National increase in the community supply of take-home naloxone associated with a mass media campaign in Scotland: a segmented time series analysis.

BACKGROUND: Take-home naloxone (THN) programmes have been associated with reductions in opioid-related mortality. In response to high rates of drug-related deaths in Scotland, the Scottish Government commissioned the 'How to save a life' (HTSAL) mass media campaign to: (1) increase awareness of drug-related deaths and how to respond to an overdose, and (2) increase the supply of THN. The aim of this study was to assess the effect of the campaign on the supply of THN. METHODS: We used an interrupted time series design to assess the effect of the HTSAL mass media campaign on the national community supply of THN. The study time period was August 2020-December 2021. We modelled two key dates: the start of the campaign (week beginning (w/b) 30th of August 2021) and after the end of the main campaign (w/b 25th of October 2021). RESULTS: The total number of THN kits distributed in the community in Scotland during the study period was 27,064. The mean number of THN kits distributed per week (relative to the pre-campaign period), increased by 126% during the campaign and 57% post-campaign. In segmented regression analyses, the pre-campaign trend in the number of THN kits supplied was increasing by an average of 1% each week (RR=1.01, 95% CI 1.01 to 1.01, p<0.001). Once the campaign started, a significant change in level was observed, and the number of kits increased by 75% (RR=1.75, 95% CI 1.29 to 2.40, p<0.001). The trend during the campaign was stable (i.e. not increasing or decreasing) but a significant change in level was observed when the campaign ended, and the number of THN kits supplied decreased by 32% (RR=0.68, 95% CI 0.46 to 0.98, p = 0.042). The trend during the post-campaign period was stable. CONCLUSIONS: The HTSAL campaign had a short term, but large and significant impact, on the community supply of THN in Scotland. Mass media campaigns could be combined with other interventions and strategies to maintain the increased uptake of THN outside of campaign periods.

Admission triage tool for adult intensive care unit admission in Hong Kong during the COVID-19 outbreak.

Intensive care is expensive, and the numbers of intensive care unit (ICU) beds and trained specialist medical staff able to provide services in Hong Kong are limited. The most recent increase in coronavirus disease 2019 (COVID-19) infections over July to August 2020 resulted in more than 100 new cases per day for a prolonged period. The increased numbers of critically ill patients requiring ICU admission posed a capacity challenge to ICUs across the territory, and it may be reasonably anticipated that should a substantially larger outbreak occur, ICU services will be overwhelmed. Therefore, a transparent and fair prioritisation process for decisions regarding patient ICU admission is urgently required. This triage tool is built on the foundation of the existing guidelines and framework for admission, discharge, and triage that inform routine clinical practice in Hospital Authority ICUs, with the aim of achieving the greatest benefit for the greatest number of patients from the available ICU resources. This COVID-19 Crisis Triage Tool is expected to provide structured guidance to frontline doctors on how to make triage decisions should ICU resources become overwhelmed by patients requiring ICU care, particularly during the current COVID-19 pandemic. The triage tool takes the form of a detailed decision aid algorithm based on a combination of established prognostic scores, and it should increase objectivity and transparency in triage decision making and enhance decision-making consistency between doctors within and across ICUs in Hong Kong. However, it remains an aid rather than a complete substitute for the carefully considered judgement of an experienced intensive care clinician.

Human papillomavirus (HPV) vaccination across a cascade of knowledge, willingness, and uptake among gay, bisexual, and other men who have sex with men in Canada's three largest cities.

BACKGROUND: Some Canadian jurisdictions offer publicly funded HPV vaccine to gay, bisexual, and other men who have sex with men (GBM) aged ≤26 years. We characterized factors associated with being in different stages of HPV vaccination. METHODS: Engage is a sexual health study of GBM in the three largest Canadian cities recruited via respondent driven sampling (RDS). We categorized participants as: (1) unaware of HPV vaccine, (2) undecided/unwilling to get vaccinated, (3) willing to get vaccinated, (4) vaccinated with one or more doses. Our RDS-II weighted analyses used multinomial logistic regression to identify factors associated with being in earlier stages of the cascade compared to Stage 4. RESULTS: Across the cities, 26-40%, 7-14%, 33-39%, and 13-28% were in Stages 1 to 4, respectively. Compared to Stage 4, being in earlier stages of the cascade was associated with bisexual-identification (Stage 1: adjusted odds ratio[aOR] = 2.84, 95% confidence interval[CI] = 1.06-7.62; Stage 2: aOR = 3.09, 95%CI = 1.19-8.05), having immigrated to Canada (Stage 1: aOR = 1.79, 95%CI 1.07-2.99), preference to keep same-sex romantic relationships private (Stage 1: aOR = 1.25, 95% CI = 1.05-1.48; Stage 2: aOR = 1.24, 95%CI = 1.05-1.46), not receiving sexual health information (Stage 1: aOR = 0.31, 95% CI = 0.13-0.71; Stage 2: aOR = 0.27, 95%CI = 0.12-0.64), not accessing a health-care provider (Stage 2: aOR = 0.36, 95%CI = 0.15-0.83), and no past hepatitis A/B vaccination (Stage 1: aOR = 0.16, 95% CI = 0.09-0.30; Stage 2: aOR = 0.18, 95%CI = 0.09-0.35; Stage 3: aOR = 0.38, 95%CI = 0.21-0.61). DISCUSSION: Interventions are needed to reduce social and financial barriers, increase sexual health knowledge, and improve GBM-competent health-care access to increase vaccine uptake among GBM.

Human papillomavirus (HPV) vaccine uptake among a community-recruited sample of gay, bisexual, and other men who have sex with men in the three largest cities in Canada from 2017 to 2019.

INTRODUCTION: In 2015/2016, Canada's largest provinces implemented publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) ≤ 26 years old. We sought to describe HPV vaccine uptake among GBM and determine barriers and facilitators to vaccine initiation with a focus on healthcare access and utilization. METHODS: Engage is a cohort study among GBM aged 16 + years in three Canadian cities recruited from 2017 to 2019 via respondent driven sampling (RDS). Men completed a comprehensive questionnaire at baseline. By publicly-funded vaccine eligibility (≤26 years old = eligible for vaccination, ≥27 years old = ineligible), we described HPV vaccine uptake (initiation = 1 + dose, completion = 3 doses) and explored factors associated with vaccine initiation using Poisson regression. All analyses were weighted with the RDS-II Volz-Heckathorn estimator. RESULTS: Across the three cities, 26-35% and 14-21% of men ≤ 26 years and 7-26% and 2-9% of men ≥ 27 years initiated and completed HPV vaccination, respectively. Vaccine initiation was significantly associated with STI/HIV testing or visiting a HIV care specialist in the past six months (≤26: prevalence ratio[PR] = 2.15, 95% confidence interval[CI] 1.06-4.36; ≥27: PR = 2.73, 95%CI 1.14-6.51) and past hepatitis A or B vaccination (≤26: PR = 2.88, 95%CI 1.64-5.05; ≥27: PR = 2.03, 95%CI 1.07-3.86). Among men ≥ 27 years old, vaccine initiation was also positively associated with accessing PrEP, living in Vancouver or Toronto, but negatively associated with identifying as Latin American and increasing age. Vaccine initiation was twice as likely among men ≥ 27 years with private insurance versus no insurance. CONCLUSIONS: Sixty-five to 74% of men eligible for publicly-funded vaccine across the three cities remained unvaccinated against HPV by 2019. High vaccine cost may partly explain even lower uptake among men ≥ 27 years old. Men seeking sexual health care were more likely to initiate vaccination; bundling vaccination with these services may help improve HPV vaccine uptake.

Feasibility of photon-counting spectral CT in dental applications-a comparative qualitative analysis.

PURPOSE: The goal of this study was to demonstrate the feasibility of using photon-counting spectral CT for dental applications. This paper qualitatively analyzes the visibility of accessory canals (ACs) and metal artefacts from dental implants for cone-beam CT (CBCT), microtomography (microCT), and photon-counting spectral CT (PCSCT). MATERIALS AND METHODS: All of the teeth in this study were extracted, and eight teeth in total were scanned on a CBCT scanner, a microCT scanner and on a PCSCT scanner. Six of the teeth that were scanned have accessory canals, one has a titanium rod attached to it, and one has a gutta-percha point inside it. Qualitative analysis was done to compare the different imaging modalities. RESULTS: The subjective image analysis demonstrated similar performance in AC detection and visualisation for PCSCT and CBCT (p value >0.05). Both PCSCT and microCT performed similarly for metal artefact reduction, and both were superior to CBCT (p value <0.05). CONCLUSION: Although microCT provides detailed information about small anatomical structures, it is not suitable for in vivo use. However, the PCSCT scanner was able to detect small anatomical structures in teeth comparable to CBCT, as well as being superior in reducing metal artefacts from dental implants. This study showed that PCSCT is a promising modality for future dentistry applications.

Disruptive Innovation in Dentistry: What It Is and What Could Be Next.

Dentistry is a technically oriented profession, and the health care sector is significantly influenced by the ubiquitous trend of digitalization. Some of these digital developments have the potential to result in disruptive changes for dental practice, while others may turn out to be just a pipedream. This Discovery! essay focuses on innovations built on artificial intelligence (AI) as the center-technology influencing 1) dental eHealth data management, 2) clinical and technical health care applications, and 3) services and operations. AI systems enable personalized dental medicine workflows by analyzing all eHealth data gathered from an individual patient. Besides dental-specific data, this also includes genomic, proteomic, and metabolomic information and therefore facilitates optimized and personalized treatment strategies and risk management. Based on the power of AI, the triangular frame of "data"/"health care"/"service" is supplemented by technological advancements in the field of social media, Internet of things, augmented and virtual reality, rapid prototyping, and intraoral optical scanning as well as teledentistry. Innovation continues to be critical to tackle dental problems until its routine implementation based on sound scientific evidence. Novel technologies must be viewed critically in relation to the cost-benefit ratio and the ethical implications of a misleading diagnosis or treatment produced by AI algorithms. Highly sensitive eHealth data must be handled responsibly to enable the immense benefits of these technologies to be realized for society. The focus on patient-centered research and the development of personalized dental medicine have the potential to improve individual and public health, as well as clarify the interconnectivity of disease in a more cost-effective way.

Is there a difference between the thicknesses of the rami in mandibular asymmetry?

The purpose of this retrospective study was to investigate whether the thicknesses of the two rami differ in patients with mandibular asymmetry. Preoperative cone beam computed tomography scans of 78 patients with mandibular asymmetry were assessed for ramus thickness, mandibular length, and mandibular shift. The results showed that the ramus was thinner on the longer side than on the shorter side in 85.9% of the patients. On average, the longer side of the mandible was 2.74mm longer (range 0.07-9.90mm, standard deviation 1.92mm) and 0.55mm thinner (range -0.61 to 2.02mm, standard deviation 0.59mm) than the shorter side (both P<0.001). This study indicates a trend in the discrepancy in ramus thickness between the longer and shorter side of about 8% of the mean thickness of the ramus. Regression analysis showed that for every 1-mm increase in the length of the mandible, the thickness of the superior aspect of the ramus was reduced by 0.041 mm (P=0.009) and the anterior aspect by 0.125 mm (P=0.001). Age and sex did not have a significant influence on the thickness of the mandible. It is concluded that the longer side of the mandible tends to be thinner at the ramus than the shorter side in patients with mandibular asymmetry. The implication of this finding could be important in relation to the sagittal split ramus osteotomy.

Bone regeneration at the distal aspect of the adjacent second molar after lower third molar coronectomy: a long-term analysis.

A residual bone defect at the distal aspect of the adjacent second molar may occur after total removal of the lower third molar. Lower third molar coronectomy has been proved to be a safe alternative to total removal, but the extent of bone regeneration at the adjacent tooth after coronectomy is not well reported. The aim of this prospective study was to investigate the long-term bone regeneration at the distal aspect of the adjacent second molar after lower third molar coronectomy. Preoperative and postoperative cone beam computed tomography scans were measured to assess bone regeneration at the distobuccal (DB), mid-distal (MD), and distolingual (DL) aspects of the lower second molar. Forty-eight coronectomies in 37 patients (23 female) with a mean±standard deviation age of 29.1±7.2 years were assessed. The mean follow-up was 93.2±8.7 months. The mean bone level increase at DB, MD, and DL aspects was 3.2±1.6mm, 3.5±1.5mm, and 3.2±1.6mm, respectively; the bone levels were significantly higher than the preoperative measurements (P<0.001). Age and impaction patterns were not factors affecting bone regeneration. Based on this study, it appears that coronectomy of the lower third molar brings favourable bone regeneration at the distal aspect of the adjacent second molar.

Congenital infections in Hong Kong: an overview of TORCH.

Congenital infections refer to a group of perinatal infections that may have similar clinical presentations, including rash and ocular findings. TORCH is the acronym that covers these infections (toxoplasmosis, other [syphilis], rubella, cytomegalovirus, herpes simplex virus). There are, however, other important causes of intrauterine/perinatal infections, including enteroviruses, varicella zoster virus, Zika virus, and parvovirus B19. Intrauterine and perinatal infections are significant causes of fetal and neonatal mortality and important contributors to childhood morbidity. A high index of suspicion for congenital infections and awareness of the prominent features of the most common congenital infections can help to facilitate early diagnosis, tailor appropriate diagnostic evaluation, and if appropriate, initiate early treatments. In the absence of maternal laboratory results diagnostic of intrauterine infections, congenital infections should be suspected in newborns with certain clinical features or combinations of clinical features, including hydrops fetalis, microcephaly, seizures, cataract, hearing loss, congenital heart disease, hepatosplenomegaly, jaundice, or rash. Primary prevention of maternal infections during pregnancy is the cornerstone of prevention of congenital infection. Available resources should focus on the promotion of public health.

A phase 2, double-blind, placebo-controlled study of NSI-189 phosphate, a neurogenic compound, among outpatients with major depressive disorder.

NSI-189 is a novel neurogenic compound independent of monoamine reuptake pathways. This trial evaluated oral NSI-189 as monotherapy in major depressive disorder. To improve signal detection, the sequential-parallel comparison design (SPCD) was chosen. Two hundred and twenty subjects were randomized to NSI-189 40 mg daily, 80 mg daily, or placebo for 12 weeks. The primary outcome measure was the Montogmery Asberg Depression Rating Scale (MADRS). Secondary subject-rated measures included the Symptoms of Depression Questionnaire (SDQ), the Cognitive and Physical Functioning Scale (CPFQ), the patient-rated version of the Quick Inventory of Depressive Symptomatology Scale (QIDS-SR), and subtests from the CogScreen and Cogstate cognitive tests. MADRS score reduction versus placebo did not reach significance for either dose (40 mg pooled mean difference -1.8, p = 0.22, 80 mg pooled mean difference -1.4, p = 0.34, respectively). However, the 40 mg dose showed greater overall reduction in SDQ (pooled mean difference -8.2; Cohen's d for Stages 1 and 2 = -0.11 and -0.64, p = 0.04), and CPFQ scores (pooled mean difference -1.9; Cohen's d for Stages 1 and 2 = -0.28 and -0.47, p = 0.03) versus placebo, as well as QIDS-SR scores in Stage 2 of SPCD (-2.5; Cohen's d Stages 1 and 2 = -0.03 and -0.68, p = 0.04). The 40 mg dose also showed advantages on some objective cognitive measures of the CogScreen (absolute Cohen's d ranged between 0.12 and 1.12 in favor of NSI-189, p values between 0.002 and 0.048 for those with overall significance), but not the Cogstate test. Both doses were well tolerated. These findings replicate those of phase 1b study, and warrant further exploration of the antidepressant and pro-cognitive effects of NSI-189.

Febrile neutropenia and its associated hospitalization in breast cancer patients on docetaxel-containing regimen: A retrospective cohort study on duration of prophylactic GCSF administration.

PURPOSE: To compare febrile neutropenia (FN) incidence and hospitalization among breast cancer patients on docetaxel with no granulocyte colony-stimulating factors (GCSF) primary prophylaxis (PP), 4/5-day PP, or 7-day PP. METHODS: We identified 3916 breast cancer patients using docetaxel-cyclophosphamide (TC), doxorubicin-cyclophosphamide then docetaxel (AC-T), fluorouracil-epirubicin-cyclophosphamide then docetaxel (FEC-T), docetaxel-carboplatin-trastuzumab (TJH), or docetaxel-doxorubicin-cyclophosphamide (TAC) from a hospital pharmacy dispensing database in Hong Kong between 2014 and 2016. Patients were offered GCSF within 5 days since administering docetaxel. Outcomes included FN incidence, time to first hospitalization, hospitalization rate, and duration. RESULTS: In TC regimen, FN incidence (with odds ratio, OR) of patients with no PP, 4/5-day PP, and 7-day PP was 21.69%, 7.95% (OR 0.31, p < 0.001), and 5.33% (OR 0.20, p < 0.001), respectively. In TJH regimen, FN incidence of patients with no PP, 4/5-day PP, and 7-day PP was 38.26%, 8.33% (OR 0.15, p < 0.001), and 8.57% (OR 0.15, p < 0.001), respectively. FN incidence of patients on AC-T regimen with no PP and 4/5-day PP was 20.93% and 6.84%, respectively (OR 0.28, p = 0.005); with FEC-T regimen, the incidence was 9.91% and 4.77%, respectively (OR 0.46, p = 0.035). Only 3.27% FN cases were not hospitalized. Mean (±standard deviation, SD) time to first hospitalization was 8.21 ± 2.44 days. Mean (±SD) duration of hospitalization for patients with no PP, 4/5-day PP, and 7-day PP was 4.66 ± 2.60, 4.37 ± 2.85, and 5.12 ± 2.97 days, respectively. CONCLUSION: GCSF prophylaxis in breast cancer patients on docetaxel could reduce FN incidence and hospitalization. 4/5-day PP demonstrated similar efficacy to 7-day PP with superior saving benefits on healthcare expenditure.

Canada's Prosthetic Coverage: a Review of Provincial Prosthetic Policy.

The Canadian healthcare system serves as an example of equity and federal service to citizens across the world. However, it is not without its challenges. Prosthetic coverage across Canada is highly variable and largely unable to provide equal coverage for Canadian persons living with amputation. Many persons with limb loss are forced to rely upon personal resources, fundraising, or the charity of non-governmental organizations in order to meet this basic healthcare need. This disparity in the Canadian healthcare system is unusual and largely undescribed in the literature. We thus explore the nature of Canadian healthcare prosthetic coverage across Canada, investigating the variability in coverage, presence of prosthetic coverage policies, clarity of policy, eligibility criteria, and interval of prosthetic replacement. Our findings highlight potential areas for improvement within current Canadian healthcare policy.

Sex differences in brain responses to food stimuli: a meta-analysis on neuroimaging studies.

The aims of the current study were to update the inclusion list of relevant neuroimaging studies, meta-analyse the neuroimaging data and thus synthesize a brain map showing locations with differential activations between men and women. Published studies to 2017 were retrieved and included into the analysis if they evaluated patients' brain responses to food or eating stimuli with functional magnetic resonance imaging or positron emission tomography and reported activation differences between the sexes in the form of brain coordinates based on whole-brain analysis. Eight studies that comprised a total of 231 participants fulfilled the inclusion criteria. Men had larger neural responses to food stimuli than women in the anterior and middle cingulate, which are related to emotion regulation. Meanwhile, women had larger neural responses to food stimuli than men in the parahippocampus, the thalamus and the precuneus, which are collectively relevant in the context of promotion of eating. The differential brain responses to food or eating stimuli between men and women may shed light on the neurobiology to help explain the sex differences in eating behaviour.

Three-dimensional radiographic evaluation of root migration patterns 4-8.5 years after lower third molar coronectomy: a cone beam computed tomography study.

This prospective study in patients with a follow-up of 4-8.5years aimed to describe the long-term, three-dimensional changes of coronectomized lower third molar roots. Pre- and postoperative cone beam computed tomography (CBCT) scans were compared. The distance of root migration, the direction of root translation and rotation, and the amount of bone regeneration at the adjacent second molar and superficially to the third molar root were recorded. Age, gender, time elapsed following surgery, the status of the retained root including, impaction pattern and depth of impaction were tested to check if they were influencing factors for the above outcomes. A total of 57 coronectomized third molars from 44 patients were included. The distance of the mean root migration was 2.82mm, and they predominantly translated mesially (76.8%). Age negatively correlated with the distance of migration. Root remnants with a soft tissue coverage had less bone regenerated at the adjacent second molar (1.27mm vs. 2.95mm) in comparison to their impacted counterparts. Based on the present radiographic results and the absence of any pathological findings, coronectomy can be recommended for selected cases of third molar removal as a safe procedure with favourable long-term outcomes.

Development of the Sports Organization Concussion Risk Assessment Tool (SOCRAT).

OBJECTIVE: In this paper, we describe the development of a novel tool-the Sports Organization Concussion Risk Assessment Tool (SOCRAT)-to assist sport organizations in assessing the overall risk of concussion at a team level by identifying key risk factors. METHODS: We first conducted a literature review to identify risk factors of concussion using ice hockey as a model. We then developed an algorithm by combining the severity and the probability of occurrence of concussions of the identified risk factors by adapting a risk assessment tool commonly used in engineering applications. RESULTS: The following risk factors for ice hockey were identified: age, history of previous concussions, previous body checking experience, allowance of body checking, type of helmet worn and the game or practice environment. These risk factors were incorporated into the algorithm, resulting in an individual risk priority number (RPN) for each risk factor and an overall RPN that provides an estimate of the risk in the given circumstances. CONCLUSION: The SOCRAT can be used to analyse how different risk factors contribute to the overall risk of concussion. The tool may be tailored to organizations to provide: (1) an RPN for each risk factor and (2) an overall RPN that takes into account all the risk factors. Further work is needed to validate the tool based on real data.