Journals
2024 EN
Shimabukuro Shizuka · Oshio Takashi · Endo Takahiro
+11 more
Background Well Parent Japan (WPJ) is a new hybrid group parent training programme combining sessions to improve mothers' psychological well‐being with a culturally adapted version of the New Forest Parenting Programme (NFPP). This study investigates the effectiveness and cost‐effectiveness of WPJ against treatment as usual (TAU) within Japanese child mental health services. Methods TRANSFORM was a pragmatic multi‐site randomised controlled trial (RCT) with two parallel arms. Altogether 124 mothers of 6–12‐year‐old children with DSM‐5 ADHD were randomised to WPJ ( n = 65) or TAU ( n = 59). Participants were assessed at baseline, post‐treatment and three‐month follow‐up. The primary outcome was parent‐domain stress following intervention. Secondary outcomes included maternal reports of child‐domain stress, parenting practices, parenting efficacy, mood, family strain, child behaviour and impairment. Objective measures of the parent–child relationship were collected at baseline and post‐treatment. Data analysis was intention to treat (ITT) with treatment effects quantified through analysis of covariance (ANCOVA) via multilevel modelling. An incremental cost‐effectiveness ratio (ICER) assessed WPJ's cost‐effectiveness. Results WPJ was superior to TAU in reducing parent‐domain stress post‐treatment (adjusted mean difference = 5.05, 95% CI 0.33 to 9.81, p = .036) and at follow‐up (adjusted mean difference 4.82, 95% CI 0.09 to 9.55, p = .046). Significant WPJ intervention effects were also observed for parenting practices, parenting efficacy and family strain. WPJ and TAU were not significantly different post‐intervention or at follow‐up for the other secondary outcomes. The incremental cost of WPJ was 34,202 JPY (315.81 USD). The probability that WPJ is cost‐effective is 74% at 10,000 JPY (USD 108.30) per one‐point improvement in parenting stress, 92% at 20,000 JPY (216.60 USD). The programme was delivered with high fidelity and excellent retention. Conclusions WPJ can be delivered in routine clinical care at modest cost with positive effects on self‐reported well‐being of the mothers, parenting practices and family coping. WPJ is a promising addition to psychosocial interventions for ADHD in Japan.
Journals
2024 EN
Tanaka Kenichi · Okada Yosuke · Umezu Saeko
+10 more
The aim of this study was to compare the effects of mitiglinide/voglibose with those of glimepiride on glycemic variability and vascular endothelial function in patients with type 2 diabetes. Materials and Methods It was a multicenter, open‐label, randomized, crossover study. Hospitalized patients received either mitiglinide/voglibose (three times daily administration of 10 mg mitiglinide and 0.2 mg voglibose) or glimepiride (once‐daily 2 mg) in random order, each for 5 days. The reactive hyperemia index (RHI) and the mean amplitude of glycemic excursions (MAGE) were measured as co‐primary endpoints using reactive hyperemia peripheral arterial tonometry and continuous glucose monitoring. Results The analysis included 30 patients (15 in each group). The RHI was 1.670 ± 0.369 during treatment with mitiglinide/voglibose and 1.716 ± 0.492 during treatment with glimepiride, with no significant difference between the two. MAGE was significantly lower in the mitiglinide/voglibose group (47.6 ± 18.5 mg/dL) than in the glimepiride group (100.6 ± 32.2 mg/dL). Although the mean blood glucose levels over the entire 24 h period were comparable between the two groups, the use of mitiglinide/voglibose was associated with a lower standard deviation of mean glucose, coefficient of variation, and mean postprandial glucose excursion compared with glimepiride. The time below range (<70 mg/dL) and the time above range (>180, >200, and 250 mg/dL) were lower in the mitiglinide/voglibose group, while the time in range (70–180 mg/dL) was higher. Conclusions In our short‐duration randomized crossover study, although not impacting vascular endothelial function, mitiglinide/voglibose demonstrated potential benefits in reducing glycemic variability, postprandial hyperglycemia, and hypoglycemia in patients with type 2 diabetes.
Asian Association for the Study of Diabetes
Journals
2024 EN
Forville Heloisa · Bernardi Laís Giacomini · Favoreto Michael Willian
+5 more
Objective To compare the color change, the risk and intensity of tooth sensitivity (TS), and gingival irritation (GI) of at‐home bleaching applied on the buccal surface only or the buccal and lingual surfaces. Materials and Methods Sixty patients with canines A 2 or darker were selected and their superior arches were randomized in two groups: at‐home bleaching on the buccal‐only or on the buccal and lingual surfaces, with 7.5% hydrogen peroxide, for 1 h daily/2 weeks. The color change was evaluated at baseline, 7, 14 days, and 1 month after bleaching using shade guides scales (ΔSGU) and a spectrophotometer (ΔE AB , ΔE 00 , and ΔWI D ). Risk and intensity of TS and GI were recorded daily using visual analogic scale (0–10). Patient satisfaction was evaluated with the orofacial esthetics. Paired t ‐test, McNemar's, and Wilcoxon signed‐rank test were used for data analysis ( α = 5%). Results Neither the color change nor the risk/intensity of TS was statistically different between groups ( p > 0.05). Patient satisfaction increased after bleaching for both groups ( p < 0.05). Conclusion The addition of one contact surface does not result in an increased whitening degree compared to bleaching applied solely on the buccal surface. Clinical Significance Understanding the influence of surfaces interacting with the bleaching agent is crucial for comprehending the bleaching mechanism and avoiding unnecessary material expenses. Notably, employing the buccal‐only technique is sufficient to achieve the desired efficacy.
Journals
2024 EN
Zeine Giovana Maria · Omoto Érika Mayumi · Ramos Fernanda de Souza e Silva
+3 more
Objectives This laboratory study evaluated the influence of the fluorescence intensity of composite resins on additional tooth wear and the presence of restorative material in different dental thirds during the retreatment of direct veneers. Materials and Methods The crown dimensions of 60 bovine incisors were reduced to 10 × 8 mm. The teeth were classified according to the fluorescence intensity of the composites: low (LOW) (TPH Spectra), medium (MED) (Opallis), and high (HIGH) (Essentia) groups. The teeth were divided according to the removal methods: conventional (CON) and fluorescence‐aided identification technique (FIT). The specimens were scanned (T0), received veneer preparation, and scanned again (T1). After restorations, the composites were removed and the teeth were scanned (T2). Measurement assessments between T1 and T2 were performed to determine additional wear, presence of residual areas, and the average between additional wear and the presence of residual areas. Kruskal Wallis, Mann–Whitney, Friedman, 2‐way ANOVA, and post‐Tukey tests were performed ( α < 0.05). Results The comparison of composite resins indicated a smaller area of additional wear and greater residue presence in the HIGH group than the LOW group for both techniques in the cervical third. Regarding removal methods, the FIT produced greater additional wear than the CON method for the LOW and MED groups in the middle and cervical thirds. The incisal third exhibited greater additional wear than the other thirds. Conclusions Composite resins with high fluorescence intensity removed using FIT had less tooth wear. The incisal third was the most affected area for direct veneer removal procedures. Clinical Significance A FIT has been proposed for composite resin removal; however, the different fluorescence intensities of composite resins can influence tooth wear caused during this procedure.
Journals
2024 EN
Toyoda Hidenori · Tada Toshifumi · Uojima Haruki
+22 more
Background and Aim While several predictive models for the development of hepatocellular carcinoma (HCC) have been proposed, including those for patients with chronic hepatitis C virus (HCV) infection who have achieved sustained virologic response (SVR), the best model may differ between regions. We compared the ability of six reported models to stratify the risk of post‐SVR HCC in Japan, where rigorous surveillance and early detection of HCC is common. Methods A total of 6048 patients with no history of HCC who achieved SVR by oral direct‐acting antiviral drugs were enrolled in this nationwide study. Patients continued HCC surveillance every 6 months after SVR. The incidence of post‐SVR HCC was compared between risk groups using the aMAP score, FIB‐4 index, Tahata model, GAF4 criteria, GES score, and ADRES score. Results During the observation period with a median duration of 4.0 years after SVR, post‐SVR HCC developed in 332 patients (5.5%). All six models performed significantly at stratifying the incidence of HCC. However, Harrell's C‐index was below 0.8 for all models (range, 0.660–0.748), indicating insufficient stratification ability. Conclusion Although all six proposed models demonstrated a good ability to predict the development of post‐SVR HCC, their ability to stratify the risk of post‐SVRHCC was unsatisfactory. Further studies are necessary to identify the best model for assessing the risk of post‐SVR HCC in regions where early detection of HCC is common.
Journals
2024 EN
MolesKalt Benjamin · SánchezMira Núria · Bernardi Laura
Objective The article examines how maternal gatekeeping practices evolve in the post‐separation trajectory and identifies the main relational and contextual factors shaping these processes over time. Background Studies of maternal gatekeeping have only recently begun to include post‐separation families based on cross‐sectional research designs. This article is theoretically grounded in a life‐course and human agency framework, and it both offers a novel understanding of maternal gatekeeping as a dynamic process and examines its relational embeddedness. Methods The data stem from the prospective qualitative study “The multiple paths of lone parenthood,” which has been ongoing in Switzerland for over a decade and includes four waves of semistructured interviews with mothers who have experienced lone parenthood ( N = 88 interviews). Results Most mothers reported active facilitation practices at the beginning of their trajectory, encouraging the father–child relationship. Subsequently, shifts toward hands‐off or active gate‐closing practices took place over time along with the evolution of relational circumstances, such as the father's involvement or children's autonomy, or by an accumulation of negative experiences. Conclusion The relationship with the nonresident father creates ongoing moral dilemmas for mothers over the post‐separation trajectory. Indeed, these mothers must navigate social norms that emphasize the importance of ensuring father–child contact while safeguarding the child's well‐being and ensuring that the father complies with visitation arrangements and alimony. Implications Professional support and legal regulations should consider the moral dilemmas experienced by mothers by establishing measures to relieve separated mothers of the need to take the initiative to obtain the father's compliance with their obligations.
Wiley Subscription Services
Journals
2024 EN
Silva de Sousa André · Pereira da Rocha Aline · Brandão Tavares Daniela Regina
+4 more
Summary Obstructive sleep apnea is the most common sleep disorder. This review aims to evaluate the effectiveness and safety of respiratory muscle training in the treatment of patients with obstructive sleep apnea. The study protocol was registered in Prospero Platform (CRD42018096980). We performed searches in the main databases: Medical Literature Analysis and Retrieval System Online (MEDLINE) via Pubmed; Excerpta Medica dataBASE (Embase) via Elsevier; Cochrane Central Register of Controlled Trials (CENTRAL) via Cochrane Library; Latin American and Caribbean Literature on Health Sciences (LILACS) through the Portal of the Virtual Health Library and Physiotherapy Evidence Database (PEDro) for all randomised–controlled trials published before July 2022. The randomised–controlled trials were assessed for risk of bias and certainty of evidence. Thirteen randomised–controlled trials were included. All studies had an overall high risk of bias. Inspiratory muscle training probably improves systolic blood pressure and sleepiness when compared with sham. However, inspiratory muscle training probably does not improve diastolic blood pressure and maximum expiratory pressure, and may not be superior to sham for apnea–hypopnea index, forced expiratory volume in 1 s, forced vital capacity, sleep quality and quality of life. In addition, it is uncertain whether there is any effect of inspiratory muscle training on maximum inspiratory pressure and physical capacity. Inspiratory muscle training may also improve maximum inspiratory pressure and maximum expiratory pressure compared with oropharyngeal exercises. However, it may not be superior for apnea–hypopnea index, sleep quality, sleepiness, quality of life and functional capacity. When associated with physical exercise, inspiratory muscle training may not be superior to physical exercise alone for maximum inspiratory pressure, maximum expiratory pressure, systolic and diastolic blood pressure, and functional capacity. At the same time, when associated with cardiac rehabilitation exercises, inspiratory muscle training may reduce apnea–hypopnea index, improve inspiratory muscle strength, sleepiness and sleep quality compared with cardiac rehabilitation alone. However, it may not be superior for improving quality of life. Regarding expiratory muscle training, it may improve expiratory muscle strength and sleep quality, but not sleepiness when compared with sham. The evidence on the effects of expiratory muscle training in apnea–hypopnea index is very uncertain.
Journals
2024 EN
Tada Toshifumi · Kumada Takashi · Hiraoka Atsushi
+41 more
Background & Aims The study goal was to compare the outcomes of patients with intermediate‐stage (Barcelona Clinic Liver Cancer [BCLC]‐B) hepatocellular carcinoma (HCC) who received atezolizumab plus bevacizumab (Atezo/Bev) or lenvatinib (LEN) as first‐line systemic therapy. Methods A total of 358 patients with BCLC‐B HCC treated with Atezo/Bev ( n = 177) or LEN ( n = 181) as first‐line systemic therapy were included. Results The median progression‐free survival (PFS) times in the Atezo/Bev and LEN groups were 10.8 months (95% confidence interval [CI], 7.8–12.6) and 7.3 months (95% CI, 6.3–8.5), respectively ( p = .019). In the propensity score‐matched cohort, the median PFS times in the Atezo/Bev ( n = 151) and LEN ( n = 151) groups were 10.2 months (95% CI, 7.0–12.3) and 6.9 months (95% CI, 5.9–8.1), respectively ( p = .020). Restricted mean survival times of PFS were significantly higher in the Atezo/Bev group than in the LEN group at landmarks of 12 and 18 months ( p = .031 and .012, respectively). In a subgroup analysis of patients with HCC beyond the up‐to‐seven criteria, the median PFS times in the Atezo/Bev ( n = 134) and LEN ( n = 117) groups were 10.5 months (95% CI, 7.0–11.8) and 6.3 months (95% CI, 5.5–7.3), respectively ( p = .044). Conclusions The use of Atezo/Bev as first‐line systemic therapy in patients with BCLC‐B HCC is expected to result in good PFS.
Journals
2024 EN
Rimini Margherita · Stefanini Bernardo · Tada Toshifumi
+75 more
Overweight is a negative prognostic factor in the general population in the long term. However, the role of body mass index (BMI) in the short‐mid term in advanced tumours is unclear. The present analysis investigates the role of BMI weight classes in a large sample of patients affected by HCC and receiving atezolizumab plus bevacizumab or lenvatinib as first‐line treatment. Methods and Material The cohort included consecutive patients affected by BCLC‐c and BCLC‐B HCC patients from a multicenter international study group who received atezolizumab plus bevacizumab or lenvatinib as first‐line therapy. Population was stratified according to the BMI in under‐, over‐ and normal‐weight according to the conventional thresholds. The primary objective of the study was to evaluate the prognostic and predictive impact of BMI in patients affected by advanced or intermediate HCC. Survival curves were estimated using the product‐limit method of Kaplan–Meier. The role of stratification factors was analysed with log‐rank tests. Results 1292 consecutive patients with HCC were analysed. 466 (36%) patients were treated with lenvatinib and 826 (64%) patients were treated with atezolizumab plus bevacizumab. In the atezolizumab plus bevacizumab arm, 510 (62%) patients were normal‐weight, 52 (6%) underweight and 264 (32%) overweight. At the univariate analysis for OS, underweight patients had significantly shorter OS compared to normal‐weight patients, whereas no differences were found between normal‐weight versus overweight. Multivariate analysis confirmed that underweight patients had significantly shorter OS compared to normal‐weight patients (HR: 1.7; 95% CI: 1.0–2.8; p = .0323). In the lenvatinib arm, 26 patients (5.6%) were categorized as underweight, 256 (54.9%) as normal‐weight, and 184 (39.5%) as overweight. At the univariate analysis for OS, no significant differences were found between normal‐weight versus underweight and between normal‐weight versus overweight, which was confirmed at multivariate analysis. Conclusion Our analysis highlighted a prognostic role of BMI in a cohort of patients with advanced HCC who received atezolizumab plus bevacizumab, while no prognostic role for low BMI was apparent in patients who received lenvatinib.
Journals
2024 EN
Pompili Enrico · Baldassarre Maurizio · Ian Giulia
+10 more
Abstract Type‐2 diabetes mellitus is a frequent comorbidity of cirrhosis independently associated with cirrhosis‐related complications and mortality. This post hoc analysis of the ANSWER trial database assessed the effects of long‐term human albumin (HA) administration on top of the standard medical treatment (SMT) on the clinical outcomes of a subgroup of 85 outpatients with liver cirrhosis, uncomplicated ascites and insulin‐treated diabetes mellitus type 2 (ITDM). Compared to patients in the SMT arm, the SMT + HA group showed a better overall survival (86% vs. 57%, p = .016) and lower incidence rates of paracenteses, overt hepatic encephalopathy, bacterial infections, renal dysfunction and electrolyte disorders. Hospital admissions did not differ between the two arms, but the number of days spent in hospital was lower in the SMT + HA group. In conclusion, in a subgroup of ITDM outpatients with decompensated cirrhosis and ascites, long‐term HA administration was associated with better survival and a lower incidence of cirrhosis‐related complications.