Comparison of superior airway dimensions and cephalometric anatomic landmarks between 8-12-year-old children with obstructive sleep apnea and healthy children using CBCT images.

Background. The etiology of obstructive sleep apnea (OSA) syndrome in children significantly differs from adults. In previous studies, only some of the indices have been investigated using CBCT. This study compares all the measurable indices of airway dimensions and anatomical cephalometric landmarks between children with OSA and healthy ones using cone-beam computed tomography (CBCT). Methods. Dimensions of the airway and cephalometric values were measured on CBCT scans of 50 children aged 8-12 (25 patients with OSA and 25 healthy subjects) and then compared between the two groups. The results of this study were analyzed with independent t test using SPSS 17 at a significance level of P<0.05. Results. Area, length, volume, anteroposterior length, and size of the upper airway in subjects with OSA were lower than those in healthy children, while the average values of SNA, SNB, and ANB in the OSA group were higher than those in the healthy group (P=0.366, P=0.012, and P=0.114, respectively). Also, BaSN, PNS/AD1, and PNS/AD2 measurements in subjects with OSA were lower than healthy subjects (P=0.041, P=0.913, and P=0.015, respectively). In addition, the width and anteroposterior length of the upper airway, SNB, BaSN, PNS/AD1, and PNS/AD2 indices were significantly different between the healthy group and those with OSA (P<0.05). Conclusion. Reduced upper airway dimensions, adenoid tissue enlargement, and cranial base flexion might play an important role in OSA development in children. However, most skeletal variables, such as the anteroposterior relationship of jaws and jaw rotation, were not significantly different between the two groups.

The effect of patient satisfaction with academic hospitals on their loyalty.

OBJECTIVES: Patients' loyalty to a health care institution can lead to the aggregation of patients' medical history in an institution and facilitating access to records by health care providers. Considering the increase of the competition between providers, it is important to gain patients' satisfaction, which leads to their return and loyalty. Therefore, this study evaluated the effect of patients' satisfaction with service quality on their loyalty. METHODS: A cross-sectional descriptive and analytical study was carried out in academic hospitals. A sample of 260 patients admitted to these hospitals was recruited. The data gathering tool was an expert-validated questionnaire which its reliability was confirmed by Cronbach's alpha. Data were analyzed using descriptive statistics, correlation coefficient, and multivariate regression analysis in SPSS20. RESULTS: The mean score of service quality was calculated 74.23 out of 100. Among the quality dimensions, "physician visit" had the highest score with 84.01 ± 20, and the "waiting time" dimension had the lowest score with the mean score of 62.45 ± 27.53. The mean score of patients' loyalty was 67.88 ± 29.79. Satisfaction with the six dimensions of service quality: "cost of services," "hospital environment," "delivered services," "access to physicians and health care institutions," "provision of information to patients," and "acquaintance with hospitals" were identified as the most influencing factors on loyalty. CONCLUSIONS: The results showed that patient satisfaction with service quality affects their hospital choices and increases loyalty. In order to increase patient loyalty to academic hospitals, improving the services quality along with delivering cost-effective cares, improving hospital environment, and providing useful information to patients are recommended.