Risk factors for a negative birth experience using the Birth Satisfaction Scale-Revised.

OBJECTIVE: To evaluate the risk factors for a negative birth experience using the Birth Satisfaction Scale-Revised (BSS-R) questionnaire. METHODS: A cross-sectional study including women who gave birth at a single tertiary hospital between February 2021 and January 1, 2022. Birth satisfaction was measured using the BSS-R questionnaire. Maternal, pregnancy, and delivery characteristics were collected. Negative birth experience was defined as a BSS-R score lower than the median. Multivariable regression analysis was used to examine the association between birth characteristics and negative birth experience. RESULTS: A total of 1495 women answered the questionnaire and were included in the analysis; 779 women comprised the positive birth experience group and 716 women comprised the negative birth experience group. Prior deliveries, prior abortions, and smoking (adjusted odds ratio [aOR], 0.52 [95% confidence interval (CI), 0.41-0.66]; aOR, 0.78 [95% CI, 0.62-0.99]; aOR, 0.52 [95% CI, 0.27-0.99], respectively) were independently associated with lower risk of negative birth experience. Immigration, answering the questionnaires in person, and cesarean delivery were independently associated with increased negative birth experience risk (aOR, 1.39 [95% CI, 1.01-1.86]; aOR 1.37 [95% CI, 1.04-1.79]; aOR, 1.92 [95% CI, 1.52-2.41], respectively). CONCLUSION: Parity, prior abortions, and smoking were associated with a lower risk of negative birth experience, while immigration, answering questionnaires in person, and cesarean delivery were associated with a higher risk of negative birth experience.

Correlation between Adverse Events and Antibody Titers among Healthcare Workers Vaccinated with BNT162b2 mRNA COVID-19 Vaccine.

Objectives: The BNT162b2 mRNA COVID-19 vaccine has been found to be highly effective in preventing COVID-19 but is associated with increased reactogenicity. We aimed to examine the correlation between immunogenicity and reactogenicity of the BNT162b2 vaccine. Methods: Subjects without prior SARS-CoV-2 infection that participated in active surveillance after being vaccinated with the BNT162b2 vaccine were included. Study participants reported adverse drug reactions (ADRs) through questionnaires administered by text message after receiving each dose of the vaccine. A reactogenicity score was developed based on the type and duration of ADRs. In addition, anti-receptor binding domain (RBD) levels and neutralization assays were performed 7−21 and 7−38 days after the first and second vaccine doses, respectively. Associations between ADRs and antibody levels were assessed by Spearman correlations. Multivariable logistic regression analyses were used to identify factors associated with ADRs. Results: A total of 831 health care workers were included. The mean age was 46.5 years (SD = 11.8) and 75.5% were females. 83.4% and 83.3% had at least one local ADR after the first and second doses, respectively. 33% and 83.2% had at least one systemic ADR after the first and second doses, respectively. Multivariate logistic regression analysis found a significant correlation between ADR score and anti-RBD-IgG titers (r = 0.366; p < 0.0001) after adjustment for age, gender, and days after the second vaccination. High anti-RBD-IgG levels, being younger than 55 and being female, were all correlated with increased rates of ADRs. Conclusion: BNT162b2 mRNA COVID-19 vaccine reactogenicity appears to be correlated with higher post-vaccination antibody levels and is independently associated with younger age and female gender.

The association between vitamin D levels and caries experience in children and youth participating in National Health and Nutrition Examination Survey 2011-2016: A cross-sectional study.

BACKGROUND: Given equivocal findings from existing nationally representative studies, the authors sought to determine associations between vitamin D levels and caries experience in US children using updated National Health and Nutrition Examination Survey data. METHODS: The authors used data from 2011-2016 National Health and Nutrition Examination Survey. Vitamin D status was assessed on the basis of the sufficiency thresholds of 50 and 75 nmol/L for serum 25-hydroxyvitamin D (25[OH]D) recommended by the Institute of Medicine (now National Academy of Medicine) and Endocrine Society, respectively. Caries experience was defined as the total number of decayed or filled tooth surfaces (dfs) and decayed, missing, or filled tooth surfaces (DMFS) and a binary measure of any dfs and DMFS. Associations between 25(OH)D and any or total dfs and DMFS were examined in children aged 2 through 5, 6 through 8, 9 through 11, and 12 through 18 years, using multivariable logistic and linear regression models after adjustment for covariates. RESULTS: Children aged 2 through 5 years with 25(OH)D above 75 nmol/L experienced fewer total dfs (ß = -1.94; 95% CI, -3.60 to -0.28) than those with 25(OH)D below 75 nmol/L. Children 6 through 8 years with 25(OH)D above 75 nmol/L had lower presence of any dfs (odds ratio, 0.59; 95% CI, 0.36 to 0.95) than those with 25(OH)D below 75 nmol/L, and those with 25(OH)D above 50 nmol/L had lower presence of any DMFS (odds ratio, 0.38; 95% CI, 0.19 to 0.79) than those with 25(OH)D below 50 nmol/L. There were no associations of 25(OH)D status with either any or total DMFS in children 12 through 18 years CONCLUSIONS: There were no consistent associations of 25(OH)D status with caries experience across age groups. PRACTICAL IMPLICATIONS: Vitamin D status was not associated consistently with reduced caries experience.

The prevalence of dental developmental anomalies among childhood cancer survivors according to types of anticancer treatment.

Survival following childhood cancer has increased considerably. In an observational cross-sectional study, we assessed the prevalence of dental developmental anomalies (DDA) among childhood cancer survivors according to types of anticancer treatment. Permanent teeth were examined clinically and radiographically in 121 adolescents with a history of childhood malignancies, to identify DDA, namely hypomineralization or hypoplasia, microdontia, root changes and hypodontia. DDA were observed in 56/121 individuals (46%), in 309/3388 teeth (9%). Hypomineralization or hypoplasia of enamel appeared in 21 (17%) patients. Altered root development appeared in 26 patients and hypodontia affected 13 (10%). Dental anomalies were observed in 36 (43%) individuals who received chemotherapy and not radiation, in 20 (52%) who received radiotherapy, and in 15 (60%) of those who received head and neck radiotherapy. Among patients who received only chemotherapy, young age (6 years or younger) was associated with a higher number of malformed teeth. In conclusion, antineoplastic treatment that combines chemotherapy and radiotherapy appears to increase the risk of DDA. Radiation to the head and neck area was shown to particularly increase the risk of DDA. No specific chemotherapy agent was found to be associated more than the others with DDA.

Outcomes of Calcium Hydroxide with Iodoform Pulpectomies in Primary Teeth.

Purpose: To assess retrospectively the success rate of calcium hydroxide with iodoform as a filling material in pulpectomies of primary molars with irreversible pulpitis or pulp necrosis, and to evaluate factors that affect outcomes.
Methods: This study consisted of records of 73 patients with primary molars treated with pulpectomy with high quality radiographs. Treatment was considered successful clinically if the tooth was not extracted and radiographs showed a decrease or no change in preexisting pathologic radiolucent defects.
Results: Follow-up ranged from three to 39 months (median: 21.5 months). The success rate of teeth restored with a stainless steel crown (SSC) on the same appointment (88.9 percent) was higher than for teeth that received a temporary restoration (P =0.001). There was no statistically significant difference between the success rate and the extent of resorption of root canal filling material. Primary second molars had a higher success rate than first molars (P =0.018). No difference was found between the level of pulpectomy filling and treatment success (P =0.17).
Conclusion: Pulpectomies done with calcium hydroxide and iodoform had an overall success rate of 74 percent. If restored with an SSC, the success rate increased to 88.9 percent. Resorption of the paste did not affect the success rate.

Sealed primary molars are less likely to develop caries.

BACKGROUND: The authors examined the association between light-polymerized resin-based fluoride-releasing sealants and the development of pit-and-fissure caries on primary molars. METHODS: In this 3-year retrospective study, the authors reviewed the dental records of 297 children (1,352 teeth) younger than 6 years who were at high caries risk. Sealant placement or nonplacement on primary molars in the outpatient clinic and operating room setting was recorded, and random-effects logistic regression analysis accounting for the effect of data clustering was performed to measure caries incidence over time. RESULTS: The odds of developing pit-and-fissure carious lesions on sealed primary molars were 0.055 times (95% confidence interval [CI], 0.011 to 0.285; P = .001) and 0.013 times (95% CI, 0.001 to 0.159; P = .001) the odds of that on nonsealed primary molars in the outpatient clinic and in the operating room, respectively. In molars that became carious, those sealed were associated with longer time to caries development in both the outpatient clinic (2.69 years, 95% CI, 2.08 to 3.29) and operating room (1.97 years, 95% CI, 1.45 to 2.48). CONCLUSIONS: Sealed primary molars were less likely to develop pit-and-fissure caries when placed in both the clinic and operating room settings. PRACTICAL IMPLICATIONS: Dental sealants on primary molars should be considered for children at high caries risk.

The effect of the waiting room's environment on level of anxiety experienced by children prior to dental treatment: a case control study.

BACKGROUND: In addition to visit purpose, one of the environmental factors that can cause anxiety prior to dental treatment includes the waiting room experience, specifically the amount of time spent awaiting treatment and the waiting room environment. The purpose of this study was to compare the effect of the waiting room's environment on the level of anxiety experienced by children in multisensory and traditional waiting rooms. METHODS: Case control study. Test group waited for treatment in a multisensory waiting room, which consisted of a lighting column that children could touch and climb; as well as, rhythmic music played on loudspeakers. Control group waited for treatment in a traditional waiting room. Study participants were asked to answer the "Venham Picture Test", a dental anxiety scale, while in the waiting room prior to entering the treatment room. Chi-squared, Fisher's Exact tests, and linear regression were utilized. A p-value less than 0.05 was considered statistically significant. RESULTS: No significant difference in dental anxiety scores was found between the test and control groups according to waiting room type (p > .05). Dental anxiety was significantly higher in patients who had longer waiting time prior to treatment (p = 0.019). In addition, dental anxiety was significantly associated with visit purpose (p < .001): children waiting for dental examination or those scheduled for dental treatment with conscious sedation were less anxious than children waiting for emergency treatment. CONCLUSIONS: A sensory adapted waiting room environment may be less important in reducing children's anxiety prior to dental treatment. Children's dental anxiety can be reduced by preventing emergency treatments, scheduling routine dental visits and decreasing waiting time. TRIAL REGISTRATION: TRN NCT03197129, date of registration June 20, 2017.

Perceptions of Healthcare-Associated Infection and Antibiotic Resistance among Physicians Treating Syrian Patients with War-Related Injuries.

Healthcare-associated infections (HAIs) constitute a major contributor to morbidity and mortality worldwide, with a greater burden on low- and middle-income countries. War-related injuries generally lead to large tissue defects, with a high risk of infection. The aim of this study was to explore how physicians in a middle-income country in an emergency setting perceive HAI and antibiotic resistance (ABR). Ten physicians at a Jordanian hospital supported by Médecins Sans Frontières were interviewed face-to-face. The recorded interviews were transcribed verbatim and analyzed by qualitative content analysis with an inductive and deductive approach. The participants acknowledged risk factors of HAI and ABR development, such as patient behavior, high numbers of injured patients, limited space, and non-compliance with hygiene protocols, but did not express a sense of urgency or any course of action. Overuse and misuse of antibiotics were reported as main contributors to ABR development, but participants expressed no direct interrelationship between ABR and HAI. We conclude that due to high patient load and limited resources, physicians do not see HAI as a problem they can prioritize. The knowledge gained by this study could provide insights for the allocation of resources and development of hygiene and wound treatment protocols in resource-limited settings.

"Reality rarely looks like the guidelines": a qualitative study of the challenges hospital-based physicians encounter in war wound management.

BACKGROUND: Globally, armed conflict is a major contributor to mortality and morbidity. The treatment of war-associated injuries is largely experience-based. Evidence is weak due to difficulty in conducting medical research in war settings. A qualitative method could provide insight into the specific challenges associated with providing health care to injured civilians. The aim of this study was to explore the challenges hospital-based physicians encounter in war wound management, focusing on surgical intervention and antibiotic use. METHODS: Semi-structured, face-to-face interviews were conducted with physicians at a Jordanian hospital supported by Médecins Sans Frontières. The interviews were recorded, transcribed verbatim and analysed using content analysis with an inductive and deductive approach. RESULTS: We found that challenges in war wound management primarily relate to protocol adherence. Protocols for the management of acute war wounds were adhered to on areas that could be considered commonly agreed principles of war wound surgery, such as the use of wound debridement and the evaluation of the systemic condition of the patient before initiating antibiotic treatment. We identified limitations imposed on the physicians that complicate or even hinder protocol adherence. Additionally, we identified factors associated with conscious deviations from the protocols. CONCLUSIONS: We conclude that adherence to established protocols around the management of acute war wounds is difficult. We present aspects that may be considered when establishing clinical projects in similar contexts. The knowledge gained by this study could provide insights for the development of protocols or guidelines for wound management and antibiotic use in an unstable setting, such as a hospital in close proximity to armed conflict. We suggest the use of a grounded theory approach to further study the discrepancy between guideline recommendations and actual practice.

Association of vitamin D and dental caries in children: Findings from the National Health and Nutrition Examination Survey, 2005-2006.

BACKGROUND: The authors sought to determine associations between serum vitamin D levels and dental caries in noninstitutionalized children aged 5 to 12 years in the United States. METHODS: The authors used National Health and Nutrition Examination Survey, 2005-2006, data to study childhood caries and vitamin D. Vitamin D deficiency and inadequacy were defined as serum 25-hydroxyvitamin D (25[OH]D) less than 30 nanomoles per liter and between 30 and 49 nmol/L, respectively. Associations between vitamin D and caries experience (a combined measure of untreated caries or restorations) were examined after adjustment for confounders using multivariate logistic regression at a critical value of 5%. Sample weights were used to generate nationally representative estimates. RESULTS: The overall prevalence of serum 25(OH)D less than 30 nmol/L and 25(OH)D between 30 and 49 nmol/L among 5- to 12-year-olds was 3% and 16%, respectively. Prevalence of 25(OH)D less than 30 nmol/L and 25(OH)D between 30 and 49 nmol/L among children with caries experience was 2% and 16%, respectively. Multivariate logistic regression analysis found no significant association between vitamin D and caries experience (P = .78). Furthermore, this association was not significant after adjusting for age, sex, race and ethnicity, ratio of family income to poverty threshold, and sugar consumption (P = .46). CONCLUSIONS: The authors did not find a significant association between 25(OH)D status and caries experience in US children who participated in NHANES, 2005-2006. PRACTICAL IMPLICATIONS: The authors' findings do not support existing evidence of an association between caries and vitamin D.

Pilot Study of the Canary System Use in the Diagnosis of Approximal Carious Lesions in Primary Molars.

PURPOSE: This study assessed the feasibility and ease of use of the Canary System in approximal carious lesion detection in primary molars. METHODS: Forty healthy five- to 12-year-olds, who presented to the Center for Pediatric Dentistry in Seattle, Wash., U.S.A., for initial or recall exams, were enrolled. Participants had one to two primary molars, with or without approximal radiographic radiolucencies. Four Canary System scans were performed at the approximal area of each study tooth. The maximum Canary number of the four scans was compared to bitewing radiographs. RESULTS: Seventy-five teeth were included in the final analysis. All study patients easily tolerated being scanned with the Canary System. The overall sensitivity and specificity of the Canary System, when compared to bitewing radiographs, was 81 percent and 35 percent, respectively. Among teeth without radiographic radiolucencies, the Canary System identified 65 percent (31 of 48) of study teeth as having carious lesions. CONCLUSIONS: The Canary System is a safe approximal caries detection device in five- to 12-year-olds. When compared to bitewing radiographs, the specificity of the Canary System for approximal carious lesion detection in primary molars was low. However, this could indicate that the Canary System is detecting lesions earlier than radiographs.

The association between community water fluoridation and adult tooth loss.

OBJECTIVES: We sought to estimate the association between community water fluoridation (CWF) exposure at various stages of life and adult tooth loss. METHODS: We used data from the 1995 through 1999 Behavioral Risk Factor Surveillance System, merged with data from the 1992 Water Fluoridation Census, to estimate interval regression models that relate CWF exposure with tooth loss. RESULTS: Our results indicate that CWF levels in the county of residence at the time of the respondent's birth are significantly related to tooth loss but current CWF levels are not. In addition, the impact of CWF exposure is larger for individuals of lower socioeconomic status. CONCLUSIONS: This study suggests that the benefits of CWF may be larger than previously believed and that CWF has a lasting improvement in racial/ethnic and economic disparities in oral health.

Review: the net benefits of depression management in primary care.

Depression is often diagnosed and treated in primary care settings. Organizational and systems interventions that restructure primary care practices and train staff have been shown to be cost-effective strategies for treating depression. Funders are increasingly calling for a cost-benefit assessment of such programs. In this study, the authors review existing cost-effectiveness studies of primary care depression treatments, classify them into categories, translate the results into net benefit terms, and assess whether more costly programs generate greater net benefit. The authors find that interventions that provide training to primary care teams in how to manage depression most consistently produce net benefits, with more costly interventions of this type generating larger net benefits than less costly interventions. Collaborative care interventions, which add specialized staff to primary care practices, and therapy interventions, in which clinicians are trained to provide therapy, also generate net social benefits at conventional valuations of quality-adjusted life years.

International quality control survey of neurochemical dementia diagnostics.

UNLABELLED: Currently, neurochemical dementia diagnostics (NDD) are increasingly entering routine clinical neurochemistry, offering improved early and differential diagnosis of dementias. However, there is an obvious lack of standardization in pre-analytical sample handling and systematic quality surveys. Therefore, in this study, 14 laboratories in Germany, Austria, and Switzerland were given aliquots of a human cerebrospinal fluid (CSF) sample, and were asked to measure Alzheimer's disease (AD) biomarkers (amyloid beta (Abeta) peptides, total Tau protein, and phosphorylated Tau protein (P-tau(181P))) according to their routine protocols. RESULTS: The inter-laboratory coefficients of variation of the results obtained by the laboratories participating in this study were in the range of 20-30%. Although the results of this quality control survey are promising, the quality of measurements has to be further optimized.