Preschool regulatory problems and attention-deficit/hyperactivity and cognitive deficits at school age in children born at risk: Different phenotypes of dysregulation?

Background

Early regulatory problems (RP), i.e., excessive crying, feeding, and sleeping difficulties, have been reported to be predictors of cognitive and attention-deficit/hyperactivity problems. However, previous studies had limitations such as small sample size or retrospective design.

Aim

To investigate whether persistent RP from infancy until preschool age are precursors of ADHD problems and cognitive deficits at school age.

Study design

A prospective study from birth to 8.5 years of age.

Subjects

1120 infants born at risk.

Measures

RP were assessed at 5 months (i.e., excessive crying, feeding, and sleeping problems), 20, and 56 months (i.e., eating and sleeping problems) via parent interviews and neurological examination. At 8.5 years of age, IQ was assessed by a standard test (K-ABC), and ADHD problems by direct observations in the test situation and by the Mannheimer Parent Interview (MPI, DSM-IV diagnosis of ADHD).

Results

23.8% of the sample born at risk had RP at least at two measurement points until preschool age. Persistent RP predicted lower IQ (β = − .17; 95% CI (− .21; − .10)), behaviour problems (β = − .10; 95% CI (− .15; − .03)), attention (OR 2.43; 95% CI (1.16; 5.09)) and hyperactivity problems (OR 3.10; 95% CI (1.29; 7.48)), and an ADHD diagnosis (OR 3.32; 95% CI (1.23; 8.98)) at school age, even when controlled for psychosocial and neurological confounders.

Conclusions

Early persistent RP increased the odds of ADHD and associated problems at school age, indicating a cascade model of development, i.e., infant behaviour problems provide the starting point of a trajectory of dysregulation through time.     

Chemomechanical caries removal in children: an operator's and pediatric patients' responses

BACKGROUND: This study investigated an operator's and pediatric patients' responses to chemo-mechanical caries removal (CMCR) versus the traditional method (TM) of caries removal using a handpiece and a round bur when treating dentinal-depth occlusal lesions with minimal enamel access in primary molars. METHODS: Data were collected from 50 children at baseline and before, during and after caries removal using CMCR or TM. The subjects in the CMCR group were on average younger than the subjects in the TM group and had more deep lesions. RESULTS: The operator rated CMCR as needing more clinical and technical effort and more total effort than TM. He was less satisfied with CMCR than with TM. Subjects in the CMCR group perceived the time needed for treatment as significantly longer than did the subjects in the TM group. Fear of the dentist decreased in subjects in the TM group from before to after the operative appointment, while it increased in subjects in the CMCR group. CONCLUSIONS: The authors found no direct advantage in using CMCR over using TM. CLINICAL IMPLICATIONS: CMCR cannot be recommended as an alternative to TM when treating dentinal depth occlusal lesions with minimal access in primary molars.     

Oral health status in individuals with dementia living in special facilities

Abstract:  Aim:  The aim of this review was to retrieve data describing the oral health status of individuals with dementia living in special facilities. Materials and methods:  A literature search on the MEDLINE database (Entrez PubMed) was performed. The literature search yielded 208 papers, of which seven publications were selected for evaluation. Results:  From the available studies poorer oral hygiene, decreased saliva flow rates and a higher caries incidence were reported in individuals with dementia living in special facilities when compared with healthy individuals. Oral health problems were more pronounced in the severe stage of the disease. Conclusions:  There is limited scientific data describing the oral health status of individuals with dementia living in special facilities. However, available data indicate that individuals with dementia living in special facilities have more oral health problems than individuals without dementia.     

Specific orofacial problems experienced by musicians

BACKGROUND: Patients who play musical instruments (especially wind and stringed instruments) and vocalists are prone to particular types of orofacial problems. Some problems are caused by playing and some are the result of dental treatment. This paper proposes to give an insight into these problems and practical guidance to general practice dentists. METHOD: Information in this paper is gathered from studies published in dental, music and occupational health journals, and from discussions with career musicians and music teachers. RESULTS: Orthodontic problems, soft tissue trauma, focal dystonia, denture retention, herpes labialis, dry mouth and temporomandibular joint (TMJ) disorders were identified as orofacial problems of career musicians. Options available for prevention and palliative treatment as well as instrument selection are suggested to overcome these problems. Conclusions: Career musicians express reluctance to attend dentists who are not sensitive to their specific needs. General practitioner dentists who understand how the instruments impact on the orofacial structures and are aware of potential problems faced by musicians are able to offer preventive advice and supportive treatment to these patients, especially those in the early stages of their career.     

Pilot pathfinder survey of oral hygiene and periodontal conditions in the rural population of The Gambia (West Africa)

To cite this article:
Int J Dent Hygiene 9 , 2011; 53–59
DOI: 10.1111/j.1601‐5037.2009.00435.x
Jordan RA, Lucaciu A, Fotouhi K, Markovic L, Gaengler P, Zimmer S. Pilot pathfinder survey of oral hygiene and periodontal conditions in the rural population of The Gambia (West Africa). Abstract: Objective: To document oral hygiene and periodontal conditions in the rural population of The Gambia. Basic research design: Cross‐sectional study according to the recommendations of the WHO for oral health surveys. Clinical setting: Examination by two calibrated investigators in the health centres of rural communities after a public radio call. Patients were randomly allocated to the investigators. Participants: 162 patients (20–54 years old; 52.5% female, 47.5% male). Interventions: Patients were interviewed for personal information and examined in a full‐mouth recording. Main outcome measures: Oral Hygiene Index (OHI), Gingival Index (GI), Community Periodontal Index (CPI), and the Gingivitis‐Periodontitis‐Missing/Teeth Index (GPM/T). Statistical analysis was performed using the Wilcoxon‐rank‐sum test and Kruskal–Wallis test with statistical significance at P < 0.05. Results: OHI increased by age from 6.9 to 9.2 (P < 0.05) and showed in tendency higher levels in men (P = 0.07), while the GI remained stable at 1.2. Community Periodontal Index codes increased by age (P < 0.05) and showed a fourfold higher prevalence for severe periodontitis in males (P < 0.05). Likewise, an age‐related increase in GPM/T was evident (20.5 versus 25.4), significantly in the number of moderate periodontitis and missing teeth (P < 0.05). In GPM/T, males again demonstrated significantly more teeth affected by periodontitis than women. No statistical associations were found between ethnic groups or for different oral hygiene methods concerning CPI or GPM/T. Conclusions: Prevalence of predominantly mild to moderate periodontal disease indicates treatment needs that should be considered when developing a national oral health care plan in The Gambia (West Africa).     

Oral cancer prevention and diagnosis

Globally, oral cancer is one of the leading cancer sites. The profile problems are similar, that is, late diagnosis, advanced tumors and poor survival and cure rates.     

基于中药饮片生产企业现状调研的相关问题分析及对策探讨

中药炮制技术是中国特有的制药技术,饮片生产企业是中药炮制技术的主要载体,其对中药饮片炮制技术的掌握、运用是否到位、规范,直接影响到饮片质量的优劣和中医临床疗效。通过开展中药饮片生产企业炮制技术现状调研,对饮片生产企业现状及存在相关问题进行梳理、归纳、总结,并提出相关的对策,以期更好的传承和发展炮制技术,促进中药饮片生产企业的发展,保障饮片质量。     

Prospective nonrandomized study to evaluate cone beam computed tomography for technical assessment of standard and complex endovascular aortic repair

ObjectiveThe objective of this study was to analyze the utility of cone beam computed tomography (CBCT) for technical assessment of standard and complex endovascular aneurysm repair (EVAR).MethodsData of consecutive patients who underwent standard or complex EVAR in 2016 and 2017 at our institution were entered into a prospective database and analyzed retrospectively. There were 154 patients (126 male; mean age, 74 ± 8 years) enrolled in a prospective study between 2016 and 2017. A total of 170 aortic procedures were investigated, including 85 fenestrated-branched EVARs (F-BEVARs), 42 abdominal and thoracic EVARs, 32 EVARs with iliac branch devices, and 11 aorta-related interventions. Technical assessment was done using CBCT with and without contrast enhancement, digital subtraction angiography (DSA), and computed tomography angiography (CTA). Patients with stage 3B or stage 4 chronic kidney disease had CBCT without contrast enhancement. Radiation exposure (mean dose-area product), effective dose (ED), and amount of iodine contrast agent were analyzed. End points were presence of any endoleak, positive findings warranting possible intervention (stent kink or compression, type I or type III endoleak, dissection, thrombus), and need for secondary intervention.ResultsRadiation exposure and amount of iodine contrast agent were significantly higher (P < .05) for F-BEVAR compared with other aortic procedures (174±101 Gy∙cm² vs 1135±113 Gy∙cm² and 144±60 mL vs 122±49 mL). ED averaged 74±36 mSv for the aortic procedure, 18 ± 18 mSv for fluoroscopy, 7 ± 7 mSv for DSA acquisition, 15±7 mSv for CBCT, and 34±17 mSv for CTA imaging (P < .001). Endoleak detection was significantly higher (P < .001) with CBCT (53%) compared with DSA (14%) and CTA (46%). CBCT identified 52 positive findings in 43 patients (28%), higher for F-BEVAR compared with other aortic procedures (35% vs 16%; P = .01). Positive findings included stent compression or kink in 29 patients (17%), type I or type III endoleak in 16 patients (10%), and arterial dissection or thrombus in 7 patients (5%). Of these, 28 patients (18%) had positive findings that prompted an intraoperative (17%) or delayed intervention (1%). Another 15 patients (10%) with minor positive findings were observed with no clinical consequence. DSA alone would not have detected positive findings in 34 of 43 patients (79%), including 21 patients (49%) who needed secondary interventions. CTA diagnosed two (1%) additional endoleaks requiring intervention (one type IC, one type IIIC) that were not diagnosed by CBCT. Replacing DSA and CTA by CBCT would have resulted in 53% ± 13% reduction in amount of iodine contrast agent and 55% ± 12% reduction in ED (P < .05).ConclusionsCBCT reliably detected positive findings prompting immediate revisions in nearly one of five patients, with the highest rates among F-BEVAR patients. Detection of any endoleak was higher with CBCT compared with DSA or CTA, but most endoleaks were observed. DSA alone failed to detect positive findings warranting revisions.     

护理个案报告中护理问题在护理分类系统中的术语映射分析

目的 了解护理个案报告中的护理问题与三大护理术语分类系统呈现交集的现况及国内护士对护理诊断的认知,为建立我 国本土化护理术语系统提供参考。方法 选取44份护理个案报告中的326条护理问题,分别按疾病、症状、功能、健康形态、风险5 类映射到国际北美护理诊断(NANDA-I)、奥马哈系统、临床照护分类系统(CCC),并对映射结果进行比较。结果 护理问题在三 大护理分类系统的分布差异有统计学意义(P<0.05,P0.61)。风险类问题存在39.4%的映射缺失。结论 护理个案中的护理问题在三大护理术语分类系统中映射的吻合程 度低,尤其是疾病与风险为焦点的护理问题。症状、功能、健康形态此类问题则在 NANDA-I和 CCC的映射结果存在共性。需结 合医护合作模式,针对三大护理分类系统各自的优点建立本土化护理术语。