Screening for elder mistreatment in dental and medical clinics

doi: 10.1111/j.1741‐2358.2010.00405.x
Screening for elder mistreatment in dental and medical clinics Objective: Elder mistreatment (EM) is a potentially fatal and largely unrecognised problem in the United States. The purpose of this study was to determine the prevalence of EM in busy clinics and specifically, we report on the feasibility of screening for EM as well as the appropriate instrumentation for screening. Background: Prevalence estimates for elder mistreatment vary, but recent data from a national sample of community‐residing adults over 60 years of age indicate that 11.4% of older adults report some form of elder mistreatment. There is a paucity of research related to screening in dental and medical clinics to understand the prevalence in such practice settings. Methods: A cross‐sectional study was conducted from January 2008 to March 2009. We enrolled 241 patients at two clinics: a medical clinic (n = 102) and dental clinics (n = 139). A mini‐mental status exam was conducted with a minimum of 18 or better for inclusion. An elder mistreatment screen was next used [elder assessment instrument (EAI‐R) for medical and Hwalek–Sengstock elder abuse screening test (HS‐EAST) for dental]. Results: For the 241 patients, we were able to compare data from the EAI‐R with the HS‐EAST. This pilot work demonstrates the feasibility of screening for EM in busy clinics since we documented patient enrolment of 20% in the medical clinics and 66% in dental clinics. Patients are willing to answer extremely‐sensitive questions related to elder mistreatment and are also willing to use computer technology for interviewing. Conclusion: Dental and medical clinics are important practice venues to screen for elder mistreatment.     

Oral disease experience of older adults seeking oral health services

doi:10.1111/j.1741‐2358.2009.00311.x
Oral disease experience of older adults seeking oral health services Objective: The objective of this investigation was to describe the dental disease (dental caries and alveolar bone loss) experience in a sample of community‐dwelling older adults who regularly utilize dental services in New York City. Background: Public financing for dental care directed at older adults in the United States is minimal. Improved preventive methods, primarily the use of fluorides, have resulted in declines in tooth loss, and concomitant increase in risk for dental diseases among older adults. While the oral disease burden in institutionalized elderly and those unable to access services is well‐documented, the dental care needs of older adults who access dental services are not well documented. Materials and Methods: Radiographic and record review were used to determine prevalence of dental caries, alveolar bone loss, frequency of service utilization, and medical status in this cross‐sectional investigation of a sample of older adults (N = 200) using dental services at Columbia University College of Dental Medicine. Results: Only 9% of the sample was completely edentulous, the mean DMFT was 19.9 and mean alveolar bone loss was 3.6 mm. Missing and Decayed Teeth accounted for 57.8% and 6.5% of the total caries burden respectively. Missing Teeth and alveolar bone loss increased with increasing age, but there was no increase in Decayed Teeth. Conclusions: While access to and utilization of dental services may result in improved tooth retention, older adults who use dental services continue to have dental care needs, especially periodontal care needs.     

我国疾病动物模型的研究现状和展望

由于医学科学研究的需要,各类疾病动物模型被广泛用来研究人类疾病的发生发展机制、药物筛选以及治疗评价等.本文全面梳理了我国疾病动物模型的研究和发展现状,分析了我国在这方面的特色优势以及与国际上的差距,内容涵盖了肿瘤、神经及精神疾病、感染及免疫性疾病、心血管与代谢性疾病、药物筛选等不同领域.简要介绍了国家自然科学基金对疾病动物模型项目的资助情况,同时指出了我国疾病模型今后的主要发展方向.     

Criteria for Patient Selection and Multidisciplinary Evaluation and Treatment of the Weight Loss Surgery Patient

Objective: To provide evidence‐based guidelines for patient selection and to recommend the medical and nutritional aspects of multidisciplinary care required to minimize perioperative and postoperative risks in patients with severe obesity who undergo weight loss surgery (WLS). Research Methods and Procedures: Members of the Multidisciplinary Care Task Group conducted searches of MEDLINE and PubMed for articles related to WLS in general and medical and nutritional care in particular. Pertinent abstracts and literature were reviewed for references. Multiple searches were carried out for various aspects of multidisciplinary care published between 1980 and 2004. A total of 3000 abstracts were identified; 242 were reviewed in detail. Results: We recommended multidisciplinary screening of WLS patients to ensure appropriate selection; preoperative assessment for cardiovascular, pulmonary, gastrointestinal, endocrine, and other obesity‐related diseases associated with increased risk for complications or mortality; preoperative weight loss and cessation of smoking; perioperative prophylaxis for deep vein thrombosis and pulmonary embolism (PE); preoperative and postoperative education and counseling by a registered dietitian; and a well‐defined postsurgical diet progression. Discussion: Obesity‐related diseases are often undiagnosed before WLS, putting patients at increased risk for complications and/or early mortality. Multidisciplinary assessment and care to minimize short‐ and long‐term risks include: comprehensive medical screening; appropriate pre‐, peri‐, and postoperative preparation; collaboration with multiple patient care disciplines (e.g., anesthesiology, pulmonary medicine, cardiology, and psychology); and long‐term nutrition education/counseling.     

Status of nutrition education in Canadian dental and medical schools.

To investigate the present status of nutrition education for dentists and physicians in Canada, we conducted a survey of the nutrition education programs in 10 Canadian dental and 16 medical schools in the academic year 1982-83. Seven of the dental schools and seven of the medical schools had a separate course in nutrition. The average duration of these courses was 22 hours for the dental schools and 26 hours for the medical schools. Nutrition education was integrated with another discipline in 4 of the dental schools and 11 of the medical schools. The average duration of this type of instruction was 14 hours for the dental schools and 18 hours for the medical schools. Six of the dental schools and eight of the medical schools employed a nutritionist/dietitian to provide instruction in nutrition. We recommend that courses in basic and applied clinical nutrition be incorporated throughout the curricula of Canadian dental and medical schools, and that personnel trained in clinical nutrition be employed to provide instruction in this area.     

Timing of testing and treatment for asymptomatic diseases

Many papers in the medical literature analyze the cost-effectiveness of screening for diseases by comparing a limited number of a priori testing policies under estimated problem parameters. However, this may be insufficient to determine the best timing of the tests or incorporate changes over time. In this paper, we develop and solve a Markov Decision Process (MDP) model for a simple class of asymptomatic diseases in order to provide the building blocks for analysis of a more general class of diseases. We provide a computationally efficient method for determining a cost-effective dynamic intervention strategy that takes into account (i) the results of the previous test for each individual and (ii) the change in the individual’s behavior based on awareness of the disease. We demonstrate the usefulness of the approach by applying the results to screening decisions for Hepatitis C (HCV) using medical data, and compare our findings to current HCV screening recommendations.     

妊娠期妇女产次与龋病及牙周病发生关系的探究

目的探究妊娠期妇女龋病及牙周病发生情况和不同产次对妊娠期妇女龋病及牙周病发生的差异。方法以228名妊娠期妇女(其中初产妇140名,经产妇88名)和85名同龄未妊娠妇女(对照)为研究对象,检查其龋病及牙周病发生状况,并记录菌斑指数(PLI)、探诊深度(PD)、临床附着丧失(CAL)、牙石指数(CI)和龈沟出血指数(SBI),进行组间统计分析。结果 (1)初产组(47.86%)、经产组(67.05%)的患龋率均高于对照组(29.41%)(P0.05),且经产组的患龋率高于初产组(P0.05)。初产组、经产组和对照组的龋均分别为1.57、2.18和0.90。(2)PLI、CI、PD、CAL和SBI在初产组(0.60±0.06,1.92±0.54,4.38±1.20,0.21±0.05,2.51±1.14)和经产组(0.71±0.59,2.06±0.97,4.77±1.35,0.22±0.08,3.05±1.40)均高于对照组(0.52±0.28,1.26±0.39,2.80±0.78,0.18±0.11,2.06±1.17)(P0.05),且经产组的PD、SBI高于初产组(P0.05),而初产组和经产组间PLI、CI、CAL的差异无统计学意义(P0.05)。结论妊娠可能导致妇女患龋率、PLI、CI、PD、CAL和SBI的增加,且产次增加可能导致妇女患龋率、PD和SBI的增加。     

Sources and patterns of referrals of oral cancer: role of general practitioners.

Referrals of patients with oral squamous cell carcinomas to an oral medicine clinic were assessed with regard to the sources, delays, and pattern of referrals from general medical practitioners and general dental practitioners. Slightly more patients were referred by dental practitioners than by medical practitioners, but general medical practitioners were far more likely to see advanced tumours and to request an urgent second opinion or suggest a diagnosis of malignant disease. The greatest delay overall was caused by the patients in seeking advice from their practitioner, particularly those who attended a general medical practitioner. Both groups of practitioners requested a hospital opinion within roughly a month--a reasonable interval. Subsequent delays were minimal. Delays occur mainly because the patients are slow in seeking professional advice and, in general, do not appear to have been reduced over the decade since a previous British study on referral patterns was carried out. This study emphasises the importance of educating patients about oral cancer since it is they who appear to be mainly responsible for the delays in diagnosis. The results also help to dispel the myth that general medical practitioners might be less competent at diagnosis and referral of patients with oral cancer than are dental practitioners, though we are aware of misdiagnoses from both groups.     

Anaesthesiological risk assessment in young/adult and elderly dental patients

Objective: Analysing the differences in number of diseases reported, medicines taken and American Society of Anaesthesiologists (ASA) scores in young/adult and elderly dental patients. Subject: Forty‐seven young/adult and 47 elderly dental patients living in the community. Setting: Private dental practice. Main outcome measures: Age, number of systemic diseases reported during anamnesis, number of medicines taken, seriousness of pre‐existent diseases measured according to the ASA (American Society of Anaesthesiologist) scale. Study design: Analytical study. Results: The differences between young/adult and elderly dental patients as far as self‐reported medical conditions, medicines taken and ASA scores were statistically significant (p < 0.001). Conclusion: The number of elderly patients’ medical conditions are greater than young/adults’. It is therefore necessary to adequately assess the elderly patient before starting any dental treatment.     

Reasons for referral of very elderly patients to the Community Dental Service in rural England and the implications for developing oral health care services

Objective : To analyse the medical conditions and dental treatment requirements. Design : Retrospective analysis. Setting : Rural South West Surrey, England. Subjects : 100 patients aged 75 or over who were referred for dental treatment to the Community Dental Services ( CDS ) because of various medical disabilities. Measurements : Age, sex, medical history including drug intake, dental treatment provided, time taken for treatment. Results : Two-thirds of the patients required domiciliary care; two-thirds had problems of mental confusion. In addition, 89% were dependent on carers. Treatment requirements indicate that the majority of dental care, although time consuming, were simple in nature and within the technical scope of a competent general dental practitioner (GDP). Conclusion : This study implies that the reasons for referral are other than lack of dental skills and may be due to perceived difficulties in managing patients. Further research is recommended to establish whether aspects of patient management are problematic so that resources, including appropriate training programmes, can be developed to enable a quality service to be provided. In the evolving health care system in the United Kingdom (UK) these issues will need to be considered when developing contracts at a local level.     

Prevalence and Global Initiative for Chronic Obstructive Lung Disease Group Distribution of Chronic Obstructive Pulmonary Disease Detected by Preoperative Pulmonary Function Test

Background

Despite being a major public health problem, chronic obstructive pulmonary disease (COPD) remains underdiagnosed, and only 2.4% COPD patients are aware of their disease in Korea. The objective of this study was to estimate the prevalence of COPD detected by spirometry performed as a preoperative screening test and to determine the Global Initiative for Chronic Obstructive Lung Disease (GOLD) group distribution and self-awareness of COPD.

Methods

We reviewed the medical records of adults (age, ≥40 years) who had undergone spirometry during preoperative screening between April and August 2013 at a tertiary hospital in Korea. COPD was defined as a postbronchodilator forced expiratory volume in 1 s/forced vital capacity ratio of <0.7. We analyzed self-administered COPD questionnaires for the assessment of the frequency of acute exacerbation over the previous year and dyspnea severity using the modified Medical Research Council dyspnea scale and COPD assessment test.

Results

Among 3029 patients aged >40 years who had undergone spirometry as a preoperative screening test, 474 (15.6%; 404 men; median age, 70 years; range, 44–93 years) were diagnosed with COPD. Only 26 (5.5%) patients reported previous diagnosis of COPD (2.1%), emphysema (0.8%), or chronic bronchitis (2.5%). The GOLD group distribution was as follows: 63.3% in group A, 31.2% in group B, 1.7% in group C, and 3.8% in group D.

Conclusions

The prevalence of COPD diagnosed by preoperative spirometry was 15.6%, and only 5.5% patients were aware of their disease. Approximately one-third of the COPD patients belonged to GOLD groups B, C, and D, which require regular treatment.     

Medical and dental status of a culture in transition,the case of the Inuit elderly of Canada

The medical and dental status, and drug utilisation pattern of Canadian Inuit elders (60+years) were evaluated. Inuit elders averaged 6.3 medical conditions per person, primarily nervous system-sense organ deficits, respiratory problems and systemic infections. The mean number of drugs being used was 2.5 per person, primarily analgesics, bronchodilators and antibiotics. Poorly fitting dentures, and high levels of tooth decay, periodontal disease, soft tissue and TMJ anomalies were documented. Compared to older southern Canadians, the medical and dental findings for these Inuit elders were different. Drug utilisation rates were consistent with older southern Canadians, but different drugs were taken.     

Immunomodulatory properties of dental tissue-derived mesenchymal stem cells: Implication in disease and tissue regeneration

Mesenchymal stem cells (MSCs) are considered as an attractive tool for tissue regeneration and possess a strong immunomodulatory ability. Dental tissue-derived MSCs can be isolated from different sources, such as the dental pulp, periodontal ligament, deciduous teeth, apical papilla, dental follicles and gingiva. According to numerous in vitro studies, the effect of dental MSCs on immune cells might depend on several factors, such as the experimental setting, MSC tissue source and type of immune cell preparation. Most studies have shown that the immunomodulatory activity of dental MSCs is strongly upregulated by activated immune cells. MSCs exert mostly immunosuppressive effects, leading to the dampening of immune cell activation. Thus, the reciprocal interaction between dental MSCs and immune cells represents an elegant mechanism that potentially contributes to tissue homeostasis and inflammatory disease progression. Although the immunomodulatory potential of dental MSCs has been extensively investigated in vitro, its role in vivo remains obscure. A few studies have reported that the MSCs isolated from inflamed dental tissues have a compromised immunomodulatory ability. Moreover, the expression of some immunomodulatory proteins is enhanced in periodontal disease and even shows some correlation with disease severity. MSC-based immunomodulation may play an essential role in the regeneration of different dental tissues. Therefore, immunomodulation-based strategies may be a very promising tool in regenerative dentistry.     

ASK1 and its role in cardiovascular and other disorders: available treatments and future prospects

ABSTRACT

Introduction: Apoptosis signal-regulating kinase 1 (ASK1), also known as MAP3K5, is a member of mitogen-activated protein kinase kinase kinase (MAP3K) family and is well reported as crucial in the regulation of the JNK and P38 pathways. ASK1 is activated in response to a diverse array of stresses such as endoplasmic reticulum stress, lipopolysaccharides, tumor necrosis factor alpha, and reactive oxygen species. The activation of ASK1 induces various stress responses.

Areas covered: Considering ASK1 as an important therapeutic drug target, here we have discussed the role of ASK1 in the progression of various diseases. We have also provided an overview of the available inhibitors for ASK1. The success of computational-based approaches toward ASK1 inhibitor design has also been discussed.

Expert opinion: A number of reports have outlined the prominent role of ASK1 in the pathogenesis of several diseases. The discovery of novel ASK1 inhibitors would have a wide range of applications in medical science. In-silico techniques have been successfully used in the design of some novel ASK1 inhibitors. The use of machine learning-based approaches in combination with structure-based virtual screening (SBVS) and ligand-based virtual screening (LBVS) will be helpful toward the development of potent ASK1 inhibitors.     

Cost-effectiveness of preoperative screening and eradication of Staphylococcus aureus carriage

Background

Preoperative screening for nasal S. aureus carriage, followed by eradication treatment of identified carriers with nasal mupirocine ointment and chlorhexidine soap was highly effective in preventing deep-seated S. aureus infections. It is unknown how cost-effectiveness of this intervention is affected by suboptimal S. aureus screening. We determined cost-effectiveness of different preoperative S. aureus screening regimes.

Methods

We compared different screening scenarios (ranging from treating all patients without screening to treating only identified S. aureus carriers) to the base case scenario without any screening and treatment. Screening and treatment costs as well as costs and mortality due to deep-seated S. aureus infection were derived from hospital databases and prospectively collected data, respectively.

Results

As compared to the base case scenario, all scenarios are associated with improved health care outcomes at reduced costs. Treating all patients without screening is most cost-beneficial, saving €7339 per life year gained, as compared to €3330 when only identified carriers are treated. In sensitivity analysis, outcomes are susceptible to the sensitivity of the screening test and the efficacy of treatment. Reductions in these parameters would reduce the cost-effectiveness of scenarios in which treatment is based on screening. When only identified S. aureus carriers are treated costs of screening should be less than €6.23 to become the dominant strategy.

Conclusions

Preoperative screening and eradication of S. aureus carriage to prevent deep-seated S. aureus infections saves both life years and medical costs at the same time, although treating all patients without screening is the dominant strategy, resulting in most health gains and largest savings.     

An eye for a tooth

Objective: To propose a possible link between dental extraction and intra‐ocular complications. Background: Several publications in medical literature describe intra‐ocular complications after different dental procedures. Results: Retinal detachment and vitreous hemorrhage following dental extraction with an appropriate anesthesia. Conclusion: Systemic complications following dental treatments should not be neglected and proper medical treatment must be provided as soon as possible.     

Oral health of the elderly living in residential homes in Slovenia

doi: 10.1111/j.1741‐2358.2011.00497.x
Oral health of the elderly living in residential homes in Slovenia Objectives:  To evaluate oral health status of the elderly, living in eight randomly selected residential homes for senior citizens across the country. Background: The percentage of the elderly is growing worldwide. With ageing, risks of various oral diseases, including dental caries and periodontal disease, are growing. Methods: Altogether 296 elderly people (88 men, 208 women) of average age 79.89 ± 7.4 years were questioned about their medical condition and oral health practice and examined orally. Evaluation of clinical examination was carried out by DMFT, plaque index ( 10 ) and Community Periodontal Index of Treatment Need (CPITN). Results: Of 296 participants, 106 (35.8%) were edentulous, 95 (32.1%) had one to nine teeth and 95 persons (32.1%) had 10 or more teeth. The average number of teeth in an individual was small: 6.76 ± 7.47. The average number of teeth with caries lesions was 3.59 ± 4.70, filled teeth 1.94 ± 3.63 and teeth without caries or fillings 1.19 ± 2.41. The average DMFT value was 30.75. In 69.5% of participants, dental plaque was visible with the naked eye. Of 171 subjects, in whom CPITN index was appraised, 81.9% would need oral hygiene education, 56.7% would need scaling and root planning and 21.6% would need periodontal surgical treatment. Conclusions: The results of this study indicate poor oral health of the elderly living in residential homes situated in different towns in Slovenia. It is of utmost importance to highlight the necessity of improving oral health care of this population.     

Preliminary fabrication and characterization of electron beam melted Ti–6Al–4V customized dental implant

The current study was aimed to fabricate customized root form dental implant using additive manufacturing technique for the replacement of missing teeth. The root form dental implant was designed using Geomagic™ and Magics™, the designed implant was directly manufactured by layering technique using ARCAM A2™ electron beam melting system by employing medical grade Ti–6Al–4V alloy powder. Furthermore, the fabricated implant was characterized in terms of certain clinically important parameters such as surface microstructure, surface topography, chemical purity and internal porosity. Results confirmed that, fabrication of customized dental implants using additive rapid manufacturing technology offers an attractive method to produce extremely pure form of customized titanium dental implants, the rough and porous surface texture obtained is expected to provide better initial implant stabilization and superior osseointegration.     

Evaluation of the strain identity between isolates from caries lesions and root canals in early childhood caries cases

Early childhood caries (ECC) has become a serious medical problem worldwide in the last decade. Bacterial microflora of the dental plaque and oral cavity is considered an important factor in the formation and progression of dental caries. The aim of this study was strain typing and comparison of bacterial isolates retrieved from caries lesions and root canal contents of the same teeth. In total, 18 pairs of presumptive streptococci and lactobacilli retrieved from dental caries and root canals isolated from ECC-affected children, were selected on the basis of biotyping results and rep-PCR fingerprinting with (GTG)₅ primer. Strain typing was further done using the RiboPrinter microbial characterization system (DuPont Qualicon). The automated ribotyping determined 14 pairs of the strains (77.8 %) to be identical. The results obtained confirmed that identical bacterial strains colonized both the decayed dental surface and the necrotic content of the dental pulp cavity during the cariogenesis. Our finding supports the assumption that bacteria could penetrate through the damaged dental surface to the inner parts of the teeth.