ABSTRACT
BACKGROUND: Contemporary studies demonstrate that non-ST-segment elevation myocardial infarction (NSTEMI) processes of care vary according to sex. Little is known regarding variation in practice between geographical areas and centers. METHODS: We identified 305 014 NSTEMI admissions in the United Kingdom (UK) Myocardial Infarction National Audit Project (MINAP), 2010-2017, including female sex (110 209). Hierarchical, multivariate logistic regression models were fitted assessing for differences in primary outcomes according to sex. Risk standardized mortality rates (RSMR) were calculated for individual hospitals to illustrate correlation with variables of interest. 'Heat-maps' were plotted to show regional and sex-based variation in opportunity-based quality-indicator score (surrogate for optimal processes of care). RESULTS: Women presented older (77y vs. 69y, P < 0.001) and were more often Caucasian (93% vs. 91%, P < 0.001). Women were less frequently managed with an invasive coronary angiogram (ICA) (58% vs. 75%, P < 0.001) or percutaneous coronary intervention (PCI) (35% vs. 49%, P < 0.001)). In our hospital-clustered analysis, we show positive correlation between the RSMR and increasing proportion of women treated for NSTEMI (R2 = 0.17, P < 0.001). There was clear negative correlation between proportion of women who had an optimum OBQI score during their admission and RSMR (R2 = 0.22, P < 0.001), with weaker correlation in men (R2 = 0.08, P < 0.001). Heat-maps according to clinical commissioning group (CCG) demonstrate significant regional variation in OBQI score, with women receiving poorer quality care throughout the UK. CONLUSION: There was a significant in variation of the management of patients with NSTEMI according to sex, with widespread geographical variation. Structural changes are required to enable improved care for women.
ABSTRACT
INTRODUCTION: Various types of oral hygiene measures have been practiced by different populations around the world, as there is difference in the oral hygiene products including toothpicks and toothpowders. Miswak or tooth cleaning stick, for mechanical tooth cleaning, can be traced back at least to pre-Islamic times. Currently, many of the world populations still use chewing sticks as the single method for tooth brushing. The present study was done to study the incidence and prevalence of caries among Miswak and non-Miswak users. MATERIALS AND METHODS: The study was done consisting of 120 cases and 120 control group (60 boys and 60 girls in each group) from the secondary school. The materials used were light, explorer, mirror, gloves, upper and lower teeth models, Miswak, and common toothbrush. After the recording of the primary data, Miswak was given to case group and the students were trained to use it on the teeth models. After 2 years, the examination of the teeth was done using the same method as before start of the study and by the same investigators. All the data were recorded, tabulated, and analyzed with the help of Statistical Package for the Social Sciences (SPSS) statistics version 17 using Student's t-test. RESULTS: From the 240 participants, only 211 had continued the study for the total period of time. Out of these, 111 were from the study group and 100 from the control group. On comparison of the decayed-missing-filled (DMF) index scores of the study and control groups, before and after completion of the study, had also shown that the caries index was increased and the difference was found to be statistically significant. CONCLUSION: From the study, it can be concluded that the study group using Miswak had less number of caries incidence than the control group of non-Miswak. CLINICAL SIGNIFICANCE: Miswak can be used as teeth cleaning aid in day-to-day life as it can reduce the caries incidence.
