Awareness and attitudes of elderly Southeast Asian adults towards telehealth during the COVID-19 pandemic: a qualitative study.

Introduction: We aimed to understand the awareness and attitudes of elderly Southeast Asians towards telehealth services during the coronavirus disease 2019 (COVID-19) pandemic in this study. Methods: In this qualitative study, 78 individuals from Singapore (51.3% female, mean age 73.0 ± 7.6 years) were interviewed via telephone between 13 May 2020 and 9 June 2020 during Singapore's first COVID-19 'circuit breaker'. Participants were asked to describe their understanding of telehealth, their experience of and willingness to utilise these services, and the barriers and facilitators underlying their decision. Transcripts were analysed using thematic analysis, guided by the United Theory of Acceptance Use of Technology framework. Results: Of the 78 participants, 24 (30.8%) were able to describe the range of telehealth services available and 15 (19.2%) had previously utilised these services. Conversely, 14 (17.9%) participants thought that telehealth comprised solely home medication delivery and 50 (51.3%) participants did not know about telehealth. Despite the advantages offered by telehealth services, participants preferred in-person consultations due to a perceived lack of human interaction and accuracy of diagnoses, poor digital literacy and a lack of access to telehealth-capable devices. Conclusion: Our results showed poor overall awareness of the range of telehealth services available among elderly Asian individuals, with many harbouring erroneous views regarding their use. These data suggest that public health education campaigns are needed to improve awareness of and correct negative perceptions towards telehealth services in elderly Asians.

Identifying Content for an Item Bank to Measure the Quality-of-Life Impact of Myopia Refractive Interventions.

Purpose: To report on the content generation and item refinement phases for a myopia refractive intervention-specific quality-of-life (QoL) item bank that will be operationalized using computerized adaptive testing. Methods: Myopia refractive intervention-specific QoL domains and items were generated from (1) a literature search of existing refractive-intervention QoL questionnaires; (2) semistructured interviews with myopic patients corrected using spectacles, contact lenses and/or refractive surgery (n = 32); (3) and myopia experts (n = 9) recruited from the Singapore National Eye Centre. After a thematic analysis, items were systematically refined and tested using cognitive interviews with 24 additional patients with corrected myopia. Results: Of the 32 participants with myopia interviewed (mean ± standard deviation age, 35.6 ± 9.0 years; 71.9% female; 78.1% Chinese), 12 (37.5%) wore spectacles, 7 (21.9%) used contact lenses, and 20 (62.5%) had undergone laser refractive surgery. Initially, 912 items within 7 independent QoL domains were identified. After refinement, 204 items were retained, including those relating to mobility challenges and work-related difficulties that are not well-represented in current refractive intervention-specific questionnaires. Conclusions: Through a rigorous item generation and selection process, we have developed a 204-item and 7-domain myopia refractive intervention-specific item bank that will now undergo rigorous psychometric testing to generate item calibrations for the validation of a novel computerized adaptive testing instrument designed for use in research and routine clinical practice. Translational Relevance: Once psychometrically validated and operationalized using computerized adaptive testing, this myopia refractive intervention-specific instrument will enable researchers and clinicians to quickly and comprehensively assess the impact of myopic refractive interventions across seven QoL domains.

Knowledge, attitudes and practices towards COVID-19 among multiethnic elderly Asian residents in Singapore: a mixed-methods study.

Introduction: We investigated the knowledge, attitudes and practice (KAP) towards coronavirus disease 2019 (COVID-19) and its related preventive measures in Singaporeans aged ≥60 years. Methods: This was a population-based, cross-sectional, mixed-methods study (13 May 2020-9 June 2020) of participants aged ≥ 60 years. Self-reported KAP about ten symptoms and six government-endorsed preventive measures related to COVID-19 were evaluated. Multivariable regression models were used to identify sociodemographic and health-related factors associated with KAP in our sample. Associations between knowledge/attitude scores and practice categories were determined using logistic regression. Seventy-eight participants were interviewed qualitatively about the practice of additional preventive measures and data were analysed thematically. Results: Mean awareness score of COVID-19 symptoms was 7.2/10. The most known symptom was fever (93.0%) and the least known was diarrhoea (33.5%). Most participants knew all six preventive measures (90.4%), perceived them as effective (78.7%) and practised 'wear a mask' (97.2%). Indians, Malays and participants living in smaller housing had poorer mean scores for knowledge of COVID-19 symptoms. Older participants had poorer attitudes towards preventive measures. Compared to Chinese, Indians had lower odds of practising three out of six recommendations. A one-point increase in score for knowledge and attitudes regarding preventive measures resulted in higher odds of always practising three of six and two of six measures, respectively. Qualitative interviews revealed use of other preventive measures, for example, maintaining a healthy lifestyle. Conclusions: Elderly Singaporeans displayed high levels of KAP about COVID-19 and its related preventive measures, with a positive association between levels of knowledge/attitude and practice. However, important ethnic and socioeconomic disparities were evident, indicating that key vulnerabilities remain, which require immediate attention.

Associations between age-related macular degeneration and sleep dysfunction: A systematic review.

BACKGROUND: Age-related macular degeneration, a prevalent degenerative retinal disease, is associated with non-visual and psychosocial impairments that may affect sleep. In this systematic review, we evaluated associations between age-related macular degeneration (AMD) and sleep, highlighted knowledge gaps and provided evidence-based recommendations to clinicians to enable holistic management of AMD patients. METHODS: We searched PubMed, Embase and the Cochrane Central registries for papers published before May 2022. Non-English, qualitative studies and grey literature were excluded. Studies evaluating the association between AMD and sleep (including sleep disorders like insomnia and sleep apnea), and vice versa, were included. The quality of shortlisted studies was evaluated using the Newcastle Ottawa Scale. RESULTS: Six (two case-control studies, three longitudinal cohort studies and one cross-sectional study) of 551 studies were included in this review. Four studies found that AMD was associated with increased rates of sleep apnea and poorer reported sleep quality, while five studies showed that patients with sleep apnea or insomnia were at higher risk of developing AMD. Associations between self-reported sleep quantity and AMD were conflicting. No study evaluated the relationship between AMD and sleep using objective sleep assessment tools. CONCLUSION: Only a limited number of studies investigated associations between AMD and sleep. These studies suggest a bidirectional relationship between AMD and sleep dysfunction yet disagree on the relationship between sleep quantity and the likelihood of AMD. Additional studies, using objective characterisation of sleep in patients with AMD are required to confirm these findings.

Identifying the content for an item bank and computerized adaptive testing system to measure the impact of age-related macular degeneration on health-related quality of life.

PURPOSE: We are developing an age-related macular degeneration (AMD) health-related quality of life (HRQoL) item bank, applicable to Western and Asian populations. We report primarily on content generation and refinement, but also compare the HRQoL issues reported in our study with Western studies and current AMD-HRQoL questionnaires. METHODS: In this cross-sectional, qualitative study of AMD patients attending the Singapore National Eye Centre (May-December 2019), items/domains were generated from: (1) AMD-specific questionnaires; (2) published articles; (3) focus groups/semi-structured interviews with AMD patients (n = 27); and (4) written feedback from retinal experts. Following thematic analysis, items were systematically refined to a minimally representative set and pre-tested using cognitive interviews with 16 AMD patients. RESULTS: Of the 27 patients (mean ± standard deviation age 67.9 ± 7.0; 59.2% male), 18 (66.7%), two (7.4%), and seven (25.9%) had no, early-intermediate, and late/advanced AMD (better eye), respectively. Whilst some HRQoL issues, e.g. activity limitation, mobility, lighting, and concerns were similarly reported by Western patients and covered by other questionnaires, others like anxiety about intravitreal injections, work tasks, and financial dependency were novel. Overall, 462 items within seven independent HRQoL domains were identified: Activity limitation, Lighting, Mobility, Emotional, Concerns, AMD management, and Work. Following item refinement, items were reduced to 219, with 31 items undergoing amendment. CONCLUSION: Our 7-domain, 219-item AMD-specific HRQoL instrument will undergo psychometric testing and calibration for computerized adaptive testing. The future instrument will enable users to precisely, rapidly, and comprehensively quantify the HRQoL impact of AMD and associated treatments, with item coverage relevant across several populations.

The longitudinal psychological, physical activity, and financial impact of a COVID-19 lockdown on older adults in Singapore: The PIONEER-COVID population-based study.

BACKGROUND: Several countries have implemented 'lockdown' measures to curb the spread of the coronavirus disease 2019 (COVID-19). AIMS: To examine the psychological, physical activity (PA), and financial impact of a 2-month COVID-19 lockdown on older adults aged ≥60 years in Singapore, and to identify factors associated with adverse lockdown-related outcomes. METHOD: We interviewed 496 community-dwelling adults (mean age [standard deviation]: 73.8 [7.6] years; 54.8% female) during the lockdown who had previously participated in a population-based epidemiological study. Validated questionnaires were utilised to assess loneliness and depressive symptoms at both timepoints, while inhouse questionnaires were used to assess PA and financial difficulty during lockdown. Multivariable regression models determined the lockdown-related change in loneliness and depression scores, and the factors associated with adverse outcomes. RESULTS: Loneliness increased significantly during the lockdown period (p < 0.001) while depressive symptoms decreased (p = 0.022). Decreased PA, greater financial problems, male gender, Indian ethnicity, living alone, having a greater body mass index and perceived susceptibility to COVID-19 were all associated with worsening loneliness scores. A total of 36.9% and 19.6% participants reported decreased PA and had financial problems during the lockdown, respectively. Unemployment was associated with decreased PA, while self-employed individuals, cleaners, retail workers and smokers had greater odds of experiencing financial difficulty. CONCLUSION: Despite a decrease in depressive symptoms, our population of older Asians reported a significant increase in loneliness and decreased PA, with one-fifth experiencing financial problems during lockdown. Our data suggest that more targeted public health efforts are needed to reduce repercussions of future lockdowns.

Retreatment of 6 ceramic restorations in a single session - the application of Er:YAG laser and CAD/CAM technology: an 1 year follow up clinical evaluation / Retratamento de 6 restaurações de cerâmica em uma única sessão ­ Utilizando o Laser ER: YAG e a tecnologia CAD/CAM com Acompanhamento de 1 ano

Background: To present the benefits of high power lasers (Er: YAG and Nd: YAG) over the use of the high speed turbine for the extraction of ceramics restorations, without damaging the surfaces of the teeth; being a relatively easier and faster procedure without the use of anesthetic agents, and the preparation of the ceramic restorations and cementing in the single session; with a follow-up of 1 year. Objective: The benefits of lasers over high-speed turbine mechanical instrumentation for crown removal encompass efficient restoration recovery without damage to tooth surfaces; and a relatively easier and faster procedure without the use of anesthetic agents. Methods: The Er: YAG laser (no contact; 3.2-4.0 W, 20 Hz) was used to extract the porcelain prosthesis, followed by a gingivectomy with the Nd: YAG laser on tooth 12 to improve the gingival contour. The dental surfaces where the ceramic prosthesis will be cemented were scanned. Then, CAD / CAM technology was used to make the ceramic veneers that were cemented in the same session. Results: The efficacy the Er:YAG laser energy was observed by the decreased of the time to remove all-ceramic materials through ablation of bonding cements, reducing working time by 75% compared to a high-speed turbine. Conclusions: An Er: YAG laser can safely remove lithium disilicate crowns with the settings used in this study. Laser-assisted removal of all ceramic PDFs is a promising treatment protocol. The use of the Nd: YAG (2.0 W power, short 20Hz, 320 µm optical fiber, in contact) laser allowed gingivoplasty to be performed, automatically cauterizing avoiding post-operative bleeding, and facilitating the preparation of ceramic restorations the same day. The use of high-power lasers and the use of accompanying CAD / CAM technology allowed this clinical case to be completed in a single visit without the use of temporary restorations, achieving absolute patient satisfaction. (AU)

Antecedentes: Apresentar os benefícios dos lasers de alta potência (Er: YAG e Nd:YAG) sobre o uso da turbina de alta velocidade para a remoção de restaurações cerâmicas, sem danificar as superfícies dos dentes; sendo um procedimento relativamente mais fácil e rápido evitando o uso de agentes anestésicos, conseguindo fazer o preparo das restaurações de cerâmica e cimentação em uma única sessão; com seguimento de 1 ano. Objetivo: Os benefícios dos lasers sobre a instrumentação mecânica com turbina de alta velocidade para a remoção da coroa abrangem a recuperação eficiente da restauração sem danos às superfícies dos dentes; e um procedimento relativamente mais fácil e rápido sem o uso de agentes anestésicos. Métodos: O laser Er: YAG (sem contato; 3,2-4,0 W, 20 Hz) foi utilizado para remover a prótese de porcelana, seguido de gengivectomia com o laser Nd: YAG no dente 12 para melhorar o contorno gengival. As superfícies dentais onde a prótese de cerâmica será cimentada foram escaneadas. Em seguida, a tecnologia CAD / CAM foi utilizada para confeccionar as facetas de cerâmicas que foram cimentadas na mesma sessão. Resultados: A eficácia da energia do laser Er: YAG foi observada pela diminuição do tempo na remoção dos materiais cerâmicos por meio da ablação dos cimentos de ligação, reduzindo o tempo de trabalho em 75% em relação a uma turbina de alta velocidade. Conclusão: Um laser Er: YAG pode remover com segurança as coroas de dissilicato de lítio com as configurações usadas neste estudo. A remoção assistida por laser de todos os PDFs de cerâmica é um protocolo de tratamento promissor. O uso do laser Nd: YAG (2,0 W potência, curta 20Hz, 320 µm fibra ótica, em contato) permitiu a realização da gengivoplastia, cauterizando automaticamente evitando sangramento pós-operatório e facilitando o preparo das restaurações cerâmicas no mesmo dia. O uso de lasers de alta potência e o uso da tecnologia CAD / CAM que o acompanha permitiram que este caso clínico fosse concluído em uma única visita, sem o uso de restaurações temporárias, alcançando a satisfação absoluta do paciente (AU)

Bioactive glass and high-intensity lasers as a promising treatment for dentin hypersensitivity: An in vitro study.

This in vitro study aimed to analyze the physical and chemical characteristics of the hypersensitive human dentin-like surface after application of a bioactive glass (BG) paste (BG/Ac) irradiated or not with high-power lasers. Dentin specimens were treated with 17% Ethylenediamine tetraacetic acid (EDTA) solution to mimic a hypersensitive dentin and then submitted to neodymium: yttrium-aluminum-garnet (Nd:YAG) laser or CO2 laser irradiation prior and after application of BG/Ac. Characterizations were performed by using X-ray diffraction, Fourier transformed infrared spectroscopy, scanning electron microscopy, and energy dispersive X-ray spectroscopy. The results suggested that application of BG/Ac by itself caused some obstructions of dentinal tubules. Nd:YAG laser irradiation reduced the opening of the dentinal tubules with no changes in the collagen structure. CO2 laser irradiation caused dentin melting and resolidification along with cracks and chemical changes in collagen fibers. However, when BG/Ac paste was irradiated with lasers, a sequence of surface reactions between glass and dentin interface led to the formation of an amorphous hydroxyapatite layer, similar to that of an inorganic component of the normal dentin. Moreover, BG/Ac was able to prevent the formation of cracks and degradation of collagen fibers caused by CO2 irradiation. Overall, this study supports that application of BG/Ac paste irradiated by high-power laser could represent an effective and long-lasting therapeutic approach for dentin hypersensitivity.

Distinct Distress Symptom Trajectories Over 3 Years Are Associated With Baseline Illness Perceptions in Individuals With Coronary Heart Disease.

BACKGROUND: Depression and anxiety symptoms (termed distress) are common among coronary heart disease (CHD) patients and associated with poor outcomes. Illness perceptions predict distinct outcome trajectories in other long-term conditions, yet it is not known how they relate to distress trajectories in CHD. PURPOSE: This study aimed to examine whether baseline illness perceptions are associated with distress symptom trajectories among primary care CHD patients. METHODS: This is a secondary analysis of 803 CHD patients from the UPBEAT-UK study, who completed the Hospital Anxiety and Depression Scale every 6 months for 3 years. Baseline assessments included the Brief Illness Perception Questionnaire. Using latent class growth analysis, Palacios et al. (2018) identified five distinct distress symptom trajectories ("stable low," "chronic high," "improving," "worsening," and "fluctuating") in this cohort. Adjusted multinomial logistic regression analyses were used to test the association between baseline illness perceptions and distress symptom trajectories. RESULTS: Compared with the stable low distress trajectory, stronger illness identity (odds ratio [OR] = 1.31, p < .01), higher perceived consequences (OR = 1.47, p < .01), illness-related emotion (OR = 1.66, p < .01), and illness concerns (OR = 1.36, p < .01) increased the odds of having chronic high distress. Stronger illness coherence (OR = 0.89, p < .05) and personal (OR = 0.77, p < .01) and treatment control (OR = 0.75, p < .01) reduced the odds of chronic high distress. Worsening distress symptoms were associated with weaker perceptions of treatment control, higher perceived consequences, and greater illness-related concerns and emotions. CONCLUSIONS: Illness perceptions of CHD are associated with distress symptom trajectories. Therapeutically modifying unhelpful illness perceptions in CHD patients who experience high levels of distress could potentially improve mental health outcomes.

A terapia fotodinâmica como benefício complementar na clínica odontológica / Photodynamic therapy as a complementary benefit in the dental clinic

Um dos grandes desafios do Cirurgião-Dentista é o controle microbiológico nas patologias dentárias. Independentemente da especialidade, a redução microbiana para o sucesso do tratamento é necessária. A terapia fotodinâmica vem sendo utilizada como coadjuvante ao tratamento tradicional, reduzindo significativamente a quantidade de microrganismos nos sítios-alvo e contribuindo para a solução de casos, principalmente na presença de infecções resistentes. Esta revisão de literatura tem como objetivo apresentar estudos laboratoriais e clínicos relacionados à terapia fotodinâmica em Periodontia, Endodontia e Estomatologia. Apesar da variedade de protocolos utilizados nas recentes pesquisas, a terapia fotodinâmica mostra-se promissora como coadjuvante ao tratamento convencional. Além disso, apresenta grande utilidade, fácil acessibilidade e baixo custo para o Cirurgião-Dentista frente a processos infecciosos em Odontologia.

One of the great challenges of the dentist is the microbiological control in dental pathologies. Regardless of specialty, microbial reduction for successful treatment is necessary. Photodynamic therapy has been used as an adjunct to traditional treatment, significantly reducing the amount of microorganisms in the target sites and contributing to the solution of cases, especially in the presence of resistant infections. This literature review aims to present laboratory and clinical studies related to photodynamic therapy in Periodontics, endodontics and Stomatology. Despite the variety of protocols used in recent research, photodynamic therapy is potentially used as an adjunct to conventional treatment. In addition, it is useful, easy to apply and with low cost to the dentist.