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Podiatry, formerly known as chiropody, is a fundamental discipline within medicine, with its own regulatory processes. Opportunities are emerging for healthcare assistants and assistant practitioners to play a significant role.

Pancreatic cancer is responsible for 6% of all cancer related deaths worldwide each year. In this article, Catherine Hayes contextualizes the clinical impact of the disease, incorporating an overview of the pre-disposing risk factors of the development of the disease. Factors of the wider public health agenda are presented as one mechanism by which early detection and mechanisms of screening patients might be enhanced. The article explores the symptoms and diagnostic pathway of the condition incorporating treatment and management plans and concludes with an overview of the progressive developments in the treatment and management of the condition.

This article aims to build capacity between nursing and allied healthcare practitioner staff in highlighting the unique challenges that caring for people with cerebral palsy (CP) brings. It gives an insight into how CP is classified and diagnosed, and briefly outlines issues of political correctness in labelling people with this condition. It covers the complexities of brain development in people with CP, with consideration of the key aetiological contributors to the incidence of the condition. A straight forward approach to unravelling the classification of movement disorders in CP is adopted. It concludes that a multidisciplinary approach to the management of CP, with the nurse at the centre of this holistic approach to patient care, is pivotal to future healthcare provision.

Children frequently refrain from disclosing being bullied. Early identification of bullying by healthcare professionals in children may prevent adverse health consequences. The aim of our study was to determine whether Health Care Utilisation (HCU) is higher in 9-year-olds who report being bullied and factors influencing type of HCU. The study consists of cross-sectional surveys of Child Cohort of Irish National Longitudinal Study of Children (Wave 1), 8,568 9-year-olds, and their carers. Being bullied was assessed by a self-reported questionnaire completed by children at home. HCU outcomes consisted of the following: visits to GP, Mental Health Practitioner (MHP), Emergency Department (ED), and nights in hospital by parent interview. Bivariate logistic regression and gender-stratified Poisson models were used to determine association. Victimisation by bullying independently increased visits to GP (OR 1.13, 95% confidence interval (CI): 1.03 to 1.25; p = 0.02), MHP (OR 1.31, 95% CI: 1.05 to 1.63; p = 0.02), though not ED visits (OR 0.99, 95% CI: 0.87 to 1.13; p = 0.8) or nights in hospital (OR 1.07 95% CI: 0.97 to 1.18; p = 0.2), adjusting for underlying chronic condition(s) and socio-demographic confounders. Victimised girls made higher GP visits (RR 1.14, 95% CI: 1.06 to 1.23; p < 0.001) and spent more nights in hospital (RR 1.10, 95% CI: 1.04 to 1.15; p < 0.001). Victimised boys were more likely to contact MHPs (RR 1.21, 95% CI: 1.02 to 1.44; p = 0.03). 9-year-old bullied subjects were more likely to utilise primary care services than non-bullied 9-year-olds. Different HCU patterns were observed according to gender and gender differences in the presentation of victimisation. Our findings may lead to the development of clinical practice guidelines for early detection and appropriate management of bullied children.

Background The authors conducted a study to assess dentists' and primary care physicians' oral cancer knowledge, attitudes and practices in the Commonwealth of Massachusetts. Methods The authors mailed a 38-item, pretested questionnaire to a stratified sample of dentists and primary care physicians in Massachusetts. The sample population included all general medicine, internal medicine and family practice physicians listed with the Massachusetts Board of Registration in Medicine and all Massachusetts Dental Society members. The authors invited a random sample of more than 1,000 clinicians to participate in the survey. They assessed knowledge, attitudes and practices of respondents and performed a bivariate analysis of responses to questions by using statistical software. Results Forty-nine percent of physicians reported performing an oral cancer examination in patients aged 40 to 55 years, compared with 92 percent of dentists ( P P P Conclusion This survey identified an existing gap in knowledge and practices among physicians and dentists and underscores the need to enhance oral cancer education among both professional groups.

Compomer restorations release fluoride to help prevent future caries. We tested the hypothesis that compomer is associated with fewer future caries compared with amalgam. The five-year New England Children’s Amalgam Trial recruited 534 children aged 6–10 yrs with ≥ 2 carious posterior teeth. Children were randomized to receive compomer or amalgam restorations in primary posterior teeth, placed with a fluoride-releasing bonding agent. The association between restorative material and future caries was assessed by survival analysis. Average follow-up of restorations (N = 1085 compomer, 954 amalgams) was 2.8 + 1.4 yrs in 441 children. No significant difference between materials was found in the rate of new caries on different surfaces of the same tooth. Incident caries on other teeth appeared slightly more quickly after placement of compomer restorations (p = 0.007), but the difference was negligible after 5 yrs. Under the conditions of this trial, we found no preventive benefit to fluoride-releasing compomer compared with amalgam.

– Objective: To measure the 5-year caries increment among high-risk children during their participation in the New England Children’s Amalgam Trial (NECAT), and to evaluate sociodemographic factors that may account for any observed disparities. Methods: NECAT recruited 534 children aged 6–10 with at least two decayed posterior occlusal surfaces from urban Boston and rural Maine. After restoration of baseline caries and application of sealants to sound surfaces, NECAT continued to provide free comprehensive semiannual dental care to participants. The net caries increment of children who completed the 5-year follow-up (n = 429) was calculated and predictors of caries increment were investigated using multivariate negative binomial models. Results: The majority of children (89%) experienced new caries by the end of the 5-year follow-up. Almost half (45%) had at least one newly decayed surface by the first annual visit. At year 5, the mean number of new decayed teeth was 4.5 ± 3.6 (range 0–25) and surfaces was 6.9 ± 6.5 (range 0–48). Time trends showed a noticeably higher increment rate among older children and young teenagers. Multivariate models showed that age (P

Objectives: To compare the prevalence of caries between rural and urban children with unmet dental health needs who participated in the New England Children's Amalgam Trial. Methods: Baseline tooth and surface caries were clinically assessed in children from rural Maine (n = 243) and urban Boston (n = 291), who were aged 6 to 10 years, with two or more posterior carious teeth and no previous amalgam restorations. Statistical analyses used negative binomial models for primary dentition caries and zero-inflated models for permanent dentition caries. Results: Urban children had a higher mean number of carious primary surfaces (8.5 versus 7.4) and teeth (4.5 versus 3.9) than rural children. The difference remained statistically significant after adjusting for sociodemographic factors and toothbrushing frequency. In permanent dentition, urban children were approximately three times as likely to have any carious surfaces or teeth. However, rural/urban dwelling was not statistically significant in the linear analysis of caries prevalence among children with any permanent dentition caries. Covariates that were statistically significant in all models were age and number of teeth. Toothbrushing frequency was also important for permanent teeth. Conclusions: Within this population of New England children with unmet oral health needs, significant differences were apparent between rural and urban children in the extent of untreated dental decay. Results indicate that families who agree to participate in programs offering reduced cost or free dental care may present with varying amounts of dental need based on geographic location.

Objectives: Previous research shows increased dental decay among immigrants, but little is known about the oral health of the growing population of children of immigrants. We compared the children of immigrants to the children of US-born caregivers in their caries experience at enrollment and their new caries increments during the 5-year New England Children's Amalgam Trial (NECAT). Methods: NECAT recruited 283 Boston-area children aged 6 to 10 with untreated caries and offered free semiannual preventive and restorative dental care during the trial. Sociodemographic factors and caregiver immigrant status were assessed through interviews. Multivariate negative binomial models evaluated the association between caregiver immigrant status and clinically assessed carious surfaces. Results: Forty percent of these Boston-area children had immigrant caregivers. At baseline, the children of immigrants had more carious surfaces (11.5 versus 9.4, adjusted for race/ethnicity, age, gender, and caregiver smoking status). Caregiver language preference explained some of this association. Immigrant status and language preference were not associated with 5-year caries increments. Conclusions: Prevalent disparities in the unmet dental needs of the immigrants' children were quickly ameliorated during participation in NECAT. Dental initiatives that target neighborhoods and are sensitive to acculturation levels may help improve and maintain the oral health of immigrant families.

All primary health care should be underpinned with a firm theoretical knowledge. The holistic management of Down syndrome patients should be an integral part of this knowledge base. The application of this knowledge should ideally encompass a positive approach to empowering patients to lead healthy, active and normal lives. This article highlights a basic documentation of what ‘Down syndrome’ is. The article gives community nursing staff the opportunity to firstly refresh their knowledge of the condition and then encourages critical reflection on professional practice within primary care, with the intention of both raising skill and awareness for the holistic management of patients with Down syndrome.

Background Limited information is available from randomized clinical trials comparing the longevity of amalgam and resin-based compomer/composite restorations. The authors compared replacement rates of these types of restorations in posterior teeth during the five-year follow-up of the New England Children's Amalgam Trial. Methods The authors randomized children aged 6 to 10 years who had two or more posterior occlusal carious lesions into groups that received amalgam (n = 267) or compomer (primary teeth)/composite (permanent teeth) (n = 267) restorations and followed them up semiannually. They compared the longevity of restorations placed on all posterior surfaces using random effects survival analysis. Results The average ± standard deviation follow-up was 2.8 ± 1.4 years for primary tooth restorations and 3.4 ± 1.9 years for permanent tooth restorations. In primary teeth, the replacement rate was 5.8 percent of compomers versus 4.0 percent of amalgams ( P = .10), with 3.0 percent versus 0.5 percent ( P = .002), respectively, due to recurrent caries. In permanent teeth, the replacement rate was 14.9 percent of composites versus 10.8 percent of amalgams ( P = .45), and the repair rate was 2.8 percent of composites versus 0.4 percent of amalgams ( P = .02). Conclusion Although the overall difference in longevity was not statistically significant, compomer was replaced significantly more frequently owing to recurrent caries, and composite restorations required seven times as many repairs as did amalgam restorations. Clinical Implications Compomer/composite restorations on posterior tooth surfaces in children may require replacement or repair at higher rates than amalgam restorations, even within five years of placement.

Background People with intellectual disabilities are more likely to have hearing loss than the general population. For those unable to self-advocate, the responsibility of detection and management falls to their caregivers. Methods This is the first cycle of a project using action research methodology to improve services. Twenty care workers were interviewed to understand their knowledge of hearing loss and hearing aids. Themes were generated using thematic analysis. Findings This group was better qualified than their peers but received minimal training in hearing loss. They were unable to accurately estimate expected prevalence and had a negative perception of hearing aids. Only 7% of service users were known to have hearing loss. Conclusions Current training is not sufficient to provide the skills for detection and management of hearing problems. This group had clear ideas on methods of learning. Working in collaboration is necessary to achieve long-term change to practice.

Background This umbrella review aimed at identifying evidence-based conditions important for successful implementation of interventions and policies promoting a healthy diet, physical activity (PA), and a reduction in sedentary behaviors (SB). In particular, we examined if the implementation conditions identified were intervention-specific or policy-specific. This study was undertaken as part of the DEterminants of DIet and Physical Activity (DEDIPAC) Knowledge Hub, a joint action as part of the European Joint Programming Initiative a Healthy Diet for a Healthy Life. Methods A systematic review of reviews and stakeholder documents was conducted. Data from nine scientific literature databases were analyzed (95 documents met the inclusion criteria). Additionally, published documentation of eight major stakeholders (e.g., World Health Organization) were systematically searched (17 documents met the inclusion criteria). The RE-AIM framework was used to categorize elicited conditions. Across the implementation conditions 25 % were identified in at least four documents and were subsequently classified as having obtained sufficient support. Results We identified 312 potential conditions relevant for successful implementation; 83 of these received sufficient support. Using the RE-AIM framework eight implementation conditions that obtained support referred to the reach in the target population; five addressed efficacy of implementation processes; 24 concerned adoption by the target staff, setting, or institutions; 43 referred to consistency, costs, and adaptations made in the implementation process; three addressed maintenance of effects over time. The vast majority of implementation conditions (87.9 %; 73 of 83) were supported by documents referring to both interventions and policies. There were seven policy-specific implementation conditions, which focused on increasing complexities of coexisting policies/legal instruments and their consequences for implementation, as well as politicians’ collaboration in implementation. Conclusions The use of the proposed list of 83 conditions for successful implementation may enhance the implementation of interventions and policies which pursue identification of the most successful actions aimed at improving diet, PA and reducing SB. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2585-5) contains supplementary material, which is available to authorized users.

While numerous new cases of adenocarcinoma of the pancreas are positively diagnosed in the UK each year, it is the fourth leading cause of cancer death in Britain. Specific risk factors include smoking, certain familial cancer syndromes, and familial chronic pancreatitis. Over half of all presenting cases have distant metastasis at the time of initial diagnosis, leading to the overall dismal prognosis of the condition. Computed tomography is the most useful diagnostic and staging tool for clinicians trying to reach a swift diagnosis of the condition. Alongside this, ultrasonography, magnetic resonance imaging, and endoscopic retrograde cholangiopancreatography may provide additional information leading to enhanced information of specific presentations. The majority of tumours are not surgically resectable because of metastasis and invasion of the major vessels posterior to the pancreas. Allied health professionals within the UK need to be aware of the symptomology, diagnosis and management of this condition.

Purpose The purpose of this study was to identify significant predictors of 4 outcomes in patients with severe odontogenic infections: abscess formation, penicillin therapeutic failure (PTF), length of hospital stay (LOS), and need for reoperation. Patients and Methods We used a prospective case series study design and enrolled 37 consecutive patients admitted for severe odontogenic infection between March 1996 and June 1999. Treatment consisted of intravenous penicillin (PCN) or clindamycin in PCN-allergic patients, surgical incision and drainage, and extraction(s) as soon as possible. Study variables were categorized as demographic, preadmission, time-related, preoperative, anatomic, treatment, microbiologic, and complications. The primary outcome variables were abscess formation, PTF, LOS, and reoperation. Multivariate linear and logistic regression techniques were used to measure associations between study variables and the outcome variables. Results The sample consisted of 37 subjects (23 male, 14 female) with a mean age of 34.9 ± 15.8 years. Multivariate analyses, controlling for confounding variables, indicated that culture of Peptostreptococci was a negative predictor of abscess formation. LOS was predicted by the number of infected spaces and duration of operation. There was no significant predictor of PTF or reoperation on multivariate analysis, although PCN-resistant organisms were isolated in all cases of PTF. Conclusion Increased LOS in severe odontogenic infections is predicted by the anatomic extent and severity of the infection and the occurrence of complications such as PTF and the need for reoperation. PTF is significantly associated with later identification of PCN-resistant organisms. The role of Peptostreptococci in abscess formation warrants further investigation.

Purpose Gradual midfacial advancement, applying the principle of distraction osteogenesis, reduces the restriction of the soft tissues and results in bony consolidation without need for grafting. The midface can be distracted by either pushing it forward, using semiburied devices, or pulling it forward by a rigid external device. For each method there are inherent technical problems, such as controlling the vector of movement, symmetry of advancement, and differential movement of the upper/lower face. We have used a combination of the 2 methods, called “push-pull,” in an effort to control the distraction process. The purpose of this paper is to describe our push-pull distraction technique and summarize our early experience. Materials and Methods Ten patients (5 males and 5 females) with a mean age of 11 years 2 months underwent midfacial advancement using push-pull distraction. Two orthodontists, blinded for landmark identification, traced preoperative and postoperative cephalograms and determined linear and angular measurements of midfacial position. A Student t test was used to assess differences between the cephalometric measures on the 2 radiographs. Interexaminer reliability was calculated by an intraclass correlation coefficient. Results Postdistraction cephalograms were taken a mean of 10 months (range, 3 to 20 months) after removal of the devices. Patients exhibited improvement at all levels of the midface after distraction. There was a statistically significant sagittal advancement from the infraorbital rim to dentoalveolus. The central midface was sufficiently advanced as shown by an improved convexity, nasolabial angle, and upper labial protrusion. There were no significant differences between examiners for any of the measurements in this study. Conclusions Push-pull distraction permits 1) equal movement at both the upper and lower facial levels, 2) advancement of the central midface, and 3) symmetric movement of the zygomaticomaxillary complexes. This method also provides a backup, in case one device malfunctions. In combination, the advantages of each device are additive; whereas the weaknesses are not. The push-pull technique is a practical method for midfacial distraction until a better single device is fabricated.

– Introduction: Several studies investigating the oral health status of children living in Ukraine after the Chernobyl catastrophe revealed an increase of caries in children residing in radionucleotide-contaminated areas. Purpose: (1) To compare prevalence of dental caries in contaminated and noncontaminated towns; and (2) to determine if there is a difference between dental behaviors and attitudes of children residing in contaminated and noncontaminated areas that may have contributed to differences in caries prevalence. Methods: Children aged 13–14 were randomly selected in two towns of approximately the same population size (33 000): Ovruch (n = 119) from a contaminated area and Mirgorod (n = 100) from a noncontaminated area. Data on behaviors and attitudes were collected via a self-administered questionnaire having six domains: (i) family background; (ii) dental anxiety; (iii) dental utilization; (iv) oral hygiene; (v) use of fluoride toothpaste; and (vi) sugar consumption. Oral examinations included information on carious lesions, restorations, missing teeth, and soft tissue abnormalities. Caries prevalence was compared using a t-test. Regression analysis was conducted to determine the independent contribution of oral hygiene behaviors and dental utilization. Results: There was a significant difference in caries prevalence in the contaminated town (mean DMFT = 9.1 ± 3.5) versus the noncontaminated town (mean DMFT = 5.7 ± 1.4; P

Objective To evaluate the effects of active infant orthopedic treatment on dental arch relationships and determine the effect on maxillary growth in children born with unilateral complete cleft lip and palate (UCCLP). Design The GOSLON Yardstick was used to assess dental models taken on patients treated with and without active infant orthopedics. Patients Two groups of nonsyndromic Caucasian children born with UCCLP (total n = 40), all treated by the same surgeon and ranging from 5 to 10 years of age, were evaluated. Interventions One group had a Latham dentomaxillary alignment (DMA) appliance inserted at 5 to 6 weeks of age, after which a lip-nasal adhesion was performed at an average age of 3.5 months. This was followed by more definitive nasolabial repair at the average age of 5.9 months. Those patients treated without preoperative orthopedics underwent a lip-nasal adhesion at average age 1.5 months followed by nasolabial repair at average age 5.1 months. Main Outcome Measures Randomized assessments using the GOSLON Yardstick were done independently at two separate times by three different examiners. Differences in GOSLON scores between the active orthopedic group and nonorthopedic group were evaluated by both categorical and continuous statistical analyses. Results The mean GOSLON score was 3.30 for the orthopedic group and 3.21 for the nonorthopedic group. There was no significant group difference in the modal scores of the two groups. Conclusions This study showed that active infant orthopedics does not affect the dental arch relationships in preadolescent children with repaired UCCLP, compared with a similar group treated without orthopedic intervention at this center.

Background: Previous campaigns to combat stigma emphasise the need for people who do not have mental health problems to behave in a non-stigmatising socially inclusive way towards those who do. Less attention has been given to the role of people with mental health problems in the construction of stigma or the impact it has upon them. Aim: To enhance services' contribution to supporting their clients in dealing with stigma, this study explores the nature and impact of stigma from the perspective of the lived experience of mental health service users. Method: In-depth interviews with 27 Caucasian service users Results: All respondents, whatever their diagnosis, reported being affected by stigma. Fear of stigma was found to be more commonplace (reported by 25 respondents) and more restrictive than overt discrimination (reported by 14 respondents). Conclusion: It is suggested that traditional campaigns that highlight discrimination may have a negative impact on the mentally ill because they highlight the prev...

A number of quantitative studies of people with severe mental illness show that, as with the general population, supportive social relationships are associated with well-being but the nature and causation of this association are unclear. To enhance services' contribution to the social support needs of their clients, this study explores the association qualitatively from the perspective of the lived experience of 27 mental health service users. Social contacts were reported to be both protective and damaging to mental health and it was common for close social relationships in particular to be both supportive and harmful. Loneliness was reported to be a problem, and almost all social contact was valued and perceived as better than none at all. Mental health problems led to changes in network composition and lack of balance in relationships, and this was sometimes difficult to reverse. Clinical implications of the findings are discussed.

It is important for clinicians to understand the type of clinical studies that appear in the literature and the inherent strengths and limitations of each study. The three possible alternative explanations, chance, bias, and confounding, must be considered for any research study. Thus, it is important to evaluate research studies critically in light of this discussion and not simply to summarize the findings. Finally, conclusions about causality can only be made on the body of evidence, not on any single study.

BackgroundBisphosphonate-related osteonecrosis of the jaw (BRONJ) is a rare, yet significant, adverse effect of bisphosphonate therapy. A multidisciplinary approach to the prevention of BRONJ is recommended due to the significant morbidity and difficulty treating the condition. Current evidence suggests that both general practitioners (GPs) and community pharmacists have limited knowledge relating to BRONJ and that preventative strategies are rarely implemented.ObjectiveTo explore the attitudes and perceptions of GPs and community pharmacists on the risks and preventative strategies for the development of BRONJ.DesignInterpretivist methodological approach using qualitative semistructured interviews.Participants9 community pharmacists and 8 GPs.SettingPrimary Care in North East England and Cumbria, UK.MethodsUsing a Grounded Theory methodology and integrating a process of constant comparison in the iterative enrichment of data sets, semistructured interviews were undertaken, transcribed and analysed using framework analysis. Salient themes were identified and related back to extant literature in the field.ResultsFour salient and inter-related themes emerged: (1) uncertain knowledge, indicating limited exposure of respondents to BRONJ, and limited awareness of the implications of its diagnosis, risk factors and preventative strategies; (2) patient specific, referring to the complexity of patients, patient education and prioritising aspects of care; (3) wider context, indicating a lack of interdisciplinary communication and referral processes between professions, workload pressures, access and patient receptivity to dental services; and (4) professional, reflecting professional roles and responsibilities, authority and educational initiativesConclusionsEffective communication or collaborative care between GPs and community pharmacists for the prevention of BRONJ is not apparent. Interventions to mitigate against the risk of developing BRONJ and clarity of GP and community pharmacy roles are required.

In this note I analyze the physics determining the proposed reactor position independent monitor (PIM), which is the ratio (240Pu/239Pu)1/3 × (135Cs/137Cs)1/2. The PIM ratios in any reactor fuel is shown to increase monotonically with the time over which the fuel is irradiated. This is because the Cs ratio determines the neutron flux, while the Pu isotopic ratio is determined by the flux times the irradiation time. If the irradiation time for all fuel rods across the reactor is fixed, the PIM ratio is approximately constant in all rods. However, no information can be extracted from the PIM ratio on Pu isotopics unless both the flux (or Cs ratio) and the irradiation time (from, say, Ru isotopics) are known separately, i.e., the PIM ratio is not a fundamental parameter of any reactor. Thus, unless the PIM ratio has been measured for the specific fuel under interrogation, no information can be deduced from measurements or reactor simulations of PIM ratios in different fuel from the same reactor. However, if a PIM measurement has been in one spent fuel rod from a given reactor, all other rods that are known to have been in the reactor for the same irradiation period canmore » be assumed to have approximately the same PIM ratio.« less

Multidisciplinary educational curriculum development is a fundamental part of my role as an academic. In practice, the term historically meant that students were segregated into their respective professional disciplines and taught in ‘optional modules’ of relevance only to them. One of the aims of my work is to build capacity within and between health-care professional disciplines through curricula which allow them to remain together in one cohort. In relation to health, this can be seen as improving interprofessional working. Following the implementation of such a curriculum, I needed a means of establishing what students thought of their experience across the programme in order to see how best to further develop or amend it in the light of their comments. This case study offers an insight into the process of choosing phenomenology as a philosophy underpinning a method and the decision-making involved in designing a phenomenological study. The reader is introduced to the relative complexity of interpreting qualitative data from a phenomenological study and the processes underpinning it. Particular attention is given to the emergent themes resulting from the data and the processes behind formulating this into a cogent discussion which clearly outlined the emergent theory from it.

Objective The purpose of this study was twofold: (1) to describe the patterns of missing teeth in patients with hemifacial microsomia (HFM) and (2) to compare the prevalence of missing teeth in subjects with HFM with a group of unaffected subjects. Study Design A descriptive study was conducted comparing HFM subjects with a group of patients selected from an orthodontic clinic. Methods The prevalence of missing teeth was assessed by evaluation of panoramic radiographs. At the time of the study, records of 125 patients with HFM were available from the Craniofacial Center at Boston's Children's Hospital. Seventy-six met inclusion criteria for radiographic analysis of hypodontia. Fifty-two patients met inclusion criteria into the comparison study in which the prevalence of hypodontia was compared with a group of patients from the Department of Orthodontics at Harvard School of Dental Medicine. A Fisher's exact test was conducted to test the hypothesis that HFM patients have a greater prevalence of missing teeth than individuals without the anomaly. A chi-square test for trend was conducted to determine whether hypodontia was more prevalent with increasing severity of the mandibular deformity in HFM. Results Hypodontia was more common among HFM patients (26.9%) versus the comparison group in which no missing teeth were recorded (p < .0001). Additionally, the degree of hypodontia was correlated with the grade of mandibular hypoplasia (p = .024). Conclusion Hypodontia was found to be more prevalent in patients with HFM than in comparison subjects, possibly indicating an etiologic link between the two conditions.

BACKGROUND This article describes the oral health of users of Veterans Administration (VA) health care using both clinical and self-report measures, and models relationships between these measures and self-perceived oral health. METHODS We conducted a cross-sectional study of 538 male users of VA outpatient care in the Boston area. Questionnaires assessed self-reported oral health, oral-specific health-related quality of life, health behaviors, and sociodemographic information. Clinical data were collected on oral mucosa status, number of teeth and root tips, dental caries, and periodontal treatment need. We report clinical and self-reported oral health status by age group (era of military service). We regressed models of self-perceived oral health on clinical indices and self-reported measures of the impact of oral health on daily life, adjusting for sociodemographic characteristics and health behavior. RESULTS Among those participants aged 65 to 91 years old, 2.8%, 18.7%, and 41.5% rated their oral health as excellent, very good, or good, respectively. Among 50- to 64-year-old men, the corresponding values were 1.4%, 18.5%, and 40.4%, while among those aged 22 to 49 years old, the values were 2.3%, 17%, and 34.1%. Tooth loss was common among users of VA care; 34% of those aged 65-90 years, 28% of those aged 50-64 years, and 8% of those aged 25-49 years had no teeth. Periodontal treatment needs were uniformly high among persons with teeth; mild mucosal change was common, and 10% had root tips. Regression models showed self-perceived oral health was better in persons with more teeth and recent dental treatment, and worse with tooth mobility, coronal decay, and more medical problems. Measures of the impact of oral conditions on daily life added significantly to the amount of explained variance in self-perceived oral health. CONCLUSIONS Clinical conditions and the impact of oral health on daily life are important determinants of self-perceived oral health.

Background Historically, breastfeeding rates in Ireland have been low compared with international averages. It has been suggested that maternal ethnicity and citizenship may influence breastfeeding rates, with ethnic minorities thought more likely to breast feed. Aim The aim of this study is to investigate the association among maternal citizenship, ethnicity, birthplace and breast feeding. It is hypothesised that Irish mothers (identified through Irish citizenship, self-identified Irish ethnicity or Irish birthplace) are less likely to breast feed than non-Irish mothers. Methods The study population of Growing Up in Ireland: the National Longitudinal Study of Children was used for this study. Analysis was restricted to 11 092 biological mother and infant pairs with a complete breastfeeding history. Logistic regression analysis was used to estimate ORs and 95% CIs for breast feeding relative to maternal citizenship and ethnicity, controlling for the confounding effects of other maternal variables. Results Results indicated that 55.9% (6202 of 11 092) of mothers had initiated breast feeding, with only 7.9% (874 of 11 092) of mothers currently breast feeding their infant (at 9 months of age). Irish citizens (4693 of 9368, 50.0%) were significantly less likely to have initiated breast feeding compared with non-Irish citizens (1503 of 1695, 88.7%). Irish born mothers (4179 of 8627, 48.8%) were also significantly less likely to have initiated breast feeding than mothers born elsewhere (2023 of 2462, 82.2%). Conclusions Maternal citizenship and ethnicity appear to be the strongest influencing factors on breastfeeding initiation and duration. However, this raises a possibility that the increase in breastfeeding rates seen recently may be the result of increased immigration into Ireland, rather than the success of policy and research efforts.

The subepithelial connective tissue graft has markedly broadened clinicians' abilities to treat gingival recession. Frequently, however, bulky soft tissue contours are sequelae of this procedure, and post-healing gingivoplasty is often performed to improve esthetics of the grafted site. As a secondary benefit, it is believed that the zone of keratinized tissue is additionally increased after gingivoplasty.To further investigate this clinical impression, 16 bilateral pairs of sites with recession in 6 consecutive patients (mean age = 38 +/- 9 years) were studied. At the time of initial grafting, one site in each pair was randomly assigned to receive either gingivoplasty 2 months later (GP+) or no further treatment (GP-). Clinical measurement of recession and keratinized tissue width was standardized using customized acrylic stents and Schiller iodine solution, which stains epithelia; values were recorded at baseline (day of graft) and at 2, 3, and 5 months after grafting. Mean clinical gingival widths over time between GP+ and GP- sites, as well as within GP+ sites, were analyzed by t test.At 5 months, both the GP+ and GP- sites demonstrated a mean root coverage of 87.4% and increased keratinized tissue width (1.2 mm) when compared to their respective baseline measures. No differences in recession depth and width of keratinized tissue were seen at 5 months between the GP+ and GP- groups. In addition, no differences in recession or gingival width were found between 2- and 5-month observations for either the GP+ or GP- groups.These data suggest that the observed clinical improvements are the outcome of the initial graft surgery and that the gingivoplasty procedure does not result in additional (or "rebound") increases in keratinized tissue width.

Introduction Common clinical experience suggests that tooth whitening agents are 100% effective. This study uses meta-analysis of data from published randomized controlled clinical trials to determine the efficacy of tooth whitening agents. Methods A MEDLINE search strategy was developed and implemented to systematically identify clinical trials on dentist-prescribed, home-applied tooth whitening agents, using 10% carbamide peroxide, published between 1989-1999. Inclusion criteria (e.g., in English, human clinical trials) and exclusion criteria (e.g., not placebo controlled) were established and clinical trials that met these criteria were critically appraised for validity and clinical applicability. Meta-analysis was then used to quantitatively integrate the findings. Results Seven studies were identified that met the inclusion and validity criteria. These studies indicated that: Whitening results in a significant mean change of 6 4 shade guide units (p < 0.01), while the placebo control group exhibited little change (0.7 0.6, p > 0.05). 93% of the bleached patients exhibited 2 shade guide unit change, while 20% of the placebo control group exhibited this change. The brand of bleaching agent had a significant effect on tooth whitening, but the daily application time and duration of treatment did not. Whitening is maintained for 6 months for 1/2 of the people treated. Neither gingival indices nor plaque indices were adversely or favorably affected by bleaching. Clinical Applicability The data from the reviewed studies indicate that rather than being 100% effective, on average: 73% (93% for bleached group minus 20% placebo group) of people who whiten their teeth will exhibit a whitening that is 2 shade guide units greater than the placebo. 20% of the people who use dentist-prescribed, home-applied bleaching will achieve a mean whitening effect of 5 shade guide units. Re-treatment for 50% of people may be necessary to maintain this effect longer than 6 months. The methods used here are Internet applicable for other clinical topics.

The effect of oral conditions on medical outcomes is not well understood. The purpose of this epidemiological investigation was to examine whether the risk for chronic obstructive pulmonary disease (COPD) is enhanced among individuals with a history of periodontal disease as assessed by radiographic alveolar bone loss (ABL). Subjects were selected from the VA Dental Longitudinal Study, a long-term study of aging and health in male veterans who were medically healthy at baseline. Subjects are not VA patients. Those subjects with a forced expiratory volume in 1 second (FEV1) less than 65% of predicted volume were categorized as having COPD. ABL was assessed by using full-mouth series periapical films measured by a Schei ruler. Bone loss at each interproximal site was measured in 20% increments, and the mean whole-mouth bone loss score was calculated. Logistic regression analysis was used to determine the independent contribution of bone loss measurement at baseline to the subsequent risk of developing COPD over a 25-year follow-up period. Covariates included measures of smoking, height, age, education, and alcohol consumption. Of the 1,118 medically healthy dentate men at baseline, 261 subsequently developed COPD. We found that ABL status at baseline was an independent risk factor for COPD, with subjects in the worst population quintile of bone loss (mean ABL > 20% per site) found to be at significantly higher risk (OR = 1.8; 95% CI = 1.3, 2.5). The results of this analysis indicate that increased ABL is associated with an increased risk for COPD

Objective To determine the survival status of children with Down syndrome (DS), and to document factors influencing survival. Design Follow-up study of cases identified from the Dublin European Register of Congenital Anomalies and Twins (EUROCAT) Register. Follow-up was attempted for each case until death or 1992 or until the date last known to be alive. Setting Eastern Health Board, Dublin. Subjects In all, 389 DS children, born between 1 January 1980 and 31 December 1989 were followed up. Results Survival rates of 88% at one year and 82% at 10 years were found. There was a non-significant improvement in survival between the cohort born in 1980-1984 and that born in 1985-1989. Congenital heart defects reduced survival to 72% and complete atrio-ventricular canal defects (CAVD) had the poorest prognosis (58% survival at 10 years). Cases with CAVD showed a trend towards improved survival when surgically treated. Maternal age mother's county of residence, sex of infant, season of birth and presence of additional non-cardiac congenital anomalies had no impact on survival. Conclusions Four out of five DS children now survive at least 10 years. Adequate educational and health service provision needs to be made for them, especially those with congenital heart defects. The need for studies which compare survival and quality of life in DS children with CAVD who undergo cardiac surgery versus those who do not, taking account of various selection factors, is identified.

The objective of this survey was to obtain an indication of the size of the methicillin-resistant Staphylococcus aureus (MRSA) problem in Ireland prior to introducing national MRSA control guidelines. A survey of all microbiology laboratories in Ireland was carried out over two weeks in Spring 1995. For patients from whom MRSA was isolated during the study period standard demographic and clinical data were requested and period prevalence/1000 discharges was calculated. All 45 microbiology laboratories surveyed responded. MRSA was isolated from 448 patients during the two-week period. The period prevalence of MRSA was 16.5/1000 discharges. Males aged > or = 65 had the highest rate (50/1000 discharges). Half of all isolates were from patients in surgical or medical wards, but 4% were from community-based sources such as GPs, nursing homes and hospices. Thirty-two percent of MRSA patients were infected rather than colonized. MRSA is clearly a significant problem in Ireland. While it is largely a hospital problem at present, the increasing trend towards day procedures and shorter hospital stay means that infection will increase in the community.

Evidence suggests that risk for early childhood caries (ECCs), the most common chronic infectious disease in childhood, is increased by specific eating behaviors. To identify whether consumption of added sugars, sugar-sweetened beverages (SSBs), and 100% fruit juice, as well as eating frequency, are associated with severe ECCs, cross-sectional data collected from a sample of low-income, racially diverse children aged 2 to 6 years were used. Four hundred fifty-four children with severe ECCs and 429 caries-free children were recruited in 2004-2008 from three pediatric dental clinics in Columbus, OH; Cincinnati, OH; and Washington, DC. Dietary data were obtained from one parent-completed 24-hour recall and an interviewer-administered food frequency questionnaire (FFQ). Multivariate logistic regression analyses were conducted to assess associations between severe ECCs and dietary variables. On average, children with severe ECCs consumed 3.2-4.8 fl oz more SSBs (24-hour recall=1.80 vs 1.17; P< 0.001; FFQ=0.82 vs 0.39; P

This article has been developed for allied health professionals. These practitioners may face significant barriers to providing high-quality healthcare to people with intellectual disabilities, just because they lack awareness of policies and initiatives in health. There are fundamental issues to address within the context of healthcare provision that are of direct relevance to improving services for people with intellectual disabilities with regard to their empowerment and the facilitation of care. Emphasis is placed upon the need for equity in healthcare for all and the need to avoid the tendency of society to homogenise all individual people with intellectual disabilities into one group, for whom empowerment cannot become panacea in reality.

Background We conducted a descriptive epidemiological study of Down syndrome (DS) in the four Irish counties (Dublin, Kildare, Wicklow and Galway) covered by EUROCAT registries of congenital malformations for the years 1981-1990. Methods EUROCAT registries, which cover defined populations, use multiple sources for case ascertainment. All DS cases born between 1 January 1981 and 31 December 1990 to mothers resident in the four counties were identified. Crude birth prevalence rates and maternal agestandardized rates (SPRs) were calculated for each county and for each year in the study period. The prevalence of DS by maternal age grouped in five-year periods and the risk for each five-year group were also estimated. Results The crude birth prevalence for the four counties was 18-5/10 000 for all births and 18-3 for live births. There was a fall in the total number of DS births over the decade, but less change in the crude birth prevalence owing to an increase in the proportion of mothers aged 35 + . Galway had the highest crude birth prevalence of DS (23-5/10 000) but the SPR was within average for the four counties as a whole - 110-3, 95 per cent confidence interval (Cl) 86 7139. The risk of having a DS child increased 70-fold from 1:1841 at age 15-19 to 1:26 at 45 years or older. Nearly half of all DS cases (47-4 per cent) had at least one additional anomaly. Conclusions The parts of Ireland covered by EUROCAT have a high birth prevalence of DS births as compared with some other countries, but the maternal age-specific rates are not substantially different from those in large international studies.

Background Being victimised by bullying is strongly associated with having an underlying chronic condition. The aim of this study was to determine whether primary and/or secondary healthcare utilisation (HCU) is increased in children who are bullied independent of having an underlying chronic illness or disability. Methods Cross-sectional survey of the first wave of the childhood (9-year-old) cohort of the Irish National Longitudinal Study of Children, encompassing 8,568 9-year-olds and their primary carers. Bully victimisation was assessed by a self-reported questionnaire completed by the child at home. The principal HCU outcomes obtained by interview-administered questionnaire with the primary caregiver at home were: visits to general practitioner (GP), Mental Health Practitioner (MHP) and nights spent in hospital in the previous 12 months. Results In logistic regression models, being victimised by bullying independently increased GP visits (OR = 1.13, 95% CI: 1.03–1.25, p = 0.02); MHP visits (OR = 1.31, 95% CI: 1.05–1.63, p = 0.02), though not nights in hospital (OR = 1.07 95% CI: 0.97–1.18, p = 0.18), irrespective of presence of chronic illness or disability. Gender stratified Poisson models demonstrated that victimised girls made increased GP visits (RR = 1.14, 95% CI: 1.06–1.23, p Conclusion 9-year-olds who are victims of bullying are more likely to utilise healthcare services. Different types of HCU patterns were observed by gender. Our study suggests health professionals need to be vigilant that medically unexplained symptoms and behavioural problems in children may be manifestations of bully victimisation, which may present differently in boys and girls. This has important implications for early detection of bullying and appropriate management of victimised children.

Article Title and Bibliographic Information Non-fluoride caries-preventive agents: executive summary of evidence-based clinical recommendations. Rethman MP, Beltran-Aguilar ED, Billings RJ, Hujoel PP, Katz BP, Milgrom P, et al; American Dental Association Council on Scientific Affairs Expert Panel on Nonfluoride Caries-Preventive Agents. J Am Dent Assoc 2011;142;1065-71. Reviewer Catherine Hayes, DMD, Dr Med Sc Purpose/Question To inform clinicians about the effectiveness of nonfluoride agents in preventing, arresting, and reversing dental caries Source of Funding The Centers for Disease Control and Prevention provided some funding Type of Study/Design Systematic review Level of Evidence Level 2: Limited-quality, patient-oriented evidence Strength of Recommendation Grade Grade B: Inconsistent or limited-quality patient-oriented evidence

The association between fluoride and risk for osteosarcoma is controversial. The purpose of this study was to determine if bone fluoride levels are higher in individuals with osteosarcoma. Incident cases of osteosarcoma (N = 137) and tumor controls (N = 51) were identified by orthopedic physicians, and segments of tumor-adjacent bone and iliac crest bone were analyzed for fluoride content. Logistic regression adjusted for age and sex and potential confounders of osteosarcoma was used to estimate odds ratios (OR) and 95% confidence intervals (CI). There was no significant difference in bone fluoride levels between cases and controls. The OR adjusted for age, gender, and a history of broken bones was 1.33 (95% CI: 0.56-3.15). No significant association between bone fluoride levels and osteosarcoma risk was detected in our case-control study, based on controls with other tumor diagnoses.

Early childhood caries (ECC) is a serious and preventable disease which pediatric clinicians can help address by counseling to reduce risk.We implemented a multifaceted practice-based intervention in a pediatric outpatient clinic treating children vulnerable to ECC (N = 635), comparing results to those from a similar nearby clinic providing usual care (N = 452).We provided communication skills training using the approach of patient centered counseling, edited the electronic medical record to prompt counseling, and provided parents/caregivers with an educational brochure.We assessed changes in provider knowledge about ECC after the intervention, and examined providers' counseling practices and incidence of ECC over time by site, controlling for baseline ECC, patient sociodemographics and parents'/caregivers' practice of risk factors (diet, oral hygiene, tooth-monitoring), among 1045 children with complete data.Provider knowledge about ECC increased after the intervention training (percentage correct answers improved from 66% to 79%). Providers at the intervention site used more counseling strategies, which persisted after adjustment for sociodemographic characteristics. Children at the intervention site had a 77% reduction in risk for developing ECC at follow up, after controlling for age and race/ethnicity, sociodemographics and ECC risk factors; Por= 0.004.The multifaceted intervention was associated with increased provider knowledge and counseling, and significantly attenuated incidence of ECC. If validated by additional studies, similar interventions could have the potential to make a significant public health impact on reducing ECC among young children.

Within the context of postgraduate education, the majority of curriculum design for allied healthcare practitioners has stemmed from assumptions that learning is a one-dimensional concept with definitive starting and completion points, undertaken by the individual in pursuit of knowledge. This knowledge is perceived as being consumed by the learner and that it requires a formalized process of teaching in order to separate it from the rest of everyday activity and experience. This article charts the strategic development of a new and innovative approach to needs-led educational provision within multidisciplinary health care in higher education through the deconstruction of traditional approaches to teaching and learning. It also presents the case for merging the theoretical underpinnings of situated learning with the concept of problem-based learning, in which knowledge is created rather than consumed within the context of a new and innovative programme that seeks to build capacity in and between professional disciplines across the healthcare arena.

Patients diagnosed with mental illness are statistically less likely to access physical healthcare services, resulting in increased mortality rates and diminished quality and decreased longevity of lifespan. This article identifies key aspects of the need for capacity building in, and between, all professional healthcare disciplines and utilizes a clinical case study to demonstrate the relevance of basic psychosocial interventions to all healthcare professionals. Alongside the practicalities of mental healthcare provision within the context of 21st-century society, discussion is extended to two basic theoretical models for understanding the relationship of mental illness to factors over which there can be no intraneous or conscious control. In this sense, the portrayal of patients with mental illness first and foremost as people whose somewhat transient demise from general wellbeing serves only to brand and stigmatize them from the point of diagnosis as fundamentally different to others. Mechanisms of how these stark rhetorical issues may be altered through building on the concept of therapeutic alliance with appropriately designed and insightful pathways of development for multidisciplinary healthcare teams aptly conclude the article.