Clinical management of voice and breathing problems in two patients with vagus nerve stimulation therapy

We report two cases highlighting the diversity of vagal nerve stimulation (VNS)‐related effects on voice and breathing in patients with refractory epilepsy. The patients had both implantation and stimulation‐related side effects, which lasted for several months, impacting on their quality of life. The adverse effects appear to be due to recurrent laryngeal nerve paralysis‐related vocal cord hypofunction and stimulation‐related vocal fold spasms, however, their inter‐relationship is complex. In one of the patients, we were able to utilize the novel programming capabilities of the VNS device to reduce the laryngeal side effects without compromising therapeutic efficacy. [Published with video sequences].     

Development of a conceptual model of oral health for malocclusion patients

Objectives:To provide an empirical test of the applicability of Locker''s conceptual model of oral health for malocclusion patients, and to suggest alternative models of the effect of malocclusion on well-being.Materials and Methods:Data from a survey of 323 adolescents attending for orthodontic treatment were analyzed to develop a new oral health model for malocclusion patients. Oral health–related quality of life (OHRQoL) was measured using the 14-item Oral Health Impact Profile; malocclusion was measured using the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN). Using structural equation modeling, the relationship between conceptual domains in Locker''s model was explored and three models of their interrelationship tested for goodness of fit.Results:Fit indexes for Locker''s model indicated that it did not fit the data well. Therefore, a modified model was developed to incorporate additional paths between other levels to better fit the data. The best fit was provided by a model in which the direct effects of malocclusion on pain, discomfort, and handicapping—and the direct effect of pain on disability—were removed. A direct effect of functional limitation on disability was allowed. The modified Oral Health Impact Profile model proved to be a good fit to the data (root mean square error of approximation  =  0.069).Conclusion:The pathways identified in Locker''s (1988) conceptual model of oral health may not be appropriate for describing the relationships between OHRQoL constructs in individuals with malocclusion. An alternative model is proposed.     

Possible role for mast cell-derived cathepsin G in the adverse remodelling of stenotic aortic valves

Aims Aortic stenosis (AS) is characterized by extensive remodellingof the valves, including infiltration of inflammatory cells,extracellular matrix degradation, and fibrosis. The molecularmechanisms behind this adverse remodelling have remained obscure.In this article, we study whether cathepsin G, an angiotensinII (Ang II)-forming elastolytic enzyme, contributes to progressionof AS. Methods and results Stenotic aortic valves (n=86) and controlvalves (n=17) were analysed for cathepsin G, transforming growthfactor-ß1 (TGF-ß1), and collagens I andIII with RT–PCR and immunohistochemistry. Valvular collagen/elastinratio was quantified by histochemistry. In stenotic valves,cathepsin G was present in mast cells and showed increased expression(P<0.001), which correlated positively (P<0.001) withthe expression levels of TGF-ß1 and collagens I andIII. TGF-ß1 was also present in mast cell-rich areasand cathepsin G induced losartan-sensitive TGF-ß1expression in cultured fibroblasts. Collagen/elastin ratio wasincreased in stenotic valves (P<0.001) and correlated positivelywith smoking (P=0.02). Nicotine in cigarette smoke activatedmast cells and induced TGF-ß1 expression in culturedfibroblasts. Fragmented elastin was observed in stenotic valvescontaining activated cathepsin G-secreting mast cells and innormal valves treated with cathepsin G. Conclusion In stenotic aortic valves, mast cell-derived cathepsinG may cause adverse valve remodelling and AS progression.     

The effects of health coaching on adult patients with chronic diseases: A systematic review

Objective

The aim of this systematic review was to describe the effects of health coaching on adult patients with chronic diseases.

Methods

The reviewers searched electronic databases and performed a manual search for studies published from 2009 to 2013. The inclusion criteria covered health coaching for adults with chronic diseases by health care professionals. The studies were original, randomized controlled trials or quasi-experimental designs.

Results

Thirteen studies were selected using the inclusion criteria. The results indicate that health coaching produces positive effects on patients’ physiological, behavioral and psychological conditions and on their social life. In particular, statistically significant results revealed better weight management, increased physical activity and improved physical and mental health status.

Conclusion

Health coaching improves the management of chronic diseases. Further research into the cost-effectiveness of health coaching and its long-term effectiveness for chronic diseases is needed.Practice implications Health care professionals play key roles in promoting healthy behavior and motivating good care for adults with chronic diseases. Health coaching is an effective patient education method that can be used to motivate and take advantage of a patient's willingness to change their life style and to support the patient's home-based self-care.     

Iron-related parameters in Spanish mares during pregnancy

During pregnancy, metabolic adjustments occur in the mare to preserve iron stores in order to have adequate amounts for the growth and development of the equine fetus. The aim of this study was to analyze the evolution of hematocrit, iron, and ferritin in Spanish Purebred mares during pregnancy. A total of 31 Spanish broodmares aged 4–17 years old were studied during three similar periods of pregnancy (I, II, and III). Hematocrit (packed cell volume, PCV) was determined by microhematocrit and iron and ferritin concentrations were analyzed using spectrophotometry and turbidimetric methods, respectively. Pregnancy in the Spanish mare was characterized by a progressive increase in PCV and serum iron and ferritin concentrations. The physiological state of pregnancy significantly modifies iron status in these animals. In comparison with the first period, the increase in iron stores during the second and third periods indicates a positive iron balance, suggesting that the fetus can tolerate iron levels compatible with the mothers during the entire fetal development process.     

Dental fear and oral health and family characteristics of Finnish children

Objectives: Our aim was to describe the occurrence of dental fear among Finnish children of different ages and to ascertain how oral health and family characteristics are associated with dental fear. Methods: The subject groups were aged 3, 6, 9, 12, and 15 years in two middle‐sized cities, and the 1474 participants were distributed over fairly equal samples of each age. A questionnaire given to each child to be filled out at home enquired about social background, oral hygiene habits, diet, and dental fear. Oral health status was examined clinically and radiographically by two calibrated dentists. Multiple logistic regression analyses were performed for each age group in order to study the associations between dental fear and selected factors. Results: Dental fear was higher among 12‐ and 15‐year‐old children than among the younger ones. Pain, drilling, and local anesthesia were reported to be the most frightening aspects. Excluding the 12‐year‐olds, children whose family members reported dental fear were more likely to report dental fear than children whose family members did not report dental fear. Six‐ and 12‐year‐olds who had experienced caries were more likely to report dental fear than were caries‐free children. Among 6‐year‐olds, father's education modified the effect of a child's caries experience on child dental fear. Frequent intake of sugary items and a limit on eating candies to only one day per week were associated with higher dental fear. Conclusions: Fear of dental treatment is still fairly common among Finnish children, and the factors associated with it differ with the age of the child.     

Parental influence on children's oral health-related behavior

Objective. The aim of this study was to determine whether there are differences between oral health-related knowledge, attitudes, beliefs and behaviors of children and their parents, and to identify the family-related factors associated with children's poor or good oral health-related behavior. Material and Methods. The data were gathered by means of questionnaires from 11–12-year-old schoolchildren and their parents who replied without having knowledge of the answers of the others. Differences between subgroups of children were analyzed by cross-tabulation, and the factors related to children's good or poor oral health-related behavior by logistic regression analyses. Results. Parents of children who reported good oral health-related behavior had better knowledge and more favorable behaviors than those of other parents. Predictors for a child's poor oral health-related behavior were the child's poor knowledge, male gender, the parent's frequent consumption of sweets, and the parent's infrequent use of xylitol gum. When a less strict threshold for the child's poor oral health-related behavior was used, more predictors entered the model: the parent's unfavorable use of fluoride toothpaste; among girls, the parent's lack of knowledge; and among children whose mother's occupation level was high, the parent's infrequent use of xylitol gum. The parents of children whose oral health behavior was favorable were more likely to have a high level occupation and favorable oral health-related behaviors. Conclusions. Oral health-related knowledge of children and their parents seems to be associated with children's oral health-related behavior. Parents’ behaviors, but not attitudes, were associated with children's oral health behavior.