Factors Predicting Removals of the Levonorgestrel-Releasing Intrauterine System in an Adolescent Cohort.

OBJECTIVE: Use of 52-mg levonorgestrel intrauterine system (LNG-IUS) in adolescents for heavy menstrual bleeding (HMB), dysmenorrhea, and contraception has increased, yet little is known about the factors predicting removal and dissatisfaction in adolescents. The aim of this study was to identify factors predicting LNG-IUS removal in adolescents. METHODS: This was a retrospective cohort study including all adolescents (9-19 years) who underwent LNG-IUS insertion between 2012 and 2021 (n = 536). A medical record review was conducted and data were collated on medical and gynecological history, age, indications for insertion, complications, expulsions, and removals. The data were analyzed using χ2 tests. RESULTS: Indications for LNG-IUS insertions (n = 536) among 517 individual patients (n = 517) included menstrual management (n = 142), HMB alone (n = 118), HMB and pelvic pain/dysmenorrhea (n = 105), dysmenorrhea/pelvic pain alone (n = 47), and contraception (n = 16). Associated diagnoses included intellectual disability (44.29%, 229/517), chronic pain conditions (12.77%, 66/517), and additional mental health concerns (24.37%, 126/517). Patient dissatisfaction with LNG-IUS led to removal in 61 (11.38%), mostly for pain or persistent bleeding. Higher removal rates occurred in those with associated chronic pain conditions (46.97%, χ2 = 55.9, P < .05), mental health concerns (16.67%, χ2 = 5.06, P < .05), and bleeding disorders (26.32%, χ2 = 5.09, P < .05). Among the cohort with an intellectual disability, lower rates of removal occurred (5.7%, χ2 = 11.2, P < .05). Whereas the LNG-IUS removal rate among gender-diverse youth was 23.07%, this was not statistically significant. Younger age was also not associated with a statistically significant increase in removals (13.72%, χ2 = 0.73, P > .05). DISCUSSION: Adolescents have a low dissatisfaction and removal rate (11.38%) of LNG-IUS. Chronic pain, bleeding tendency, and mental health concerns are associated with higher removal rates and intellectual disability with lower rates. These findings are useful in counselling patients and families about LNG-IUS.

Intimate partner violence education in Australian medical schools: has anything changed?

OBJECTIVES: To describe current intimate partner violence (IPV) education delivery to Australian medical students, and the barriers influencing this delivery, including any changes in the quantity and nature of IPV education delivery since 2010. METHODS: A cross-sectional analysis of Australian medical schools providing primary medical degrees was conducted by identifying one staff member, from each of the disciplines of general practice, obstetrics and gynaecology, paediatrics, and where necessary, medical education, to complete an online survey. RESULTS: Sixteen of the 17 medical schools provided IPV education, typically within the general practice or obstetrics and gynaecology curriculum. The median contact hour range was 3-6 hours. Key barriers included time constraints and resource shortages. The overall response rate was 89.5%. CONCLUSION: Most Australian medical students receive limited IPV education and there is substantial variability in the depth and content of education. The proportion of medical schools providing education and the number of contact hours has only slightly increased. IMPLICATIONS FOR PUBLIC HEALTH: Effective identification and management of IPV by healthcare providers can significantly improve health outcomes for victims and training in IPV may improve attitudes, knowledge and clinical skills. The need to provide more consistent and comprehensive IPV training for future doctors remains, and it is feasible to include integrated IPV education programs within a crowded medical curriculum.

Postoperative discomfort after implant placement according to the All-on-4 concept with or without Zygoma implants: A prospective clinical study.

OBJECTIVES: The purpose of the study was to assess patients' postoperative discomfort after implantations according to the All-on-4 concept with and without using Zygoma implants. MATERIAL AND METHODS: Three treatment groups were formed for this prospective study: All-on-4 rehabilitation in the maxilla (group 1, N = 25), All-on-4 rehabilitation in the maxilla using at least two Zygoma implants (group 2, N = 25), and All-on-4 rehabilitation in the mandible (group 3, N = 20). Principal outcome parameters were postoperative pain (100 mm VAS) and perceived swelling (100 mm VAS). Also, the use of analgesics was documented. RESULTS: The worst postoperative pain of 21.3 (SD 18.9) VAS was observed in group 2, but there was no statistically significant difference between the groups (mixed ANOVA p = .791). The postoperative total intake of painkillers was significantly higher in group 2 than in the other groups (p < .001). On postoperative day 28, the mean pain scores in all groups declined to values below 5 VAS. Postoperative perceived swelling in group 2 was significantly more severe than it was in group 1 and 3 (p < .001). CONCLUSIONS: The use of Zygoma implants in All-on-4 surgical interventions had an essential effect on postoperative swelling, but less so on postoperative pain. The slightly increased, but statistically not significantly different postoperative pain in group 2 was compensated by an overall higher postoperative intake of painkillers compared to the other groups.

Biofilm inhibition by an experimental dental resin composite containing octenidine dihydrochloride.

OBJECTIVES: The aim of the present study was to investigate an antimicrobial additive containing experimental resin composite with regards to its impact on biofilm formation under oral conditions. METHODS: Biofilms were established in situ on composite specimens (n=192) which contained octenidine dihydrochloride (ODH, 3 wt.% or 6 wt.%). Samples without antimicrobial additive served as control (n=96). Composite specimens were fixed on custom made splints and exposed to the oral cavity of six healthy volunteers for three or seven days. Biofilm formation was assessed by scanning electron microscopy (SEM) and fluorescence microscopy (FM). RESULTS: The biofilm formation was significantly reduced on ODH containing samples compared to controls after three as well as after seven days in situ. FM evaluation additionally showed a lower viability of the reduced biofilms for both ODH concentrations. SIGNIFICANCE: During this short term investigation, incorporation of ODH into resin based composite materials caused biofilm inhibiting effects in situ.

Pulse-duration dependency of femtosecond laser refractive index modification in poly(methyl methacrylate).

Refractive index modification of pure poly(methyl methacrylate) (PMMA) is investigated as a function of pulse duration using femtosecond lasers at 800 and 387 nm wavelength. It is observed that at 800 nm, the refractive index is modified more efficiently as the pulse duration decreases below 100 fs, whereas at 387 nm, efficient index modification is accomplished with longer, 180 fs pulses. Results suggest that three- and two-photon absorption is responsible for modification of pure PMMA at 800 nm and 387 nm, respectively. Repeated irradiation with short pulses of low laser fluence allows control of the photomodification via incubation, thus reducing bulk damage.

Photochemistry of refractive index structures in poly(methyl methacrylate) by femtosecond laser irradiation.

Femtosecond, subablation threshold photomodification of poly(methyl methacrylate) (PMMA) at 387 nm is explored to enable fabrication of optical components. Volatile fragment analysis (thermal desorption gas chromatography-mass spectrometry) and molecular weight distribution monitoring (size exclusion chromatography) suggest photochemical modification, involving direct cleavage of the polymer backbone and propagation via chain unzipping under formation of monomers, similar to the pyrolytic degradation of PMMA. Waveguides were produced in undoped, clinical-grade PMMA, showing an increased refractive index in the laser focal region (Dnmax=4x10(-3)).