Clinical classification of 14–16-year-old Danish children according to functional status of the masticatory system

The high prevalence of functional disturbances in the masticatory system and the tendency to increasing severity with duration stresses the necessity for a reproducible index. Clinical examination of the masticatory system was performed in 14-16-yr-old children. The sequence of examination, TMJ-muscles-opening capacity was chosen in order to minimize the bias. For the same reason, information on symptoms and occlusal conditions was not available for the examiner. According to the amount and character of the signs of dysfunction, the children were classified into three groups. Both single traits of dysfunction and the classification of the subjects were tested for reproducibility. The reproducibility of the compound clinical index was high. The ability to differentiate between children with moderate/severe signs and without signs was higher but the highest value was reached when differentiation was made between children with no/moderate signs and children with severe signs.     

Rollen und Rollendynamiken in der partizipativen Forschungsgemeinschaft

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Aus dem Ansatz der partizipativen Forschung ergeben sich für Forschende und Co-Forschende andere Rollen und Beziehungen als...     

Pessary types and discontinuation rates in patients with advanced pelvic organ prolapse

Introduction and hypothesis

The aim of this study was to investigate factors associated with long-term pessary use in patients with advanced pelvic organ prolapse (POP).

Methods

This was a retrospective chart review of patients with POP of stage ≥2 managed with a pessary. Patients were excluded if the date of fitting or follow-up was unavailable. Long-term use was defined as more than 1 year. Patient demographics, pessary fitting, and follow-up visit dates were collected. The primary end point was the duration of use and the prognostic impact of pessary type. Secondary objectives addressed other influencing factors including age, estrogen use, and prolapse stage. The data were analyzed using SPSS version 21.

Results

The final analysis included 311 patients. The mean (±?standard deviation, SD) duration of pessary use was 7.0?±?0.72 years (median 5.7 years). Long-term use was found in 76 % (164) of these patients. Factors associated with longer use were age >65 years (p?=?0.004) and estrogen use (p?=?0.048). The estimated mean (±?SD) durations of use of the Gellhorn, open ring, ring with support, cube and donut pessaries were 10.5?±?0.7 years, 3.4?±?0.6 years, 1.8?±?0.2 years, 1.8?±?0.3 years and 1.7?±?0.5 years, respectively. The Gellhorn pessary was associated with significantly longer use than other pessary types (10.5?±?0.7, p?<?0.0000001); this finding was independent of age, prolapse stage, hysterectomy, and vaginal estrogen use.

Conclusions

In this retrospective analysis, the duration of use was longest with the Gellhorn pessary. Older age and vaginal estrogen use were associated with longer pessary use.

     

High dose methotrexate for pediatric high grade glioma: results of the HIT-GBM-D Pilot study

We conducted a phase II study to test methotrexate (5 g/m²), as a single agent prior to radiochemotherapy for pediatric high-grade glioma and diffuse intrinsic pontine glioma. Thirty patients (19 male, median age 10.8) were enrolled. Tumors were located as follows: cortex 10, pons 7, other 13. Tumor resection was classified as gross total in 6, subtotal in 6, partial in 4, biopsy in 11 and not performed in 3. WHO grading of the histology was: IV: 11, III: 12 and II: 3. Patients received methotrexate 5 g/m² in 24-hour infusions on days 1 and 15. Subsequently 54 Gy radiation was administered with simultaneous chemotherapy including cisplatin, etoposide, vincristine and ifosfamide as previously described. Eight 6-weeks cycles of maintenance chemotherapy consisted of vincristine 1.5 mg/m² on days 1, 8 and 15; lomustine 100 mg/m² on day 2 and prednisone 40 mg/kg on days 1–17. Event-free survival rates in the whole group of 30 patients were: 43, 20, and 13% after 1, 2 and 5 years, respectively. The response evaluation after methotrexate was available in 19 of the 24 patients who started treatment with measurable disease: CR: 0, PR: 1, SD 18, PD: 0. After radiochemotherapy the response of 24 patients with measurable disease was CR: 1, PR 10, SD 12, PD 1. Both response and event-free survival were superior to the control group of 330 patients treated in various protocols of the same cooperative group. In subgroup analyses the use of dexamethasone during early treatment was linked to poor event free survival. Giving two cycles of high-dose methotrexate prior to radiochemotherapy was feasible, and the approach was taken forward to a randomized phase III trial.     

Association between type 1 and type 2 diabetes with periodontal disease and tooth loss

Aim: The aim of this study was to determine whether both type 1 (T1DM) and type 2 diabetes mellitus (T2DM) are associated with increased prevalence and extent of periodontal disease and tooth loss compared with non-diabetic subjects within a homogeneous adult study population.
Material and Methods: T1DM, T2DM and non-diabetic subjects were recruited from the population-based Study of Health in Pomerania. Additionally, T1DM subjects were retrieved from a Diabetes Centre. The total study population comprised 145 T1DM and 2647 non-diabetic subjects aged 20–59 years, and 182 T2DM and 1314 non-diabetic subjects aged 50–81 years. Periodontal disease was assessed by attachment loss (AL) and the number of missing teeth.
Results: Multivariable regression revealed an association between T1DM ( p <0.001) and T2DM ( p <0.01) with mean AL after full adjustment. After age stratification ( p =0.04 for interaction), the effect of T2DM was only statistically significant in the 60–69-year-old subjects (B=0.90 (95% confidence intervals [95% CI]; 0.49, 1.31). T1DM was positively associated with tooth loss (adjusted, p <0.001). The association between T2DM and tooth loss was statistically significant only for females (odds ratios=1.60 [95% CI: 1.10, 2.33]).
Conclusions: Our study confirmed an association between both T1DM and T2DM with periodontitis and tooth loss. Therefore, oral health education should be promoted in diabetic subjects.