SUMMARY: The emotional impulsivity manifestation in adolescence and adulthood related to the under-managed emotional dysregulation in childhood is found to be associated with subtle confounding impact of 5-HTTLPR (serotonin-transporter-linked promoter region) genotype. The genotype of interest affects the neurochemistry, neurophysiology, and psychophysiology of the cognition for executive function. The established practice of using methylphenidate in treating ADHD surprisingly has a neurogenetic effect in targeting the genotype of interest. Methylphenidate provides neuroprotective effects throughout the neurodevelopment timeline from childhood to adulthood.
KEY MESSAGES: The emotional dysregulation element in ADHD which is often overlooked should be addressed to improve the prognostic outcomes in adolescence and adulthood.
AIM: To evaluate the predictors of successful non-operative management in adhesive SBO.
METHODS: A retrospective study was performed for all consecutive cases of adhesive SBO from November 2015 to May 2018. Data collated included basic demographics, clinical presentation, biochemistry and imaging results and management outcomes. The imaging studies were independently analyzed by a radiologist who was blinded to the clinical outcomes. The patients were divided into group A operative (including those that failed initial non-operative management) and group B non-operative for analysis.
RESULTS: Of 252 patients were included in the final analysis; group A (n = 90) (35.7%) and group B (n = 162) (64.3%). There were no differences in the clinical features between both groups. Laboratory tests of inflammatory markers and lactate levels were similar in both groups. From the imaging findings, the presence of a definitive transition point [odds ratio (OR) = 2.67, 95% confidence interval (CI): 0.98-7.32, P = 0.048], presence of free fluid (OR = 2.11, 95%CI: 1.15-3.89, P = 0.015) and absence of small bowel faecal signs (OR = 1.70, 95%CI: 1.01-2.88, P = 0.047) were predictive of the need of surgical intervention. In patients that received water soluble contrast medium, the evidence of contrast in colon was 3.83 times predictive of successful non-operative management (95%CI: 1.79-8.21, P = 0.001).
CONCLUSION: The computed tomography findings can assist clinicians in deciding early surgical intervention in adhesive SBO cases that are unlikely to be successful with non-operative management to prevent associated morbidity and mortality.
METHODS: A questionnaire regarding details of the PD program and training practices was distributed to IPPN member centers, while peritonitis and ESI rates were either derived from the IPPN registry or obtained directly from the centers. Poisson univariate and multivariate regression was used to determine the training-related peritonitis and ESI risk factors.
RESULTS: Sixty-two of 137 centers responded. Information on peritonitis and ESI rates were available from fifty centers. Training was conducted by a PD nurse in 93.5% of centers, most commonly (50%) as an in-hospital program. The median total training time was 24 hours, with a formal assessment conducted in 88.7% and skills demonstration in 71% of centers. Home visits were performed by 58% of centers. Shorter (
METHOD: The annual cost of HF per patient was estimated using unweighted average and inverse probability weighting (IPW). Unweight average estimated the annual cost by considering all observed cases regardless of the availability of all the cost data, while IPW calculated the cost by weighting against inverse probability. The economic burden of HF was estimated for different HF phenotypes and age categories at the population level from the public healthcare system perspective.
RESULTS: The mean (standard deviation) annual costs per patient calculated using unweighted average and IPW were USD 5,123 (USD 3,262) and USD 5,217 (USD 3,317), respectively. The cost of HF estimated using two different approaches did not differ significantly (p = 0.865). The estimated cost burden of HF in Malaysia was USD 481.9 million (range: USD 31.7 million- 1,213.2 million) per year, which accounts for 1.05% (range: 0.07%-2.66%) of total health expenditure in 2021. The cost of managing patients with heart failure with reduced ejection fraction (HFrEF) accounted for 61.1% of the total financial burden of HF in Malaysia. The annual cost burden increased from USD 2.8 million for patients aged 20-29 to USD 142.1 million for those aged 60-69. The cost of managing HF in patients aged 50-79 years contributed 74.1% of the total financial burden of HF in Malaysia.
CONCLUSION: A large portion of the financial burden of HF in Malaysia is driven by inpatient costs and HFrEF patients. Long-term survival of HF patients leads to an increase in the prevalence of HF, inevitably increasing the financial burden of HF.
METHODS: Potential relevant undergraduate paediatric dentistry topics were initially drafted and revised according to the revised national competency statement. The final draft included 65 topics clustered under 18 domains. A fuzzy Delphi method was used and experts who fulfilled the inclusion criteria were invited to anonymously ranked the importance of relevant topics using a five-point Likert scale and proposed suitable cognitive and psychomotor levels for each topic. Fuzzy evaluation was then performed, and experts were considered to have reached a consensus if the following three conditions were achieved: (a). the difference between the average and expert rating data was ≤ 0.2; (b). the average expert consensus was ˃70%; and (c). the average fuzzy number was ≥ 0.5. Subsequently, the mean ratings were used to determine the cognitive and psychomotor levels.
RESULTS: 20 experts participated in the survey. 64 out of 65 paediatric dentistry topics were deemed acceptable. The average fuzzy number ranged from 0.36 to 0.85, while the average Likert score ranged from 3.05 to 5.00. The topic "Dental amalgam" was rejected based on expert consensus since the average fuzzy number was 0.36. The most significant topic was "Pit and fissure sealant", followed by "Preventive advice", "Early childhood caries", "Dental caries in children & adolescent", "Management of dental caries in paediatric patients", and "Consent" which were equally ranked as the second most important topics. According to Bloom's and Simpson's taxonomies, most of the paediatric dentistry topics were rated adequate for undergraduate students at the cognitive level of "Apply" (C3) and a psychomotor level of "Guided response" (P3).
CONCLUSION: The current study successfully identified relevant undergraduate paediatric dentistry topics using the fuzzy Delphi method, which can facilitate future educators to improve existing Malaysian undergraduate paediatric dental curricula.
METHODS: The study was a cross-sectional, web-based survey conducted on primary healthcare workers in Kediri Regency, Indonesia, with the highest Omicron case surge worldwide. It was conducted right after the surge between July and August 2022, the third year of the COVID-19 pandemic hit Indonesia. Under coordination with the local government health officials, primary healthcare workers were invited to participate in an online survey. The respondents were asked to evaluate their sociodemography, work conditions, personal life, and perceived stress (using the Perceived Stress Scale) during the pandemic. Their work-life balance was evaluated using the Work/Non-work Interference and Enhancement Scale. We used several hierarchical linear regression models to determine which variables contribute to work stress among primary healthcare workers.
RESULTS: Sociodemographic characteristics, including gender, age, marital status, years of professional experience, and educational level, were not significantly associated with stress levels among our respondents. Separately, work conditions and personal life variables did not associate with stress levels. However, primary healthcare workers' work and personal lives interfere with each other during the pandemic and are associated with their higher stress.
CONCLUSION: During the pandemic, the work life of primary health workers interferes with their personal life more than the interference of personal life on their work life. At the same time, the work life's enhancement on the personal life and vice versa were lower than its interference. Those conditions are associated with higher perceived stress of primary health workers.