[Oral health in older adults, a challenge? Determinants of oral health in older adults.] / Mondzorg bij ouderen: een uitdaging? Determinanten voor mondgezondheid bij ouderen.

Current data show many older adults to have poor oral health, deteriorating even more when they become frail or care dependent. In order to achieve a structural and sustained improvement of this situation, it is necessary to have a clear view of the factors determining oral health in older adults, such as (endogenous (biological, lifestyle), environmental determinants and determinants associated with the organisation of healthcare. The various determinants show oral health in older adults is the result of thecombined effects of very diverse factors and for that reason, a solution will have to be based on a multidisciplinary approach, also involving people outside of clinical care. To promote good oral health over the full course of life, it is important to invest in a good start in life, that helps accumulate oral health gains, and at the same time it is essential to adapt the healthcare system and prevention strategies to the individual's needs in order to make oral care effective for the full course of life.

[A view on collective oral care for frail older people: united we stand]. / Visie op de collectieve mondzorg voor kwetsbare ouderen: eendracht maakt macht.

Oral health in frail older people is often poor. There are a number of reasons for this, such as increased morbity and decreased motivation for (self) care. Good oral health is, however, very important. Studies have revealed poor oral health to cause or aggravate several medical and psychological problems. Illness and medication can, in turn, damage oral health. Oral health among the elderly should therefore be carefully monitored and maintained. This requires multidisciplinary and interprofessional collaboration on the part of healthcare professionals and others involved. Such collaboration is now still very limited; hardly anything has been written about how such collaboration in the area of oral care for frail older people should or could be organised. This article provides an overview of the possibilities and the relevant factors in the area of oral care for the elderly in promoting collaboration among healthcare professionals and others involved. All of this is under the banner of 'united we stand'.

Influence of shoes and foot orthoses on lower extremity muscle activation onset times in healthy subjects during the transition from double-leg stance to single-leg stance.

AIM: The aim of this study was to evaluate the influence of shoes and foot orthoses on lower extremity muscle activation patterns in healthy subjects during the transition from double-leg stance to single-leg stance. METHODS: Eight male and seven female young asymptomatic adults who wear foot orthoses were recruited. Muscle activation onset times of 9 lower extremity muscles were recorded using surface electromyography during the transition from double-leg stance to single-leg stance, performed with eyes open and with eyes closed. This was tested in 4 experimental conditions: 1) barefoot (BF); 2) shoes only (SO); 3) shoes with standardized FO (SSFO); and 4) shoes with customized FO (SCFO). RESULTS: Based on a four-way (condition-region-leg-vision) linear model for repeated measures, we found a significant condition effect (P=0.025). Differences between conditions did not depend on the leg and/or the vision condition, but on the region (ankle-knee-hip). Based on a two-way (condition-muscle) linear model within each region, only significant differences between conditions for peroneus longus (P=0.003) were found. The onset times of peroneus longus were significantly earlier in SO (P=0.029) and SCFO (P=0.001) compared to BF. CONCLUSION: These results indicate that SO and SCFO can accelerate peroneus longus muscle activation onset times during the transition from double-leg stance to single-leg stance. Further research is required to determine how these adaptations may develop over time.

Triple pelvic osteotomy in dogs less than 12 kg in weight. Technical feasibility and short-term radiographic and clinical complications in fourteen hips.

Triple pelvic osteotomy (TPO) was used to treat a selected group of young dogs with clinical and radiographic signs of hip dysplasia. Good clinical outcomes have been reported in dogs between 17-85 kg body weight. Hip dysplasia however is also encountered in smaller dogs. If surgery is performed in smaller dogs, femoral head and neck ostectomy is the main treatment method used. We wanted to determine if TPO could also be used in dogs under 12 kg bodyweight. Our study showed that it is technically possible to perform TPO surgery in dogs less than 12 kg of weight (down to 4.6 kg) with a good clinical outcome even in hips with high angles of reduction and subluxation.

Screw loosening six weeks after triple pelvic osteotomy: comparison of pre-tapped with self-tapping 3.5 mm cortical screws.

A retrospective study of 62 dogs that underwent unilateral triple pelvic osteotomy with a Slocum triple pelvic osteotomy plate and Synthes 3.5 mm cortical screws. We compared the probability of screw loosening after six weeks in dogs in which pre-tapped screws were used (30 dogs), with dogs in which self-tapping screws were used (32 dogs). Screw loosening was significantly less prevalent with self-tapping screws than pre-tapped screws.

The influence of hepatic impairment on the pharmacokinetics of paliperidone.

OBJECTIVES: This study assessed the impact of hepatic impairment on the pharmacokinetics (PK) of paliperidone and its enantiomers. METHODS: A single 1 mg dose of paliperidone immediate-release (IR) was administered to subjects with moderate hepatic impairment (n = 10) and demographically matched individuals with normal hepatic function (n = 10). RESULTS: Plasma protein binding was lower in hepatically impaired subjects resulting in a 27% higher unbound fraction of paliperidone compared with healthy individuals. After correcting for the difference in plasma protein binding, unbound exposures were comparable between groups. All other PK parameters were similar between the two groups. Paliperidone IR was equally well tolerated in both groups. CONCLUSIONS: The impact of moderate hepatic impairment on paliperidone PK is not considered clinically relevant as the PK profile of unbound paliperidone is similar for subjects with moderate hepatic impairment and those with normal hepatic function. Dosage adjustments of paliperidone are not required in subjects with mild or moderate hepatic impairment.

Lumbosacral degenerative stenosis in the dog. The results of epidural infiltration with methylprednisolone acetate: a retrospective study.

Thirty-eight dogs with Hansen type II lumbosacral disc protrusion were treated with epidural infiltration of methylprednisolone acetate between the seventh lumbar vertebra and the sacrum. Epidural infiltration was carried out under C-arm fluoroscopic guidance at standardised intervals for the first three treatments and later on demand. Retrospective evaluation by owner questionnaire found that 79% of the animals were considered to have improved, and 53% were totally cured. Epidural infiltration with methylprednisolone acetate has a clinical outcome comparable to decompressive surgery and can be safely used as a less invasive alternative.

Grossly apparent cartilage erosion of the patellar articular surface in dogs with congenital medial patellar luxation.

One hundred and forty-five stifles of client-owned dogs that underwent corrective surgery for congenital medial patellar luxation were inspected for cartilage erosion on the articular surface of the patella. The lesions were mapped in surface percentage ranges of 20% and by location. Two-thirds of the patellae had cartilage erosion. Cartilage erosion varied between 0 and 100% of the total patellar articular surface and was localised mainly on the medial and distal side of the patella. Dogs with Grade IV patellar luxations and heavier dogs were more affected. The majority of dogs in our study with congenital medial patellar luxation had grossly apparent cartilage erosion on the articular surface of the patella, which may help to explain why certain patients do not function well clinically after technically successful corrective surgery.

Review of the dental treatment backlog of people with disabilities in Europe.

AIM: The present research aims at reviewing the oral health conditions and treatment needs of people with disabilities in Europe. METHODS: A comprehensive literature search was conducted using Medline and Embase with a timeframe from January 2008 until December 2017. Subsequently, a citation tracking was undertaken. Articles in English, French and Dutch were included. RESULTS: Forty-two articles were included. A variety of oral health problems and treatment needs was reported. More untreated carious lesions, less restorations, a higher number of extractions and less prosthetic rehabilitations were seen in people with disabilities compared with other individuals without disabilities. The oral hygiene level and the periodontal conditions were poor. Moreover, a higher risk of dental trauma, orthodontic problems and tooth wear were reported. DISCUSSION: Different determinants contribute to the oral health condition and treatment needs of people with disabilities. These determinants can be inherent in persons with a disability (biological factors), their lifestyle, the environment or the organization of oral health care. A treatment backlog was a common finding in people with disabilities. However, results need to be interpreted with caution because of the variety of people with disabilities included in this literature review. Proposed solutions can be put at the level of daily oral care, through oral health promotion programs and the creation of a supportive environment, but also at the level of dental attendance, facilitating the access to oral health care services and focusing the training of dental students and dentists. CONCLUSION: This comprehensive review clearly shows a dental treatment backlog in people with disabilities. Solutions require efforts from the caregivers and dental professionals.

The atomic lensing model: New opportunities for atom-by-atom metrology of heterogeneous nanomaterials.

The atomic lensing model has been proposed as a promising method facilitating atom-counting in heterogeneous nanocrystals [1]. Here, image simulations will validate the model, which describes dynamical diffraction as a superposition of individual atoms focussing the incident electrons. It will be demonstrated that the model is reliable in the annular dark field regime for crystals having columns containing dozens of atoms. By using the principles of statistical detection theory, it will be shown that this model gives new opportunities for detecting compositional differences.

Associations between Measures of Structural Morphometry and Sensorimotor Performance in Individuals with Nonspecific Low Back Pain.

BACKGROUND AND PURPOSE: To date, most structural brain imaging studies in individuals with nonspecific low back pain have evaluated volumetric changes. These alterations are particularly found in sensorimotor-related areas. Although it is suggested that specific measures, such as cortical surface area and cortical thickness, reflect different underlying neural architectures, the literature regarding these different measures in individuals with nonspecific low back pain is limited. Therefore, the current study was designed to investigate the association between the performance on a sensorimotor task, more specifically the sit-to-stand-to-sit task, and cortical surface area and cortical thickness in individuals with nonspecific low back pain and healthy controls. MATERIALS AND METHODS: Seventeen individuals with nonspecific low back pain and 17 healthy controls were instructed to perform 5 consecutive sit-to-stand-to-sit movements as fast as possible. In addition, T1-weighted anatomic scans of the brain were acquired and analyzed with FreeSurfer. RESULTS: Compared with healthy controls, individuals with nonspecific low back pain needed significantly more time to perform 5 sit-to-stand-to-sit movements (P < .05). Brain morphometric analyses revealed that cortical thickness of the ventrolateral prefrontal cortical regions was increased in patients with nonspecific low back pain compared with controls. Furthermore, decreased cortical thickness of the rostral anterior cingulate cortex was associated with lower sit-to-stand-to-sit performance on an unstable support surface in individuals with nonspecific low back pain and healthy controls (r = -0.47, P < .007). In addition, a positive correlation was found between perceived pain intensity and cortical thickness of the superior frontal gyrus (r = 0.70, P < .002) and the pars opercularis of the inferior ventrolateral prefrontal cortex (r = 0.67, P < .004). Hence, increased cortical thickness was associated with increased levels of pain intensity in individuals with nonspecific low back pain. No associations were found between cortical surface area and the pain characteristics in this group. CONCLUSIONS: The current study suggests that cortical thickness may contribute to different aspects of sit-to-stand-to-sit performance and perceived pain intensity in individuals with nonspecific low back pain.

[Primary amenorrhea: constitutional delayed puberty or hormonal disturbance]. / Primaire amenorroe: constitutioneel vertraagde puberteit of hormonale stoornis.

Investigations were carried out in 2 women of 17 and 18 years with primary amenorrhea, normal external female genitalia and delayed secondary sexual characteristics, for the reasons for delayed puberty. The 17-year-old patient had reduced values of FSH, LH and oestradiol. This disturbance in the hypothalamo-hypophysary axis was caused by hydrocephalus. Menarche occurred following drainage of the fluid. The 18-year-old patient had raised values ofFSH and LH and a lowered oestradiol value. There was therefore a disfunction existing at ovarian level, which appeared to be caused by an XX-gonadal dysgenesis. The patient was treated with hormones which led to breast development and menarche taking place. The cause ofprimary amenorrhea can mainly be divided into three categories: constitutional delayed puberty, delayed puberty due to hypogonadotropic hypogonadism, or delayed puberty due to hypergonadotropic hypogonadism. A carefully taken medical history, together with determination of the serum levels of FSH and LH, is helpful in differentiating between these categories. Subsequently, structured clinical management must be performed in order to approach the differential diagnosis of each of these categories, which will then be followed by the final diagnosis.

The oldest case yet reported of osteoarthritis in a dog: an archaeological and radiological evaluation.

A century ago the remains of a dog skeleton were found in an archaeological double human burial, near Bonn-Oberkassel (Germany). Recent re-examination of the dog remains revealed that they were about 14,500 years old. Based on the growth plates, the animal was considered to be approximately 7·5 months old at the time of death. Based on the minimal humeral diameter, it was calculated that it was approximately 0·47 m tall at the shoulder and weighed approximately 15·7 kg. The right proximal ulna of this skeleton showed osteoarthritis, manifested by an osteophyte of 5×3×1·5 mm3 at its cranial edge, with no identified primary developmental causes for osteoarthritis. Osteochondritis dissecans, joint incongruity and trauma are possible aetiologies. The left ulna did not reveal any abnormalities.

[Challenges of adolescents' adherence to therapy]. / Uitdagingen rond de therapietrouw van adolescenten.

Non-adherence occurs at any age, in all chronic diseases, and has a major impact on clinical outcomes. Non-adherence is primarily determined by perceptions of illness and medication beliefs. During puberty, adolescents attain independence from their parents and attach to their peers. This complicates successful self-management of chronic illness, because the adolescents avoid standing out from their peers. Discussion of barriers hindering successful self-management in adolescents can be promoted by seeing the patient alone, without the parents being present, and by acknowledging the patient's independence and responsibilities.

Continuous twin screw granulation of controlled release formulations with various HPMC grades.

HPMC is a popular matrix former to formulate tablets with extended drug release. Tablets with HPMC are preferentially produced by direct compression. However, granulation is often required prior to tableting to overcome poor flowability of the formulation. While continuous twin screw granulation has been extensively evaluated for granulation of immediate release formulations, twin screw granulation of controlled release formulations including the dissolution behavior of the formulations received little attention. Therefore, the influence of the HPMC grade (viscosity and substitution degree) and the particle size of theophylline on critical quality attributes of granules (continuously produced via twin screw granulation) and tablets was investigated in the current study. Formulations with 20 or 40% HPMC, 20% theophylline and lactose were granulated with water at fixed process parameters via twin screw granulation. The torque was influenced by the viscosity and substitution degree of HPMC, but was not a limiting factor for the granulation process. An optimal L/S ratio was selected for each formulation based on the granule size distribution. The granule size distributions were influenced by the substitution degree and concentration of HPMC and the particle size of theophylline. Raman and UV spectroscopic analysis on 8 sieve fractions of granules indicated an inhomogeneous distribution of theophylline over the size fractions. However, this phenomenon was not correlated with the hydration rate or viscosity of HPMC. Controlled release of theophylline could be obtained over 24h with release profiles close to zero-order. The release of theophylline could be tailored via selection of the substitution degree and viscosity of HPMC.

Short-term effects of early intravenous treatment with a beta-adrenergic blocking agent or a specific bradycardiac agent in patients with acute myocardial infarction receiving thrombolytic therapy.

OBJECTIVES: This study was conducted to explore mechanisms that could explain the possible clinical benefit of early administration of a beta 1-selective adrenoreceptor blocking agent or a bradycardiac drug as adjunct to thrombolysis in acute myocardial infarction. BACKGROUND: The effects of beta-blockers given concomitantly with thrombolytic therapy in patients with acute myocardial infarction have not been fully examined. The potential role of specific bradycardiac agents lacking negative inotropism as an alternative to beta-blockers in this setting has never been studied in humans. METHODS: In a double-blind study, we examined the effects of early intravenous and continued oral administration of a beta-blocker (atenolol), a specific bradycardiac agent (alinidine) or placebo on left ventricular function, late coronary artery patency, infarct size, exercise capacity and incidence of arrhythmias. RESULTS: A total of 292 patients with acute myocardial infarction of < or = 5 h duration and without contraindications to thrombolytic or beta-blocker therapy were studied. Of these, 100 were allocated to treatment with atenolol (5 to 10 mg intravenously followed by 25 to 50 mg orally every 12 h), 98 to alinidine (20 to 40 mg intravenously followed by 20 to 40 mg orally every 8 h) and 94 to placebo. All patients received 100 mg of alteplase over 3 h and full intravenous heparinization. No significant differences in coronary artery patency, global ejection fraction or regional wall motion were observed at 10 to 14 days among the three groups. Likewise, enzymatic and scintigraphic infarct size were also very similar. Neither atenolol nor alinidine was associated with a significant reduction in the incidence of arrhythmias during the 1st 24 h. No significant differences in clinical events were observed, with the exception of a greater incidence of nonfatal pulmonary edema in the atenolol group (6% vs. 1% in the alinidine group and 0% in the placebo group, p = 0.021). CONCLUSIONS: In the absence of contraindications, the administration of a beta-blocker or a specific bradycardiac agent together with thrombolytic therapy was safe. In this limited number of patients, these agents did not appear to enhance myocardial salvage or preservation of left ventricular function or to reduce the incidence of major arrhythmias in the early phase of infarction.

Simultaneous analysis of single-photon timing data for the one-step determination of activation energies, frequency factors and quenching rate constants. Application to tryptophan photophysics.

A general global analysis of single-photon timing data is presented in which each fluorescence decay curve can be described by a different decay law. The model parameters can be held in common within one curve and/or between related curves. Any or all parameters can be kept fixed, or they may be variable to seek optimum values. This general analysis allows the determination of activation energies, frequency factors and quenching rate constants in one step. The construction of the global mapping table which relates parameters in one experiment to those in another is explained in detail. The use and performance of this general simultaneous analysis are examined using tryptophan fluorescence decays at pH 6.0 obtained at various emission wavelengths as a function of temperature and added solute quencher. The results show that tryptophan at pH 6.0 decays as a biexponential with decay times which are independent of the analysis wavelength. The decay component with the short lifetime has a deactivation rate constant of 1.4 x 10(9) s-1 independent of temperature. The decay component with the long lifetime has an activation energy of 28 kJ/mol and a frequency factor of 3 x 10(13) s-1; its temperature-independent decay rate constant equals 1 x 10(8) s-1. Recursion formulas for a computer program to estimate activation energies, frequency factors, and decay rate constants are provided.

Frequency perception of individual and group successes as a function of competition, coaction, and isolation.

The frequency perception of successful and unsuccessful outcomes obtained in serial tasks was investigated in two experiments. Subjects were assigned to serial tasks in which the outcome stimuli ("right" and "wrong") immediately followed subjects' responses to each task item. Subjects' perceptual judgment about the number of "rights and wrongs" obtained was requested at the end of the serial task (incidental event perception). In Experiment 1, subjects performing in groups of four were compared with individual performers both in competing and noncompeting (coacting) conditions. In Experiment 2, the influence of verbal communication and competition versus isolation was examined. Significant and predicted differences in frequeency perception were found (a) in group performers as compared with individual performers, (b) in groups with verbal communication as compared with groups without verbal communication, and (c) in competing groups as compared with noncompeting, especially isolated, groups. The frequency perception of success is discussed in the context of impression formation processes, and its impact on person perception and learning is mentioned. A tentative explanation in terms of affective and cognitive processes related to social interaction is submitted.

The Primary Health Care Project in Belgium: a survey on the utilization of health services.

The article consists of two major parts. In the Introduction a general overview is given of the Primary Health Care Project, carried out in Belgium from 1975 to 1978 in the broader framework of a large National Project in the Social Sciences. An explanation is given of the scope of the study, its method and sampling. Since the very broad study design, it was decided to make a selection of interesting results. An overview is given of the most relevant data with respect to the utilization of health care services and of medicines. After a short clarification of the concept of utilization behaviour, some data are presented in order to describe the use of medical services and the consumption of medicines. Secondly an attempt is made to explain utilization behaviour. For the explanatory model used in this project, the WHO-model functioned as an important source of inspiration. In this way it surmounted the limitations of much previous research. This model included variables on the level of the individual-perceived morbidity, predisposing factors and enabling factors-as well as system variables--such as degree of urbanization, proximity and the way of functioning of the medical supply. The research results have successfully shown that: there is a strong relationship between perceived presence and perceived seriousness of morbidity on the one hand, utilization behaviour on the other hand; the health perspective (including medical knowledge, values and attitudes) seems to have a differential influence on utilization behaviour, depending on age and social background of the respondent; the inclusion of socio-structural variables is an innovation in the Belgian health care research. The hypothetical character of the relationships found here is largely supported by the research simultaneously conducted in the French-speaking region of Belgium; accessibility and socialization are factors having a clear influence on the use of general practice services. The importance of the presence and the organization of the supply in the explanation of utilization behaviour is partly confirmed.