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Fitzgerald Ahmed posted an update 6 days ago
mmunicable diseases.OBJECTIVE Hypoplastic left heart syndrome is a single ventricle defect. While staged surgical palliative treatments have revolutionised care, patients with hypoplastic left heart syndrome continue to have significant morbidity and mortality. In 2017, the National Pediatric Cardiology Quality Improvement Collaborative recommended all single ventricle patients to receive a prenatal palliative care consult. This study aimed to elucidate provider perspectives on the implementation of prenatal palliative care consults for families expecting a child with hypoplastic left heart syndrome. METHODS An online survey was administered to obstetric and paediatric providers of relevant disciplines to assess their experience with palliative care involvement in hypoplastic left heart syndrome cases. RESULTS Nearly, all physicians (97%) and most registered nurses (79%) agreed that the initial palliative care consult for patients with hypoplastic left heart syndrome should occur during the prenatal period. Respondents also indicated that prenatal palliative care consults should also be offered in a variety of other CHD conditions. Participants believed positive aspects of this new referral protocol included an expanded support network for families, decreased family stress during the postnatal period, increased patient education about what to expect during the postnatal period, and continuity of care. CONCLUSION Multidisciplinary healthcare professionals believe that prenatal palliative care consults provide a variety of benefits for patients and families with hypoplastic left heart syndrome. Additional, multi-centre research is necessary to evaluate whether prenatal palliative care consults should become standard of care for families expecting a child with a single ventricle defect.This paper assesses the reasons for non-use of contraceptive methods, and the possible complexity of reported data on women in India. The study used recent data from two successive rounds of the National Family Health Survey (NFHS) (2005-06 N=37,296; 2015-16 N=247,024), which surveyed currently married women aged 15-49 years. The reporting on non-use of contraceptives and the changing pattern of the reasons for non-use were analysed, classified into fertility and other cited reasons. The self-reported reasons for non-use of contraception were verified with other related information captured in the survey. Bivariate and logistic regression analyses were conducted. Sexual abstinence (not having sex 10%; infrequent sex 3%) and infecundity (menopausal/hysterectomy 12%; subfecund/infecund 10%) were the most commonly reported reasons for non-use of contraceptive methods in 2015-16, followed by refusal to use (10%). The proportion of non-users who wanted to have a child soon (25% to 21%), were pregnant (16% to 13%), in postpartum amenorrhoea (68% to 40%) and who had method-related reasons (10% to 6%) declined over time (from 2005-06 to 2015-16, respectively). A higher proportion of less-educated women reported abstinence (6%) and menopause/hysterectomy (19%) than educated women. Abstinence was more commonly reported in states with low prevalence of modern contraceptive use. The findings suggest that the increasing trend of abstinence and infecundity among non-users of contraception may be a concern for future research and reproductive health programmes, as it questions both the quality of data and sexual health of married couples.OBJECTIVES This prospective, epidemiological British Ophthalmological Surveillance Unit study into ophthalmic complications of functional endoscopic sinus surgery aimed to determine the minimum incidence, presenting features and management throughout the UK. METHODS Cases of ophthalmic complications of functional endoscopic sinus surgery, between February 2016 and February 2018, were identified through the British Ophthalmological Surveillance Unit reporting card system. Reporting ophthalmic consultants were sent an initial questionnaire, followed by a second questionnaire at six months. RESULTS Twenty-six cases of ophthalmic complications of functional endoscopic sinus surgery were reported. The majority (16 cases (62 per cent)) had limitations of ocular motility at presentation. TGF-beta inhibitor The most common final diagnosis was rectus muscle (33 per cent) and nasolacrimal duct trauma (27 per cent). Using national data, this study reports a minimum incidence of ophthalmic complications of functional endoscopic sinus surgery in the UK of 0.2 per cent over two years. CONCLUSION In terms of ophthalmic complications, functional endoscopic sinus surgery is shown to be safe. Ophthalmic complications are rare, but when they do occur, they commonly result in rectus muscle trauma, often requiring surgical intervention.BACKGROUND Loneliness is a growing public health issue in the developed world. Among older adults, loneliness is a particular challenge, as the older segment of the population is growing and loneliness is comorbid with many mental as well as physical health issues. Comorbidity and common cause factors make identifying the antecedents of loneliness difficult, however, contemporary machine learning techniques are positioned to tackle this problem. METHODS This study analyzed four cohorts of older individuals, split into two age groups – 45-69 and 70-79 – to examine which common psychological and sociodemographic are associated with loneliness at different ages. Gradient boosted modeling, a machine learning technique, and regression models were used to identify and replicate associations with loneliness. RESULTS In all cohorts, higher emotional stability was associated with lower loneliness. In the older group, social circumstances such as living alone were also associated with higher loneliness. In the younger group, extraversion’s association with lower loneliness was the only other confirmed relationship. CONCLUSIONS Different individual and social factors might underlie loneliness differences in distinct age groups. Machine learning methods have the potential to unveil novel associations between psychological and social variables, particularly interactions, and mental health outcomes.