A randomized trial evaluating efficacy of overminus lenses combined with prism in the children with intermittent exotropia

Background To evaluate the efficacy of overminus lenses combined with prism spectacles in children of 3 to 6 years of age with intermittent exotropia (IXT). Methods Sixty patients with IXT were randomly assigned to the treatment and observation groups. Each group included 30 IXT children aged 3 to 6 years. The treatment group was prescribed overminus lenses of − 2.50 D incorporated with the 2 PD base-in prisms on each side. Ocular alignment, the status of binocular vision, as well as the refraction changes were carried out and followed at 1, 3, 6, and 12 months. A revised form of the Newcastle Control Score (NCS) was used to evaluate the patients’ ability to control their IXT. Results After 12 months, the mean refractive error was 1.42 ± 1.25 D, and 1.43 ± 1.12 D for the observation and the treatment group, respectively (95% CI: − 0.61 to 0.62)); the mean exotropia control score was 5.72 ± 1.28 and 1.75 ± 1.18 in the observation and the treatment group, respectively (95% CI: − 4.63 to − 3.33); the mean near stereoacuity was 2.16 ± 0.42 log arcsec and 1.91 ± 0.26 log arcsec in the observation and the treatment group, respectively (95% CI: − 0.44 to − 0.06). Conclusions In our randomized clinical trial, overminus spectacles with prism significantly improved the control of IXT and stereopsis, by reducing the angle of strabismus in children with IXT. This treatment does not appear to cause myopia, at least in the manner used this series. A further randomized trial is warranted to assess the effect of overminus spectacles with prism after the treatment has been discontinued. Trial registration This study adheres to CONSORT 2010 guidelines. Chinese Clinical Trial Registry, ChiCTR1900025243. Registered 17 August 2019.

Schielen oder nicht Schielen? – Strabismus divergens intermittens, eine besondere Schielform

Zusammenfassung Hintergrund Schielen tritt bei ca. 5–7 % der gesunden Kinder auf. Außenschielen ist mit 1,24 % weltweit seltener als Innenschielen. Der Strabismus divergens intermittens stellt mit 40–90 % die häufigste divergente Schielform dar. Das klinische Bild wurde von vielen AutorInnen beschrieben. Dennoch stellt es durch die Variabilität der Befunde eine therapeutische Herausforderung dar. Material und Methode Es wurden im Rahmen einer Literaturrecherche die Ergebnisse von Studien zum Strabismus divergens intermittens mit Fokus auf klinisches Bild, Untersuchungskriterien und Therapieansätze gesammelt und die Ergebnisse dargestellt. Resultate Der Strabismus divergens intermittens zeichnet sich durch eine besondere Binokularsituation und bisher ursächlich nicht vollends geklärte Symptome (Photophobie, Kneifen) aus. Konservative Therapien dienen der Entlastung des visuellen Systems, in vielen Fällen ist aber eine Schieloperation nötig. In der präoperativen Beurteilung ist der Stabilität des Schielwinkels besonderes Augenmerk zu schenken, als Entscheidungshilfe hinsichtlich Schieloperation hat sich der New Castle Control Score bewährt. Schlussfolgerung Die klinischen Charakteristika des Strabismus divergens intermittens sind klar beschrieben. Hinsichtlich therapeutischer Ansätze zeigen sich im internationalen Vergleich Unterschiede. Die Bedeutung der Einbeziehung der Eltern („shared decision making“) bei der Beurteilung der Schielhäufigkeit und bei der Operationsentscheidung ist zu betonen.

Development of a Questionnaire to Assess the Relationship Between Weight Status and Sociocultural Factors

Objectives Cultural factors influence obesity risk, but this relationship has not been systematically studied due to the lack of a validated survey instrument. The objective of this project was to develop a prototype questionnaire to assess the relationship between body mass index (BMI) and sociocultural factors. Methods Interviews and focus groups were conducted in the US (N = 24) and France (N = 25). Recordings were transcribed and analyzed (NVivo), and results informed the new questionnaire. The questionnaire was administered in two pilots using Amazon Mechanical Turk (pilot 1: N = 25 adults in France and 25 in US; pilot 2: N = 120 US adults). Demographic information was also collected. Questions were grouped by theme and scores were created from response averages within each theme. The scores were analyzed in relation to BMI, age and country (ANOVA, Spearman correlation). The scores included cultural insularity (high score = greater role of cultural identity in food choices), external eating pressures (high score = stronger perceived and overt pressures), food insecurity (high score = greater food insecurity), childhood intake control (high score = stricter parental control of eating during childhood), and nutrition knowledge (high score = better discernment of healthy vs. unhealthy foods). Results In France, the cultural insularity score was higher than in the US (P = 0.01) and was correlated with BMI (r = 0.5, P = 0.03). The childhood intake control score was also inversely associated with BMI in France (r = −0.5, P = 0.03). In the US, BMI was positively associated with the external eating pressures (pilot 2: r = 0.2, P = 0.03) and nutrition knowledge (pilot 2: r = 0.2, P = 0.04) scores, and was inversely associated with the food insecurity score (pilot 2: r = −0.24, P = 0.008). In both countries, age was associated with the childhood intake control score (France: r = 0.5, P = 0.03, and US pilot 1: r = 0.4, P = 0.03, pilot 2: r = 0.4, P < .0001). Conclusions This approach and prototype questionnaire identified novel cultural factors associated with high BMI in France and the US. Additional research is needed to validate the prototype and identify core cultural factors associated with risk of obesity in different cultures. Funding Sources USDA agreement #8050–51,000-105–01S; Danone Research; Institute of Cardiometabolism and Nutrition.

Health-Related Effects of Home Nebulization With Glycopyrronium on Difficult-to-Treat Asthma: Post-Hoc Analyses of an Observational Study

Background Bronchial asthma remains a clinical enigma with poorly controlled symptoms or exacerbations despite regular use of inhaled corticosteroids. Home nebulization offers a simplified solution for the delivery of rescue and maintenance bronchodilators, which is especially true for patients with frequent exacerbations during management of uncontrolled or difficult-to-treat asthma. Objective We aimed to assess the clinical impact and outcomes associated with home nebulization—delivered long-acting bronchodilators for uncontrolled or difficult-to-treat asthma. Methods This observational, concurrent study was conducted with 60 patients at 2 centers during November 2018. Statistical analyses for prebronchodilator forced expiratory volume in one second (FEV1) and Global Initiative for Asthma (GINA) asthma control score in patients on long-acting bronchodilators and corticosteroids were conducted, with two-tailed P values <.05 considered statistically significant. Results Per protocol analyses (53/60) for consecutive cases receiving home nebulization with long-acting bronchodilators and corticosteroids were conducted. The baseline demographics included a male-to-female ratio of 30:23 and mean values of the following: age, 60.3 years (SD 11.8 years); weight, 64 kg (SD 16.8 kg); FEV1, 43% (SD 16%); GINA asthma control score, 3.0 points (SD 0.8 points); serum eosinophil level, 4% (SD 3%); fractional exhaled nitric oxide (FeNO), 12.1 ppb (SD 6 ppb). Of the patients, 100% (53/53) had uncontrolled symptoms, 69.8% (37/53) had prior exacerbations, 100% (53/53) used formoterol/budesonide, and 75.5% (40/53) used glycopyrronium. The per protocol group (n=53) had significantly improved mean prebronchodilator FEV1 (23.7%, SD 29.8%; 0.46 L, SD 0.58 L; P<.001) and GINA asthma control score (2.1 points, SD 0.8 points, P<.001). At baseline, patients (n=40) receiving glycopyrronium/formoterol/budesonide (25/20/500 mcg) nebulization admixture had the following mean values: prebronchodilator FEV1, 38% (SD 15%); GINA asthma control score, 3.0 points (SD 0.8 points); reversibility, 12% (SD 6%); peripheral eosinophil level, 4% (SD 3%); FeNO, 12 ppb (SD 5.7 ppb). In the post hoc analyses, these patients had significantly improved mean prebronchodilator FEV1 of 27.7% (SD 26.2%; 0.54 L, SD 0.51 L; P<.001) at 8 weeks compared with baseline. At baseline, patients (n=13) receiving formoterol/budesonide (20/500 mcg) nebulization had the following mean values: FEV1, 55% (SD 12%); GINA asthma control score, 3.0 points (SD 1.2 points); reversibility, 14% (SD 7%); serum eosinophil level, 4% (SD 3%); FeNO, 13.3 ppb (SD 6.8 ppb). In the post hoc analyses, these patients showed a significant improvement in prebronchodilator FEV1 of 11.2% (SD 13.1%; 0.22 L, SD 0.25 L; P<.001) from baseline. Breathlessness of mild to moderate intensity was reported by 10 cases (10/53, 18.9%), with no other treatment-emergent adverse events or serious adverse events. Conclusions Home nebulization remains a viable option for symptomatic difficult-to-treat asthma cases with frequent use of rescue medications. Glycopyrronium as add-on therapy offers a synergistic response in patients on corticosteroids with difficult-to-treat asthma. Trial Registration Clinical Trial Registry of India CTRI/2018/11/016319; https://tinyurl.com/y78cctm3

Pengembangan Buku Bergambar Bertekstur Dilengkapi Teka-Teki Silang Sebagai Media Pembelajaran Biologi Sub Materi Jaringan Epitel Kelas XI SMA

Media is one of tool to help the learning process. The media used in Senior Hight School 7 Semarang still general like book and LKS, the media admitted still has weakness from the presentation of contents, picture and increasing students interest, so that the learning looks monotonic and less to give progress of learning which is fun in the class. The thing explained raises the results of research like Developing The Book Which has Pictures and Textured and It is Completed with Crossword Puzzle As Media Learning Sub Material Materials Epitel Class XI SMA. This research uses the method. (R & D) with 4-D development model Thiagarajan dkk production Defind, Design, Develop and Dessiminate. The result of the research is based on the assessment of media material expert has decent criteria (Very Good) with 90.9% percentage, assessment according to the media expert is included in the criteria worth (excellent) with 85.5% percentage and the assessment according to the teacher is included in the appropriate category (Very Good) with a percentage of 98.48%. The effectiveness of the media on the value of entry in the category is quite effective with the mean of the average student control score of 5.70. Media readability test after using in the learning category is very good with a percentage of 86.1%. The result of reseach showing deserves using in the learning.

Health-Related Effects of Home Nebulization With Glycopyrronium on Difficult-to-Treat Asthma: Post-Hoc Analyses of an Observational Study (Preprint)

BACKGROUND Bronchial asthma remains a clinical enigma with poorly controlled symptoms or exacerbations despite regular use of inhaled corticosteroids. Home nebulization offers a simplified solution for the delivery of rescue and maintenance bronchodilators, which is especially true for patients with frequent exacerbations during management of uncontrolled or difficult-to-treat asthma. OBJECTIVE We aimed to assess the clinical impact and outcomes associated with home nebulization—delivered long-acting bronchodilators for uncontrolled or difficult-to-treat asthma. METHODS This observational, concurrent study was conducted with 60 patients at 2 centers during November 2018. Statistical analyses for prebronchodilator forced expiratory volume in one second (FEV1) and Global Initiative for Asthma (GINA) asthma control score in patients on long-acting bronchodilators and corticosteroids were conducted, with two-tailed <i>P</i> values &lt;.05 considered statistically significant. RESULTS Per protocol analyses (53/60) for consecutive cases receiving home nebulization with long-acting bronchodilators and corticosteroids were conducted. The baseline demographics included a male-to-female ratio of 30:23 and mean values of the following: age, 60.3 years (SD 11.8 years); weight, 64 kg (SD 16.8 kg); FEV1, 43% (SD 16%); GINA asthma control score, 3.0 points (SD 0.8 points); serum eosinophil level, 4% (SD 3%); fractional exhaled nitric oxide (FeNO), 12.1 ppb (SD 6 ppb). Of the patients, 100% (53/53) had uncontrolled symptoms, 69.8% (37/53) had prior exacerbations, 100% (53/53) used formoterol/budesonide, and 75.5% (40/53) used glycopyrronium. The per protocol group (n=53) had significantly improved mean prebronchodilator FEV1 (23.7%, SD 29.8%; 0.46 L, SD 0.58 L; <i>P</i>&lt;.001) and GINA asthma control score (2.1 points, SD 0.8 points, <i>P</i>&lt;.001). At baseline, patients (n=40) receiving glycopyrronium/formoterol/budesonide (25/20/500 mcg) nebulization admixture had the following mean values: prebronchodilator FEV1, 38% (SD 15%); GINA asthma control score, 3.0 points (SD 0.8 points); reversibility, 12% (SD 6%); peripheral eosinophil level, 4% (SD 3%); FeNO, 12 ppb (SD 5.7 ppb). In the post hoc analyses, these patients had significantly improved mean prebronchodilator FEV1 of 27.7% (SD 26.2%; 0.54 L, SD 0.51 L; <i>P</i>&lt;.001) at 8 weeks compared with baseline. At baseline, patients (n=13) receiving formoterol/budesonide (20/500 mcg) nebulization had the following mean values: FEV1, 55% (SD 12%); GINA asthma control score, 3.0 points (SD 1.2 points); reversibility, 14% (SD 7%); serum eosinophil level, 4% (SD 3%); FeNO, 13.3 ppb (SD 6.8 ppb). In the post hoc analyses, these patients showed a significant improvement in prebronchodilator FEV1 of 11.2% (SD 13.1%; 0.22 L, SD 0.25 L; <i>P</i>&lt;.001) from baseline. Breathlessness of mild to moderate intensity was reported by 10 cases (10/53, 18.9%), with no other treatment-emergent adverse events or serious adverse events. CONCLUSIONS Home nebulization remains a viable option for symptomatic difficult-to-treat asthma cases with frequent use of rescue medications. Glycopyrronium as add-on therapy offers a synergistic response in patients on corticosteroids with difficult-to-treat asthma. CLINICALTRIAL Clinical Trial Registry of India CTRI/2018/11/016319; https://tinyurl.com/y78cctm3

Age and Sex Differences in Fundamental Movement Skills Among a Cohort of Irish School Children

The purpose of this study was to assess the fundamental movement skill (FMS) proficiency of Irish primary school children relative to age and sex. Data collected were baseline measures forProject Spraoi, a physical activity (PA) and nutrition-based intervention. Participants (N = 203) were senior infant (n = 102,Mage: 6.0 ± 0.4 years) and fourth class (n = 101,Mage: 9.9 ± 0.4 years) children from three primary schools in the south of Ireland. FMS testing was conducted using the Test of Gross Motor Development-2 (TGMD-2), assessing six locomotor and six object-control skills. Analysis of variance (ANOVA) was used to assess age and sex related differences in FMS proficiency. Older children scored significantly higher than younger children in both locomotor (p < .05) and object-control score (p < .05). Boys scored significantly higher than girls in object-control score (p < .05), while girls scored significantly higher in locomotor score (p < .05). FMS levels among Irish primary school children are similar to children worldwide, with age and sex differences evident. Early interventions, aimed at improving FMS, are warranted among Irish primary school aged children as greater proficiency is related to greater PA participation and numerous health benefits.

Does Patient Perception of Pain Influence How Patients Rate Their Experience after Total Knee Arthroplasty?

Press Ganey (PG) is an increasingly used measure to determine patient satisfaction. It has yet to be determined which factors influence the PG scores most amongst patients with inadequate pain control after total knee arthroplasty (TKA). Therefore, we assessed (1) which PG factors influence overall hospital rating (OHR) in patients who had poor pain control in comparison to those with good pain control and (2) whether pain control influences OHR during hospital admission following TKA. An institutional database search was performed between November 2009 and January 2015 for all TKA patient responders to the PG questionnaire. This yielded 148 patients (mean = 61 years; range, 24–92 years). Pain control was graded on a scale from 1(least satisfied) to 4 (most satisfied). Patients were separated into two cohorts: those who had poor pain control (score ≤ 2) and those who had good pain control (score > 2). Multiple regression analysis assessed the weighted means (β) of all PG categories on OHR. To compare the demographics and survey responses between the two cohorts, χ 2 and t-tests were utilized. For patients with poor pain control, the responsiveness of hospital support staff had the highest influence on OHR (β = 2.103), followed by communication about medications (β = 1.230). For patients with good pain control, communication with nurses had the strongest effect on hospital rating (β = 0.233, p = 0.056), followed by communication about medications (β = 0.200, p = 0.049). The patients with good pain control had significantly higher OHR (6.0 vs. 9.1, p = ≤ 0.001) and scores in each category of PG. Communication about medications and responsiveness of hospital staff had a significant effect on OHR. Well-controlled patients were highly influenced by communication of medication and communication with nurses. Moreover, patients with good pain control had significantly higher scores in all areas of PG survey, signifying that patient perception of pain affects patient satisfaction with the hospital. Orthopaedists should be involved in direct efforts to improve pain control as well as address the aforementioned PG domains.