What are health professionals' perceptions and attitudes regarding children with early childhood caries and their families? A qualitative research protocol to assess oral health stigma in the medical setting

INTRODUCTION

Dental caries is one of the most common non-communicable diseases in children. The disease management of caries relies on both a preventive individual approach (fluoridation, risk evaluation) and the surgical treatment of established carious lesions. Similar to other non-communicable diseases (obesity, mental diseases, etc), health professionals' negative perceptions of patients have been shown to affect the quality of disease management. Regarding dental caries in children, some data have indicated the presence of discriminating beliefs and behaviours towards these children and their families in the medical setting. However, oral health stigma related to dental care remains a largely unexplored issue.

METHODS AND ANALYSIS

This study presents an exploratory research protocol focusing on the perceptions and attitudes of health professionals towards children with early childhood caries (ECC) and their parents. Semistructured interviews will be conducted among medical and dental health professionals, and verbatim quotations obtained from audio transcriptions will be analysed to identify health professionals' perceptions of ECC and the influence of these perceptions on clinical care for these children.

ETHICS AND DISSEMINATION

The research ethics committee of the Department of Family Medicine at University Lyon 1 approved this protocol. The results will be published in peer-reviewed journals and presented at scientific meetings.

TRIAL REGISTRATION NUMBER

NCT05284279.

Temporal Trend of Transient Ischemic Attack Management over a 10-Year Period: Data from the Rhône County, France

BACKGROUND

Timely recognition and management of transient ischemic attack (TIA) offer the greatest opportunity to prevent subsequent stroke. But variability of TIA management quality exists across hospitals. Under the impetus of national plans, measures were adopted to improve TIA management, including a structured local pathway. Our objective was to compare TIA management between two periods over 10 years, before and after the implementation of these measures.

METHODS

A before-and-after study was conducted with two identical population-based cohort studies in 2006-2007 (AVC69) and 2015-2016 (STROKE69) including all patients with TIA diagnosis over a 7-month period in six public and private hospitals in the Rhône county in France. The primary outcome was the adequate TIA management defined as brain and vessel imaging within 24 h of admission and the prescription of antithrombotic treatment at discharge.

RESULTS

We identified 109 patients TIA patients in 2006-2007, and 458 over the same period in 2015-2016. A higher proportion of patients were adequately managed in 2015-2016 compared to 2006-2007 (14/96 [15%] in 2006-2007 vs. 306/452 [68%] in 2015-2016, p < 0.001). This difference was mainly driven by a marked increase of vessel imaging performed within 24 h of admission, most often by computed tomography angiography. Furthermore, patients called more often emergency medical dispatch before admission, were admitted with a shorter delay after symptom onset, and were more likely discharged to home in 2015-2016 compared to 2006-2007.

CONCLUSION

Our study demonstrated an increasing rate of adequate TIA management, mainly driven by a marked increase of vessel imaging within 24 h of admission, over a 10-year period in the Rhône county in France.

Stroke Care in Brazil and France: National Policies and Healthcare Indicators Comparison

Objective

To identify the commonalities and discrepancies between national health policies to combat stroke in France and Brazil.

Justification

Both healthcare systems were structured as universal access and comprehensive care attention, hierarchized by the level of care, politically and administratively decentralized. France is an industrialized, high-income country, with health care involving copayment and reimbursement of expenses, and spontaneous demand for services. Brazil is a member of the BRICs, of upper middle income with totally free health care, with an active search for hypertension and diabetes in the general population.

Methods

Data regarding policies, risk factors, and health indicators about stroke care, from 2010 to 2017, were obtained from both countries (publicly accessible information or on request) from the respective Ministries of Health or international agencies.

Results

About acute stroke hospitalizations, on average, Brazil has 0.75 per 1000 annual population hospitalizations versus 1.54 per 1000 in France. Brazil has 0.21 per 1000 population deaths per year versus 0.40 per 1000 in France. The in-hospital mortality rate in Brazil has 139 per 1000 hospitalized people versus 263 in France. The average length of stay of acute hospitalizations was 7.6 days in Brazil versus 12.6 in France. The prevalence of strokes by age group shows from 0 to 39 years old (this rate is stable); 40–59 years (it is increasing in both countries); and 60–79 and 80+ years (this rate has been increasing in France and decreasing in Brazil).

Conclusion

No major differences were found about the health policies and the National Health Plans related to stroke. However, the data directly linked to the period of hospitalization differed substantially between countries. Subsequent studies can be implemented to identify the explanatory factors, notably among the risk factors and actions in primary care, and the moments after hospital care, such as secondary prevention and palliative care.

Usefulness of repetitive transcranial magnetic stimulation as a maintenance treatment in patients with major depression

OBJECTIVES

To investigate the clinical efficacy of repetitive transcranial magnetic stimulation (rTMS), venlafaxine or a combination of both treatments as a maintenance treatment in patients with treatment-resistant depression (TRD).

METHODS

In a three-arm open-label study, 66 patients, including 45 remitters, who responded to rTMS (n = 25), venlafaxine (n = 22), or a combination of both treatments (n = 19) continued to receive the treatment that led to a response as a maintenance treatment over 12 months. Maintenance rTMS was administered twice per week for 1 month, once per week for 2 months, and once every 2 weeks for 9 months. Venlafaxine was maintained at the dose that induced a clinical response (150 or 225 mg/day).

RESULTS

After the 12-month follow-up, the rates of remitters (HDRS < 8) were not different between the three groups (χ²=1.25; P = .3). The rates of patients who not relapsed (HDRS < 15) were not different between groups (χ²=0.33; P = .8): 40.0% in the rTMS group, 45.1% in the venlafaxine group and 36.9% in the combination group.

CONCLUSIONS

The three maintenance approaches exhibited similar efficacies in relapse prevention and the maintenance of remission in patients with TRD.

Mayo Adhesive Probability Score Is an Independent Computed Tomography Scan Predictor of Adherent Perinephric Fat in Open Partial Nephrectomy

OBJECTIVE

To evaluate predictive radiological elements for adherent perinephric fat (APF) and the Mayo adhesive probability (MAP) score in the setting of open partial nephrectomy, and to assess their reproducibility.

PATIENTS AND METHODS

We performed a retrospective case-control study involving 86 patients who had open partial nephrectomies performed by a single surgeon between January 1, 2009 and April 1, 2015. Radiological elements were assessed by 4 readers blinded to patient APF status. Univariate and multivariate analyses were performed for all radiological and clinical factors. Reproducibility was analyzed using agreement coefficients.

RESULTS

On univariate analysis for radiological findings, lateral and posterior fat thickness (odds ratio [OR]: 1.084 [1.033, 1.138], P < .001), stranding (OR: 2.179 [1.431, 3.318], P < .001), -80 HU fat area, and the MAP score (OR: 1.797 [1.332, 2.424], P < .001) were predictive of APF. On multivariate analysis, only age and the MAP score remained statistically significant (OR: 1.060 [1.005, 1.118], P = .03; and OR: 1.560 [1.137, 2.139], P = .0058, respectively). The reproducibility of the MAP score was fair (AC1 = 0.367 and kappa F = 0.353), as was that of stranding (AC1 = 0.499, kappa F = 0.376). The agreement was important if we defined a "low" (0 to 3) or "high" (4 or 5) score (AC1 = 0.706 and kappa F = 0.681).

CONCLUSION

The MAP score was the element that best predicted APF in our study, although its reproducibility among our readers was only fair. The agreement becomes important if we defined "low or high" score.

Factors associated with adenoma detection rate and diagnosis of polyps and colorectal cancer during colonoscopy in France: results of a prospective, nationwide survey

Introduction

Colonoscopy can prevent deaths due to colorectal cancer (CRC) through early diagnosis or resection of colonic adenomas. We conducted a prospective, nationwide study on colonoscopy practice in France.

Methods

An online questionnaire was administered to 2,600 French gastroenterologists. Data from all consecutive colonoscopies performed during one week were collected. A statistical extrapolation of the results to a whole year was performed, and factors potentially associated with the adenoma detection rate (ADR) or the diagnosis of polyps or cancer were assessed.

Results

A total of 342 gastroenterologists, representative of the overall population of French gastroenterologists, provided data on 3,266 colonoscopies, corresponding to 1,200,529 (95% CI: 1,125,936-1,275,122) procedures for the year 2011. The indication for colonoscopy was CRC screening and digestive symptoms in 49.6% and 38.9% of cases, respectively. Polypectomy was performed in 35.5% of cases. The ADR and prevalence of CRC were 17.7% and 2.9%, respectively. The main factors associated with a high ADR were male gender (p=0.0001), age over 50 (p=0.0001), personal or family history of CRC or colorectal polyps (p<0.0001 and p<0.0001, respectively), and positive fecal occult blood test (p=0.0005). The prevalence of CRC was three times higher in patients with their first colonoscopy (4.2% vs. 1.4%; p<0.0001).

Conclusions

For the first time in France, we report nationwide prospective data on colonoscopy practice, including histological results. We found an average ADR of 17.7%, and observed reduced CRC incidence in patients with previous colonoscopy.

Self-perception of quality of life by adolescents with neuromuscular diseases

PURPOSE

Little is known about quality of life of adolescents with neuromuscular diseases or the factors that influence it. We searched whether physical impairment, physical disability, and medical complications were predictors of low quality of life.

METHODS

Motor function, health, orthopedic status, and rehabilitation were assessed in 43 adolescents with neuromuscular diseases (mean age, 13.8 years, standard deviation 1.7 year; sex ratio 2.9/1). Quality of life was measured with the VSP-A ("Vécu Santé Perçu par l'Adolescent"; self-perceived health state in adolescents), a validated health-related quality of life self-perception test. A mixed linear regression related quality of life to impairment, disability, and respiratory status. Comparisons were made with results from an age/sex-matched nondisabled group.

RESULTS

On the average, the VSP-A scores in physically disabled adolescents were: (1) similar to those of the nondisabled group with regard to vitality, body image, relationships with parents and friends, and physical and psychological well-being; (2) higher with regard to school performance (score 68 vs. 52.8) and relationships with teachers (67.4 vs. 43.2); and (3) lower with regard to leisure activities (43.9 vs. 60.9). Physical disability and physical impairment were not negatively associated with seven of the nine VSP-A dimensions, but physical impairment was negatively associated with leisure activities and vitality (p < .001 and p < .01, respectively). Adolescents with ventilatory support did not express lower scores than adolescents not requiring ventilatory support (67.7+/-11 vs. 62.9+/-15, p=.39).

CONCLUSIONS

These surprising results should lead us question our medical, educational, and rehabilitation practices. Already well-managed disabled adolescents should benefit from less compassionate but more daring and dynamic interpersonal contacts.