Introducing 'Ngaruroro', a New Model for Understanding Maori Wellbeing.

Indigenous peoples around the world are revitalising their ancestral beliefs, practices, and languages, including traditional understandings of health and wellbeing. In the Aotearoa (New Zealand) context, a number of ground-breaking Maori health- and wellbeing-related models have emerged, each with their own scope and applications. We sought in our qualitative studies to explore and identify several key sources of wellbeing for Maori individuals. Nine interviews were conducted with members of Maori communities to identify key themes of Maori wellbeing. We performed a Reflexive Thematic Analysis on these data and then conducted a further fifteen interviews to revise, refine, and reposition the previously generated themes. The Ngaruroro model describes wellbeing as the embodied and active process of being well in relation with one's (1) here tangata (social and familial ties), (2) te taiao (the environment), and (3) taonga tuku iho (cultural treasures) while doing what one can to make lifestyle choices that are conducive to the health of one's (4) tinana (body) and (5) wairua (spirit) while cultivating a balanced (6) ngakau (inner-system), fulfilling (7) matea (core needs) and exercising your (8) mana (authority). These themes illustrate that Maori wellbeing is dynamic, interconnected, and holistic.

The Psychological, Social and Behavioral Impact of Intravitreal Anti-VEGF Therapy: An Analysis from the ALBATROS Data.

BACKGROUND: Retinal diseases such as neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), or branch/central retinal vein occlusion (B/CRVO) have significant implications for patients' social and psychological well-being. The ALBATROS study aimed to assess the care situation of patients who received anti-VEGF (vascular endothelial growth factor) treatment. To gain a comprehensive understanding of patients' backgrounds and attitudes, we developed an exploratory, structured questionnaire, the Basic Care and Patient Satisfaction Questionnaire (BPZ-9). METHODS: The data collection took place at the beginning and after twelve months of anti-VEGF therapy. The BPZ-9 questionnaire comprises nine questions to evaluate patients' psychological and social situation and satisfaction with treatment. RESULTS: Data were collected from 1478 nAMD (mean 78 years), 445 DME (67 years), 233 BRVO (70 years), and 144 CRVO (71 years) patients at 102 study centers throughout Germany. One in four patients had difficulties walking, and one in five needed an accompanying person for treatment. Anxiety about losing vision was present in three out of four patients at the beginning, and it slightly decreased to two out of three patients over the 12-month treatment period. The distress of having a retinal disease was generally higher than the distress related to the treatment. Most patients reported high treatment satisfaction (73%) and felt well-informed (81%). CONCLUSIONS: There is a relevant social and psychological impact related to anti-VEGF treatment. The patients' perception, attitudes, and commitment need further investigation.

Impact of Routinely Performed Optical Coherence Tomography Examinations on Quality of Life in Patients with Retinal Diseases-Results from the ALBATROS Data Collection.

The use of OCT to monitor intravitreal treatment varies in clinical practice and is not always mandatory. The ALBATROS data collection aimed to clarify the impact of routinely implemented OCT on clinical outcomes and its impact on vision-related quality of life (VRQoL). METHODS: An observational cohort study included patients with retinal diseases starting an intravitreal anti-vascular endothelial growth factor treatment in Germany. Treatment followed clinical practice except mandatory OCT examination during the 12-month observation period. VRQoL was assessed by NEI VFQ-25 and compared with respect to OCT examinations and number of intravitreal injections in the different diseases (nAMD, DME, BRVO, CRVO). RESULTS: 1478 patients (74.5 ± 10.9 years, 54.9% female) were included in the analysis. Patients had neovascular AMD (65.2%), DME (18.4%), BRVO (9.5%), or CRVO (6.9%). 8.8 ± 2.6 OCT examinations and 6.1 ± 3.2 intravitreal injections were performed within 12 months. VRQoL differed between indications at baseline, with substantially lower values for neovascular AMD and CRVO. After twelve months, an increase in visual acuity and visual functional scale was observed for nAMD, DME, and BRVO, while in DME only, there was an association between number of OCT examinations and VRQoL. CONCLUSION: Intravitreal treatment was able to maintain VRQoL over twelve months in a real-world setting. Regular OCT examinations were associated with higher gain in VRQoL in DME patients after 12 months.

The Impact of Immunosuppression on Chronic Kidney Disease in People Living With Human Immunodeficiency Virus: The D:A:D Study.

BACKGROUND: Relations between different measures of human immunodeficiency virus-related immunosuppression and chronic kidney disease (CKD) remain unknown. METHODS: Immunosuppression measures included baseline, current, time-lagged and nadir CD4, years and percentage of follow-up (%FU) with CD4 ≤200 cells/µL, and CD4 recovery. CKD was defined as confirmed estimated glomerular filtration rate <60 mL/minute/1.73 m2. RESULTS: Of 33 791 persons, 2226 developed CKD. Univariably, all immunosuppression measures predicted CKD. Multivariably, the strongest predictor was %FU CD4 ≤200 cells/µL (0 vs >25%; incidence rate ratio [IRR], 0.77 [95% confidence interval [CI], .68-.88]), with highest effect in those at low D:A:D CKD risk (IRR, 0.45 [95% CI, .24-.80]) vs 0.80 [95% CI, .70-.93]). CONCLUSIONS: Longer immunosuppression duration most strongly predicts CKD and affects persons at low CKD risk more.

Artificial Intelligence for Rapid Meta-Analysis: Case Study on Ocular Toxicity of Hydroxychloroquine.

BACKGROUND: Rapid access to evidence is crucial in times of an evolving clinical crisis. To that end, we propose a novel approach to answer clinical queries, termed rapid meta-analysis (RMA). Unlike traditional meta-analysis, RMA balances a quick time to production with reasonable data quality assurances, leveraging artificial intelligence (AI) to strike this balance. OBJECTIVE: We aimed to evaluate whether RMA can generate meaningful clinical insights, but crucially, in a much faster processing time than traditional meta-analysis, using a relevant, real-world example. METHODS: The development of our RMA approach was motivated by a currently relevant clinical question: is ocular toxicity and vision compromise a side effect of hydroxychloroquine therapy? At the time of designing this study, hydroxychloroquine was a leading candidate in the treatment of coronavirus disease (COVID-19). We then leveraged AI to pull and screen articles, automatically extract their results, review the studies, and analyze the data with standard statistical methods. RESULTS: By combining AI with human analysis in our RMA, we generated a meaningful, clinical result in less than 30 minutes. The RMA identified 11 studies considering ocular toxicity as a side effect of hydroxychloroquine and estimated the incidence to be 3.4% (95% CI 1.11%-9.96%). The heterogeneity across individual study findings was high, which should be taken into account in interpretation of the result. CONCLUSIONS: We demonstrate that a novel approach to meta-analysis using AI can generate meaningful clinical insights in a much shorter time period than traditional meta-analysis.

Use of Contemporary Protease Inhibitors and Risk of Incident Chronic Kidney Disease in Persons With Human Immunodeficiency Virus: the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) Study.

BACKGROUND: It is unclear whether use of contemporary protease inhibitors pose a similar risk of chronic kidney disease (CKD) as use of older protease inhibitors. METHODS: Participants in the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) study were followed up until the earliest occurrence of CKD, the last visit plus 6 months, or 1 February 2016. Adjusted Poisson regression was used to assess associations between CKD and the use of ritonavir-boosted atazanavir (ATV/r) or ritonavir-boosted darunavir (DRV/r). RESULTS: The incidence of CKD (10.0/1000 person-years of follow-up; 95% confidence interval, 9.5-10.4/1000 person-years of follow-up) increased gradually with increasing exposure to ATV/r, but the relation was less clear for DRV/r. After adjustment, only exposure to ATV/r (adjusted incidence rate ratio, 1.4; 95% confidence interval, 1.2-1.6), but not exposure to DRV/r (1.0; .8-1.3), remained significantly associated with CKD. CONCLUSION: While DRV/r use was not significantly associated with CKD an increasing incidence with longer ATV/r use was confirmed.

Effect of automated messaging on oral hygiene in adolescent orthodontic patients: A randomized controlled trial.

OBJECTIVE: To determine whether automated text messages sent daily to adolescent orthodontic patients improves oral hygiene more than weekly reminders. MATERIALS AND METHODS: A blinded, prospective, randomized controlled trial was designed to evaluate the effects of automated messages on oral hygiene. Subjects were recruited from patients undergoing orthodontic treatment at the Texas A&M University College of Dentistry, Department of Orthodontics. They were being treated with a variety of fixed full appliances in both arches. Subjects were randomly assigned to either a once-a-week text message group or a daily text message group. There were 52 females and 27 males who were 12 to 17 years of age. Oral hygiene was measured at the beginning of the study and again 8.6 ± 0.9 weeks later. RESULTS: The daily reminder group (N = 42) had significantly greater improvements in oral hygiene compliance than the weekly reminder group (N = 37). The daily score decreases were 48%, 21% and 19% for the bleeding index (BI), plaque index (PI), and gingival index (GI), respectively. The weekly score decreases were 27%, 14% and 13% for the BI, PI, and GI. There were no sex differences in hygiene changes during the study. The 42% of patients who completed the survey at the end of the study wanted more frequent messages and reported that messages related to decreasing treatment time were the most effective, while those related to oral hygiene were the least effective. CONCLUSIONS: Daily text messages are more effective at improving oral hygiene than weekly text messages.

Renal Impairment and Cardiovascular Disease in HIV-Positive Individuals: The D:A:D Study.

BACKGROUND: While the association between renal impairment and cardiovascular disease (CVD) is well established in the general population, the association remains poorly understood in human immunodeficiency virus (HIV)-positive individuals. METHODS: Individuals with ≥2 estimated glomerular filtration rate (eGFR) measurements after 1 February 2004 were followed until CVD, death, last visit plus 6 months, or 1 February 2015. CVD was defined as the occurrence of centrally validated myocardial infarction, stroke, invasive cardiovascular procedures, or sudden cardiac death. RESULTS: During a median follow-up duration of 8.0 years (interquartile range, 5.4-8.9 years) 1357 of 35 357 individuals developed CVD (incidence rate, 5.2 cases/1000 person-years [95% confidence interval {CI}, 5.0-5.5]). Confirmed baseline eGFR and CVD were closely related with 1.8% of individuals (95% CI, 1.6%-2.0%) with an eGFR > 90 mL/minute/1.73 m(2) estimated to develop CVD at 5 years, increasing to 21.1% (95% CI, 6.6%-35.6%) among those with an eGFR ≤ 30 mL/minute/1.73 m(2) The strong univariate relationship between low current eGFR and CVD was primarily explained by increasing age in adjusted analyses, although all eGFRs ≤ 80 mL/minute/1.73 m(2) remained associated with 30%-40% increased CVD rates, and particularly high CVD rates among individuals with an eGFR ≤ 30 mL/minute/1.73 m(2) (incidence rate ratio, 3.08 [95% CI, 2.04-4.65]). CONCLUSIONS: Among HIV-positive individuals in a large contemporary cohort, a strong relation between confirmed impaired eGFR and CVD was observed. This finding highlights the need for renal preventive measures and intensified monitoring for emerging CVD, particularly in older individuals with continuously low eGFRs.

Predicted and actual end-of-treatment occlusion produced with aligner therapy.

OBJECTIVE: To compare three-dimensional (3D) ClinCheck™ models with the subjects' actual 3D posttreatment models using the American Board of Orthodontics Objective Grading System (OGS). MATERIALS AND METHODS: This prospective, within-subject study included 27 consecutive cases treated with aligner therapy. The posttreatment plaster models taken immediately after treatment were scanned and converted to stereolithography (STL) files; the ClinCheck models were also converted to STL format. MeshLab software was used to measure the seven components of the OGS, including alignment, marginal ridges, buccolingual inclinations, occlusal contacts, occlusal relationships, overjet and interproximal contacts. An overall OGS deduction score was also calculated. RESULTS: Compared with the posttreatment models, the ClinCheck models showed significantly (P  =  .016) fewer overall OGS point deductions (24 vs 15). These overall differences were due to significantly (P < .05) more deductions among the posttreatment models than the ClinCheck models for alignment (4.0 vs 1.0 deductions), buccolingual inclinations (4.0 vs 3.0 deductions), occlusal contacts (3.0 vs 2.0 deductions), and occlusal relations (4.0 vs 2.0 deductions). CONCLUSION: The ClinCheck models do not accurately reflect the patients' final occlusion, as measured by the OGS, at the end of active treatment.

Comparative time efficiency of aligner therapy and conventional edgewise braces.

OBJECTIVE: To compare the time efficiency of aligner therapy (ALT) and conventional edgewise braces (CEB) based on large samples of patients treated by the same highly experienced orthodontist, with the same treatment goals for both groups of patients. MATERIALS AND METHODS: The retrospective portion of the study evaluated 150 CEB patients who were matched, based on mandibular crowding and number of rotated teeth, to 150 ALT patients. All records were obtained at one orthodontist's office. All of the patients had mild-to-moderate Class I malocclusions (≤5 mm incisor crowding) and were treated nonextraction. Age, gender, total treatment time, total number of appointments, types of appointments, materials used, mandibular crowding, and number of rotated teeth were recorded from the patients' records. The prospective portion of the study timed the various types of appointments for both treatments with a stopwatch. RESULTS: Compared to ALT, CEB required significantly (P<.01) more visits (approximately 4.0), a longer treatment duration (5.5 months), more emergency visits (1.0), greater emergency chair time (7.0 minutes), and greater total chair time (93.4 minutes). However, ALT showed significantly (P<.01) greater total material costs and required significantly more total doctor time than CEB (P<.01). CONCLUSIONS: Whether the greater time efficiency of ALT offsets the greater material costs and doctor time required depends on the experience of the orthodontist and the number of ALT case starts.

Comparative time efficiency of aligner therapy and conventional edgewise braces.

Abstract Objective: To compare the time efficiency of aligner therapy (ALT) and conventional edgewise braces (CEB) based on large samples of patients treated by the same highly experienced orthodontist, with the same treatment goals for both groups of patients. Materials and Methods: The retrospective portion of the study evaluated 150 CEB patients who were matched, based on mandibular crowding and number of rotated teeth, to 150 ALT patients. All records were obtained at one orthodontist's office. All of the patients had mild-to-moderate Class I malocclusions (≤5 mm incisor crowding) and were treated nonextraction. Age, gender, total treatment time, total number of appointments, types of appointments, materials used, mandibular crowding, and number of rotated teeth were recorded from the patients' records. The prospective portion of the study timed the various types of appointments for both treatments with a stopwatch. Results: Compared to ALT, CEB required significantly (P < .01) more visits (approximately 4.0), a longer treatment duration (5.5 months), more emergency visits (1.0), greater emergency chair time (7.0 minutes), and greater total chair time (93.4 minutes). However, ALT showed significantly (P < .01) greater total material costs and required significantly more total doctor time than CEB (P < .01). Conclusions: Whether the greater time efficiency of ALT offsets the greater material costs and doctor time required depends on the experience of the orthodontist and the number of ALT case starts.