"Watch Me Grow- Electronic (WMG-E)" surveillance approach to identify and address child development, parental mental health, and psychosocial needs: study protocol.

BACKGROUND: The COVID-19 pandemic and the associated economic recession has increased parental psychosocial stress and mental health challenges. This has adversely impacted child development and wellbeing, particularly for children from priority populations (culturally and linguistically diverse (CALD) and rural/regional communities) who are at an already increased risk of health inequality. The increased mental health and psychosocial needs were compounded by the closure of in-person preventive and health promotion programs resulting in health organisations embracing technology and online services. Watch Me Grow- Electronic (WMG-E) - developmental surveillance platform- exemplifies one such service. WMG-E was developed to monitor child development and guide parents towards more detailed assessments when risk is identified. This Randomised Controlled Trial (RCT) aims to expand WMG-E as a digital navigation tool by also incorporating parents' mental health and psychosocial needs. Children and families needing additional assessments and supports will be electronically directed to relevant resources in the 'care-as-usual' group. In contrast, the intervention group will receive continuity of care, with additional in-person assessment and 'warm hand over' by a 'service navigator' to ensure their needs are met. METHODS: Using an RCT we will determine: (1) parental engagement with developmental surveillance; (2) access to services for those with mental health and social care needs; and (3) uptake of service recommendations. Three hundred parents/carers of children aged 6 months to 3 years (recruited from a culturally diverse, or rural/regional site) will be randomly allocated to the 'care-as-usual' or 'intervention' group. A mixed methods implementation evaluation will be completed, with semi-structured interviews to ascertain the acceptability, feasibility and impact of the WMG-E platform and service navigator. CONCLUSIONS: Using WMG-E is expected to: normalise and de-stigmatise mental health and psychosocial screening; increase parental engagement and service use; and result in the early identification and management of child developmental needs, parental mental health, and family psychosocial needs. If effective, digital solutions such as WMG-E to engage and empower parents alongside a service navigator for vulnerable families needing additional support, will have significant practice and policy implications in the pandemic/post pandemic period. TRIAL REGISTRATION: The trial (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819 ) on July 21st, 2021 and reporting of the trial results will be according to recommendations in the CONSORT Statement.

Global, Regional, and National Levels and Trends in Burden of Oral Conditions from 1990 to 2017: A Systematic Analysis for the Global Burden of Disease 2017 Study.

Government and nongovernmental organizations need national and global estimates on the descriptive epidemiology of common oral conditions for policy planning and evaluation. The aim of this component of the Global Burden of Disease study was to produce estimates on prevalence, incidence, and years lived with disability for oral conditions from 1990 to 2017 by sex, age, and countries. In addition, this study reports the global socioeconomic pattern in burden of oral conditions by the standard World Bank classification of economies as well as the Global Burden of Disease Socio-demographic Index. The findings show that oral conditions remain a substantial population health challenge. Globally, there were 3.5 billion cases (95% uncertainty interval [95% UI], 3.2 to 3.7 billion) of oral conditions, of which 2.3 billion (95% UI, 2.1 to 2.5 billion) had untreated caries in permanent teeth, 796 million (95% UI, 671 to 930 million) had severe periodontitis, 532 million (95% UI, 443 to 622 million) had untreated caries in deciduous teeth, 267 million (95% UI, 235 to 300 million) had total tooth loss, and 139 million (95% UI, 133 to 146 million) had other oral conditions in 2017. Several patterns emerged when the World Bank's classification of economies and the Socio-demographic Index were used as indicators of economic development. In general, more economically developed countries have the lowest burden of untreated dental caries and severe periodontitis and the highest burden of total tooth loss. The findings offer an opportunity for policy makers to identify successful oral health strategies and strengthen them; introduce and monitor different approaches where oral diseases are increasing; plan integration of oral health in the agenda for prevention of noncommunicable diseases; and estimate the cost of providing universal coverage for dental care.

Problem based review: a patient with Parkinson's disease.

Parkinson's disease (PD) is a chronic, progressive neurodegenerative disease characterized by bradykinesia, tremor and/ or rigidity, often with gait disturbance and postural instability. In addition to these typical features, patients with PD may experience further problems related to the disease itself or to the medications used to treat it. These comorbid problems include neuropsychiatric conditions (including psychosis, hallucinations, excessive daytime sleepiness, anxiety, depression, fatigue and dementia) as well as problems associated with autonomic nervous system function such as bowel and bladder function. PD can also present in emergency situations with a 'neuroleptic malignant like picture' and acute psychosis. It is not uncommon to see motor fluctuations due to drug interactions and 'withdrawal' symptoms following dose reduction of dopamine agonists. In patients with PD, disturbances of mental state constitute some of the most difficult treatment challenges of advanced disease, often limiting effective treatment of motor symptoms and leading to increased disability and poor quality of life. While some of these symptoms may be alleviated by antiparkinsonian medication, especially if they are 'off-period' related, treatment-related phenomena are usually exacerbated by increasing the number or dosage of antiparkinsonian drugs. Elimination of exacerbating factors and simplification of drug regimens are the first and most important steps in improvement of such symptoms.

Objective assessment of learning curves for the Voxel-Man TempoSurg temporal bone surgery computer simulator.

INTRODUCTION: Simulators are becoming an increasingly important part of surgical training. Temporal bone surgery is one area in which simulators, such as the Voxel-Man TempoSurg simulator, are likely to play a significant role in training. We present learning curve data from novice trainees using this simulator to learn cortical mastoidectomy, exposure of the sigmoid sinus, and exposure of the short process of the incus. METHODS: We measured the time taken to perform the procedures, the volume of reference bone removed, and the structures damaged during dissection. RESULTS: We found improvement in a number of parameters over the course of the study. The overall scores, structural damage scores and time taken improved, to differing degrees, for each task. The volume of reference bone removed remained constant. CONCLUSION: These results indicate that the trainees' efficiency improved as they became more proficient at removing a given volume of reference bone.

Development of tool for the assessment of comprehension of informed consent form in healthy volunteers participating in first-in-human studies.

Informed consent is a process that involves providing all pertinent study information to the potential study participant. The information imparted in the form gives all such information as would enable a potential participant to come to a decision regarding his/her participation in the study. Various study related aspects are outlined in the participant information leaflet including the background of the study, the benefits and risks, treatment alternatives; the methodology of the study, follow up schedules, confidentiality of the data, compensations and remunerations and right to not participate or withdraw from the study. We have continued a similar exercise for a phase I, first-in-human study, conducted by our center. Here, the volunteers were asked certain questions pertaining to the trial background, design, patients' rights and miscellaneous categories. They were then assessed and the scores compared to come up with certain conclusions. The median (range) for the entire comprehension score was calculated and statistically analyzed on various aspects. Readability of the ease of reading of the consent form was also analyzed on a Flesch-Kinkaid reading scale. A total of 69 volunteers were screened out of which 50 were enrolled in the study. The median (range) score was 27 (19 to 33) and the mean (S.D.) score was 28.9 (3.1). The maximum correct responses were observed for the questions falling under the volunteers' rights category. The Flesch reading ease score was 54 and the Flesch-Kincaid Grade level score was 9.8. Investigators may be encouraged to incorporate such tools in their informed consent process.

Use of botulinum toxin in voice restoration after laryngectomy.

BACKGROUND: Following laryngectomy, a distinct population of patients fails to achieve successful tracheoesophageal voice. These patients' voices range from strained and effortful to none at all. Such patients may present with severe hypertonicity or spasm of the pharyngoesophageal segment. Botulinum toxin has been used to chemically denervate the pharyngeal musculature, and is an alternative to invasive surgical procedures. The aim of this article is to review the evidence for using botulinum toxin to achieve an improvement in post-laryngectomy voice. METHODS: A Medline literature review (1966 to January 2009) and a search of the Cochrane database were performed. Foreign language articles and those not pertaining to post-laryngectomy voice restoration were excluded. RESULTS: Nine articles reporting a total of 134 patients were identified. Although there were differences in the outcome measures used, objective improvement in voice production occurred in between 70 and 100 per cent of cases. CONCLUSION: Botulinum toxin can be used as a safe and cost-effective treatment in patients with confirmed pharyngoesophageal segment hypertonicity and/or spasm following laryngectomy, to obtain an improvement in voice quality.

Profile of menopausal women in rural north India.

OBJECTIVE: To ascertain the profile of menopausal women in rural north India. Setting Six villages were selected in a rural field practice area of Department of Community Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, north India. METHODS: A female social worker obtained relevant data in the study area during 1999-2001. This involved individual interviews of women aged 35-55 years through a house-to-house survey. RESULTS: Of the 558 enlisted women, 152 (27.2%) had attained menopause. Average age at menopause was 44.1 years. More than half (53%) reported seven or more symptoms at menopause. Diminished vision was reported as the most common symptom at menopause. The majority (85%) admitted that menopause adversely affected women's physical health. However, most of them (95%) considered menopause socially good for women and welcomed it. None of our respondents reported use of hormone replacement therapy. CONCLUSION: Women in rural north India viewed menopause positively. Medication of menopause was minimal.

Medical therapy for gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is a chronic condition that ranges from mild, intermittent symptoms to more severe cases of esophageal strictures and possibly adenocarcinoma of the esophagus. The etiology of GERD is multifactorial, although transient lower esophageal sphincter relaxations are thought to play an important role in addition to poor esophageal clearance and weak lower esophageal sphincter pressures. Lifestyle modifications and over-the-counter medications may be used to treat GERD. After these methods are tried, therapy with histamine receptor type 2 antagonists is the best treatment, although increasingly, proton pump inhibitors are being used. Long-term therapy needs to be maintained in patients with GERD, in contrast to those patients with peptic ulcer disease. The role of lifestyle modifications is described, and the costs of the various regimens are compared.

Social customs and beliefs regarding breast feeding.

PIP: This study, undertaken to investigate the social customs and beliefs surrounding breast feeding in Western Rajasthan, India, was conducted at the Umaid Hospital for Women and Children in Jodhpur. 300 women attending the pediatric outpatient and impatient departments and underfive clinics at the hospital constituted the study subjects. The women ranged in age from 15-42 years. They were interviewed to collect information on social and family variables and on breast feeding. Of the 300 women, 65.3% were residents of urban areas. 92.7% of the respondents believed in inaugural feeding with 32.3% preferring honey, followed by, among others, animal milk (17.6%), and janam ghutti (11.7%). Honey and janam ghutti were preferred by rural respondents; jaggery (13.8%), water (9.7%), and tea (7.7%) were preferred by urban women. Ceremonial ritual prior to beginning breast feeding was observed by 47.9% of the urban women (despite better education in urban areas) and 57.7% of the rural women. Colostrum feeding was denied by 32.6% women, but it was favored by 65.8% urban and 46.1% rural women. Nearly 33% urban and 40.9% rural mothers favored the restriction of breast feeding during maternal illness. During illness of the child, 48.4% urban and 51.9% rural women favored breast feeding restriction. The breast-feeding practices reflect a strong interlocking influence with social customs and beliefs as do the preference of women for inaugural feeds. The use of these feeds depends upon local customs and beliefs and the socioeducational level of the population. This is strongly supported by the observation that 79.7% of the women gave inaugural feed because of advice of an elderly family member or family tradition.^ieng