Parental role in decision-making for pediatric surgery: Perceptions of involvement in consultations for tonsillectomy

ObjectiveParental role in decision-making has implications for quality of care. We describe roles of parent participation in decision-making for tonsillectomy.MethodsParents reported preferred role in decision-making before consultations for tonsillectomy and the role they experienced after their consult. Parents completed questionnaires, including items evaluating clinician/parent communication. Clinicians rated perception of parents’ preferred role in decision-making. Congruence between parent and clinician responses was evaluated via kappa analysis. Logistic regression identified associations between decision-making roles and socioemotional and communication factors.ResultsConsults between 63 parents and 8 otolaryngologists were analyzed.There was inadequate agreement between clinician and parent ratings of preferred roles (37%, p = 0.6, 95% CI [-0.09, 0.001]). Parents perceived greater involvement when clinicians discussed reasons to have (OR = 4.3, p = 0.03) or not have (OR = 4.1, p = 0.005) surgery. Parents perceived less involvement when clinicians used jargon (OR = 0.1, p = 0.03), and when parents trusted clinicians (OR = 0.4, p = 0.049), or experienced greater decisional conflict (OR = 0.9, p = 0.03).ConclusionsParents and clinicians perceived parental preference for decision-making involvement differently during consultations for tonsillectomy. Clinician information-sharing, jargon use, and parent trust in clinician predicted extent of perceived engagement.Practice implicationsFindings may enhance understanding of strategies to effectively communicate and engage parents in shared decision-making for pediatric surgical care.     

Do patients’ beliefs about type 2 diabetes differ in accordance with complications: An investigation into diabetic foot ulceration and retinopathy

Background: Previous research has examined patients’ beliefs in diabetes and how these beliefs may affect patient outcomes. However, changes in symptoms and complications are a common feature of diabetes, and these can significantly alter the patient’s “disease experience.” However, no consideration has been given to how beliefs about diabetes vary according to the complications patients have. Purpose: The present study was designed to compare the beliefs of 22 patients with diabetic foot ulcers and 22 age- and gender-matched patients with diabetic retinopathy, and 22 age- and gender-matched controls with type 2 diabetes but without either complication. Methods: Beliefs about diabetes were assessed with the Revised Illness Perception Questionnaire (IPQ-R; Moss-Morris et al., 2002). Results: Patients with foot ulcers held a greater belief in personal control of diabetes, but perceived treatment control was lower than that of diabetic controls without serious complications (p < .05). Patients with foot ulcers also demonstrated less illness coherence than patients with retinopathy and diabetic controls (p < .01) and also perceived their diabetes to be more cyclical in nature (p < .01). Conclusion. Differences were found in diabetic patients’ beliefs according to their complications. Future interventions should consider how the complications associated with diabetes may affect patients’ beliefs and subsequent emotional and behavioral responses to the disease.     

How does anger coping style affect glycemic control in diabetes patients?

Background: Although various forms of anger have been found to influence the psychological and physical health in many chronic illness populations, little is known about the effects of anger in diabetes patients. Purpose: Associations between anger coping style, diabetes-related psychological distress, and glycosylated hemoglobin (HbA1c) were examined in 100 diabetes patients. Method: Participants completed the Problem Areas in Diabetes and Coping Styles questionnaires, and had HbA1c assessments at study entry (Time 1 = T1), six months (T2), and 12 months after T1 (T3). Results: Linear regression analyses revealed T1 anger coping associated with T3 HbA1c (β = .22, p < .05), but T1 HbA1c did not associate with T3 anger coping (β = .13, p = NS). After controlling for significant covariates (of gender, age, education, type and duration of diabetes), regression analyses revealed that T2 diabetes-related psychological distress partially mediated this association. Conclusion: These results suggested that higher levels of anger coping may promote poorer glycemic control in diabetes patients by provoking greater diabetes-related distress. Areas of future research on this topic are discussed. This research was supported by the National Science Foundation (National Science Foundation Graduate Research Fellowship Grant), the National Institute of Mental Health (R01 MH57663), and the Harvard Medical School Priscilla White Fellowship, National Institute of Diabetes and Digestive and Kidney Diseases (R01 NIDDK24315, R01 NIDDK60115). The authors gratefully acknowledge the reviewers’ thoughtful suggestions and comments, as well as Stephanie Horton, Scarlett Mai, Alexandra Toner, and Brent Tatsuno for their assistance.     

A follow-up study of postpartum depressed women: recurrent maternal depressive symptoms and child behavior after four years

Summary Objective: To investigate the prevalence of depressive symptoms and self reported health of women who have shown previous postpartum depressive symptoms. To examine the behavior of four-year-old children born to mothers affected by postpartum depression. Methods: Longitudinal study. The index group (n = 251) constituted of all women with postpartum depressive symptoms on the Edinburgh Postnatal Depression Scale (EPDS), in a population-based study made in the late 1990s. The control group (n = 502) consisted of women without postpartum depressive symptoms on the EPDS at the same occasion. Approximately four years after delivery these women were asked to answer a short questionnaire on general health, the EPDS, and also to assess their child’s behavior with the Richman Pre-School Behaviour Checklist. Results: Women with a history of postpartum depressive symptoms were approximately 6 times more likely to have recurrent depressive symptoms (OR = 5.82, 95% CI: 3.79–8.93), compared to those without postpartum depressive symptoms, and they were also more likely to experience physical and mental illness. Although postpartum depressive symptoms in the mothers were involved in explaining the likelihood of behavioral problems in their four-year-old children, mothers with current depressive symptoms were the most likely to have a child with behavioral problems (OR = 4.71, 95% CI: 1.88–11.78). Conclusion: Postpartum depressive illness constitutes a risk for future illness as well as maternal perceived behavioral problems in offspring. In order to diminish long-term adverse consequences for the mother and the child there is a great need to recognize and treat women with postpartum depressive symptoms as early as possible.     

Characterizing patient-oncologist communication in genomic tumor testing: The 21-gene recurrence score as an exemplar

ObjectiveWomen with early-stage, ER + breast cancer are recommend to receive genomic profiling tests, such as the 21-gene Recurrence Score (RS) test, to guide treatment decisions. We examined test- and treatment-related information discussed and the associations between RS categories and aspects of communication during patient-oncologist clinical encounters.MethodsAs part of a larger trial, clinical encounters (N = 46) were audiorecorded and coded for 1) RS- and treatment-related information, 2) shared decision making, 3) patient active participation, and 4) oncologist patient-centered communication. We examined differences by RS category using mixed models, adjusting for nesting within oncologist.ResultsPatients with a high RS were more likely to receive a chemotherapy recommendation (p < .01), hear about the risks/side effects of chemotherapy (p < .01), and offer their preferences (p = .02) than those with intermediate or low RS. Elements of shared decision making increased with RS. Oncologist patient-centered communication (M = 4.09/5, SD = .25) and patient active participation (M = 3.5/4, SD = 1.0) were high across RS.ConclusionFindings suggest that disease severity, rather than clinical uncertainty, impact treatment recommendations and shared decision making.Practice implicationsOncologists adjust test- and treatment-related information and shared decision making by disease severity. This information provides a framework to inform decision making in complex cancer and genomics settings.     

Determinants for the Development of Oropharyngeal Colonization or Infection by Fluconazole-Resistant Candida Strains in HIV-Infected Patients

 A point prevalence study to document oral yeast carriage was undertaken. Risk factors for the development of oropharyngeal colonization or infection by fluconazole-resistant Candida strains in HIV-infected patients were investigated with a case-control design. Cases included all patients with fluconazole-resistant strains (MIC≥64 μg/ml), and controls were those with susceptible (MIC≤8 μg/ml) or susceptible-dependent-upon-dose (MIC 16–32 μg/ml) strains. One hundred sixty-eight Candida strains were isolated from 153 (88%) patients, 28 (16%) of whom had oropharyngeal candidiasis. Overall, 19 (12%) of the patients harbored at least one resistant organism (MIC≥64 μg/ml). Among patients with resistant strains, tuberculosis (P<0.001), esophageal candidiasis (P=0.001), clinical thrush (P<0.001), and a CD4+ cell count <200/mm³ (P=0.03) were more frequent. These patients had also been treated more commonly with antituberculous drugs (adjusted odds ratio [OR] 6.13; 95% confidence interval [CI] 2.11–17.80), ciprofloxacin (OR 6.0; 95% CI 1.23–29.26), fluconazole (OR 4.59; 95% CI 1.55–13.52), and steroids (OR 4.13; 95% CI 1.11–15.39). Multivariate analysis showed that the determinants for fluconazole resistance were therapy with antituberculous drugs (OR 3.61; 95% CI 1.08–12.07;P=0.03) and one of the following: previous tuberculosis (OR 3.53; 95% CI 1.08–14.57;P=0.03) or fluconazole exposure (OR 3.41; 95% CI 1.10–10.54). Findings from this study indicate that treatment with antituberculous drugs, previous tuberculosis, and fluconazole exposure are the strongest determinants for development of oropharyngeal colonization or infection by fluconazole-resistant Candida strains in HIV-infected patients.     

Analysis of Risk Factors for Ventilator-Associated Pneumonia in a Multidisciplinary Intensive Care Unit

 A prospective study was conducted to determine the incidence, risk factors and pathogens of ventilator-associated pneumonia (VAP) in 198 patients requiring mechanical ventilation for more than 48 hours. VAP occurred in 67 (33.8%) patients. Risk factors associated with VAP were admission APACHE II score >20 (odds ratio [OR] 4.77, 95% confidence interval [CI] 2.04–11.27, P<0.001), mechanical ventilation >10 days (OR 44.4, 95% CI 2.16–26.7, P<0.0001), ICU length of stay >10 days (OR 9.4, 95% CI 3.55–25.65, P<0.0001), and admission PaO₂/FiO₂ ratio <200 mmHg (OR 3.4, 95% CI 1.00–11.41, P<0.05). Logistic regression analysis showed a relationship between VAP and length of stay in ICU, duration of fever and presence of catheter-related infection. The pathogens isolated were predominantly gram-negative bacteria (83.2%), with a high proportion of Acinetobacter spp. (35%) resistant to commonly used antimicrobial agents. The mortality rate was not influenced by VAP.     

Proinflammatory cytokine polymorphisms and the risk of preterm birth and low birthweight in a Japanese population

Pregnancy and parturition involve a complex and poorly understoodmolecular and biological interplay between mother and fetus.Inflammatory cytokines have been reported to be associated withfetal growth and parturition. The aim of this study was to examinewhether common proinflammatory cytokine polymorphisms are associatedwith preterm birth (PTB), low birthweight or intrauterine growthrestriction in a Japanese population. We assessed a consecutiveseries of 414 women who had singleton deliveries in Sapporo,Japan between 2001 and 2005. Genotyping of IL1A –889C/T,+4845G/T (A114S), IL1B –511C/T, –31C/T, IL2 –384T/Gand IL6 –634C/G polymorphisms was determined by an allelicdiscrimination assay. The risk of PTB significantly increasedin women carrying the IL1A –889T allele (CC genotype [reference];CT genotype, odds ratios (OR): 2.5; 95% confidence intervals(95% CI): 1.4–4.8; CT+TT genotypes [dominant genotypemodel], OR: 2.5, 95% CI: 1.3–4.6). Similarly, the riskof PTB significantly increased in women carrying the IL1A +4845Tallele (GG genotype [reference]; GT genotype, OR: 2.4, 95% CI:1.3–4.4; GT+TT genotypes [dominant genotype model], OR:2.3, 95% CI: 1.2–4.2). The frequency of the IL1A TT haplotypein mothers with PTB was significantly higher than in motherswho had a term birth (P < 0.001), whereas the frequency ofthe IL1A CG haplotype in mothers who had a PTB was significantlylower (P < 0.001). Our findings suggest that the polymorphismsand haplotypes in the IL1A gene are associated with PTB in Japanesewomen.     

Risk factors for bacteremia in patients with limb cellulitis

The aim of this study was to identify the risk factors for bacteremia in patients with limb cellulitis. Using the administrative and microbiology laboratory databases of a community teaching hospital, a review was conducted of all cases of community-acquired limb cellulitis that occurred during the period 1997–2004 and in which blood cultures had been performed. A comparison of demographical, clinical, and analytical data of patients with bacteremia versus patients without bacteremia was performed by univariate and multivariate analyses. Of 2,678 patients with cellulitis who presented to the hospital’s emergency department, 308 were diagnosed with limb cellulitis and had blood cultures. Of these, 57 (18.5%) had bacteremia. In 24 of the 57 (42.1%) patients with bacteremia, the microorganism isolated in blood cultures was non-group-A β-hemolytic Streptococcus, and in another 14 (24.6%), the microorganism identified was a gram-negative bacterium. Staphylococcus aureus was determined as the cause of bacteremia in just 6 (10.5%) patients and group A Streptococcus in 2 (3.5%). By logistic regression analysis, the following factors were associated with bacteremia: absence of previous antibiotic treatment (OR 5.3, 95% CI 1.4–20.3), presence of two or more comorbid factors simultaneously (OR 4.3, 95% CI 1.6–11.7), length of illness <2 days OR 2.44, 95% CI 1.07–5.56), and proximal limb involvement (OR 6, 95% CI 3.03–12.04). Patients with limb cellulitis who exhibit any of these characteristics are at increased risk of bacteremia. In such patients, it is imperative that blood cultures be performed.     

The impact of the number of tests presented and a provider recommendation on decisions about genetic testing for cancer risk

ObjectiveTo determine how the method of presenting testing options and a provider recommendation can influence a decision about genetic testing for inherited cancer predispositions.MethodsAn online hypothetical vignette study was completed by 454 healthy volunteers. Participants were randomized to receive one of two survey versions which differed by genetic testing choice presentation. One group was shown three options simultaneously (no test, 5-gene or 15-gene), and a second group received the 15-gene option after choosing between the no test and 5-gene options. A preference-based provider recommendation was also incorporated. We examined the effect of these interventions on test selection.ResultsParticipants in the simultaneous group were more likely to choose a genetic test than those in the sequential group (OR: 2.35, p=0.003). This effect was no longer observed when individuals who had selected no-test in the sequential group were told about the 15-gene test (OR: 1.03 p=0.932). Incorporating a provider recommendation into the hypothetical scenario led to more preference-consistent choices (χ² = 8.53, p < 0.0035,).ConclusionsA larger menu of testing choices led to higher testing uptake. A preference-based clinician recommendation resulted in more preference-consistent choices.Practice ImplicationsThe structuring of testing options and preference-sensitive recommendations appear to facilitate informed testing decisions.     

Treatment recommendations to parents during pediatric tonsillectomy consultations: A mixed methods analysis of surgeon language

ObjectiveA deeper understanding of the dialogue clinicians use to relay treatment recommendations is needed to fully understand their influence on patient decisions about surgery. We characterize how otolaryngologists provide treatment recommendations and suggest a classification framework.MethodsWe qualitatively analyzed surgeon recommendations from 55 encounters between otolaryngologists and parents of children evaluated for tonsillectomy, and classified recommendation types by phrasing. Multilevel logistic regression identified predictors of recommendation phrasing.ResultsClinicians provided 183 recommendations (mean/visit = 3.3). We identified four domains of recommendation-phrasing (direct, passive, acceptable, parent-oriented). Direct recommendations (n = 68, 37%) included presumptive statements phrasing intentions as inevitable. Passive recommendations (n = 65, 36%) included practice-based recommendations utilizing general statements. Acceptable recommendations (n = 29, 16%) included speaking positively about treatment options. Parent-oriented recommendations (n = 21, 11%) included parent choice statements. Clinicians more commonly made direct recommendations to parents who were racial minorities (OR = 2.7, p = .02, 95% CI [1.7, 5.9]) or had an annual income <$50,000 (OR = 2.2, p = .03, 95% CI [1.1, 4.4]).ConclusionClinicians provide treatment recommendations in a variety of ways that may introduce more or less certainty and choice to parental treatment decisions.Practice implicationsFindings may be implemented into training which increases clinician awareness of dialogue use when recommending treatment alternatives to patients.     

Association of CAV1 polymorphisms with the risks of breast cancer: A systematic review and meta-analysis

BackgroundCaveolin-1 (CAV1) polymorphisms have been shown to correlated with breast cancer risk in previous studies. However, the role of CAV1 polymorphisms still remained indecisive, and dual functions of CAV1 was demonstrated in breast cancer development. Consequently, a meta-analysis to evaluate and summarize the association of the CAV1 polymorphisms with breast cancer susceptibility.Material and methodsExtensive search was performed in PubMed, Web of Science, Google scholar, EMBASE.com, CNKI and Wanfang searching platform up to March 2019. The Newcastle–Ottawa Scale (NOS) were used to evaluate the quality of each study. The Odds ratios (ORs) and the 95% confidence intervals (CIs) were analyzed to evaluate the strength of the associations in five genetic models. Inter-study heterogeneity was quantified using the I-squared (I²) test. In addition, the Egger’s test and Begg’s test were applied to evaluate the publication bias.Results4 case-control studies with 2115 cases and 2138 controls were enrolled into this analysis. There was a significant association between rs3807987 polymorphism of CAV1 and breast cancer in allele comparison (A vs. G: OR = 1.288, 95％CI = 1.162–1.428, P < 0.001), heterozygote comparison (AG vs. GG: OR= 1.422, 95％CI=1.233–1.639, P < 0.001), and dominant comparison (AA+AG vs. GG: OR=1.395, 95％CI=1.228-1.586, P < 0.001). A significant association of rs3807987 polymorphism in allele comparison (A vs. G: OR=1.238, 95％CI=1.109–1.383, P < 0.001), heterozygote comparison (AG VS. GG: OR=1.466, 95％CI=1.267–1.697, P < 0.05), and dominant comparison (AA+AG vs. GG: OR=1.384, 95％CI=1.209–1.585, P < 0.001) was also founded amongst Chinese population. A significant association between rs7804372 polymorphism and breast cancer amongst Chinese population in recessive comparison (AA vs. AT + TT: OR = 0.730, 95％CI = 0.567–0.940, P = 0.015) was identified. No significant association between breast cancer risk and rs1997623 was found.ConclusionCAV1 rs3807987 and rs7804372 polymorphisms are associated with the change of breast cancer risk. More well-designed and large studies in various populations are needed to further elaborate these associations.     

Impact of multi-drug-resistant <Emphasis Type="Italic">Acinetobacter baumannii</Emphasis> on clinical outcomes

We conducted a retrospective matched cohort study to examine the impact of isolation of multi-drug-resistant (MDR) Acinetobacter baumannii on patient outcomes. Cases from whom MDR A. baumannii was isolated in a clinical culture (n = 118) were compared with controls from whom MDR A. baumannii was not isolated (n = 118). Cases and controls were matched according to ward, calendar month of hospitalization, and duration of hospitalization before culture. The following outcomes were compared in multivariable analysis: in-hospital mortality, length of stay, need for mechanical ventilation, and functional status at discharge. MDR A. baumannii was determined to be a pathogen in 72% of cases. In 36% of cases, the patient died, versus 21% of controls (odds ratio [OR] 2.21, 95% confidence interval [CI] 1.17–4.16, P = 0.014). Median length of stay for surviving cases was 17 days, versus 11 for surviving controls (multiplicative effect 1.55, 95% CI 0.99–2.44, P = 0.057). Fifty-two percent of cases required mechanical ventilation, versus 25% of controls (OR 3.72, 95% CI 1.91–7.25, P<0.001); 60% of surviving cases were discharged with reduced functional status, versus 38% of controls (OR 4.4, 95% CI 1.66–11.61, P = 0.003). In multivariable analysis, clinical isolation of MDR A. baumannii remained a significant predictor of mortality (OR 6.23, 95% CI 1.31–29.5, P = 0.021), need for mechanical ventilation (OR 7.34, 95% CI 2.24–24.0, P<0.001), and reduced functional status on discharge (OR 7.93, 95% CI 1.1–56.85, P = 0.039). Thus, MDR A. baumannii acquisition is associated with severe adverse outcomes, including increased mortality, need for mechanical ventilation, and reduced functional status.     

MSI status is associated with distinct clinicopathological features in BRAF mutation colorectal cancer: A systematic review and meta-analysis

BackgroundMicrosatellite stable (MSS) BRAF p.V600E mutation colorectal cancer (BRAF-CRC) has a poor prognosis, whereas microsatellite instability (MSI) in BRAF-CRC is associated with a favorable prognosis. Although usually considered a single clinical entity, the MSI BRAF-CRC subtype shows some distinct characteristics in comparison with the MSS BRAF-CRC subtype.MethodsWe conducted a meta-analysis to investigate the influence of clinicopathological features on MSI status in BRAF-CRC. We searched publications up to March 2019 from PubMed, Embase, and the Cochrane Library. The effect of MSI status on outcome parameters was assessed using odds ratios (ORs) with 95% confidence intervals (CIs) and fixed- or random-effects models according to the heterogeneity.ResultsAfter reviewing 2839 reports, 16 eligible studies including 1381 patients with BRAF-CRC met the criteria. The MSI BRAF-CRC subtype was associated with older age, female sex (OR = 1.70; 95% CI = 1.35–2.14; P < 0.00001), proximal tumor location (OR = 5.10; 95% CI = 3.70–7.03; P < 0.00001), early TNM stage (OR = 5.28; 95% CI = 3.93–7.09; P < 0.00001), and poor differentiation (OR = 2.29; 95% CI = 1.60–3.28; P < 0.00001).ConclusionsMSI was significantly correlated with distinct favorable clinicopathological characteristics in BRAF-CRC. These results suggest that MSI status should be considered as a stratification factor for better management of the BRAF-CRC.     

A gender comparison of psychological distress among medical students in Nigeria during the Coronavirus pandemic: a cross-sectional survey

BackgroundThe Coronavirus disease (COVID-19) pandemic as a large scale stressor could have negative effects on the mental health of medical students. Since gender differences in mental health may exist, it is important to see if a large scale stressor like the pandemic may be associated with variances in the psychological distress between both genders.ObjectivesTo assess and compare the psychological distress of male and female medical students during the COVID-19 pandemic.MethodsA cross-sectional survey was carried out among 1010 medical students from three universities in southwestern Nigeria within the first six months of the first reported case of the COVID-19 pandemic. The respondents were purposively selected. Data was obtained online on participants'' demographic and psychological distress using the General Health Questionnaire 12 (GHQ-12). Data was analyzed using the SPSS version 21, student t and chi-square tests were used to assess gender differences, and multivariate regression to assess the predictors of psychological distress among both genders. p values less than 0.05were considered statistically significant.ResultsOverall, female participants (OR=1.455, 95% CI= 1.095–1.936) were twice more likely to have experienced psychological distress than males during the COVID-19 pandemic. Age (OR=0.922, 95% CI= 0.867–0.979), being in pre-clinical years (OR= 1.394, 95% CI= 1.004–1.938), having a family income less than 100,000 naira (OR= 1.379, 95% CI=1.442–6.723) a previous history of mental illness (OR=3.077, 95% CI= 1.430–6.615) and having a relative/acquaintance diagnosed with COVID 19(OR=1.646, 95% CI= 1.062–2.551) were independently associated with psychological distress among the respondents. When comparing both genders, among females, age (OR=0.886, 95% CI= 0.803–0.978), family income less than 100,000 naira (OR=1.898, 95% CI= 1.306–2.759) and a previous history of mental illness (OR=5.266, 95% CI= 1.894–14.635) were associated with psychological distress, while, being in pre-clinical years (OR= 1.713, 95% CI= 1.052–2.790) was associated with psychological distress among males.ConclusionFemales had more psychological distress compared to male students. It is recommended that gender-specific interventions addressing psychological distress among medical students are instituted.     

Identifying candidates for arthroscopic primary repair of the anterior cruciate ligament: A case-control study

IntroductionThere has been a recent resurgence of interest in arthroscopic primary repair of proximal anterior cruciate ligament (ACL) tears. Patient selection is critical but not much is currently known on what predicts the possibility of repair. Goal of this study was therefore to assess predictive factors for the possibility of arthroscopic primary ACL repair.MethodsIn this retrospective case–control study, all patients undergoing ACL surgery in a ten-year interval were included. Patients were treated with primary repair if there was a proximal tear and good tissue quality, or otherwise underwent ACL reconstruction. Collected data were age, gender, BMI, injury-to-surgery delay, injury mechanism and concomitant injuries. Receiver operating characteristic curves were used to find cutoff values, and all significant dependent variables were used in multivariate logistic analysis to assess independent predictors for the possibility of primary repair.ResultsThree hundred sixty-one patients were included, of which in 158 patients (44%) primary repair was possible. Multivariate analysis (R² = 0.340, p < 0.001) showed that age > 35 years (Odds ratio [OR] 4.2, 95% CI 2.4–7.5,p < 0.001), surgery within 28 days (OR 3.3, 95% CI 1.9–5.7, p < 0.001), and BMI < 26 (OR 1.9, 95% CI 1.1–3.3,p = 0.029) were predictive for the possibility of primary repair, and lateral meniscus injury presence decreased the likelihood of repair (OR 0.5, 95% CI 0.3–0.8, p = 0.008).ConclusionIn this large cohort study, it was noted that 44% of patients had repairable ACL tears. Primary repair was more likely to be possible in older patients, patients with lower BMI and when surgery was performed within four weeks of injury.     

Premenstrual dysphoric disorder amongst Nigerian university students: prevalence, comorbid conditions, and correlates

Summary Aims: The rate of premenstrual dysphoric disorder (PMDD) amongst sub-Saharan Africans is unknown. This study aimed to estimate the rate of PMDD amongst Nigerian undergraduates and to evaluate psychosocial correlates and comorbid psychiatric conditions. Method: Female university students (n = 410) completed questionnaires detailing sociodemographic, menstruation, and gynaecological history. They also completed the Big Five Personality Inventory (BFI), and the presence of PMDD and any other DSM-IV axis 1 psychiatric diagnosis was assessed with the Mini International Neuropsychiatric Interview (MINI). Results: The prevalence of PMDD was 6.1% and the correlates included older age (p = 0.001), painful menstruation (p = 0.006), and high score on neuroticism scale (p = 0.019). Compared with participants without PMDD, participants with PMDD have significantly higher rates for the following psychiatric diagnoses: dysthymia (odds ratio [OR], 3.82; 95% confidence interval [CI], 1.68–8.69), major depressive disorder (OR, 17.00; 95% CI, 6.72–43.00), panic disorder (OR, 4.39; 95% CI, 1.35–14.30), and generalised anxiety disorder (OR, 1.21; 95% CI, 1.21–17.83). Conclusion: The rate of PMDD in sub-Saharan African women was comparable to that in the western cultures. Planning and implementing an effective strategy to manage perimenstrual problems in this region should be an issue of priority. Correspondence: A. O. Adewuya, Department of Psychiatry, Lagos State University College of Medicine, PMB 21266, Ikeja, Lagos State, Nigeria     

Preferences in trust regarding the provision of cancer information among adults

Background: Disparities associated with trust in health information exist warranting a need for research assessing this relationship among adults. Therefore, the aim of this study was to assess trust of cancer information among U.S. adults.Methods: A weighted sample of 237,670,167 adults from the Health Information National Trends Survey (HINTS) from 2011-2014 was used for the analyses. Dependent variables were dichotomized answers to whether individuals trusted information from family/friends, the internet, or a doctor. Independent variables included age, sex, region, race/ethnicity, and cancer diagnosis to investigate associations between demographic factors and differences in trust. Logistic regression was run using R survey package.Results: There were statistically significant differences in trust based on race/ethnicity, age, and cancer diagnosis. Minorities were less likely to trust information from a doctor, with Hispanics more likely to trust information from the internet (OR=1.8 (95% CI 1.36,2.43)), and Non-Hispanic Blacks trusting information from family and friends (OR=1.5 (95% CI 1.06, 2.13)). Adults ≥45 years of age were less likely to trust the doctor ‘a lot’ (45-64 years: OR=0.6 (95% CI 0.50, 0.83); 65+ years (OR=0.7 (95% CI 0.54, 0.92)), but more likely to not trust information from family and friends or the internet. Patients with cancer were more likely to trust information from a doctor ‘a lot’ (78%; p=0.01).DiscussionSignificant differences in preferences regarding trust in cancer information occurred based on sociodemographic characteristics.Conclusion: These finding suggest targeting specific population subgroups for information from sources they trust could be helpful in reducing disparities in trust.     

On the way to universal coverage of maternal services in Iringa rural District in Tanzania. Who is yet to be reached?

BackgroundStrategies to tackle maternal mortality in sub-Saharan Africa include expanding coverage of reproductive services. Even where high, more vulnerable women may not access services. No data is available on high coverage determinants. We investigated this in Tanzania in a predicted high utilization area.MethodsData was collected through a household survey of 464 women with a recent delivery. Primary outcomes were facility delivery and ≥4 ANC visits. Determinants were analysed using multivariate regression.ResultsAlmost all women had attended ANC, though only 58.3% had ≥4 visits. ≥4 visits were more likely in the youngest age group (OR 2.7 95% CI 1.32–5.49, p=0.008), and in early ANC attenders (OR 3.2 95% CI 2.04–4.90, p<0.001). Facility delivery was greater than expected (87.7%), more likely in more educated women (OR 2.7 95% CI 1.50–4.75, p=0.002), in those within 5 kilometers of a facility (OR 3.2 95% CI 1.59–6.48, p=0.002), and for early ANC attenders (OR 2.4 95% CI 1.20–4.91, p=0.02).ConclusionRural contexts can achieve high facility delivery coverage. Based on our findings, strategies to reach women yet unserved should include promotion of early ANC start particularly for the less educated, and improvement of distant communities'' access to facilities.     

Anxiety disorders among Nigerian women in late pregnancy: a controlled study

Summary This study aimed to investigate the rate and type of anxiety disorders among Nigerian women in late pregnancy. Women in late pregnancy (n = 172) and a non-pregnant control group were assessed for DSM-IV anxiety disorders. The rate of any anxiety disorder in the pregnant women was 39.0% compared with 16.3% in the non-pregnant population (p < 0.001). Although all the anxiety disorders were more common, only the rate of social anxiety disorder was significantly higher among the pregnant than non-pregnant population. Correlates of anxiety disorder in the pregnant population include age less than 25 years (OR 4.62, 95% CI 2.39–8.92), primiparity (OR 3.90, 95% CI 2.00–7.59) and presence of medical conditions (OR 3.60, 95% CI 1.28–10.12). More research is needed in this field to ascertain the specific association between pregnancy and anxiety disorders.