The relationship between orthodontic and orthopaedic interventions in the influence of postural position on the bite.

OBJECTIVE: In orthodontic treatment, the influence of posture on the bite plays a significant role in achieving stable results. With modern lifestyles, posture problems are becoming more common. The aim of this study was to comprehensively analyze the relationship between orthodontics, orthopedics, and the influence of posture on bite. The study reviewed statistics on the growth and popularity of orthodontic treatment methods and identified the importance of a comprehensive medical approach, especially for concomitant spine, posture, and flat feet problems. METHODS: The following methods were used to achieve the objective: collection and analysis of statistical data on the popularity of orthodontic treatment; review of studies; clinical observations; and a comparative analysis of the effectiveness of different treatment methods. RESULTS: The study revealed a high degree of correlation between orthodontics, orthopedics, and the effect of posture on bite formation. A detailed analysis of the statistical data confirmed the increased interest in orthodontic treatment, including the use of modern technologies such as braces and eliners. This relevance is particularly noticeable in cases where there are concomitant problems with the spine, posture, and flat feet. CONCLUSION: One of the significant findings of the study was the confirmation of the urgent need for the convergence of orthodontic and orthopedic techniques to optimize the quality of care for patients suffering from combined posture and bite problems.

Generative AI in Medical Practice: In-Depth Exploration of Privacy and Security Challenges.

As advances in artificial intelligence (AI) continue to transform and revolutionize the field of medicine, understanding the potential uses of generative AI in health care becomes increasingly important. Generative AI, including models such as generative adversarial networks and large language models, shows promise in transforming medical diagnostics, research, treatment planning, and patient care. However, these data-intensive systems pose new threats to protected health information. This Viewpoint paper aims to explore various categories of generative AI in health care, including medical diagnostics, drug discovery, virtual health assistants, medical research, and clinical decision support, while identifying security and privacy threats within each phase of the life cycle of such systems (ie, data collection, model development, and implementation phases). The objectives of this study were to analyze the current state of generative AI in health care, identify opportunities and privacy and security challenges posed by integrating these technologies into existing health care infrastructure, and propose strategies for mitigating security and privacy risks. This study highlights the importance of addressing the security and privacy threats associated with generative AI in health care to ensure the safe and effective use of these systems. The findings of this study can inform the development of future generative AI systems in health care and help health care organizations better understand the potential benefits and risks associated with these systems. By examining the use cases and benefits of generative AI across diverse domains within health care, this paper contributes to theoretical discussions surrounding AI ethics, security vulnerabilities, and data privacy regulations. In addition, this study provides practical insights for stakeholders looking to adopt generative AI solutions within their organizations.

What do health care professionals, students, and laypeople in Greece believe about informed consent for research on medical practices? Unleashing Pandora's box.

Background: Attitudes toward informed consent for research on medical practices has been little investigated in Greece in the general population as well as in health care students and professionals, and at the same time, undergraduate and postgraduate curricula with focus on informed consent issues are entirely missing. Methods: To explore attitudes toward informed consent for research on medical practices among students, doctors, and laypeople in Greece across several demographic variables. A total of 380 participants (180 first-year healthcare university students from various faculties including medicine, pharmacy, biology, nursing, physiotherapy, midwifery, health care engineers, 100 medical doctors of various specialties working in hospitals and private practice, and 100 laypeople) completed a survey questionnaire along with a detailed demographics questionnaire. Results: The results revealed that between the three groups, there were statistically significant differences in the responses for all aspects of attitudes toward informed consent. Overall, Greek participants reported more negative attitudes when compared with findings from the United States. In addition, most of the participants reported lack of educational experience regarding informed consent. Conclusion: The findings showed that the efforts and relevant initiatives by the Greek State, private institutions, and the Greek Medical Societies should refocus and emphasize on educational programs concerning the dissemination of relevant scientific information on informed consent processes, either as a provider or as a consumer. Future research should further investigate in more depth the complex influence of additional social and/or psychological factors for the reported differences.

Physician Ownership for the Virtuous Practice of Medicine.

The shift from physicians as owners or shareholders of practices to being employees of corporations is now a widespread trend with over 50% of physicians now considered employees. If continued, this trend will have profound effects on the medical profession and on physicians' personal lifestyles and sense of agency. However, ownership is not a morally neutral consideration but is important for safeguarding the traditions of virtue in the medical profession. Virtue develops within localized communities of practice and thrives in settings that embody principles such as solidarity, subsidiarity, and participation found in Catholic social teaching. Ownership increases physicians' investment in moral communities where they practice, affording physicians greater agency to benefit these communities according to their best judgment. This ownership can vary by type of organization and degree of shareholding. Because moral communities are the settings in which physicians form virtue, and ownership increases physicians' commitment and investment in communities, I make a principled argument that physicians who value developing virtue should consider having ownership of their practices when planning their careers. Ownership will be an important aspect of any medical ethics based on virtue rather than on principlism.

Impact of COVID-19 on Surgical Interventions and Medical Practices in Pediatric Otolaryngology: A Narrative Review.

The novel coronavirus disease 2019 (COVID-19) pandemic has become a major public health challenge. All types of elective and semi-urgent medical care and procedures have been discontinued during the pandemic to maintain the capacity to care for patients with this disease. The pandemic has had a significant impact on almost every medical field, including pediatric otolaryngology. This review highlights the impact of COVID-19 on surgical interventions and medical practices in pediatric otolaryngology owing to its direct association with ear, nose, and throat disorders, with an emphasis on immediate and potential long-term transformations in clinical practice. We reviewed several articles and scientific websites and summarized the currently available evidence and best practices for safety in the field of otolaryngology during the COVID-19 pandemic. Extensively discussed issues in pediatric otolaryngology include surgical interventions, medical practices, modes of transmission of COVID-19, personal protective equipment, and duration of exposure. Otolaryngologists should preserve their integrative medical approaches and subspecialty expertise during the COVID-19 pandemic. There has been a marked change in the approach to managing pediatric ear, nose, and throat conditions, both in the outpatient department and operating room, during the COVID-19 pandemic. The pandemic requires a great deal of flexibility and necessitates exploring new opportunities to create a safe and patient-friendly environment for children with otolaryngology problems. Many of the precautions implemented will remain necessary until a robust evidence shows the pandemic has come to an end.

O trânsito de plantas: circulação de saberes e práticas médicas na América Meridional durante a Época Moderna / The transit of plants: circulation of medical knowledge and practices in South America during the Modern Era

Resumo A partir dos registros sobre plantas e ervas de médicos, agentes de cura, missionários, administradores coloniais nos séculos XVII e XVIII, o artigo explora as formas de construção do conhecimento sobre a flora, utilizando o conceito de circulação proposto por Kapil Raj. As experiências distintas e os documentos analisados demonstram o processo de observação, coleta, sistematização e circulação do conhecimento e a influência da história natural e da tradição hipocrática na classificação das ervas e plantas e na descrição adotada nos textos reunidos neste artigo. Desde livros impressos até anotações dispersas em diários de viagens, os usos das espécies para a vida humana foi o elemento valorizado por aqueles que observaram diretamente o potencial de plantas, frutos e ervas americanas.

Abstract From records on plants and herbs made by doctors, healers, missionaries, and colonial administrators in the seventeenth and eighteenth centuries, this article explores ways of constructing knowledge about flora using the concept of circulation proposed by Kapil Raj. The distinct experiences and documents analyzed demonstrate the process of observing, collecting, systematizing, and circulating knowledge, and the influence of natural history and the Hippocratic tradition on the classification of herbs and plants and on the descriptions adopted in these texts. From printed books to notes scattered through travel diaries, usefulness of these species to humankind was the element valued by those who directly observed the potential of American plants, fruits, and herbs.

A biography of Dr Carl Bodon: Pioneer of intracardiac injection of adrenaline.

This biographical essay will provide historical insights about Dr Carl Bodon who performed one of the first successful intracardiac injections of adrenaline to a patient and made important contributions to the understanding of cardiac diseases and women's health. Dr Bodon's biography reveals the story of a medical doctor who lived during tumultuous times between two world wars and ultimately died in the Holocaust. His story sheds light on forgotten contributors to the medical field and its practices.

Effects of implementing a postabortion care strategy in Kinshasa referral hospitals, Democratic Republic of the Congo.

OBJECTIVES: To evaluate the effects of the implementation of a postabortion care (PAC) strategy in Kinshasa referral hospitals, this study analyzed the quality of postabortion care services, including postabortion contraception, and the duration of hospitalization. METHODOLOGY: We estimated the effects of the PAC strategy using a quasi-experimental study by evaluating the outcomes of 334 patients with the diagnosis of a complication of induced abortion admitted to 10 hospitals in which the PAC strategy was implemented compared to the same outcomes in 314 patients with the same diagnosis admitted to 10 control facilities from 01/01/2016 to 12/31/2018. In response to government policy, the PAC strategy included the treatment of abortion complications with recommended uterine evacuation technology, the family planning counseling and service provision, linkages with other reproductive health services, including STI evaluation and HIV counseling and/or referral for testing, and partnerships between providers and communities. The information was collected using a questionnaire and stored using open data kit software. We supplemented this information with data abstracted from patient records, facility registries of gynecological obstetrical emergencies, and family planning registries. We analyzed data and developed regression models using STATA15. Thus, we compared changes in use of specific treatments and duration of hospitalization using a "difference-in-differences" analysis. RESULTS: The implementation of PAC strategy in Kinshasa referral hospitals has resulted in the utilization of WHO recommended uterine evacuation method MVA (29.3% more in the experimental structures, p = 0.025), a significant decline in sharp-curettage (19.3% less, p = 0.132), and a decline in the duration of hospitalization of patients admitted for PAC (1 day less, p = 0.020). We did not observe any change in the use of PAC services, mortality, and the provision of post abortion contraception. CONCLUSION: Despite significant improvement in the management of PAC, the uptake in WHO approved technology-namely MVA, and the duration of hospitalization, these outcomes while a significant improvement for DRC, indicate that additional quality improvement strategies for management of PAC and risk-mitigating strategies to reduce barriers to care are required.

Antecedents of Individuals' Concerns Regarding Hospital Hygiene and Surgery Postponement During the COVID-19 Pandemic: Cross-sectional, Web-Based Survey Study.

BACKGROUND: The COVID-19 pandemic poses a major challenge to people's everyday lives. In the context of hospitalization, the pandemic is expected to have a strong influence on affective reactions and preventive behaviors. Research is needed to develop evidence-driven strategies for coping with the challenges of the pandemic. Therefore, this survey study investigates the effects that personality traits, risk-taking behaviors, and anxiety have on medical service-related affective reactions and anticipated behaviors during the COVID-19 pandemic. OBJECTIVE: The aim of this study was to identify key factors that are associated with individuals' concerns about hygiene in hospitals and the postponement of surgeries. METHODS: We conducted a cross-sectional, web-based survey of 929 residents in Germany (women: 792/929, 85.3%; age: mean 35.2 years, SD 12.9 years). Hypotheses were tested by conducting a saturated path analysis. RESULTS: We found that anxiety had a direct effect on people's concerns about safety (ß=-.12, 95% CI -.20 to -.05) and hygiene in hospitals (ß=.16, 95% CI .08 to .23). Risk-taking behaviors and personality traits were not associated with concerns about safety and hygiene in hospitals or anticipated behaviors. CONCLUSIONS: Our findings suggest that distinct interventions and information campaigns are not necessary for individuals with different personality traits or different levels of risk-taking behavior. However, we recommend that health care workers should carefully address anxiety when interacting with patients.

The role of alternative and complementary medical practices in vaccine hesitancy among nurses: A cross-sectional survey in Brittany.

INTRODUCTION: Given today's increasing calling into question of vaccination, we have studied possible connections between alternative and complementary medical practices (CAM) and vaccine hesitancy (VH) among nurses. METHOD: Ours was a cross-sectional study by self-administered online questionnaire addressed to a panel of nurses in Brittany. After adjustment for other proximal and distal determinants of VH, we examined the impact of CAM use. RESULTS: Multivariate logistic regressions confirmed the existence of a link between CAM and VH. While trust in medical institutions seems to have an important role, CAM use appears largely independent of VH. CONCLUSION: Association between CAM and VH in nurses raises the question not only of their training with respect to these alternative practices, but also of the role of medical institutions in the training of practitioners availing themselves of the latter.

Sobre médicos, piaches y teguas: Una historia particular de la persecución, expropiación y transculturación de la medicina prehispánica en el Virreinato Del Nuevo Reino de Granada durante la conquista y la colonia / On Doctors, Piaches, and Quacks: A Particular History of the Persecution, Expropriation, and Transculturation of Pre-Hispanic Medicine in the Viceroyalty of the New Kingdom of Granada during the Conquest and the Colony

Resumen Los procesos que se llevaron a cabo luego del contacto de los pueblos originarios con el conquistador español, en términos de saberes médicos en el territorio conocido como Virreinato de Nueva Granada, influyeron en las relaciones de conquistador-conquistado en procesos como la estigmatización y persecución de saberes ancestrales, las diversas formas de transculturación y el proceso de expropiación de algunos elementos de la cultura prehispánica.

Abstract The processes that took place after the contact of the original peoples with the Spa nish conqueror, in terms of medical knowledge, in the territory known as the Viceroyalty of New Granada, influenced the relations of conqueror-conquered in processes, such as the stigmatization and persecution of ancestral knowledge, the various forms of transculturation, and the expropriation process of some elements of pre-His panic culture.

[Osteoporosis treatment in patients over 75 years old with fractures living in nursing home]. / Prise en charge de l'ostéoporose fracturaire chez les patients de plus de 75 ans vivant en institution.

OBJECTIVE: Recommendations for the management of major fractures in institutionalized patients over 75 years old were updated by the GRIO (French group for research and information on osteoporosis) in 2012 and in 2018. This study is an evaluation of practices in osteoporosis management in institutionalized old patients. METHODS: Evaluation of diagnostic and therapeutic management in medical observations of all residents over 75 years old with a history of major fracture in 4 nursing homes. RESULTS: 105 residents were included with the prevalence of osteoporosis fracture of 32.1%. The most common fractures were hip fractures (60.9%) and vertebral fracture (45.8%). Treatments were: calcium supplementation (14.3% of residents), vitamin D (52.4%), rehabilitation (70.5%) and specific treatment (biphosphonates 11.4%). Complete management (calcium supplementation, vitamin D, physical activity and osteoporosis treatment) was found in 5 residents (4.7%). Few factors were related to complete treatment initiation. Residents initially managed in medicine departments were more treated than those in surgical wards (25.0 vs 6.5%; p = 0.0144) rather than those managed by specialists (rheumatologist or geriatrician: 8 vs 4; p < 0.001). Creatinine clearance was significantly higher in residents with calcium supplementation (52.7 ± 27.9 vs 39.1 ± 9.6; p = 0.0505). Regimen number tend to be higher in residents receiving vitamin D (8.9 ± 2.7 vs 6.7 ± 3.4; p = 0.0753). CONCLUSION: This evaluation of professional practices showed that only a minority of residents received complete anti-osteoporotic treatment despite their risk factor for fracture recurrence. Such an evaluation should be systematic at the entry in nursing home, given the number of falling residents.

A good "doctor" is hard to find: Assessing uncredentialed expertise in assisted injection.

This article examines how laypeople assess uncredentialed expertise in a high-risk practice: assisted injection, in which one person injects another with illicit drugs. In metropolitan areas in the US, about 2.3% of the population injects illicit drugs. Injection assistance is common and recipients of injection assistance are at high-risk for injury, overdose, and infection. Yet little is known about how injection recipients attempt to reduce these risks by assessing their injection provider's expertise. Drawing on ethnographic observations and interviews from 2015 to 2018 with 59 people who inject drugs in San Francisco, California, this article examines how people who need injection assistance assess injection provider expertise. It finds that people use an informal hierarchized decision-tree approach of three measures of trust to assess expertise: strong personal ties, referrals, or professional rhetoric. Using measures of trust to assess expertise minimizes some forms of risk by increasing the chance that injection providers are motivated to help them. However, this strategy offers little protection against technically unskilled providers. Moreover, it may increase health risks because people employ few self-protective strategies in trust-based relationships. This research offers new insights for theorization on expertise and trust in social contexts where high-risk skills are in demand. This approach also has implications for public health research and interventions for reducing risks related to lay medical practices, particularly those in assisted injection.

Pattern of Care and Outcomes of Adolescent and Young Adults with Lymphoma Treated in the Rhône-Alpes Region.

Background: Management of adolescent and young adults (AYAs) cancer is very heterogeneous. In the case of lymphomas, outcomes are mostly favorable but there is still room for improvement. Design: We retrospectively collected the pattern of care of all institutional 13- to 25-year-old AYAs patients with classical Hodgkin lymphoma (HL) or non-Hodgkin lymphoma (NHL) diagnosed in the Rhône-Alpes region between the years 2000 and 2005. Management, including adherence to Clinical Practice Guidelines (CPGs), and long-term survival were analyzed by comparing adult units (AU) and pediatric units (PU). Results: 278 patients were included: 198 treated for HL (median age of 19 years), 80 treated for NHL (median age of 20 years). Among them, 74% were managed in AU and 26% in PU. The median time between diagnosis and starting treatment was significantly lower in PU than in AU. Sixty-five patients (23%) were included in clinical trials, mostly in AU. Five-year overall survival was 96% for HL [14 deaths, median follow-up 91 months (9-180)] and 90% for NHL [nine deaths, median follow-up 80 months (3-180)]. Secondary cancers occurred for 2% (n = 3) of HL patients and for none in NHL. Other major late complications included cardiovascular accidents in two patients and fatal pulmonary fibrosis in one patient. Major differences in chemotherapy and radiotherapy use are emphasized. Global management conformed to CPGs by 56%. Conclusions: Important differences between adult and pediatric management were reported, without any impact on survival. A few patients can be included in clinical trials: Homogeneity in management could improve specific care for AYAs.

Management and outcomes of cardiac arrests at nursing homes: A French nationwide cohort study.

BACKGROUND: The incidence of cardiac arrest (CA) in nursing homes is rising. Our objective was to compare nursing home CAs with at-home CAs in patients aged 65 and over with regard to the CAs' characteristics, the use and characteristics of cardiopulmonary resuscitation (CPR), and the outcome. METHODS: We performed an ancillary analysis of a French nationwide cohort of over-65 patients having experienced an out-of-hospital CA (at home or in a nursing home) treated by a physician-manned mobile intensive care unit (MICU) between July 2011 and September 2015. RESULTS: Out of 21,720 CAs, 1907 (9%) occurred in a nursing home. The presence of a witness was more frequent in the nursing home than at home (77% vs. 62%, respectively; p < 0.001) and bystander-initiated CPR was more frequent (62% vs. 34%, respectively; p < 0.001). CPR by a MICU was less likely in the nursing home than at home - even after adjustment for the patients' and CAs' characteristics (adjusted odds ratio (aOR) [95% confidence interval] = 0.49 [0.42-0.57]). A return of spontaneous circulation was less frequent in the nursing home than at home (14% vs. 16%, respectively; OR = 0.86 [0.75-0.99]; p = 0.03) except when CPR was performed by the MICU (31% vs. 26%, respectively; OR = 1.25 [1.07-1.47]; p = 0.005). There was no intergroup difference in the CA outcome at day 30. CONCLUSIONS: Nursing home residents who experience a CA are less likely to receive CPR from a MICU. If CPR is performed, however, the residents' prognosis is no worse than that of patients treated at home.

"You have to believe in something": Risk of psychosis and psychiatrists' beliefs in the self-fulfilling prophecy.

BACKGROUND: Psychiatric care is a fruitful setting for exploring the rise of surveillance medicine, which shapes gray zones of uncertainty between health and illness. Predicting psychosis has become a priority in the international mental health field, but French psychiatrists appear reluctant to refer their young patients for standardized assessments or disclose their risks to them. AIM: This research addressed French psychiatrists' attitudes towards risk disclosure about psychosis to adolescents presenting symptoms that might reflect either typical teenager unease or the first signs of psychosis onset. METHODS: A mixed-method design included 12 in-depth qualitative interviews followed by an online survey with responses from 487 psychiatrists. RESULTS: French psychiatrists' reluctance to engage in risk disclosure emerges from a professional norm: a belief in the self-fulfilling prophecy. They - especially those with a background in social science and psychology - believe in the optimistic self-fulfilling prophecy. They fear the consequences of pessimistic predictions, struggle to maintain functional optimism, favor long-term inconspicuous medical watchfulness, and systematically understand favorable outcomes as a consequence of medical care, independent of the accuracy of risk detection.

Changes in the Medical Cost and Practice Pattern according to the Implementation of per Diem Payment in Hospice Palliative Care / 보건행정학회지

BACKGROUND: As of July 2015, per diem payment was changed from fee for service Therefore, this study aims to analyse changes in medical charges and medical services before and after enforcement of the palliative care, targeting palliative care wards in a general hospital, and provide basic data needed for development of per diem payment. METHODS: The subjects of the study were a total of 610 cases consisting of 351 patients of service fee who left hospital (died) from July 2014 to June 2016 and 259 ones of per diem payment at Chosun University Hospital in Gwangju Metropolitan City. RESULTS: The results are summarized as follows. First, after the palliative care system was applied, benefit medical service charges and insurance increased significantly (p<0.001). As benefit medical service charges increased, benefit private insurance payment increased significantly (p<0.001). Second, after the per diem payment was applied, total private insurance payment to medical institutes decreased significantly (p=0.050) and non-benefit also decreased significantly (p=0.001). CONCLUSION: It is suggested that additional rewards in the obligatory palliative care items should be continuously remedied and monitored to provide good quality hospice palliative care.

Intersex Activists in Israel: Their Achievements and the Obstacles They Face.

This article focuses on the dynamic between the medical policy on intersex bodies and intersex activists in Israel. Recently, in many countries changes have taken place in medical guidelines regarding intersex patients and laws that regulate medical practices and prohibit irreversible surgeries for intersex babies for cosmetic reasons and without the patient's consent. In Israel, intersex activists are limited by several factors. On the one hand, they are influenced by the achievements of intersex activism around the world but on the other, the pathologizing medical discourse and socio-medical practices, which include early diagnosis, early irreversible surgeries, and secrecy surrounding intersexed bodies, present obstacles to achieving bodily autonomy for intersex individuals and social recognition of different sex development. Nevertheless, intersex activists are attempting to find different social and media spaces in which to achieve public acknowledgement and future bodily autonomy for intersexed people and seeking medical professionals' cooperation. Recently, the Israeli Ministry of Health published a new circular for intersex/DSD patients, and while it does not clearly forbid irreversible surgeries, it provides information about the complexities of intersex people and their experience.

Guidelines and best practices: remarks on the Gelli-Bianco law.

The paper's authors aim to elaborate on the innovations brought by law n. 24/2017, issued by the Italian Parliament with a close focus on art. 5, which pertains to the drafting of guidelines and the adoption of best practices. The guidelines constitute in fact an element of innovation brought by the above-mentioned law, and compliance with them can shield from possible liability those health care professionals who find themselves embroiled in professional accidents while in the fulfillment of their duties. Besides, there are several critical aspects within the law that need to be highlighted as well. As far as best practices are concerned, the lawmakers who drafted the legislation make no mention as to the standards of evidence needed in order to characterize any given professional behavior as "best practice". The reform appears unlikely to be effective in providing doctors with clear behavioral standards, thus reducing the margin for liability claims against them.