A Comparative study to measure the horizontal condylar guidance obtained by protrusive interocclusal records and panoramic radiographic images in completely edentulous patients

Background &amp; Objectives:The study was conducted with objective to compare the horizontal condylar guidance (HCG) obtained by protrusive interocclusal records and panoramic radiographic images in completely edentulous patients.Materials &amp; Methods:The horizontal condylar guidance was measured in 25 completely edentulous patients by protrusive interocclusal records using zinc oxide eugenol paste through a face bow transfer (HanauTM Spring bow, Whip Mix Corporation, USA) to a semi-adjustable articulator (HanauTM Wide-Vue Articulator, Whip Mix Corporation, USA).  In the same patients, HCG was traced in the panoramic radiograph. The angles formed by the intersection of two lines: Frankfurt’s horizontal plane and posterior slope of articular eminence was measured using protractor to represent the horizontal condylar guidance angle on each side.Results:The mean difference between the horizontal condylar guidance angles values obtained using protrusive interocclusal record and panoramic radiograph was 2.68 degrees and 3.40 degrees for the right and the left side respectively, with the panoramic radiograph values being higher. This difference between the values was found to be highly significant between the two methods for the right side (t = 2.70, p = 0.012) and left side (t = 3.69, p = 0.001). A significant positive correlation was found between the horizontal condylar guidance obtained from protrusive interocclusal record and panoramic radiograph for the right (r = 0.643, p = 0.001) and left sides (r = 0.622, p = 0.001) separately.Conclusion:The panoramic radiographic tracing can be used to calculate the mean horizontal condylar guidance in the completely edentulous patients and these values can be used to programme semi-adjustable articulators avoiding the cumbersome process of obtaining protrusive interocclusal records.</p

Cross-cultural adaptation of motivational interviewing for use in rural Nepal.

BackgroundMotivational Interviewing (MI) has a robust evidence base in facilitating behavior change for several health conditions. MI focuses on the individual and assumes patient autonomy. Cross-cultural adaptation can face several challenges in settings where individualism and autonomy may not be as prominent. Sociocultural factors such as gender, class, caste hinder individual decision-making. Key informant perspectives are an essential aspect of cross-cultural adaptation of new interventions. Here, we share our experience of translating and adapting MI concepts to the local language and culture in rural Nepal, where families and communities play a central role in influencing a person's behaviors.MethodsWe developed, translated, field-tested, and adapted a Nepali MI training module with key informants to generate insights on adapting MI for the first time in this cultural setting. Key informants were five Nepali nurses who supervise community health workers. We used structured observation notes to describe challenges and experiences in cross-cultural adaptation. We conducted this study as part of a larger study on using MI to improve adherence to HIV treatment.ResultsParticipants viewed MI as an effective intervention with the potential to assist patients poorly engaged in care. Regarding patient autonomy, they initially shared examples of family members unsuccessfully dictating patient behavior change. These discussions led to consensus that every time the family members restrict patient's autonomy, the patient complies temporarily but then resumes their unhealthy behavior. In addition, participants highlighted that even when a patient is motivated to change (e.g., return for follow-up), their family members may not "allow" it. Discussion led to suggestions that health workers may need to conduct MI separately with patients and family members to understand everyone's motivations and align those with the patient's needs.ConclusionsMI carries several cultural assumptions, particularly around individual freedom and autonomy. MI adaptation thus faces challenges in cultures where such assumptions may not hold. However, cross-cultural adaptation with key informant perspectives can lead to creative strategies that recognize both the patient's autonomy and their role as a member of a complex social fabric to facilitate behavior change