In 2010, the World Health Organization Global Code of Practice for International Recruitment of Health Personnel (the WHO Code) was adopted by the 193 Member States of the WHO. The WHO Code is a tool ...for global diplomacy, providing a policy framework to address the challenges involved in managing dentist migration, as well as improving the retention of dental personnel in source countries. The WHO Code recognizes the importance of migrant dentist data to support migration polices; minimum data on the inflows, outflows and stock of dentists are vital. Data on reasons for dentist migration, job satisfaction, cultural adaptation issues, geographic distribution and practice patterns in the destination country are important for any policy analysis on dentist migration. Key challenges in the implementation of the WHO Code include the necessity to coordinate with multiple stakeholders and the lack of integrated data on dentist migration and the lack of shared understanding of the interrelatedness of workforce migration, needs and planning. The profession of dentistry also requires coordination with a number of private and nongovernmental organizations. Many migrant dentist source countries, in African and the South‐Asian WHO Regions, are in the early stages of building capacity in dentist migration data collection and research systems. Due to these shortcomings, it is prudent that developed countries take the initiative to pursue further research into the migration issue and respond to this global challenge.
Objectives
To assess income‐based life‐course models between the age of 13 and 30 years and caries in young adults.
Methods
In 1988–89, n = 7673 South Australian school children aged 13 years were ...sampled with n = 4604 children (60.0%) and n = 4476 parents (58.3%) returning questionnaires. In 2005–06, n = 632 baseline study participants aged 30 years responded (43.0% of those traced and living in Adelaide). Life‐course models representing critical period, cumulative risk and social mobility were constructed using income tertiles at ages 13 and 30 years. Critical period was evaluated by comparing the low tertile with the middle and higher tertiles at age 13. Cumulative risk was evaluated by coding the low tertile as 2, the middle tertile as 1 and highest tertile as 0, and summing to produce a cumulative risk score categorized into lower (score 0–1), moderate (score of 2) and higher risk (scores 3–4). Social mobility was classified using tertiles into stable disadvantaged, downwardly mobile, stable middle income, upwardly mobile and stable advantaged.
Results
Models adjusting for sex, visiting and toothbrushing at age 30 showed no association between caries at age 30 and low income at age 13 years (critical period model). Compared to the low cumulative risk group based on income, decayed teeth (RR = 1.6) and missing teeth (RR = 7.2) were higher (P < 0.05) in the higher risk group, and missing teeth (RR = 6.0) were higher in the moderate risk group (cumulative risk model). There were more (P < 0.05) decayed teeth in the disadvantaged (RR = 3.1) and stable middle income groups (RR = 2.2), more missing teeth for those classified as disadvantaged (RR = 6.4), stable middle (RR = 6.3) and downwardly mobile (RR = 2.8), and higher DMFT for the disadvantaged group (RR = 1.5) compared to the upwardly mobile group (social mobility model).
Conclusions
Socioeconomic advantage and upward mobility were associated with fewer decayed and missing teeth at age 30 years. Life‐course models of cumulative risk and social mobility influenced oral health outcomes across childhood to adulthood.
The pituitary gland functions prominently in the control of most endocrine systems in the body. Diverse processes such as metabolism, growth, reproduction, and water balance are tightly regulated by ...the pituitary in conjunction with the hypothalamus and various downstream endocrine organs. Benign tumors of the pituitary gland are the primary cause of pituitary pathology and can result in inappropriate secretion of pituitary hormones or loss of pituitary function. First-line management of clinically significant tumors often involves surgical resection. Understanding of normal pituitary physiology and basic testing strategies to assess for pituitary dysfunction should be familiar to any skull base surgeon.
Atrial fibrillation (AF) requires arrhythmogenic changes in atrial ion channels/receptors and usually altered atrial structure. AF is commonly treated with antiarrhythmic drugs; the most effective ...block many ion channels/receptors. Modest efficacy, intolerance, and safety concerns limit current antiarrhythmic drugs. We hypothesized that combining agents with multiple anti-AF mechanisms at reduced individual drug doses might produce synergistic efficacy plus better tolerance/safety.
HARMONY tested midrange ranolazine (750 mg BID) combined with 2 reduced dronedarone doses (150 mg BID and 225 mg BID; chosen to reduce dronedarone's negative inotropic effect-see text below) over 12 weeks in 134 patients with paroxysmal AF and implanted pacemakers where AF burden (AFB) could be continuously assessed. Patients were randomized double-blind to placebo, ranolazine alone (750 mg BID), dronedarone alone (225 mg BID), or one of the combinations. Neither placebo nor either drugs alone significantly reduced AFB. Conversely, ranolazine 750 mg BID/dronedarone 225 mg BID reduced AFB by 59% versus placebo (P=0.008), whereas ranolazine 750 mg BID/dronedarone 150 mg BID reduced AFB by 43% (P=0.072). Both combinations were well tolerated.
HARMONY showed synergistic AFB reduction by moderate dose ranolazine plus reduced dose dronedarone, with good tolerance/safety, in the population enrolled.
ClinicalTrials.gov; Unique identifier: NCT01522651.
An organized and directed approach to a thorough review of evidence has resulted in the production of clinical practice guidelines that assist physicians in selecting the best management strategy for ...an individual patient. ...clinical practice guidelines can provide a foundation for other applications, such as performance measures, appropriate use criteria, and both quality improvement and clinical decision support tools. For certain conditions for which inadequate data are available, recommendations are based on expert consensus and clinical experience and are ranked as LOE C.\n Sanborn Official Reviewer--SCAI None The Medicines Company Merck None St. Jude Medical (DSMB) None None Jeffrey L. Anderson Content Reviewer--ACCF/AHA Task Force on Practice Guidelines BMS/sanofi-aventis Daiichi-Sankyo Eli Lilly None None None None None William E. Boden Content Reviewer Abbott CV Therapeutics/Gilead* Sanofi-aventis Schering-Plough Medicure Pharma None None None None Matthew Budoff Content Reviewer--ACCF Imaging Council None None None None None None Kim A. Eagle Content Reviewer None None None None None None Gordon A. Ewy Content Reviewer None None None None None None Victor Ferrari Content Reviewer--ACCF Imaging Council None None None None None None Raymond J. Gibbons Content Reviewer Cardiovascular Clinical Studies Lantheus Medical Imaging Medscape Molecular Insight TherOx None None Velomedix* None None Linda Gillam Content Reviewer--ACCF Imaging Council Abbott Vascular Edwards Lifesciences None None None Core Lab Services None Robert A. Guyton Content Reviewer--ACCF/AHA Task Force on Practice Guidelines None None None Edwards Lifesciences None None L. David Hillis Content Reviewer None None None None None None David R. Holmes Content Reviewer--ACCF Interventional Scientific Council None None None None None None Hani Jneid Content Reviewer-- AHA Council on Clinical Cardiology None None None None None None Sanjay Kaul Content Reviewer None None None None None None Howard C. Lewin Content Reviewer--ACCF Imaging Council None None Positron Imaging Partners None None None Todd D. Miller Content Reviewer--AHA Council on Clinical Cardiology The Medicines Company TherOx None None Kai Pharmaceuticals King Pharmaceuticals Lantheus Medical Imaging Molecular Insight Pharmaceuticals None None L. Kristin Newby Content Reviewer-- AHA Council on Clinical Cardiology Adolor Biovascular CV Therapeutics Inverness Medical Johnson & Johnson Novartis Roche Diagnostics Daiichi-Sankyo None AstraZeneca BG Medicine Carvio Dx* GlaxoSmithKline* Medicare* Millennium Pharmaceuticals Schering-Plough* None None Elizabeth Ross Content Reviewer None None None None None None William S. Weintraub Content Reviewer AstraZeneca* Bayer* Bristol-Myers Squibb Cardionet Eli Lilly Pfizer* Sanofi-aventis Shionogi None None Abbott* AstraZeneca* Bristol-Myers Squibb* Otsuka* Sanofi-aventis* None 2004; Defendant; Aprotinin 2008; Defendant; Quetiapine 2008; Defendant; Celebrex * This table represents the relationships of reviewers with industry and other entities that were disclosed at the time of peer review. Relationships noted in this table are modest unless otherwise noted.AATS indicates American Association for Thoracic Surgery; ACCF, American College of Cardiology Foundation; ACP, American College of Physicans; AHA, American Heart Association; NIH, National Institutes of Health; PCNA, Preventive Cardiovascular Nurses Association; SCAI, Society for Cardiovascular Interventions and Angiography; and STS, Society of Thoracic Surgeons.
Root surface caries among older Australians Hariyani, Ninuk; Spencer, A. John; Luzzi, Liana ...
Community dentistry and oral epidemiology,
December 2018, 2018-12-00, 20181201, Letnik:
46, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Objectives
Root caries has increased as a clinical problem in recent decades. However, the use of multiple waves of longitudinal follow‐up data in estimating root caries increment has not been ...previously attempted. The aims of this study were to quantify root caries increment from a longitudinal study of older adults with 4 oral examinations over 11 years and to examine behavioural factors associated with root caries.
Methods
A secondary analysis was undertaken using data collected in 4 waves (baseline, 2‐year, 5‐year and 11‐year) of the South Australian Dental Longitudinal Study which began in 1991/92. The study group consisted of a stratified random sample of people aged 60+ years at baseline. A total of 358 participants with complete oral examinations in all 4 waves were included. The examinations were performed by trained and calibrated dentists. Baseline behavioural risk factors (toothbrushing frequency, flossing frequency, dental visiting pattern, reason for dental visiting and tobacco smoking status) and time in years across the 4 waves were the main exposures. Baseline clinical oral conditions (gingival condition and gingival recession), demographic and socio‐economic risk factors served as covariates. Root caries was measured as mean number of untreated root surfaces (root DS) and decayed/filled root surfaces (root DFS) at each wave of examinations. Multivariable multilevel growth model using linear regression analysis was used to get an estimate for root caries increment and associated oral health‐related behaviours adjusting for all the covariates.
Results
Findings from the multivariable models indicated that the annual increment of root DS and root DFS were 0.07 (SE = 0.01) and 0.11 (SE = 0.02) surfaces, respectively. Irregular brushing (E SE = 0.25 0.12), visiting the dentist only for problems (E SE = 0.30 0.13) and smoking (E SE = 0.33 0.12) were risk factors for the increase in root DS. Irregular flossing and more frequent dental visit were associated with the increase in root DFS.
Conclusions
Root caries increased slowly across time among relatively healthier Australian older adults. Irregular brushing, unfavourable dental visiting and tobacco smoking were risk factors for the increase in untreated root caries, while irregular flossing and more frequent dental visiting were associated with the increase in root DFS.
•Parasites occur even in owned companion animals under veterinary care.•Cats are significantly more frequently diagnosed positive for parasites than dogs.•Two of the three most frequently diagnosed ...parasite genera in dogs are zoonotic or potentially zoonotic.•Young dogs were significantly more likely to be diagnosed in PEI in autumn in the first years of the laboratory results, compared to the baseline.
Although many studies on the frequency of endoparasites in dogs and cats in Canada have been reported, seasonal and/or annual patterns are often not evaluated. The frequency and risk factors of endoparasite infections from fecal samples of cats and dogs submitted to the Veterinary Teaching Hospital of the Atlantic Veterinary College, University of Prince Edward Island-Canada were determined, using univariable and multivariable logistic regression analyses. Investigated predictors of endoparasitism available in the 2000–2017 database included sex, age, geographic origin and seasonality. A total of 15,016 dogs and 2,391 cats were evaluated for endoparasite status using specific diagnostic tests: direct smear, Baermann, and/or 33 % zinc sulfate solution in a standardized centrifugal flotation method. Overall, twelve and eight parasite genera were detected in dogs and cats, respectively. The overall proportional infection was 14.6 %, and the cat population showed a higher frequency of positivity to parasites compared to the dog population (P < 0.001). The most frequent genera recovered in the whole population (dogs and cats), were Giardia duodenalis (5.2 %), Cystoisospora spp. (3.3 %) and Toxocara spp. (3.2 %). Endoparasitism levels were diagnosed more in feces submitted from young, female intact dogs from PEI compared to the baselines of mature, sterilized male dogs from other provinces, respectively, and diagnoses occurred more often in autumn months than in winter months. There was no significant diagnostic trend across the years for the individual parasites models. The frequency of detected potentially zoonotic parasites in this study highlights the veterinary public health and One Health context of parasitic infections in pets. Although the presented results are not from a random sample and therefore frequency results should be interpreted with caution, the model relationship results may still be relevant. In addition, results are of value to estimate parasite impact and to assist researchers, veterinarians and pet-owners with suitable information to control parasites.
Abstract
Object
The consistency of pituitary macroadenomas affects the complexity of surgical resection. On T2-weighted (T2W) imaging, the intensity ratio of the tumor to the cerebellar peduncle ...(tumor to cerebellar peduncle T2-weighted imaging intensity TCTI ratio) correlates with meningioma consistency. We aimed to determine the correlation of this radiographic finding with pituitary macroadenoma consistency and to determine whether it can be used for preoperative planning.
Methods
We performed a retrospective evaluation of 196 patients with macroadenomas who underwent endoscopic transsphenoidal resection from January 2012 to June 2017. Macroadenoma consistency was determined by one senior neurosurgeon at the time of surgery. Axial and coronal T2W magnetic resonance imaging images were evaluated retrospectively, and adenoma size, Knosp grade, suprasellar extension and TCTI were calculated.
Results
The mean TCTI ratio was 1.70 (95% confidence interval CI: 1.65–1.75). Intraoperatively, 140 (71.4%) adenomas were classified as soft and 48 (24.5%) as fibrous. Gross total resection was achieved in 66.7% of fibrous adenomas and in 86.4% of soft adenomas (
p
= 0.007). The mean ratio was 1.68 (95% CI: 1.62–1.74) for soft tumors and 1.76 (95%CI: 1.67–1.84) for fibrous tumors. There was no difference in the mean TCTI ratio between groups. Lactotroph and somatotroph adenomas had a lower mean TCTI ratio compared with other functioning and nonfunctioning adenomas with a mean TCTI of 1.52 compared with 1.77.
Conclusions
In this retrospective cohort study, we found that the TCTI ratio does not correlate with tumor consistency. We also noted that the TCTI ratio is increased in prolactin and growth hormone-secreting adenomas.
OBJECTIVE The object of this study was to compare the outcomes of primary and revision transsphenoidal resection (TSR) of nonfunctioning pituitary macroadenomas (NFPMAs) using endoscopic methods. ...METHODS The authors retrospectively reviewed the records of 287 consecutive patients who had undergone endoscopic endonasal TSR for NFPMAs at their institution in the period from 2005 to 2011. Fifty patients who had undergone revision TSR were retrospectively matched for age, sex, and duration of follow-up to 46 patients who had undergone primary TSR. Medical and surgical complications were documented, and Kaplan-Meier analysis was performed to assess rates of radiological progression-free survival (PFS). RESULTS The median follow-up periods were 45 and 46 months for the primary and revision TSR groups, respectively. There were no significant differences between the primary and revision groups in rates of new neurological deficit (0 in each), vascular injury (2% vs 0), postoperative CSF leak (6% vs 2%), transient diabetes insipidus (DI; 15% vs 12%), chronic DI (2% vs 2%), chronic sinusitis (4% vs 6%), meningitis (2% vs 2%), epistaxis (7% vs 0), or suprasellar hematoma formation (0 vs 2%). However, patients who underwent primary TSR had significantly higher rates of syndrome of inappropriate antidiuretic hormone (SIADH; 17% vs 4%, p = 0.04). Patients who underwent primary operations also had significantly higher rates of gross-total resection (GTR; 63% vs 28%, p < 0.01) and significantly lower rates of adjuvant radiotherapy (13% vs 42%, p < 0.01). Radiological PFS rates were similar at 2 years (98% vs 96%) and 5 years (87% vs 80%, p = 0.668, log-rank test). CONCLUSIONS Patients who underwent primary TSR of NFPMAs experienced higher rates of SIADH than those who underwent revision TSR. Patients who underwent revision TSR were less likely to have GTR of their tumor, although they still had a PFS rate similar to that in patients who underwent primary TSR. This finding may be attributable to an increased rate of adjuvant radiation treatment to subtotally resected tumors in the revision TSR group.
– Objectives: The nature of the relationship between status and health has theoretical and applied significance. To compare the shape of the socioeconomic ‐oral health relationship using a measure ...of relative social status (MacArthur Scale of Subjective Social Status) and a measure of absolute material resource (equivalised household income); to investigate the contribution of behaviour in attenuating the socioeconomic gradient in oral health status; and to comment on three hypothesised explanatory mechanisms for this relationship (material, psychosocial, behavioural).
Methods: In 2003, cross‐sectional self‐report data were collected from 2,915 adults aged 43–57 years in Adelaide, Australia using a stratified cluster design. Oral conditions were (1) <24 teeth, (2) 1+ impact/s reported fairly often or very often on the 14‐item Oral Health Impact Profile; (3) fair or poor self‐rated oral health, and (4) low satisfaction with chewing ability. Prevalence ratios and 95% confidence intervals (PR, 95%CI) were calculated from a logistic regression model. Covariates were age, sex, country of birth, smoking, alcohol use, body mass index, frequencies of toothbrushing and interdental cleaning.
Results: There was an approximately linear relationship of decreasing prevalence for each oral condition across quintiles of increasing relative social status. In the fully adjusted model the gradient was steepest for low satisfaction with chewing (PR = 4.1, 95%CI = 3.0–5.4). Using equivalised household income, the shape more closely resembled a threshold effect, with an approximate halving of the prevalence ratio between the first and second social status quintiles for the adverse impact of oral conditions and fair or poor self‐rated oral health. Adjustment for covariates did not attenuate the magnitude of PRs.
Conclusion: The nature of the relationship between social status and oral conditions differed according to the measure used to index social status. Perception of relative social standing followed an approximately straight‐line relationship. In contrast, there was a discrete threshold of income below which oral health deteriorated, suggesting that the benefit to oral health of material resources occurs mostly at the lower end of the across the full socioeconomic distribution.
PDF
