Patients' recommendations to improve help-seeking for vaginismus: a qualitative study.

BACKGROUND: Research to improve healthcare experiences for women with vaginismus tends to be produced from the perspective of healthcare professionals or health-based researchers. There is lacking research on women's experiences and recommendations to improve help-seeking for vaginismus from their perspective. To address this research gap, this qualitative study aimed to identify the issues that women face when help-seeking for vaginismus and their recommendations to address it. This sought to support the wellbeing of patients to advocate for their healthcare needs which is often overlooked. METHODS: Using a feminist theoretical approach, semi-structured interviews were conducted with 21 participants who sought help for their vaginismus. Thematic analysis was employed to analyse participants' recommendations. RESULTS: Four main themes emerged: Increase awareness of vaginismus, Dismantle myths about sex, Destigmatise vaginismus, and Empower people with vaginismus during medical consultations. Subthemes were identified as actionable strategies that participants recommended to improve help-seeking and healthcare for vaginismus. CONCLUSIONS: The findings from this study can inform healthcare practice and policy to foster better synchronicity between health professionals and their patients' perceptions and expectations of treating vaginismus. This can promote more acceptance of patients' advocacy of their needs and goals to improve the therapeutic alliance and treatment outcomes for vaginismus in healthcare practice. The strategies recommended to increase awareness of vaginismus and challenge its stigma should be considered in policy to incite a culture of change in healthcare practice and broader society.

The Effectiveness of Massage in Managing Pregnant Women with Pelvic Girdle Pain: a Randomised Controlled Crossover Feasibility Study.

Introduction: Pelvic girdle pain is a common problem experienced during pregnancy, with high incidence rates and significant impacts on quality of life. Remedial massage might be able to provide some reduction in pain. Aim: This study aimed to investigate the feasibility of conducting a randomised controlled trial on the effectiveness of massage in treating pregnant women with pelvic girdle pain to determine its merits and viability for use in a large-scale study. Methods: A two-arm pilot randomised feasibility crossover-controlled trial. The two treatment phases were a) remedial pregnancy massage, and b) exercise. Results: Twenty-four women started the study and 19 women completed the study. Data were collected on recruitment and retention rates, crossover study design methodology, participant sub-characteristics, and acceptability of the outcome measures (pain, quality of life, and disability). Conclusion: Recruiting participants for a pregnancy-related pelvic girdle pain study is indeed feasible; however, a crossover study design is not appropriate and future studies should consider a mixed methods study design.

The experiences of women seeking help for vaginismus and its impact on their sense of self: An integrative review.

BACKGROUND: There is low social awareness of vaginismus despite it being a relatively common female sexual dysfunction that makes vaginal penetration painful, difficult, and/or impossible. While existing literature on vaginismus has had a clinical focus on the affected genitalia, there is a lack of research on women's help-seeking experiences of vaginismus from their perspective. OBJECTIVES: This integrative review's objective was to explore: women's help-seeking experiences of vaginismus, and how such help-seeking experiences impact their sense of self. DESIGN: Cooper's five-step integrative review approach was followed to develop a research question, a search strategy, selection criteria, and data evaluation, analysis, and presentation. DATA SOURCES AND METHODS: A systematic search of the literature was completed in the following seven databases in January 2023: PsycINFO, ProQuest Central, PubMed, Scopus, CINAHL, Cochrane, and Embase. Out of the 373 articles found through database searches and additional citation searching, 22 studies were included in this review for meeting the eligibility criteria of having an empirical design, being written in English, and examining women's help-seeking experiences for vaginismus and its impact on their sense of self. RESULTS: Thematic analysis was used to summarize the findings from the included studies which were informed by 1671 participants. Help-Seeking Process, Medical Management, Help-Seeking and Sense of Self, and Holistic Care Recommendations from the Findings emerged as four major themes with corresponding subthemes. CONCLUSION: This review indicates that women continue to face difficulties in seeking and receiving help for vaginismus even through the healthcare system. However, the studies did not explicitly discuss how women's help-seeking for vaginismus impacted their sense of self. This highlights an epistemological gap on how women's help-seeking for their vaginismus impacts their sense of self, which can affect their treatment responses. Recommendations are provided for future healthcare and research to improve health outcomes for women with vaginismus.

PRO-C3 is a predictor of clinical outcomes in distinct cohorts of patients with advanced liver disease.

Background & Aims: Fibroblast activity is a key feature of fibrosis progression and organ function loss, leading to liver-related complications and mortality. The fibrogenesis marker, PRO-C3, has been shown to have prognostic significance in relation to fibrosis progression and as a treatment efficacy marker. We investigated whether PRO-C3 was prognostic for clinical outcome and mortality in two distinct cohorts of compensated cirrhosis. Methods: Cohort 1 was a rapid fibrosis progression cohort including 104 patients with HCV and biopsy-proven Ishak fibrosis stage ≥3 without prior clinical events. Cohort 2 was a prospective cohort including 172 patients with compensated cirrhosis of mixed aetiology. Patients were assessed for clinical outcomes. PRO-C3 was assessed in serum at baseline in cohorts 1 and 2, and compared with model for end-stage liver disease and albumin-bilirubin (ALBI) scores. Results: In cohort 1, a 2-fold increase in PRO-C3 was associated with 2.7-fold increased hazard of liver-related events (95% CI 1.6-4.6), whereas a one unit increase in ALBI score was associated with a 6.5-fold increased hazard (95% CI 2.9-14.6). In cohort 2, a 2-fold increase in PRO-C3 was associated with a 2.7-fold increased hazard (95% CI 1.8-3.9), whereas a one unit increase in ALBI score was associated with a 6.3-fold increased hazard (95% CI 3.0-13.2). A multivariable Cox regression analysis identified PRO-C3 and ALBI as being independently associated with the hazard of liver-related outcomes. Conclusions: PRO-C3 and ALBI were independent prognostic factors for predicting liver-related clinical outcomes. Understanding the dynamic range of PRO-C3 might enhance its use for both drug development and clinical practice. Impact and Implications: We tested novel proteins of liver scarring (PRO-C3) in two groups of liver patients with advanced disease to see if they could predict clinical events. We found that this marker and an established test called ALBI were both independently associated with future liver-related clinical outcomes.

Development of Food Group Tree-Based Analysis and Its Association with Non-Alcoholic Fatty Liver Disease (NAFLD) and Co-Morbidities in a South Indian Population: A Large Case-Control Study.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a global problem growing in parallel to the epidemics of obesity and diabetes, with South Asians being particularly susceptible. Nutrition and behaviour are important modifiers of the disease; however, studies to date have only described dietary patterns and nutrients associated with susceptibility to NAFLD. METHODS: This cross-sectional case-control study included 993 NAFLD patients and 973 healthy controls from Trivandrum (India). Dietary data was collected using a locally validated food frequency questionnaire. A tree-based classification categorised 2165 ingredients into three levels (food groups, sub-types, and cooking methods) and intakes were associated with clinical outcomes. RESULTS: NAFLD patients had significantly higher consumption of refined rice, animal fat, red meat, refined sugar, and fried foods, and had lower consumption of vegetables, pulses, nuts, seeds, and milk compared to controls. The consumption of red meat, animal fat, nuts, and refined rice was positively associated with NAFLD diagnosis and the presence of fibrosis, whereas consumption of leafy vegetables, fruits, and dried pulses was negatively associated. Fried food consumption was positively associated with NAFLD, whilst boiled food consumption had a negative association. Increased consumption of animal fats was associated with diabetes, hypertension, and cardiovascular outcomes among those with NAFLD, whereas consumption of wholegrain rice was negatively associated with these clinical-related outcomes. CONCLUSIONS: The tree-based approach provides the first comprehensive method of classifying food intakes to enable the identification of specific dietary factors associated with NAFLD and related clinical outcomes. This could inform culturally sensitive dietary guidelines to reduce risk of NAFLD development and/or its progression.

The Relationship Between Corticomotor Reorganization and Acute Pain Severity: A Randomized, Controlled Study Using Rapid Transcranial Magnetic Stimulation Mapping.

OBJECTIVE: Although acute pain has been shown to reduce corticomotor excitability, it remains unknown whether this response resolves over time or is related to symptom severity. Furthermore, acute pain research has relied upon data acquired from the cranial "hotspot," which do not provide valuable information regarding reorganization, such as changes to the distribution of a painful muscle's representation within M1. Using a novel, rapid transcranial magnetic stimulation (TMS) mapping method, this study aimed to 1) explore the temporal profile and variability of corticomotor reorganization in response to acute pain and 2) determine whether individual patterns of corticomotor reorganization are associated with differences in pain, sensitivity, and somatosensory organization. METHODS: Corticomotor (TMS maps), pain processing (pain intensity, pressure pain thresholds), and somatosensory (two-point discrimination, two-point estimation) outcomes were taken at baseline, immediately after injection (hypertonic [n = 20] or isotonic saline [n = 20]), and at pain resolution. Follow-up measures were recorded every 15 minutes until 90 minutes after injection. RESULTS: Corticomotor reorganization persisted at least 90 minutes after pain resolution. Corticomotor depression was associated with lower pain intensity than was corticomotor facilitation (r = 0.47 [P = 0.04]). These effects were not related to somatosensory reorganization or peripheral sensitization mechanisms. CONCLUSIONS: Individual patterns of corticomotor reorganization during acute pain appear to be related to symptom severity, with early corticomotor depression possibly reflecting a protective response. These findings hold important implications for the management and potential prevention of pain chronicity. However, further research is required to determine whether these adaptations relate to long-term outcomes in clinical populations.

Detecting chronic liver disease: are liver function tests the solution?

By 2020, chronic liver disease will have eclipsed ischaemic heart disease as the leading cause of working life years lost in the UK. As mortality from chronic liver disease continues to rise, the landscape of aetiology has shifted from infectious to non-communicable causes. In parallel with the growing prevalence of obesity and type 2 diabetes, non-alcoholic fatty liver disease is estimated to affect 25% of the UK adult population. Simultaneously, escalating alcohol consumption has fuelled public health and economic concerns regarding its widespread impact on working-age adults. Given that chronic liver disease remains clinically silent until its advanced stages, there is an urgent unmet need to identify affected individuals earlier in the disease process, enabling targeted intervention strategies which may improve prognosis. Robust epidemiological data have shown that liver fibrosis is the strongest predictor of clinically meaningful outcomes, including decompensation, liver cancer and overall mortality. Detecting fibrosis among at-risk individuals, in a manner that is reproducible, non-invasive, safe and cost effective, has become a major challenge of our time. This article addresses the pitfalls of the standard panel of liver function tests, discusses other non-invasive biomarkers and reviews imaging technologies which may revolutionise community-based diagnosis and stratification of chronic liver disease.

Cohort profile: the Trivandrum non-alcoholic fatty liver disease (NAFLD) cohort.

PURPOSE: The Trivandrum non-alcoholic fatty liver disease (NAFLD) cohort is a population-based study designed to examine the interaction between genetic and lifestyle factors and their association with increased risk of NAFLD within the Indian population. PARTICIPANTS: Between 2013 and 2016, a total of 2222 participants were recruited to this cohort through multistage cluster sampling across the whole population of Trivandrum-a district within the state of Kerala, South India. Data were collected from all inhabitants of randomly selected households over the age of 25. FINDINGS TO DATE: Full baseline clinical and pathological data were collected from 2158 participants. This included detailed demographic profiles, anthropometric measures and lifestyle data (food frequency, physical activity and anxiety and depression questionnaires). Biochemical profile and ultrasound assessment of the liver were performed and whole blood aliquots were collected for DNA analysis.The NAFLD prevalence within this population was 49.8% which is significantly higher than the global pooled prevalence of 25%. This highlights the importance of robust, prospective studies like this to enable collection of longitudinal data on risk factors, disease progression and to facilitate future interventional studies. FUTURE PLANS: The complete analysis of data collected from this cohort will give valuable insights into the interaction of the phenotypic and genotypic profiles that result in such a dramatic increased risk of NAFLD within the Indian population. The cohort will also form the basis of future lifestyle interventional studies, aimed at improving liver and metabolic health.

Spleen stiffness to liver stiffness ratio significantly differs between ALD and HCV and predicts disease-specific complications.

BACKGROUND & AIMS: Both liver stiffness (LS) and spleen stiffness (SS) are widely used to non-invasively assess liver fibrosis and portal hypertension, respectively. We aimed to identify the impact of disease etiology, namely the localization of inflammation (portal vs. lobular), on the SS/LS ratio. METHODS: In this multicenter study, LS and SS were prospectively assessed in 411 patients with alcohol-related liver disease (ALD) or hepatitis C virus (HCV) using FibroScan® (Echosens, Paris); changes in these parameters were also studied in response to treatment (alcohol withdrawal, HCV therapy). LS and spleen length (SL) were further analyzed in a retrospective cohort of 449 patients with long-term data on decompensation/death. RESULTS: Both, SS and SL were significantly higher in HCV compared to ALD (42.0 vs. 32.6 kPa, p≪0.0001, 15.6 vs. 11.9 cm, p≪0.0001) despite a lower mean LS in HCV. Consequently, the SS to LS ratio and the SL to LS ratio were significantly higher in HCV (3.8 vs. 1.72 and 1.46 vs. 0.86, p≪0.0001) through all fibrosis stages. Notably, SL linearly increased with SS and the relation between SS and SL was identical in HCV and ALD. In contrast, livers were much larger in ALD at comparable LS. After treatment, LS significantly decreased in both diseases without significant changes to the SS/LS ratio. In the prognostic cohort, patients with ALD had higher LS values (30.5 vs. 21.3 kPa) and predominantly presented with jaundice (65.2%); liver failure was the major cause of death (p≪0.01). In contrast, in HCV, spleens were larger (17.6 vs. 12.1 cm) while variceal bleeding was the major cause of decompensation (73.2%) and death (p≪0.001). CONCLUSION: Both SS/LS and SL/LS ratios are significantly higher in patients with portal HCV compared to lobular ALD. Thus, combined LS and SS or SL measurements provide additional information about disease etiology and disease-specific complications. LAY SUMMARY: Herein, we show that patients with hepatitis C virus infection (HCV) have higher spleen stiffness and portal pressure than patients with alcohol-related liver disease (ALD), within the same fibrosis stage and matched to liver stiffness. Thus, the spleen stiffness to liver stiffness ratio is significantly higher in patients with HCV compared to ALD. Additionally, patients with HCV more commonly progress to portal hypertension-related complications (e.g. variceal bleeding), while patients with ALD more commonly progress to liver failure (e.g. jaundice). The spleen stiffness to liver stiffness ratio is a useful tool to confirm disease etiology and predict disease-specific complications.

The use of infrared thermography in the measurement and characterization of brown adipose tissue activation.

Interest in brown adipose tissue has increased in recent years as a potential target for novel obesity, diabetes and metabolic disease treatments. One of the significant limitations to rapid progress has been the difficulty in measuring brown adipose tissue activity, especially in humans. Infrared thermography (IRT) is being increasingly recognized as a valid and complementary method to standard imaging modalities, such as positron emission tomography-computed tomography (PET/CT). In contrast to PET/CT, it is non-invasive, cheap and quick, allowing, for the first time, the possibility of large studies of brown adipose tissue (BAT) on healthy populations and children. Variations in study protocols and analysis methods currently limit direct comparison between studies but IRT following appropriate BAT stimulation consistently shows a change in supraclavicular skin temperature and a close association with results from BAT measurements from other methods.

Opinions on the provision of dental care in Iowa nursing homes.

Using a stratified random sample, a questionnaire was mailed to 400 practicing dentists and 200 directors of nursing (DONs). Response rates were 58.3% for dentists and 50% for DONs. Dentists were representative of Iowa dentists, with 85% male, mean age 49.1 years, and 22.4 years in practice. All DONs were female, with mean age of 44.9 years. Of the participating dentists, 86% had provided dental care for nursing home residents, but the majority of care was completed in dental offices. Three-quarters of dentists were somewhat/not interested in nursing home dentistry. Dentists and DONs held common perceptions of the most frequent problems related to care provision at nursing homes: low financial reimbursement, especially for Medicaid patients; no portable dental equipment; no suitable area for dentistry; dentist's preference to treat patients at their dental practice; and transportation of residents to a dental practice. Dentists and DONs had some differing perceptions about oral health care (p < .01). Minimal dental care was provided on-site at Iowa nursing homes.

Dental utilization by adult Medicaid enrollees who have indicators of intellectual and developmental disabilities (IDD).

The purpose of this study was to determine dental utilization and type of dental services for Medicaid-enrolled adults who had been identified as having intellectual and developmental disabilities (IDD). Using Iowa claims data, the authors identified adults who met any of five IDD criteria for inclusion during calendar year 2005. Service utilization rates, including use of preventive dental, routine restorative, and complex restorative services, were determined. Approximately 60% of adults with IDD had at least one dental visit in 2005. Among adults with at least one dental visit, 83% received a preventive service, 31% a routine restorative service, and 16% a complex dental service. Those age 65 and older had fewer preventive dental services than other age groups. In Iowa, dental utilization for adults 22-64 years of age with IDD was reasonably high (64%) in 2005, but individuals over age 65 had lower utilization (45%).

Iowa intermediate care facilities: an evaluation of care providers'attitudes toward oral hygiene care.

This study investigated the oral hygiene care (OHC) activities and attitudes of care providers in Intermediate Care Facilities for the Mentally Retarded (ICF/MR) in the state of Iowa. Questionnaires were distributed to care providers employed at three ICF/MRs. About 98% of the staff ranked OHC as important to extremely important for residents. Twenty-three percent disliked OHC occasionally or more frequently. Lack of time and lack of staff were the main reasons preventing care providers from assisting residents with OHC. Residents' behaviors resulted in inadequate OHC for 64.9%, and 49% of residents required complete assistance with OHC. Most common OHC difficulties reported were residents biting the toothbrush, refusing OHC, or not opening their mouths. Subjects reported spending 3.0 minutes brushing a resident's teeth and 3.0 minutes cleaning dentures. Care providers experienced significant behavioral and physical difficulties while providing OHC, but still found OHC important. Training programs for care providers are needed to address these difficulties.

Knowledge, attitudes, and behaviors of federal service and civilian dentists concerning minimal intervention dentistry.

BACKGROUND: Although minimal intervention dentistry (MID) is on the increase, little is known about the patterns of knowledge, attitudes, and behaviors of dentists in the United States. METHODS: Federal service and civilian dentists who were active members of the American Dental Association (N = 1,500) received a pretested questionnaire about their knowledge, attitudes, and behaviors concerning MID. Descriptive statistics and bivariate analyses were conducted to assess dentist personal and practice characteristics associated with the knowledge, attitudes, and behaviors. RESULTS: Federal service dentists reported more knowledge of MID than civilian dentists (Cochrane Mantel Haenszel Ridit Scores), p < 0.0043, with similar attitudes toward fluoride (p = 0.11), and decisions regarding monitoring or restoring enamel caries (p = 0.22). Federal service dentists remineralized noncavitated carious lesions more (p < 0.0001) and had lower composite scores, indicating more MID tendency (Wilcoxon p < 0.0001). CONCLUSION: Federal service dentists reported more knowledge and clinical practices regarding minimal intervention dentistry compared to civilian dentists.

Preventive dental utilization for Medicaid-enrolled children in Iowa identified with intellectual and/or developmental disability.

OBJECTIVES: To compare preventive dental utilization for children with intellectual and/or developmental disability (IDD) and those without IDD and to identify factors associated with dental utilization. METHODS: We analyzed Iowa Medicaid dental claims submitted during calendar year (CY) 2005 for a cohort of children ages 3-17 who were eligible for Medicaid for at least 11 months in CY 2005 (n = 107,605). A protocol for identifying IDD children was developed by a group of dentists and physicians with clinical experience in treating children with disabilities. Utilization rates were compared for the two groups. Crude and covariate-adjusted odds ratios were estimated using conditional logistic regression modeling. RESULTS: A significantly higher proportion of non-IDD children received preventive care than those identified as IDD (48.6 percent versus 46.1 percent; P < 0.001). However, the final model revealed no statistically significant difference between the two groups. Factors such as older age, not residing in a dental Health Professional Shortage Area, interaction with the medical system, and family characteristics increased one's likelihood of receiving preventive dental care. CONCLUSION: Although IDD children face additional barriers to receiving dental care and may be at greater risk for dental disease, they utilize preventive dental services at the same rate as non-IDD children. Clinical and policy efforts should focus on ensuring that all Medicaid-enrolled children receive need-appropriate levels of preventive dental care.

A literature review of aesthetic perceptions of dental fluorosis and relationships with psychosocial aspects/oral health-related quality of life.

UNLABELLED: Aesthetic perceptions and oral health-related quality of life concerning dental fluorosis have been assessed in several studies during the past two decades. However, no comprehensive review article summarizing the studies investigating this issue has been published. OBJECTIVE: To assess the relationships between perceptions of dental appearance/oral health-related quality of life (OHRQoL) and dental fluorosis. METHODS: The PubMed database was searched using the Medical Subject Headings (MeSH) for English-language studies from 1985 to March 2009. Thirty-five articles qualified for inclusion and then were classified into three categories based on the type of study approach: (i) respondent review of photographs and assessment concerning satisfaction/acceptance, (ii) respondent assessment of study subject's teeth concerning satisfaction/acceptance, and (iii) respondent assessments of the psychosocial/OHRQoL impact. RESULTS: There were varied results from earlier studies focused on satisfaction/acceptance of very mild to mild fluorosis. More recent studies with methodological improvements to assess impact on quality of life clearly showed that mild fluorosis was not a concern. Furthermore, mild fluorosis was sometimes associated with improved OHRQoL. Severe fluorosis was consistently reported to have negative effects on OHRQoL. CONCLUSION: Because dental fluorosis in the United States and other nations without high levels of naturally-occurring fluoride is mild or very mild, with little impact on OHRQoL, dental professionals should emphasize the appropriate use of fluorides for caries prevention and preventing moderate/severe fluorosis.

The inhibitory effect of MI paste, fluoride and a combination of both on the progression of artificial caries-like lesions in enamel.

This in-vitro study evaluated the inhibition of demineralization in enamel sections produced by MI paste, fluoride and a combination of both, compared to artificial saliva and NaF 5000 ppm in a caries progression pH-cycling model. Twenty-one teeth were demineralized to create subsurface enamel lesions (approximately 200 microns in depth). The teeth were sectioned and characterized using polarized-light-microscopy (PLM). A single section from each lesion was assigned to a treatment group: Artificial saliva, NaF 5000 ppm (Prevident, Colgate), MI paste (Recaldent, GC America Inc), NaF 1100 ppm (Crest, Procter & Gamble) and NaF 1100 ppm plus MI paste. The sections were covered with varnish except for an exposed window on the external surface of the lesion and placed in a six-day pH-cycling model with two daily treatment applications of two minutes each. The sections were characterized by PLM, and the lesion areas were measured using a digital image analysis system. Based on a paired-sample t-test, significant differences (p < .05) in percentage of change in lesion size were found between the high fluoride group and all the other groups. No significant difference was found between the artificial saliva and MI paste group, neither was there any significant difference between the NaF 1100 ppm, the combined application group or the MI paste group alone. In conclusion, the higher concentration of NaF (5000 ppm) reduced lesion progression to the greatest extent. The MI paste group did not show any effect on the inhibition of lesion progression. Further studies on the preventive effect and longer treatment applications are recommended.

Dental utilization for Medicaid-enrolled adults with developmental disabilities in Iowa residential care facilities.

The goal of this study was to evaluate the dental utilization of Medicaid-enrolled adults in Iowa residential care facilities (n=1423). Medicaid enrollment and claims files for 2003 were used, as well as information from the Iowa Department of Inspections and Appeals. Dental utilization was defined as having any dental visit during 2003. Of the residents, 74.1% utilized at least one dental service in 2003. Residents in facilities that were part of smaller organizations, and younger residents, were more likely to have had a dental visit. Of those with a visit, over 80% received a preventive service but this declined with age. Despite additional barriers, dental utilization was generally good for Medicaid-enrolled residents of residential care facilities in Iowa. Residents in smaller facilities of smaller organizations received more personalized care. Older residents were less likely to have a parent involved, were more likely to be edentulous, and sought care less frequently.