Effects of scleral contact lenses for keratoconus management on visual quality and intraocular pressure

Purpose: To evaluate the visual acuity level achieved by scleral contact lens (CL) fitting in patients affected by keratoconus and to evaluate possible intraocular pressure (IOP) changes during the scleral CL wear using a transpalpebral tonometer. Methods: In a prospective case series a comparison was made between visual acuity obtained with glasses, RGP and 16.8mm diameter scleral CL in 30 consecutive patients affected by keratoconus. IOP was tested during scleral CL wear by transpalpebral Diaton Tonometer (DT) and also by Goldmann Applanation Tonometer (GAT) before and after scleral CL wear. Results: The mean logMAR visual acuity improved from 0.2±0.25SD with glasses and 0.1 ±0.02SD with RGP, to -0.002±0.041SD when using the scleral CL (p<0.05). The mean IOP value before scleral CL wear was 12.93mmHg±2.20SD when measured with GAT and 7.85mmHg±2.27SD when measured with DT. During scleral CL wear, IOP was assessed through DT, with a mean value of 8.86mmHg±2.36SD; values were stable after 8 hours of scleral CL use. Immediately after scleral CL removal, the mean IOP measured with GAT was 12.85mmHg ±2.40SD and the mean IOP measured with DT was 7.66mmHg±1.88SD. Therefore, during scleral CL wear, it was evidenced a small but statistically significant increase of the mean IOP value (1.01mmHg; p<0.01), with a reversion to values prior to application when scleral CL was removed. Conclusion: Scleral CLs remarkably improved visual acuity in keratoconus patients when compared to glasses or RGP contact lenses. Even if it was evidenced a small increase of the mean IOP value during their wear, it may not be significant in otherwise healthy eyes. Statistical analysis demonstrated good agreement between GAT and DT but their numerical values presented a constant gap, that should be taken into account when there is a need to relate the DT values to the reference ones

Evaluation of vision in gnathological and orthodontic patients with temporomandibular disorders: a prospective experimental observational cohort study

Objectives: Temporomandibular disorders (TMDs), orthodontic diseases, and vision dysfunctions seem to be strictly related. The purpose of this study was to prove the relationship, to evaluate the prevalence and the distribution of vision defects in dysfunctional and orthodontic patients, and to establish the type of the relationship. Materials and Methods: A total of 100 patients with TMDs were selected and studied through epidemiological analyses of the following factors: gnathological parameters (temporomandibular joint pathologies according to Diagnostic Criteria for Temporomandibular Disorders); occlusal and skeletal parameters (overjet, overbite, dental class, transversal discrepancies, and mandibular asymmetry); and orthoptic parameters (refractive defects and oculomotor diseases). A prospective experimental observational cohort study was conducted. A comparison with the average frequency of vision defects of the Italian population was performed. The prevalence of vision defects was evaluated. All gnathological and orthodontic parameters were associated with the orthoptic ones. A descriptive and statistical analysis of the data was carried out with the Statistical Package for the Social Sciences software; z test (P 0.05), frequency analysis (frequency 50%), chi-square test, and Student's t test (P 0.05) were performed. The scientific consistency was evaluated by using the scientific criteria of Bradford Hill. Results: The comparison with the Italian population showed a higher frequency of refractive defects in the study sample (P 0.001). The most frequent vision defects were phorias (92%) and tropia (3%). The increased frequency of ocular convergence reduction in the presence of disc displacement with reduction was significant (n = 28; 60%; P 0.05). In the presence of asymmetry, low frequencies of astigmatism (n = 18; 30%) were observed compared to its absence (n = 22; 54%) (P 0.05) and high frequencies of motor ocular deviations (n = 59; 100%) were observed compared to its absence (n = 36; 88%) (P 0.05). In the presence of headache, low frequencies of emmetropia (n = 13; 22%) and higher frequencies of hyperopia (n = 18; 30%) were observed (P 0.05). Two of five scientific criteria of Bradford Hill were met. Conclusion: It seems to emerge a possible positive relationship between TMD and vision defects. In particular, the most interesting associations were found between functional or skeletal orthognathic alterations and oculomotor dysfunctions. However, it was not possible to establish the type of relationship

LGBT+ Training needs for health and social care professionals: a cross-cultural comparison among seven European countries

Introduction Research suggests that specific training on LGBT+ issues may improve the competencies and skills of health and social care (HSC) professionals, which reduces the negative attitudes toward LGBT+ people. Despite this, there seems to be a lack of coverage of LGBT+ needs in HSC education. The present study aims to explore the specific LGBT+ training needs of HSC professionals and to examine the relationship between these training needs and the four dimensions of the Papadopoulos model, i.e. cultural awareness, cultural knowledge, cultural sensitivity, and cultural competence. Methods The research used data from a cross-cultural project, “Intercultural Education for Nurses in Europe (IENE9),” which was administered to 412 HSC academics and workers (62% females; Mage=46.06, SDage=10.48) between February 2020 and July 2020, in seven European countries: UK (coordinator), Denmark, Spain, Germany, Cyprus, Italy, and Romania. Results Hierarchical multiple regression showed that higher training needs were associated with cultural awareness, cultural knowledge, and cultural competence. The need for training on LGBT+ issues was higher for Cyprus, Romania, Spain, Italy, and the UK, compared with Denmark (no differences between Germany and Denmark were found). Conclusions We believe that there has been a lack of focus on the LGBT+ training needs of HSC professionals: Greater efforts are required to develop a culturally competent and compassionate LGBT+ curriculum. Social Policy Implications Findings from the present study will inform the development of a free, Massive Open Online Course (MOOC), for culturally competent and compassionate HSC professionals in Europe to improve the quality of their car

Role of previous hospitalization in clinically-significant MRSA infection among HIV-infected inpatients: results of a case-control study

<p>Abstract</p> <p>Background</p> <p>HIV-infected subjects have high incidence rates of <it>Staphylococcus aureus </it>infections, with both methicillin-susceptible and methicillin-resistant (MRSA) strains. Possible explanations could include the high burden of colonization, the behavioral risk factors, and the frequent exposures to health care facilities of HIV-infected patients. The purpose of the study was to assess the risk factors for clinically- significant methicillin-resistant <it>Staphylococcus aureus </it>(CS-MRSA) infections in HIV-infected patients admitted to Infectious Diseases Units.</p> <p>Methods</p> <p>From January 1, 2002 to December 31, 2005, we conducted a retrospective case-control (1:2) study. We identified all the cases of CS-MRSA infections in HIV-infected patients admitted to the National Institute for Infectious Diseases (INMI) "Lazzaro Spallanzani" in the 4-year study period. A conditional logistic regression model was used to identify risk factors for CS-MRSA infection.</p> <p>Results</p> <p>We found 27 CS-MRSA infections, i.e. 0.9 CS-MRSA infections per 100 HIV-infected individuals cared for in our Institute. At multivariate analysis, independent predictors of CS-MRSA infection were cumulative hospital stay, invasive procedures in the previous year, and low CD4 cell count. Particularly, the risk for CS-MRSA increased by 14% per an increase of 5 days hospitalization in the previous year. Finally, we identified a low frequency of community-acquired MRSA infections (only 1 of 27; 3.7%) among HIV-infected patients.</p> <p>Conclusion</p> <p>Clinicians should be aware of the risk for CS-MRSA infection in the clinical management of HIV-infected patients, especially in those patients with a low CD4 cell count, longer previous hospital stay, and previous invasive procedures.</p

Urban women's socioeconomic status, health service needs and utilization in the four weeks after postpartum hospital discharge: findings of a Canadian cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>Postpartum women who experience socioeconomic disadvantage are at higher risk for poor health outcomes than more advantaged postpartum women, and may benefit from access to community based postpartum health services. This study examined socioeconomically disadvantaged (SED) postpartum women's health, and health service needs and utilization patterns in the first four weeks post hospital discharge, and compared them to more socioeconomically advantaged (SEA) postpartum women's health, health service needs and utilization patterns.</p> <p>Methods</p> <p>Data collected as part of a large Ontario cross-sectional mother-infant survey were analyzed. Women (N = 1000) who had uncomplicated vaginal births of single 'at-term' infants at four hospitals in two large southern Ontario, Canada cities were stratified into SED and SEA groups based on income, social support and a universally administered hospital postpartum risk screen. Participants completed a self-administered questionnaire before hospital discharge and a telephone interview four weeks after discharge. Main outcome measures were self-reported health status, symptoms of postpartum depression, postpartum service needs and health service use.</p> <p>Results</p> <p>When compared to the SEA women, the SED women were more likely to be discharged from hospital within the first 24 hours after giving birth [OR 1.49, 95% CI (1.01–2.18)], less likely to report very good or excellent health [OR 0.48, 95% CI (0.35–0.67)], and had higher rates of symptoms of postpartum depression [OR 2.7, 95% CI(1.64–4.4)]. No differences were found between groups in relation to self reported need for and ability to access services for physical and mental health needs, or in use of physicians, walk-in clinics and emergency departments. The SED group were more likely to accept public health nurse home visits [OR 2.24, 95% CI(1.47–3.40)].</p> <p>Conclusion</p> <p>Although SED women experienced poorer mental and overall health they reported similar health service needs and utilization patterns to more SEA women. The results can assist policy makers, health service planners and providers to develop and implement necessary and accessible services. Further research is needed to evaluate SED postpartum women's health service needs and barriers to service use.</p

The role of peer victimization, sexual identity, and gender on unhealthy weight control behaviors in a representative sample of Texas youth

Objective: The aim of the study is to examine the association between victimization and unhealthy weight control behaviors (UWCB), accounting for other key correlates of UWCB while considering the moderating role of sexual identity and gender. Method: This study used data from the 2017 Texas Youth Risk Behavior Survey (YRBS), a representative sample of students in grades 9–12 in the U.S. state of Texas, including 2,067 students (1,754 heterosexuals and 313 sexual minorities). We used survey-weighted logistic regression to examine the association of sexual identity, gender, and victimization (dating violence, cyberbullying, and school bullying) with UWCB, after adjusting for demographic information and indicators of weight, physical activity, and support from adults. Results: Unhealthy weight control behaviors were associated with older age, being obese, lack of support from adults, low physical activity, and cyberbullying. A significant three-way interaction between gender, sexual identity and bullying showed that bullying was associated with high levels of UWCB among sexual minority males. Discussion: Our study highlights the role of victimization in health behaviors for stigmatized groups, and the importance of school efforts to implement an equitable and safe learning environment for all students

Relational variables and psychological well-being in lesbian, gay, bisexual and transgender elders: A critical review

Only recently the psychological literature started paying more attention to lesbian, gay, bisexual and transgender (LGBT) elders, partly because of the methodological challenges that characterise the study of this population. This paper aims to research in depth the relational life of older LGBT adults and its impact on several fundamental processes such as coming-out and isolation, which in turn influence psychological well-being and physical health. When it comes to LGBT elderly, one of the main risk factors concerns the invisibility and marginalization in dealing with social and health care. On the other hand, the presence of a social support and care network is an important protective factor

Psychophysical Impact of COVID-19 Pandemic and Same-Sex Couples’ Conflict: The Mediating Effect of Internalized Sexual Stigma

Research on the effects of the COVID-19 pandemic on same-sex relationships is limited. The present study aimed at analyzing the association between the psychophysical impact of the COVID-19 pandemic and same-sex couples’ conflict, also considering the potential mediating effect of internalized sexual stigma (ISS). For this purpose, psychophysical challenges and couples’ conflict during the COVID-19 pandemic, ISS, age, biological sex, sexual orientation, relationship duration, religiosity, involvement in lesbian, gay, and bisexual (LGB) associations, sexual satisfaction, and interpersonal partner violence were assessed in an Italian sample of 232 LGB people engaged in a same-sex relationship (aged 18–45 years; Mage = 28.68, SD = 6.91). The results indicated that the psychophysical impact of the COVID-19 pandemic was significantly associated with couples’ conflict, and ISS mediated this relationship. Among the covariates considered, only sexual satisfaction was associated with couples’ conflict. The findings suggest that ISS, over and above the adverse effects of the COVID-19 pandemic on psychophysical health, triggered conflict within same-sex relationships. Studying the role of ISS in various relational and social contexts is important, as ISS may have an adverse effect on the mental health of sexual minority people. We recommend that more efforts be made to improve research on the LGB population during the public health response to the COVID-19 emergency, because the paucity of studies underlines the invisibility of this population in many domains, including the domain of romantic relationships. Implications and directions for future research are discussed

Helicopter mothers and helicopter fathers: Italian adaptation and validation of the helicopter parenting instrument

The aim of this study is to validate the Italian version of the Helicopter Parenting Instrument (HPI), a self-report instrument that evaluate adolescents’ and young adults’ perception of parenting behaviors. The term helicopter parenting describes a style of child-rearing characterized by parents who are over-involved in every aspect of their children’s lives in inappropriate ways, compromising their autonomy. The HPI (maternal and paternal version) was administered to 602 adolescents (356 females), between 14 and 18 years of age (Mfemales = 16.56; SD = 1.43; Mmales = 16.63; SD = 1.41). The factorial analysis confirmed the original one-factor structure for both versions. The two versions of the instrument demonstrated good concurrent and divergent validity and the reliability was high. In general, our participants perceived mothers with higher levels of helicopter parenting than fathers, regardless of gender and age of the participants. In conclusion, the instrument demonstrated good psychometric properties, indicating that it may be a valid measure for evaluating parental overparenting in the Italian context

Sexism and Attitudes Toward Same-Sex Parenting in a Sample of Heterosexuals and Sexual Minorities: the Mediation Effect of Sexual Stigma

The present study aimed to: (a) investigate the relationship between attitudes toward same-sex parenting and sexism both in heterosexuals and sexual minorities; (b) verify whether sexism predicted negative attitudes toward same-sex parenting via the mediating role of sexual stigma (sexual prejudice in heterosexual people and internalized sexual stigma [ISS] in lesbians and gay men [LG]). An Italian sample of 477 participants (65.6% heterosexual people and 34.4% LG people) was used to verify three hypotheses: (a) heterosexual men showed higher levels of sexism than heterosexual women and LG people; (b) heterosexual men reported more negative attitudes toward same-sex parenting than those of heterosexual women and LG people; and (c) sexual prejudice in heterosexual people and ISS in LG people mediated the relationship between sexism and attitudes toward same-sex parenting. Overall, men and heterosexual people showed stronger sexist tendencies and more negative attitudes toward same-sex parenting. Moreover, sexism affected attitudes toward same-sex parenting via sexual prejudice in heterosexual people and ISS in LG people. These results suggest that negative attitudes toward same-sex parenting reflect sociocultural inequalities based on the traditional gender belief system and points to the necessity of social policies to reduce prejudice toward sexual minority groups