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1.  Total knee arthroplasty: good agreement of clinical severity scores between patients and consultants 
Background
Nearly 20,000 patients per year in the UK receive total knee arthroplasty (TKA). One of the problems faced by the health services of many developed countries is the length of time patients spend waiting for elective treatment. We therefore report the results of a study in which the Salisbury Priority Scoring System (SPSS) was used by both the surgeon and their patients to ascertain whether there were differences between the surgeon generated and patient generated Salisbury Priority Scores.
Methods
The Salisbury Priority Scoring System (SPSS) was used to assign relative priority to patients with knee osteoarthritis as part of a randomised controlled trial comparing the standard medial parapatellar approach versus the sub-vastus approach in TKA. The operating surgeons and each patient completed the SPSS at the same pre-assessment clinic. The SPSS assesses four criteria, namely progression of disease, pain or distress, disability or dependence on others, and loss of usual occupation. Crosstabs and agreement measures (Cohen's kappa) were performed.
Results
Overall, the four SPSS criteria showed a kappa value of 0.526, 0.796, 0.813, and 0.820, respectively, showing moderate to very good agreement between the patient and the operating consultant. Male patients showed better agreement than female patients.
Conclusion
The Salisbury Priority Scoring System is a good means of assessing patients' needs in relation to elective surgery, with high agreement between the patient and the operating surgeon.
doi:10.1186/1471-2474-7-61
PMCID: PMC1552065  PMID: 16879741
2.  Evaluation of SOVAT: An OLAP-GIS decision support system for community health assessment data analysis 
Background
Data analysis in community health assessment (CHA) involves the collection, integration, and analysis of large numerical and spatial data sets in order to identify health priorities. Geographic Information Systems (GIS) enable for management and analysis using spatial data, but have limitations in performing analysis of numerical data because of its traditional database architecture.
On-Line Analytical Processing (OLAP) is a multidimensional datawarehouse designed to facilitate querying of large numerical data. Coupling the spatial capabilities of GIS with the numerical analysis of OLAP, might enhance CHA data analysis. OLAP-GIS systems have been developed by university researchers and corporations, yet their potential for CHA data analysis is not well understood. To evaluate the potential of an OLAP-GIS decision support system for CHA problem solving, we compared OLAP-GIS to the standard information technology (IT) currently used by many public health professionals.
Methods
SOVAT, an OLAP-GIS decision support system developed at the University of Pittsburgh, was compared against current IT for data analysis for CHA. For this study, current IT was considered the combined use of SPSS and GIS ("SPSS-GIS"). Graduate students, researchers, and faculty in the health sciences at the University of Pittsburgh were recruited. Each round consisted of: an instructional video of the system being evaluated, two practice tasks, five assessment tasks, and one post-study questionnaire. Objective and subjective measurement included: task completion time, success in answering the tasks, and system satisfaction.
Results
Thirteen individuals participated. Inferential statistics were analyzed using linear mixed model analysis. SOVAT was statistically significant (α = .01) from SPSS-GIS for satisfaction and time (p < .002). Descriptive results indicated that participants had greater success in answering the tasks when using SOVAT as compared to SPSS-GIS.
Conclusion
Using SOVAT, tasks were completed more efficiently, with a higher rate of success, and with greater satisfaction, than the combined use of SPSS and GIS. The results from this study indicate a potential for OLAP-GIS decision support systems as a valuable tool for CHA data analysis.
doi:10.1186/1472-6947-8-22
PMCID: PMC2438346  PMID: 18541037
3.  Prevalence of Hand Disorders in Type 2 Diabetes Mellitus and its Correlation with Microvascular Complications 
Background:
Physicians have long recognized the association between diabetes mellitus and several pathologic conditions of the hand. The most commonly recognized maladies are limited joint mobility (LJM), Dupuytren's disease (DD), trigger finger (TF), and carpal tunnel syndrome (CTS). Incidence of these hand disorders has increased in the setting of diabetes. Collectively, these are described as diabetic hand syndrome.
Aim:
The aims were to find out the prevalence of hand disorders in diabetic patients, and to study the relation of these hand disorders with microvascular complications.
Subjects and Methods:
This is an observational cross-sectional case-control study done over a period of 1 year Patients of type 2 DM, of age < 65 years, who visited Gandhi Memorial Hospital, Lucknow were enrolled and were described as cases. Age- and sex-matched nondiabetic individuals were taken in the control group. The data were analyzed using software SPSS. SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc. Means and standard deviations were computed; the Student t-test and Chi-square (χ2) test were used as appropriate.
Results:
A total of 400 subjects were studied, 200 each in the case and control groups. Of total 200 diabetic patients, 30% (60/200) patients had neuropathy, 37.5% (75/200) had nephropathy, and 44.5% (89/200) patients had retinopathy. In the study population, 67% patients were having one or more hand disorders, in which LJM was found in 40.5% (81/200) patients, DD was found in 19% (38/200) patients, TF in 16.5% (33/200), and CTS in 14% (28/200) patients.
Conclusions:
This study shows a high prevalence of hand disorders in diabetic patients and also correlates with the duration of type 2 DM, LJM being the most common hand disorder and more common in patients who have microvascular complications.
doi:10.4103/2141-9248.117942
PMCID: PMC3793438  PMID: 24116312
Carpal tunnel syndrome; Dupuytren's disease; Limited joint mobility; Trigger finger
4.  Effect of Progressive Muscle Relaxation in Female Health Care Professionals 
Background:
Increasing population, fast paced industrialization, increased, competitiveness, unanticipated problems in the work place have increased the stress among the females working in health care in recent times.
Aim:
The aim of the following study is to detect the stress levels among female health care professionals in the age group of 25-35 years and its impact on health.
Subjects and Methods:
A prospective cross-sectional pilot project was conducted in a tertiary care hospital in Eastern part of India, after receiving approval from the Institutional Ethics Committee and informed consent form was taken from the subjects. Stress level in the subjects was assessed according to the presumptive life event stress scale. Females with scores above 200 were selected. For these, initial assessment of anthropometric measurement, electrocardiogram and lipid profile analysis, resting pulse rate, blood pressure, physical fitness index (PFI), breath holding time (BHT), isometric hand grip (IHG) test results were evaluated and recorded. All subjects were given training of progressive muscle relaxation (PMR) for 3 months. After 3 months, the lipid profile and vital parameters, Perceived Stress Scale values were re-evaluated and subjects were asked to repeat the same exercises and data thus recorded were analyzed using Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc. Released 2007. SPSS for Windows, Version 16.0. Chicago, SPSS Inc.).
Results:
Significant decrease in resting heart rate, blood pressure and Perceived Stress Scale levels was seen after PMR training in the subjects. Results of BHT, IHG tests and PFI were significantly increased after PMR training. There was a significant decrease in total cholesterol, triglyceride and low-density lipoprotein cholesterol in subjects after practicing PMR for 3 months.
Conclusions:
Increasing stress among female health care professionals is a cause for concern and there is a need to adopt early life-style modification by practicing relaxation exercises to ameliorate stress and to improve not only their quality-of-life in general, but patient care in particular.
doi:10.4103/2141-9248.141573
PMCID: PMC4199176  PMID: 25328795
Female stress; relaxation techniques; health care professionals
5.  Suprascapular nerve block for the treatment of frozen shoulder 
Saudi Journal of Anaesthesia  2012;6(1):52-55.
Aims:
The aim of our study was to compare the effects of suprascapular nerve block in patients with frozen shoulder and diabetes mellitus unresponsive to intraarticular steroid injections.
Settings and Design:
Ten patients without improvement of sign and symptoms after intraarticular injections were made a suprascapular nerve block.
Methods:
Pain levels and active range of movement of patients were recorded at initial attendance and after 1, 4, and 12 weeks. All patients’ simple pain scores, total pain scores, and range of motion of their shoulders were improved significantly after suprascapular nerve block.
Statistical Analysis:
In this study, the statistical analyses were performed by using the SPSS 8.0 program (SPSS Software, SPSS Inc., USA). To compare pre- and post-injection results of simple pain score, total pain score, shoulder abduction and external rotation, Wilcoxon test was used.
Results:
Patient's simple pain scores, total pain scores also abduction, external rotation and internal rotation angles were improved significantly after suprascapular nerve block.
Conclusion:
Effective results after suprascapular nerve blockage was obtained for the treatment of refractory frozen shoulder cases.
doi:10.4103/1658-354X.93061
PMCID: PMC3299117  PMID: 22412778
Frozen shoulder; nerve block; suprascapular nerve
6.  KMWin – A Convenient Tool for Graphical Presentation of Results from Kaplan-Meier Survival Time Analysis 
PLoS ONE  2012;7(6):e38960.
Background
Analysis of clinical studies often necessitates multiple graphical representations of the results. Many professional software packages are available for this purpose. Most packages are either only commercially available or hard to use especially if one aims to generate or customize a huge number of similar graphical outputs. We developed a new, freely available software tool called KMWin (Kaplan-Meier for Windows) facilitating Kaplan-Meier survival time analysis. KMWin is based on the statistical software environment R and provides an easy to use graphical interface. Survival time data can be supplied as SPSS (sav), SAS export (xpt) or text file (dat), which is also a common export format of other applications such as Excel. Figures can directly be exported in any graphical file format supported by R.
Results
On the basis of a working example, we demonstrate how to use KMWin and present its main functions. We show how to control the interface, customize the graphical output, and analyse survival time data. A number of comparisons are performed between KMWin and SPSS regarding graphical output, statistical output, data management and development. Although the general functionality of SPSS is larger, KMWin comprises a number of features useful for survival time analysis in clinical trials and other applications. These are for example number of cases and number of cases under risk within the figure or provision of a queue system for repetitive analyses of updated data sets. Moreover, major adjustments of graphical settings can be performed easily on a single window.
Conclusions
We conclude that our tool is well suited and convenient for repetitive analyses of survival time data. It can be used by non-statisticians and provides often used functions as well as functions which are not supplied by standard software packages. The software is routinely applied in several clinical study groups.
doi:10.1371/journal.pone.0038960
PMCID: PMC3376120  PMID: 22723912
7.  Predicting Factors of Breakthrough Infection in Children with Primary Vesicoureteral Reflux 
Yonsei Medical Journal  2012;53(4):748-752.
Purpose
Many pediatric urologists still favor using prophylactic antibiotics to treat children with vesicoureteral reflux (VUR). However, breakthrough infection sometimes occurs, leading to significant increases in morbidity as a result of renal scarring. Therefore, we tested whether abnormal renal scan and other factors are predictive of breakthrough infection using univariate analyses.
Materials and Methods
We retrospectively reviewed the medical records of 163 consecutive children who were diagnosed with vesicoureteral reflux between November 1997 and June 2010. Clinical parameters for the statistical analysis included form of presentation, gender, age, VUR grade, laterality, presence of intrarenal reflux, class of antibiotic drug, and presence of abnormal renal scan by Dimercapto-succinic acid. Clinical parameters used for prognostic factors were established by univariate analyses. Fisher's exact test and unpaired t-test were done using SPSS software [SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA)].
Results
Breakthrough infection developed in 61 children (48.0%). A total of 58 children (45.7%) had abnormal renal scans. Time to development of breakthrough infection was significantly longer in girls (9.0±8.2 months) than in boys (5.8±4.8 months, p<0.05). On univariate analysis, though statistically not significant, the most predictive factor of breakthrough infection was abnormal renal scan (p=0.062). In patients with abnormal renal scans, breakthrough infection was not associated with mode of presentation, gender, grade or prophylactic antibiotics. However, there was a significant difference between patients younger than 1 year and those 1 year old or older. Mean±SD age at diagnosis of VUR in patients with breakthrough infection (1.14±3.14) was significantly younger than in those without breakthrough infection (5.05±3.31, p=0.009). There was also a significant difference between patients with bilateral or unilateral reflux (p=0.028).
Conclusion
Our data showed that abnormal renal scan was the most predictive factor of breakthrough infection and demonstrated statistical significance in patients under the age of 1 year. Parents and physicians should remain aware that these patients are at high risk of breakthrough urinary tract infection, which may potentially lead to renal damage.
doi:10.3349/ymj.2012.53.4.748
PMCID: PMC3381488  PMID: 22665341
Vesico-ureteral reflux; radioisotope scanning; urinary tract infections; antibiotic prophylaxis
8.  The relationship between binocular vision symptoms and near point of convergence 
Indian Journal of Ophthalmology  2013;61(7):325-328.
Aim and Background:
Due to the relatively high prevalence of binocular vision anomalies, a regular examination including tests for assessment and determination of these anomalies is necessary. The aim of this study was to assess the relationship between near point of convergence (NPC) and near binocular vision symptoms and finding of an NPC cutoff point for symptoms in university students.
Materials and Methods:
In this cross-sectional study, 124 students of different majors of Zahedan University of Medical Sciences were randomly selected. If they met the inclusion criteria, they were divided into two groups (symptomatic and asymptomatic) according to the convergence insufficiency symptom survey questionnaire. For NPC measurement, a small isolated letter E of approximately 20/30 size on a metal rod was used. After data collection, data were analyzed in SPSS.17 software (SPSS for Windows, SPSS Inc., Chicago, IL) using descriptive and analytical statistics, including Mann–Whitney U test and receiver operating characteristic (ROC) curve.
Results:
The mean NPC findings in the symptomatic and asymptomatic groups were 11.7 ± 5.0 and 8.4 ± 3.4 cm, respectively, with a significant difference between the two groups (P < 0.001). The ROC curve suggests an NPC cutoff point of 9.5 cm for the presence of symptoms with the testing procedures used in this study.
Conclusion:
The determination of NPC is helpful in the differentiation of symptomatic from asymptomatic subjects.
doi:10.4103/0301-4738.97553
PMCID: PMC3759101  PMID: 23552348
Binocular vision; near point of convergence; visual symptoms
9.  Medicaid Policies and Practices in US State Prison Systems 
American journal of public health  2014;104(3):418-420.
Medicaid is an important source of health care coverage for prison-involved populations. From 2011 to 2012, we surveyed state prison system (SPS) policies affecting Medicaid enrollment during incarceration and upon release; 42 of 50 SPSs participated.
Upon incarceration, Medicaid benefits were suspended in 9 (21.4%) SPSs and terminated in 28 (66.7%); 27 (64.3%) SPSs screened prisoners for potential Medicaid eligibility.
Although many states supported Medicaid enrollment upon release, several did not. We have considered implications for Medicaid expansion.
doi:10.2105/AJPH.2013.301563
PMCID: PMC3953759  PMID: 24432881
10.  Estimation of Dental and Facial Proportions Using Height as Criteria 
Background:
Ideal dental restoration is one which not only restores optimal functions but also confirm to standard dental and facial relations. This is important to achieve long term patient satisfaction both with regard to esthetics as well as functions. Objective was to find a credible relationship between dental and facial proportions using height of individuals as the criteria in a specific group of population. To determine a regression equation for determination of various dental and facial proportions using height.
Materials and Methods:
One hundred and forty-four (n = 144) students, of which 91 were males (n = 91) and 53 were females (n = 53) of the dental college participated in this study. Height of the individual, the lower facial height, inter-incisal and inter-canine and inter-commissural width was measured as per protocol and resulting data was analyzed using SPSS 17 (SPSS Statistics for Windows, Version 17.0. Chicago SPSS Inc. Released 2008) version software regression equations were obtained.
Results:
The study included 144 college students significant correlations were found between height of the individuals, inter-canine distance and lower facial height using Pearson correlation coefficient. The calculated values of t-test were significant. Regression equations were determined for determination of various parameters using height as the sole criteria.
Conclusion:
There exists a definite relationship between height of the individual and their dental and facial parameters in this group of population and values of maxillary anterior teeth can be determined using regression equations.
PMCID: PMC4148568  PMID: 25214728
Height; inter-canine distance; maxillary anterior teeth
11.  Self-Confidence in Women with and without Polycystic Ovary Syndrome 
Objective: To compare self-confidence in woman with and without PCOS according to their ages.
Materials and methods: This comparative study was conducted on 400 women (100 with and 300 without PCOS) in clinics of Shahid Akbar-Abadi and Firouzgar Hospitals, from July 2012 to February 2013. SPSS-16 used for statistical analysis (SPSS; SPSS Inc., Chicago, IL, USA).
Results: This study showed 98% of PCOS and 93% in non-PCOS groups had average self-confidence with scores of 15-25. None of women in PCOS group and 6.7% of non-PCOS group had high self-confidence (score>25). There was a significant difference between two groups in term of self-confidence level (p< 0.001). There was no significant difference in self-confidence between age group ≤ 30 and age group> 30 in both group, but in PCOS group, self-confidence were significantly higher in both age group under 30 (p<0.0001) and 30 and higher (p<0.0001).
Conclusion: Impaired self-confidence in PCOS groups (under 30 and 30 and higher age groups) in comparison with related value of non-PCOS group shows that mental health status in women with PCOS requires urgent psychological attention and support.
PMCID: PMC4275552  PMID: 25628720
Polycystic Ovary Syndrome; PCOS; Self-Confidence; Self-Reliance
12.  Treatment and prognosis of pyogenic liver abscess 
Background
There are many combinations of treatments for pyogenic liver abscess (PLA). Different treatments are indicated for different clinical courses of PLA.
Aims
To realize the current prevalence, clinical course, trend of treatment, and prognosis of pyogenic liver abscess (PLA) in Taiwan.
Methods
We retrospectively reviewed the medical records of 126 patients with PLA. We divided them into four groups: M, MD, MS, and MDS, represented as parenteral antibiotic only, parenteral antibiotic with drainage, parenteral antibiotic with surgical intervention, and parenteral antibiotic with surgical drainage. We analyzed data by commercial statistical software (SPSS for Windows, version 11.0, SPSS Ltd., Chicago, IL). We used Student’s t-test and χ2 test for statistical analyses, and significance was set at a p value less than 0.05.
Results
PLA patients who were treated only with parenteral antibiotics had early diagnosis of PLA with a mean fever period of 3.3 days (p = 0.043). Patients who needed surgical drainage were highly associated with shock presentation in the clinical course (35.7% versus 14.3%, p = 0.007).
Conclusion
The earlier we can diagnose PLA, the shorter the patient's hospital stay (20.6 days) will be. In PLA patients with shock, a higher rate of surgical intervention is mandatory to save their lives.
doi:10.1007/s12245-010-0232-6
PMCID: PMC3047832  PMID: 21373309
Pyogenic liver abscess; Fever; Abdominal pain; Shock; Drainage
13.  Primary Vesico-Ureteral Reflux: Comparison of Factors between Infants and Children 
Korean Journal of Urology  2011;52(3):206-209.
Purpose
The association of age, sex and renal parenchymal damage (RPD) in vesicoureteral reflux (VUR) is well known. We compared various factors between infants and children in a cohort of patients with primary VUR.
Materials and Methods
Medical records of 147 patients diagnosed as VUR between 1997 and 2010 were reviewed. Of these children 91 (61.9%) were boys and 56 (38.1%) were girls. 99 (67.3%) of the 147 patients were younger (Group 1), and 48 (32.7%) were older than 1 year (Group 2). The impact of patient's gender and age as well as VUR grade on RPD were analyzed in each patient. The Fisher's exact test and chi square test was done with SPSS ver. 12.0 (SPSS Inc., Chicago, IL, USA).
Results
VUR was unilateral in 88 patients (59.9%) and bilateral in 59 patients (40.1%). Abnormal renal scan was found in 78 (37.7%) renal units. The incidence of VUR was significantly higher in male in group 1 (p<0.01) and in female in group 2 (p<0.01). The incidence of abnormal renal scan was significantly higher in intermediate and high grade VUR comparing low grade VUR in group 1 (p=0.042). In both group, abnormal renal scan didn't show any difference between male and female statistically (p>0.05).
Conclusions
Our data showed that VUR in infant was significantly higher in male than in female, whereas VUR in children was significantly higher in female. This may be due to that characteristic of a population where neonatal circumcision is not a common procedure in infant and urinary tract infections are more common in female children. Further study may be needed to identify gender difference in RPD in infant with high grade reflux.
doi:10.4111/kju.2011.52.3.206
PMCID: PMC3065134  PMID: 21461286
Age groups; Radioisotope scanning; Urinary tract infections; Vesico-ureteral reflux
14.  Treatment, Services and Follow-up for Victims of Family Violence in Health Clinics in Maputo, Mozambique 
Background:
Family violence (FV) is a global health problem that not only impacts the victim, but the family unit, local community and society at large.
Objective:
To quantitatively and qualitatively evaluate the treatment and follow up provided to victims of violence amongst immediate and extended family units who presented to three health centers in Mozambique for care following violence.
Methods:
We conducted a verbally-administered survey to self-disclosed victims of FV who presented to one of three health units, each at a different level of service, in Mozambique for treatment of their injuries. Data were entered into SPSS (SPSS, version 13.0) and analyzed for frequencies. Qualitative short answer data were transcribed during the interview, coded and analyzed prior to translation by the principal investigator.
Results:
One thousand two hundred and six assault victims presented for care during the eight-week study period, of which 216 disclosed the relationship of the assailant, including 92 who were victims of FV. Almost all patients (90%) waited less than one hour to be seen, with most patients (67%) waiting less than 30 minutes. Most patients did not require laboratory or radiographic diagnostics at the primary (70%) and secondary (93%) health facilities, while 44% of patients received a radiograph at the tertiary care center. Among all three hospitals, only 10% were transferred to a higher level of care, 14% were not given any form of follow up or referral information, while 13% required a specialist evaluation. No victims were referred for psychological follow-up or support. Qualitative data revealed that some patients did not disclose violence as the etiology, because they believed the physician was unable to address or treat the violence-related issues and/or had limited time to discuss.
Conclusion:
Healthcare services for treating the physical injuries of victims of FV were timely and rarely required advanced levels of medical care, but there were no psychological services or follow-up referrals for violence victims. The healthcare environment at all three surveyed health centers in Mozambique does not encourage disclosure or self-report of FV. Policies and strategies need to be implemented to encourage patient disclosure of FV and provide more health system-initiated victim resources.
PMCID: PMC3117612  PMID: 21731793
15.  Uterine leiomyoma and its association with menstrual pattern and history of depo-medroxyprogesterone acetate injections 
Background and aim:
Despite the high prevalence of uterine leiomyoma, according to recent review studies there is uncertainty and a paucity of information regarding its predisposing or protective factors. The aim of this study was to assess the possible association between menstrual cycle pattern and occurrence of surgically treated myomas and also to check if depo-medroxyprogesterone acetate (DMPA) injection earlier in reproductive life can affect the later occurrence of myomas needing surgical treatment.
Methods:
In a case–control study in Ardabil, 85 women with definite diagnosis of surgically treated uterine leiomyoma and 154 community controls were enrolled. Possible predictors of myoma including menstrual cycle and menstrual bleeding patterns were assessed. Data were analyzed using SPSS software (SPSS, IBM, Somers, NY). Odds ratios were used as the main statistic in assessing the strength of observed associations.
Results:
Mean age of the participants was 41.8 ± 8.5 years. Length of menstrual cycle was associated with myoma and a higher likelihood of myoma was observed among those having shorter menstrual cycles (P < 0.05). Number of menstrual bleeding days was also associated with surgically treated myoma and longer bleeding periods increased the likelihood of myoma (P < 0.05). Only one of the eight women who had a history of depo-medroxyprogesterone acetate injections had developed surgically treated uterine leiomyoma and the others belonged to the control group without a history of surgical treatment for uterine leiomyoma.
Conclusion:
Menstrual cycle pattern is associated with developing leiomyomas requiring surgical treatment. DMPA, other than its role in myoma treatment, is also assumed to have a role in preventing myomas, but due to the small sample size in this study, larger scale prospective trials are needed in the future.
doi:10.2147/IJGM.S23337
PMCID: PMC3150177  PMID: 21845062
myoma; uterine leiomyoma; DMPA; medroxyprogesterone; menstrual cycle; menstrual; depo-provera
16.  Antibiotics prescribing practices in oral implantology among jordanian dentists. A cross sectional, observational study 
BMC Research Notes  2011;4:266.
Background
In oral implantology, there is no consensus on the most appropriate regimen for antibiotics prescribing, the decision to prescribe antibiotic is usually based on procedure, patient and clinician related factors. The aim of this study was to investigate the rationale of antibiotic prescribing among Jordanian clinicians who practice oral implantology.
Findings
The target sample for the study was the 250 Jordan Dental Implant Group members. A five page questionnaire contained 41 questions, both closed and open questions were used to collect data. Statistical analysis was performed using SPSS Windows 16.0 (SPSS Inc., Chicago, IL, USA). Descriptive statistics were generated.
The response rate was (70.4%) 176/250. Mean age was 37.2 yrs, 49.4% always prescribe antibiotics mainly oral amoxicillin and amoxicillin with clavulinic acid. Antibiotics prescribing increased with flap raising, multiple implants and sinus or bone augmentation. Patient medical condition, periodontitis and oral hygiene were the most important clinical factors in antibiotic prescribing, non-clinical factors were; reading scientific materials, courses and lectures, knowledge gained during training, and the effectiveness and previous experience with the drug.
Conclusions
Wide variations in antibiotics types, routes, dose and duration of administration were found. Recommendations on antibiotic prescribing are needed to prevent antibiotic overprescribing and misuse.
doi:10.1186/1756-0500-4-266
PMCID: PMC3160395  PMID: 21798040
Antibiotics; Dental Implants; Cross Sectional Study
17.  Characteristic of victims of family violence seeking care at health centers in Maputo, Mozambique 
Background:
Family violence (FV) is a common, yet often invisible, cause of violence. To date, most literature on risk factors for family, interpersonal and sexual violence is from high-income countries and might not apply to Mozambique.
Aims:
To determine the individual risk factors for FV in a cohort of patients seeking care for injuries at three health centers in Maputo, Mozambique.
Setting and Design:
A prospective multi-center study of patients presenting to the emergency department for injuries from violence inflicted by a direct family member in Maputo, Mozambique, was carried out.
Materials and Methods:
Patients who agreed to participate and signed the informed consent were verbally administered a pilot-tested blank-item questionnaire to ascertain demographic information, perpetrator of the violence, historical information regarding prior abuse, and information on who accompanied the victim and where they received their initial evaluation. De-identified data were entered into SPSS 13.0 (SPSS, version 13.0) and analyzed for frequencies.
Results:
During the 8-week study period, 1206 assault victims presented for care, of whom 216 disclosed the relationship of the assailant, including 92 being victims of FV (42.6%). The majority of FV victims were women (63.0%) of age group 15-34 years (76.1%) and were less educated (84%) compared to national averages. Of the patients who reported assault on a single occasion, most were single (58.8%), while patients with multiple assaults were mostly married (63.2%). Most commonly, the spouse was the aggressor (50%) and a relative accompanied the victim seeking care (54.3%). Women most commonly sought police intervention prior to care (63.2%) in comparison to men (35.3%).
Conclusion:
In Mozambique, FV affects all ages, sexes and cultures, but victims seeking care for FV were more commonly women who were less educated and poorer.
doi:10.4103/0974-2700.83866
PMCID: PMC3162707  PMID: 21887028
Emergency care; family violence; injuries; Mozambique
18.  High Frequency of A2143G Mutation in Clarithromycin-Resistant Helicobacter pylori Isolates Recovered from Dyspeptic Patients in Iran 
Background/Aim:
Resistance to clarithromycin in H. pylori isolates is accepted as a main cause of treatment failure in developing countries. We aimed to determine the prevalence of clarithromycin-resistant strains isolated from dyspeptic patients in northern Iran, furthermore we aimed to assess the relationship between clinical outcomes of infection with point mutations.
Materials and Methods:
A total of 147 consecutive patients infected with H. pylori were included for determining the status of resistant H. pylori strains. With upper gastroscopy, three antral biopsies were taken from each patient, first section for rapid urea test, second for pathology and third section was used for bacterial culture in microbiologic lab. The antimicrobial susceptibility tests in this examination were agar dilution, in accordance with clinical and laboratory standards institue guidelines. Restriction fragment length polymorphism-PCR (RFLP-PCR) method was applied to determine the frequency of point mutations in 23s rRNA gene. Statistical analysis was performed using SPSS software (15.0) (SPSS, Inc., Chicago, Ill). Chi-square and Fisher's exact tests were applied to our analysis. A P value less than 5% was considered as statistically significant.
Results:
Our results showed that there was no point mutation in clarithromycin-susceptible strains of H. pylori.
Conclusion:
The important findings in our study indicate that A2143G is the most prevalent point mutation (30/32: 93.7%) attributed in clarithromycin resistance among the H. pylori strains. The current study concluded that clarithromycin could still be involved in the empirical treatment of H. pylori infection, although a high frequency of A2143G mutation may increase the concerns regarding treatment failure.
doi:10.4103/1319-3767.87181
PMCID: PMC3221114  PMID: 22064338
Clarithromycin; Helicobacter pylori; Iran
19.  Microhardness of dual-polymerized resin cement around a translucent fiber post in the intraradicular environment 
Aim:
In this study, we evaluated the effect of photopolymerization on Vickers microhardness of dual-polymerized resin cement at three locations when a translucent quartz fiber post was used.
Materials and Methods:
Single-rooted bovine teeth received quartz fiber post systems (length: 12 mm) using a dual-polymerized resin cement. In Group 1, the posts were cemented but not photopolymerized, and in Group 2, the posts were both cemented and photopolymerized. After cementation, approximately 1.5-mm thick sections were obtained (two cervical, two middle, and two apical) for regional microhardness evaluations.
Statistical Analysis:
Statistical analyses were performed using the SPSS software (ver. 11.0 for Windows; SPSS, Inc., Chicago, IL, USA). Microhardness (kg/mm2) data were submitted to two-way analysis of variance (two-way ANOVA) and repeated measures with microhardness values as the dependent variable and polymerization status (two levels: with and without) and root region (three levels: cervical, middle, and apical) as independent variables. Multiple comparisons were made using Dunnett's T3 post-hoc test. P values of <0.05 were considered to indicate statistical significance in all tests.
Results:
Photopolymerization did not significantly change the microhardness values when compared with no photopolymerization. Microhardness values also showed no significant difference between the three regions in the root canals in both groups.
Conclusions:
The mode of polymerization of the cement tested in combination with the translucent quartz fiber post system did not affect the microhardness of the cement at the cervical, middle, or apical regions of the root.
doi:10.4103/0972-0707.87200
PMCID: PMC3227283  PMID: 22144805
Fiber posts; microhardness; photopolymerization; resin cement
20.  HIV voluntary counseling and testing practices among military personnel and civilian residents in a military cantonment in southeastern Nigeria 
HIV/AIDS (Auckland, N.Z.)  2011;3:107-116.
Background
Voluntary counseling and testing (VCT) services are expected to lower rates of HIV transmission through a reduction in high-risk sexual behavior and through improved access to medical treatment, care, and support. However, increasing access to and uptake of VCT, especially among groups at high risk for HIV infection, has remained a major challenge in Africa.
Purpose
The study was undertaken to determine the uptake of VCT (measured by whether study participants had ever received an HIV test) and the factors influencing this practice among military and civilian residents of a military cantonment in Abakaliki, southeastern Nigeria.
Methods
A cross-sectional descriptive survey of all cantonment residents aged between 20 and 64 years was conducted. A multistage sampling technique was used to establish the sample size; data were collected from 350 military and civilian cantonment residents using a pretested questionnaire. Data were analyzed using SPSS software (v 16.0; SPSS Inc, Chicago, IL) and the significance of any association was tested at P < 0.05 using the chi-square statistic.
Results
One hundred and forty-five (41.4%) respondents reported having ever been tested for HIV; however, only 44 (12.6%) respondents had received the test between 4 and 12 months prior to the survey period. Some of the significant factors that positively influenced uptake of VCT were awareness of VCT (P < 0.001), education level (P < 0.006), and knowledge of antiretroviral therapy benefits (P < 0.01).
Conclusion
The uptake of VCT by the residents of the cantonment was low. The establishment of VCT services in the cantonment is urgently recommended, together with the targeting of high-risk population groups in HIV/AIDS and VCT information dissemination efforts.
doi:10.2147/HIV.S23774
PMCID: PMC3234128  PMID: 22163173
VCT uptake; HIV test; most-at-risk population (MARP); people living with HIV/AIDS (PLWHAs)
21.  Neuroendocrine Liver Metastases and Orthotopic Liver Transplantation: The US Experience 
Liver transplantation remains a controversial therapy for Neuroendocrine liver metastases (NLM), with coflicting suvival data reported. The aim was to assess the evolution of outcomes for patients transplanted for NLM in the US, both before and after the introduction of the MELD scoring system in 2002. The UNOS/OPTN database was reviewed to identify patients diagnosed with NLM who subsequently underwent a liver transplantation from 1988 to March 2011 (n = 184); Patient survival was determined using Kaplan-Meier methods and log-rank tests, and cox regression analysis was performed, using SPSS 15.0 (SPSS, Inc, Chicago, IL). The overall NLM patient survivals in the pre-MELD era were 79.5%, 61.4%, and 49.2% at 1, 3, and 5 years, respectively. After the introduction of the MELD score, NET/NLM patients had improved overall patient survivals at 1, 3, and 5 years of 84.7%, 65%, and 57.8%. Patients transplanted after 2002 had an improved survival outcome. Notably, the overall patient survival for NET is not significantly different when compared to the outcomes of patients transplanted for HCC, in the current era. This progress acknowleges the significant improvement in outcomes for NLM patients after liver transplantation and the potential for further gain in the survival of otherwise nonsurgical, terminal patients.
doi:10.4061/2011/742890
PMCID: PMC3255281  PMID: 22254141
22.  Transvaginal ultrasonography: a survey of the acceptability and its predictors among a native African women population 
Objective
To determine the acceptability of transvaginal ultrasonography (TVU) and associated factors among Nigerian women.
Method
A cross-sectional survey was conducted among 3137 women who presented for transabdominal ultrasound scan between August and November 2010 in two referral hospitals in Nigeria. Data were obtained using a questionnaire. Descriptive and multivariate analysis was performed applying logistic regression analysis; predictors of willingness of participants regarding transvaginal ultrasound were identified using SPSS Statistics (SPSS Inc, Chicago, IL) version 17 software.
Results
The mean age of the women was 33.8 years (standard deviation = 7.9), with 88.8% currently married. About 84% were willing to have TVU, while 54.2% were indifferent about the gender of the sonologist. About 17.3% believed that the procedure is painful. Significant predictors of willingness to have TVU were previous sexual experience and douching, prior painful vaginal examination, and vaginal surgery.
Conclusion
The majority of Nigerian women expressed a willingness to have the TVU procedure without necessarily opting for any gender preference of the operator. Women should be adequately counseled on the operations of the procedure so as to be able to psychologically prepare for them.
doi:10.2147/IJWH.S23533
PMCID: PMC3271809  PMID: 22312194
transvaginal ultrasound; willingness; Nigeria; Africa
23.  The association between cortisol dynamics and the course of aneurysmal subarachnoid hemorrhage 
Asian Journal of Neurosurgery  2011;6(2):83-87.
Context:
One of aneurysmal subarachnoid hemorrhage complication is delayed ischemic neurological deficits (DIND). It is postulated that cortisol dynamics might be associated with the severity of this complication.
Aims:
The goal of the study is to investigate whether the peak of morning serum cortisol levels are associated with the severity of its complication during the course of the disease.
Settings and Design:
This is a prospective cohort study conducted from January 2009 to June 2011, at our institution.
Materials and Methods:
The study follows a consecutive cohort of patients for 14 days after the aneurysmal subarachnoid hemorrhage. Serum cortisols, cortisol binding globulin, adenocorticotrophic hormone (ACTH) were measured pre operatively and then on post operative days (POD) 2, 4, 7, and 10. Blood was drawn to coincide with peak cortisol levels between 08.00-09.00 hours. Neurological examinations were conducted at least twice daily and patient outcome were graded according to modified Ranklin Scale. DIND was defined by a decrease in the Glasgow Coma Scale of two or more points compared to the status on POD 1.
Statistical Analysis:
All the results were analyzed using statistical software, Statistical Package for Social Sciences (SPSS v61; SPSS, Inc., Chicago, IL). Logistic regression analysis was used to compare the relationship between the variables.
Results:
Thirty six consecutive patients are collected, but only 28 patients (12 M and 16 F) were eligible for the cohort analysis. Average patient age is 50.75 years old (50.75±12.27), and more than 50% (15/28) arrived with World Federation of Neurologic Surgeons grade 3 or better. Elevated total cortisol levels of more than 24 mg/dl on day 2, 4, and 10 were associated with DIND, and the most significant being on day 4 (P=0.011). These patients also had a higher grade on the modified Ranklin scale of disability.
Conclusions:
This study shows that the elevated levels of morning total cortisol in the serum are associated with the onset of DIND during the disease course, and it's also associated with bad outcomes.
doi:10.4103/1793-5482.92166
PMCID: PMC3277075  PMID: 22347329
Aneurismal subarachnoid hemorrhage; clipping; cortisol; delayed ischemic neurological deficits; outcome
24.  Recurrent spine surgery patients in hospital administrative database 
GMS German Medical Science  2012;10:Doc03.
Introduction: Hospital patient databases are typically used by administrative staff to estimate loss-profit ratios and to help with the allocation of hospital resources. These databases can also be very useful in following rehospitalization. This paper studies the recurrence of spine surgery patients in our hospital population based on administrative data analysis.
Methods: Hospital data on 4,958 spine surgery patients operated between 2002 and 2009 were retrospectively reviewed. After sorting the cohort per ascending discharge date, the patient official name, consisting of first, middle and last names, was used as the variable determining duplicate cases in the SPSS statistical program, designating the first case in each group as primary. Yearly recurrence rate and change in procedure distribution were studied. In addition, hospital charges and length of stay were compared using the Wilcoxon-Mann-Whitney test.
Results: Of 4,958 spine surgery patients 364 (7.3%) were categorized as duplicate cases by SPSS. The number of primary cases from which duplicate cases emerged was 327 meaning that some patients had more than two spine surgeries.
Among primary patients (N=327) the percentage of excision of intervertebral disk procedures was 33.3% and decreased to 15.1% in recurrent admissions of the same patients (N=364). This decrease was compensated by an increase in lumbar fusion procedures. On the other hand, the rate of cervical fusion remained the same.
The difference in hospital charges between primary and duplicate patients was $2,234 for diskectomy, $6,319 for anterior cervical fusion, $8,942 for lumbar fusion – lateral technique, and $12,525 for lumbar fusion – posterior technique. Recurrent patients also stayed longer in hospital, up to 0.9 day in lumbar fusion – posterior technique patients.
Conclusion: Spine surgery is associated with an increasing possibility of additional spine surgery with rising invasiveness and cost.
doi:10.3205/000154
PMCID: PMC3278978  PMID: 22355279
recurrent spine surgery; hospital charges; cost; length of stay
25.  An evaluation of the accuracy of the ORange® (Gen II) by comparing it to the IOLMaster® in the prediction of postoperative refraction 
Purpose
The aim of this study was to evaluate the accuracy of ORange® Gen II (WaveTec Vision, Aliso Viejo, CA).
Setting
The Surgical Suites, Honolulu, HI.
Methods
The prospective 28 consecutive cataract surgical cases were selected from 85 cataract surgical cases between December 16, 2010 and February 24, 2011. With the same intraocular lens implantation, the predicted spherical equivalent refraction from IOLMaster® (Carl Zeiss AG, Oberkochen, Germany) and ORange Gen II were statistically compared and verified with 1-month postoperative manifest refraction. The data were put into IBM SPSS 19 (SPSS Inc, Chicago, IL) for analysis of variance. Pearson’s correlation coefficient was also calculated to evaluate the correlation between the IOLMaster, ORange Gen II, and 1-month postoperative manifest refraction.
Results
There were no statistically significant differences in the mean spherical equivalent refraction from the IOLMaster, ORange Gen II, and 1-month postoperative manifest refraction (IOLMaster −0.40 diopters, P = 0.07; ORange Gen II −0.43 diopters, P = 0.16; 1-month refraction −0.41 diopters, P = 0.07). Pearson’s correlation study demonstrated that all three were positively correlated (P < 0.05), with the strongest correlation between the ORange Gen II and 1-month postoperative manifest refraction (r = +0.6, P < 0.01).
Conclusion
The ORange Gen II can be considered as an alternative method for intraocular lens selection for cataract patients.
doi:10.2147/OPTH.S30153
PMCID: PMC3307668  PMID: 22457590
cataract surgery; phacoemulsification; IOL implantation; IOLMaster®; ORange® Gen II; postoperative refraction

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