Interpretation of bitewing radiographs. Part 2 evaluation of the size of approximal lesions and need for treatment

Objective: The decision to treat initial approximal carious lesions is based mainly on interpretation of bitewing radiographs. In a previous report, it was shown that artificial approximal lesions of uniform size are more readily detected on radiographs in premolars than in molars. The objective of the present study was to compare the ability to evaluate the depth of similar size artificial lesions on radiographs and reach decisions concerning treatment, in premolars and molars.

Method: Clinicians were asked to evaluate on radiographs, the size of in vitro prepared artificial lesions, and decide at which point they would perform a restoration.

Results: Significant differences were found in the evaluation of lesion depth between different tooth surfaces. The interaction between lesion depth and tooth surface originated from the examiners' trend to score same size lesions as penetrating deeper into the tooth in premolars than in molars. The probability of the examiners to decide on restorative treatment in shallow lesions (0.25 mm, 0.50 mm) was higher in premolars than in molars.

Conclusions: The findings suggest that clinicians evaluate initial lesions as being deeper and more prone to treatment in premolars than in molars.     

School climate, observed risky behaviors, and victimization as predictors of high school students' fear and judgments of school violence as a problem.

The primary aim of this study is to explore how school-related variables predict high school students' subjective judgements of school violence. Using a nationally representative sample (Israel) of 3,518 high school-aged youth, this study tested the hypotheses that (a) students' personal fear of attending school due to violence and (b) students' assessment of a school violence problem are best understood as separate conceptual constructs. The findings support the proposition that student fear of attending school and assessments of school violence as a problem are influenced by different types of school-related variables. Student fear of attending school due to violence was directly related to experiences of personal victimization by students and school staff. In contrast with fear, students'judgements of their schools' overall violence problem were directly associated with the variables of school climate, observed risk behaviors, and personal victimization. Implications for policy, theory, and future research are highlighted.     

Fatal pulmonary artery thrombosis in a patient with Beh?et's disease, activated protein C resistance and hyperhomocystinemia.

Beh?et's disease (BD) is known for its tendency for thromboembolism, which is thought to be due to vascular injury. The important role of inherited thrombophilias is now becoming increasingly clear. However, conflicting data exist in terms of the contribution of these factors to the thrombotic risk in BD. In this case report, we describe a patient with BD who presented with severe cor pulmonale due to recurrent chronic venous thromboembolism and pulmonary artery thrombosis. The biochemical evaluation revealed that the patient was homozygotic for the factor V Leiden (R506Q) mutation and had increased levels of homocysteine. His condition deteriorated despite adequate anticoagulation treatment, and he died suddenly after 7 months of follow-up. We assume that the presence of thrombophilic risk factors augments and synergizes with the hypercoagulable state already existing in BD, leading to fatal thrombosis in this patient.     

Hip protectors decrease hip fracture risk in elderly nursing home residents: a Bayesian meta-analysis

OBJECTIVE: To design a Bayesian random effects model for pooling binary outcome data from cluster randomized trials (CRTs) with individually randomized trials (IRTs) and then use this model to determine if hip protectors decrease the risk of hip fracture in elderly nursing home residents. STUDY DESIGN AND SETTING: Eight electronic databases were searched; abstracts and papers were reviewed in duplicate. Randomized controlled trials of hip protectors in nursing homes were included. The pooled mean odds ratio (OR) of a hip fracture in an individual allocated to hip protectors with 95% credibility interval (CRI) was calculated. RESULTS: We included four trials of 1,922 individuals (including three CRTs). The pooled OR of an elderly nursing home resident sustaining one or more hip fractures with hip protector allocation was 0.40 (95% CRI 0.25, 0.61). The model was robust in multiple sensitivity analyses assuming alternative intracluster correlation coefficient values. CONCLUSION: The Bayesian approach may be used in meta-analyses of IRTs and CRTs. Using this approach, we have determined that hip protectors decrease the risk of hip fracture in elderly nursing home residents. Methodologic limitations of the included trials and a possible herd effect in CRTs may have influenced these results.