Van der Woude syndrome: dentofacial features and implications for clinical practice

Background:  Van der Woude syndrome (VWS) is the most common clefting syndrome in humans. It is characterized by the association of congenital lower lip fistulae with cleft lip and/or cleft palate. VWS individuals have a high prevalence of hypodontia. Although caused by a single gene mutation, VWS has variable phenotypic expression. This study aimed to describe the range of clinical presentations in 22 individuals with VWS to facilitate its diagnosis.
Methods:  A retrospective study of 22 patients with a diagnosis of VWS was undertaken at the Australian Craniofacial Unit (ACFU) in Adelaide. Three extended families with affected members were included in the study cohort.
Results:  The overall prevalence of lip pits in this study cohort was 86%. Cleft phenotypes included bilateral cleft lip and palate (32%); unilateral cleft lip and palate (32%); submucous cleft palate (23%); and isolated cleft hard and soft palate (9%). Missing permanent teeth were reported in 86% of affected individuals.
Conclusions:  Submucous cleft palate in VWS may go undiagnosed if the lower lip pits are not detected. Associated hypodontia and resultant malocclusions will also require management by a dental team.     

Italian healthcare workers' views on mandatory vaccination

Background  

Mandatory vaccination has contributed to the success of immunisation programmes but voluntary vaccination allows people to be responsible for their own health. There are benefits from both policies and the arguments between them remain subject to debate within and without the scientific community, both nationally and internationally. The aim of this study is to assess the opinions of those who actually work in the Vaccination Service.     

Lakota health and healing

This article examines the nature of Lakota health and healing in its traditional form, how the Lakota both adapted to and resisted western medicine, and the state of contemporary healthcare, traditional and western, on the Pine Ridge Reservation and among the Lakota people of South Dakota.     

Toward optimal recording of surgical complications: concurrent tracking compared to the discharge data set

BACKGROUND: Information extracted from the hospital discharge data set is used increasingly for outcomes research and for benchmarking hospital and provider performance. The accuracy of these data in detecting vascular complications has never been validated. METHODS: We compared morbidity and mortality data derived from the hospital discharge data set to similar data recorded concurrently by our Surgical Activity Tracking System (SATS) for 1 year on the vascular surgery service. RESULTS: Of 798 total admissions, no complications were detected by either system in 598 admissions (75%). In 200 admissions (25%), there were 335 complications, including 24 deaths (3.0%), that occurred either in-hospital or within 30 days of the date of operation or the date of discharge for nonoperative admissions. Of the 335 complications, 180 (53.7%) were recorded by both systems; the SATS missed 59 complications recorded in the hospital discharge data set (17.6%), whereas the hospital discharge data set missed 96 complications recorded in the SATS (28.7%, P = .003). Of the 289 in-hospital complications, the SATS recorded 230 (79.5%), whereas the hospital discharge data set recorded 229 (79.2%). Of the 24 deaths, the hospital discharge data set missed 6 that occurred after discharge but within the 30-day reporting period CONCLUSIONS: Both systems are not completely accurate for tracking inpatient complications. The SATS was more representative than the hospital discharge data set in capturing 30-day morbidity and mortality. An amalgamation of the 2 systems would provide more optimal tracking of complications.     

Cytomegalovirus infection in sexually active adolescents.

To determine whether cytomegalovirus (CMV) infection in teenage girls is related to sexual activity, 254 girls 12-18 years old (mean, 15.8) attending a contraceptive counseling clinic were studied. Participants were screened for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis, and serum antibody to CMV was determined. Demographic and sexual history data were collected by interview. The mean number of lifetime sex partners was 2.2; 173 (68%) were seropositive. Race, greater than 3 years of sexual activity, and greater than 2 lifetime sex partners were significant risk factors for CMV infection (odds ratios [OR], 1.8-4.7; P less than .05). Using logistic regression analysis, a composite sexual activity variable was the most important risk factor for CMV infection (OR, 4.8; P = .003), followed by race (OR, 3.4; P = .004) and a sexually transmitted disease composite variable (OR, 2.4; P = .016). Sexual activity is an important risk factor for CMV infection in adolescent girls.     

Health impacts of family planning

Among the many effects of family planning is the influence ithas on mortality and morbidity in women and children throughthe mechanism of changing the number and spacing of children.There is a complex set of relationships between mother's age,parity, birth spacing and infant and child mortality and morbidity.Much effort has been put into untangling this web in the hopeof identifying clear causal connections, but for the most parton the basis of inadequate data. Rather than attempt to establishthe relative importance of child spacing as a cause of decreasesin mortality, this paper takes as its starting point that thereis a connection, and presents some possible causal mechanismswhich explain how short birth intervals and child mortalitycould be related. In addition the most frequently cited hypotheses-maternaldepletion and sibling competition-a third is examined-birthcrowding which, it is suggested, influences the pattern of thetransmission of infectious diseases and, in turn, mortality. In the field of maternal mortality, the data which could beused to quantify the benefits of family planning are in evenshorter supply; however, the causal connections are rather moreeasily identified. The final section combines parity-specificdata on maternal mortality with evidence of changes in fertilitypatterns brought about by family planning to assess how successfulwe can hope to be in reducing through birth control the numberof women who die in childbirth.