Background: Chronic pain is a major public health problem. The impact of stages of chronic pain adjusted for disease load on societal burden has not been assessed in population surveys. Methods: A cross-sectional survey with 4360 people aged ≥ 14 years representative of the German population was conducted. Measures obtained included demographic variables, presence of chronic pain (based on the definition of the International Association for the Study of Pain), chronic pain stages (by chronic pain grade questionnaire), disease load (by self-reported comorbidity questionnaire) and societal burden (by self-reported number of doctor visits, nights spent in hospital and days of sick leave/disability in the previous 12 months, and by current unemployment). Associations between chronic pain stages with societal burden, adjusted for demographic variables and disease load, were tested by Poisson and logistic regression analyses. Results: 2508 responses were received. 19.4% (95% CI 16.8% to 22.0%) of participants met the criteria of chronic non-disabling non-malignant pain. 7.4% (95% CI 5.0% to 9.9%) met criteria for chronic disabling non-malignant pain. Compared with no chronic pain, the rate ratio (RR) of days with sick leave/disability was 1.6 for non-disabling pain and 6.4 for disabling pain. After adjusting for age and disease load, the RRs increased to 1.8 and 6.8. The RR of doctor visits was 2.5 for non-disabling pain and 4.5 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.7 and 2.6. The RR of days in hospital was 2.7 for non-disabling pain and 11.7 for disabling pain if compared with no chronic pain. After adjusting for age and disease load, the RR fell to 1.5 and 4.0. Unemployment was predicted by lower educational level (Odds Ratio OR 3.27 [95% CI 1.70-6.29]), disabling pain (OR 3.30 [95% CI 1.76-6.21]) and disease load (OR 1.70 [95% CI 1.41-2.05]). Conclusion: Chronic pain stages, but also disease load and societal inequalities contributed to societal burden. Pain measurements in epidemiology research of chronic pain should include chronic pain grades and disease load.:Background; Methods; Results; Discussion; Conclusion

Introduction The rapid expansion of the novel SARS-CoV-2 virus has raised serious public health concerns due to the possibility of misdiagnosis in regions where arboviral diseases are endemic. We performed the first study in northern Peru to describe the detection of SARSCoV-2 IgM antibodies in febrile patients with a suspected diagnosis of dengue and chikungunya fever. Materials and methods A consecutive cross-sectional study was performed in febrile patients attending primary healthcare centers from April 2020 through March 2021. Patients enrolled underwent serum sample collection for the molecular and serological detection of DENV and CHIKV. Also, serological detection of IgM antibodies against SARS-CoV-2 was performed. Results 464 patients were included during the study period, of which (40.51%) were positive for one pathogen, meanwhile (6.90%) presented co-infections between 2 or more pathogens. The majority of patients with monoinfections were positive for SARS-CoV-2 IgM with (73.40%), followed by DENV 18.09% and CHIKV (8.51%). The most frequent co-infection was DENV + SARS-CoV-2 with (65.63%), followed by DENV + CHIKV and DENV + CHIKV + SARSCoV-2, both with (12.50%). The presence of polyarthralgias in hands (43.75%, p<0.01) and feet (31.25%, p = 0.05) were more frequently reported in patients with CHIKV monoinfection. Also, conjunctivitis was more common in patients positive for SARS-CoV-2 IgM (11.45%, p<0.01). The rest of the symptoms were similar among all the study groups. Conclusion SARS-CoV-2 IgM antibodies were frequently detected in acute sera from febrile patients with a clinical suspicion of arboviral disease. The presence of polyarthralgias in hands and feet may be suggestive of CHIKV infection. These results reaffirm the need to consider SARS-CoV-2 infection as a main differential diagnosis of acute febrile illness in arboviruses endemic areas, as well as to consider co-infections between these pathogens. Copyright: / Revisión por pares

Bakgrund: Kariessjukdomen hör till en av världens vanligaste sjukdomar med flertalet kända orsaks- och riskfaktorer. För att bevara en god oral hälsa utgör förebyggande tandvård en betydelsefull del bland äldre och kan ha en stor inverkan på en individs livskvalitet. Karies kan förebyggas och behandlas med stöd av patientutbildning och förebyggande tandvård, en hälsoinsats som främjar framförallt individen men även samhället med minskade resurs- och vårdkostnader. Syfte: Övergripande syftet med studien var att kartlägga förekomst och fördelning av registrerade förebyggande åtgärder i relation till karies bland individer 65 till 70 år, bofasta i Värmland 2017. Metod: Studiens design var en tvärsnittsstudie av individdata (n=2738) från 65- till 70-åriga individer bosatta i Värmland och undersökta i tandvården, Region Värmland 2017. Data baseras på Svenskt Kvalitetsregister för Karies och Parodontit (SKaPa) åren 2017 och 2018. Resultat: Närmare trefjärdedelar av individerna hade ingen tillståndskod för karies registrerad (72,1%). Det var ungefär dubbelt så vanligt med tillståndskoder för sekundärkaries jämfört med primärkaries, 684 respektive 291 registreringar. Totalt registrerades 742 sjukdomsförebyggande åtgärder (200-serien) och 3495 sjukdomsbehandlande åtgärder (300-serie). ”Icke-operativ behandling” var den åtgärd som starkast associerades till individer med kariestillstånd (OR 3,83; CI 3,04–4,83). ”Information vid risk för sjukdom” var starkast associerad till individer utan kariestillstånd.  Antalet erhållna förebyggande åtgärder var snedfördelad och kunde variera från en upp till nio behandlingar per individ. Konklusion: Resultatet i denna studie talar för betydelsen av ytterligare studier inom förebyggande tandvård som hälsofrämjande insats för att främja oral hälsa bland äldre individer med kariessjukdom. Beteendemedicinsk prevention är en underutnyttjad åtgärd som behöver övervägas inom den förebyggande tandvården. / Introduction: Dental caries is one of the most common diseases worldwide with well-known risk factors. In order to maintain a good oral health, preventive dental care is an important part for elderly people and impacts on an individual´s quality of life. Dental caries can be prevented and treated with patient support, education and preventive dental care. Health promotion activities within dental care contributes to the individual’s well-being and reduces costs for the society.   Aim: The overall aim was to identify the occurrence and distribution of registered preventive dental care in relation to caries, among individuals aged 65 to 70 years resident in the county of Värmland in 2017.  Method: A cross-sectional register-based study of individual data (n= 2738) from 65 to 70-year-old individuals resident and dental examined, in the county of Värmland in 2017. Data was obtained from The Swedish Quality Registry for Caries and Periodontal Diseases (SKaPa) from years 2017 and 2018.  Results: Nearly three-quarters of the individuals had no caries conditions registered (72,1%). Secondary caries-conditions were about twice as common compared to primary caries, 684 and 291 registrations, respectively.  A total of 742 preventive-treatments and 3495 preventive disease-treatments were registered. “Non-invasive treatment” had the strongest association to individuals with caries conditions (OR 3,83; CI 3,04-4,83). The treatment “information when risk for disease” had the strongest association to individuals without caries conditions. The number of obtained preventive treatments were skewed and could vary from one up to nine treatments per individual. Conclusion; The results of this study indicate the importance of further studies of preventive dental care as a health promotion achievement to promote oral health among older individuals with dental caries disease. Behavioral medical prevention is underused and needs to be considered in preventive dental care in the future.

An acht isolierten Hinterbeinen gliedmaßengesunder Rinder wurden röntgen- und querschnittsanatomische Untersuchungen des Tarsus, Metatarsus und der Phalangen durchgeführt. Im Gegensatz zu anderen Tierarten gab es bisher für das Rind noch keine Erkenntnisse zur Interpretation von MRT-Befunden. Zur besseren Orientierung werden magnetresonanztomographische und anatomische Schnitte gegenübergestellt und bewertet. Es sind 23 transversale Ebenen in T1-gewichteten Sequenzen beschrieben worden. Die röntgenanatomischen Untersuchungen erfolgten immer in den beiden Standardebenen und für Sprunggelenk und Zehe zusätzlich in zwei schrägen Aufnahmerichtungen. Mit den Untersuchungen wurde nachgewiesen, dass die verwendeten Röntgenrichtungen für eine umfassende Darstellung von Knochen und Gelenken geeignet sind. Durch die verschiedenen Aufnahmerichtungen konnten die meisten Bereiche überlagerungsfrei herausprojiziert und der Beurteilung zugänglich gemacht werden. Fast alle anatomischen Strukturen wurden in der MRT-Untersuchung dargestellt und voneinander differenziert. Über den direkten Vergleich zum anatomischen Sägeschnitt zeichneten sich die MRT-Befunde durch einen sehr hohen Informationsgehalt aus. Das Magic Angle Phänomen konnte im Bereich von Sehnen und Bändern nachgewiesen werden. Die Aufzweigungen des Ramus profundus des N. plantaris lateralis konnten im Rahmen dieser Untersuchung bis in den mittleren Metatarsusbereich nachgewiesen werden. Sie sind bei anderen Tierarten als Nn. metatarsei plantares in der Nomenklatur zu finden. Ausgehend von einer sehr umfangreichen Literaturauswertung erfolgte eine umfassende Zusammenstellung des Erkenntnisstandes unter anatomischen und orthopädischen Gesichtspunkten. Die dabei zusammengetragenen Ergebnisse bilden eine entscheidende Grundlage für die Auswertung und Interpretation von Befunden der Hintergliedmaße des Rindes mit Hilfe der bildgebenden Diagnostik. / The study was based on the evaluation of eight hindlimbs from animals free from orthopedic disease. The tarsus, metatarsus and phalanges were examined radiographically and by MRI to characterize anatomical structures. Twenty-three transverse MRI sections of each limb were collected using T1 weighted images. Corresponding MRI and cross-section anatomical preparations were compared to optimize understanding of structural features. In addition to standard 0° and 90° views of the hindlimbs, oblique views of the tarsus and phalanges were made. Comparison of photographs and images was satifactory for the evaluation of bony structures without superimposition in most cases. MRI examination resulted in visualization and differentiation of tissues in almost every situation. The magic angle phenomenon was observed in areas of tendons and ligaments. The terminal branches of the R. profundus of the N. plantaris lateralis were discernable to the level of the middle of the metatarsus. These branches are described in other species as the Nn. metatarsei plantares. This work was undertaken to document anatomical findings and relationships which may be used as a resource for interpretation of images obtained from the hindlimbs of cattle using various diagnostic imaging modalities.

Aims: Work-related diabetes distress (WRDD) can be defined as the combination of anxiety and exhaustion to combine work with diabetes in working life and this is a current problem. The aims of this study were to assess the prevalence of WRDD and covariation between WRDD and working life variables relevant to occupational health among professionals diagnosed with type 1 diabetes in Sweden. Method: This is a quantitative cross-sectional study in the form of a survey. The sample was a closed group on Facebook for people with type 1 diabetes, all members were offered to answer a questionnaire with validated questions about psychosocial working conditions, work requirements, work ability, diabetes acceptance and blood sugar levels. To investigate the occurrence of WRDD, descriptive analyses and cross-tabulation were carried out. Logistic regression analysis was used to investigate associations between the dependent variable (WRDD) and the independent variables (psychosocial working conditions, work requirements, work ability, diabetes acceptance and blood sugar levels). Main result: The survey was answered by 191 respondents. The incidence of WRDD in the sample was 71.7%. The multiple logistic regression analysis showed a significant relationship (p &lt;0.05) between the independent variables work ability, blood sugar level, diabetes acceptance, and the dependent variable WRDD. The odds of having WRDD were three times higher in those individuals who experienced poorer work ability, had difficulty accepting their diabetes or maintained a higher blood sugar level at work. Conclusions: The results showed that WRDD is a problem causing working life consequences and should be given more attention both in healthcare and working life. Increased knowledge and understanding of the challenges WRDD can cause for people with type 1 diabetes in working life is necessary to be able to prevent WRDD. / Syfte: Work-related diabetes distress (WRDD) kan definieras som en kombination av oro för och utmattning av att förena arbete med diabetes i arbetslivet och är ett aktuellt problem. Studiens syfte var att studera förekomsten av WRDD och samvariationen mellan WRDD och andra arbetsrelaterade variabler relevanta för arbetshälsa bland yrkesverksamma diagnostiserade med typ 1 diabetes i Sverige. Metod: Studien var en kvantitativ tvärsnittsstudie i form av en enkätundersökning riktad till yrkesverksamma personer med typ 1 diabetes. Urvalet var en sluten grupp på Facebook för personer med typ 1 diabetes, alla medlemmar i gruppen fick erbjudande om att svara på en enkät innehållande validerade frågor om psykosociala arbetsförhållanden, arbetskrav, arbetsförmåga, diabetesacceptans och blodsockernivå. För att undersöka hur förekomsten av WRDD såg ut genomfördes deskriptiva analyser och korstabulering. Logistisk regressionsanalys användes för att undersöka om det fanns samband mellan den beroende variabeln (WRDD) och de oberoende variablerna (psykosociala arbetsförhållanden, arbetskrav, arbetsförmåga, diabetesacceptans och blodsockernivå). Huvudresultat: Enkäten besvarades av 191 respondenter. Förekomsten av WRDD hos de svarande var 71,7%. Den multipla logistiska regressionsanalysen visade ett signifikant samband (p &lt;0.05) mellan arbetsförmåga, blodsockernivå, diabetesacceptans och WRDD. Oddsen för att ha WRDD var tre gånger högre hos de individer som upplevde sämre arbetsförmåga, hade svårt att acceptera sin diabetes eller höll en högre blodsockernivå på arbetet. Slutsatser: Resultaten visade att WRDD är ett problem med arbetslivskonsekvenser som behöver uppmärksammas mer både inom vården och i arbetslivet. Ökad kunskap och förståelse för de utmaningar WRDD kan medföra för personer med typ 1 diabetes i arbetslivet är nödvändigt för att kunna förebygga WRDD.

An ongoing debate concerning Neandertal ecology is whether or not they utilized long range weaponry. The anteroposteriorly expanded cross-section of Neandertal humeri have led some to argue they thrusted their weapons, while the rounder cross-section of Late Upper Paleolithic modern human humeri suggests they threw their weapons. We test the hypothesis that Neandertal humeri were built to resist strains engendered by thrusting rather than throwing using finite element models of one Neandertal, one Early Upper Paleolithic (EUP) human and three recent human humeri, representing a range of cross-sectional shapes and sizes. Electromyography and kinematic data and articulated skeletons were used to determine muscle force magnitudes and directions during three positions of spear throwing and three positions of spear thrusting. Maximum von Mises strains were determined at the 35% and 50% cross-sections of all models. During throwing and thrusting, von Mises strains produced by the Neandertal humerus fell roughly within or below those produced by the modern human humeri. The EUP humerus performed similarly to the Neandertal, but slightly poorer during spear thrusting. This implies the Neandertal and EUP human humeri were just as well adapted at resisting strains during throwing as recent humans and just as well or worse adapted at resisting strains during thrusting as recent humans. We also did not find any correlation between strains and biomechanical metrics used to measure humeral adaptation in throwing and thrusting (retroversion angle, Imax/Imin, J). These results failed to support our hypothesis and suggest they were capable of using long distance weaponry.

INTRODUCTION: Coronavirus Disease (COVID-19) vaccine acceptance, and hesitancy amongst Health Care Workers (HCWs) on the African continent have been examined through observational studies. However, there are currently no comprehensive reviews among these cadre of population in Africa. Hence, we aimed to review the acceptance rate and possible reasons for COVID-19 vaccine non-acceptance/hesitancy amongst HCWs in Africa. METHODS: We searched Medline/PubMed, Google Scholar, and Africa Journal Online from January, 2020 to September, 2021. The Newcastle-Ottawa Quality Assessment tool adapted for cross-sectional studies was used to assess the quality of the retrieved studies. DerSimonian and Laird random-effects model was used to pool the COVID-19 vaccine acceptance rate. Sub-group and sensitivity analyses were performed. Reasons for COVID-19 vaccine hesitancy were also systematically analyzed. RESULTS: Twenty-one (21) studies were found to be eligible for review out of the 513 initial records. The estimated pooled COVID-19 vaccine acceptance rate was 46% [95% CI: 37%-54%]. The pooled estimated COVID-19 vaccine acceptance rate was 37% [95% CI: 27%-47%] in North Africa, 28% [95% CI: 20%-36%] in Central Africa, 48% [CI: 38%-58%] in West Africa, 49% [95% CI: 30%-69%] in East Africa, and 90% [CI: 85%-96%] in Southern Africa. The estimated pooled vaccine acceptance was 48% [95% CI:38%-57%] for healthcare workers, and 34% [95% CI:29%-39%] for the healthcare students. Major drivers and reasons were the side effects of the vaccine, vaccine's safety, efficacy and effectiveness, short duration of the clinical trials, COVID-19 infections, limited information, and social trust. CONCLUSION: The data revealed generally low acceptance of the vaccine amongst HCWs across Africa. The side effects of the vaccine, vaccine's safety, efficacy and effectiveness, short duration of the clinical trials, COVID-19 infections, limited information, and social trust were the major reasons for COVID-19 hesitancy in Africa. The misconceptions and barriers to COVID-19 vaccine acceptance amongst HCWs must be addressed as soon as possible in the continent to boost COVID-19 vaccination rates in Africa.

BACKGROUND: Studies have consistently demonstrated low rates of adoption of Advance Care Planning in the community. METHODS: We studied Medicare enrollees age 65 and over and non-Medicare patients using a cross-sectional survey undertaken in February and March 2019 using questionnaires completed by out-patients attending a teaching hospital clinic in East Tennessee USA. We evaluated patient knowledge, attitudes, satisfaction and aspirations towards Advance Care Planning. RESULTS: 141 properly completed questionnaires were used. All Medicare enrollees were aware of Advanced Care Planning compared to 43% in the non-Medicare group. 70% of the Medicare enrollees and 94% of non-Medicare group were not ready to complete a written Advanced Care Plan. Of the respondents, 46% had appointed spouses, 24% adult children, 11% siblings, 10% parents, 3.6% friends and 1.2% aunts as their surrogate medical decision makers. 41% agreed that they were satisfied with their current advance care planning arrangements. This research identified that individual's knowledge, attitudes and aspirations influenced the adoption of Advance Care. CONCLUSIONS: Patients have adopted the Advance Care Plan concept but have modified it to reduce their concerns by using family and loved ones to convey their wishes instead of filling the required legal documents. Clinicians could improve this informal system and increase the observability of the treatment choices including the use of video and web-based tools.

When children are diagnosed with developmental delays, their parents may experience psychological turmoil similar to that experienced by suicidal individuals. We sought to identify adaptive characteristics that may or may not be present in parents of children with developmental delays. Forty-nine children, with disabilities ranging from mild to severe, and their parents, were administered the Reasons for Living Inventory. No significant differences were revealed between men and women, or between individuals in 1-parent versus 2-parent households. The experience of having a disabled child may help to strengthen adaptive characteristics and, possibly, reduce the risk of suicide.

BACKGROUND: Households experiencing "food insecurity" have limited access to food due to a lack of money or resources. Poor nutrition, from food insecurity, can impact physical and cognitive development of children. Study objectives were to document the prevalence of Tennessee child care programs screening for food insecurity, explore differences between programs receiving child and adult care food program (CACFP) funding and those screening for food insecurity, and understand possible burdens food insecurity places on child care families as perceived by child care program directors. METHODS: In this cross-sectional study of licensed Tennessee child care programs, a 10-question survey and four-question follow-up survey were electronically distributed. Analysis included descriptive statistics, a chi-square of programs receiving CACFP funds and screening for food insecurity, and themes analysis of open-ended responses. RESULTS: The average child care program enrollment (N = 272) was 80.16 with programs serving mostly preschoolers (98.53%) and toddlers (91.91%). Over half (56.99%) of programs reported they received CACFP funding, yet only 9.19% screen for food insecurity. Chi-square analysis found that programs receiving CACFP funds differ significantly on whether they screen households for food insecurity [Formula: see text] (1, n = 237) = 16.93, p ≤ 0.001. Themes analysis (n = 41) revealed that many child care program directors do not view food insecurity as a burden for families. CONCLUSIONS: Child care programs receiving CACFP funds are more likely to screen families for food insecurity than programs who do not. Programs indicate a willingness to include food insecurity screening questions on child care paperwork.