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Globally, populations are ageing and the estimated number of hip fractures will increase from 1.7 million in 1990 to more than 6 million in 2050. The greatest increase in hip fractures is predicted in Low- and Middle-Income Countries (LMICs), largely in the Asia-Pacific region where direct costs are expected to exceed $US15 billion by 2050. The aims of this qualitative study are to identify barriers to, and enablers of, evidence-informed hip fracture care in LMICs, and to determine if the Blue Book standards, developed by the British Orthopaedic Association and British Geriatrics Society to facilitate evidence-informed care of patients with fragility fractures, are applicable to these settings. This study utilized semi-structured interviews with clinical and administrative hospital staff to explore current hip fracture care in LMICs. Transcribed interviews were imported into NVivo 12 and analysed thematically. Interviews were conducted with 35 participants from 11 hospitals in 5 countries. We identified five themes-costs of care and the capacity of patients to pay, timely hospital presentation, competing demands on limited resources, delegation and defined responsibility and utilization of available data-and within each theme, barriers and enablers were distinguished. We found a mismatch between patient needs and provision of recommended hip fracture care, which in LMICs must commence at the time of injury. This study describes clinician and administrator perspectives of the barriers to, and enablers of, high-quality hip fracture care in LMICs; results indicate that initiatives to overcome barriers (in particular, delays to definitive treatment) are required. While the Blue Book offers a starting point for clinicians and administrators looking to provide high-quality hip fracture care to older people in LMICs, locally developed interventions are likely to provide the most successful solutions to improving hip fracture care., (© The Author(s) 2022. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background & Aims: To investigate the relationship between maternal serum fatty acid levels and gestational diabetes mellitus (GDM) subtypes across pregnancy., Methods: A total of 680 singleton mothers enrolled in the Complex Lipids in Mothers and Babies (CLIMB) study in Chongqing, China were included. Clinical information and serum samples were collected at gestational weeks (GWs) 11-14, 22-28, and 32-34. 75 g Oral Glucose Tolerance Test (OGTT) was conducted at GW 24-28 and GDM subtypes divided into three groups using International Association of Diabetes and Pregnancy Study Group (IADPSG) guidelines criteria: elevated fasting plasma glucose (FPG group; n = 59); 1-h and/or 2-h post-load glucose (1h/2h-PG group; n = 94); combined group (FPG&1h/2h-PG group; n = 42). Non-GDM pregnancies were included (n = 485) as controls. Twenty fatty acids were quantified in serum using gas chromatography-mass spectrometry (GC-MS) analysis., Results: Overall, most serum fatty acid concentrations increased rapidly from the first to second trimester, followed by a plateauing or reduction in the third trimester (p < 0.001). In cross sectional analysis, fatty acid concentrations were significantly higher in the FPG group at GW 11-14 and decreased in the 1h/2h-PG group at GW 32-34, relative to controls. Moreover, higher α-linolenic acid (ALA; the second tertile: adjusted odds ratio [aOR] = 2.53, 95% CI: 1.17 to 5.47; the third tertile: aOR = 2.60, 95% CI: 1.20 to 5.65) and docosahexaenoic acid (DHA; the second tertile: aOR = 2.34, 95% CI: 1.10 to 4.97; the third tertile: aOR = 2.16, 95% CI: 1.00 to 4.63) were significantly associated with a higher risk of GDM in women with elevated fasting plasma glucose at GW 11-14 (first tertile as reference)., Conclusions: Our findings highlight the importance of considering GDM subtypes for the individualised management of GDM in pregnancy. ALA and DHA in early pregnancy are associated with a higher risk of FPG-GDM subtype. This has widespread implications when recommending n-3 PUFAs supplementation for women with GDM., Competing Interests: Conflicts of interest No potential conflicts of interest relevant to this article were reported., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The oral hygiene habits of clients wearing fixed orthodontic appliances is poorly understood. Assessment of oral hygiene behavioural patterns is essential for understanding clients' oral health care needs. The aim of this study was to investigate orthodontic clients' oral hygiene behaviours, brushing techniques, and oral hygiene awareness., Methods: A total of 200 orthodontic clients wearing fixed orthodontic appliances were consecutively recruited from the Sichuan Provincial Hospital, Chengdu, China, and the Faculty of Dentistry, University of Otago, Dunedin, New Zealand. A 47-item questionnaire was used to survey study participants., Results: The survey had a 92% response rate, with 67.5% of respondents being female and 32.5% male. Most were non-smokers (94.2%) and the majority (80.0%) brushed their teeth twice daily. Most (80.4%) brushed their teeth for 1 to 2 minutes, and 68.7% positioned their toothbrush both horizontally and vertically, with horizontal being the preferred direction of motion. One-third (33.5%) did not use any auxiliary oral hygiene aids; most snacked between meals; only 31.4% received professional tooth cleaning during orthodontic treatment; and 56.8% experienced an increased level of halitosis after appliance placement. Most respondents (79.4%) thought their oral hygiene was good, but 51.0% reported bleeding gums during tooth brushing, 31.4% found they rarely bled, and only 17.6% reported no bleeding. Most respondents agreed that good oral health was very important for orthodontic treatment and that their own efforts were the most important factors., Conclusions: Client awareness of the importance of oral hygiene during orthodontic treatment requires improvement. Clinician reinforcement of oral hygiene should become a priority for orthodontic clients., Competing Interests: The authors have declared no conflicts of interest., (Copyright © 2020, CDHA | ACHD.)

Objective: The aim of this study was to systematically review and assess the accuracy of cone beam computed tomography (CBCT) in the measurement of alveolar bone height and thickness., Study Design: MEDLINE, Embase, the Cochrane Library, the China National Knowledge Infrastructure, and the gray literature were searched to identify all relevant articles published before July 2018. The Quality Assessment of Measurement Accuracy Studies tool was used to assess the quality of the included studies. Meta-analysis was performed to analyze the mean differences in alveolar bone height and thickness measurements between CBCT and gold standard references (direct measurement on human skulls or live patients)., Results: In total, 28 studies were included in the qualitative synthesis, and 18 were included in the quantitative synthesis. The meta-analysis results showed that the mean differences between CBCT measurements and the gold standard references for alveolar bone height (mean difference = 0.03 mm; 95% confidence interval -0.03 to 0.08; P = .382) and alveolar bone thickness (mean difference = 0.11 mm; 95% confidence interval -0.02 to 0.24; P = .088) were not statistically significant., Conclusions: Current evidence suggests that there is no significant difference between CBCT and the gold standard references for the measurement of alveolar bone height and thickness., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Objectives: Differences in oral health perceptions complicate comparisons of self-reported oral health in countries with considerably different cultures, traditions, and dental care. We compared it in China and New Zealand (NZ), to determine whether adults in those countries differ in how self-report oral health item responses distinguish those with different clinical oral disease states., Materials and Methods: Analysis of representative data on dentate 35-44-year-olds and 65-74-year-olds from the 3rd National Oral Health Survey of China in 2005 (for Sichuan province) and the NZ Oral Health Survey in 2009. Self-rated oral health in the Chinese survey was assessed by asking "Overall, how would you rate your oral health?"(responses: "Very poor," "Poor," "Fair," "Good," and "Very good"). The NZ survey asked "How would you describe the health of your teeth or mouth?" (responses: "Excellent," "Very good," "Good," "Fair," or "Poor"). To enable comparability, these were combined to create a four-category ordinal measure of self-reported oral health. The slope index of inequality (SII) and the relative index of inequality (RII) determined the extent to which the four-category self-report item distinguished those with better or poorer oral status., Results: A higher proportion of Chinese than NZ 35-44-year-olds rated their oral health as poor or fair, and the NZ proportion rating their oral health as very good was four times that observed among Chinese. The 65-74-year-olds differed even more in their overall responses. For most aspects of clinical disease experience, the two populations were responding similarly to the self-reported oral health item, although the SII and RII values were more pronounced among 35-44-year-olds in NZ than in China; among 65-74-year-olds, both countries were more similar., Conclusions: Chinese and NZ adults' self-ratings reflect their oral disease experience in largely similar ways, despite considerable absolute differences., Clinical Relevance: These findings support the cross-cultural applicability of self-report oral health measures.

Objectives: To use recent national survey data to compare dentition status and oral diseases in China and New Zealand (NZ), with a particular focus on differences by sex and education level., Methods: We undertook secondary analysis of representative data from oral health surveys conducted in 2009 in Sichuan (China) and NZ. Both surveys had an oral examination component and collected detailed demographic data. Socioeconomic position in this analysis was represented by the highest level of education completed. Participants were allocated to 1 of 3 comparable ordinal categories of years of education (primary, middle or tertiary). Analyses used survey weights., Results: The proportion of Chinese who had been educated to only primary level was 3 times higher than that among their NZ counterparts, and the proportion with a tertiary education was correspondingly lower. In the 35-44 age group, the dentate proportions were similar, although the mean number of teeth was higher in China than in NZ. There were substantial differences in dental caries experience, with the mean DMFT in NZ being almost 3 times that observed in China. New Zealanders had more filled teeth, but the prevalence of 1+ missing teeth was lower. Periodontitis was more common in the NZ sample than in the Chinese one, although the extent of bleeding on probing was almost 3 times higher among the latter. For the 65-74 age group, there were significant differences in dentition status, with greater tooth retention among Chinese people. There were also significant differences in dental caries experience, with Chinese 65- to 74-year-olds having more decayed teeth but fewer filled or missing teeth, and lower DMFT scores, on average. Periodontal health was better among the New Zealanders. There were notable differences by sex and education level., Conclusions: The differences observed in this study provide strong support for using broader sociocultural models of oral health., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: To identify any potentially toxic elements in porcelain-fused-to-metal (PFM) crowns and a bridge manufactured in China., Materials and Methods: Eight PFM crowns and part of a bridge were sourced from China for testing. They were given a typical glaze firing cycle prior to scanning electron microscope analysis. Electron dispersive spectroscopic spot and mapping analysis was carried out on the porcelain/metal collar interface areas in order to determine their elemental composition and distribution., Results: No toxic elements were detected. The alloy used in the crowns was a nickel-chromium base metal, and that in the bridge was a gold-palladium noble alloy. The veneering porcelain was similar to a standard dental veneering porcelain., Conclusions: Within the limitations of the testing method and small sample size, no toxic elements were detected.