RESUMO
Environmental toxins are known to have many impacts on growth and development in humans, starting in utero. Alterations in amelogenesis, caused by chemical and physical trauma that occur during the antenatal, perinatal and postnatal time periods, may result in developmental defects in deciduous and permanent tooth enamel, as demonstrated in animal studies. These defects can be clinically visible and result in a variety of morphological and functional problems in the dentition. Since enamel does not remodel after formation, it may serve as a permanent record of insults during organ development.Our primary purpose was to investigate any possible relationship between intrauterine exposure to endocrine disrupting chemicals (phenols and phthalates) and developmental defects in enamel in children, while also accounting for fluoride exposure. Our secondary purpose was to report descriptively on findings from comprehensive dental examinations performed on 356 children that were drawn from the general paediatric population. A cohort of children from the Utah Children's Project (N = 356) that had full medical exams, comprehensive medical and family histories and available biospecimens were given extraoral and intraoral examinations. They also completed an oral health questionnaire. Standardized intraoral photographs were taken of the teeth and viewed by standardised examiners and the dental observations were recorded for a full inventory of findings, including: tooth morphology, caries, restorations, colorations, attrition, erosion, fractures and hypomineralization. Perinatal maternal urine samples were assessed for the concentration of fluoride, phenols and phthalates, including bisphenol A (BPA).Pairwise statistical analyses were done to correlate the dental findings with one another and with the presence of environment chemicals found in the urine samples. Hypomineralization was the most common finding (96% of children; 37% of deciduous teeth, 42% of permanent teeth), consistent with molar incisor hypomineralization (MIH) described in other human populations. No consistent correlations were seen between dental findings and the presence of phenols and phthalates in prenatal urine, but the number of samples available for the assessment was limited (n = 35).In conclusion, we found a high proportion of dental hypomineralization in a population based paediatric cohort, but did not find an association with prenatal exposure to phenols and phthalates.
Assuntos
Hipoplasia do Esmalte Dentário , Efeitos Tardios da Exposição Pré-Natal , Animais , Humanos , Criança , Feminino , Gravidez , Hipoplasia do Esmalte Dentário/induzido quimicamente , Hipoplasia do Esmalte Dentário/epidemiologia , Fluoretos , Esmalte Dentário , Fenóis/toxicidade , PrevalênciaRESUMO
BACKGROUND: The global incidence of oropharyngeal cancer (OPC) is increasing. Dental professionals play a key role in the detection of oral lesions that could lead to cancer. However, scientific-based HPV-OPC visual inspection guidelines are underdeveloped and HPV knowledge and awareness has been reported to be low among dental students and professionals. The present study adapted and performed pretesting of a multi-scale survey evaluating knowledge, perceptions, and clinical practices regarding HPV and HPV-OPC for Latin American Spanish-speaking populations. METHODS: A previously developed questionnaire for English-speaking dental students was translated to Spanish. The questionnaire was administered to first year dental students at two Latin American universities with dental programs. Internal consistencies were measured using Cronbach Alpha. Analyses were conducted in SAS Version 9.4. RESULTS: Data from a total of 114 students, a majority of the which were female (61%), and Hispanic/Latino(a)/Spanish (91%). The HPV, HPV-OPC, and HPV vaccine knowledge subscales demonstrated good internal consistency, the Cronbach's alpha was 0.83, 0.75, and 0.86 respectively. The Barriers subscale had a Cronbach's alpha of 0.93, showing excellent internal consistency. The Clinical Procedures subscale, focused on factors surrounding dental students' hypothetical clinical practice procedures, had a Cronbach's alpha of 0.86. The Scope of Practice scale had a Cronbach's alpha of 0.93. CONCLUSIONS: Ultimately, this survey demonstrated reliability and applicability for the assessment of dental students' knowledge, perceptions, and clinical practices regarding HPV and HPV-OPC in Latin America.
Assuntos
Infecções por Papillomavirus , Comparação Transcultural , Feminino , Hispânico ou Latino , Humanos , América Latina , Masculino , Infecções por Papillomavirus/complicações , Percepção , Reprodutibilidade dos Testes , Estudantes de Odontologia , Inquéritos e QuestionáriosRESUMO
Human papillomavirus-related oropharyngeal cancers (HPV-OPCs) are on the rise, yet HPV knowledge among dental professionals remains low. The purpose of this multi-state study was to examine sociodemographic factors associated with final year dental hygiene (DH), third year dental (DS3), and fourth year dental (DS4) students' knowledge regarding HPV, HPV-OPC, and HPV vaccination. Twenty dental programs in the USA were approached in the implementation phase to complete an online, 153-item, self-administered questionnaire that was developed and tested in a previous study. Descriptive statistics and chi-square analyses were conducted in SAS version 9.4 to examine the relationship between sociodemographic variables with HPV, HPV-OPC, and HPV vaccination knowledge levels. This study included the participation of students from 15 dental programs (n = 380) with an overall response rate of 28%. Although the results cannot be generalized to the entire population of dental students in the USA, most students had inadequate overall HPV knowledge (65%), HPV-OPC knowledge (80%), and HPV vaccination knowledge (55%). While all student groups displayed adequate general HPV knowledge levels (≥ 70% correct responses), gender, racial, religious, age, and regional differences were observed. Future dental professionals need to have adequate levels of HPV knowledge to aid in reducing the HPV-OPC burden. This study identified sociodemographic factors related to lower knowledge of HPV, HPV-OPC, and HPV vaccination, and highlights groups of students with greater needs for HPV education. This study provides a foundation for future research and interventions to be developed. Dental institutions can use findings to strengthen curricula development.
Assuntos
Alphapapillomavirus/isolamento & purificação , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias Orofaríngeas/epidemiologia , Infecções por Papillomavirus/complicações , Vacinas contra Papillomavirus/administração & dosagem , Estudantes de Odontologia/psicologia , Vacinação/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Saúde Bucal , Neoplasias Orofaríngeas/virologia , Infecções por Papillomavirus/prevenção & controle , Infecções por Papillomavirus/virologia , Inquéritos e Questionários , Estados Unidos/epidemiologia , Vacinação/estatística & dados numéricos , Adulto JovemRESUMO
This was the first study to develop and pilot test an assessment tool for the examination of human papillomavirus (HPV)-related oropharyngeal cancer (OPC) knowledge, perceptions, and clinical practices of oral health students. An interdisciplinary team developed the tool using surveys that examined this topic in other populations. The tool was then pilot tested at two different dental programs. Results from the pilot informed revisions to the final version of the tool. Of the 46 student participants, 18 were first-year dental hygiene and 28 were first-year dental students. The majority of participants were female (N = 29, 63%) and ages 18 to 29 years old (N = 41, 89%). Four scales used in the questionnaire were analyzed for reliability. Of these, the HPV and HPV-OPC knowledge and the HPV vaccination knowledge scales had Cronbach alphas of 0.71 and 0.79, respectively. Questions assessing HPV and the role of dental professionals had a correlation coefficient of 0.71. Questions assessing willingness to administer vaccines in the dental office had a correlation coefficient of 0.85. Assessing oral health students' HPV-OPC knowledge, perceptions, and clinical practices are important for future assessment of possible HPV-OPC cases. Dental professionals may be optimally positioned to provide HPV patient education. The tool developed and pilot tested in this study can help schools assess their students' knowledge and guide their dental curriculum to address deficiencies. Since this topic has not been effectively examined with dental health students, the results could help improve dental education and dental care.
Assuntos
Higienistas Dentários/educação , Odontólogos/educação , Conhecimentos, Atitudes e Prática em Saúde , Neoplasias Orofaríngeas/prevenção & controle , Infecções por Papillomavirus/complicações , Vacinas contra Papillomavirus/administração & dosagem , Estudantes de Odontologia/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Orofaríngeas/virologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/virologia , Projetos Piloto , Inquéritos e Questionários , Vacinação/psicologia , Adulto JovemRESUMO
OBJECTIVES: Breath analysis and exhaled breath condensate (EBC) collection are simple and noninvasive processes whereby inflammatory mediators and other biomarkers can be assessed in diseases that affect the lung. It was hypothesised that markers of epithelial dysfunction and secretion, such as a low pH, 8-isoprostane, and release of epithelial factors such as trefoil factor 2 (TFF2) and mucin, would be elevated in the breath of those with inflammatory bowel disease (IBD). The aim was to compare the levels of these biomarkers in EBC and the fraction of expired nitric oxide (FENO) in children with Crohn disease (CD), in those with asthma, and in normal individuals in a pilot study. METHODS: EBC was collected from patients in the 3 groups mentioned above in a cross-sectional design. pH, 8-isoprostane, TFF2, and mucin levels were measured in the EBC. Spirometry was performed in asthmatic patients and patients with IBD, whereas FENO and skin prick tests were performed in patients with IBD. RESULTS: Breath samples including EBC were collected from 80 patients (30 CD, 30 asthma, 20 controls). Compared with controls, EBC pH was lower in children with IBD (P < 0.0001) or asthma (P = 0.0041). 8-Isoprostane levels differed between the 3 groups (P < 0.05). EBC TFF2 was mainly less than the limit of detection, whereas mucin levels did not differ significantly between the 3 groups. FENO was measurable in children with IBD, but did not correlate with disease activity or serum markers of inflammation. CONCLUSIONS: A lower EBC pH may reflect inflammatory events either in the lung or systemically. 8-Isoprostane, FENO, and mucin were detected for the first time in the EBC of children with IBD. Further studies are required to assess the value of these assessments.
Assuntos
Asma/metabolismo , Doença de Crohn/metabolismo , Inflamação/metabolismo , Isoprostanos/metabolismo , Pulmão/metabolismo , Óxido Nítrico/metabolismo , Peptídeos/metabolismo , Adolescente , Biomarcadores/metabolismo , Testes Respiratórios , Criança , Estudos Transversais , Dinoprosta/análogos & derivados , Expiração , Feminino , Humanos , Concentração de Íons de Hidrogênio , Mediadores da Inflamação/metabolismo , Masculino , Mucinas/metabolismo , Projetos Piloto , Valores de Referência , Fator Trefoil-2RESUMO
RATIONALE: Unrecognized airway infection and inflammation in young children with cystic fibrosis (CF) may lead to irreversible lung disease; therefore early detection and treatment is highly desirable. OBJECTIVES: To determine whether the lung clearance index (LCI) is a sensitive and repeatable noninvasive measure of airway infection and inflammation in newborn-screened children with CF. METHODS: Forty-seven well children with CF (mean age, 1.55 yr) and 25 healthy children (mean age, 1.26 yr) underwent multiple-breath washout testing. LCI within and between-test variability was assessed. Children with CF also had surveillance bronchoalveolar lavage performed. MEASUREMENTS AND MAIN RESULTS: The mean (SD) LCI in healthy children was 6.45 (0.49). The LCI was higher in children with CF (7.21 [0.81]; P < 0.001). The upper limit of normal for the LCI was 7.41. Fifteen (32%) children with CF had an elevated LCI. LCI measurements were repeatable and reproducible. Airway infection was present in 17 (36%) children with CF, including 7 (15%) with Pseudomonas aeruginosa. Polymicrobial growth was associated with worse inflammation. The LCI was higher in children with Pseudomonas (7.92 [1.16]) than in children without Pseudomonas (7.02 [0.56]) (P = 0.038). The LCI correlated with bronchoalveolar lavage IL-8 (R(2) = 0.20, P = 0.004) and neutrophil count (R(2) = 0.21, P = 0.001). An LCI below the upper limit of normality had a high negative predictive value (93%) in excluding Pseudomonas. CONCLUSIONS: The LCI is elevated early in CF, especially in the presence of Pseudomonas and airway inflammation. The LCI is a feasible, repeatable, and sensitive noninvasive marker of lung disease in young children with CF.
Assuntos
Líquido da Lavagem Broncoalveolar/microbiologia , Fibrose Cística/diagnóstico , Pneumopatias/diagnóstico , Troca Gasosa Pulmonar/fisiologia , Austrália , Estudos de Casos e Controles , Pré-Escolar , Fibrose Cística/complicações , Diagnóstico Precoce , Feminino , Volume Expiratório Forçado , Humanos , Lactente , Pneumopatias/etiologia , Pneumopatias/microbiologia , Masculino , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/etiologia , Pseudomonas aeruginosa/isolamento & purificação , Curva ROC , Valores de Referência , Estudos Retrospectivos , Índice de Gravidade de Doença , Estatísticas não ParamétricasRESUMO
We aimed to ascertain the fit of the European Respiratory Society Global Lung Initiative 2012 reference ranges to contemporary Australasian spirometric data. Z-scores for spirometry from Caucasian subjects aged 4-80 years were calculated. The mean (SD) Z-scores were 0.23 (1.00) for forced expirtory volume in 1 s (FEV(1)), 0.23 (1.00) for forced vital capacity (FVC), -0.03 (0.87) for FEV(1)/FVC and 0.07 (0.95) for forced expiratory flows between 25% and 75% of FVC. These results support the use of the Global Lung Initiative 2012 reference ranges to interpret spirometry in Caucasian Australasians.
Assuntos
Pulmão/fisiologia , Espirometria/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valores de Referência , População Branca , Adulto JovemRESUMO
BACKGROUND AND OBJECTIVE: Advances in statistical modelling have allowed the creation of smoothly changing spirometry reference ranges that apply across a wide age range and better define the lower limit of normal. The objective of this study was to assess the agreement of the Stanojevic 2009 all-age reference ranges to contemporary lung function data to verify the appropriateness of this reference for clinical use in Australia and New Zealand. METHODS: Spirometry data from healthy Caucasians measured between 2000-2009 in Australia and New Zealand were collected. Z-scores were calculated for the standard spirometry outcomes based on the all-age reference ranges. RESULTS: Spirometry from 2066 subjects aged 4-80 years (55% male) from 14 centres were eligible. Statistically, the collated contemporary dataset differed from the all-age reference ranges, but these differences were relatively small and clinically irrelevant representing differences of approximately 3% predicted. Significant differences were also observed between some centres and equipment, potentially indicating varying influence of equipment or subject selection. CONCLUSIONS: Spirometry from contemporary Australasian healthy subjects fits the all-age reference ranges well. While the current study supports the use of the all-age reference ranges, the between-centre differences highlight the need for spirometry to be used in conjunction with other clinical findings.
Assuntos
Espirometria/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Criança , Pré-Escolar , Feminino , Humanos , Pulmão/fisiologia , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Valores de Referência , População Branca , Adulto JovemRESUMO
HPV oropharyngeal cancers have now surpassed cervical cancer rates in the US. Dental providers' engagement in HPV education and vaccination efforts may help reduce the burden of HPV oropharyngeal cancers. We examined factors associated with oral health students' willingness to train and administer the human papillomavirus (HPV) vaccine in dental settings. US students in 15 oral health programs participated in an online survey in 2016. Unadjusted and adjusted multivariable logistic regression were conducted and odds ratios (OR) and 95% confidence intervals (CI) were reported. Analyses were conducted in SAS Version 9.4. Data from a total of Nâ¯=â¯306 students were analyzed to examine sociodemographic, educational, practice, and attitudinal factors associated with willingness to train and administer the HPV vaccine. Majority of the participants were female (70.3%), non-Hispanic/Latino (90.8%), and White (62.1%). Perceiving that HPV vaccination recommendation (ORâ¯=â¯1.95, 95% CIâ¯=â¯1.14-3.35) and administration (ORâ¯=â¯3.79, 95% CIâ¯=â¯1.63-8.81) was in the dental professional's scope was positively associated with outcome measures when other factors were held constant. Students with greater patient contact time (ORâ¯=â¯4.47, 95% CIâ¯=â¯1.14-17.58) and lower role conflict (agreed that HPV vaccine administration was in the dental professional's scope) had higher odds of willingness to administer the HPV vaccine when other factors were held constant (ORâ¯=â¯5.9, 95% CIâ¯=â¯2.27-15.3). The major barrier to engaging oral health students in HPV vaccination efforts was role conflict. Professional organizations and oral health programs should strongly support the role of oral health professionals in HPV oropharyngeal prevention.
RESUMO
BACKGROUND: The value of lifestyle modification in reducing physiological cardiovascular disease (CVD) risk factors remains controversial because changes in patient behaviour following CVD prevention counseling have failed to correlate with or impact reductions in physiological variables. OBJECTIVES: To determine whether nonpharmacological CVD prevention counselling significantly reduces behavioural and physiological risk factors, and to examine correlations between changes in these variables. METHODS: At baseline, dyslipidemic individuals with or at risk of developing CVD completed CVD risk factor questionnaires. At baseline and three months, participants submitted dietary logs, self-classified their readiness for behaviour change for eight lifestyles, and had their blood lipid profiles, weight and height assessed. Following CVD risk factor screening, lower and higher risk participants were recommended for multidisciplinary group counselling (GC) or group plus individual counselling (GIC), respectively. A prospective time series design assessed behavioural and physiological risk factor changes. RESULTS: Participants progressed forward (P<0.01) through the stage of change continuum for all behaviours. GIC participants progressed to a higher average stage of behaviour change for achieving optimal body weight (P<0.01), drinking less alcohol (P<0.05) and controlling blood pressure (P<0.05). Significant reductions in body mass index (2.1% and 1.9%), total cholesterol (7.0% and 5.5%), low density lipoprotein cholesterol (6.2% and 5.4%), total cholesterol to high density lipoprotein cholesterol ratio (5.1% and 3.8%) and triglyceride levels (10.8% and 8.5%) were observed in GC and GIC participants, respectively. Furthermore, significant correlations were observed between concurrent changes in lifestyle behaviour and physiological risk factors. CONCLUSIONS: Multidisciplinary CVD prevention counseling positively influenced participant readiness for lifestyle behaviour change which translated into significant reductions in several physiological risk factors.
Assuntos
Doenças Cardiovasculares/epidemiologia , Aconselhamento , Adulto , Idoso , Biomarcadores/sangue , Glicemia/metabolismo , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/fisiopatologia , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Atividade Motora/fisiologia , Ontário , Avaliação de Programas e Projetos de Saúde , Fatores de Risco , Comportamento de Redução do Risco , Estatística como Assunto , Fatores de Tempo , Resultado do Tratamento , Triglicerídeos/sangueRESUMO
PURPOSE: This report describes the overall process used for setting the pass/fail score for the National Board Dental Hygiene Examination (NBDHE). METHODS: The Objective Standard Setting (OSS) method was used for setting the pass/fail score for the NBDHE. The OSS method requires a panel of experts to determine the criterion items and proportion of these items that minimally competent candidates would answer correctly, the percentage of mastery and the confidence level of the error band. A panel of 11 experts was selected by the Joint Commission on National Dental Examinations (Joint Commission). Panel members represented geographic distribution across the U.S. and had the following characteristics: full-time dental hygiene practitioners with experience in areas of preventive, periodontal, geriatric and special needs care, and full-time dental hygiene educators with experience in areas of scientific basis for dental hygiene practice, provision of clinical dental hygiene services and community health/research principles. Utilizing the expert panel's judgments, the pass/fail score was set and then the score scale was established using the Rasch measurement model. RESULTS: Statistical and psychometric analysis shows the actual failure rate and the OSS failure rate are reasonably consistent (2.4% vs. 2.8%). The analysis also showed the lowest error of measurement, an index of the precision at the pass/fail score point and that the highest reliability (0.97) are achieved at the pass/fail score point. CONCLUSION: The pass/fail score is a valid guide for making decisions about candidates for dental hygiene licensure. This new standard was reviewed and approved by the Joint Commission and was implemented beginning in 2011.
Assuntos
Higienistas Dentários/educação , Avaliação Educacional/métodos , Licenciamento , Competência Clínica/normas , Avaliação Educacional/normas , Docentes , Humanos , Resolução de Problemas , Reprodutibilidade dos Testes , Estados UnidosRESUMO
Patient cases with associated questions are a method for increasing the clinical relevance of licensure exams. This study used generalizability theory to assess changes in score reliability when the number of questions per case varied in the National Board Dental Hygiene Examination (NBDHE). The experimental design maintained the same total number of case-based items, while varying the number of cases and items within cases to assess changes in score reliability. Using generalizability theory, the amounts of error variance within cases and between cases on the NBDHE were assessed. Impact on score reliability (generalizability) was computed. The data were from the responses of 4,528 candidates who took the paper-pencil version of the NBDHE in spring 2009. Results showed that the minimum value of generalizability occurred when fourteen cases with ten items each were used in the examination. The maximum value of generalizability occurred when fifty cases with three items each were used in the examination. The research findings support the development of more cases with fewer items per case on the NBDHE in order to enhance test score reliability and validity. Practical constraints should be considered if more cases with fewer items per case are developed for future examinations.
Assuntos
Higienistas Dentários/educação , Avaliação Educacional/normas , Licenciamento/normas , Competência Clínica/normas , Educação Baseada em Competências/normas , Educação Baseada em Competências/estatística & dados numéricos , Avaliação Educacional/estatística & dados numéricos , Humanos , Resolução de Problemas , Estados UnidosRESUMO
Thiopurine methyltransferase genotyping and thiopurine metabolite testing has been established as an adjunct to monitoring patients taking thiopurine drugs. This special report describes the clinical implications for this type of testing for patients with inflammatory bowel disease who are taking thiopurine drugs. A total of 10% of patients were found to be intermediate metabolizers and the mean dosage (in mg/kg equivalent) was lower in intermediate metabolizers than extensive metabolizers. The metabolite levels did not correlate with scores measuring clinical severity but levels of 6-methylmercaptopurine were related to the dosage of the drugs. Despite considerable study of thiopurine methyltransferase testing in the literature, it is still not widely used in many geographical areas. This study adds to the evidence about using such testing as well as expanding the role of simultaneously measuring thiopurine metabolites. Further work is planned to evaluate the uptake when such testing becomes available locally as a clinical service.
Assuntos
Doenças Inflamatórias Intestinais/enzimologia , Doenças Inflamatórias Intestinais/genética , Mercaptopurina/metabolismo , Mercaptopurina/uso terapêutico , Metiltransferases/genética , Metiltransferases/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Testes Genéticos/métodos , Humanos , Doenças Inflamatórias Intestinais/tratamento farmacológico , Pessoa de Meia-Idade , Adulto JovemRESUMO
It was a special day for my patient, who was nearly 100. Today I pushed her in a wheelchair, but years ago, she'd helped pave my way.