Essays on the effect of immigration and assimilation on immigrants’ health and health behaviours: evidence from the United Kingdom and Russian Federation

This thesis investigates the effects of immigration and assimilation on immigrants’ health and health behaviours in the United Kingdom and Russian Federation. By using longitudinal survey data from both countries, we test the hypotheses that whether immigrants are more willing to take risk than the native population and if this is the case whether it leads them to be more likely to engage in potentially risky health behaviours (e.g. smoking, regular alcohol drinking, eating fast food). Our results show that even though immigrants are more willing to take risks and are more likely to engage in certain health behaviours, with respect to others they have some protective factors and they never converge to the health level of natives. We show that the reason for immigration (political vs. economic) and the cultural distance determine the health assimilation process to a large extent. The first chapter explores general and domain-specific risk preferences of immigrant population in the United Kingdom (UK) and provides a comparison with the native population. We also aim to investigate how immigrants’ engagement in potentially risky health behaviours is different from native UK population and whether it can be explained by the difference in risk and/or time preferences. We exploit wave 6 of the Innovation Panel that is a part of the UK Household Longitudinal Study to answer the questions of interest. We apply interval regression model to study the effect of immigrant status on risk and time preferences. OLS and probit models are also estimated as a robustness check. We find that, despite being more risk loving, immigrants are less engaged in some potentially risky health behaviours (binge drinking and eating fast food) than native individuals and they also arrive with lower discount rate than natives have. The second chapter explores the effect of acculturation on immigrants’ health behaviours and lifestyle choices such as smoking, alcohol consumption, physical activity and diet. We exploit the UK Household Longitudinal Study, waves 1-7 (2009-2016). The panel nature of the data allows us to specify a correlated random effects linear probability model. We use length of stay in the UK and national identity as proxies for acculturation. We also allow for different acculturation trajectories based on the factors that are believed to affect the acculturation process, such as social support, family background, life satisfaction and mental health condition. Most importantly, we introduce a measure of cultural distance as we believe that acculturation trajectories will differ for immigrants with different cultural proximity to the UK. Our results indicate that length of stay is associated with lower rates of smoking, higher probability of consuming a healthy diet and regular physical activity. Identifying yourself as British is associated with lower rate of smoking, but lower probability of following a healthy diet and, for female immigrants, more alcohol units consumed over time. We find that immigrants, whose culture is close to the British one, do not change their behaviours almost at all over time and if they do, this change is towards less healthy lifestyle such as lower levels of physical activity and unhealthier diets. In contrast, those with distant cultures experience a considerable change in health behaviours towards healthier lifestyles. In the third chapter we explore the existence of the healthy immigrant effect (HIE) for Russian immigrants, who arrived after the collapse of the Soviet Union. These immigrants tend to be ethnically Russian and mostly arrived from former Soviet Union republics due to exogenous political reasons. This allows us to isolate the effect of immigration on immigrants’ health abstracting from often unobserved characteristics such as cultural background, health perception, language proficiency etc. We compare their health assimilation with that of economically motivated immigrants, who arrived in Russia before 1989. To answer the question of interest we exploit the panel component of the Russian Longitudinal Monitoring Survey from 2010 to 2016. We make use of linear probability model (LPM) with correlated random effects, pooled LPM and standard random effects LPM. As a robustness check we specify the same set of probit models. We find support of HIE in the economic immigrant subsample and a partial support for the effect in the political immigrant sub-sample. In political immigrants, young age at arrival and Islamic country of origin have a protective effect because they are associated with change towards healthier lifestyle over time. The greatest deterioration in health is experienced by political immigrants, who arrived in Russia later in their life (after 30 years old)

Therapeutic alternatives with CPAP in obstructive sleep apnea

Obstructive Sleep Apnea (OSA), characterized by airflow cessation (apnea) or reduction (hypopnea) due to repeated pharyngeal obstructions during sleep, causes frequent disruption of sleep and hypoxic events. The condition is linked to many adverse health related consequences, such as neurocognitive and cardiovascular disorders, and metabolic syndrome. OSA is a chronic condition requiring long-term treatment, so treatment using continuous positive airway pressure (CPAP) has become the gold standard in cases of moderate or severe OSA. However, its effectiveness is influenced by patients’ adherence. Surgery for OSA or treatment with oral appliances can be successful in selected patients, but for the majority, lifestyle changes such as exercise and dietary control may prove useful. However, exercise training remains under-utilized by many clinicians as an alternative treatment for OSA. Other interventions such as oral appliance (OA), upper way stimulation, and oropharyngeal exercises are used in OSA. Because the benefit of all these techniques is heterogeneous, the major challenge is to associate specific OSA therapies with the maximum efficacy and the best patient compliance

Therapeutic alternatives with CPAP in obstructive sleep apnea

Obstructive Sleep Apnea (OSA), characterized by airflow cessation (apnea) or reduction (hypopnea) due to repeated pharyngeal obstructions during sleep, causes frequent disruption of sleep and hypoxic events. The condition is linked to many adverse health related consequences, such as neurocognitive and cardiovascular disorders, and metabolic syndrome. OSA is a chronic condition requiring long-term treatment, so treatment using continuous positive airway pressure (CPAP) has become the gold standard in cases of moderate or severe OSA. However, its effectiveness is influenced by patients’ adherence. Surgery for OSA or treatment with oral appliances can be successful in selected patients, but for the majority, lifestyle changes such as exercise and dietary control may prove useful. However, exercise training remains under-utilized by many clinicians as an alternative treatment for OSA. Other interventions such as oral appliance (OA), upper way stimulation, and oropharyngeal exercises are used in OSA. Because the benefit of all these techniques is heterogeneous, the major challenge is to associate specific OSA therapies with the maximum efficacy and the best patient compliance

Splenectomy through the laparoscopic approach and how I do it

Scopul lucrării. Studierea cazurilor de splenectomie prin abord laparoscopic și clasic în vederea stabilirii cauzalității tip procedurăincidente perioperatorii și demonstrării superiorității abordului laparoscopic. Materiale și metode. Au fost selectate cazurile de splenectomie efectuate prin abord clasic și laparoscopic în Clinica de Chirurgie Colțea, perioada 01.01.2019-31.12.2022. Am revăzut filmările intraoperatorii, am evaluat factorii generali și locali asociați abordului chirurgical preferat. Rezultate. Au fost selectate 29 de cazuri, vârsta medie 54.8 ani, 72.4% femei, 27.6% barbati, 55.2% (16) cu multiple comorbidități: antecedente chirurgicale majore, insuficiența cardiacă, asmul bronșic sever etc. Cazurile au fost împărțite în 2 grupe: Gr. I- cu abord laparoscopic 34.5% (10), Gr. II- cu abord clasic 65.5% (19). Incidența comorbidităților a fost de 10% (1) în Gr.I, cu dimensiunea medie a splinei de 13.2 cm (min 8.5 cm, max 21 cm) și 84.2 % (16) în Gr.II cu dimensiunea medie a splinei de 20.4 cm (min 10 cm, max 34 cm). Doar în Gr.II au fost înregistrate sângerări intraoperatorii în 78.9% (15), iar in 15.8% (3) au fost complicații postoperatorii. Pacienții din Gr.I au avut o perioadă de spitalizare postoperatorie medie de 4 zile, iar cei din Gr. II de 7 zile și au fost externați cu o evoluție postoperatorie favorabilă. Concluzie. Abordul laparoscopic are aceleași indicații ca abordul clasic conform EAES, cu avantajul complicațiilor perioperatorii mult reduse și o spitalizare postoperatorie mai mică comparativ cu abordul clasic, iar în cazul echipelor experimentate este posibil abordul laparoscopic inclusiv la pacienții cu splenomegalii masive (>20cm), care poate fi asistat manual.Aim of study. Study of cases of splenectomy by laparoscopic and classic approach in order to establish causality type procedureperioperative incidents and demonstrate the superiority of the laparoscopic approach. Materials and methods. The cases of splenectomy performed by classical and laparoscopic approach in the Colțea Surgery Clinic, period 01.01.2019-31.12.2022, were selected. We reviewed intraoperative films, assessed general and local factors associated with the preferred surgical approach. Results. 29 cases were selected, average age 54.8 years, 72.4% women, 27.6% men, 55.2% (16) with multiple comorbidities: major surgical antecedents, heart failure, severe bronchial asthma, etc. The cases were divided into 2 groups: Gr. I- with laparoscopic approach 34.5% (10), Gr. II- with classic approach 65.5% (19). The incidence of comorbidities was 10% (1) in Gr.I, with mean spleen size of 13.2 cm (min 8.5 cm, max 21 cm) and 84.2% (16) in Gr.II with mean spleen size of 20.4 cm (min 10 cm, max 34 cm). Only in Gr.II, intraoperative bleeding was recorded in 78.9% (15), and in 15.8% (3) there were postoperative complications. The patients in Gr. I had an average postoperative hospitalization period of 4 days, and those in Gr. II of 7 days, and were discharged with a favorable postoperative evolution. Conclusions. The laparoscopic approach has the same indications as the classic one according to EAES, with the advantage of reduced perioperative complications and a shorter postoperative hospitalization, and in the case of experienced teams, the laparoscopic approach is possible, including patients with massive splenomegaly (>20cm), being manually assisted

Covid-19 infection in children, infants and pregnant subjects: An overview of recent insights and therapies

Background: The SARS-CoV-2 pandemic has involved a severe increase of cases worldwide in a wide range of populations. The aim of the present investigation was to evaluate recent insights about COVID-19 infection in children, infants and pregnant subjects. Methods: a literature overview was performed including clinical trials, in vitro studies, reviews and published guidelines regarding the present paper topic. A descriptive synthesis was performed to evaluate recent insights and the effectiveness of therapies for SARS-CoV-2 infection in children, infants and pregnant subjects. Results: Insufficient data are available regarding the relationship between COVID-19 and the clinical risk of spontaneous abortion and premature foetus death. A decrease in the incidence of COVID-19 could be correlated to a minor expression of ACE2 in childrens’ lungs. At present, a modulation of the dose-effect posology for children and infants is necessary. Conclusions: Pregnant vertical transmission has been hypothesised for SARS-CoV-2 infection. Vaccines are necessary to achieve mass immunity for children and also pregnant subjects

The Efficacy of a New AMCOP® Elastodontic Protocol for Orthodontic Interceptive Treatment: A Case Series and Literature Overview

Background: Elastodontics is a specific interceptive orthodontic treatment that uses removable elastomeric appliances. They are functional appliances that produce neuromuscular, orthopedic and dental effects. Thus, these devices are useful in the developmental age, when skeletal structures are characterized by important plasticity and adaptation capacity, allowing to remove factors responsible for malocclusions. Elastomeric devices are generally well tolerated by patients requiring simple collaboration and management. This work can be useful to update all orthodontists already adopting these appliances or for those who want to approach them for the first time. This study aimed to describe four cases treated with new elastomeric devices called AMCOP Bio-Activators and to provide an overview of elastodontics, its evolution, indications and limits. Methods: A total of four clinical cases were presented after a treatment period of 16–20 months to evaluate the clinical and radiological effects of the elastodontic therapy. Results: The effectiveness of Bio-Activators on clinical cases was evidenced with a significant improvement in skeletal and dentoalveolar relationship, and malocclusion correction in a limited treatment period (16–20 months). Conclusions: The Bio-Activators showed clinical effectiveness to achieve therapeutic targets according to a low impact on the patient’s compliance

Group antenatal care (Pregnancy Circles) for diverse and disadvantaged women: study protocol for a randomised controlled trial with integral process and economic evaluations

Background Group antenatal care has been successfully implemented around the world with suggestions of improved outcomes, including for disadvantaged groups, but it has not been formally tested in the UK in the context of the NHS. To address this the REACH Pregnancy Circles intervention was developed and a randomised controlled trial (RCT), based on a pilot study, is in progress. Methods The RCT is a pragmatic, two-arm, individually randomised, parallel group RCT designed to test clinical and cost-effectiveness of REACH Pregnancy Circles compared with standard care. Recruitment will be through NHS services. The sample size is 1732 (866 randomised to the intervention and 866 to standard care). The primary outcome measure is a ‘healthy baby’ composite measured at 1 month postnatal using routine maternity data. Secondary outcome measures will be assessed using participant questionnaires completed at recruitment (baseline), 35 weeks gestation (follow-up 1) and 3 months postnatal (follow-up 2). An integrated process evaluation, to include exploration of fidelity, will be conducted using mixed methods. Analyses will be on an intention to treat as allocated basis. The primary analysis will compare the number of babies born “healthy” in the control and intervention arms and provide an odds ratio. A cost-effectiveness analysis will compare the incremental cost per Quality Adjusted Life Years and per additional ‘healthy and positive birth’ of the intervention with standard care. Qualitative data will be analysed thematically. Discussion This multi-site randomised trial in England is planned to be the largest trial of group antenatal care in the world to date; as well as the first rigorous test within the NHS of this maternity service change. It has a recruitment focus on ethnically, culturally and linguistically diverse and disadvantaged participants, including non-English speakers. Trial registration Trial registration; ISRCTN, ISRCTN91977441. Registered 11 February 2019 - retrospectively registered. The current protocol is Version 4; 28/01/2020

Management of patients suffering from xerostomia with a combined mouthrinse containing sea salt, xylitol and lysozyme

Dry mouth, including xerostomia, is a common symptom especially in older adults. The causes of dry mouth include medication, autoimmune disease (Sjögren’s Syndrome), radiotherapy or chemotherapy for cancer, hormone disorders and infections (1-3). There is a huge variety of therapeutic approaches for relieving dry mouth symptoms such as chewing-gum, sugar-free lozenges, moisturizers and toothpastes, but most of them are are frequently restricted to palliative treatment. A Cochrane review concluded that there is no strong evidence that any topical therapy is effective in relieving the symptom of dry mouth, and more studies are required to provide evidence to guide clinical care (4-7). The inclusion of antimicrobial agents, such as lysozyme, lactoferrin, lacoperoxidase, or xylitol in xerostomia healthcare products, was proposed as early as the 1990s, and appears to be a promising approach for the prevention of microbial-related diseases in xerostomic patients (8, 9). Despite the significant prevalence of xerostomia in the general population, however, no standard treatment guidelines exist. Successful treatments are typically individualized for the specific patient and should be targeted at the underlying pathophysiology of the disease (10-12). The aim of the present study was to evaluate the efficiency of a combined mouthrinse containing purified water, sea salt, xylitol, lysozyme, and menthol (H2Ocean Sea Salt Mouthwash) in the management of patients suffering from xerostomia and hyposalivation

Evaluation of the outcome of various laser therapy applications in root canal disinfection: A systematic review

Background: Any successful endodontic therapy requires elimination of the endodontic biofilms through meticulous root canal disinfection methods. Sodium hypochlorite (NaOCl) and ethylenediaminetetraacetic acid (EDTA) are the most common effective irrigants, in removing smear-layer from the coronal and middle thirds of the dental canals but reduced considerably towards the apical one third. In recent years, newly alternative treatment modalities have been proposed, including high-power lasers and antimicrobial photodynamic therapy (aPDT). Our work was conducted to evalaute the outcome of root canal disinfection in relation to the efficacy of various treatment modalities. Furthermore, every effort was made to present an overview of the aPDT outcomes, as a model for this application, and to propose laser parameters protocol with positive results. Methods: The electronic databases PubMed was searched from January 2013- January 2019. Our inclusive criteria based on laser therapy applications, as a model for root canal disinfection. The search terms utilised various combinations as follows: photodynamic therapy or antimicrobial photodynamic therapy or photoactivated disinfection or light activated disinfection or laser activated disinfection or laser therapy, and endodontic. Results: The results of this systematic review concluded that the effectiveness of aPDT and various laser wavelengths protocols, in removing endodontic biofilms from infected root canals, remains unattainable. Conclusions: Study concluded that the combination of aPDT with antimicrobial irrigants could provide a synergetic effect. However, due to the heterogeneity of the selected studies and their limitations, in terms of lack of standardised protocol or discrepancy in the methodology, authors suggest further validated approaches to achieve optimal outcomes

Efficacy of combined sea salt based oral rinse with xylitol in improving healing process and oral hygiene among diabetic population after oral surgery

n/