The needs of primary care mental health service users: a Q-sort study

Background Within scientific and policy literature, the broader needs and preferences of the service user are usually described as being relatively homogenous for any particular condition. Additionally, despite common adult mental health problems being a huge burden to primary care services, there has been little research into the client's perspective of their needs regarding such difficulties. The aim of this research was thus to uncover the issues and preferences for this sample.Method The attitudes of 28 service users were explored through use of a Q-methodology approach. This procedure involves statistical analysis of the order that participants rank pertinent statements associated with the area of study.Results Five independent factors (clusters of preferences) were identified. These differed over issues associated with: relationships with service providers, access/barriers associated with services, information provision, stigma, choices associated with therapy and the care pathway, medication and complementary approaches, as well as social support.Discussion The study suggests that differing individual needs exist within diagnostic categories which, unless considered, may impede service engagement. Issues associated with the implications for service delivery for these differing clusters of perceived needs and viewpoints are outlined.     

Bacteriological tests as an aid in the management of dental caries in Iceland

The activities of three natural coumarins, xanthotoxin and bergapten (fromAmmi majus, Umbelliferae) and psoralene (fromFicus cycomorus, Moraceae), were tested against mycelial growth and aflatoxin production of a toxigenic strain ofAspergillus flavus grown in a rice/corn steep liquor medium. Two other natural chromones, khellin and visnagin (fromAmmi visnaga) were also compared. Complete inhibition of aflatoxin release occurred with either xanthotoxin or khellin at 5 mM. The other three compounds also at 5 mM reduced aflatoxin to 12 to 16% of its original concentration. The mould growth was only slightly inhibited by all the compounds used.     

The role of lead and cadmium in deciduous teeth and saliva on dental caries in children residing in Tehran,Iran

BackgroundLead (Pb) and Cadmium (Cd) are important environmental contaminants. There is no biological monitoring of exposure to these heavy metals and their potential effect on dental caries in children in Tehran, Iran, a polluted megacity. Therefore, the present study investigated the potential association between Pb and Cd levels in primary teeth and saliva and dental caries.MethodsIn a cross-sectional design, 211 children aged 6–11 years referred to Tehran University of Medical Sciences, School of Dentistry and residing in Tehran were examined. Pb and Cd levels of exfoliated primary teeth and stimulated saliva were determined by atomic absorption spectrophotometry (AAS). Dental caries prevalence was evaluated according to WHO criteria. Socioeconomic status, oral hygiene behavior, snacking frequency and salivary pH data were acquired as confounding factors. Frequency and percentages were reported for categorical variables, mean and standard deviation (SD) for continuous variables, and geometric mean for skewed continuous variables. A simple linear regression and Pearson correlation tests were used for statistical analyses. P-values < 0.05 were considered as significant.ResultThe mean (95 % confidence interval) Pb and Cd levels in teeth were 213.26 ppb (164.29–274.84) and 23.75 ppb (20.86–27.05), respectively. The mean Pb and Cd levels in saliva were 11.83 ppb (10.71–13.06) and 3.18 ppb (2.69–3.75), respectively. Furthermore, Pb and Cd in primary teeth and saliva were not associated (p > 0.05) with socioeconomic status, oral hygiene behavior and snacking frequencyConclusionThis study showed no association between Pb and Cd concentrations in primary teeth and in saliva with dental caries prevalence.     

A link between copper and dental caries in human teeth identified by X-ray fluorescence elemental mapping

Quantitative X-ray fluorescence imaging of sections of human teeth revealed an increased concentration of copper and zinc in carious regions of dentine compared with unaffected portions of the tooth. Higher-resolution images provided strong evidence that the copper was transported and localized mainly in the dentinal tubules. While similar levels of zinc were found in these areas and concentrated in the tubules, zinc was also more evident in the hydroxyapatite, and the increase in zinc levels compared with the levels in background (normal) areas was less than that for copper. These results suggest a role for copper and zinc in the formation and progression of dental caries and present a potential point of intervention for treatment. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users. Dedicated to the memory of the late Harold Eastgate.     

The implication of probiotics in the prevention of dental caries

The current oral health crisis, whose causes are varied and complex, necessitates timely oral evaluation and early detection and treatment of oral health problems. Dramatic changes in eating habits and lifestyles are associated with the recent decline in oral health. Probiotics are “good” bacteria that support digestion and a healthy immune system and offer various health benefits to the host. Traditionally, probiotics have been used to improve gut health; the most common uses have historically been as a treatment or prevention of gastrointestinal infections and disease. During the last decade, studies have additionally suggested the intake of probiotics for oral health purposes. Probiotic use provides an effective strategy to combat oral disease, including the development of dental caries and periodontal infection. The aim of this review is to describe the beneficial roles of probiotic bacteria in the oral cavity and the potential mechanisms by which these bacteria exert their effects on oral health.

     

Concentration of selected elements in the roots and crowns of both primary and permanent teeth with caries disease

We examined the differences between the concentrations of chemical elements in caries-changed primary teeth and permanent ones with a division into the root and the crown. The study comprised 27 children aged from 4 to 11 yr and 36 adults aged from 36 to 71 yr. We examined the elements with the total reflection X-ray fluorescence method. The lowest concentrations of calcium, manganese, strontium, lead, and copper were in the roots of primary teeth compared to the roots of permanent ones. The calcium, nickel, zinc, lead, and copper concentrations were significantly higher in the roots of primary teeth than in the roots of permanent teeth. However, the zinc concentration was higher both in the root and crown of primary teeth than in permanent teeth. On the basis of our investigations, we can conclude that the content of some elements (manganese, copper, strontium, and lead) is higher in caries permanent teeth than in primary ones. The nickel and zinc concentrations are higher in the teeth of the children than the adults. However, the content of other elements (calcium, chromium, iron) is similar in both kinds of teeth.     

The scientific and public-health imperative for a vaccine against dental caries

Dental caries is caused by one of the most ubiquitous bacterial infections of humans. In many countries such as Brazil and China, this disease is reaching epidemic proportions, and it is clear that a more effective public-health measure to combat dental caries is needed, because disadvantaged children are the most severely affected. One of the main groups of oral microorganisms, the mutans streptococci, has been associated with the aetiology of dental caries, and preclinical studies of immunological interventions have shown the feasibility of interfering with this disease. Moreover, clinical trials have indicated that a mucosal immune response to a crucial antigen(s) of mutans streptococci can influence the pathogenesis of dental caries. Evidence that this antigen(s) is appropriate for use in a vaccine against dental caries, as well as evidence for an appropriate target population of individuals and a logical time of administration, has now emerged.     

Sustainability governance service providers: the role of third-party product certification in facilitating corporate life cycle management

Purpose

This article aims to analyze the role that third-party product sustainability certifications play in supply chain sustainability governance and hence the impact that they may have on facilitating corporate life cycle management (LCM). Particular emphasis is given to exploring the extent to which such schemes allow firms to outsource the work of communication, motivation, enablement, and control of sustainability-related information and performance upstream in the supply chain.

Methods

The research design is based on a comparative case study methodology. The corporate practices of sourcing the sustainability certified products in the food retailing and textile sectors are compared, to explain when third-party product sustainability certification reduces the corporate need to engage in collaborative relationships with suppliers, thereby reducing efforts associated with implementation of corporate life cycle management.

Results and discussion

In our study, we found evidence that affirms the role of third-party product sustainability certification in reducing corporate necessity to actively engage with coordination of sustainability issues upstream in the supply chain. However, we also identified a range of factors—the intention of the buying company, the supply chain context, and the design of the certification scheme—that influence the extent, to which third-party product sustainability certification replaces the corporate need for additional work to facilitate supplier compliance. Some of these factors, e.g., the design of the certification scheme, are new and have been underexplored in the supply chain management and value chain governance literature yet.

Conclusions

Our findings suggest that corporate LCM practitioners should consider third-party sustainability certification as an instrument for the transfer of significant life cycle information along the supply chain and as a tool to facilitate corporate life cycle management. The extent to which third-party product sustainability certification would be able to facilitate corporate life cycle management depends not only on whether certification requirements are based on the LCA studies but also on the market scope of the certification schemes, the scope of the certification requirements, and the architecture of the certification management services. If these parameters are aligned with corporate ambitions and allow buyers to fully outsource the work associated with communication, motivation, enablement, and control of sustainability-related information and supplier performance, the life cycle management can be exercised by companies by simply choosing to procure sustainability certified products.

     

The estimation of dental caries incidence in the presence of diagnostic error.

Diagnostic error in large scale screening programs for dental caries is frequent, as when teeth initially classified as carious are later diagnosed as never having been affected by caries. This paper presents a general formulation of diagnostic error in dental caries screening. The basic parameter of the formulation is the caries incidence rate. The general formulation of this paper permits an explicit comparison, in a common notation, of two specific models of diagnostic error--one due to Carlos and Senning, the other to Lu. Each model gives rise to a consistent estimator of the incidence rate. The distributional properties of these estimators had not previously been examined because of the dependence of teeth in the same mouth with respect to caries experience. Using the present formulation, the sampling scheme may be regarded as a one-stage cluster sample with mouths as clusters. This approach accounts for intracluster dependence thus permitting the derivation of an estimator of the relevant covariance matrix and a confidence interval for the incidence rate.     

The deflecting wrinkle on the teeth of Icelanders and the Mongoloid dental complex

Three local populations from Northeast Iceland are surveyed for the occurrence of the deflecting wrinkle of the metaconid on second deciduous and first permanent lower molars. The trait occurs more frequently on dm2 than on M1, and no sexual dimorphism is found, as expected. However, the frequencies are clearly within those predicted by the Mongoloid dental complex for Mongoloid populations. It is therefore suggested that the inclusion of the deflecting wrinkle in the Mongoloid dental complex be re-evaluated, and the racial diagnostic value of the trait taken with reservation.     

Salivary levels of immunoglobulin and dental caries in children

IgG, IgA, IgM and lysozyme levels were determined in whole unstimulated saliva from ten children aged seven-nine years. IgA levels were significantly higher (p less than 0.05) in caries-susceptible subjects when compared with the caries-free ones. High levels of IgG seemed to correlate with a high DMF score. No correlation was found between lysozyme levels and DMF score.