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In Australia, the proportion, volume and type of orthodontic care provided by general practitioners and orthodontists are largely unknown. The overall objective of this study was to create a profile of orthodontic services provided by general practitioners and orthodontists for a cohort of insured patients using private practices in New South Wales, Australia, from 1st January 1992 to 31st December 1995. Data were derived from claims records submitted by members of a health insurance fund for rebates for fees paid to private practitioners for orthodontic services they received during the study period. Distribution of the volume and type of service provided by general practitioners and orthodontists was compared using the Chi-squared test. Statistical significance was taken at the 5 per cent level. Orthodontic services were provided predominantly by orthodontists (80%). Fixed orthodontic treatment was provided almost exclusively (91%) by orthodontists. The majority of removable appliance services was provided by general practitioners. Orthodontists provided more orthodontic services in the capital city and other metropolitan areas, whereas general practitioners provided more orthodontic services in rural areas. Orthodontists provided more services to members in the highest socio-economic group, whereas general practitioners provided more services to members in the lowest socioeconomic group.

Low-intensity shockwave therapy (LiSWT) has emerged as a promising non-invasive treatment modality for erectile dysfunction (ED) yet the well-designed randomized clinical trials are still lacking to prove its claimed benefits. A randomized, prospective, double-blinded sham-controlled study was conducted to evaluate the effectiveness and safety profile of short course LiSWT on vasculogenic ED patients. The International Index of Erectile Function-5 (IIEF-5) and Erection Hardness Score (EHS) questionnaires were used for evaluation. Patients underwent weekly sessions for 4 weeks and were re-assessed at 1, 3 and 6 months post therapy. Fifty one patients were recruited and randomized into sham and treatment arms. The mean IIEF-5 scores were significantly improved in the treatment arm compared to worsening of scores in the sham arm after 1 month (14.1 vs. 9.3 p < 0.001), 3 months (14.9 vs. 8.6, p < 0.001) and 6 months (14.2 vs. 7.9, p < 0.001) post treatment. A significant improvement of EHS was demonstrated at 1 month (2.4 vs. 1.8, p = 0.001, 3 months 2.7 vs. 1.7, p < 0.001) and 6 months (2.7 vs. 1.6, p < 0.001) in the treatment arm compared to sham arm. The success rate based on IIEF score increment more than five points was 26% in treatment arm and 0% in sham arm. Improvement in EHS score ≥3 in the treatment versus sham arm was 63% and 4%, respectively. There was no adverse effect reported. This 4-week LiSWT protocol reflects better treatment compliance, and it prevents further deterioration of erectile function among this cohort of patients. This study proves that LiSWT is a well-tolerated treatment with modest improvements in erectile function and hardness, among patients with vasculogenic ED., (© 2022 The Authors. Andrologia published by Wiley-VCH GmbH.)

A man in his early 50s presented with a spontaneous large left-sided retroperitoneal haematoma (RPH), on a background of therapeutic anticoagulation with warfarin for homozygous factor V Leiden. His international normalised ratio was found to be supra-therapeutic at 9.0 on presentation. He was treated non-operatively with prompt reversal of the coagulopathy and close monitoring. On day 4 of the admission, the patient reported scrotal pain and swelling. An urgent scrotal ultrasound revealed infarction of the left testis and the patient was taken to an emergency scrotal exploration. Intraoperatively, the left testis was found to be no longer viable with the left spermatic vein and venules completely thrombosed with extensive clots, while the left testicular artery remained intact. Consequently, a left orchidectomy was performed. Therapeutic anticoagulation was recommenced on day 3 postoperatively. It is thought that the large RPH caused extrinsic compression of the left testicular vein, in addition to the patient's pre-existing factor V Leiden, which resulted in thrombosis of the blood vessel., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Female sexual dysfunction (FSD) among the obese women is often under diagnosed and ignored especially in Malaysia, a nation of conservative multiethnic society. There are only a few studies on FSD resolution post-bariatric surgery. The objective was to identify the rate and resolution or improvement of FSD, among obese multiethnic Malaysian women post-bariatric surgery., Material and Methods: This is a prospective study of women undergoing bariatric surgery, between May 2017 and April 2018. FSD was diagnosed using the Malay version of Female Sexual Function Index (MVFSFI) questionnaire. Patients filled up the questionnaire before and 6 months after surgery. Association between BMI reduction and FSFI score improvement was measured using Fisher's exact test. Outcomes between types of surgery (sleeve gastrectomy and gastric bypass) was compared., Results: Fifty-two women completed the study. The mean age was 38.77 ± 6.7. There were 44 (84.6%) Malay patients, 7 (13.5%) Indian patients, and 1 (1.9%) Chinese patient. There was a significant reduction in mean BMI, 39.89 ± 6.9 pre-surgery to 30.32 ± 5.4 post-surgery (p value < 0.001). The rate of FSD among the obese is 75.0% pre-surgery compared to 36.0% post-surgery. There was a significant improvement in mean FSFI score pre- and post-surgery: 18.73 and 25.93 respectively and in each of all 6 domains (p value < 0.001). There was a significant association between BMI reduction and improvement in FSFI score (p = 0.019). There was no difference in outcomes between types of surgery., Conclusion: FSD is highly prevalent among the obese multiethnic Malaysian women. Bariatric surgery has proven benefit in resolving FSD across all sexual domains and should be considered as a management option in this group of women.

Expression of HLA-B27 is strongly associated with ankylosing spondylitis (AS) and other spondyloarthropathies. While this is true for the majority of HLA-B27 allotypes, HLA-B*27:06 and HLA-B*27:09 are not associated with AS. These two subtypes contain polymorphisms that are ideally positioned to influence the bound peptide repertoire. The existence of disease-inducing peptides (so-called arthritogenic peptides) has therefore been proposed that are exclusively presented by disease-associated HLA-B27 allotypes. However, we have recently demonstrated that this segregation of allotype-bound peptides is not the case and that many peptides that display sequence features predicted to favor binding to disease-associated subtypes are also capable of being presented naturally by protective alleles. To further probe more subtle quantitative changes in peptide presentation, we have used a combination of data-independent acquisition (DIA) and multiple reaction monitoring (MRM) mass spectrometry to quantify the abundance of 1646 HLA-B27 restricted peptides across the eight most frequent HLA-B27 allotypes (HLA-B*27:02-HLA-B*27:09). We utilized K means cluster analysis to group peptides with similar allelic binding preferences across the eight HLA-B27 allotypes, which enabled us to identify the most-stringent binding characteristics for each HLA-B27 allotype and further refined their existing consensus-binding motifs. Moreover, a thorough analysis of this quantitative dataset led to the identification of 26 peptides, which are presented in lower abundance by HLA-B*27:06 and HLA-B*27:09 compared with disease-associated HLA-B27 subtypes. Although these differences were observed to be very subtle, these 26 peptides might encompass the sought-after arthritogenic peptide(s)., (© 2016 by The American Society for Biochemistry and Molecular Biology, Inc.)

Background: It is important to evaluate concurrently the benefit for dental caries and the risk for dental fluorosis from early exposure to fluoride among children., Aim: To evaluate associations of different levels of exposure to fluoride in early childhood with dental caries and dental fluorosis experience in school children., Methods: A Child Dental Health Survey (CDHS) was conducted among school children in the Australian state of New South Wales (NSW) in 2007. Trained and calibrated examination teams conducted oral epidemiologic examinations to assess caries experience as decayed, missing or filled tooth surfaces of the primary and permanent dentitions (dmfs/DMFS) and fluorosis using the Thylstrup & Fejerskov (TF) index on the maxillary central incisors only. A parental questionnaire collected information on residential histories and tap water usage to enable calculation of percentage of 3-year lifetime exposure to fluoride in water. Use of dietary fluoride supplements was also collected. Dental caries and fluorosis experience were compared among groups by levels of exposure to fluoride from water and fluoride supplements in bivariate and multivariable analysis, controlling for socioeconomic factors., Results: Exposure to different fluoride sources varied in the group of 2611 children aged 8-12 years. Lower household income was significantly associated in both bivariate and multivariable analyses with the greater prevalence and severity of primary tooth caries among 8-10-year-old children and permanent tooth caries among 8-12 year old. Exposure to fluoride in water during the first 3 years of life was associated with both caries and fluorosis experience observed at age 8-12 years. Having higher percentage of 3-year lifetime exposure to fluoride in water was associated with higher prevalence of mostly mild fluorosis, but significantly lower prevalence and severity of caries in the primary and permanent dentitions., Conclusion: There were significant associations of dental caries and fluorosis experience with sources of early childhood fluoride exposure among children aged 8-12 years in New South Wales. Exposure to fluoridated water during the first 3 years of life was associated with better oral health of school-age children., (© 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

The State of New South Wales (NSW) in Australia has over half a century of experience with water fluoridation. Yass was the first town to be fluoridated in 1956 and Sydney in 1968, and by the late 1970s, approximately 90% of NSW was fluoridated. However, since then, there have been no new fluoridation schemes. In NSW under the Fluoridation of Public Water Supplies Act 1957, the decision to fluoridate rests with local government authorities (councils). Since 2004, the NSW Health Department has been proactive in promoting and extending water fluoridation to unfluoridated rural communities in an attempt to reduce oral health inequalities. This has resulted in 20 councils implementing fluoridation, increasing population coverage of water fluoridation from 90% in 2004 to 96% in 2012. When the remaining 16 councils that have been gazetted to fluoridate implement fluoridation, approximately 98% of NSW residents will have access to fluoridated water. This article provides an overview of the framework used to extend water fluoridation to many rural communities in New South Wales in the 21st century., (© 2012 John Wiley & Sons A/S.)

Background: Data regarding the long-term effects of smoking, smoking cessation and environmental tobacco smoke (ETS) on tooth loss are limited., Methods: The authors collected information about tooth loss and other health-related characteristics from a questionnaire administered to 103,042 participants in the 45 and Up Study conducted in New South Wales, Australia. The authors used logistic regression analyses to determine associations of cigarette smoking history and ETS with edentulism, and they adjusted for age, sex, income and education., Results: Current and former smokers had significantly higher odds of experiencing edentulism compared with never smokers (prevalence odds ratio [OR], 2.51; 95 percent confidence interval [CI], 2.31-2.73 and OR, 1.50; 95 percent CI, 1.43-1.58, respectively). Among former smokers, the risk declined significantly with increasing time since smoking cessation; however, the risk remained elevated even in those who ceased smoking 30 or more years previously compared with that in never smokers (OR, 1.10; 95 percent CI, 1.02-1.19). Furthermore, among never smokers, the OR for edentulism was 1.37 (95 percent CI, 1.17-1.60) in those who reported having exposure to ETS for six or more hours per week versus those who were not exposed to any ETS., Conclusions: and, Clinical Implications: Although the risk of experiencing tooth loss declines with time since smoking cessation, the effects of smoking may persist for at least 30 years. The effect of ETS requires further investigation.

Objectives: This article describes the strategies adopted to influence the outcome of a plebiscite held in March 2004 in favor of water fluoridation in Deniliquin, a rural town in New South Wales, Australia., Methods: The health promotion strategies undertaken included the following: a) the skillful use of media to educate the community on the benefits of water fluoridation; b) disseminating contemporary local data to demonstrate oral health disparities with neighboring fluoridated townships; and c) a well-established lobbying machine to mobilize the community., Results: Out of a total population of 5,280 on the electoral roll, 4,539 residents voted, giving a response rate of 86 percent. The wording of the plebiscite was "Do you support the addition of fluoride to Deniliquin town water supply?" There were 2,533 "yes" votes (55.8 percent), 1,879 "no" votes (41.4 percent), and 127 spoiled votes (2.8 percent)., Conclusions: The council resolved to implement water fluoridation and the residents received fluoridated water in January 2005.

Objectives: The 2004-06 National Survey of Adult Oral Health was Australia's second oral examination survey of a nationally representative sample of adults. The aim of this paper is to provide a brief overview of oral health in the NSW adult population from the findings of the survey., Methods: A three-stage, stratified, clustered sampling design was used to select NSW residents aged 15 years and over. Self-reported information about oral health was obtained through telephone interviews. People with natural teeth were offered clinical examinations., Results: 3630 people were interviewed and 1099 underwent a clinical examination. Only 5.5% of the study population were edentulous (all natural teeth missing) compared with the national estimate of 6.4%. The Decayed, Missing, Filled Teeth (DMFT) caries severity index was 12.8, equal to that of the Australian population; prevalence of untreated decay was 27.1%, which was not significantly different to the national estimate of 25.5%. Some 60.3% of the NSW survey sample had visited a dentist within the last 12 months (nationally 59.4%) and 56.8% visited for a check-up (56.2% nationally). Oral health, use of dental services and perceptions of need varied significantly by geographic location, private insurance patronage and eligibility for public dental care., Conclusions: The oral health of the NSW adult population and patterns of dental care are similar to that estimated nationally. The prevalence and severity of dental diseases and oral health behaviours are influenced by social and geographic factors.

Objective: To determine cost of dental services provided to a cohort of insured population 18 years and over, who used private general dental practice in New South Wales, Australia., Basic Research Design: This cohort study used the person-years method and Weibull regression for analysis. Setting Data were derived from claims records submitted for rebates by members of a health insurance fund for services they received in private general dental practice during 1 January 1992-31 December 1995., Participants: 75,501 members from New South Wales., Main Outcome Measures: To determine, by age groups, the cost per item of dental service, cost of services received at a visit and cost of services received per year., Results: The median cost per item of dental service received for all ages was A$36.7; with cost increasing with age until 55-64 year age group where an apparent plateau occurred. The median cost of services received at a visit for all ages was Australian dollars 93.5. Cost of services received at a visit increased with age, reaching a plateau in the middle aged groups. The median cost of providing services for all age groups per year was Australian dollar 183.6. The cost of services per year when compared with the youngest age group (18-24 years) increased by about 20% for each successive age group up to the 45-54 year age group. From 55 years onwards the cost levelled off at approximately 70% more than the youngest age group., Conclusion: The cost of providing dental services increased with age to reach a plateau in the middle age groups.

Objective: To determine patterns of dental services provided to a cohort of the insured population 18 years and over, in private general practice in New South Wales, Australia., Basic Research Design: A cohort study using the person-years method and Poisson regression for analysis., Setting: Data were derived from claims records submitted by members of a health insurance fund (Government Employees Health Fund-GEHF) for rebates during the study period 1 January 1992-31 December 1995., Participants: There were 133,467 members aged 18 years and over from New South Wales., Main Outcome Measures: To determine, by age group, for those members who used private general practice and made a claim (referred to as 'patients') the annual number of visits, total number of services received per year and number of services received at a visit., Results: The mean number of visits per patient was 2.4 per year with patients under 45 years making fewer visits than the 45-54 age group reference category. Mean number of services utilised per patient-year was 5.9, with services provided increasing from 3.5 for the 18-24-year-old group, reaching a plateau of approximately 6.2 for those aged 45 years or more. The number of services received per visit was 2.4 and there were no differences by age. Service mix was dominated by restorative (35%), diagnostic (27%), and preventive services (18%); with age specific variations observed., Conclusions: Age was found to be an important determinant in the use of dental services, independent of membership duration and gender.

The study reports on data relating to the apparent consumption, food content, and contribution of different food groups to the sugar (sucrose) intake in Australia. The trends and patterns of sugar (sucrose) usage have been summarised. The apparent annual sugar consumption has remained very high (up to 50 kg per person) for the last three decades with an increase in sugar consumed in manufactured foods. There has been some decrease in sugar consumed in confectionery, bakeries and vegetable products and as refined sugar. The greatest increase in sugar intake has been through non-alcoholic beverages, ice-cream and frozen confectionery, and cereals. The prevalence of dental caries in Australia has dropped dramatically over the past three decades while the consumption of sugar remains very high.