective cohort study aimed to explore the effects of different ovulation induction regimens on the levels of sex hormones and serum C1q/TNF-related protein-3 (CTRP3) and C1q/TNF-related protein-15 (CTRP15) in patients with PCOS. Methods. A total of 100 patients with PCOS treated in the department of gynecology and obstetrics from February 2019 to April 2021 in our hospital were enrolled. The patients were arbitrarily assigned into control group and study group. The treatment effect, pregnancy rate, ovulation rate, follicle size, thickness of endometrium, number of mature follicles and ovulation, serum levels of follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), testosterone (T), serum CTRP3, CTRP15 and menstrual score were compared. Results. There exhibited no statistical difference in baseline clinical data between the two kinds of patients. The therapeutic effects were compared, the effective rate was 98.00% in the study group, 13 cases in the control group, 20 cases in the effective group and 7 cases in the control group, and the effective rate was 86.00%. The effective rate in the study group was higher (P <0.05). The size of follicles and the thickness of endometrium in the two groups were compared before and after intervention. There exhibited no significant difference in the size of follicles and the thickness of endometrium before and after intervention (P >0.05). The size of follicles and the thickness of endometrium in the study group were significantly higher (P <0.05). The size of follicles and the thickness of endometrium in the study group were significantly higher (P <0.05). There exhibited no significant difference in the number of mature follicles and ovulation before and after intervention (P >0.05). After intervention, the number of mature follicles and ovulation in the two groups increased. The number of mature follicles and ovulation in the study group were (4.76 ± 0.90) and (4.48 ± 0.73), respectively, which were higher compared to the control group (2.45 ± 0.86) and (2.82 ± 0.84), respectively (P <0.05). The levels of serum LH, FSH, E2 and T were not significantly different before and after intervention. After the intervention of different ways of ovulation induction, the levels of serum LH, FSH, E2 and T in the two groups continued to decrease, and the levels of the above sex hormones in the study group were significantly lower (P <0.05). The menstrual score and the levels of serum CTRP3 and CTRP15 were compared before and after intervention. After intervention, the menstrual score of patients in both groups decreased, and the menstrual score of the study group was lower. In addition, the levels of serum CTRP3 and CTRP15 in the two groups decreased after intervention. Compared with the control group, the levels of CTRP3 and CTRP15 in the study group were lower after intervention (P <0.05). The ovulation rate and pregnancy rate of the two groups were compared. In the study group, there were 45 ovulation cases, the ovulation rate was 90.00% (45/50), the pregnancy rate was 33 cases, the pregnancy rate was 66.00% (33/50), and the ovulation rate in the control group was 31 cases, the ovulation rate was 62.00% (31/50), the pregnancy rate was 20 cases, and the pregnancy rate was 40.00% (20/50). The ovulation rate and pregnancy rate in the study group were higher (P <0.05). Conclusion. Different ovulation induction regimens have different effects on the levels of sex hormones and serum CTRP3 and CTRP15 in patients with PCOS. Long-acting follicular phase regimens can effectively promote the therapeutic effect of patients and increase the ovulation rate and pregnancy rate. In addition, it can also reduce the levels of serum LH, follicle stimulating FSH, E2 and testosterone T, and help to promote the levels of serum CTRP3 and CTRP15, which is worth popularizing and applying in clinic. [ABSTRACT FROM AUTHOR]