Understanding Perspectives of African American Medicaid-Insured Women on the Process of Perinatal Care: An Opportunity for Systems Improvement

Abstract

Objectives To address disparities in adverse birth outcomes, communities are challenged to improve the quality of health services and foster systems integration. The purpose of this study was to explore the perspectives of Medicaid-insured women about their experiences of perinatal care (PNC) across a continuum of clinical and community-based services. Methods Three focus groups (N = 21) were conducted and thematic analysis methods were used to identify basic and global themes about experiences of care. Women were recruited through a  local Federal Healthy Start (HS) program in Michigan  that targets services to African American women. Results Four basic themes were identified: (1) Pursuit of PNC; (2) Experiences of traditional PNC; (3) Enhanced prenatal and postnatal care; and (4) Women's health: A missed opportunity. Two global themes were also identified: (1) Communication with providers, and (2) Perceived socio-economic and racial bias. Many women experienced difficulties engaging in early care, getting more help, and understanding and communicating with their providers, with some reporting socio-economic and racial bias in care. Delays in PNC limited early access to HS and enhanced prenatal care (EPC) programs with little evidence of supportive transitions to primary care. Notably, women's narratives revealed few connections among clinical and community-based services. Conclusions The process of participating in PNC and community-based programs is challenging for women, especially for those with multiple health problems and living in difficult life circumstances. PNC, HS and other EPC programs could partner to streamline processes, improve the content and process of care, and enhance engagement in services.

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Relationship of Adverse Family Experiences to Resilience and School Engagement Among Vermont Youth

Abstract

Introduction

Adverse childhood experiences (ACEs) are associated with a range of health outcomes and risk behaviors. In 2011–2012, the National Survey of Children's Health (NSCH) included questions about adverse family experiences (AFEs). AFE survey questions are similar to ACE questions, except there are no questions about emotional/physical/sexual trauma, and questions are asked of parents rather than children. Although the relationship between ACEs and work/school absenteeism has been studied, the relationships between AFEs of school-aged children, school performance, and buffering behaviors have not been explored in depth.

Methods

We examined AFEs and measures of resilience and school engagement among 1330 Vermont children (6–17 years) included in the NSCH, using descriptive, bivariate, and multivariable analyses.

Results

The most prevalent AFEs were divorce/separation of parents; family income hardship; substance use problems; and mental illness, suicidality, or severe depression. Adjusting for sex, age, special health care needs, poverty level, and maternal physical/mental-emotional health status, children who had three or more AFEs had lower odds of completing all required homework [adjusted odds ratio (AOR) 3.3, 95% confidence interval (CI) 1.7–6.3] and higher odds of failing to exhibit resilience (AOR 2.1, 95% CI 1.2–3.8), compared to children having no AFEs.

Discussion

Children with three or more AFEs had difficulty engaging in school and completing homework, though poor outcomes were buffered when children showed resilience. Parents, school-based mental health professionals, and teachers could help identify children who may be less resilient and have difficulties completing homework assignments. Preventive approaches to children's emotional problems (e.g., promoting family health, using family-based approaches to treat emotional/behavioral problems) could be applied in schools and communities to foster resilience and improve school engagement of children.

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Comparing Different Partograph Designs for Use in Standard Labor Care: A Pilot Randomized Trial

Abstract

Backgound Partographs are used in many labour settings to provide a pictorial overview of a woman's cervical dilation pattern in the first stage of labor and to alert clinicians to slow progress possibly requiring intervention. Recent reviews called for large trials to establish the efficacy of partographs to improve birth outcomes whilst highlighting issues of clinician compliance with use. Previous studies have also reported issues with participant recruitment related to concerns regarding the possibility of a longer labour. Objectives We sought to compare a standard partograph with an action line, to a newly designed partograph with a stepped line, to determine the feasibility of recruitment to a larger clinical trial. Methods A pragmatic, single-blind randomised trial wherein low-risk, nulliparous women in spontaneous labour at term were randomized to an action-line or stepped-line partograph. First stage labour management was guided by the allocated partograph. Primary outcomes included the proportion of eligible women recruited, reasons for failed recruitment and compliance with partograph use. Secondary outcomes included rates of intervention, mode of birth, maternal and neonatal outcomes. Results Of the 384 potentially eligible participants, 38% (149/384) were approached. Of these 77% (116/149) consented, with 85% (99/116) randomized, only nine women approached (6%) declined to participate. A further 9% (14/149) who were consented antenatally were not eligible at onset of labor and 7% (10/149) of women approached in the birth suite but did not meet the inclusion criteria. Compliance with partograph completion was 65% (action) versus 84% (dystocia line). Conclusions for Practice Participant recruitment to a larger randomized controlled trial comparing new labour management guidelines to standard care is feasible. Effective strategies to improve partograph completion compliance would be required to maintain trial fidelity.

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Adverse Childhood Experiences and Child Health Outcomes: Comparing Cumulative Risk and Latent Class Approaches

Abstract

Objectives This study seeks to further the work exploring adverse childhood experiences (ACEs) by proposing a novel approach to understanding the impact of ACEs through applying advanced analytical methods to examine whether combinations of ACEs differentially impact child health outcomes. Methods Using National Survey of Children's Health data, we use latent class analysis to estimate associations between classes of ACEs and child health outcomes. Results Class membership predicts child poor health, with differences found for specific ACE combinations. A subgroup of children exposed to poverty and parental mental illness are at higher risk for special healthcare needs than all other groups, including children exposed to 3 or more ACEs. Conclusions Different combinations of ACEs carry different risk for child health. Interventions tailored to specific ACEs and ACE combinations are likely to have a greater effect on improving child health. Our findings suggest children who experience specific ACE combinations (e.g., poverty and parental mental illness) are at particularly high risk for poor health outcomes. Therefore, clinicians should routinely assess for ACEs to identify children exposed to the most problematic ACE combinations; once identified, these children should be given priority for supportive interventions tailored to their specific ACE exposure and needs.

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Endotracheal intubation: ultrasound-guided versus fiberscope in patients with cervical spine immobilization

Abstract

Background

Ultrasound has growing applications in airway management during anesthesia. The aim of the present study was to evaluate the feasibility of real-time ultrasound-guided tracheal intubation in patients with cervical spine immobilization relative to fiberscope-guided tracheal intubation.

Patients and methods

This randomized controlled study was carried out on 266 adult patients who have a rigid neck collar in place for cervical spine immobilization and were randomly allocated into two equal groups. All patients were subjected to the same anesthetic protocol. After full neuromuscular blockade, neck collar was removed and tracheal intubation was done in the neutral position. In group A, the trachea was intubated guided by a 5–12-MHz linear ultrasound probe attached to a Sonoscape A5 ultrasound machine. In group B, the trachea was intubated by an endotracheal tube mounted over a fiberscope (Karl Storz, working length 65 cm, distal tip diameter 5.6 mm). Hemodynamic measurements and oxygen saturation were recorded. Tracheal intubation criteria for both groups including duration of the intubation procedure, number of intubation attempts, success rate at each attempt, and the lowest oxygen saturation recorded during tracheal intubation were recorded.

Results

Ultrasound and fiberscope achieved comparable time for tracheal intubation (57 ± 12 vs. 55 ± 10 s), respectively. Success rate of tracheal intubation at the first attempt was higher in the fiberscope group than the ultrasound group, with a P value of 0.032. The overall success rate was not significantly different between the two groups.

Conclusions

Ultrasound-guided tracheal intubation showed a lower first attempt success rate in patients with cervical spine immobilization compared to fiberscope-guided tracheal intubation but the overall success rates were comparable. Ultrasound can be an alternative technique for guiding tracheal intubation in patients with cervical spine immobilization.

Registry number

PACTR201602001476292.

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Preoperative flurbiprofen axetil administration for acute postoperative pain: a meta-analysis of randomized controlled trials

Abstract

Objective

Non-steroidal anti-inflammatory drugs have been shown to effectively decrease postoperative pain and reduce opioid requirements. Flurbiprofen axetil is an injectable non-selective cyclooxygenase inhibitor that has a high affinity for inflammatory tissues to achieve targeted drug therapy and prolonged duration of action. This meta-analysis examined the use of preoperative flurbiprofen axetil and its impact on postoperative analgesia.

Methods

An electronic literature search of the Library of PubMed, Cochrane CENTRAL, and EMBASE databases was conducted in Feb 2016. Searches were limited to randomized controlled trials. The primary outcome was pain scores. The secondary outcomes included cumulative postoperative opioid consumption and opioid-related adverse effects.

Results

A total of nine RCT studies involving 457 patients were included in this study. Compared to patients without perioperative flurbiprofen axetil, patients treated with preoperative flurbiprofen axetil had lower pain scores at 2 h (SMD −1.00; 95% CI −1.57 to −0.43, P = 0.0006), 6 h (SMD −1.22; 95% CI −2.01 to −0.43; P = 0.002), 12 h (SMD −1.19; 95% CI −2.10 to −0.28; P = 0.01), and 24 h (SMD −0.79; 95% CI −1.31 to −0.27; P = 0.003) following surgery. Preoperative flurbiprofen axetil had no significant effect on postoperative opioid consumption (SMD −13.11; 95% CI −34.56 to 8.33; P = 0.23). There was no significant difference between the groups with regard to adverse effects. Compared to patients with postoperative flurbiprofen axetil, however, preoperative flurbiprofen axetil resulted in decreased pain score only at 2 h after operation.

Conclusions

Preoperative use of flurbiprofen axetil will result in significantly lower postoperative pain scores, but no difference in nausea, vomiting, and opioid consumption compared to those who did not receive flurbiprofen axetil. However, more homogeneous and well-designed clinical studies are necessary to determine whether preoperative flurbiprofen axetil administration has more efficacy than that given at the end of surgery.

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Swallowing disorders and 1-year functional decline in community-dwelling older adults receiving home care

Abstract

The purpose of this study was to clarify the effect of swallowing disorders on functional decline in community-dwelling older adults receiving home care. This was a 1-year follow-up survey of 176 individuals ≥60 years living at home and receiving homecare services, without total dependence in basic daily living activities, in two mid-sized municipalities in Fukuoka, Japan. Functional decline was measured using the Barthel index (BI), and the primary outcome was total dependence in basic daily living activities (BI <20 points). Swallowing function was assessed using cervical auscultation, and the primary predictor was swallowing disorders. Logistic regression models were used to assess univariate and multivariate associations between baseline swallowing function and functional decline during follow-up. During follow-up 16 (9.1%) the participants became totally dependent in basic daily living activities. The participants with swallowing disorders had 6.41 times higher odds of total dependence in basic daily living activities compared to participants with normal swallowing function. After adjusting for potential confounders, swallowing disorders were significantly associated with higher odds of total dependence in basic daily living activities (odds ratio = 5.21, 95% confidence interval = 1.33–20.44). Regarding swallowing disorders, the corresponding population attributable fraction (%) of the incidence of total dependence in basic daily living activities was 50.4%. The current findings demonstrated that swallowing disorders were associated with greater risk of functional decline in basic daily living activities among older adults living at home and receiving home nursing care. Maintenance and improvement of swallowing function may prevent late-life functional decline.

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A 5-year longitudinal study of association of maximum bite force with development of frailty in community-dwelling older adults

Abstract

Objectives

To determine whether maximum bite force (MBF), an objective measure of oral function, is associated with development of frailty in community-dwelling older adults.

Methods

This prospective cohort study included community-dwelling Japanese adults aged 75 years at baseline (n = 322). Baseline MBF was measured using an electronic recording device (Occlusal Force-Meter GM10). Follow-up examinations, including physical fitness and anthropometric evaluation and structured questionnaires, were administered annually over a 5-year period to determine the incidence of frailty, which was defined by the presence of three or more of the following five components derived from the Cardiovascular Health Study: low level of mobility, low physical activity level, weakness, shrinking, and poor endurance and energy. Adjusted hazard ratios (HRs) of incidence of frailty according to sex-stratified tertiles of baseline MBF were calculated using Cox proportional hazards regression models.

Results

During the follow-up, 49 participants (15.2%) developed frailty. Participants in the lower tertile of MBF exhibited a significantly greater risk of frailty than those in the upper tertile. After adjustment for sex, depression, diabetes, and Eichner index, the adjusted HRs for frailty in the upper through lower tertiles of MBF were 1.00 (reference), 1.27 (95% confidence interval [CI], 0.50–3.20), and 2.78 (95% CI, 1.15–6.72), respectively (P for trend = 0.01).

Conclusions

Poor oral function, as indicated by low MBF, increases the risk of development of frailty among elderly men and women.

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Patient Satisfaction with Occlusal Scheme ofConventional Complete Dentures: A Randomized Clinical Trial (Part I)

Abstract

Bachground

Occlusal scheme can affect denture retention, stability, occlusal force distribution, esthetics, masticatory function, patient comfort, and general patient satisfaction with dentures.

Objectives

This study aimed to compare the patient satisfaction with three types of complete denture occlusion including fully bilateral balanced occlusion (FBBO), newly presented buccalized occlusion (BO), and lingualized occlusion (LO).

Methods

In this parallel randomized clinical trial, new conventional complete dentures (CCDs) were fabricated for 86volunteers. Participants were randomly allocated to three groups with three different occlusal schemes. All patients were recalled at one and thre emonths after delivery for data collection. The 19-item version of Oral Health Impact Profile for Edentulous Patients (OHIP-EDENT) questionnaire was used in this study.The visual analogue scale (VAS) was used for assessment of the prosthodontist's attitude towards denture quality, patient's attitude towards different occlusal schemes and evaluation of patient satisfaction. Data were analyzed using the Wilcoxon Signed Rank test, the Kruskal Wallis test and the post-hoc Dunn test via SPSS version 18.0 (P≤0.05).

Results

Eighty-sixpatients completed the study and their data were analyzed (mean age ± standard deviation=57.78 ± 9.98 years). The only significant difference when comparing the three groups was physical pain, which was significantly higher in FBBO group. No significant differences were found for the VAS scores of patient and prosthodontist satisfaction or the domain scores among the three occlusal schemes either at one or at three months post-delivery. The VAS score of patient satisfaction and prosthodontist satisfaction increased at three months compared to one month after delivery.

Conclusion

The results of this randomized clinical trial provided evidence that BO is as effective as LO for the fabrication of complete dentures.

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TMJ Online: Investigating Temporomandibular Disorders as “TMJ” on YouTube

Abstract

Aim

As the understanding of temporomandibular disorders' (TMDs) etiologies and treatments develops from non-evidence-based to evidence-based approaches, the availability of sound information will likewise grow and need to be disseminated. The purpose of this study is to describe the content most commonly viewed in YouTube videos related to TMDs or "TMJ" and see if videos from different sources have different content

Methods

Video information was gathered by searching YouTube for the term "TMJ" and data was recorded related to descriptive information as well as content. Statistical analyses included Kruskal-Wallis H Test, Spearman's Rho, and univariate logistic regression

Results

The sources of upload were Consumer (n=62), Professional (n=29), and News (n=9). There were almost no statistically significant differences in content distribution among video sources. Videos garnered a total of 4,749,360 views, with an overall median of 7,014.5 views. About two thirds of the videos (68/100) explained what "TMJ" is, with a surprising third of Professional videos (9/29) not covering the subject. Roughly half of the videos mentioned at least one reason "TMJ" occurs (55/100) and seven in ten mentioned some kind of treatment (70/100). Video names mentioned a cure or treatment in 64 cases, while the other 36 referred to TMJ anatomy or "TMJ" etiology

Conclusion and Significance

Future research should focus on ways to popularize professional videos with reliable information for those who are searching on YouTube for advice related to "TMJ."

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