Surgical Management of Missed Pediatric Monteggia Fractures: A Systematic Review and Meta-Analysis.

OBJECTIVES: To review surgical management and outcomes of missed pediatric Monteggia fractures. DATA SOURCES: A systematic review was conducted using PubMed, Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library from inception through March 2, 2020. The keywords were "Monteggia fracture," "missed Monteggia," "neglected Monteggia," "chronic Monteggia," and "chronic radial head dislocation." STUDY SELECTION: All original human studies on missed pediatric Monteggia fractures were included. Congenital Monteggia fractures and isolated radial head dislocations were excluded. DATA EXTRACTION: The revised Methodological Index for Nonrandomised Studies tool was used to assess the quality of studies. DATA SYNTHESIS: Each patient's data were retrieved individually. The χ2 test and Fisher exact test were used to analyze the difference in outcomes for different surgical managements. Multivariate analysis was performed for variables that were significant on univariate analysis. CONCLUSIONS: Thirty studies with 600 patients were included. Proximal ulnar osteotomies (P = 0.016) and the absence of transcapitellar pinning (P = 0.001) were the most significant predictors for eventual reduction of radial head. Other surgical management variables were not significant predictors. These include open or closed reduction approach of radial head reduction; presence or absence of ulnar osteotomy; presence or absence of lengthening, angular correction, overcorrection, or bone grafting of ulnar osteotomy; type of fixation for ulnar osteotomy; presence or absence of radial osteotomy; presence or absence of annular ligament repair or reconstruction; and repair or reconstruction of annular ligament. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Association between pet ownership and physical activity and mental health during the COVID-19 "circuit breaker" in Singapore.

INTRODUCTION: The negative impact of the coronavirus disease 2019 (COVID-19) pandemic on mental health and physical activity is well reported. While prior studies showed a positive influence of pet ownership on physical activity and mental health, the interactions between the pandemic and pet ownership are not well studied. OBJECTIVE: To determine the association between pet ownership, physical activity levels and mental health during the COVID-19 pandemic. MATERIALS AND METHODS: A cross-sectional study was conducted from May 19 to July 13, 2020 among Singapore residents aged 21 to 64 years through a previously published questionnaire. Inverse probability treatment weighting was used to develop mixed-effects models for outcome comparisons. We recorded participant data on pet ownership, duration and intensity of physical activity, and RAND 36-item Health Survey mental health domains during the COVID-19 pandemic. RESULTS: The questionnaire was completed by 431 pet owners and 103 non-pet owners. A greater proportion of pet owners were female, non-married, employed and owned pets in the past. Pet owners reported 31.8 (95% CI 13.6 to 50; p = .001) more minutes per week of mild-intensity physical activity compared to non-pet owners. No statistically significant differences were found for moderate- and vigorous-intensity physical activity. Pet owners had better emotional well-being (ꞵ = 9.66, 95% CI 4.97 to 14.4; p < .001), energy (ꞵ = 8.29, 95% CI 3.46 to 13.1; p = .001) and social functioning (ꞵ = 11.2, 95% CI 5.03 to 17.4; p < .001) scores than non-pet owners. However, no statistically significant difference was observed for general health scores. Pet owner physical activity levels, general health, emotional well-being and energy scores correlated positively with pet attachment scores. CONCLUSION: Pet ownership was associated with greater physical activity levels and better mental health, particularly in main caregivers with higher pet attachment scores. These findings suggest that pet ownership is beneficial to physical and mental well-being during periods of social isolation amidst a global pandemic.

The impact of death and dying on the personhood of medical students: a systematic scoping review.

BACKGROUND: The re-introduction of medical students into healthcare systems struggling with the COVID-19 pandemic raises concerns as to whether they will be supported when confronted with death and dying patients in resource-limited settings and with reduced support from senior clinicians. Better understanding of how medical students respond to death and dying will inform educationalists and clinicians on how to best support them. METHODS: We adopt Krishna's Systematic Evidence Based Approach to carry out a Systematic Scoping Review (SSR in SEBA) on the impact of death and dying on medical students. This structured search process and concurrent use of thematic and directed content analysis of data from six databases (Split Approach) enhances the transparency and reproducibility of this review. RESULTS: Seven thousand six hundred nineteen were identified, 149 articles reviewed and 52 articles included. The Split Approach revealed similar themes and categories that correspond to the Innate, Individual, Relational and Societal domains in the Ring Theory of Personhood. CONCLUSION: Facing death and dying amongst their patients affect how medical students envisage their personhood. This underlines the need for timely, holistic and longitudinal support systems to ensure that problems faced are addressed early. To do so, there must be effective training and a structured support mechanism.

Association between pet ownership and physical activity levels, atopic conditions, and mental health in Singapore: a propensity score-matched analysis.

Although existing literature increasingly suggests a positive influence of pet ownership on human physical activity levels, results from many European, American, and Japanese studies have been inconsistent. How pet ownership impacts mental health and atopy is likewise controversial and whether distinct demographic subgroups experience differential effects is unclear. This cross-sectional study surveyed participants (n = 823) via a self-administered online questionnaire. Comparisons of outcomes between pet owners and non-pet owners with subgroup analyses were performed within a propensity score-matched subset (n = 566) of respondents. There were no differences in physical activity levels or mental health scores between pet owners and non-pet owners. In subgroup analyses, compared to non-pet owners, main pet caregivers reported 14.1 (95% CI 2.79-25.3) and 19.0 (95% CI 4.70-33.3) more minutes per week of moderate- and vigorous-intensity physical activity respectively and higher SF-36 emotional well-being (ß = 2.7, 95% CI 0.100-5.32) and energy scores (ß = 3.8, 95% CI 0.410-7.27). Age was a significant effect modifier of the association between pet ownership and emotional well-being, energy and social functioning scores, with greater scores above the ages of 39, 35 and 39 years old respectively (interaction p = 0.043, 0.044, 0.042). Finally, pet acquisition was associated with worsening of allergic rhinitis, while pet ownership cessation was associated with improvement of allergic rhinitis and eczema symptoms. To our knowledge, this is the first study addressing the public health impact of pet ownership in Southeast Asia and its findings add contextual nuance to suggest potential benefits derived from pet ownership.