Sensory Modulation Disorder (SMD) reduces a child’s ability to respond to sensory stimuli in the environment in a manner that corresponds to the nature or intensity of the stimulus; this disorder therefore significantly can impact participation in developmentally appropriate play and functional activities. More studies are needed to enhance research in the field of SMD and aid the general community in understanding the disorder and its causes. The purpose of this study was to characterize the prevalence of SMD among Puerto Rican preschoolers and examine the relationship between specific risk factors (socioeconomic status, pre-natal alcohol exposure, low birth weight, preterm delivery, and lead exposure) and SMD in this population. The sample consisted of 141 caregivers of preschool children; 78 were from Head Start programs and 63 were from private preschools. The Short Sensory Profile was used to determine the presence of SMD. A Demographic and Risk Factors Data Sheet was used to obtain information about the risk factors, except for lead exposure, which was measured using results of blood lead levels tests available in the records of Head Start preschoolers. Prevalence of SMD among the total sample, calculated through descriptive statistics, was 19.9%, which is higher than previously reported estimates of studies with children on the US mainland. According to an Analysis of Variance test, no differences were found in the prevalence of SMD based on parents’ education and/or household income. Diverse multivariate analyses, including structural equation modeling, were used to determine the relevance of risk factors used to explain variance in SMD scores. Due to limitations of the data collected, it was not possible to provide a definite conclusion about the most relevant risk factors identified in this study. In general, when compared to the other risk factors included, findings point to household income and low birth weight as relevant variables to explain scores on the SSP for the total sample. For the Head Start sample, lead exposure and low birth weight, followed by household income, achieved the better relative relevance to explain scores in the SSP (when compared to the other risk factors considered). However, due to the low effect sizes and low percentage of shared variance found among the variables, findings from this study do not support strong associations between risk factors and SMD as suggested in previous literature. More research is required to further understand SMD and the complex interaction among potential risk factors that might be associated with its prevalence.

Few studies have investigated cracks involving the pulp chamber walls or floor. The purpose of this study was to create a classification system for intrapulpal cracks and analyze associated clinical characteristics. Retrospective analysis included 52 teeth confirmed to have an intrapulpal crack. The classification system describes the crack based upon its location within the pulpal walls and floor. Documentation consisted of demographic, subjective and objective examination data. Chi-squared analysis tested associations with the intrapulpal crack classifications. Ninety-two percent of intrapulpal cracks run M-D, 75% involve one pulp chamber wall, and 84% terminate at the floor-wall junction or extend into an orifice without involving the pulpal floor. There was a statistically significant (P<0.05) relationship between the location of the intrapulpal crack and tooth type as well as between the classification system and bite test and transillumination. The classification system was adaptable to clinical practice and provides insight into these challenging situations.

Decreased sound tolerance (DST) conditions, including misophonia and hyperacusis, are emerging clinical conditions in behavioral medicine. Misophonia involves an extreme emotional response (often anger, disgust, or annoyance) to specific sounds (such as people chewing, swallowing, tapping their foot on the floor, etc.), while hyperacusis is defined by high sensitivity to sounds below normal sound sensitivity thresholds. Although research on these DST conditions is increasing, clearly defined prevalence rates, associations with other mental health conditions, and development of assessment tools that can identify and differentiate DST symptoms are needed. Research and clinical reports also suggest that DST problems are more likely to occur in individuals affected by tinnitus, and that drawing upon a bio-psychosocial conceptualization of tinnitus and other behavioral medicine conditions may be useful in understanding and treating DST conditions. This cross-sectional survey study was administered to college student (N=451) and community adult (N=375) samples and investigated DST prevalence rates, clinical correlates, and risk factors and mechanisms of action for misophonia and hyperacusis. In addition, the study developed and validated a new scale to identify misophonia and hyperacusis type sound sensitivity. Nearly 35% of individuals surveyed reported some degree of general auditory sensitivity, with 15-63% endorsing misophonia symptoms, and 17-26% endorsing hyperacusis symptoms, with rates depending on assessment method. Moderate to strong correlations were found between DST conditions and other mental and physical health conditions, including obsessive compulsive disorder, autism-spectrum traits, anxiety, depression, social phobia, medical conditions, and somatic and neurobehavioral symptoms. Mediation models revealed that the process by which misophonia symptoms become clinically significant and functionally impairing is partially mediated by amplification of bodily sensations and anxiety sensitivity. Risk factors for functional impairment related to misophonia symptoms were identified in moderation analyses and included neuroticism, synesthesia, and sensory sensitivity. An assessment instrument, the DST-10, and its subscales the Loudness Sensitivity Scale and Human Sounds Scale, was subjected to exploratory and confirmatory factor analysis and initial evidence for construct validity was demonstrated. This study was the first to assess hyperacusis, misophonia, and tinnitus rates in large general population samples and provides initial support for conceptualizing DST problems as behavioral medicine conditions.

Background – An increase in opioid prescribing has led to an increase in opioid overdoses.1,2 No study has estimated the incremental costs subsequent to an opioid overdose event in prescription opioid users, or the prevalence and costs of overdose events in family members of prescription opioid users and in overdose victims with no identifiable source of prescription opioid. The latter group will be referred to as “others”. Objectives – The first objective of this study was to estimate the prevalence of opioid overdoses in aforementioned groups. The second objective was to estimate the incremental costs and resource utilization associated with opioid overdoses in these groups. Methods – This study is a retrospective analysis using claims data from SelectHealth, a not-for-profit health insurance organization in Utah and southern Idaho. We estimated the prevalence of opioid overdoses in the sample population, as well as in each group, by year. For the cost estimation we collapsed family members and others into one category – “non-medical users”. To estimate costs we used an incremental cost approach whereby we used propensity scores to match cases (patients who suffered from an opioid overdose) to appropriate controls (patients who did not suffer from an opioid overdose) and estimated the direct medical costs incurred in each group in the year following an overdose. Generalized Linear Models were used to estimate incremental costs and resource utilization. Sensitivity analyses were conducted to measure the robustness of the estimates. Results – The prevalence of opioid overdoses increased by 84.8% in prescription opioid users (from 55.6 per 100,000 in 2011 to 102.8 per 100,000 in 2014), increased by 37.9% in family members of prescription opioid users (from 5.9 per 100,000 in 2011 to 8.2 per 100,000 in 2014) and increased by 179.9% in others (from 8.2 per 100,000 in 2011 to 23.1 per 100,000 in 2014). The prevalence of opioid overdoses in acute users increased by 14.7% (from 43.8 per 100,000 in 2011 to 50.3 per 100,000 in 2014) as compared to 165.9% in chronic users (from 187.0 per 100,000 in 2011 to 497.3 per 100,000 in 2014). The incremental direct medical costs per patient per year were estimated to be $65,277 (p-value<0.05) in prescription opioid users who suffered from an overdose and $41,102 (p-value<0.05) in non-medical users who suffered from an overdose. Overdose-specific costs were estimated to be $12,111 for prescription opioid users and $11,070 in non-users. Conclusions – Our study found that the prevalence of opioid overdoses increased steadily from 2011 to 2014 in the sample population. The prevalence of overdoses was much higher in chronic opioid users as compared to acute users. Differences between overdose-specific costs and total incremental costs may suggest that overdoses are associated with substantial costs in addition to costs for the initial treatment of the overdose. While the cost to payers due to overdoses in prescription opioid users is substantial, payers also incur costs from diversion of opioids.

Background The period of adolescence is typical for first experiments and initiation of substance use. The onset of experiments emerges between 11 and 15 years of age according to different authors. Although many adolescents end with experiments, there is still a group of those who proceed to regular use. Frequent, regular and especially heavy substance use represents various risks in many aspects of individual's life. According to various studies earlier onset of substance use may predict serious difficulties in adult stages of life. Important and currently widely discussed question is differences in substance use between boys and girls. Aims To identify the age of cigarette, alcohol and cannabis use onset according to gender. To find out prevalence of use among boys and girls. To find out whether incidence of substance use is higher during school year or summer holidays. Methods The ESPAD questionnaire was used for data collection, which was realized in the period of 34 months from August 2007 until June 2010. Indicators were defined for categories of cigarette smoking, alcohol drinking and experience with cannabis. For clarification of the given hypothesis statistical analyses in Microsoft Office Excel 2007 were used - descriptive statistics, contingency tables, Fisher's F-test and (Student)...

The thesis analyzes the determinants of pharmaceutical expenditures on cardiovascular diseases with particular focus on Central Europe. We show how the pharmaceutical expenditure varies across the countries. We try to empirically verify that factors such as age, GDP, total health expenditure, education and prevalence of a particular disease cause the variation. Applying the fixed effect model on selected countries in the period 2000-2009, we find that the increase in pharmaceutical expenditures on cardiovascular diseases is explained mainly by aging population and prevalence of the diseases. Additionally, countries with higher GDP tend to also have somewhat higher pharmaceutical expenditures on cardiovascular diseases. Key words Pharmaceutical expenditures, cardiovascular diseases, GDP, health expenditure, fixed effect model, prevalence of a disease, aging of population.

Title: Work-Related Musculoskeletal Disorders amongst Physical Therapists and Assistants in Jeddah, Saudi Arabia Aim: 1) To determine the prevalence of work related musculoskeletal disorder among physical therapist and assistants in physical therapy departments in Jeddah city. 2) To determine what age and sex (male- female) has the highest rates of disorders 3) To determine the most problematic area in the body that physical therapist and assistants complain from. Methods: Modified Nordic musculoskeletal questionnaire which was adapted in a study was made Kuwait in the year of 2010 it's a combination of self-writing and multiple choice questions. Paper based survey was distributed to 165 participants from different work settings in Jeddah City then analysed with SPSS analytics software. Result: The percentage of Work related musculoskeletal disorder among physical therapists in Jeddah city is 86.1%. The risk factors associated with work was scored as moderate by 70.3%. The low back region is most body parts complained about by 42.42%. Both sexes (Male-Female) where affected equally as age, BMI was not related significantly except in few body parts. Also, the absence of assistive machinery devices was only significant in two (Shoulder and Wrist) body region where the rest was not significant. Thus...

Title: Evaluation of musculoskeletal disorders in pianists Background: Musculoskeletal (MS) disorders are common in pianists. Allsop and Ackland (2010) in their study describe that pianists suffer from MS disorders in 42 %. However, the prevalence of MS disorders differs depending on the region. There has not been done yet any evaluation of prevalence of MS disorders in pianists in Czech republic. This evaluation is crutial to make a comparison of our national results internationally. Furthermore, it is required to establish well-prepared preventional program for starting pianists. Aims: The purpose of this study is to evaluate prevalence of musculoskeletal disorders in pianists. Methods: Our data were collected using questionnaire survey. We distributed questionnaires among czech profesional pianists, piano teachers, and piano students by emails who were older than 18. Results: We sent 390 questionnaires by emails and received 78 of them completed. We revealed that the prevalence of musculoskeletal disorders of all respondents was 72 %. The prevalence was the highest in the group of the age from 18 to 60 reaching 90 %. The most common locality of musculoskeletal disorder was in the forearm. The group of pianists who started to play piano at the age from 3 to 4 were more prone to present with...

Introdução: As doenças cardiovasculares continuam sendo a principal causa de morte no Brasil e as cirurgias cardíacas são consideradas um procedimento de alta complexidade e apesar de melhorar a sobrevida e qualidade de vida dos indivíduos não está isento de riscos. Umas das principais complicações no pós-operatório é a infecção. Objetivo: identificar os fatores de risco associados à ocorrência de IRAS em pacientes submetidos à cirurgia cardíaca em um hospital, público, geral e de ensino, de Minas Gerais, no período de julho de 2005 a novembro de 2015. Métodos: trata-se de um estudo retrospectivo, de corte transversal, com abordagem quantitativa, que analisou 725 prontuários de pacientes adultos submetidos à cirurgia cardíaca. Ressalta-se que o paciente foi considerado no estudo uma única vez. Para a coleta de dados utilizou-se um instrumento contendo variáveis sociodemográficas, clínicas e referentes ao perioperatório o qual foi validado quanto à forma e conteúdo por cinco especialistas na temática. Os dados foram inseridos em uma planilha eletrônica do programa Excel® versão para Windows XP® validados por dupla entrada (digitação) para verificação de inconsistências e após a correção dos erros, os dados foram exportados para o programa Statistical Package for the Social Sciences (SPSS) versão 18.0 para Windows XP® onde foi construído o banco definitivo e procedeu-se a analise estatística descritiva e analítica Resultados: a população do presente estudo foi constituída por 725 prontuários, houve predominância do sexo feminino, média de idade de 55,8 anos e a taxa global de infecção relacionada à assistência à saúde (IRAS) foi de 26,9%, sendo a infecção do trato respiratório (20,8%) a mais frequente, seguida por infecção do sítio cirúrgico (ISC) (8,1%). Os principais preditores para a ocorrência de IRAS foram doença pulmonar obstrutiva crônica (DPOC), ter apresentado intercorrência no intraoperatório, tempo de intubação > 24 horas, reintubação e hemotransfusão no pós-operatório. A incidência de óbito foi maior entre os pacientes que desenvolveram IRAS (30,3%) quando comparado com os que não tiveram infecção (4,3%). O tempo médio de permanência hospitalar pós-operatória foi maior para os pacientes com IRAS (23,4 dias). Conclusão: O presente estudo permitiu identificar os principais preditores para a ocorrência de IRAS nos pacientes submetidos à cirurgia cardíaca. Medidas direcionadas para a promoção da saúde e para controle de IRAS durante a hospitalização podem contribuir para minimizar esse evento e garantir uma assistência à saúde mais segura / Introduction: Cardiovascular diseases are still the main cause of death in Brazil, and thoracic surgeries are considered a high-complexity procedure, as despite increasing the survival and improving the quality of life of individuals, it is not risk free. Infection is one of the main complications in the post-operative period. Objective: to identify the risk factors associated with the occurrence of healthcare-associated infections (HAI) in patients submitted to thoracic surgery in a public general teaching hospital, in Minas Gerais, from July 2005 to November 2015. Methods: a retrospective, cross section study, using a quantitative approach, was developed to analyze 725 medical records of adult patients submitted to thoracic surgery. It is noteworthy that patients were considered only once in the study. Data were collected using an instrument containing sociodemographic and clinical variables, as well as data on the perioperative period, which was validated as for its face and content by five experts on the theme. The collected data were inserted into an Excel® for Windows XP® spreadsheet and validated by double entry (typing) in order to verify the existence of inconsistencies and, after the correction of errors, the data were exported to the Statistical Package for the Social Sciences (SPSS) version 18.0 for Windows XP®, where the final database was built, proceeding to a descriptive and analytical statistical analysis. Results: the population of the study was made up of 725 medical records, in which there was a predominance of women, with a mean age of 55.8 years and an overall rate of HAI of 26.9%, with respiratory tract infections (20.8%) being the most frequent, followed by surgical site infection (8.1%). The main predictors for the occurrence of HAI were chronic obstructive pulmonary disease, having had a complication in the intraoperative period, length of intubation > 24 hours, reintubation and hemotransfusion in the post-operative period. The incidence of death was higher among patients who developed HAI (30.3%) when compared to those who did not have an infection (4.3%). The mean length of post-operative hospital stay was higher among patients with HAI (23.4 days). Conclusion: The present study allowed to identify the main predictors for the occurrence of HAI in patients submitted to thoracic surgery. Measures targeted at health promotion and HAI control during hospitalization can contribute to minimize this event and guarantee the delivery of safe health care

Résumé : L’hémiplégie laryngée (HP) est une affection courante et une cause majeure de contre-performances dans l’espèce équine. Plusieurs études ont montré que la prévalence était variable selon les races et les disciplines étudiées. De plus, un développement important des techniques chirurgicales peu invasives ont émergé ces dernières années. Les objectifs de ce travail étaient de 1) déterminer la prévalence de l’HL chez une population de Trotteurs Français (TF) à l’entrainement et son impact sur les performances, 2) évaluer la pertinence des protocoles actuels de sédanalgésie utilisés lors d’interventions chirurgicales sur cheval debout.Deux études ont été réalisées pour répondre aux objectifs. La première étude portait sur 112 TF en situation d’entrainement. La prévalence a été calculée sur l’ensemble de l’effectif puis une étude longitudinale sur l’évolution du grade HL a été réalisée sur 18 chevaux. La prévalence de l’HL chez ces chevaux était relativement importante mais aucune corrélation avec les performances, ni le sexe ou l’âge des animaux n’a pu être montrée. Une large proportion de chevaux voit son grade d’abduction se dégrader avec le temps. La deuxième étude a comparé 4 protocoles de sédanalgésie. Huit juments saines ont été utilisées et les effets des protocoles ont été notés. Les protocoles testés étaient adéquats pour les interventions envisagées mais des différences notoires ont été démontrées. L’utilisation du butorphanol entrainait des mouvements involontaires et brusques de la tête, tandis que la lidocaïne pouvait engendrer un collapsus pharyngé. Des recommandations pour l’utilisation de ces protocoles ont été émises. / Abstract : Laryngeal hemiplegia (LH) is a common disease in sport- and racehorses, but also a frequent cause of poor performance. Several studies have shown that the prevalence of the disease is rather variable among the different breeds and disciplines. Furthermore, minimally invasive surgical therapies to correct this condition have recently gained popularity. The objectives of our work were to 1) determine the prevalence of LH in a population of French Trotters in training and 2) assess the efficacy of sedation and analgesia protocols in minimally invasive upper airway surgery. Two experiments were conducted. The first experiment investigated the prevalence of LH in 112 French Trotters horses in training, showing that a large number of horses were affected but it did not severely impact their performance. A longitudinal study was performed in 18 of these horses showing that the LH grade decreased with time in a large proportion of horses. The second study compared 4 sedation/analgesia protocols used in upper airway standing surgery. All protocols tested were adequate to provide sedation and analgesia of the pharynx and larynx but there were some important differences between protocols. Butorphanol induced frequent head jerking as lidocaine caused pharyngeal collapse, which can impair proper surgical accuracy. Recommandations were made for the use of these protocols in upper airway surgery.