Evidence-Based Medicine in Otolaryngology Part 16: Qualitative and Quantitative Methods-Contrasting and Complementary Approaches

Qualitative methods have been increasingly applied in our literature, providing richness to data and incorporating the nuances of patient and family perspectives. These qualitative research techniques provide breadth and depth beyond what can be gleaned through quantitative methods alone. When both quantitative and qualitative approaches are coupled, their findings provide complementary information which can further substantiate study conclusions. We thus aim to provide insight into qualitative and quantitative methods in comparison and contrast to each other, as well as guidance on when each approach is most apt. In relation, we also describe mixed methods and the theory supporting their framework. In doing so, we provide the foundation for an ensuing, more detailed exposition of qualitative methods.

Unintended impacts of COVID-19 on the epidemiology and burden of paediatric respiratory infections

Acute respiratory infections (ARI), especially lower respiratory infections (LRI), are a leading cause of childhood morbidity and mortality globally. Non-pharmaceutical interventions (NPI) employed during the COVID-19 pandemic have impacted on the epidemiology and burden of paediatric ARI, although accurately describing the full nature of the impact is challenging. For most ARI pathogens, a reduction was observed in the early phase of the pandemic, correlating with the most stringent NPI. In later phases of the pandemic resurgence of disease was observed as NPI eased. This pattern was most striking for seasonal viruses, such as influenza and respiratory syncytial virus. The impact on ARI-associated bacterial disease varied; marked reductions in invasive Streptococcus pneumoniae and Streptococcus pyogenes were observed, followed by a resurgence that correlated with increases in respiratory viral infections. For Corynebacterium diphtheriae,Bordetella pertussis, andMycoplasma pneumoniae, a sustained reduction of disease was observed well into 2022 in most regions. Proposedmechanisms for the varied epidemiological disruption amongst ARI pathogens includedifferential effects of NPI on specific pathogens, population-level immunological effects, and ecological and genetic pathogen adaptations. Additionally, important indirect effects of pandemic restrictions on paediatric respiratory infections have been identified. These occurred as a result of disruptions to routine health services, reductions in vaccination coverage, and disruptions to respiratory infection research and surveillance activities. Impacts have been disproportionately borne by those in low resource settings. We discuss opportunities to leverage pandemic learnings to support improved understanding of the epidemiology of paediatric respiratory infections to inform future prevention and health system strengthening.

Insights into the schizophrenia and dental care: focusing on interaction between implant treatments and oxidative stress

Schizophrenia is a complex mental condition characterized by the deterioration of thought processes and inappropriate emotional responses. Compared to the general population, individuals diagnosed with schizophrenia have an increased risk of developing various dental diseases, including dental caries, periodontal disease, oral mucosal diseases, and conditions associated with oral resonance. In this context, we propose to establish links between schizophrenia and dental illness, emphasizing the importance of oxidative stress (OS) markers in schizophrenia, and also the role of dental treatments, particularly dental implants. This highlights the urgent need for an intervention program to improve oral health in patients with schizophrenia, including aspects such as prevention and prosthetic treatment. Dental implants can be a favorable option, offering good aesthetic and functional results for treated patients with schizophrenia. Additionally, a carefully developed surgical plan is essential, requiring collaboration between psychiatry, oral and maxillofacial surgery, anesthesiology, and prosthodontics departments.

Melatonin for preventing postoperative delirium in elderly patients: A multicenter randomized placebo-controlled pilot study

BACKGROUND

Postoperative delirium (POD) in older adults is associated with high risk of morbidity and mortality. With limited treatment options, prevention is essential. Melatonin has been suggested to prevent delirium through regulating the sleep-wake cycle and serotonin metabolism, which has been shown to be disrupted in patients with POD. However, the evidence regarding the use of melatonin for POD prevention is limited and inconclusive.

METHODS

Our multicenter, 2-arm, parallel-group, feasibility randomized controlled trial evaluated the effect of melatonin on POD incidence after noncardiac surgery in patients >65 years (n = 120). Patients were randomized to 3 mg oral melatonin or placebo once preoperatively and for 7 days postoperatively. Patients were assessed twice daily for delirium and followed at 3 months postoperatively. Feasibility outcomes were recruitment rate, medication adherence, and proportion completing 3-month follow-up. Clinical outcomes were delirium incidence, sleep quality, institutional discharge, and cognitive status at 3 months.

RESULTS

Between September 2021 and June 2023, 85 patients were randomized (~1 patient/wk); of these, 92.9% adhered to study medications and 87.1% completed the 3-month follow-up. POD occurred in 9 patients with no statistical difference between the groups (melatonin group, n = 7; placebo group, n = 2; adjusted odds ratio: 1.12; 95% confidence interval: 0.006-150.1). There were no differences in any other clinical outcomes. Pandemic-related challenges, including interruption of surgeries and restrictions on research procedures impacted feasibility and the study was terminated early due to futility.

CONCLUSIONS

Based on our observations, a sample size of >1000 patients is required for a definitive trial to evaluate the role of melatonin in reducing the incidence of POD. Design changes need to be considered to address feasibility challenges and ongoing post-pandemic modifications to patient care.

How much do opinions regarding cultivated meat vary within the same country? The cases of São Paulo and Salvador, Brazil

The problems related to conventional meat production have been widely discussed globally and alternative proteins emerge as more sustainable and ethical options. Thus, understanding the intention to consume cultivated meat is key. This work aimed to study the intention to consume cultivated meat by residents of São Paulo and Salvador, Brazil, studying demographic differences. An online questionnaire comprising 17 multiple-choice and open-ended questions about opinions on conventional and cultivated meat was administered. The results were analyzed using quantitative methods, including binary logistic regression and ordinal regression models, as well as the qualitative Collective Subject Discourse methodology. With 809 participants, 419 (51.8%) from São Paulo and 390 (48.2%) from Salvador, 265 (32.8%, of which 170 (64.2%) from São Paulo and 95 (35.8%) from Salvador) respondents stated they would eat cultivated meat. Residents of São Paulo demonstrated higher familiarity with cultivated meat (187 (44.6%) had heard of it compared to 123 (31.5%) in Salvador). Such disparity in awareness seems coherent with differences in access to information and educational levels. Our results suggest that the acceptance of cultivated meat varies significantly across different regions of Brazil, likely related to the country's continental size, uneven economic and educational status and rich cultural diversity. We conclude that the acceptance of cultivated meat correlates with knowledge about it and that efforts to raise such knowledge require the consideration of cultural and socioeconomic aspects on a regional rather than national level, especially for geographically big and culturally diverse countries. Continued research is essential due to dynamics of acceptance and its entanglement with familiarity and knowledge regarding cultivated meat.

Optimizing in-store warehouse safety: A DEMATEL approach to comprehensive risk assessment

INTRODUCTION

In-store warehouses can be a dangerous place due to the storage of a high volume of diverse life goods which may raise the total risk of warehouse. The turnover of goods in this kind of warehouse is very high. Therefore, safety risk is a multi-criteria problem and risk assessment of a such dynamic place needs an accurate and simple method to use. This study was conducted to design and validation of a method for risk assessment of in-store warehouses using the DEMATEL method.

MATERIALS & METHODS

This cross-sectional descriptive analytical study was conducted between 2015 to 2016. First, a preliminary questionnaire was prepared by reviewing the available studies and documents. After assigning the group of experts and validating the questionnaire base on the content validity index (CVI) and content validity ratio (CVR), the weight of each of the parameters affecting the safety of the warehouse was determined. Then, the risk calculation model was developed. This model was validated using the failure modes and effects analysis (FMEA) method and Bland-Altman statistical method. Finally, to simplify the use of the developed risk assessment method, the algorithm of the model was also created.

RESULTS

The results showed that 21 factors are among the main factors affecting the safety of the in-store warehouse, among which the "igniting and explosive property of the goods" factor had the most impact and the "warehouse working hours" factor had the least impact. The results achieved from the designed model were consistent with the FMEA method.

CONCLUSION

Based on the results, the newly designed risk assessment method can analyze the risks in the in-store warehouses faster and more accurately than the existing methods.

The portrayal of panic-buying and stockpiling in English newspapers during Covid, a mixed-method content analysis

Panic-buying and stockpiling during Covid disrupted the supply chain, causing food shortages and impacting the vulnerable. The government faced criticism for its lack of food system resilience, poor communications planning, and reliance on retailers. The British media frequently reported on panic-buying during early lockdown stages in 2020 and throughout Covid. The media play an important role in communicating information to the British public during times of crisis and influence public opinion. This mixed-method study examined English media portrayal of panic-buying, analysing text and visual data from six of the highest-circulating newspapers from March to July 2020. It reviewed reporting trends, use of imagery, themes, and prominent stakeholder voices. Content analysis of 209 articles showed that coverage was dominated by popular and left-wing press, with 89% of articles using sensationalised language and 68% coded as negative. In a subset of 125 articles, visual imagery showed empty shelves in 64% of analysed images, reinforcing the impression of food shortages. Supermarkets were the most quoted stakeholders, appearing in 62% of articles. Contradictions included reports of no food shortages alongside images of empty shelves and early newspaper advice encouraging stockpiling. Reporting peaked between March 16-22, 2020. Six key themes were identified: supermarket prominence, food supply/access, food policy, individual behaviour, socio-economic impacts, and panic-buying drivers-all themes had relevance to food system resilience. Future civil unrest linked to food-system challenges, potentially driven by climate change, conflict, or political instability, could see panic-buying play a significant role. Research on media portrayals of panic-buying can help policymakers enhance communication strategies and identify critical issues during crises. The Covid pandemic revealed crucial lessons about the media's potential role in shaping public behaviour, highlighting the need for stronger government communication and collaboration with both the media and retailers to ensure consistent messaging, particularly to protect vulnerable groups.

Efficacy of a Blended Low-Intensity Internet-Delivered Psychological Program in Patients With Multimorbidity in Primary Care: Randomized Controlled Trial

BACKGROUND

Multimorbidity is a highly prevalent phenomenon whose presence causes a profound physical, psychological, and economic impact. It hinders help seeking, diagnosis, quality of care, and adherence to treatment, and it poses a significant dilemma for present-day health care systems.

OBJECTIVE

This study aimed to assess the effectiveness of improved treatment as usual (iTAU) combined with a blended low-intensity psychological intervention delivered using information and communication technologies for the treatment of multimorbidity (depression and type 2 diabetes or low back pain) in primary care settings.

METHODS

A 2-armed, parallel-group, superiority randomized controlled trial was designed for this study. Participants diagnosed with depression and either type 2 diabetes or low back pain (n=183) were randomized to "intervention + iTAU" (combining a face-to-face intervention with a supporting web-based program) or "iTAU" alone. The main outcome consisted of a standardized composite score to consider (1) severity of depressive symptoms and (2a) diabetes control or (2b) pain intensity and physical disability 3 months after the end of treatment as the primary end point. Differences between the groups were estimated using mixed effects linear regression models, and mediation evaluations were conducted using path analyses to evaluate the potential mechanistic role of positive and negative affectivity and openness to the future.

RESULTS

At 3-month follow-up, the intervention + iTAU group (vs iTAU) exhibited greater reductions in composite multimorbidity score (B=-0.34, 95% CI -0.64 to -0.04; Hedges g=0.39) as well as in depression and negative affect and improvements in perceived health, positive affect, and openness to the future. Similar positive effects were observed after the intervention, including improvements in physical disability. No significant differences were found in glycosylated hemoglobin, pain intensity, or disability at 3-month follow-up (P=.60; P=.79; and P=.43, respectively). Path analyses revealed that the intervention had a significant impact on the primary outcome, mediated by both positive and negative affect (positive affect: indirect effect=-0.15, bootstrapped 95% CI -0.28 to -0.03; negative affect: indirect effect=-0.14, bootstrapped 95% CI -0.28 to -0.02).

CONCLUSIONS

This study supports the efficacy of a low-intensity psychological intervention applied in a blended format on multimorbidity in primary care. It justifies the exploration of the conceptualization of depression in type 2 diabetes as well as the analysis of the implementation of such interventions in routine clinical practice.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03426709; https://clinicaltrials.gov/study/NCT03426709.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/S12888-019-2037-3.

The Global Trends and Advances in Oral Microbiome Research on Oral Squamous Cell Carcinoma: A Systematic Review

The oral microbiome is increasingly recognized as a key factor in the development and progression of oral squamous cell carcinoma (OSCC). Dysbiosis has been associated with inflammation and tumorigenesis, highlighting the potential of microbial alterations and salivary biomarkers as tools for early, non-invasive diagnosis. This review examines recent advancements in understanding the oral microbiome's role in OSCC. A comprehensive synthesis of studies from 2016 to 2024 was conducted to identify emerging themes and significant findings in the field. Key topics included the interplay between microbiome-driven mechanisms and cancer development, with a focus on microbial communities and their metabolic byproducts. The findings emphasize the importance of specific microbial alterations in modulating immune responses and tumor microenvironments, as well as the promise of biomarkers such as interleukins and miRNA signatures in improving diagnostic accuracy. Recent research trends indicate growing interest in the therapeutic potential of targeting the oral microbiome in OSCC management. Despite significant advancements, gaps remain in the understanding of the precise mechanisms linking dysbiosis to cancer progression. This review underscores the need for continued research to develop personalized diagnostic and therapeutic strategies based on the oral microbiome, with the potential to transform OSCC management.

Data-Sharing Statements Requested from Clinical Trials by Public, Environmental, and Occupational Health Journals: Cross-Sectional Study

BACKGROUND

Data sharing plays a crucial role in health informatics, contributing to improving health information systems, enhancing operational efficiency, informing policy and decision-making, and advancing public health surveillance including disease tracking. Sharing individual participant data in public, environmental, and occupational health trials can help improve public trust and support by enhancing transparent reporting and reproducibility of research findings. The International Committee of Medical Journal Editors (ICMJE) requires all papers to include a data-sharing statement. However, it is unclear whether journals in the field of public, environmental, and occupational health adhere to this requirement.

OBJECTIVE

This study aims to investigate whether public, environmental, and occupational health journals requested data-sharing statements from clinical trials submitted for publication.

METHODS

In this bibliometric survey of "Public, Environmental, and Occupational Health" journals, defined by the Journal Citation Reports (as of June 2023), we included 202 journals with clinical trial reports published between 2019 and 2022. The primary outcome was a journal request for a data-sharing statement, as identified in the paper submission instructions. Multivariable logistic regression analysis was conducted to evaluate the relationship between journal characteristics and journal requests for data-sharing statements, with results presented as odds ratios (ORs) and corresponding 95% CIs. We also investigated whether the journals included a data-sharing statement in their published trial reports.

RESULTS

Among the 202 public, environmental, and occupational health journals included, there were 68 (33.7%) journals that did not request data-sharing statements. Factors significantly associated with journal requests for data-sharing statements included open access status (OR 0.43, 95% CI 0.19-0.97), high journal impact factor (OR 2.31, 95% CI 1.15-4.78), endorsement of Consolidated Standards of Reporting Trials (OR 2.43, 95% CI 1.25-4.79), and publication in the United Kingdom (OR 7.18, 95% CI 2.61-23.4). Among the 134 journals requesting data-sharing statements, 26.9% (36/134) did not have statements in their published trial reports.

CONCLUSIONS

Over one-third of the public, environmental, and occupational health journals did not request data-sharing statements in clinical trial reports. Among those journals that requested data-sharing statements in their submission guidance pages, more than one quarter published trial reports with no data-sharing statements. These results revealed an inadequate practice of requesting data-sharing statements by public, environmental, and occupational health journals, requiring more effort at the journal level to implement ICJME recommendations on data-sharing statements.

"I need everybody to understand that he's a whole child": A mixed-methods study exploring caregivers' experiences with their children with medical complexities

PURPOSE

Children with medical complexities (CMC) access medical care at high rates and rely heavily on caregivers for daily care. Little research has explored the medical care experiences of caregivers of CMC to understand the holistic impact on the caregiver and their children. The goal of this study was to understand the experiences and challenges faced by CMC and their caregivers, explore the impact of COVID-19 on this population, and highlight the suggestions caregivers have to improve medical care for their children.

DESIGN AND METHODS

We conducted an explanatory sequential mixed method study utilizing surveys (n = 149) and in-depth interviews (n = 26) with a subset of survey participants. Descriptive and inferential quantitative analysis strategies as well as qualitative thematic and content analysis techniques were used to analyze the survey and interview data.

RESULTS

Our findings included insights such as the frequent need to access medical care/specialists, the demand and emotional process of caring for CMC, the risk of pediatric medical trauma and stress, the unique impact of COVID-19 on this population, challenges navigating medical insurance, and the impact of the medical provider and system qualities on overall experiences. We also had findings related to the personal challenges associated with caregiving for CMC, caregiver coping and advocacy, and suggestions for improving care for CMC.

CONCLUSIONS

These findings suggest a need for improved practices and policies to support CMC and their families.

PRACTICE IMPLICATIONS

This study identifies opportunities for healthcare professionals to learn from the experiences of caregivers of CMC.

Trends in Research Payments for Age-related Macular Degeneration From 2015 to 2021

OBJECTIVE

This study aimed to evaluate characteristics of industry and public research payments for age-related macular degeneration studies.

MATERIALS AND METHODS

Studies involving "age-related macular degeneration" or "AMD" from 2015 to 2021 were extracted from the Open Payments Database and the National Eye Institute RePORTER tool and compared to each other.

RESULTS

From 2015 to 2021, 620 ophthalmologists received $178,394,734.09 in industry research payments with a 76.9% increase from 2015 to 2020 and a subsequent 40.7% decrease in 2021. There were 84 female industry funding recipients (13.7%) compared to 528 (86.3%) male recipients (P < 0.001). For public funding, 119 ophthalmologists received $157,319,575.00 with a 31.0% increase from 2015 to 2021. Among 119 principal investigators, 37 (31.1%) were women and 82 (68.9%) were men (P = 0.05).

CONCLUSION

Industry-funded and publicly funded age-related macular degeneration-related research payments overall increased from 2015 to 2021. Funding distribution by sex trended towards male recipients. [Ophthalmic Surg Lasers Imaging Retina 2025;56:95-100.].

Osteonecrosis with Concomitant Septic Arthritis of Bilateral Hips following Severe COVID-19 Infection: A Case Report

Introduction

Among the various musculoskeletal manifestations of post-acute Coronavirus disease 2019 (COVID-19) syndrome, osteonecrosis and pyogenic infections are of serious concern due to their potential for joint destruction and the need for major surgery, even among young patients. Spontaneous septic arthritis is rare among healthy adults. Very few cases of osteonecrosis of the femoral heads (ONFH) with concomitant septic arthritis of the hip following a COVID-19 infection are reported in the literature.

Case Report

We report the case of a 43-year-old male patient, who presented with bilateral ONFHs and concomitant septic arthritis of the hips (caused by Pseudomonas aeruginosa), 8 weeks following a severe COVID-19 infection. His serum inflammatory markers were elevated. Radiologic findings were equivocal, and suggestive of osteonecrosis, with possible septic arthritis of the hip. In view of disabling end-stage arthritis, he was advised bilateral total hip arthroplasty (THA), in one or two stages, depending on the intraoperative findings. The diagnosis of infection was confirmed through intraoperative frozen section analysis. Bilateral two-staged THA was performed. At 3 years' follow-up, the patient had no recurrence of symptoms, and was found to be doing well, with a Harris Hip Score of 93 points, and no limb length discrepancy.

Conclusion

COVID-19 infection predisposes patients to the development of ONFH. Concomitant septic arthritis of the hip, however, is scarcely reported, and needs to be ruled out in cases with rapid progression of symptoms.

The impact of the COVID-19 pandemic on dietary behaviors among school-age children, adolescents, and young adults: a systematic review and meta-analysis

CONTEXT

The COVID-19 pandemic has had a global impact on food security and nutrition, both in the short and long term. The influence on school-age children, adolescents, and young adults may be particularly significant and long-lasting.

OBJECTIVE

This systematic review and meta-analysis aimed to quantify the impact of the COVID-19 pandemic on dietary habits among school-age children, adolescents, and young adults worldwide.

DATA SOURCES

PubMed, Web of Science, and Embase were searched from inception to October 5, 2023.

DATA EXTRACTION

We included observational studies published in English that reported dietary quality scores and dietary intake quantities during and before the COVID-19 pandemic among school-age children, adolescents, and young adults. We included a total of 22 cohort studies and 20 cross-sectional studies of high or moderate quality.

DATA ANALYSIS

We conducted a meta-analysis, expressing dietary quality scores and dietary intake quantities as standardized mean differences (SMD) with 95% confidence intervals (CIs). For studies with low heterogeneity, we used a fixed-effects model; otherwise, we applied a random-effects model. The Newcastle-Ottawa Scale was employed by 2 reviewers independently to evaluate methodological quality. The analysis indicated that, overall, juice intake increased (SMD = 0.12, 95% CI: 0.04 to 0.20), while alcohol consumption reduced during the COVID-19 pandemic (SMD = -0.28, 95% CI: -0.47 to -0.08). However, the age-stratified results varied. Among school-age children, intake of fruit, dairy products, sugar, and juice increased. Adolescents showed an increase in meal frequency and vegetable intake. Young adults showed reduced carbohydrate and alcohol intakes, while protein and dairy product intakes increased, based on limited included studies.

CONCLUSION

Dietary changes in school-age children from before to during the pandemic were mixed, while dietary behavior changes in adolescents and young adults tended to be more positive. Considering the lasting effects of negative dietary behaviors, attention should be given to addressing the increased sugar and juice intakes. It is also crucial that caregivers and researchers monitor whether positive dietary behaviors will rebound after returning to normal study and life.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42023420923.

Association between suicidal ideation and oxidative balance score (OBS): National Health and Nutrition Examination Survey (NHANES) 2005-2018

BACKGROUND

The oxidative balance score (OBS) serves as an indicator of systemic oxidative stress status, where a higher OBS indicates significant exposure to antioxidants through dietary and lifestyle choices. Studies exploring the relationship between OBS and suicidal ideation are limited. Therefore, this study aimed to examine the association between OBS and suicidal ideation.

METHODS

This cross-sectional study selected 28,598 individuals aged ≥20 years from the 2005-2018 National Health and Nutrition Examination Survey dataset. The OBS was determined using 16 dietary components and 4 lifestyle components. Item 9 of the Patient Health Questionnaire-9 was used to evaluate suicidal ideation. The association between suicidal ideation and OBS, dietary OBS, and lifestyle OBS was examined using weighted logistic regression and restricted cubic spline. The subgroup analyses and interaction tests were further conducted to assess the robustness of these associations across different populations.

RESULTS

The prevalence of suicidal ideation was 3.35 %. OBS, dietary OBS, and lifestyle OBS were substantially and inversely linked with suicidal ideation in Models 1, 2, and 3 (p < 0.05). The odds ratio for the highest quartile (Q4) of these variables and suicidal ideation in Model 3 was 0.44 [95 % confidence interval (CI): 0.30-0.65], 0.54 (95 % CI: 0.37-0.78), and 0.50 (95 % CI, 0.34-0.74), respectively, compared with the lowest quartile (Q1). The subgroup analyses revealed consistent connections between the three oxidative stress indices and suicidal ideation. The lifestyle OBS was negatively correlated with suicidal ideation, especially in women (p for interaction < 0.05).

CONCLUSIONS

The dietary and lifestyle OBSs may influence suicidal ideation by modulating oxidative balance. An antioxidant diet and lifestyle are crucial in mitigating suicidal ideation. These findings suggest a potential sex-specific suicide ideation risk, which significantly correlates with suicidal ideation in women but not in men.

F127/chlorin e6-nanomicelles to enhance Ce6 solubility and PDT-efficacy mitigating lung metastasis in melanoma

Photodynamic Therapy (PDT) is a promising paradigm for treating cancer, especially superficial cancers, including skin and oral cancers. However, the effectiveness of PDT is hindered by the hydrophobicity of photosensitizers. Here, chlorin e6 (Ce6), a hydrophobic photosensitizer, was loaded into pluronic F127 micelles to enhance solubility and improve tumor-specific targeting efficiency. The resulting Ce6@F127 Ms demonstrated a significant increase in solubility and singlet oxygen generation (SOG) efficiency in aqueous media compared to free Ce6. The confocal imaging and fluorescence-activated cell sorting (FACS) analysis confirmed the enhanced internalization rate of Ce6@F127 Ms in murine melanoma cell lines (B16F10) and human oral carcinoma cell lines (FaDu). Upon laser irradiation (666 nm), the cellular phototoxicity of Ce6@F127 Ms against B16F10 and FaDu was approximately three times higher than the free Ce6 treatment. The in vivo therapeutic investigations conducted on a murine model of skin cancer demonstrated the ability of Ce6@F127 Ms, when combined with laser treatment, to penetrate solid tumors effectively, which resulted in a significant reduction in tumor volume compared to free Ce6. Further, the Ce6@F127 Ms demonstrated upregulation of TUNEL-positive cells, downregulation of proliferation markers in tumor tissues, and prevention of lung metastasis with insignificant levels of proliferating cells and collagenase, as validated through immunohistochemistry. Subsequent analysis of serum and blood components affirmed the safety and efficacy of Ce6@F127 Ms in mice. Consequently, the developed Ce6@F127 Ms exhibits significant potential for concurrently treating solid tumors and preventing metastasis. The photodynamic formulation holds great clinical translation potential for treating superficial tumors.

Cost-effectiveness-analysis of oral health remotivation and reinstruction in nursing homes in a cluster-randomized controlled trial

OBJECTIVES

We conducted a cluster-randomized-controlled trial (cRCT) in 18 German nursing homes (NH) to evaluate the cost-effectiveness of reinstruction and remotivation of nursing staff by dental assistants (DAs) over 13 months.

METHODS

In the intervention arm, dentists examined NH residents, identified oral health conditions, and prescribed individualized oral care interventions. Nursing staff delivered these interventions, with regular follow-up support from DAs (reinstruction and remotivation). In the control group, similar interventions were prescribed via a standardized form, without reinstruction and remotivation (standard of care). The primary outcome was Oral-Health-related Quality-of-Life (OHrQoL) using the Geriatric/General Oral Health Assessment Index (ADD-GOHAI). Secondary outcomes included Health-related Quality-of-Life (HrQoL) using the EQ-5D summary index and caries experience (DMFT index). Costs, including those for staff, materials, and travel, were assessed in Euro 2022. Cost-effectiveness ratios and bootstrapping simulations assessed cost-effectiveness-acceptability at different willingness-to-pay thresholds.

RESULTS

Of 358 recruited participants, 68 and 63 in the intervention and control group completed the study. No significant differences existed between groups in demographics or baseline health measures. After 13 months, changes in ADD-GOHAI and DMFT scores were minimal and non-significant, while EQ-5D scores decreased in the intervention group (p < 0.001). Total costs were higher in the intervention arm (median 121.10 Euro) versus the control (median 0 Euro, p < 0.001), mainly due to travel expenses. The intervention increased dental service use but demonstrated lower cost-effectiveness acceptability.

CONCLUSIONS

DA-led reinstruction did not improve OHrQoL, negatively impacted HrQoL, and increased costs. Notably, our study was suffering from significant attrition, impacting on statistical power.

CLINICAL SIGNIFICANCE

Reinstruction and remotivation by dental assistants did not improve OHrQoL, but generated significant costs, mainly due to an uptake of dental services.

TRIAL REGISTRATION

ClinicalTrials.gov (Trial registration number NCT04140929).

The legacy of the COVID-19 pandemic on critical care research: A descriptive interview study

Background

The COVID-19 pandemic challenged both research and clinical teams in critical care to collaborate on research solutions to new clinical problems. Although an effective, nationally coordinated response helped facilitate critical care research, reprioritisation of research efforts towards COVID-19 studies had significant consequences for existing and planned research activity in critical care.

Aims

Our aim was to explore the impact of the COVID-19 pandemic research prioritisation policies and practices on critical care research funded prior to the pandemic, the conduct of pandemic research, and implications for ongoing and future critical care research.

Methods

We undertook a descriptive qualitative study recruiting research-active clinician researchers and research delivery team members working in critical care. We conducted digitally recorded, semi-structured interviews in 2021-2022. Framework Analysis was used to analyse the data.

Results

We interviewed 22 participants comprising principal investigators, senior trial coordinators and research delivery nurses from across the UK. Six themes were identified: Unit, organisational and national factors; Study specific factors; Resources; Individual/clinician factors; Family/patient factors; Contextual factors. These themes explained how a nationally coordinated response during the pandemic affected individuals, studies and wider organisations in managing the research response in critical care, highlighting future implications for critical care research.

Conclusion

Harnessing the collective response seen in the COVID-19 pandemic in critical care could better support integration of research activity into routine critical care activities. Future endeavours should focus on workforce preparations, contingency planning, strategies for study prioritisation and integration of research as part of the continuum of clinical care.

Single-Sided Peak Nasal Inspiratory Flow as an Adjunct Objective Measure in Functional Septorhinoplasty

OBJECTIVE

Nasal obstruction can negatively impact patient quality of life, which can be alleviated by functional nasal surgery. Quantification of improvement is most commonly evaluated with the use of validated survey instruments but lacks widely utilized objective measures. Herein, we evaluate the utility of single-sided peak nasal inspiratory flow (PNIF) as an objective outcome measure in the evaluation and management of nasal obstruction.

METHODS

Adults presenting with nasal obstruction who were recommended septorhinoplasty were included in the study. Single-sided and bilateral PNIF measures, nasal obstruction symptom evaluation (NOSE) scores, surgeon-rated percent nasal obstruction, and nasal obstruction visual analog scale (VAS) scores were recorded preoperatively with Spearman's correlation coefficients (ρ) calculated. Correlation coefficients were also calculated between the change in the above variables from the pre- to postoperative state.

RESULTS

One Hundred Fifteen patients were enrolled in the study and underwent septorhinoplasty. Significant correlations between single-sided PNIF and the associated VAS scores of the same laterality were found for the worse (ρ = -0.366; p < 0.001) and better (ρ = -0.313; p < 0.001) breathing sides. Correlations between postoperative improvement in single-sided PNIF and improvement in VAS scores were also found (ρ = -0.330; p = 0.007, ρ = -0.354; p = 0.004). No correlation between NOSE scores and single-sided PNIF was found except in the subgroup of patients presenting with bilateral asymmetric nasal obstruction, in who NOSE scores correlated with worse side PNIF (ρ = -0.369; p = 0.038).

CONCLUSIONS

Single-sided PNIF has a better correlation to patients' symptoms as rated by VAS score than bilateral PNIF and may be a useful adjunct objective measure in the evaluation and quantification of improvement in patients undergoing septorhinoplasty.

LEVEL OF EVIDENCE

3 Laryngoscope, 135:641-647, 2025.

What is known about near miss events in the operating room? A systematic review of studies of mixed methods design

BACKGROUND

A near miss event (NME) in healthcare is an event that did not happen but would have caused serious harm if it did. The operating room (OR) is prone to risk and incidents, with estimates that 50% of all hospital adverse events occur in the OR, yet reporting of NME is uncommon in the OR.

OBJECTIVE

To carry out a systematic review of studies with mixed methods to establish what is known about NME reporting in the OR.

METHOD

Inclusion criteria will be those studies of mixed methods design, which have been conducted in the OR, with teams of surgeons, anaesthetists or nurses alone or in any combination. Using a publication timeframe of 2001-2023, the following databases were searched: Medline (OVID), CINAHL, Pubmed and Google Scholar. Selected papers for the review were assessed using the Quality Assessment Tool for Studies of Diverse Designs.

RESULTS

Fourteen papers were included in the review. NMEs are common occurrences that are underreported in the OR. When NMEs occur in multiples for the same patient, the risk of serious harm increases. Feedback and education about NME helps to improve reporting; ORs with high rates of NME reporting have less serious patient harm events.

DISCUSSION

The implications of the findings for improving healthcare safety are discussed and in particular the adoption of the science of Human Factors Ergonomics into healthcare.

Comparative Analysis of Healthy Lifestyles in Peruvian University Students During and After the COVID-19 Pandemic

The COVID-19 pandemic has provoked a worldwide mental health crisis, affecting university students in an exacerbated way, exposing them to the risk of emotional isolation and development of eating disorders. The present study aimed to examine the quality of healthy lifestyle practices in university students from the Faculty of Human Medicine and the Faculty of Education of a Peruvian university during and after the COVID-19 pandemic. This study was conducted during the academic period 2020 and 2023. Data collection was performed between July and August 2020, during the first wave of the COVID-19 pandemic (M1) and between November and December 2023, post-pandemic (M2). In M1 and M2, 370 and 82 students participated, respectively. The results of the Mann-Whitney test revealed significant differences between the total healthy lifestyle score of students in M1 and M2. In the nutrition domain, there are significant differences between the scores obtained in M1 and M2, revealing a decrease in nutritional care. Significant differences were also found between both faculties in substance use in M1 and physical activity practice in M2. Although a trend toward the adoption of healthy habits was observed in the initial stages, the longitudinal analysis reveals a generalized decrease in concern for health and well-being. Medical students, on the other hand, showed greater resilience and more successful adaptation to new circumstances, evidencing the importance of academic training in the promotion of healthy lifestyles. These results underscore the need to implement intervention strategies aimed at promoting healthy habits in the student population, especially in contexts of health crisis.

Burnout and organisational stressors among healthcare staff working with adults with intellectual disabilities in Ireland

BACKGROUND

The associations between organisational stressors and burnout among healthcare staff working with adults with intellectual disabilities are underexplored. This study investigated rates of burnout and associated stressors among Irish healthcare workers during the COVID-19 pandemic.

MATERIALS AND METHODS

A convenience sample of 329 Irish frontline staff supporting adults with intellectual disabilities completed a survey assessing personal, work-related, and client-related burnout, and organisational stressors. Quantitative correlational analysis assessed bivariate and multi-variate associations, while qualitative accounts were analysed thematically.

RESULTS

Compared to international data, we observed very high levels of personal and work-related burnout, with lower levels of client-related burnout. "Lack of resources" was the stressor holding the strongest association with burnout, followed by "bureaucracy" and "work-home conflict". Qualitative responses highlighted the negative impact of the pandemic on workload, service quality, and staff wellbeing.

DISCUSSION

Our findings highlight an important association between organisational stressors and burnout among frontline staff, suggesting the potential benefit of designing organisationally focused interventions to reduce stress and promote staff wellbeing.

Association of over-the-counter mouthwash use with markers of nitric oxide metabolism, inflammation, and endothelial function-a cross-sectional study

Introduction

Regular use of mouthwash can disrupt nitrate reduction by oral bacteria and may affect systemic nitric oxide (NO) levels, which are important for inflammation and endothelial function. We aim to assess the association between over-the-counter (OTC) mouthwash use and nitrate/nitrite, markers of inflammation (IL-6, TNF-α, CRP) and endothelial function (sICAM-1, sVCAM-1) in serum and saliva, and to assess the relationship between nitrate/nitrite levels and these biomarkers, as well as how OTC mouthwash modulated this relationship. We hypothesize that nitrates/nitrites are associated with these biomarkers, and that their associations would vary with the frequency of mouthwash use.

Method

Our cross-sectional study used data and specimen from the baseline of the San Juan Overweight Adult Longitudinal Study (SOALS). Robust Gamma regression with log-link function, Spearman correlations and partial correlations adjusted for covariates were used for the analysis.

Results

Using OTC mouthwash twice a day or more was significantly associated with lower serum nitrite levels compared to less frequent use (β = -0.357, 95% CI: -0.650, -0.064), but not with other markers of inflammation and endothelial function. Mouthwash use differentially impacted the relationship between nitrate/nitrite and TNF-α, sICAM-1 and sVCAM-1. Specifically, in the participants who used mouthwash less than twice a day or no use, TNF-α (β = -0.35, 95% CI: -0.52, -0.18), and sICAM-1 (β = -0.21, 95% CI: -0.32, -0.09) were negatively associated with serum nitrite. In the participants who used mouthwash twice a day or more use, TNF-α was positively associated with serum nitrate (β = 3.36, 95% CI: 2.07, 4.65), salivary nitrite (β = 1.04, 95% CI: 0.39, 1.69) and salivary nitrate (β = 0.48, 95% CI: 0.25, 0.71); sICAM-1 was positively associated with serum nitrate (β = 1.58, 95% CI: 0.86, 2.29). In both subgroups of mouthwash users, sVCAM-1 was positively correlated with serum nitrate and salivary nitrate. In addition, sVCAM-1 was positively correlated with serum nitrite in participants who used mouthwash frequently (ρ_S = 0.18, p = 0.045).

Discussion

Regular use of OTC mouthwash was associated with systemic nitric oxide. This raises concerns about its potential effects on the levels of inflammatory and endothelial biomarkers associated with cardiometabolic diseases.

Level of tuberculosis-related stigma and associated factors in Ugandan communities

Tuberculosis (TB) stigma remains a significant barrier to TB control efforts globally, especially in countries with a high TB burden. Studies about TB stigma done in Uganda so far have been limited in scope and focused on data collected health facilities. In this study we report TB related stigma at community level for the period 2021/2022. We used the 2021/22 Lot Quality Assurance Sampling (LQAS) data from a sample of 33,349 participants across 77 districts, to measure TB stigma determine factors associated. We included demographic characteristics, knowledge and participant perspectives as our study variables. Univariable and multivariate logistic regression analyses were performed to identify factors associated with TB stigma. TB stigma was assessed as a categorical variable (below or above the median) due to the skewness of the data when fitting the scores. The data set had equal proportions of males and females. The largest age group was 20-29 years old (38.47%). Most participants were married (62.94%) and had primary level education (65.80%). The TB stigma scores were assigned on a scale from 0 to 30, with an average score of 21.67 (±8.22) and a median score of 24 (19-28). Overall, 45.48% of participants had TB stigma scores above the median. Variations in TB stigma levels were observed across different districts. Factors associated with higher TB stigma included older age, higher education levels, urban residence, and TB knowledge. To reduce TB stigma and misinformation that can make an impact on TB response, community interventions should balance increasing awareness with minimizing fear. These interventions should be well-rounded and context-specific to address disparities within communities and bolster TB control efforts in the country.

Preventing Underage Tobacco Access: A Cross-Sectional Study of Retailer Training in Southern Illinois

Background. Stringent regulations restricting tobacco access to those under 21 are in place, yet young people continue accessing tobacco products. This study aimed to assess the knowledge, opinions, resource utilization, and training needs of tobacco retailers in terms of preventing underage tobacco sales. Methodology. This cross-sectional study analyzed anonymized responses from 467 licensed tobacco retailers in 16 southern counties of Illinois. The survey included 29 questions adapted from validated items, utilized a hybrid methodology (online and in-person), and targeted both retail store owners and managers. Results. Among 118 respondents, 98.3% were aware of the Tobacco-21 law, but 56.8% doubted its impact on reducing underage sales. Gaps in knowledge persisted, especially regarding policies and enforcement laws for Electronic Nicotine Delivery Systems (ENDS). Overall, there was a disparity in preventive measures and program utilization with a low engagement in rural areas and smaller stores. Approximately 48.3% encountered older youths attempting to purchase tobacco. Most respondents (72.9%) supported training for newly hired clerks, focusing on underage sales refusal (54.2%) and ID verification (62.7%). Nearly half (44.9%) felt the need for training in handling aggressive young buyers. The main barrier to training was time constraints for in-person sessions (28.0%), although 41.5% reported no barriers. While "We Card" was widely used (82.2%), only 38.5% displayed the FDA's "This is Our Watch." Conclusion. A discrepancy exists between awareness and effective practice among retailers, especially in rural areas and smaller establishments. Findings highlighted the need for targeted retailer training and resource utilization to combat underage tobacco access.

Psychological, psychiatric, and behavioral sciences measurement scales: best practice guidelines for their development and validation

Psychiatric, psychological, and behavioral sciences scales provide quantitative representations of phenomena such as emotions, beliefs, functioning, and social role perceptions. Methodologists and researchers have criticized current scale development practices, emphasizing that inaccurate measurements can derail theory development and clinical decisions, thereby impeding progress in mental health research and practice. These shortcomings often stem from a lack of understanding of appropriate scale development techniques. This article presents a guide to scope, organize, and clarify the process of scale development and validation for psychological and psychiatric use by integrating current methodological literature with the authors' real-world experience. The process is divided into five phases comprising 18 steps. In the Preliminary Phase, the need for a new scale is assessed, including a review of existing measures. In the Item Development Phase, the construct is defined, and an initial pool of items is generated, incorporating literature reviews, expert feedback, and target population evaluation to ensure item relevance and clarity. During the Scale Construction Phase, the scale is finalized through the administration of surveys to a large sample, followed by parallel analysis, exploratory factor, and item descriptive statistics to identify functional items. In the Scale Evaluation Phase, the dimensionality, reliability, and validity of the scale are rigorously tested using both classical and modern psychometric techniques. Finally, in the Finalization Phase, the optimal item sequence is decided, and a comprehensive inventory manual is prepared. In sum, this structured approach provides researchers and clinicians with a comprehensive methodology for developing reliable, valid, and user-friendly psychological, psychiatric, and behavioral sciences measurement scales.

Cost of Illness Study on Oral Cancer in Australia

OBJECTIVES

The aim of this study is to estimate the economic burden of oral cancer in Australia from the societal perspective.

METHODS

The population consisted of the prevalence of lip and oral cavity cancer, and other lip, oral cavity, and pharynx cancers for ages 40 years and older. Healthcare costs of oral cancer were estimated using 2019-2020 Australian Disease Expenditure Data. Productivity losses were estimated using disability-adjusted life years, derived from the 2019 Global Burden of Disease Study and 2019 Australian gross domestic product per capita.

RESULTS

The estimated annual healthcare costs for oral cancer in Australia were approximately AUD$113.2 million. Over half of the total healthcare costs (54%) were attributable to public hospital admissions (AUD$61.2 million), followed by private hospital services (28%) and pharmaceutical benefits (8%). The total costs, including healthcare and productivity losses, were around AUD$2.1 billion. The productivity losses due to oral cancer were higher for males compared to females (AUD$1.5 billion versus AUD$0.6 billion).

CONCLUSIONS

The study reveals a significant economic burden of oral cancer for 2019 in Australia at AUD$2.1 billion, largely due to productivity losses and public hospital admissions. This highlights the need for effective screening and prevention programs.

Effects of computer-assisted learning for removable partial denture design on learning outcomes and satisfaction

BACKGROUND

Computer-assisted learning (CAL) has the potential to enhance learning outcomes and satisfaction. However, there are limited reports in the literature that describe or evaluate the implementation of this method to promote competency-based learning in removable partial denture (RPD) design. Therefore, this study aimed to: (1) compare the effectiveness of different learning methods using a 3D software-aided RPD design program, (2) evaluate the learning outcomes associated with these different methods following active learning, and (3) assess students' satisfaction.

METHODS

Forty undergraduate dentistry students were divided into four groups of ten students. Each group was assigned different learning methods for a period of 28 days using the CMU-3D RPD Design program. The learning methods included lecture-based learning (LBL), case-based learning (CBL), a combination of LBL and CBL, and a control group that did not engage in LBL or CBL. Following this period, participants in all four groups engaged in active learning activities related to RPD design. Learning outcomes were measured three times: prior to the experiment, after using the software, and after participating in active learning activities.

RESULTS

Analysis of pre- and post-training assessments using multiple-choice questions revealed that dental students in the combined LBL and CBL group demonstrated statistically significant improvements in test scores compared to baseline (p < 0.05). Notably, there were marked enhancements in comprehension, application, and analysis skills. Outcomes following active learning were significantly improved in groups with a foundation in lecture-based learning. Furthermore, all groups reported high levels of satisfaction (over 90%) after utilizing the software and participating in active learning activities.

CONCLUSIONS

Computer-assisted learning, combined with active learning strategies, improves learners' outcomes and satisfaction. Learning RPD design through computer-assisted methods positively influenced learning outcomes, particularly when both lecture-based and case-based learning approaches were used. Active learning strategies resulted in more substantial improvements when applied to students with a strong foundation in lecture-based learning.

Practitioner, patient and public views on the acceptability of mobile stroke units in England and Wales: A mixed methods study

BACKGROUND

Evidence for Mobile Stroke Units (MSUs) demonstrates that onset to treatment times for intravenous thrombolysis can be reduced and access to mechanical thrombectomy might be improved. Despite growing use of MSUs internationally, to date there have been no studies in NHS England and NHS Wales exploring the acceptability of MSUs to clinicians, patient and public representatives and other key stakeholders, which are important when considering potential feasibility and implementation.

METHODS

This study used a mixed methods design with a cross-sectional survey and qualitative workshops and interviews between October 2023 to May 2024. Survey data were collected from clinicians involved in emergency stroke care. Qualitative data involved clinical and non-clinical professionals involved in stroke care alongside patient and public representatives with experience of stroke. Survey data were descriptively analysed while content analysis was used on open-ended questions. Qualitative data were thematically analysed, prior to triangulation using a convergent coding matrix.

RESULTS

The study results, drawn from 25 respondents to the survey and 21 participants in qualitative workshops, found that almost all participants had positive affective attitudes to the concept of MSUs. However, several key areas of concern were identified that need to be addressed prior to implementing MSUs. These concerns included how MSUs would be staffed; whether and how telemedicine could contribute; the types of economic impacts; extent to which triage systems could accurately identify stroke patients for MSUs to attend; where the base location and geographic coverage of MSUs should be, the impact of MSUs on equitable access to stroke care, and how to improve public awareness of MSUs.

CONCLUSION

Whilst MSUs are mostly acceptable to key stakeholders, numerous areas of concern need to be addressed prior to MSU implementation. We recommend further research to address these issues prior to implementation in the NHS.

Experiencing Traumatic Violence: An Interpretative Phenomenological Analysis of One Man's Lived Experience of a Violent Attack Involving a Knife

A review of the violent knife crime literature suggests that the experiential perspective is one which has not been addressed in academic study. The research presented hereafter aims to address this literary gap and generate transferable knowledge relevant to the lived experience of violent knife crime. The experiential study of the single case within psychological research involves detailed examination of a particular event. Participant 'J' is the survivor of an extremely violent attack, involving the use of a knife, in his own home. J's experience was analysed using Interpretative Phenomenological Analysis with reference to elements of the lifeworld: temporality, spatiality, intersubjectivity, and embodiment. Three themes were identified: 1. switching from past to present tense when relaying traumatic experience; 2. The presence of redemption sequences; and 3. making sense as a temporal process, which included an additional two subthemes-'The long journey' and 'Seeking belongingness'. This case emphasises that the traumatic event is conceptualised as one part of a longer journey towards recovery, and that recovery itself is central to the experience of violent knife crime. Finally, the need to understand recovery as temporal process highlights the need to provide victims with appropriate support in order to avoid negative outcomes.

Adoption of AI writing tools among academic researchers: A Theory of Reasoned Action approach

This research explores the determinants affecting academic researchers' acceptance of AI writing tools using the Theory of Reasoned Action (TRA). The impact of attitudes, subjective norms, and perceived barriers on researchers' intentions to adopt these technologies is examined through a cross-sectional survey of 150 researchers. Structural Equation Modeling (SEM) is employed to evaluate the measurement and structural models. Findings confirm the positive influence of favorable attitudes and subjective norms on intentions to use AI writing tools. Interestingly, perceived barriers did not significantly impact attitudes or intentions, suggesting that in the academic context, potential benefits may outweigh perceived obstacles to AI writing tool adoption. Contrarily, perceived barriers do not significantly affect attitudes and intentions directly. The TRA model demonstrates considerable explanatory and predictive capabilities, indicating its effectiveness in understanding AI writing tool adoption among researchers. The study's diverse sample across various disciplines and career stages provides insights that may be generalizable to similar academic contexts, though further research with larger samples is needed to confirm broader applicability. Results offer practical guidance for tool developers, academic institutions, and publishers aiming to foster responsible and efficient AI writing tool use in academia. Findings suggest strategies such as demonstrating clear productivity gains, establishing AI Writing Tool programs, and developing comprehensive training initiatives could promote responsible adoption. Strategies focusing on cultivating positive attitudes, leveraging social influence, and addressing perceived barriers could be particularly effective in promoting adoption. This pioneering study investigates researchers' acceptance of AI writing tools using a technology acceptance model, contributing to the understanding of technology adoption in professional contexts and highlighting the importance of field-specific factors in examining adoption intentions and behaviors.

Challenges in multinational rare disease clinical studies during COVID-19: regulatory assessment of cipaglucosidase alfa plus miglustat in adults with late-onset Pompe disease

PROPEL (ATB200-03; NCT03729362) compared the efficacy and safety of cipaglucosidase alfa plus miglustat (cipa + mig), a two-component therapy for late-onset Pompe disease (LOPD), versus alglucosidase alfa plus placebo (alg + pbo). The primary endpoint was change in 6-min walk distance (6MWD) from baseline to week 52. During PROPEL, COVID-19 interrupted some planned study visits and assessment windows, leading to delayed visits, make-up assessments for patients who missed ≥ 3 successive infusions before planned assessments at weeks 38 and 52, and some advanced visits (end-of-study/early-termination visits). These were remapped to the respective planned visits. To evaluate if remapping may have overestimated treatment effects, we conducted post hoc analyses using a mixed-effect model for repeated measures based on actual time points of assessments. In this post hoc analysis, estimated mean treatment difference between cipa + mig and alg + pbo for change from baseline to week 52 in 6MWD was 11.7 m (95% confidence interval [CI] - 1.0 to 24.4; p = 0.072). In the original published analyses, between-group difference using last observation carried forward was 13.6 m (95% CI - 2.8 to 29.9; p = 0.071 [p value from separate non-parametric analysis of covariance]). Both statistical analysis approaches led to similar results and consistent conclusions, confirming the efficacy of cipa + mig for adults with LOPD. NCT03729362; trial start date: December 4, 2018.Trial registration number.

Practice of self-medication to manage oral health issues in a community setting of Nepal

BACKGROUND

Self-medication has been defined as the practice of self-diagnosis and medication use without seeking professional healthcare advice. Its prevalence for alleviating dental problems in Nepali communities has not been explored. This study was conducted to assess self-medication for oral health problems in a community setting in Nepal.

METHODS

A community-based cross-sectional study was conducted in two conveniently selected wards of Baraha Municipality of Sunsari district in August 2021 using a pre-validated questionnaire in the Nepali language. The prevalence of self-medication for oral health problems was assessed. The chi-square and Mann-Whitney U tests were used to check its association with demographic variables.

RESULTS

The prevalence of self-medication was found to be 43.3%. The most common health problem leading to self-medication was toothache (78.5%). Around half of the respondents (55.1%) replied achieving temporary relief after its use while around a quarter (25.1%) thought that self-medication was effective in taking care of their problems. Three-quarters of the respondents (75.7%) knew that they had to visit a dentist if their problems persisted. The annual family income was significantly associated with the practice of self-medication for oral health problems. (p = 0.013) CONCLUSION: Self-medication was found to be frequently utilized by the people of Baraha municipality with almost every second person with oral health problems reporting using it to solve their problems. This phenomenon is disproportionately seen in those with lower economic status.

CLINICAL TRIAL NUMBER

Not applicable.

Alternative healthcare delivery arrangements in Nepal: a systematic review of comparative effectiveness, safety and cost-effectiveness studies

BACKGROUND

The way that healthcare services are organised and delivered (termed 'healthcare delivery arrangements') is a key aspect of a health system. Changing the way health care is delivered, for example, task shifting that delivers the same care at lower cost, may be one way of improving healthcare system sustainability. We synthesised the existing randomised trial evidence to compare the effects of alternative healthcare delivery arrangements versus usual care in Nepal.

METHODS

For eligible studies published since 2005, we searched MEDLINE, Embase, CENTRAL, CINAHL, Scopus, the WHO clinical trials registry and NepJOL on 31 October 2024. Two authors independently assessed studies for eligibility, extracted data and evaluated the risk of bias using the Cochrane risk of bias tool and certainty of evidence using Grading of Recommendations, Assessment, Development and Evaluations. We calculated risk ratios (RRs), mean differences (MDs) and percentage points (PPs) with 95% CIs for the outcomes and performed meta-analysis where appropriate.

RESULTS

Four studies met the inclusion criteria. One evaluated task shifting, two information and communication technology, and one care coordination. No meta-analyses were performed. Low certainty evidence indicates task shifting of medical abortion by doctors to midlevel providers may result in equivalent complete abortion (RR: 2.55, 95% CI: 0.82 to 4.27). Similarly, the use of a mobile phone call reminder may improve on-time medicine collection among patients with HIV compared with usual care (RR: 1.29, 95% CI: 1.12 to 1.48), while the integration of postpartum family planning and postpartum intrauterine contraceptive device (PPIUCD) insertion with maternity services may improve PPIUCD uptake compared with usual care (PP: 0.173, 95% CI: 0.098 to 0.246).

CONCLUSION

More evaluation is needed for alternative delivery arrangements due to limited low-certainty evidence from current trials. There was insufficient evidence on outcomes such as cost, safety, and patient and provider perspectives.

PROSPERO REGISTRATION NUMBER

CRD42022327298.

Digital Health Technology Research Funded by the National Institutes of Health

Importance

Digital health in biomedical research and its expanding list of potential clinical applications are rapidly evolving. A combination of new digital health technologies (DHTs), novel uses of existing DHTs through artificial intelligence- and machine learning-based algorithms, and improved integration and analysis of data from multiple sources has enabled broader use and delivery of these tools for research and health care purposes. The aim of this study was to assess the growth and overall trajectory of DHT funding through a National Institutes of Health (NIH)-wide grant portfolio analysis.

Observations

This study used 21 preselected DHT search terms to identify the funding allocations in DHT research across a 9-year period between fiscal year 2015 and fiscal year 2023. A subset of grants were manually curated to confirm the search terms' accuracy and ascertain the stage of development, focus, and types of tools or approaches. To understand the translation of DHTs from biomedical research to clinical application, common measures, such as digital health publications and clinical trials were included. The DHT portfolio represented 3.2% (US $7 628 967 500) of the overall NIH grants funded from 2015 to 2023. DHT research funding increased during this period from $348 725 600 to $1 533 281 000. DHT research publications and clinical trials using the same search terms increased from 3714 to 14 786 and from 89 to 240, respectively. More DHT research funding was used for research and development purposes (59.3%) than for clinical or regulatory purposes (41.0%) based on manual, second-level data curation.

Conclusions and Relevance

This study found that investments in DHT research at the NIH has increased over the past 9 years and that this increase has been steady since 2015, including during and even after the COVID-19 pandemic. Increased use of DHTs is expected to continue as these technologies become a more integral part of the biomedical research ecosystem.

Effects of recalling place memory on promoting cooperative behaviors in local communities

AIMS

The present study aimed to develop a theoretical model that explores the influence of recalling place memory on cooperative behaviors in local communities.

METHODS

Five hundred ninety-five Japanese residents (mean age = 49.75 years) participated in an online survey, in which they received one of the three interventions: (1) positive memory; (2) neutral memory and (3) negative memory. Participants were instructed to recall their place memories within their living areas and provide ratings for their place attachment, emotional valence, perceived self-interest, and willingness to engage in cooperative behaviors.

RESULTS

The results revealed that individuals who recalled positive-valenced place memories exhibited a higher willingness to engage in cooperative behaviors. Additionally, this study reveals the previously unreported mediating role of place attachment and perceived self-interest in promoting cooperative behaviors.

CONCLUSION

The findings hold significance in elucidating the relationship between place memory and cooperative behaviors, offering novel insights for community management.

Vaccine Uptake and Perspectives Among Latina Immigrant Mothers in Rural Communities in a Midwestern State

PURPOSE

Examine the prevalence of and characteristics related to COVID-19 vaccine uptake.

DESIGN

Quantitative and qualitative data collected at two-time points via phone interviews.

SETTING

Rural Midwestern communities.

SAMPLE

109 Latina mothers with incomes < 185% FPL, at least one child < age 12 recruited from a Midwestern state based on two previous studies.

MEASURES

Mothers responded to the following variables through a survey: Vaccine uptake measured by responses to, Have you received a vaccination shot for COVID-19. Tested predictors of vaccine uptake included: income, gender, education, immigration status, confidence in vaccine, belief the pandemic is over). Mothers' perspectives regarding the vaccine explored via responses to Why haven't you received COVID-19 vaccine?.

ANALYSIS

Binary logistic regression analysis was conducted. Demographic variables and attitudes toward the vaccine served as predictors of mothers' vaccine uptake. Qualitative data were analyzed to shed light on mothers' perspectives on receiving the vaccine.

RESULTS

Mother's confidence in the vaccine predicted vaccine uptake in 2021 (aOR=1.332, 95% CI: 1.07-1.65) and 2022 (aOR=1.48, 95%CI: 1.11-1.97). In 2021, income also predicted vaccine uptake (aOR=1; 95% CI: 1-1.002). Overarching themes: "vaccination is not necessary","mistrust of the vaccine", and "vaccine as protector".

CONCLUSION

Vaccinated mothers viewed the vaccine as a protection from being infected or gravely ill. For unvaccinated mothers, messages are needed that communicate the vaccine can protect them from virus transmission from household members who unknowingly are infected, as well as from different virus strains.

A scoping review of evidence on routine cervical cancer screening in South Asia: investigating factors affecting adoption and implementation

NEED: Cervical cancer is a major global public health issue, particularly affecting low and middle-income countries, distinctly in the South Asian region. This geographical region lacks a well-organized routine cervical screening program. Consequently, this scoping review aimed to investigate the evidence on factors influencing the adoption and implementation of routine cervical cancer screening in South Asia.

METHODS

Adopting the "Arksey and O'Malley and Levac et al." methodology, databases such as PubMed, CINAHL, Web of Science, and Scopus were scrutinized in the pursuit of relevant studies. Subsequently, the collected data were synthesized by adopting the Consolidated Framework for Implementation Research (CFIR) model.

RESULTS

A total of 837 records were initially identified and screened for eligibility, including 55 studies. The successful adoption and implementation of cervical cancer screening in South Asia encounter numerous obstacles within the health system, including the absence of a comprehensive program protocol for screening, inadequate health infrastructure, and the presence of multiple sociocultural factors, such as social stigma, low levels of education, and concerns related to modesty.

CONCLUSION

To optimize adoption and implementation, it is imperative to construct a customized policy framework that incorporates a risk communication strategy tailored to the specific contexts of these nations. Drawing insights from the experiences of South Asian countries in executing cervical cancer screening programs can inform the formulation of policies for similar healthcare initiatives aimed at facilitating the expansion of HPV vaccination efforts.

A survey of NHS nurses' delivery of treatments to prevent recurrence of venous leg ulcers

Preventing recurrence of venous leg ulcers can be achieved through strongest tolerated compression and endo-venous ablation surgery, but it is not clear how often this is done in practice. This study explores (1) nurses' awareness of strongest tolerated compression and endo-venous ablation surgery as prophylactic treatments for venous leg ulcer, (2) how often these treatments are offered, and (3) assessment of the barriers and enablers to deploying those treatments using the capabilities, opportunities and motivations model of behaviour change. An online cross-sectional survey was conducted among nurses who treat and manage venous leg ulcers across the United Kingdom. Data were analysed descriptively using within-participants ANOVA, within-participants MANOVA and multiple linear regression. We received 96 questionnaire responses. All the respondents reported that they were aware of strongest compression to prevent recurrence while 87.5% reported they were aware of endo-venous ablation surgery for recurrence prevention. Nurses' capabilities, opportunities, and motivations to offer the strongest tolerated compression were significantly greater when offering the strongest compression compared with referring to vascular surgery. Both preventative treatments were associated with marked deficits in opportunities (social and physical) and automatic motivation. Interventions targeted at increasing nurses' opportunities and boosting their motivation are needed to support the delivery of both preventive treatments. Further research is required to gain in-depth understanding of those barriers and enablers to identify candidate behaviour change techniques.

Mood disorders after COVID-19 infection: a single-center experience

Objectives

The present study aimed to examine mood disorders in patients discharged from the hospital due to Coronavirus Disease-19 (COVID-19).

Methods

The study included patients who were admitted to Akdeniz University with the diagnosis of COVID-19. Post-Traumatic Stress Disorder (PTSD) Checklist - Civilian Version (PCL-5), and Beck Anxiety and Depression Inventories were administered to the patients at least 30 days after discharge.

Results

A total of 215 patients were included. The median age was 56 years, and 60.9%(131) were male. There was no statistically significant difference in mood disorders scale scores between male and female. However, there was a weak negative correlation between age and PCL-5 scores (rho: -0.157, p: 0.021). The depression scores (p < 0.001), anxiety scores (p < 0.001) and PCL-5 (p = 0.001) scores were statistically significantly higher in patients with respiratory symptoms at the time of enrollment (after a mean duration of 87.9 days following discharge). Married individuals had statistically significantly lower anxiety, depression, and PCL-5 scores. Beck anxiety scores were statistically significantly higher in patients receiving systemic steroid.

Conclusion

A substantial portion of patients with COVID-19 suffer from mood disorders after hospital discharge. Those patients with residual symptoms who live alone and receive corticosteroid represent a vulnerable population.

Neurological Nurses' Perspectives on Communication of Stroke Recurrence Risks: A Mixed-Method Study

AIM

To gain a comprehensive understanding of the practices, attitudes, and thoughts of neurological nurses regarding communication about the risk of stroke recurrence.

DESIGN

This is a mixed-method study with a sequential explanatory design.

METHODS

An electronic survey was conducted amongst 280 neurological nurses from 30 hospitals to explore their clinical practice and attitudes towards stroke recurrence risk communication (RC). Furthermore, 10 nurses' from three tertiary hospitals were interviewed using a convenience sampling approach, and data were analysed with Colaizzi's methods.

RESULTS

Most neurological nurses view recurrence RC essential and beneficial. Quantitative results indicated that nurses frequently discuss warning symptoms, risk factors, the likelihood, and severity of stroke recurrence with patients. However, qualitative analysis indicated that these communications are often non-standardised, with cautious language, use of informal language, non-fixed timing, and limited focus on structured communication strategies. Factors influencing communication practices span three levels: the nurse, the patient, and the organisation. Influencing factors fall into three categories: nurse-related (age, education, experience, confidence, and knowledge), patient-related (trust and preferences), and organisational (lack of standardised models for communication).

CONCLUSIONS

Although neurological nurses recognise the significance of recurrence RC, their skills in this area could benefit from further development. Developing training and supporting nurses in delivering effective stroke recurrence risk education independently or in collaboration with physicians is crucial.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The findings highlight the necessity of standardising stroke recurrence RC, including the development of assessment tools, training programs, and communication strategies. These are essential for optimising risk education in stroke secondary prevention and promoting effective cardiovascular RC in clinical practice.

REPORTING METHOD

This study adhered to the GRAMMS checklist.

PATIENT OR PUBLIC CONTRIBUTION

Not applicable.

TRAIL REGISTRATION

CTR2000034244.

Community pharmacists' knowledge, beliefs, and perceived barriers toward vaccination services at community pharmacies: A cross-sectional study from Saudi Arabia

Community pharmacists were recently authorized to provide vaccination services in Saudi Arabia. However, the implementation is still limited. Consequently, this study aimed to assess the knowledge, beliefs, and views of community pharmacists in the Qassim region regarding vaccines and vaccination services and to identify the barriers to providing such services. A total of 170 community pharmacists participated in the study (response rate = 73.91%). The mean overall knowledge of vaccines and vaccination was 10.25 ± 1.35 out of a maximum score of 14. The majority stated that vaccines are rigorously tested for their safety (92.94%), go through a stringent approval process to ensure their quality and efficacy (93.53%), and vaccines play a key role in preventing and controlling infectious disease outbreaks (97.06%). However, only 48.82% were aware that community pharmacists are legally authorized to provide adult vaccination services. Few participants were also aware of the dosing of the varicella vaccine (14.12%) and indications of the herpes zoster vaccine (21.18%). The overall mean score on beliefs/views was 31.91 ± 5.53 out of a maximum of 40, indicating positive beliefs/views regarding vaccination services. The study identified many barriers to implementing vaccination services. These included lack of support staff and technicians in community pharmacies (79.41%), lack of requirements and equipment to provide the service (74.11%), the service will add extra workload (72.94%), and lack of formal certification in pharmacy-based immunization delivery (66.48%). Consequently, a holistic strategy is required to improve pharmacists' clinical knowledge of vaccines and to address the barriers to the implementation of vaccination services at community pharmacies.

Concise Recommendations for EDitorials: Enhancing Narratives and Composition Effectively (CREDENCE)

An editorial article is a type of scholarly communication providing expert views and critical analysis of issues. It may reflect the view of the author(s) or of the organization/journal on a certain topic. An editorial may also comment on a published paper. Editorials are expected to be objective, evidence-based, and informative focusing attention on recent developments and matters of current societal/disciplinary concern. This format allows for timely dissemination of expert insight and facilitates ongoing scholarly discourse. The structure of editorials varies: critical, explanatory, and commendatory types serve varied purposes. Authors of editorials should follow certain principles of academic writing. The aim should be provided in an introductory paragraph. Thereafter, a constructive and balanced critique of the index article and/or a detailed yet concise analyze of the subject of matter should be provided. The conclusion paragraph should include brief take-home messages. Critical arguing should be supported by relevant references. A declaration of any potential conflicts of interests is essential to maintain objectivity and fairness. The current article aims to provide a primer, along with a checklist, on writing editorials.

Assessment of myocardial infarctions knowledge, attitudes and beliefs among adults living in Riyadh Saudi Arabia - insights from cross-sectional study

Globally, the prevalence of coronary artery disease (CAD) is increasing, accounting for a third of all deaths worldwide including myocardial infarctions (MIs) which represent the most severe clinical manifestation of CAD and are among the most dangerous coronary events. Therefore, this study aims to assess the knowledge of symptoms and risk factors of MIs, as well as attitudes and beliefs regarding MIs and confidence in recognizing CAD symptoms in Riyadh, Saudi Arabia. A cross-sectional study was conducted among individuals living in Riyadh, Saudi Arabia between November 2023 and April 2024 to assess their knowledge and beliefs about CAD and MIs. Data collection was done using convenience sampling with pretested and validated questionnaire. Furthermore, recruiting more sample was achieved by distributing the questionnaires using the snowball technique. ANOVA and Student's t-test were used to determine the association between variables, with a p-value of < 0.05 considered statistically significant. Among respondents, approximately 65.5% were male, 27.3%, fell between the ages of 26 and 30 and 59.1% held a master's degree. In terms of marital status, the majority, 76.2%, were married. The majority (90%) stated that jaw pain was a symptom of a heart attack, followed by chest pain/pressure (85.9%), weakness/fatigue (85.8%), palpitations/rapid heart rate, and chest discomfort (83.4%). Most respondents (91.6%) were aware that smoking and obesity could increase the risk of MIs, while 85.3% believed that a family history of coronary heart disease could affect the risk of MIs. Additionally, 92.3% said they would seek medical care if they experienced chest pain within 15 min. The respondents' gender (p = 0.001), age (p = 0.004), education (p = 0.001), and marital status (p = 0.004) were significantly associated with levels of knowledge of MI. The findings showed that half of the study population had good knowledge and were well-informed about jaw and chest pain as the main symptoms of MI. Despite understanding the clinical potential of MI, the majority expressed low confidence in their ability to identify heart attack symptoms and recommended health education about the illness to provide prompt assistance.

Inhibition of Oral Biofilms and Enhancement of Anticancer Activity on Oral Squamous Carcinoma Cells Using Caffeine-Coated Titanium Oxide Nanoparticles

The fungus Candida albicans is a prominent cariogenic fungal agent that works in association with Streptococcus mutans to accelerate the formation of oral cancer and tooth decay. This study evaluates caffeine-encapsulated titanium oxide nanoparticles (CF-TiO2 NPs) for their potential to prevent biofilm formation on teeth and enhance oral anticancer treatment by influencing apoptotic gene regulation. The synthesized CF-TiO2 NPs were characterized using ultraviolet, scanning electron microscopy, energy-dispersive X-ray spectroscopy, and Fourier-transform infrared spectroscopy analyses, and their antioxidant activity was confirmed through free radical quenching studies. Antimicrobial efficacy was assessed using a zone of inhibition test, revealing strong activity against dental pathogens with a minimal inhibitory concentration of 80 µg/mL. Molecular docking using AutoDock explored interactions between CF and biofilm target sites, supporting their inhibitory potential. In vitro cytotoxicity studies on KB cancer cells showed a dose-dependent increase in cytotoxic effects, with CF-TiO2 NPs promoting apoptotic gene upregulation at concentrations of 20-160 µg/mL. CF-TiO2 NPs demonstrated excellent antioxidant, antibacterial, and anticancer properties, showcasing their promise for oral therapeutic applications. This research highlights a novel approach to managing oral infections and associated complications while improving systemic oral health. Notably, this study is the first to report the biofilm-inhibitory and anticancer potential of CF-TiO2 NPs.

Understanding Post-COVID-19: Mechanisms, Neurological Complications, Current Treatments, and Emerging Therapies

COVID-19, a highly infectious disease, caused a worldwide pandemic in early 2020. According to the World Health Organization (WHO), COVID-19 has resulted in approximately 774 million cases and around 7 million deaths. The effects of COVID-19 are well known; however, there is a lack of information on the pathophysiological mechanisms underlying the symptoms that comprise Post-Acute COVID-19 Syndrome (PACS) or Long COVID-19. Neurological sequelae are common, with cognitive dysfunction being one of the foremost symptoms. Research indicates that elevated inflammatory levels and increased oxidative stress may play a role in the etiology and severity of PACS. Treatment options are extremely limited, and there is no consensus among the medical and scientific communities on how to manage the disease. Nevertheless, many scientists advocate for using antioxidants for symptomatic therapy and cognitive behavior therapy for supportive care. Additionally, current research aims to ameliorate several aspects of the inflammatory cascade. This review highlights the intracellular and extracellular pathways crucial to the neurological manifestations of PACS, providing valuable information for healthcare professionals and scientists. Given the complex nature of PACS, understanding these pathways is essential for developing new treatment options. Assessing PACS is challenging, and reviewing current therapeutic options while proposing a triad of potential therapeutic elements will add value to clinical assays and guidelines. Current therapeutic strategies, such as antioxidants/vitamin supplements, neurogenic stem cell therapy, and mitochondrial therapy, could be combined to enhance their effectiveness. Future research should focus on validating these approaches and exploring new avenues for the effective treatment of PACS.

Living well with advanced cancer: a scoping review of non-pharmacological supportive care interventions

PURPOSE

The increasing number of people living longer with advanced cancer presents unique physical, psychosocial, financial, legal, practical and complex care needs. Supportive care interventions aim to address these needs by improving symptom management, promoting wellbeing, enhancing quality of life and potentially improving prognosis. To integrate supportive care interventions into clinical practice, a comprehensive review of existing studies is needed. This scoping review maps the evidence on non-pharmacological supportive care interventions for people with advanced cancer and identifies gaps to inform future research.

METHODS

We systematically searched four electronic databases-CINAHL, Medline, Cochrane and PsycINFO-for peer-reviewed original research on non-pharmacological supportive care interventions for adults with advanced cancer, published from January 1, 2013, to July 1, 2024.

RESULTS

Out of 3716 studies, 84 publications met the inclusion criteria. These studies were categorised into key supportive care domains: physical activity, psychosocial support, patient care and autonomy, multimodal approaches and others. Most publications focused on interventions addressing physical and psychosocial needs, showing benefits such as reduced fatigue, pain and improved mood. However, significant gaps were found in research on interventions addressing practical needs essential to autonomy, including health system and information needs, patient care and support and financial needs.

CONCLUSION

Mapping the studies to the needs of the advanced cancer population showed that domains with greatest unmet needs have the fewest interventions available. Our scoping review suggests that non-pharmacological supportive care interventions can improve the wellbeing and quality of life of people living with advanced cancer. However, addressing methodological limitations requires further large-scale, multi-centre studies focusing on the identified gaps to inform the implementation of suitable supportive care programs.

IMPLICATIONS FOR CANCER SURVIVORS

Non-pharmacological interventions can boost wellbeing and quality of life for advanced cancer survivors, but addressing gaps in practical and systemic support is crucial.

Using AI in Optimizing Oral and Dental Diagnoses-A Narrative Review

Artificial intelligence (AI) is revolutionizing the field of oral and dental healthcare by offering innovative tools and techniques for optimizing diagnosis, treatment planning, and patient management. This narrative review explores the current applications of AI in dentistry, focusing on its role in enhancing diagnostic accuracy and efficiency. AI technologies, such as machine learning, deep learning, and computer vision, are increasingly being integrated into dental practice to analyze clinical images, identify pathological conditions, and predict disease progression. By utilizing AI algorithms, dental professionals can detect issues like caries, periodontal disease and oral cancer at an earlier stage, thus improving patient outcomes.