Dental Age Assessment: a comparison of 4- to 24-year-olds in the United Kingdom and an Australian population

Background.  The physiological age of a person is determined by the degree of maturation of the different tissue systems. Children of the same chronological age (CA) can demonstrate different degrees of maturation. Dental age (DA) is based on the maturation of teeth. Tooth formation is a continuous process, where the developmental stages of the tooth can be sequenced and defined depending on the degree of mineralization. These stages can be visualized on a dental panoramic tomograph (DPT).
Aim.  The aim of this study was to use a new method of Dental Age Assessment (DAA) to compare a United Kingdom (UK) and an Australian (AUS) population.
Design.  The DPTs used are from the archives of the Westmead Centre for Oral Health (Westmead, Australia) and the King's College London Dental Institute. From the preliminary sample of 89 DPTs from each population, 77 were suitable for use as matched pairs. The radiographic technique used was developed by Demirjian and describes eight stages of tooth development. This was used in combination with numerical data derived from a meta-analysis of a single UK subject.
Results.  A significant difference was shown between the CA and DA of the AUS patients. The AUS patients were also shown to have a significant 0.82 years delay in their DA compared to the UK patients. The findings indicate a difference in AUS compared to UK patients. These results indicate the need to develop a reference data set for the AUS population for DAA.
Conclusions.  This research is of significance in a number of clinical disciplines and can also be used to assist in age determination of subjects of unknown birth date to assist in forensic dentistry or social deliberations.     

Waste in the U.S. Health Care System: A Conceptual Framework

Context: Health care costs in the United States are much higher than those in industrial countries with similar or better health system performance. Wasteful spending has many undesirable consequences that could be alleviated through waste reduction. This article proposes a conceptual framework to guide researchers and policymakers in evaluating waste, implementing waste‐reduction strategies, and reducing the burden of unnecessary health care spending. Methods: This article divides health care waste into administrative, operational, and clinical waste and provides an overview of each. It explains how researchers have used both high‐level and sector‐ or procedure‐specific comparisons to quantify such waste, and it discusses examples and challenges in both waste measurement and waste reduction. Findings: Waste is caused by factors such as health insurance and medical uncertainties that encourage the production of inefficient and low‐value services. Various efforts to reduce such waste have encountered challenges, such as the high costs of initial investment, unintended administrative complexities, and trade‐offs among patients', payers', and providers' interests. While categorizing waste may help identify and measure general types and sources of waste, successful reduction strategies must integrate the administrative, operational, and clinical components of care, and proceed by identifying goals, changing systemic incentives, and making specific process improvements. Conclusions: Classifying, identifying, and measuring waste elucidate its causes, clarify systemic goals, and specify potential health care reforms that—by improving the market for health insurance and health care—will generate incentives for better efficiency and thus ultimately decrease waste in the U.S. health care system.     

Motor development from 4 to 8 months corrected age in infants born at or less than 29 weeks' gestation

Aim  Clinically, preterm infants show motor delay and atypical postures compared with their peers born at term. A longitudinal cohort study was designed to describe the motor development of very preterm infants from 4 to 18 months corrected age (CA). The study was also designed to investigate how the atypical postures observed in early infancy in the preterm infants might be related to their later motor development. Here we report the findings in early motor skills from 4 to 8 months CA.
Method  Early motor skills were assessed in 62 preterm infants (32 males, 30 females, mean gestation 26.94wks, SD 1.11) and 53 term infants (32 males, 21 females, mean gestation 39.55wks, SD 1.17) using the Alberta Infant Motor Scale (AIMS).
Results  The preterm infants demonstrated different motor behaviours from their term peers, with an uneven progression of motor skills in different positions from 4 to 8 months CA. At 8 months CA, 90%of the term infants were able to sit without arm support, but only 56%of the preterm infants could maintain sitting very briefly without arm support.
Interpretation  This uneven progression may have been due to an imbalance between the active flexor and extensor strength and hence inadequate postural control in these positions. The AIMS has also been shown to be a valid assessment tool to demonstrate unique characteristics in movement quality in the preterm population.     

Robotic urological surgery in patients with prior abdominal operations is not associated with increased complications

BACKGROUND: The da Vinci Surgical Robotic System is being increasingly used to perform complex urological operations by minimally invasive techniques. Prior abdominal surgery associated with intra-abdominal adhesions may complicate robotic surgery. METHODS: We used a cohort of consecutive 49 patients undergoing a variety of robotic urological procedures at our institution to study the impact of prior abdominal operations on early perioperative complications. RESULTS: A total of 21/49 (43%) patients (Group A) had no history of prior abdominal surgery and the rest 28/49 (57%; Group B) had undergone prior abdominal surgery. The incidence of peritoneal adhesions was significantly higher in patients with prior abdominal surgery compared to the rest of the cohort, 54% versus 10% (P=0.002). The median operative time, estimated blood loss, postoperative drop in hemoglobin, time to hospital discharge, postoperative narcotic analgesic use and postoperative complication rate between group A and group B were not statistically different. The overall perioperative complication rate for the entire cohort was 14.3%, with 6-8% of complications occurring in each of the two groups (P=1.0). Comparative subset analysis of 28 patients in Group B, 15 (54%) and 13 (46%) with or without intra-abdominal adhesions did not reveal a significant difference in perioperative complication rates either. However, operative time was longer in patients with intra-abdominal adhesions compared to patients without, median of 590 (281-922) and 434 (153-723) min respectively, although not statistically significant (P=0.059). CONCLUSION: Our study demonstrates that robotic urological surgery can be performed in patients with prior abdominal surgery without increased perioperative complications.     

Influenza vaccination coverage in the geriatric population of the State of Geneva, Switzerland

Background: In Switzerland, every year the Federal Office ofPublic Health publishes recommendations for the use of influenzavaccine in people over 65 years, patients of all ages sufferingfrom chronic conditions or immunosuppression, families of thelatter and health professionals. However, prior to the presentstudy, there has been no evaluation of the degree to which theserecommendations are implemented. The purpose of the survey describedin this article was to evaluate flu vaccination coverage ofthe geriatric population living in the community, to obtainqualitative information on the motivation for receiving vaccinationand to understand the network of communication on flu prevention.Methods: The study was performed on a random sample of 1,200residents of the State of Geneva aged 65 years or older. Itinvolved a mail questionnaire and semi-structured telephoneinterviews on a subsample of respondents. Results: The estimatedvaccination coverage for 1994 was equal to 35.5% in persons65 years-old or older. Receiving information from a physicianwas the major determinant in the decision to be vaccinated.Misconceptions about flu were common. Conclusions: The resultsof this study indicate that national recommendations concerningvaccination of elderly people are insufficiently observed inthe State of Geneva. It is necessary to reinforce preventivemessages that explain why flu vaccination should be performed.These messages should aim at correcting and completing elementsof information already present in the at-risk population.     

Estimating alcohol‐attributable mortality among Indigenous Australians: Towards Indigenous‐specific alcohol aetiologic fractions

Introduction and Aims. Past estimates of Indigenous alcohol‐attributable health in Australia have been based on drinking prevalence estimates from the general population, rather than prevalence figures from the Indigenous population. The purpose of this paper is to demonstrate the efficacy of using Indigenous‐specific drinking prevalence to estimate alcohol‐attributable deaths among Indigenous Australians. Design and Methods. Estimates of Indigenous alcohol‐attributable deaths between 2000 and 2004 were obtained using both (i) national general‐population drinking prevalence estimates and (ii) national Indigenous‐specific drinking prevalence. Estimates were calculated using the ‘aetiologic fraction’ method. Results. By using national general‐population drinking prevalence figures, past reports on Indigenous health have underestimated alcohol‐attributable deaths for the national Indigenous population. Female deaths due to alcohol‐attributable haemorrhagic stroke were estimated to be approximately four times higher and alcohol‐attributable suicides among men were estimated to be 30% higher than was previously held, when Indigenous‐specific drinking prevalence figures were used. Discussion and Conclusions. By substituting Indigenous‐specific alcohol consumption prevalence estimates for general‐population drinking prevalence, the accuracy of estimates of alcohol‐related harm among Indigenous Australians can be significantly improved.[Pascal R, Chikritzhs T, Gray D. Estimating alcohol‐attributable mortality among Indigenous Australians: Towards Indigenous‐specific alcohol aetiologic fractions. Drug Alcohol Rev 2009;28:196–200]     

Review article: Leukocyte-endothelial dysregulation in systemic small vessel vasculitis

Aberrant interaction between the leukocyte and the endothelial cell (EC) results in the uncontrolled inflammation seen in systemic small vessel vasculitis. This review discusses our current understanding of this process and includes consideration of the role of adhesion molecules, proteases and the neutrophil respiratory burst. The effects of anti-neutrophil cytoplasm antibodies and anti-endothelial cell antibodies and their pathogenic roles are examined, and we look at experimental disease models. Specificity of disease-targetted endothelial beds and the role of circulating EC are discussed.