Marianne Haapea

Objective: We assessed whether preoperative advanced multisegmental degeneration is associated with worse 1-year outcomes of primary single-level lumbar discectomy. Materials and methods: A literature-based scoring system was developed to quantify degeneration in the operated and adjacent lumbar segments, based on advanced phenotypes of common intervertebral disc–related degenerative features. Each segment received a score from 0 to 3: cranial and caudal ≥ 25% endplate damage (EPD) and Modic changes type I (MC1) were assigned 0.5 points each, and Pfirrmann grade ≥ 4 was assigned 1 point. The final adjacent segment degeneration score was calculated as the mean of the operated and adjacent segment scores. Prospectively collected data from primary single-level lumbar discectomy patients operated in a single center between 2017 and 2022 were retrospectively analyzed. Patients were stratified into none-to-mild (≤ 0.5), moderate (0.5 < score < 1.33), and severe (≥ 1.33) degeneration groups, using the 40th and 80th percentile cut-offs. A linear mixed-effects model was employed to assess between-group differences in 1-year improvements in low back (LBP) and leg pain (VAS, 0–100), disability (ODI), and quality of life (EQ-5D-3L). Results: Among the 140 patients included (mean age 45.3 years; 57.9% male), all PROMs improved overall. The severe group showed significantly smaller improvements from baseline to 1-year follow-up, with adjusted mean differences in change of 20.2 for LBP, 31.6 for leg pain, and 11.1 for disability relative to the none-to-mild reference group. Conclusion: Severe preoperative adjacent segment degeneration may be associated with smaller 1-year improvements in pain and disability after primary single-level lumbar discectomy.

Objective: To evaluate maxillary sinus and odontogenic findings in low-dose CBCT, and to test if associations exist between these findings. Methods: From 263 consecutive CBCT scans, 212 were included. Evaluated odontogenic parameters were periapical lesions (PAI), marginal periodontal bone loss (PBL), root contact to the maxillary sinus, the presence of crowns, implants, defective restorations and extensive caries. Maxillary sinus findings were categorized as mucosal thickening (MT; generalized and localized), mucosal retention cysts, and opacification/fluid level. Crosstabulations and generalized estimating equations were used as statistical tests. Prevalence and bias adjusted kappas were calculated for inter- and intra-observer agreement. Results: The only dental finding statistically associated with sinus pathology when compared to healthy sinuses was root contact, which increased the risk for generalized MT (OR = 1.47, p = 0.015), mucosal retention cysts (OR = 2.60, p < 0.001) and opacification/fluid (OR = 1.76, p = 0.018). All parameters showed almost perfect or substantial intra- and interobserver reliability, except for PBL, where the former was moderate and the latter fair. Conclusion: Root contact was the only dental finding significantly associated with sinus pathology. Thus, there may be fewer associations between radiological dental findings and sinus pathology than previously thought. With the exception of PBL, all parameters demonstrated at least substantial intra- and interobserver reliability, indicating that the assessment is reliable overall.

Background: Treatment-resistant schizophrenia (TRS) is a severe form of schizophrenia associated with low adherence to treatment and poor outcomes. Mobile health (mHealth) interventions may be effective in preventing relapses, increasing treatment adherence, and managing some of the symptoms of schizophrenia. Mobile therapeutic attention for treatment-resistant schizophrenia (m-RESIST) is an innovative mHealth developed specifically for TRS. Objective: We aim to evaluate the effects of m-RESIST on the clinical and functional outcomes and on the perceived quality of life in people with TRS. Methods: A feasibility study without a control group was performed to test the m-RESIST solution on patients with TRS. Participants were recruited from Spain, Israel, and Hungary. This study’s population (N=31) followed 3 months of intervention. The m-RESIST was configured by an app, a wearable, and a web-based platform. The severity of symptoms was evaluated by using the Positive and Negative Syndrome Scale (PANSS) and the Clinical Global Impression-Schizophrenia (CGI-SCH) scale. Functionality was assessed by the Global Assessment of Functioning and perceived quality of life was evaluated by the EuroQol visual analogue scale (EQ-VAS). Results: Significant reductions were found in symptoms from pretrial to posttrial on the PANSS total (mean difference −7.2, 95% CI −11.1 to −3.4; P=.001), the PANSS positive (mean difference −1.36, 95% CI −2.6 to −0.1; P=.04), the PANSS negative (mean difference −2.1, 95% CI −3.1 to −1.1; P<.001), and the PANSS general symptoms (mean difference −3.8, 95% CI −6.8 to −0.8; P=.02). In almost one-fifth of the participants (6/31), the overall score for the PANSS decreased by more than 20%, which may be considered a clinically significant change. On the CGI-SCH scale, the sum of total severity of illness decreased significantly (P=.03). A decrease in the sum of positive and negative symptoms of the CGI-SCH score was also found (P=.04 and P=.03, respectively). The sum of depressive or cognitive symptoms did not change. The functionality of participants increased significantly on the Global Assessment of Functioning (P≤.001). The perceived quality of life on the EQ-VAS also improved (mean difference 6.7, 95% CI 0.5 to 12.9; P=.04). Conclusions: To our best knowledge, this was the first study to address the efficacy of the mHealth app m-RESIST on the symptoms and functional capacity and on the quality of life for people with TRS. Our preliminary findings showed that implementing the m-RESIST solution decreased the symptoms and severity of disease, and improved the functionality and perceived quality of life among those with TRS. The change of symptoms on the PANSS total may be clinically significant. Modern technologies such as mHealth interventions may be useful in treating symptoms and functionality even in TRS, which is a major clinical challenge, with usually poor outcomes. These results should be corroborated by performing a controlled trial.

BACKGROUND Treatment-resistant schizophrenia (TRS) is a severe form of schizophrenia associated with low adherence to treatment and poor outcomes. Mobile health (mHealth) interventions may be effective in preventing relapses, increasing treatment adherence, and managing some of the symptoms of schizophrenia. Mobile therapeutic attention for treatment-resistant schizophrenia (m-RESIST) is an innovative mobile health (mHealth) solution based on novel technology offering high modular and flexible functioning developed specifically for TRS. To our best knowledge no studies have addressed the efficacy of mHealth applications on the symptoms and functional capacity, and on the quality of life in subjects having TRS. OBJECTIVE To evaluate the effects of m-RESIST on the clinical and functional outcomes, and on the perceived quality of life among participants having TRS. METHODS A feasibility study without a control group was performed to test the m-RESIST solution in TRS patients. Participants were recruited from Spain, Israel and Hungary. Study population (N=31) followed the 3 months of intervention. The m-RESIST was configured by an app, a wearable and a web-based platform. The severity of symptoms was evaluated by using the Positive and Negative Syndrome Scale (PANSS) and Clinical Global Impression Schizophrenia (CGI-SCH). Functionality was assessed by the Global Assessment of Functioning (GAF) and perceived quality of life was evaluated by the Analogue Visual Scale of EuroQol 5 dimensions 5 levels questionnaire (EQ-VAS). RESULTS Significant reductions were found in symptoms from pretrial to post trial on the PANSS total; mean difference -7.2 (P=.001), on the PANSS positive; -1.36 (P =.036) and PANSS negative; -2.1 (P <.001), and also on the PANSS general symptoms; -3.8 (P =.015). In almost one-fifth of the participants (6/31), the overall score for PANSS decreased by more than 20% which may be considered a clinically significant change. On CGI-SCH the sum of total severity of illness decreased significantly (P=.027). A decrease in the sum of positive and negative symptoms of the CGI-SCH-score was also found (P=.037 and P=.03, respectively). The sum of depressive or cognitive symptoms did not change. The functionality of participants increased significantly on the GAF (P =<.001). The perceived quality of life on EQ-VAS improved also (mean difference 6.7, P=.035). CONCLUSIONS To our best knowledge, this was the first study collecting data on the symptoms, functional capacity, and quality of life in TRS by using the mHealth platform (m-RESIST solution). Our novel findings showed that implementing m-RESIS-solution decreased the symptoms and severity of illness, and improved the functionality and perceived quality of life among those having TRS. The change of symptoms on the PANSS total may be clinically significant. Modern technologies like mHealth interventions seem to be useful in treating symptoms and functionality even in TRS which is a major clinical challenge having usually poor outcomes. These results should be corroborated by performing a controlled trial. CLINICALTRIAL ClinicalTrials.gov NCT03064776; https://clinicaltrials.gov/ct2/show/record/NCT03064776 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2017-021346

Aim: The purpose of the study was to describe the preparation of children for day surgery from the parent's viewpoint.Design: Empirical Research Mixed Method.Methods: The research applied a mixed‐methods study design. The study was conducted at the Paediatric Day Surgical Department of one REDACTED between 2018 and 2020 at the same time as an associated randomised controlled conduct trial. Parents of 41 children (ages 2–6 years) completed measures assessing their preparation for day surgery and satisfaction with the procedure. Semi‐structured interviews were conducted with 15 parents to better understand their experiences.Results: According to the results, most of the parents (95%) told their children about the upcoming day surgery procedure. The child was prepared for the surgery with cognitive and sensory information, and the preparation usually started at home well before the surgery. The parents' experiences with the most critical aspects of preparing their child included three main categories: (1) usability of the preparation method; (2) content and timing of the preparation method and (3) consideration of the family perspective.

Background: Day surgery allows families to return home quickly. Only a few approaches to preparing for day surgery have demonstrated how digital solutions can support families and children. Objective: This study aims to evaluate the effectiveness of a mobile app intervention on preschool children’s fear and pain and parents’ anxiety and stress in preparing children for day surgery. Methods: This study was conducted at the Pediatric Day Surgical Department of a university hospital in Finland between 2018 and 2020. Parents of children (aged 2-6 y) who were in a queue for elective day surgery were randomized into the intervention group (IG; n=36) and control group (CG; n=34). The CG received routine preparations, whereas the IG was prepared using a mobile app. Parents’ and children’s outcomes were measured using validated scales at 4 different points: at home (T1 and T4) and at the hospital (T2 and T3) before and after surgery. Group differences were analyzed using statistical methods suitable for the material. Results: Before surgery, parents in both groups experienced mild anxiety, which decreased after surgery. Parental anxiety did not differ between groups preoperatively (P=.78) or postoperatively (P=.63). Both groups had less anxiety at home after surgery compared with before. The IG showed a significant decrease (P=.003); the CG also improved (P=.002). Preoperatively at home, most parents in both groups experienced no stress or mild stress (P=.61). Preoperatively at the hospital, parents in both groups experienced mild stress; however, parents in the IG experienced more stress during this phase (P=.02). Parents in the IG experienced significantly less stress postoperatively than those in the CG (P=.05). Both groups showed decreased stress levels from before to after surgery (IG: P=.003; CG: P=.004) within each group. There were no significant differences in children’s pain levels between the groups and measurement points. This was observed before surgery at home (P=.25), before surgery at the hospital (P=.98), and after surgery at the hospital (P=.72). Children’s fear decreased more in the IG (P=.006) than in the CG (P=.44) comparing the phases before and after surgery at home. Fear did not differ between the IG and CG preoperatively at home (P=.20) or at the hospital (P=.59) or postoperatively at the hospital (P=.62) or at home (P=.81). Conclusions: The mobile app intervention did not reduce anxiety or pain. However, it was observed that parents in the IG experienced substantially heightened stress levels before surgery at the hospital, which decreased significantly after surgery at home. In addition, fear levels in children in the IG decreased over time, whereas no significant change was observed in the CG. These results are important for developing health care service chains and providing families with innovative and customer-oriented preparation methods. Trial Registration: ClinicalTrials.gov NCT03774303; https://classic.clinicaltrials.gov/ct2/show/NCT03774303

BACKGROUND Day surgery allows families to return home quickly. Only a few approaches to preparing for day surgery have demonstrated how digital solutions can support families and children. OBJECTIVE This study aims to evaluate the effectiveness of a mobile app intervention on preschool children’s fear and pain and parents’ anxiety and stress in preparing children for day surgery. METHODS This study was conducted at the Pediatric Day Surgical Department of a university hospital in Finland between 2018 and 2020. Parents of children (aged 2-6 y) who were in a queue for elective day surgery were randomized into the intervention group (IG; n=36) and control group (CG; n=34). The CG received routine preparations, whereas the IG was prepared using a mobile app. Parents’ and children’s outcomes were measured using validated scales at 4 different points: at home (T1 and T4) and at the hospital (T2 and T3) before and after surgery. Group differences were analyzed using statistical methods suitable for the material. RESULTS Before surgery, parents in both groups experienced mild anxiety, which decreased after surgery. Parental anxiety did not differ between groups preoperatively (P=.78) or postoperatively (P=.63). Both groups had less anxiety at home after surgery compared with before. The IG showed a significant decrease (P=.003); the CG also improved (P=.002). Preoperatively at home, most parents in both groups experienced no stress or mild stress (P=.61). Preoperatively at the hospital, parents in both groups experienced mild stress; however, parents in the IG experienced more stress during this phase (P=.02). Parents in the IG experienced significantly less stress postoperatively than those in the CG (P=.05). Both groups showed decreased stress levels from before to after surgery (IG: P=.003; CG: P=.004) within each group. There were no significant differences in children’s pain levels between the groups and measurement points. This was observed before surgery at home (P=.25), before surgery at the hospital (P=.98), and after surgery at the hospital (P=.72). Children’s fear decreased more in the IG (P=.006) than in the CG (P=.44) comparing the phases before and after surgery at home. Fear did not differ between the IG and CG preoperatively at home (P=.20) or at the hospital (P=.59) or postoperatively at the hospital (P=.62) or at home (P=.81). CONCLUSIONS The mobile app intervention did not reduce anxiety or pain. However, it was observed that parents in the IG experienced substantially heightened stress levels before surgery at the hospital, which decreased significantly after surgery at home. In addition, fear levels in children in the IG decreased over time, whereas no significant change was observed in the CG. These results are important for developing health care service chains and providing families with innovative and customer-oriented preparation methods. CLINICALTRIAL ClinicalTrials.gov NCT03774303; https://classic.clinicaltrials.gov/ct2/show/NCT03774303