An evaluation of pelvic floor disorders in a public and private healthcare setting

INTRODUCTION AND HYPOTHESIS

The objectives were to determine whether a difference exists in the duration of pelvic floor disorder (PFD) symptoms among patients presenting to urogynecologists in two healthcare systems: private and county; and to elucidate differences in baseline characteristics, type of PFDs, symptom severity and management, stratified by healthcare plans.

METHODS

A multi-center retrospective study was conducted including new patients presenting to three urogynecology clinics between March 2016 and May 2018: one private clinic (site A) and two public clinics in the same county healthcare system (sites B and C). Baseline data included age, race, BMI, parity, and comorbidities. Primary outcome was "time to presentation" defined as PFD duration in months. Secondary outcomes were symptom severity and PFD management, analyzed by healthcare setting and insurance type.

RESULTS

A total of 1,055 private and 439 public patients were included. Patients in the public setting were younger (54 vs 61 years, p<0.001), largely Hispanic (76% vs 14%, p<0.001), of higher parity (4 vs 3, p=0.001), and had more comorbidities, with a predominance of county-funded healthcare plans. There was no difference in duration of symptoms between the public and private groups respectively (54 vs 56 months, p=0.94). Patients in the public setting had more severe urinary incontinence (3 vs 2 pads/day, p<0.001) and prolapse (stages 3-4, 71% vs 61%, p=0.004); however, they had lower rates of surgical management for stress incontinence and prolapse. Differences in fecal incontinence could not be evaluated owing to small sample size.

CONCLUSIONS

Public patients presented younger with more severe symptoms but had lower rates of surgery for PFDs traditionally managed surgically.

Spatiotemporal visual function in tinted lens wearers

PURPOSE

Tinted lenses have been widely publicized as a successful new treatment for reading disorders and visual stress in children. The present study was designed to investigate a variety of visual deficits reported by children who experience high levels of visual stress and perceptual distortions when reading (Meares-Irlen syndrome; MIS) and to assess the improvements in visual comfort they report when tinted lenses are worn.

METHODS

Twenty children (13.1 +/- 0.9 years of age) were recruited who had successfully worn tinted lenses for at least 6 months and were compared with an age-matched control group (12.6 +/- 2.2 years of age) of 21 children who were not lens wearers. A range of psychophysical tasks was adapted to identify specific anomalous visual perceptions. Spatiotemporal contrast sensitivity and contrast increment thresholds were used to investigate subjective reports of dazzle and hypercontrast, and a minimum motion perception (D(min)) and a motion-coherence task were used to assess subjective reports of visual instability and motion.

RESULTS

In all viewing conditions (with versus without lens), no selective functional visual loss was demonstrated with any of the tasks used. Psychometric functions also revealed no significant difference between subject groups (control versus MIS).

CONCLUSIONS

Under thorough psychophysical investigation, these results revealed no significant difference in visual function between subject group, and this finding is consistent with the absence of any effect of the tinted lenses in the group with MIS.

Dental amalgam stabilization by selective interfacial amalgamation

The purpose of this investigation was to explore the feasibility of enhancing the electrochemical stability of dental amalgam restorations by a process of "selective interfacial amalgamation." If dental amalgam restorations can be selectively alloyed at the tooth-amalgam interface, to a minor thickness as compared with the dimensions of the bulk amalgam, so as to present a more electrochemically stable phase than psi2 to the oral environment, corrosion will be reduced and desirable qualities of existing amalgams can be utilized. It was found that selective interfacial amalgamation was indeed possible and that it could be readily accomplished using a silver suspension as a cavity liner. By then placing a conventional silver-tin amalgam according to ordinary dental techniques, mercury expressed during hand condensing reacted with the silver in the liner resulting in the formation of an integral amalgam restoration with the more noble psi1 phase adjacent to tooth structure. In vitro corrosion tests of samples so prepared exhibited corrosion resistance far superior to unlined control samples.