Using Protection Motivation Theory to develop a survey of over-the-counter decision-making by older adults.

BACKGROUND: Older adults (aged 65+) are responsible for 30% of the over-the-counter (OTC) medication use in the US. Each year, over 175,000 older adults are hospitalized due to OTC-related adverse drug events (ADEs). A major barrier to improving OTC use has been the dearth of actionable research on factors that affect older adult decision-making during OTC selection. Risk perception and health literacy are two such factors known to impact health behavior. However, to date no studies have characterized risk perceptions of OTCs nor how they relate to health literacy in the decision-making processes of older adults. OBJECTIVE: This paper presents the development and validation of a survey instrument to measure older adults' risk perception toward over-the-counter medications. The survey also explores the relation of risk perception to health literacy efficacy. METHODS: The Protection Motivation Theory (PMT) and the Tripartite Risk Perception Model (TRIRISK model) formed the basis for conceptualizing relationships between this study's constructs of interest. The utility of the PMT and the TRIRISK model in the context of OTC medication safety was tested in a survey of 103 older adults; exploratory factor analysis (EFA) and Spearman's correlation coefficients were used to test construct validity. RESULTS: The EFA yielded a 4-factor model of protection motivation, which included deliberative risk perception, emotional risk perception, perceived threat severity, and perceived coping efficacy. The EFA-based item reduction resulted in a final 14-item OTC Protection Motivation survey. CONCLUSION: The survey generated through this study is a tool for characterizing older adult risk perceptions of OTCs. The development of a measure of OTC risk perceptions is a promising step toward designing and evaluating patient-centered interventions to improve older adult medication safety.

Correction of Secondary Alveolar Clefts with Iliac Bone Grafts.

INTRODUCTION: Cleft lip and palate deformities are one of the most common birth defects. The alveolar cleft requires bony repair to allow proper eruption of dentition. The purpose of this study is to evaluate success in the repair of alveolar clefts with iliac bone grafts. AIM: The aim of this study is to restore the function and form of both arches with a proper occlusal relationship and eruption of tooth in the cleft area. SUBJECTS AND METHODS: Five patients were selected irrespective of sex and socioeconomic status and whose age was within the mixed dentition period. The iliac crest is grafted in the cleft area and subsequently evaluated for graft success using study models, periapical, and occlusal radiographs. RESULTS: At the time of evaluation, teeth were erupted in the area and good alveolar bone levels were present. Premaxilla becomes immobile with a good arch form and arch continuity. There are no major complications regarding pain, infection, paresthesia, and hematoma formation at donor site without difficulty in walking. There is no complication regarding pain, infection, exposure of graft, rejection of graft, and wound dehiscence at the recipient site except in one case. CONCLUSIONS: Long-term follow-up is required to achieve maximum advantage of secondary alveolar grafting; the age of the patient should be within the mixed dentition period, irrespective of sex and socioeconomic status. It may be unilateral or bilateral.

Regional and seasonal variations in ultraviolet B irradiation and vitamin D synthesis in India.

UNLABELLED: Evaluation of ultraviolet B index (UVBI) and its impact on vitamin D synthesis is important. We observed the maximum UVBI between 11 am and 1 pm. There was no increase in serum 25(OH)D levels following sun exposure during winter as the UVBI was significantly low, emphasizing the need for vitamin D supplementation during these months. INTRODUCTION: The amount of vitamin D3 synthesizing UVB irradiation (290-320 nm) reaching the earth's surface at different altitudes and seasons in different parts of India and it's impact on vitamin D synthesis has not been well studied. METHODS: The hourly UVB index (UVBI) from 10 am to 3 pm everyday for 12 months was measured by a solar meter in 4 different zones (North, Northeast, West and South) of the country. To study the impact of sun light exposure on vitamin D synthesis during winter, healthy school children aged 10-15 years were exposed to sunlight for a period of 30 min per day, between 11 am to 12 noon with 10 % body surface area, for 4 weeks. The main outcome measures were serum 25(OH)D, PTH, calcium, phosphate, and alkaline phosphatase levels before and after sun exposure. RESULTS: The mean UVBI was highest between 11 am and 1 pm throughout the year in all locations. The highest UVBI was recorded from the North zone (4.5 ± 2.7 µW/Cm(2)), while the least was recorded in the Northeast zone (2.1 ± 1.2 µW/Cm(2)). UVBI readings in the Northeast zone were consistently low throughout the year, while all the other three zones showed significant seasonal fluctuations. Surprisingly, we observed a significant decrease in serum 25(OH)D levels from baseline (6.3 ± 4.6 to 5.1 ± 2.7 ng/mL; p < 0.001) despite sun exposure. CONCLUSION: The mean UVBI was highest between 11 am and 1 pm throughout the year in all locations. No increase in the serum 25(OH)D levels was observed following sun exposure in winter, emphasizing the need for vitamin D supplementation during these months.