Basal-IQ technology in the real world: satisfaction and reduction of diabetes burden in individuals with type 1 diabetes.

AIM: To describe person-reported outcomes of the Basal-IQ predictive low-glucose-suspend system (Tandem Diabetes Care, San Diego, CA, USA) in real-world use. METHODS: Adults with type 1 diabetes/caregivers of minors with type 1 diabetes completed the Diabetes Impact and Device Satisfaction questionnaire (11 items scored on 10-point Likert scales) prior to Basal-IQ system initiation, and at 2, 4 and 6 months post-initiation. Analysis was stratified by previous insulin treatment method. Beta mixed models were used to measure change in device satisfaction (e.g. trust, ease of use) and diabetes impact (e.g. hypoglycaemia fear, poor sleep) scores between time points, adjusting for baseline covariates. RESULTS: A total of 967 adults and caregivers [54% women, mean (sd) age 36 (17) years, 57% Tandem pump users, 27% non-Tandem pump users, 17% multiple daily injection users] completed surveys. Device satisfaction significantly increased from baseline to 2 months in all groups (P<0.001 multiple daily injection and non-Tandem pump users; P=0.048 Tandem pump users), and was sustained from 2 to 6 months in all groups. Diabetes impact decreased significantly from baseline to 2 months in all groups (P<0.001 for all), was sustained from 2 to 6 months in multiple daily injection and Tandem pump users, and increased slightly at 4 months/decreased at 6 months in non-Tandem users. CONCLUSION: The Basal-IQ system increased device satisfaction and reduced diabetes impact in all users in the first 2 months of use, and satisfaction was sustained over 6 months, with small fluctuations.

Best friend or spy: a qualitative meta-synthesis on the impact of continuous glucose monitoring on life with Type 1 diabetes.

AIMS: This is a meta-synthesis of extant qualitative literature related to impact of continuous glucose monitoring (CGM). CGM has been available for a decade for the management of Type 1 diabetes and is the lynchpin of future artificial pancreas technologies. Clinical uptake of CGM is an important area of inquiry. The purpose of this meta-synthesis is to understand the impact of CGM on individuals with Type 1 diabetes and others (parents, significant others, providers) in order to design appropriate clinical interventions for adherence. METHODS: Studies published in English between 2007 and 2017 were included, reflecting commercial CGM availability. PubMed, PsychINFO, CINALH, Web of Science and EMBASE databases were queried using search terms related to CGM, qualitative, experience and Type 1 diabetes. Included articles contained original qualitative or mixed-method research on CGM, sensor-augmented pump or closed-loop therapies. Articles underwent quality appraisal and thematic interpretive integration by a multidisciplinary team. RESULTS: Nine articles (343 participants) met the inclusion criteria and were included in the synthesis. Six novel themes emerged: interacting with CGM, burden of living with CGM, feeling different from others, feeling empowered, interacting with glucose information and impact on relationships. CONCLUSION: CGM affects physical, emotional and relational aspects of life. Clinicians can help minimize the burden of CGM with carefully delivered education and expectation-setting with individuals. Empowerment and relational partnerships in diabetes care can be explored to maximize satisfaction with CGM. Systematic interpretive synthesis of qualitative studies provides a comprehensive, contextual understanding of the impact of CGM on daily life and relationships.

Unmet core needs for self-determination in HIV-infected women of color in medical care.

The levels of satisfaction of the core self-determination needs (relatedness, autonomy and competence) among HIV-infected women of color as well as the association between need fulfillment and patient characteristics were examined. Having less than a high-school education was associated with lowest need satisfaction: autonomy (ß = -1.90; 95%CI = -3.20, -0.60), relatedness (ß = -2.70; 95%CI = -4.30, -1.10) and competency (ß = -2.50; 95%CI = -3.60, -1.30). Each additional point increase in affective symptoms of depression was associated with decrements in need satisfaction (-.61 autonomy, -.68 relatedness and -.59 competency). Relatedness satisfaction was lower with higher responses on all three measures of violence (psychological abuse: ß = -0.13, 95%CI = -0.19 to -0.07; adult traumatic experiences: ß = -0.24, 95%CI = -0.35 to -0.13 and childhood traumatic experiences: ß = -0.24, 95%CI = -0.40 to -0.08). Interventions that address core self-determination needs, and the characteristics that influence them, may enhance the motivation for self-care of HIV-infected women.

Dental admissions in children under two years--a total-population investigation.

BACKGROUND: There is a lack of literature describing dental admissions in children particularly very young children. This paper describes dental and oral cavity admissions and associated factors in children under two years of age using total-population databases. METHODS: The data used for this study were extracted from population-based databases which are linkable with midwives' data collected on all births in Western Australia. Children born from 1980 to 1998 inclusive (n = 459,831) were followed until two years of age including data on deaths, hospital admissions, birth defects and intellectual disability. Dental admissions (by ICD-9 category) and associated factors were investigated. RESULTS: There were 1513 dental admissions occurring in 1459 of the children up to the age of two years. Children were most frequently admitted under ICD-9 category 521, which includes a hospital admission for dental caries (39% of all oral cavity admissions), followed by ICD-9 category 528 (29%), which includes diseases of the oral soft tissues. Univariate analysis indicated that those with intellectual disability (OR 2.10, 95%CI 1.40-3.16), birth defect (1.74, 1.45-2.09), residing in a region without fluoridated water (2.15, 1.72-2.69) being male (1.14, 1.03-1.26), those from rural areas (2.29, 2.07-2.54) and Indigenous children (4.45, 3.91-5.05) were significantly more likely to have had a dental admission. CONCLUSION: Using total-population data allowed us to describe the admissions in children under two years and associated factors while able to identify children with intellectual disability or birth defects.

An in vitro comparison of detection methods for approximal carious lesions in primary molars.

BACKGROUND/AIMS: This study aimed to compare and contrast in vitro six methods to determine the most accurate method for detecting approximal carious lesions in primary molars. METHODS: Extracted primary molars (n = 140) were stored in 0.02% chlorhexidine solution and mounted in light-cured resin in pairs. The six carious lesion detection methods used by the three examiners to assess approximal carious lesions were visual inspection, digital radiography, two transillumination lights (SDI and NSK), and two laser fluorescence instruments (CDD and DDP). Five damaged teeth were discarded. The teeth (n = 135) were sectioned, serially ground, and examined under light microscopy using Downer's histological (HST) criteria as the gold standard. Intra- and inter-examiner reliability, agreement with HST, specificity, sensitivity, receiver operating characteristic (ROC) curves, and areas under the curve were calculated. RESULTS: This study found visual inspection to be the most accurate method when validated by histology. Transillumination with NSK light had the highest specificity, and digital radiography had the highest sensitivity for detecting enamel and/or dentinal carious lesions. Combining specificity and sensitivity into the area under ROC curves, enamel plus dentinal lesions were detected most accurately by visual inspection followed by digital radiography; dentinal lesions were detected most accurately by digital radiography followed by visual inspection. CONCLUSIONS: None of the four newly developed methods can be recommended as suitable replacements for visual inspection and digital radiography in detecting carious lesions on approximal surfaces of primary molars, and further developmental work is needed.

Oral health attitudes and behaviours of final-year dental students.

OBJECTIVES: The objectives of this study of final-year dental students in 10 classes (1997, 2001-2009) were to examine their self-reported oral health attitudes and behaviours and describe any trends in these attributes. PARTICIPANTS AND METHODS: Students were surveyed in final semester via an anonymous questionnaire (34 behaviour questions; eight attitude statements). Distributions, trends over time and attitude-behaviour associations were examined. RESULTS: Of 583 students, 459 responded (79%). All tooth-brushed with fluoride toothpaste; 80% brushed ≥2/day. Overall, 85% flossed; over time flossing behaviour increased significantly (P < 0.05), and those flossing 1-2/day increased (P < 0.005). Over time, significant decreases occurred in those taught toothbrushing (P < 0.001) and flossing (P < 0.05), and in use of mouth rinses (P < 0.05) and tooth cleansing sticks/picks (P < 0.001). Almost all (96%) had received a dental examination; 77% attended a dentist 1-3/year. Between-meal snacking was common (84%); 71% chewed gum. Although 18% had ever smoked, 5% currently smoked. Most strongly agreed they expected to keep most of their teeth for all their life (76%); their future needs for fillings would be minimal (61%); smoking could adversely affect their teeth or gums (85%); and regular dental attendance was important for their dental health (51%). Congruent attitudes and behaviours favouring oral health were widely held concerning dental attendance, flossing and smoking. CONCLUSIONS: Final-year dental students showed well established, favourable oral hygiene attitudes and behaviours, with evidence to suggest this knowledge was developed whilst in dental school. Despite many ceasing smoking, 5% still smoked. All dental students should receive training in motivational counselling and tobacco cessation to ensure this is included in patient care.

Psoriatic arthritis with hyperuricemia: more peripheral, destructive, and challenging to treat.

OBJECTIVE: To study the impact of hyperuricemia on clinical presentation, severity, and associated comorbidities of psoriatic arthritis (PsA). METHODS: Retrospective bicentric case-control study performed in Strasbourg and Colmar, France, from 2009 to 2019. Patients with PsA (according to ICD-10 coding) and at least one available serum urate (SU) measurement were included. Demographic, comorbidities, clinical, and radiographic data were collected. Hyperuricemia was defined as SU level ≥ 360 µmol/L. RESULTS: We included 242 patients: 73 (30.2%) had hyperuricemia and 15 (6.2%) met 2015 ACR/EULAR criteria for gout. On univariate analysis, as compared with normo-uricemic patients, hyperuricemic patients were more frequently male (72.6% vs 39.1%, p = 1.6 × 10-6) with higher body mass index (30.9 vs 28.7 kg/m2, p = 0.015) and more comorbidities (Charlson comorbidity index: 2.6 vs 1.8, p = 0.005). PsA started at an older age (47.5 vs 43 years, p = 0.016) was more polyarticular (56.2% vs 41.9%, p = 0.049) than axial (9.6% vs 22.8%, p = 0.019) and more destructive (52.8% vs 37.4%, p = 0.032). PsA patients with joint destruction more frequently had hyperuricemia than did others (37.6% vs 25.8%, p = 0.047). Multivariable analysis confirmed the association of hyperuricemic PsA with peripheral joint involvement (odds ratio 2.98; 95% confidence interval 1.15-7.75; p = 0.025) and less good response to treatment (0.35; 0.15-0.87; p = 0.024). CONCLUSION: Patients with hyperuricemic PsA show poorer response to PsA treatment and have more peripheral and destructive joint damage than normo-uricemic patients. Key Points • Gout and psoriatic arthritis (PsA) can co-exist in the same patient. • Monosodium urate crystals might have a deleterious impact on PsA. • Hyperuricemic PsA is more polyarticular, less frequently axial, and more destructive than normo-uricemic PsA. • PsA with hyperuricemia should lead to more personalized medicine.

Knowledge, attitudes and practices of primary health care providers towards oral health of preschool children in Qatar.

OBJECTIVE: Health care providers can effectively participate in oral health promotion for children in primary care setting. Currently, there are no oral health promotion programs that involve primary health care professionals in Qatar. Hence, this study was undertaken to examine the knowledge, attitudes and practices of all health professionals who work in the Well baby Clinics in the primary health centers. METHOD: A 23-item questionnaire was distributed across 20 primary health centers. The questionnaire sought information on the demographic data of health professionals, their knowledge of oral health and their practices and attitudes towards critical oral health issues. Data were examined by Pearson Chi-squared tests or Fisher's Exact test (p = 0.05). RESULTS: The response rate of the health professionals was 67%. Only 35.7% of the 225 participants received some form of oral health training during their undergraduate programme. The participants would assess the dental problem of the child (p = 0.05) and discuss the importance of tooth brushing with the mother (p = 0.03). A significant number of respondents (p = 0.04) were unlikely to assess the children's fluoride intake. There was a significant difference in the group of participants that would examine the child's teeth (p = 0.1) and counsel the mothers on prevention of dental problems (p = 0.01). This group would also refer children to dentist at 12 months of age (p = 0.05). CONCLUSIONS: Health professionals had a positive attitude towards the anticipatory guidance elements of oral health. However, the knowledge of healthcare professionals on childhood oral health is rather limited.

Urban-rural residence and the occurrence of neural tube defects in Texas, 1999-2003.

Neural tube birth defects (NTDs) affect more than 4000 pregnancies in the US annually. The etiology of NTDs is believed to be multifactorial, but much remains unknown. We examined the pattern and magnitude of urban-rural variation in anencephaly, spina bifida without anencephaly, and encephalocele in Texas in relation with urban-rural residence for the period 1999-2003. There was no evidence that urban-rural residence was associated with changes in the rate of anencephaly or spina bifida without anencephaly in unadjusted or adjusted analyses. In contrast, rates of encephalocele were statistically significantly higher in areas classified as suburban or more rural compared to urban areas using four different urban-rural residence indicators.

Dental management of amelogenesis imperfecta patients: a primer on genotype-phenotype correlations.

Amelogenesis imperfecta (AI) represents a group of hereditary conditions which affects enamel formation in the primary and permanent dentitions. Mutations in genes critical for amelogenesis result in diverse phenotypes characterized by variably thin and/or defective enamel. To date, mutations in 5 genes are known to cause AI in humans. Understanding the molecular etiologies and associated inheritance patterns can assist in the early diagnosis of this condition. Recognition of genotype-phenotype correlations will allow clinicians to guide genetic testing and select appropriate management strategies for patients who express different phenotypes. The purpose of this paper was to provide a narrative review of the current literature on amelogenesis imperfecta, particularly regarding recent advances in the identification of candidate genes and the patterns of inheritance.

Adding casein phosphopeptide-amorphous calcium phosphate to sports drinks to eliminate in vitro erosion.

PURPOSE: Enamel erosion can occur with frequent consumption of sports drinks. The purpose of this study was to determine a minimal concentration of casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP) which when added to a sports drink would eliminate such erosion in vitro. METHODS: Human enamel specimens were immersed in: (1) the sports drink Powerade; (2) Poweradeplus 4 concentrations of CPP-ACP (0.063%, 0.09%, 0.125%, 0.25%); or (3) double deionized water. Windows of test and control enamel were profiled, and the enamel surface characteristics were examined under scanning electron microscopy (SEM). RESULTS: The pH of test solutions increased and the titratable acidity decreased with increasing CPP-ACP concentrations. Erosive step lesions occurred in specimens immersed in Powerade (mean depth=38.70kA +/- 5.60), which were eliminated by the addition of CPP-ACP to Powerade at all test concentrations except 0.063% CPP-ACP. Microscopic surface irregularities on test enamel were observed, apparent as adherent granules or globules. These may represent redeposited mineral phases following mobilization of calcium and phosphate from CPP-ACP. Tasters in a taste panel could not distinguish Powerade from Powerade plus 0.125% CPP-ACP. CONCLUSIONS: Adding casein phosphopeptide-stabilized amorphous calcium phosphate to the sports drink Powerade significantly reduced the beverage's erosivity without affecting the product's taste.

Developmental Programming: Priming Disease Susceptibility for Subsequent Generations.

Racial and/or ethnic minorities carry the highest burden of many adverse health outcomes intergenerationally We propose a paradigm in which developmental programming exacerbates the effects of racial patterning of adverse environmental conditions, thereby contributing to health disparity persistence. Evidence that developmental programming induces a heightened response to adverse exposures ("second hits") encountered later in life is considered. We evaluated the evidence for the second hit phenomenon reported in animal and human studies from three domains (air, stress, nutrition). Original research including a gestational exposure and a childhood or adulthood second hit exposure was reviewed. Evidence from animal studies suggest that prenatal exposure to air pollutants is associated with an exaggerated reaction to postnatal air pollution exposure, which results in worse health outcomes. It also indicates offspring exposed to prenatal maternal stress produce an exaggerated response to subsequent stressors, including anxiety and hyper-responsiveness of the hypothalamic-pituitary-adrenal axis. Similarly, prenatal and postnatal Western-style diets induce synergistic effects on weight gain, metabolic dysfunction, and atherosclerotic risk. Cross-domain second hits (e.g., gestational air pollution followed by childhood stressor) were also considered. Suboptimal gestational environments induce exaggerated offspring responses to subsequent environmental and social exposures. These developmental programming effects may result in enhanced sensitivity of ongoing, racially patterned, adverse exposures in race/ethnic minorities, thereby exacerbating health disparities from one generation to the next. Empirical assessment of the hypothesized role of priming processes in the propagation of health disparities is needed. Future social epidemiology research must explicitly consider synergistic relationships among social environmental conditions to which gestating females are exposed and offspring exposures when assessing causes for persistent health disparities.

Isolation of lambda amp3 genomic recombinants coding for antigens of Eimeria tenella.

Eimeria are the causative agents of coccidosis, a disease which is of world wide economic importance in the poultry industry. Immunity resulting from infection is species-specific and both antibody and cell-mediated responses have been implicated. As an initial step in the development of a genetically-engineered vaccine against coccidiosis, libraries of EcoRI-digested genomic DNA from E. tenella have been constructed in Escherichia coli using the expression vector lambda amp3. Screening of the libraries with serum from chickens immunized by infection has identified at least 24 different recombinant phage which produce eimeria antigens fused to beta-galactosidase. A significant proportion of the Eimeria DNA inserts cross-hybridise with each other and contain sequences which are highly represented in the genome. The identification of these clones will enable the isolation of intact genes from E. tenella DNA and facilitate detailed analysis of the antigens and immune responses.

MHC class II compatibility in aborted fetuses and term infants of couples with recurrent spontaneous abortion.

Maternal-fetal histocompatibility for alleles at HLA class II loci, HLA-DQA1 and HLA-DQB1, was examined in 40 abortuses and 31 liveborn children of 68 couples with a history of idiopathic recurrent spontaneous abortion (RSAB) who underwent leukocyte immunization prior to the index pregnancy. Significantly more couples with RSAB shared two HLA-DQA1 alleles as compared with fertile control couples (0.18 vs. 0.03, respectively; P = 0.031). There were no differences in HLA sharing between couples with RSAB who experienced a repeat abortion in the index pregnancy as compared with couples with RSAB who were delivered of a liveborn child. Non-significant deficits of abortuses who were compatible for alleles at the HLA-DQA1 (6 observed vs. 8.5 expected; P = 0.225) and the HLA-DQB1 (7 observed vs. 9.2 expected; P = 0.254) loci were observed. A significant deficit of HLA-DQA1 compatible liveborn children was observed (1 observed vs. 5.5 expected; P = 0.0069). The overall deficit of HLA-DQA1 compatible fetuses (7 observed vs. 14.0 expected; P = 0.0018) after approximately 8 weeks gestation suggests that HLA-DQA1 compatible fetuses may be aborted early in pregnancy, prior to the time when fetal tissue can be recovered for genetic studies.

Long term effects of primary molar pulpotomies on succedaneous bicuspids.

Forty-three bicuspids which replaced successfully pulpotomized vital or non-vital primary molars, and twenty bicuspids, which erupted following unsuccessful pulpotomies requiring extraction of the preceding teeth, were examined for defects of position and enamel. In comparison with contralateral control teeth, test teeth in both groups showed an increased prevalence of rotation and enamel surface defects.

A genetic contribution to dental caries, occlusion, and morphology as demonstrated by twins reared apart.

The heritability of dental characteristics has been systematically studied in animals, human populations, families, and twins, but not in twins reared apart. Under the assumption that environmental factors are no different for monozygotic twins reared apart than for dizygotic twins reared apart, the present study measured the genetic variance of several dental characteristics in twins reared apart. Ninety-seven subjects (44 twin pairs, three triplet sets) of mean age 40.6 years (S.D. 11.7) were examined over a six-year period by means of clinical and radiographic examinations, study models, and dental history questionnaires. Characteristics assessed retrospectively were: dentate status, treatment status, treatment/caries status, tooth size, malalignment, occlusion, and morphology. Data were analyzed by two-way ANOVA, intraclass correlations, heritability estimates, and concordance. There was statistically significant resemblance within monozygotic but not dizygotic pairs in the number of teeth present (p less than 0.001), percentage of teeth and surfaces restored (p less than 0.001), percentage of teeth and surfaces restored or carious (p less than 0.001), tooth size (p less than 0.001), and malalignment (p less than 0.009). Intercanine and intermolar arch width showed significant resemblance within both monozygotic (p less than 0.001) and dizygotic (p less than 0.01, p less than 0.05) pairs, whereas overjet and overbite showed no significant resemblance within pairs. Morphological features (Carabelli's trait and mandibular first premolar groove configuration) were more highly concordant in monozygous than in dizygous twins. This study provides new evidence for a marked genetic component to dentate status and dental caries experience and confirms previous reports of acknowledged inherited contributions to tooth size, malalignment, occlusion, and morphology.

Microleakage in class II composite restorations bonded to dentin using thermal and load cycling.

The effectiveness of a dentin-bonding agent (DBA) and a glass-ionomer cement liner (GIC) in reducing the marginal microleakage at the cervical margin of Class II posterior composite restorations was examined. The effect of load cycling on microleakage of this type of restoration was evaluated. The Class II cavities were prepared in extracted human pre-molar teeth, with the cervical margins finished approximately 1 mm below the CEJ. Combinations of DBA, GIC, and control (no liner) were used as mediators between resin and dentin. All restorations were placed incrementally with a 40-second cure per increment and finished with high-speed diamond burs. Half the samples of each treatment group received cyclical axial loading and half did not. All samples were thermocycled at 5 degrees and 55 degrees C for 500 cycles of one min each, stained (four hr) in 50% AgNO3, and sectioned following stain development. Microleakage was scored linearly along the dentin-restoration interface. All restorations exhibited microleakage which was unaffected by load cycling. Both the DBA and the GIC significantly reduced microleakage independently. When GIC was present, the additional presence of the DBA did not provide a statistically significant additional reduction of microleakage.