Counting on U training to enhance trusting relationships and mental health literacy among business advisors: protocol for a randomised controlled trial.

BACKGROUND: Financial distress is thought to be a key reason why small-medium enterprise (SME) owners experience higher levels of mental health conditions compared with the broader population. Business advisors who form trusting, high-quality relationships with their SME clients, are therefore well placed to: (1) help prevent/reduce key sources of financial distress, (2) better understand the business and personal needs of their clients and, (3) recognise the signs and symptoms of mental health conditions and encourage help-seeking where appropriate. The aim of this study is to compare the effectiveness of relationship building training (RBT) combined with mental health first aid (MHFA) training for business advisors with MHFA alone, on the financial and mental health of their SME-owner clients. METHODS: This is a single blind, two-arm randomised controlled trial. Participants will be business advisors who provide information, guidance and/or assistance to SME owner clients and are in contact with them at least 3 times a year. The business advisors will invite their SME-owner clients to complete 3 online surveys at baseline, 6- and 12-months. Business advisors will be randomised to one of two conditions, using a 1:1 allocation ratio: (1) MHFA with RBT; or (2) MHFA alone, and complete 3 online surveys at baseline, 2- and 6-months. Primary outcomes will be measured in the business advisors and consist of the quality of the relationship, stigmatizing attitude, confidence to offer mental health first aid, quality of life and provision of mental health first aid. Secondary outcomes will be measured in the SME owners and includes trust in their business advisors, the quality of this relationship, financial wellbeing, financial distress, psychological distress, help-seeking behaviour, and quality of life. To complement the quantitative data, we will include a qualitative process evaluation to examine what contextual factors impacted the reach, effectiveness, adoption, implementation, and maintenance of the training. DISCUSSION: As there is evidence for the connections between client trust, quality of relationship and financial and mental wellbeing, we hypothesise that the combined RBT and MHFA training will lead to greater improvements in these outcomes in SME owners compared with MHFA alone. TRIAL REGISTRATION: ClinicalTrials.gov : NCT04982094 . Retrospectively registered 29/07/2021. The study started in February 2021 and the recruitment is ongoing.

Lessons learnt from the field: a qualitative evaluation of adolescent experiences of a universal mental health education program.

teen Mental Health First Aid (teenMHFA) is a school-based mental health program that trains adolescents to support peers who are experiencing mental health problems or crises. The program has been evaluated for adolescents aged 15-18 years as part of a randomized controlled trial, however qualitative feedback from students on their perceptions of the program is yet to be explored. The current study describes the perspectives of students who took part in the trial. Feedback on the perceived strengths and weaknesses of the program was provided by 979 Year 10 students (M = 15.82 years, female = 43.94%, English as a first language = 72.77%) at four government funded public schools in Melbourne, Australia via online surveys. A content and thematic analysis was performed on the data using a six-step process. Students generally found the program relevant and they connected with the visual material, personal stories and interactive activities. Suggestions for improvements included encouraging active student participation in classroom discussion and providing opportunities to practice skills. School-based mental health education can benefit from input from stakeholder perspectives, particularly when designing mental health content for delivery by external trainers.

The use of computer-guided flapless dental implant surgery (Nobel guide®) and immediate function to support a fixed full-arch prosthesis in fresh frozen homologous bone grafted patients: a retrospective cohort study with 5 to 8-year follow-up.

The introduction of computer-assisted and guided surgery has radically improved the possibility of using all available bone for implant support, reducing the need for extensive grafting procedures and allowing for better implant placement and restoration. Moreover, fresh frozen homologous bone (FFB) grafts have shown good osteoconductive properties and biocompatibility with results comparable to autologous bone patients. The purpose of this retrospective cohort study was to evaluate the survival and the success rate of implants and related fixed full arch prosthesis at the 5 to 8 years follow-up when performed with immediate function using a flapless surgical procedure and computer-aided technology (NobelGuide®, Nobel Biocare® AB, Goteborg, Sweden) in patients previously treated with FFB grafts; treated at the University of Verona with the NobelGuide® system from January 2007 to December 2012 with at least 5 years follow-up were reviewed. Survival implants and survival prosthesis' percentage reached 95% in a 5 to 8-year period. This study indicates that patients previously augmented with FFB graft for maxillary or mandibular bone atrophy can be safely treated with implant supported prosthesis based on the NobelGuide® protocol, with the aid of computer-generated guide.

Relationship between obesity and health problems in help-seeking military veterans.

BACKGROUND: UK Armed Forces (UK AF) veterans may be particularly vulnerable to obesity and its comorbid physical and mental health problems. AIM: To examine the relationship between body mass index (BMI), physical health problems, mental health disorders and sociodemographic characteristics in UK AF veterans engaged in psychological treatment. METHODS: Information regarding veteran BMI, demographic characteristics, physical health conditions and mental health problems was collected and analysed using univariate and multivariate regression analyses. Rates of veteran obesity were also compared with the UK general population. RESULTS: Of the 384 help-seeking veterans, 37.5% (n=151) were overweight (BMI 26-30) and 35.5% (n=143) were obese. Obesity in help-seeking male veterans was two to four times higher than that of the general population of UK. Higher scores on measures of anger and common mental health problems were significantly associated with greater BMI. Problems with physical systemic functioning and mobility were also significantly associated with greater BMI. CONCLUSIONS: The results indicate that treatment-seeking UK AF veterans exhibit higher levels of obesity compared with the general population, and clinically significant physical and mental comorbidities. The findings highlight a need for mental health services to offer treatments that effectively integrate physical and mental healthcare in the treatment of people with mental health problems.

De Novo Solid Tumors After Kidney Transplantation: Is It Time for a Patient-Tailored Risk Assessment? Experience From a Single Center.

BACKGROUND: Progress in immunosuppressive therapy and perioperative techniques has improved the survivals of both grafts and patients. The patient, however, is exposed to the risks of aging and side effects of immunosuppression. De novo tumors are the 2nd cause of death in the organ transplant population. The aim of this study was to evaluate whether the current accepted guidelines for the pre-transplantation study and the post-transplantation follow-up have been effective, in our kidney transplant population, regarding early detection and treatment, improving prognosis, and reducing mortality of some curable neoplastic diseases. METHODS: We considered de novo tumors in kidney transplant patients from 1995 to 2010 (n = 636) excluding hematologic and nonmelanoma skin tumors from our study. RESULTS: There were 64 de novo tumors in 59 patients out of 636 kidney transplant patients; 29.68% were urogenital cancer, 26.56% gastrointestinal cancer, 12.5% melanoma, 6.25% lung cancer, 6.25% biliopancreatic cancer, 4.68% visceral Kaposi sarcoma, 4.68% breast cancer, 4.68% thyroid cancer, 1 pleural mesothelioma, 1 meningioma, 1 merkeloma. Twenty patients died because of cancer. Ten patients had a late de novo tumor diagnosis, when the stage of tumor was advanced and not suitable for curative treatment. CONCLUSIONS: Because of the increased neoplastic risk, we consider it mandatory to carry out a meticulous screening and to implement pre-transplantation study concerning this increased neoplastic risk population to detect a subgroup of patients presenting the highest risk to improve their outcome.

Success of bone grafts in atrophic posterior edentulous mandible: literature review.

Background: The success of implant therapy depends on the availability of an adequate bone volume in the edentulous site. In the case of posterior bone atrophy, the increase of the alveolar ridge is a prerequisite for the optimal placement of endosseous implants. Purpose: The purpose of this research is to analyze in Literature the success of bone grafts in posterior atrophic edentulous mandible. Materials and methods: The Literature analysis includes only relevant articles specifically on the topic. The following parameters were evaluated: the type of materials used, the average gain expressed in millimeters, the success of the grafts over time and their complications, the outcome of the grafts according of the materials used and the survival rate of endosseous implants over time. Results: Autologous, homologous and heterologous materials were used for the grafts, either separately or in combination. However autologous bone, obtained from the mandible, was preferentially used for grafts in atrophic posterior mandible. Membranes could be also associated to the grafts. The gain in the alveolar ridge was achieved both horizontally and vertically, and usually reflected the surgeon's effort to meet patient's needs. Conclusions: A review of literature reveals that the intraoral autologous bone graft is the most used and allows to achieve the best result in restoring posterior atrophic mandible.

Lateral periodontal cyst (LPC) mimicking periodontal socket in a young patient: report of a case and review of the literature.

Background: Lateral Periodontal cyst (LPC) is an uncommon development odontogenic cyst. Most papers are single case reports or series. Methods: We present a case of LPC occurred in a patient which symptoms and signs could mislead the diagnosis. A review of the literature is reported, emphasizing the clinical, radiographic and histopathological features of LPC. Results: A 28-years old female patient presented reporting pain and swelling at the lingual site of the #31.Spot lingual probing depth was 9 mm; sulcus bleeding and suppuration were found at probing. Radiographically well-defined radiolucency appeared in periodontal foramen area. The patient was treated with non-surgical and surgical therapy. Conclusions: LPC is an infrequent cystic lesion that occurs on lateral root vital tooth. In this case, the cyst mimicked a periodontal lesion. The surgical LPC excision solved the symptoms reported by the patient and improved periodontal parameters of the dental element. After 18 months since surgical treatment there aren't signs or symptoms of recurrence.

Dental white spots associated with bulimia nervosa in orthodontic patients.

Bulimia nervosa is an eating disorder characterized by consuming a large amount of food in a short amount of time followed by an attempt to rid oneself of the food consumed (purging), typically by vomiting, taking a laxative, diuretic, or stimulant, and/or excessive exercise, because of an extensive concern for body weight. The frequent contact between teeth and gastric acid, in particular, may cause: severe dental erosion, perimolysis, or the erosion of tooth enamel and swollen salivary glands. Constant vomiting can lead to gastroesophageal reflux. The aim of this article is to report two cases of patients with severe dental demineralization associated with bulimia nervosa during orthodontic treatment. Diagnosis and prevention aspects are highlighted and discussed.

Experimental analysis about the evaluation of tungsten carbide-bur, piezoelectric and laser osteotomies.

AIM: Osteotomies are performed in oral surgery with five kinds of cutting instruments: 1) burs (Tungsten carbide cylindric burs), 2-3) ultrasound Piezosurgery (type I and II), 4-5) and lasers (Er:YAG; Er,Cr:YSGG). This study compares the quality of cutting of every single instruments, evaluating accuracy (length, thickness, depth and morphology), velocity (number of passages and time) and entity of damage. METHODS: In vitro experiments with ten osteotomies were performed on one-hundred of cow ribs with each instrument. In vivo surgery was performed on New Zealand white rabbit: two osteotomies are made with all instruments on the mandible and on the shinbone, totalizing four osteotomies for each instrument. Samples are processed to be evaluated through histological exam at stereo microscopy. DISCUSSION: Results show a statistically significant variability on "thickness" (p value=0.001), "time" (p value=0.001), "depth" and penetration speed (p-value=0.001; p-value=0.001) and the "number of passages" (p-value=0.001). No differences have been observed in "length" (p-value=0.078). Histological analysis reveals that osteotomy performed with laser and Piezosurgery II generates major damage to osteocytes near cutting surfaces. CONCLUSIONS: Currently, purchase and management elevated costs, minor versatility of use, and long training times for equipments such as Piezosurgery and laser limit their general use, but remain advantageous in case of risky interventions near noble structures. Choice of device depends on experience maturated by operator in time, characteristics of operation and patient's clinical conditions.

Reduction of precocious peri-implant resorption cone.

AIM: After implant-insertion, bone tissue, newly-formed on peri-implant crest, undergoes to a mild marginal osseous readjustment due to build-up of inflammatory cell tissue (ICT). The present study verifies the possibility to limit bone resorption by placing implant fixtures 0.5 mm outside cortical bone edge. METHODS: A clinically-controlled randomized study on 100 implants has been performed to compare early resorption process of implant fixtures placed 0.5 mm outside cortical bone edge with implant-fixtures inserted according to juxtacortical bone conventional protocols. RESULTS: After 6 months, bone implant level was higher with emersion approach (-1.01±0.54 mm, mean±SD) than with submerged treatment (-1.56±0.5 mm) (P<0.001). CONCLUSIONS: Factors to achieve an excellent result at mean-long term seem to be very good, even though the latter have to be confirmed by follow-up.

Nd-YAP laser assisted frenulectomy: a case series on 23 patients.

Abnormal frenula may require treatment by frenulectomy. Several techniques are available, but using a laser for this purpose represents an innovative technology that may provide more efficient, more comfortable and more predictable treatment outcomes for both patient and surgeon. On this respect, Nd-YAP laser treatment is very useful allowing for excellent clinical outcomes with low morbidity. This case series reports on the use of Nd-YAP laser for a labial frenulectomy. Twenty-three patients were treated and afterward controlled. Laser treatment, above all Nd-YAP, appears to be the gold standard technique.

Evaluation of quality of life in patients with total or partial edentulism treated with computer-assisted implantology.

AIM: The study deals with a preliminary analysis that compares quality of life of a randomized sample of patients with total or partial edentulism rehabilitated through conventional implantology or computer-assisted implantology. METHODS: The first group was treated with conventional implantology, while the second group was treated with NobelGuide™ computer-assisted implantology. every patient has filled up a questionnaire about quality of life in presurgical period (sf-361), in postsurgical period (sf-361; tiq2) and about the gratification after prosthetic treatment. the questionnaire has evaluated physical, general and psycho-emotive health parameter. RESULTS: SF-36 has demonstrated an improvement in quality of life after computer-assisted surgery. tiq has revealed that patients symptoms in post-surgical week were inferior in quality and in quantity in NobelGuide™ technique. gratification questionnaire has demonstrated that quality of life improvement matches patient full satisfaction after the treatment. CONCLUSIONS: NobelGuide™ protocol improves physical health after implantology with positive reflections on psycho-emotive health. furthermore prefabricated temporary prostheses reduces treatment time and patient discomfort.

NobelGuide™ influence in the perception of postoperative pain.

AIM: The aim of this study was to evaluate the perception of pain after Computer-aided-implantology Implant Surgery (NobelGuideTM, Nobel Biocare, Göteborg, Sweden) compared to the conventional implant surgery. METHODS: Eighteen patients from dental and maxillo-facial clinic of Policlinico G. B. Rossi (Verona, Italy) have been recruited: 9 were treated with the NobelGuide™ Technique, and 9 with the conventional one (approved by Local Ethical Committee) After the operation, painkillers (Ibuprofene tablets of 400 mg) were prescribed to the patients. Patients were asked to answer a questionnaire during the postoperative days and to report on the Visual Analogue Scale form (VAS), the intensity of pain and the number of painkillers used. RESULTS: The VAS mean one day after the operation (peak of maximum pain) was 47.22 for the conventional technique, and 12.77 for the NobelGuide™ technique, and also the number of painkillers assumed is smaller for the NobelGuide™ technique. The 5th day after the operation all the patients treated with the NobelGuide™ Technique stopped painkillers and nobody felt pain, while the patients treated with the conventional technique felt more pain and for a longer period. They also took painkillers until the 7th day. CONCLUSIONS: Pain is minor and disappears more quickly with the Nobelguide™ Implant Surgery compared with the conventional surgical technique. Nobelguide™ Implant Surgery can reduce hospitalization improving the compliance of odontophobic patients towards implant therapy.

Expression of Vascular Endothelial Growth Factor (VEGF) mRNA in healthy bone tissue around implants and in peri-implantitis.

Peri-implantitis is an inflammatory process involving peri-implant bone. Angiogenesis is critical for the development, remodeling and healing of bone. Vascular Endothelial Growth Factor (VEGF) is a glycoprotein that induces endothelial cell proliferation, angiogenesis and capillary permeability. VEGF is expressed in a variety of highly vascularized tissues and seems to be a prerequisite for tumor growth and invasion. VEGF takes part in bone cell differentiation and by promoting angiogenesis at the site of bone formation. Aim of the present study was an evaluation of VEGF mRNA in bone around healthy and failing dental implants. Twenty patients participated in this study. Twenty bone biopsies were obtained, 10 at second-stage surgery from bone covering the healing screws (control), and 10 from implants presenting the typical signs and symptoms for peri-implantitis lesions (test). VEGF mRNA levels were not present in any of the controls, while it was identified in all tissues obtained from test implants. The difference was statistically significant (p < 0.05). Our results point to the fact that VEGF may be important in the regulation of tissue healing and bone remodeling in the peri-implantitis lesions because VEGF has been reported to play a role in the formation and attraction of osteoclasts, and osteoclasts have been shown to be a prominent feature of the peri-implantitis lesions.

The immediate functional loading of seven and mistral implants with new multi unit titanium abutments. 24 months follow up report.

Immediate loading of dental implants has been defined as a situation where the superstructure is attached to the implants at time of the surgery or however no later than 72 hours after surgery. Micromovements have been deeply studied in dental implants loading but the question of reduction of micromovements has not been addressed in controlled studies dealing with immediate loading of oral implants. Passive fit of provisional prostheses has been mentioned as an important factor in the osseointegration of immediately loaded implants. The ultimate goal of an immediate loading protocol is to reduce the number of surgical interventions and shorten the time frame between surgery and prosthetic delivery, all without sacrificing implant success rates. Aim of this study was to evaluate the use of a new titanium abutments for screw retained prosthesis in edentulous patients in an immediate loading procedure in order to reduct the number of surgical steps.

Use of bone compressors and atraumatic bone elevators in crestal sinus lift.

Atrophy of the alveolar processes of the jaws, as a result of edentulism, often cannot allow a prosthetic rehabilitation, also if it only consists of a total removable prosthesis - for the inadequate base support - and also if it is backed by implants, because the small residual thickness bone compromises the primary implant stability, a fundamental requirement for a correct osseointegration. In addition to atrophy itself, the presence of noble structures (maxillary sinus, inferior alveolar nerve) make an implant-prosthetic rehabilitation contraindicated. To obviate this problem, there are many techniques to increase bone. The technique of the maxillary sinus elevation allows the increasing of the residual bone up to reach the minimum thickness in order to insert an implant. With this work we want to analyze the properties of the Bone Compression Kit (MIS, Israel) that make this surgical procedure safe, simple to perform, and predictable.

The dilemma of pneumatosis intestinalis with pneumoperitoneum: nonoperative or surgical management-analysis of a case.

Pneumatosis intestinalis (PI) is an uncommon condition and can be associated with a wide spectrum of diseases, ranging from life-threatening to innocuous conditions. We report the case of a 46-year-old women coming to our attention for an acute abdominal pain, nausea, vomiting, constipation, and increased inflammatory marks, with a CT showing pneumoperitoneum and pneumatosis intestinalis. The previous diagnosis was advanced neoplasia of unknown origin. Despite the surgical intervention, which excluded an ischemic colitis, the patient died in the early postoperative period. The postmortem diagnosis was carcinoma of thymus gland, and the presence of pneumatosis was put down to metastasis nodes in the pulmonary parenchima. This case demonstrates the wide spectrum of presentation of pneumatosis intestinalis, the importance of a careful radiologic evaluation beside the clinical history, since the identification of correct pathogenesis and treatment can be very difficult.