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This study investigated the perceived health care needs, unmet health need, and barriers to health care in 224 rural-dwelling adolescents. A cross-sectional, descriptive design was used to survey adolescents attending a public high school in a low-resource, rural Indiana community. One in five adolescents reported an unmet health need. The most common barriers to health care were related to access, apathy, anxiety, and parenting issues. Implications include confidentiality protocols in family healthcare practices, school-based health centers, and intervention research targeting adolescents’ communication skills and healthcare consumer skills.

Objectives : To determine the current pattern of using angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) in diabetic nephropathy (DN), and assess physician awareness of using vitamin D in the prevention and treatment of DN. Methods : A cross-sectional study implementing a validated questionnaire, which was distributed to physicians in the aforementioned specialties in 3 hospitals in Saudi Arabia (Almanee Hospital, King Saud Medical City [KSMC], and Riyadh Care Hospital [RCH]) between April 2019 and November 2019. We used IBM SPSS 26.0 to perform descriptive statistical analyses and comparisons were based on the Chi-square test. Results : Forty-one physicians (30%) reported the use of combination therapy of ACEi and ARBs. Fifty-six (41%) physicians reported that they never used vitamin D in the treatment of DN, and 48% agreed that vitamin D can benefit patients with DN. 52% of the respondents reported the existence of guidelines. The vast majority (94%) recommended clearer guidelines on monitoring renal function in patients treated with ACEi or ARBs. Conclusion : Th ere is a universal agreement among physicians regarding the use of ACEi and ARBs for the treatment of DN with limited awareness of the bene ts of using vitamin D. Hence, the development of specific guidelines for its use are recommended. Saudi Med J 2020; Vol. 41 (10): 1083-1089 doi: 10.15537/smj.2020.10.25428 How to cite this article: Hatouf H. Sukkarieh , Rami T. Bustami, Manasik N. Abdu, Ayesha A. Khokhar, Amir A. Salih, Hana K. Abdalla. The current practice of using angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in diabetic hypertensive and non-hypertensive patients. Is there a room for vitamin D? Saudi Med J 2020; Vol. 41 (10): 1083-1089. doi: 10.15537/smj.2020.10.25428

The purpose of this study was to evaluate associations among depressive symptoms, trust of healthcare provider, and health behavior in adolescents who live in a rural area. Two hundred twenty-four adolescents aged 14–19 years old attending public high school in the Midwestern United States were surveyed. Results showed a diagnosis of depression, trust of healthcare provider, health awareness, and stress management predicted depressive symptoms in adolescents living in a rural area. Healthcare providers should take extra care to promote trust in the healthcare provider-patient relationship with adolescents and to follow guidelines for annual screening of adolescents for depressive symptoms. Nursing implications include adolescent psychoeducation to improve health awareness and stress management.

Despite prolific demands and sales, commercial sleep assessment is primarily limited by the inability to “measure” sleep itself; rather, secondary physiological signals are captured, combined, and subsequently classified as sleep or a specific sleep state. Using markedly different approaches compared with gold-standard polysomnography, wearable companies purporting to measure sleep have rapidly developed during recent decades. These devices are advertised to monitor sleep via sensors such as accelerometers, electrocardiography, photoplethysmography, and temperature, alone or in combination, to estimate sleep stage based upon physiological patterns. However, without regulatory oversight, this market has historically manufactured products of poor accuracy, and rarely with third-party validation. Specifically, these devices vary in their capacities to capture a signal of interest, process the signal, perform physiological calculations, and ultimately classify a state (sleep vs. wake) or sleep stage during a given time domain. Device performance depends largely on success in all the aforementioned requirements. Thus, this review provides context surrounding the complex hardware and software developed by wearable device companies in their attempts to estimate sleep-related phenomena, and outlines considerations and contributing factors for overall device success.

Low recruitment of Saudi nationals into the nursing profession, coupled with a growing population, has led to a severe nursing shortage in Saudi Arabia, particularly of nurses with advanced qualifications in clinical nursing. While the role of nurse practitioner has been successfully integrated into the healthcare systems of the U.S., Canada, the UK and Australia for decades, the advanced practice registered nurse (APRN), which includes nurse practitioners and clinical nursing specialists, is still not being implemented effectively in Saudi Arabia due to a variety of regulatory, institutional and cultural barriers. The author looks at some of those barriers and offers recommendations of how they might be overcome. Given that in many parts of the world, nurse practitioners are considered an essential component to meeting healthcare demands, the author considers the question of whether APRNs can find a role in Saudi Arabia’s healthcare system.

IntroductionNontuberculous mycobacteria (NTM) cause chronic, debilitating pulmonary disease. Patient-reported outcomes provide measures of symptoms, functioning and treatment response. Here we describe the preliminary validation of the recently developed NTM Module.MethodsThe study population included Northwest NTM Biobank patients in whom Mycobacterium avium complex (MAC) was isolated and who had ever met the 2007 American Thoracic Society/Infectious Diseases Society of America pulmonary disease criteria. The NTM Module was administered at enrolment and 12 months; a subset also completed the Quality of Life Questionnaire–Bronchiectasis (QOL-B). The NTM Module generates four domain scores (0–100; higher scores indicate better functioning) reflecting NTM-specific symptoms (NTM Symptoms, Body Image, Digestive Symptoms and Eating Problems). We described patient characteristics and mean scores, and evaluated psychometric properties, including response to treatment at 12 months, for each domain.ResultsOverall, 203 patients with pulmonary MAC disease were included. Average enrolment scores ranged from 76 (NTM Symptoms) to 84 (Eating Problems). Ceiling effects were observed for Body Image (26% of participants) and Eating Problems (52%). Internal consistency (Cronbach's alpha) ranged from 0.67 (Digestive Symptoms) to 0.89 (Eating Problems). The intraclass correlation for test–retest reproducibility (n=27) ranged from 0.72 (Body Image) to 0.94 (Eating Problems). Patients starting treatment (n=35) had statistically significant increases in scores for NTM Symptoms (+5, p=0.04), Digestive Symptoms (+7, p=0.002), Body Image (+7, p=0.03) and QOL-B Respiratory Symptoms (n=25, +10, p=0.006). NTM Symptoms scores increased by 15 points (p=0.002) in the 16 patients with scores ≤80 at enrolment.ConclusionThe NTM Module generally performs well as a valid patient-reported outcome for pulmonary MAC disease and was responsive to MAC treatment.

Although associated with increased morbidity and mortality, AKI has not been systematically examined in military personnel injured from combat operations in Iraq and Afghanistan.Patients evacuated from Iraq and Afghanistan to a burn unit were examined. AKI was classified by the Acute Kidney Injury Network (AKIN) and Risk-Injury-Failure-Loss-End Stage (RIFLE) schemas. Age, sex, percentage of total body surface area burned (TBSA), percentage of full-thickness burn, inhalation injury, and injury severity score were recorded. Additional data that could be associated with poor outcomes were recorded for patients with TBSA ≥20%. Multivariate logistic regression analyses were performed to determine factors associated with morbidity and mortality.AKI prevalence rates by the RIFLE and AKIN criteria were 23.8% and 29.9%, respectively. After logistic regression, RIFLE categories of risk (odds ratio [OR], 15.34; 95% confidence interval [CI], 1.75-134; P=0.01), injury (OR, 46.28; 95% CI, 5.02-427; P0.001), and failure (OR, 126; 95% CI, 13.39-999; P0.001); AKIN-2 (OR, 23.70; 95% CI, 2.32-242; P=0.008); and AKIN-3 (OR, 130; 95% CI, 13.38-999; P0.001) were significantly associated with death. AKIN-3, injury, and failure remained significant in the subset of patients with ≥20% TBSA. There was also a strong interaction between TBSA and the stage of AKI with respect to ventilator and intensive care unit days.AKI is prevalent in military casualties with burn injury and is independently associated with morbidity and mortality after adjustment for factors associated with injury severity.

Summary Magnetic therapy was applied in the present study, which play two roles; as antimicrobial (Escherichia coli, Staphylococcus auras, Streptococcus spp, Klebsialla ,and Pseudomona ) and as stimulator to tissue repair.24 rabbits were used in this study, they divided into two groups; 1 st group(treated group) contains 20 rabbits, 2 nd group (control group) contains 4 rabbits, the last subdivided into two subgroup (standard control subgroup and sham-control subgroup, the left side of all animals in control group is standard control subgroup, while the left side is sham-control subgroup). After surgery to all, the wounds were exposed to pulsed magnetic field except standard control subgroup, they healed with conventional treatment, 1 st group(treated group) and sham-control subgroup were treated with(600 Gauss,50 Hz) twice daily for 30 minutes during 7 days. Microbiologically, the bacterial Petri dish were exposed to pulsed magnetic field in present study (600 Gauss, 50Hz) 30 minutes/day for one only, after re-culture of these bacteria at new media, there weren’t bacteria growth appeared which were used in present study. Clinically, the clinical signs of wounds were recorded at 1, 3, 5,7, and 9 days post induce wound ; the sham-control subgroup was healed after 5.5 days after induce wound, 1 st treated group was healed after 7-10 day post induce wound, while standard control subgroup was healed after 9 day post induce wound. Biopsies were toke after 3,5,7,and 9 days post induce wound, the histopathological study of sham-control subgroup revealed that show more develop compare with other. Key word: pulse magnetic field, wound healing, infected wound

Summary Objective Elevated anti-Mullerian hormone (AMH) and adrenal androgen levels have been observed during childhood in girls at risk of developing polycystic ovarian syndrome (PCOS). The aim of this study was to evaluate ovarian function and adrenal steroid levels in prepubertal girls with type 1 diabetes mellitus (T1D). Design Cross-sectional study. Patients/Measurements We evaluated hormonal and ultrasonographic characteristics in girls with T1D (N = 73) and compared them to characteristics found in a control group of healthy girls (N = 86). Data are reported as geometric means (95% CI). Results Prepubertal girls with T1D had higher levels of AMH (29·1 pmol/l (23·2–36·3) vs 20·9 pmol/l (16·6–26·1), P = 0·038), inhibin B (arithmetic mean: 16·7 pg/ml (11·6–21·7) vs 11·7 pg/ml (10·0–13·5), P = 0·044) and dehydroepiandrosterone sulphate (DHEAS) (0·3 nmol/l (0·2–0·6) vs 0·2 nmol/l (0·1–0·3)) than controls (P = 0·045). During puberty, decreasing AMH levels were observed in girls with T1D only (P

While acute kidney injury (AKI) has been well studied in a variety of patient settings, there is a paucity of data in patients injured in the course of the recent wars in Iraq and Afghanistan. We sought to establish the rate of early AKI in this population and to define risk factors for its development.We combined the results of two studies performed at combat support hospitals in Afghanistan. Only US service members who required care in the intensive care unit were included for analysis. Data on age, race, sex, Injury Severity Score (ISS), first available lactate, and requirement for massive transfusion were collected. Univariate analyses were performed to identify factors associated with the subsequent development of early AKI. Multivariable Cox regression was used to adjust for potential confounders.The two observational cohorts yielded 134 subjects for analysis. The studies had broadly similar populations but differed in terms of age and need for massive transfusion. The rate of early AKI in the combined cohort was 34.3%, with the majority (80.5%) occurring within the first two hospital days. Patients with AKI had higher unadjusted mortality rates than those without AKI (21.7% vs. 2.3%, p0.001). After adjustment, ISS (hazard ratio, 1.02; 95% confidence interval, 1.00-1.03; p = 0.046) and initial lactate (hazard ratio, 1.16; 95% confidence interval, 1.03-1.31; p = 0.015) were independently associated with the development of AKI.AKI is common in combat casualties enrolled in two prospective intensive care unit studies, occurring in 34.3%, and is associated with crude mortality. ISS and initial lactate are independently associated with the subsequent development of early AKI.Prognostic and epidemiologic study, level III.

Introduction Traditional risk scoring prediction models for trauma use either anatomically based estimations of injury or presenting vital signs. Markers of organ dysfunction may provide additional prognostic capability to these models. The objective of this study was to evaluate if urinary biomarkers are associated with poor outcomes, including death and the need for renal replacement therapy. Methods We conducted a prospective, observational study in United States Military personnel with traumatic injury admitted to the intensive care unit at a combat support hospital in Afghanistan. Results Eighty nine patients with urine samples drawn at admission to the intensive care unit were studied. Twelve patients subsequently died or needed renal replacement therapy. Median admission levels of urinary cystatin C (CyC), interleukin 18 (IL-18), L-type fatty acid binding protein (LFABP) and neutrophil gelatinase-associated lipocalin (NGAL) were significantly higher in patients that developed the combined outcome of death or need for renal replacement therapy. Median admission levels of kidney injury molecule-1 were not associated with the combined outcome. The area under the receiver operating characteristic curves for the combined outcome were 0.815, 0.682, 0.842 and 0.820 for CyC, IL-18, LFABP and NGAL, respectively. Multivariable regression adjusted for injury severity score, revealed CyC (OR 1.97, 95 % confidence interval 1.26-3.10, p = 0.003), LFABP (OR 1.92, 95 % confidence interval 1.24-2.99, p = 0.004) and NGAL (OR 1.80, 95 % confidence interval 1.21-2.66, p = 0.004) to be significantly associated with the composite outcome. Conclusions Urinary biomarker levels at the time of admission are associated with death or need for renal replacement therapy. Larger multicenter studies will be required to determine how urinary biomarkers can best be used in future prediction models.

The expansion of the internet has become apparent in recent years, both by the number of users, and by the number of services available on the network. Considering such an expansion it is essential that the content be accessible to all people, regardless their abilities or different disabilities. Thus, it is necessary that IT professionals dedicate time and effort in planning accessible online solutions. In this paper, we proposed the Homero framework in order to support the development of accessible interface layer of web applications. Developed using the PHP language, the Homero framework automates the generation of web pages in accordance with guidelines defined in Web Content Accessibility Guidelines (WCAG) 2.0. In order to provide evidence of the quality of web applications generated using the framework, an empirical study was conducted. The results showed the effectiveness of Homero to assist the development of accessible web applications, achieving level AAA in automatically detectable WCAG 2.0 success criteria.

The aim of this study was to investigate the correlation between dental anxiety, salivary cortisol, and salivary alpha amylase (sAA) levels. Furthermore, the aim was to look into individual differences such as age, race, gender, any existing pain, or traumatic dental experience and their effect on dental anxiety. This study followed a cross-sectional design and included a convenience sample of 46. Every patient was asked to complete the Dental Anxiety Scale (DAS) and a basic demographic/dental history questionnaire. A saliva sample, utilizing the method of passive drooling, was then collected in 2-mL cryovials. Samples were analyzed for salivary cortisol and sAA levels by Salimetrics. Significant associations were observed between DAS scores and presence of pain and history of traumatic dental experience. However, no significant correlations were observed between DAS, cortisol, and sAA levels. Our study reconfirms that dental anxiety is associated with presence of pain and a history of traumatic dental experience. On the other hand, our study was the first to our knowledge to test the correlation between the DAS and sAA; nevertheless, our results failed to show any significant correlation between dental anxiety, cortisol, and sAA levels.

In spite of the wide coverage of Internet and the need for Web systems to support various governmental tasks, the Brazilian state of Mato Grosso do Sul (Central West region) did not have a technological infrastructure which was sufficient to meet these needs in 2001. This led to setting up the Laboratory of Software Engineering (LEDES) at the Department of Computing and Statistics (DCT), the current Computing Faculty (FACOM), at the Federal University of Mato Grosso do Sul (UFMS), which is now collaborating effectively with the state government providing technological solutions, especially in Web sites and Web applications (WebApps). Developing these solutions has made it possible to capture patterns, define flexible architecture and subsequently set up a process of a Software Product Line (SPL) to develop WebApps in e-gov domain, as well as create computational support tools which automatize this process. This paper presents such computational support tools, lessons learnt during the most relevant projects which have been developed since the creation of LEDES, and the architecture for e-gov web systems development, resultant from early experience.

Objective To evaluate the prevalence and risk factors of menstrual cycle irregularities in adolescents with type 1 diabetes mellitus. Design Prospective diary of menstrual cycle. Setting Pediatric diabetes clinics and nearby schools. Patient(s) Adolescents with type 1 diabetes mellitus treated with multiple daily insulin doses (n = 56) and 56 healthy adolescents. Main Outcome Measure(s) Duration and variability of menstrual cycle. Result(s) Duration of the menstrual cycle was 48 ± 39 and 32 ± 7 days in girls with type 1 diabetes mellitus and controls, respectively. Oligomenorrhea (58.9% vs. 19.6%) and amenorrhea (10.7% vs. 1.8%) were more prevalent in girls with type 1 diabetes mellitus than in controls. Oligomenorrhea was observed in 53.3% of the girls with type 1 diabetes mellitus with optimal metabolic control. Girls with an HbA1c level of 7.6% to 8.9% exhibited increased cycle duration, menstrual cycle variability, and prevalence of oligomenorrhea compared with controls. Regression analysis showed that, for each point of increase in HbA1c, the menstrual cycle duration increased by 5.1 days. Cycle variability was associated with a higher daily insulin dose. Conclusion(s) Despite optimal metabolic control, a higher prevalence of oligomenorrhea was observed in girls with type 1 diabetes mellitus compared with controls. This is the first report to describe the high variability of the menstrual cycle in type 1 diabetes mellitus. HbA1c and insulin dose are important factors related to menstrual irregularities in type 1 diabetes mellitus.

This article presents a framework for the development of adaptive proxies for context-aware mobile applications. The framework is in charge of collecting clients’ current context (device and network), and trigger the appropriate adaptations. MoCA’s Proxy Framework offers mechanisms for cache management, as well as for adaptation management. Developers need only create their application-specific adaptations (developing adapters modules) and define trigger conditions, priorities and selectors. This is done by specifying rules in XML format, which define the actions to be applied at the moment of a context change. The other extension point of the Proxy Framework is the caching policy to be used.

This article present a software architecture and services, which comprise a middleware infrastructure for the development and operation of collaborative applications for mobile users. The design of the architecture, named Mobile Collaboration Architecture - MoCA, was driven by the following goals: support scalability in terms of the number of users and services, flexibility and extensibility with respect to the used communication protocols and the application requirements, and facilitate the monitoring, processing and use of context information regarding single users and the collaborative group within the applications.

One hundred fifty-seven patients, 126 women and 24 men, 10 to 75 years of age, completed a self-administered questionnaire. The questionnaire contained questions asking about the patients' chief complaint, treatment received before coming to the clinic, the patients' view of their problem, and who informed them of the possible end result of an untreated “TMJ problem.” The results revealed that pain was the most commonly reported complaint (54%), discomfort and headache came second and third (52.2% and 46.5%, respectively). A significant correlation was found between inability to chew and pain, discomfort, tightness in the masticatory muscles, and locking and clicking of the joint. Most patients had received three or more types of treatment before coming to the University of Michigan, TMJ and Oral Facial Pain Clinic. A significant correlation was found between an increased number of reported symptoms and an increase in the number of treatments. The most frequently used treatment methods were pain medication, mouth guard (appliances), and occlusal adjustment. Most patients (84.1%) were referred to the TMJ and Oral Facial Pain Clinic by dentists because of clicking, locking, and limitation of movement, with or without pain.