Bimetallic Nanomaterials-Based Electrochemical Biosensor Platforms for Clinical Applications

Diabetes is a foremost health issue that results in ~4 million deaths every year and ~170 million people suffering globally. Though there is no treatment for diabetes yet, the blood glucose level of diabetic patients should be checked closely to avoid further problems. Screening glucose in blood has become a vital requirement, and thus the fabrication of advanced and sensitive blood sugar detection methodologies for clinical analysis and individual care. Bimetallic nanoparticles (BMNPs) are nanosized structures that are of rising interest in many clinical applications. Although their fabrication shares characteristics with physicochemical methodologies for the synthesis of corresponding mono-metallic counterparts, they can display several interesting new properties and applications as a significance of the synergetic effect between their two components. These applications can be as diverse as clinical diagnostics, anti-bacterial/anti-cancer treatments or biological imaging analyses, and drug delivery. However, the exploitation of BMNPs in such fields has received a small amount of attention predominantly due to the vital lack of understanding and concerns mainly on the usage of other nanostructured materials, such as stability and bio-degradability over extended-time, ability to form clusters, chemical reactivity, and biocompatibility. In this review article, a close look at bimetallic nanomaterial based glucose biosensing approaches is discussed, concentrating on their clinical applications as detection of glucose in various real sample sources, showing substantial development of their features related to corresponding monometallic counterparts and other existing used nanomaterials for clinical applications.

A Proposed Model for Dental Services Management in Iran

Background: Oral health is an integral part of general health and one of the necessities of a good life. Having a healthy mouth and teeth requires individual care, the development and implementation of community-based intervention programs, and professional care. The purpose of this study was to design a model for the management of dental services in Iran. Methods: This was an applied research in terms of purpose, descriptive in terms of implementation method, and a survey research in terms of descriptive typology. The statistical population included dental experts. To conduct the study among policy makers, planners, managers, university professors and the staff of the dental services, dental experts were chosen using purposive non-probability sampling for in-depth interviews based on grounded theory method to collect indicators of dental services management for providing a suitable selection model. To reach theoretical saturation, the text of the interviews was analyzed, phrase by phrase and sentence by sentence, through constant comparative analysis. For analysis, the grounded theory method was used, and the collected data were coded in 3 steps. In order to assess the validity of the research regarding interviews, the participants' feedback and the opinions of colleagues were used. To ensure the reliability of the interviews, 2 methods of test-retest and double coding were used. In this study, Delphi method was used in designing the model. Results: According to the obtained model, 29 factors were effective in managing dental services. The obtained indicators were included in the Delphi survey. During the Delphi stages, consensus was reached on 29 indicators which were classified into 5 dimensions (components) including planning, organizing, mobilizing of resources and facilities, guiding, monitoring and controlling. Conclusion: The results of the study showed that a 5-component model is suitable for the management of dental services in Iran, and health planners and policy makers can use it to improve the delivery of dental services.

Group Medical Care: A Systematic Review of Health Service Performance

Group care models, in which patients with similar health conditions receive medical services in a shared appointment, have increasingly been adopted in a variety of health care settings. Applying the Triple Aim framework, we examined the potential of group medical care to optimize health system performance through improved patient experience, better health outcomes, and the reduced cost of health care. A systematic review of English language articles was conducted using the Cochrane Controlled Trials Register (CENTRAL), MEDLINE/PubMed, Scopus, and Embase. Studies based on data from randomized control trials (RCTs) conducted in the US and analyzed using an intent-to-treat approach to test the effect of group visits versus standard individual care on at least one Triple Aim domain were included. Thirty-one studies met the inclusion criteria. These studies focused on pregnancy (n = 9), diabetes (n = 15), and other chronic health conditions (n = 7). Compared with individual care, group visits have the potential to improve patient experience, health outcomes, and costs for a diversity of health conditions. Although findings varied between studies, no adverse effects were associated with group health care delivery in these randomized controlled trials. Group care models may contribute to quality improvements, better health outcomes, and lower costs for select health conditions.

The Effectiveness of a Caregiver Support and Education Intervention Designed for Caregivers of Veterans

Veterans are at increased risk for dementia and multiple comorbid conditions, often making the family caregiving experience particularly challenging. The objective of this study was to examine the effectiveness of a telephone-based, collaborative dementia care program for improving caregiver (CG) outcomes in CGs of veterans with dementia. All CGs (n=107) received individual care management and were randomized to either individual intervention alone or individual plus group education and social support. CGs were on average 72.5 (+/-11.0) years old, and the majority were female, spouses/partners of the care recipient (CR), and providing care for ≥1 year. Pre-post analyses indicate that CGs experienced a significant reduction in both the frequency of CRs’ dementia-related symptoms (e.g. memory difficulties, disruptive behaviors, depressive affect) and their own distress in response to these symptoms. Our study adds to the literature on the development and evaluation of understudied CG populations, such as CGs of veterans with dementia.

COVID-19 Vaccine Intentions Within the Medicare Population

COVID-19 vaccine intentions by older adults reflect individual care seeking behavior and medical system trust and broader systemic cultural shifts related to vaccine hesitancy. The purpose of this paper is to examine the October wave of the rapid response panel survey fielded by the Centers for Medicare and Medicaid Services (CMS) to track and monitor the effects of the pandemic within the Medicare population. With a sample size of 9686 Medicare beneficiaries, the calculated statistics use replicate weights to adjust for the complex survey sample design and balanced repeated replication using Fay’s adjustment of 0.3 for variance estimation. When asked about the likelihood of getting the COVID-19 vaccine if one were available, 58 percent of the Medicare population definitely or probably intended to get the vaccine, 16 percent expressed they would probably or definitely not, and 26 percent were not sure. Black or Hispanic Medicare beneficiaries were significantly more likely to express they would probably not or definitely not get the vaccine than White, non-Hispanic Medicare beneficiaries. Distrust of what government says about the vaccine and concern about the safety or side effects were the most common reasons for not intending to get the vaccine. Those expressing intentions to not get the COVID-19 vaccine in the October 2020 survey wave were more likely to lack access to the internet, which is a potential systematic barrier if they changed their intentions following the FDA approvals of the COVID-19 vaccines and more information became available in the winter and spring of 2021.

COVID-19 pandemic and mental health of a sample of Brazilian caregivers of people with dementia

ABSTRACT Social distancing policies adopted in the COVID-19 pandemic generated a negative psychological impact on the general population and can affect caregivers of people with dementia more severely. Objective: This study screened for indications of mental health problems among informal caregivers of people with dementia. Main changes in the people’s routine and behavior resulting from the social isolation measures adopted due to the pandemic were also investigated. Method: Thirty-five informal caregivers of people with dementia from a medium-sized Brazilian city responded to a telephone interview. Results: Risks for mental health problems were found in 31.4% of the sample. These participants stated that they found it very difficult to deal with routine care changes during the pandemic. The variables related to the caregiver’s characteristics and those related to changes in routine significantly affected the caregiver’s mental health scores. Discussion: Indices of mental disorders in the studied sample did not differ from the prevalence of mental health problems in the general population during COVID-19 pandemic; however, participants reported worsening symptoms such as nervousness, sadness, and sleep during quarantine. Conclusions: Results show the complexity of this topic and the need for individual care for this group, especially in situations like the COVID-19 pandemic.

Birth outcomes for medically high-risk pregnancies: comparing group to individual prenatal care

Objective(s): Group prenatal care models were initially designed for women with medically low risk pregnancies, and early outcome data focused on these patient populations. Pregnancy outcome data for women with medically high-risk pregnancies participating in group prenatal care is needed to guide clinical practice. This study compares rates of preterm birth, low birthweight, and neonatal intensive care unit admissions among women with medical risk for poor birth outcomes who receive group vs. individual prenatal care. Study Design: This retrospective cohort study uses vital statistics data to compare pregnancy outcomes for women from 21 obstetric practices participating in a statewide expansion project of group prenatal care. The study population for this paper included women with pregestational or gestational hypertension, pregestational or gestational diabetes, and high body mass index (BMI >45). Patients were matched using propensity scoring, and outcomes were compared using logistic regression. Two levels of treatment exposure based on group visit attendance were evaluated for women in group care: any exposure (1 or more groups) or minimum threshold (≥ 5 groups). Results: Participation in group prenatal care at either treatment exposure level was associated with a lower risk of NICU admissions (10.2% group vs 13.8% individual care, OR 0.708, p<0.001). Participating in the minimum threshold of groups (≥5 sessions) was associated with reduced risk of preterm birth (11.4% group vs. 18.4% individual care, OR 0.569, p<0.001) and NICU admissions (8.4% group vs. 15.9% individual care, OR 0.483, p<0.001). No differences in birthweight were observed. Conclusion: This study provides preliminary evidence that women who have or develop common medical conditions during pregnancy are not at greater risk for preterm birth, low birthweight, or NICU admissions if they participate in group prenatal care. Practices who routinely exclude patients with these conditions from group participation should reconsider increasing inclusivity of their groups.

Bariatric Surgery—from the Non-surgical Approach to the Post-Surgery Individual Care: Role of Endoscopy in Bariatric Therapy

Obesity is the underlying constant for the development of the most common modern diseases such as insulin resistance, high blood pressure, lipid metabolism disorders, non-alcoholic steatohepatitis (fatty liver), joint problems and various malignancies. The role of endoscopic diagnostic and therapy in obese patients is highlighted in this chapter. In this chapter all devices and methods used in flexible endoscopy for diagnostic and treatment in obese patients are introduced. Role of endoscopy is presented in three parts: in preoperative setting, in post-operative complication management and instead of surgery as endoscopic bariatric therapy. If possible presentation of the effectiveness is compiled with study data. Finally, the interaction between endoscopy and surgery in the treatment of obesity is complex, essential and promising. Endoscopy is indispensable in preoperative preparation, as a primary therapeutic approach, and also in the detection and treatment of acute complications and long-term complications of obesity surgery.

Care precarity among older British migrants in Spain

Northern European international retirement migrants are often viewed as affluent and use migration as a route to a better quality of life. However, as these migrants transition into the ‘fourth age’, the onset of age-related illnesses, frailty and care needs can lead to increased levels of risk and insecurity. Through 34 qualitative interviews with older British migrants in Spain, the paper explores how these migrants access and experience care as they age. It draws on a lens of precarity that allows an understanding not only of individual care needs, but of the political, economic and social context in which they are situated, including social protections and public safety nets. The findings suggest that distant family relationships and limited access to formal social protection can both create and exacerbate precarity. These older migrants therefore develop different strategies to access care that include drawing on informal relationships and voluntary organisations within the British community in Spain. The paper contributes to understanding how international retirement migrants manage their care needs, and theoretically extends our understanding of how the intersection of old age, migration and care can create new forms of precarity.