Background: To determine the level of knowledge on human papillomavirus (HPV) infection and vaccination, and the attitude towards HPV vaccination in pediatricians, obstetricians and gynecologists (OBG). Materials and Methods: Participants were administered a 40-question survey, investigating the demographic properties, the knowledge on the HPV infection-vaccination and attitudes towards vaccination. Results: The study enrolled a total of 228 participants (131 pediatricians and 97 OBGs). At a rate of 99.6%, the participants agreed with the fact that the HPV infection was the most common sexually transmitted disease and 33.8% of the participants had the opinion that the HPV vaccination should be administered only in women. The lowest level of HPV vaccine recommendation was among the pediatrics specialists (59.4%, p=0.012). When asked whether they would have their daughters receive HPV vaccination, 79.5% of the participants answered favorably; this rate was 36.7% for the sons. At a rate of 59.5% of the participants thought that the HPV vaccine needed to be included in the national vaccine schedule. Most of the participants (91.6%) had the idea that reduction of the vaccine costs would increase the vaccination frequency. Conclusions: We observed that the consideration of the costs and the prejudices relating to the inefficacy of vaccination as well as the inadequate level of knowledge were involved in the physicians' resistance to HPV vaccination. We believe that the healthcare professionals should be informed adequately to overcome false beliefs, thereby ensuring success of the HPV vaccine upon inclusion in the national vaccine schedule in the future.
Purpose: To evaluate the effectiveness of repeated corneal collagen cross-linking (CXL) in eyes with progressive keratoconus after primary CXL. Methods: Twelve eyes of 10 patients who underwent repeated CXL were included in this study. All cases were treated with a second CXL when disease progression was noted. Uncorrected visual acuity, best-corrected distance visual acuity, and corneal tomography were performed before and after repeated CXL. Common risk factors for progression were recorded. Results: The mean age of the patients was 23.4 ± 6.2 (14–34) years. Eye rubbing was detected in 6 patients. The preoperative maximum keratometry (Kmax) value was >58.0 diopters (D) in 11 eyes (62.2 ± 4.9 D). Repeated CXL was performed with a mean interval of 19.3 months after the first CXL procedure when a disease progression of 2.3 D on average in Kmax was determined. With a mean follow-up of 36 months, Kmax regressed in 8 eyes, remained stable in 2 eyes, and progressed in 2 eyes after repeated CXL. Uncorrected and corrected visual acuity remained unchanged. No complications were observed. Conclusions: Repeated CXL seems to be effective in stabilizing keratoconus progression after failure of primary CXL. Patients should be followed up at least for 2 years after primary CXL.
Purpose: To assess corneal thickness changes with isotonic riboflavin (RF) solution with hydroxylpropyl methylcellulose in patients undergoing accelerated corneal collagen crosslinking (CXL) with and without an eyelid speculum. Methods: Fifty-two eyes of 48 patients with progressive keratoconus were enrolled in this study. The patients in this study were divided into 2 groups: in group 1 an eyelid speculum was removed during 20-minute RF (0.1%) + hydroxylpropyl methylcellulose (Mediocross M; Avedro Inc, Waltham, MA) instillation, and in group 2 the eyelid speculum was retained in place during the entire CXL procedure. All patients underwent accelerated CXL using continuous ultraviolet-A (UVA) light exposure at 9 mW/cm2 for 10 minutes; total energy dose was 5.4 J/cm2. Intraoperative ultrasound pachymetry measurements were obtained before and after epithelial removal, after RF loading, and after UVA light exposure at 5 and 10 minutes. Results: The preoperative pachymetric measurements decreased in both groups after the removal of epithelium [group 1 (n = 26): −25 μm, group 2 (n = 26): −31 μm, P = 0.234]. Although the thinnest pachymetry significantly increased after soaking in both group 1 (52.26 μm) and group 2 (27.88 μm, P < 0.001), closure of the eyelids during RF instillation further increased the pachymetry readings (P < 0.0001). The corneal thickness remained stable in both groups during UVA irradiation at 5 and 10 minutes (P > 0.05). Conclusions: Closure of the eyelids further induces corneal swelling that may offer an advantage to improve safety of the procedure particularly in thin corneas.
Objective: Although meningococcal infections are most feared infectious diseases due to their high mortality and the possibility of leading to epidemics, there is no common practice for vaccination yet. In this study, we aimed to determine the level of knowledge about meningococcal infection and vaccination, and the attitude towards meningococcal vaccination among pediatricians. Material and Methods: Participants were administered a 41-question survey, investigating the demographic properties, the knowledge on the meningococcal infection-vaccination and attitudes towards vaccination. Results: The study enrolled a total of 169 participants (73 pediatrics specialists and 96 pediatric residents). Of the participants, 22.7% responded that meningococci (Neisseria meningitidis) was the most common cause of bacterial meningitis, while 99.1% of the participants agreed that the only reservoir in meningococcal infections was human, and 98.2% were contagious droplets. Participants stated that effective methods for protection from meningococcal infection were vaccination (81.1%), droplet isolation (66.3%), contact isolation (62.8%) and postcontact chemoprophylaxis (59.1%). While 40.7% of the participants reported that meningococcal vaccine recommended to all patients, 56.8% recommend to patients in the risk group, and 2.5% of respondents never suggested vaccination. 81.8% of the participants agreed that the meningococcal vaccine to be included in the national childhood vaccination schedule. At a rate of 86.7%, the participants had the idea that reduction of the vaccine costs would increase the vaccination frequency. Özet Giriş: Meningokok enfeksiyonları, yüksek mortalite ve epidemilere yol açabilmesi nedeniyle en korkulan enfeksiyon hastalıklarının başında geldiği halde henüz aşılama konusunda yaygın bir uygulama yapılamamaktadır. Bu çalışmamızda pediatri uzmanları ve uzmanlık eğitimi görmekte olan pediatri asistanlarının meningokok enfeksiyonu ve aşısı hakkındaki bilgi düzeyi ile meningokok aşısına yaklaşımlarını ölçmeyi amaçladık. Gereç ve Yöntemler: Katılımcılara araştırmacılar tarafından hazırlanmış 41 soruluk bir anket uygulandı. Ankette katılımcıların demografik özellikleri ile ilgili sorular (n= 10), meningokok enfeksiyonu ile ilgili sorular (n= 10), meningokok aşısı ile ilgili sorular (n= 10) ve katılımcıların aşıya yaklaşımı ile ilgili sorular (n= 11) bulunmaktaydı. Bulgular: Anket formunu doldurup çalışmaya katılmayı 169 hekim kabul etti. Katılımcıların 73 (%43.2)'ü uzman, 96 (%56.8)'sı uzmanlık öğrencisi hekimdi. Bakteriyel menenjitlerin en sık etkeni sorusunu katılımcıların %22.7'si meningokok (Neisseria meningitidis) olarak yanıtlarken, katılımcıların %99.1'i meningokok enfeksiyonlarında tek rezervuarın insan olduğuna, %98.2'si bulaşmanın damlacık yoluyla olduğuna katılmaktaydı. Katılımcılar meningokok enfeksiyonundan korunmada etkili yöntemlerin sırasıyla aşılama (%81.1), damlacık izolasyonu (%66.3), temas izolasyonu (%62.8), temas sonrası kemoprofilaksi (%59.1) olduğunu belirtmişlerdi. Katılımcıların %40.7'si ...
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