Workplace oral health promotion activities among community-aged care workers: A qualitative exploration.

BACKGROUND: The workplace is an ideal-and priority-setting for health promotion activities. Developing and implementing workplace health promotion interventions, including oral health promotion activities, can help create health-supporting workplace environments. OBJECTIVE: To pilot workplace oral health promotion activities among staff working in the aged care sector, report their impact and explore participants' views on the factors that contribute to participation and effectiveness. METHODS: This study comprised three phases: (i) the development and face validation of the resources, (ii) a 3-h educational session and (iii) five interview sessions with participants 4-6 weeks following the education session. The recorded interviews were transcribed verbatim and analysed thematically. RESULTS: Eleven community-aged care workforce were invited to five feedback sessions. Ten participants were female and ranged in age from 18 to 64. All participants gave favourable comments about the content and delivery of the training session and accompanying resources. The participants felt that the benefits of WOHP include improved staff knowledge, awareness and oral care routine, the ability to share (and put into practice) the gained knowledge and information with their dependants, a lower risk of having poor oral health that adversely affects their well-being and work tasks, and potentially beneficial impacts on the organization's staff roster. Their attendance in the WOHP was facilitated by being paid to attend and scheduling the sessions during work time. Future WOHP suggestions include the possibility of a one-stop dental check-up at the workplace or staff dental care discounts from local dental practitioners and combining oral health with other health promotion activities. CONCLUSIONS: Planning and implementing WOHP was deemed acceptable and feasible in this study context and successfully achieved short-term impacts among community-aged care workers. Appropriate times and locations, organizational arrangements and a variety of delivery options contributed to successful programme planning and implementation.

Medication taking in a national sample of dependent older people.

BACKGROUND: Polypharmacy is associated with inappropriate medication use, and subsequently increasing older persons' risk of drug-related harm and health-related costs to individuals and society. OBJECTIVE: To examine and describe, using a national sample of patient-level medication data, the prevalence of older people's polypharmacy and medication use across dependency levels. To examine oral and general pain prevalence and associated analgesic usage. METHODS: Medication data from the 2012 New Zealand Older People's Oral Health Survey, a nationally-representative, cross-sectional study of dependent older people's oral health, were analysed descriptively, comparing classes and sub-classes of drugs and nutrient supplements taken across four categories of dependency: very low (own homes receiving in-home support), low, high and psychogeriatric (all receiving aged residential care). Self-reported current general pain and frequency of orofacial pain data were cross-tabulated by sub-classes of analgesics taken. RESULTS: All participants were taking at least one medication overall, 53.2% (95% CI: 50.4, 56.0) took between five and nine (polypharmacy), and 13.9% (95% CI: 17.4, 22.5) took 10 or more (hyperpolypharmacy). Antihypertensives, analgesics, antiulcer drugs, aspirin, laxatives, statins and antidepressants were the most common drug classes taken, the proportions differing between psychogeriatric level care and all other dependency groups. Overall, simple analgesics were taken (34.5%; 95%CI: 30.8, 38.4) more commonly than other analgesics; the use of nonsteroidal anti-inflammatory drugs was low (3.6%; 95% CI: 2.7, 4.7). Of those reporting experiencing extreme general bodily pain, 63.3% (95% CI: 56.6, 69.4) took an analgesic, more than those experiencing mouth pain occasionally or often. Fat-soluble vitamins were the most common vitamin supplement taken (32.0%; 95%CI: 27.0, 37.4). CONCLUSIONS: Polypharmacy and hyperpolypharmacy are common among older people, regardless of dependency level, and pain may be undertreated.

Characteristic sequences in the promoter region of the chicken tyrosinase-encoding gene.

We have isolated and sequenced a genomic DNA sequence encoding chicken tyrosinase (TYR) that includes 2125 nt of 5' flanking sequence, the first exon and a part of the first intron. The 5' flanking sequence was able to drive transcription of a reporter gene in immortalised quail neural crest cells. The sequence, which is the most extensive to be reported for a lower vertebrate TYR gene to date, was further analyzed using primer extension and computer-aided homology searches. Transcription initiation appears to occur at heterogeneous start points and in the absence of a TATA box, but may be mediated via a potential initiator (Inr) element and Sp1-binding motif. We have identified two evolutionarily conserved regions within the 5' flanking sequence that may be functionally significant, as they contain regulatory elements previously reported to play a role in melanocyte-specific expression of TYR in mammals. This study contributes towards an understanding of the requirements for melanocyte-specific TYR expression in lower vertebrates.

Using epidemiology to target staff influenza vaccination programs.

We examined staff influenza vaccination rates in rural hospitals that had both acute- and long-term-care (LTC) units. After controlling for hospital, acute-care staff were less likely to be vaccinated than LTC staff. There was no consistent association between type of worker and vaccination after controlling for both hospital and type of care.

Effects of DDT and permethrin on neurite growth in cultured neurons of chick embryo brain and Lymnaea stagnalis.

The pesticides permethrin and 1,1-bis(4-chlorophenyl)-2,2,2-trichloroethane (DDT), dissolved in either ethanol (EtOH) or dimethylsulphoxide (DMSO), were studied to determine their effect on neurite growth from cultured neurons of Lymnaea stagnalis and embryonic chicks. Both of these toxins decreased the percentage of neurons growing neurites, mean neurite length, and number of neurites/cell in a dose-dependent manner. DMSO increased the toxicity of permethrin and DDT in L. stagnalis neurons. EtOH was not used as a solvent with the embryonic chick cultures. Pre-existing neurites of L. stagnalis neurons exposed to permethrin regressed in a dose- and time-dependent manner. These two toxins may affect neurite outgrowth through interference with intracellular calcium regulation.

Non-GABA(A)-mediated effects of lindane on neurite development and intracellular free calcium ion concentration in cultured rat hippocampal neurons.

Changes in transmembrane Ca(2+) fluxes and intracellular free Ca(2+) ion concentrations ([Ca(2+)](in)) regulate many aspects of neurite development in cultured neurons. Lindane has been shown to increase [Ca(2+)](in) in several cell types. It was therefore hypothesized that lindane exposure would increase [Ca(2+)](in) and thereby alter neurite development in cultured rat hippocampal neurons. The study reported here showed that lindane (50-100 muM) increased [Ca(2+)](in) during short-term exposure (up to 4 hr); in contrast, with long-term exposure (24-48 hr) lindane (1-50 mum) decreased [Ca(2+)](in) significantly below control levels. Lindane decreased neurite initiation at high concentrations (25 mum or above). Lindane increased dendrite number at low concentrations (0.5-1 muM), but decreased dendrite number at high concentrations (50 mum or above). Lindane decreased axon and dendrite elongation and branching at 50 mum. Loading neurons with 1 mum 1,2-bis-(o-aminophenoxy)-ethane-N,N,N',N'-tetraacetic acid (BAPTA), a calcium chelator that partially 'clamps' [Ca(2+)](in), eliminated the effects of 50 mum lindane on [Ca(2+)](in) in short-term exposures. BAPTA did not significantly reverse the inhibition of neurite initiation or axonal elongation caused by 50 mum lindane. However, BAPTA partially reversed the inhibition of dendrite elongation and completely reversed the inhibition of axon and dendrite branching caused by 50 mum lindane. Therefore, some, but not all, of lindane's effects on neurite development may be due to changes in [Ca(2+)](in). Picrotoxin, a gamma-aminobutyric acid A (GABA(A))-associated chloride channel antagonist, had no effect on [Ca(2+)](in) or any parameters of neurite growth, suggesting that the effects of lindane on neurite development and [Ca(2+)](in) were not mediated through actions on GABA(A)-associated chloride channels.

The forensic pediatrician as a child advocate.

This paper focuses on the medicolegal activities of a group of six pediatricians from the Winnipeg Children's Hospital. Increasing legal demands resulted in 93 court appearances for the group, during a 12-month period ending in December 1982. The educational processes and the individual court room issues confronted by both the courts and the six pediatricians, dealing with problems of child protection, are described. Major pediatric roles and principles of advocacy resulting from these experiences are delineated. Society's accountability is discussed with specific reference to the pediatrician's role.

Dental management of people with renal disease and renal transplants.

Chronic renal failure is the result of progressive loss of functioning nephrons leading to loss of renal function and accumulation of excretory products. Loss of the regulatory and excretory functions of the kidneys causes oral manifestations and multiple complications which have implications for dental care. Dental management of patients with renal failure and renal transplants involves consideration of specific haematological and cardiovascular effects, and implications for the prescribing and use of pharmaceuticals. It also requires the dentist to appreciate the potential for involvement of multiple organ systems in the disease process and the implications this has for dental care. The orofacial manifestations of chronic renal failure are secondary to systemic manifestations and are not specific to the diagnosis of end-stage renal disease.

Fabrication of high quality plan-view TEM specimens using the focused ion beam.

We describe a technique using a focused ion beam instrument to fabricate high quality plan-view specimens for transmission electron microscopy studies. The technique is simple, site-specific and is capable of fabricating multiple large, >100 µm(2) electron transparent windows within epitaxially grown thin films. A film of La0.67Sr0.33MnO3 is used to demonstrate the technique and its structural and functional properties are surveyed by high resolution imaging, electron spectroscopy, atomic force microscopy and Lorentz electron microscopy. The window is demonstrated to have good thickness uniformity and a low defect density that does not impair the film's Curie temperature. The technique will enable the study of in-plane structural and functional properties of a variety of epitaxial thin film systems.

Extreme value theory applied to the definition of bathing water quality discounting limits.

The European Community Bathing Water Directive (European Parliament, 2006) set compliance standards for bathing waters across Europe, with minimum standards for microbiological indicators to be attained at all locations by 2015. The Directive allows up to 15% of samples affected by short-term pollution episodes to be disregarded from the figures used to classify bathing waters, provided certain management criteria have been met, including informing the public of short-term water pollution episodes. Therefore, a scientifically justifiable discounting limit is required which could be used as a management tool to determine the samples that should be removed. This paper investigates different methods of obtaining discounting limits, focusing in particular on extreme value methodology applied to data from Scottish bathing waters. Return level based limits derived from threshold models applied at a site-specific level improved the percentage of sites which met at least the minimum required standard. This approach provides a method of obtaining limits which identify the samples that should be removed from compliance calculations, although care has to be taken in terms of the quantity of data which is removed.

The radiology of intracranial tuberculosis in children.

Radiology provides valuable clues to the correct diagnosis of intracranial tuberculosis. Twenty-three children with this problem were reviewed. Fifteen had meningitis, 12 of whom had abnormal chest radiographs, nine of them suggestive of tuberculosis. Common neuroradiologic findings were minor suture separation, abnormal activity in the region of the sylvian fissure on brain scans, mild ventricular dilatation, and vasculitis. Among the eight patients with tuberculomas, abnormal chest radiographs were less common. Neuroradiologic abnormalities included evidence of increased intracranial pressure on skull radiographs, focal deep lesions on brain scans, and hydrocephalus and mass lesions on air studies. Most tuberculomas were calcified one year later.

The regulation of tyrosinase gene transcription.

Tyrosinase is one of the key enzymes essential for melanogenesis. The control of its activity rests in part at the level of transcriptional regulation. The 5' promoter regions of the human, mouse, chicken, quail, snapping turtle, and frog tyrosinase sequences have been isolated and the mechanisms regulating the activity of these sequences are beginning to be elucidated. This review provides an update on the following aspects of tyrosinase gene regulation: basal promoter elements that determine the site of transcription initiation for RNA polymerase II; the cis-acting elements and DNA-binding factors that mediate melanocyte-specific expression of the tyrosinase gene; promoter elements involved in the temporal control of tyrosinase gene expression; additional elements that may be required to achieve wild-type levels of gene expression; and specific elements that may be required for modulation of tyrosinase gene expression in response to humoral factors or external stimuli that are known to influence the amounts of melanin synthesized by fully differentiated melanocytes. The wild type expression of tyrosinase is the result of the interaction of many different factors and it is becoming evident that certain elements and factors play more than one role in this process.

Effects of some platinum IV complexes on cell division of Escherichia coli.

A comparison was made of the effects of cis-tetrachlorodiaminoplatinum (IV) (cis-TCDPt), rans-TCDPt), and hexachloroplatinum (HCP) on growth and cell division of Escherichia coli strains D21 and D22. At or below 40 microgram/mL, cis-TCDPt inhibited cell division but not growth, DNA, or protein synthesis, although areas of increased electron density could be demonstrated in treated cells. In contrast, 40 microgram/mL of trans-TCDPt or HCP inhibited growth. Trans-TCDPt-treated cells developed condensed nucleoids; HCP-treated cells showed no obvious cytological changes to correlate with growth inhibition. Combination of cis-TCDPt with nalidixic acid, both at one-half the lowest filament-forming concentrations, resulted in formation of filaments, suggesting an additive effect. Combination of cis-TCDPt followed by ampicillin on E. coli B/r resulted in single bulges near the center of the filaments. Cis-TCDPt could therefore inhibit an initial step in the septation sequence, possibly at the level of the regulation of the hydrolytic enzymes. Whether cis-TCDPt exerts its effect by interreaction with DNA or with a membrane target is still uncertain.

Calcification of axillary lymph nodes following BCG vaccination.

Axillary lymph node calcification was found in 18 children following BCG vaccination. Five of these also had symptomatic adenitis. The calcifications involved one to four nodes and appeared as discrete, oval densities. They disappeared over the course of several months in three patients. No axillary lymph node calcification was seen on chest radiographs of 60 other children who had had BCG vaccination in the neonatal period.

Temporospatial cell interactions regulating mandibular and maxillary arch patterning.

The cellular origin of the instructive information for hard tissue patterning of the jaws has been the subject of a long-standing controversy. Are the cranial neural crest cells prepatterned or does the epithelium pattern a developmentally uncommitted population of ectomesenchymal cells? In order to understand more about how orofacial patterning is controlled we have investigated the temporal signalling interactions and responses between epithelium and mesenchymal cells in the mandibular and maxillary primordia. We show that within the mandibular arch, homeobox genes that are expressed in different proximodistal spatial domains corresponding to presumptive molar and incisor ectomesenchymal cells are induced by signals from the oral epithelium. In mouse, prior to E10, all ectomesenchyme cells in the mandibular arch are equally responsive to epithelial signals such as Fgf8, indicating that there is no pre-specification of these cells into different populations and suggesting that patterning of the hard tissues of the mandible is instructed by the epithelium. By E10.5, ectomesenchymal cell gene expression domains are still dependent on epithelial signals but have become fixed and ectopic expression cannot be induced. At E11 expression becomes independent of epithelial signals such that removal of the epithelium does not affect spatial ectomesenchymal expression. Significantly, however, the response of ectomesenchyme cells to epithelial regulatory signals was found to be different in the mandibular and maxillary primordium. Thus, whereas both mandibular and maxillary arch epithelia could induce Dlx2 and Dlx5 expression in the mandible and Dlx2 expression in the maxilla, neither could induce Dlx5 expression in the maxilla. Reciprocal cell transplantations between mandibular and maxillary arch ectomesenchymal cells revealed intrinsic differences between these populations of cranial neural crest-derived cells. Research in odontogenesis has shown that the oral epithelium of the mandibular and maxillary primordia has unique instructive signaling properties required to direct odontogenesis, which are not found in other branchial arch epithelia. As a consequence, development of jaw-specific skeletal structures may require some prespecification of maxillary ectomesenchyme to restrict the instructive influence of the epithelial signals and allow development of maxillary structures distinct from mandibular structures.

The battered child syndrome.

The experience of the Children's Hospital of Winnipeg from 1957 to 1971 with abused infants and children is presented with statistical data on 132 children. Details as to incidence, source and types of abuse are presented along with a discussion of the management of the problem. A follow-up study on a group of the abused children is also presented with comments directed towards some preventive measures.

The Winnipeg Children's Hospital child protection centre: a provincial medical initiative.

The Winnipeg Children's Hospital child protection centre is a hospital-based provincial protection program that focuses on the diagnosis, treatment and prevention of child abuse and neglect in Manitoba. The multidisciplinary group of professionals working in the centre differs from most hospital-based teams in that it has a strong government liaison both functionally and financially, has strong ties to the welfare system and has legal counsel relating to the court system. The centre represents the philosophy that medical participation in welfare matters relating to children need not be relegated to the sidelines. This paper describes the centre's history and structure, and it outlines some of its research projects.

Rheumatic fever in native children in Manitoba.

From data reported to a central computer file, cases of rheumatic fever in persons under 17 years of age in Manitoba were reviewed. Although the overall incidence of the disease declined throughout the study period, Jan. 1, 1970 to July 1, 1979, the rates per 100 000 population were higher overall (36) and for non-natives (29) and much higher for natives (126) than average rates in urban centres around the world. Rates of death and readmission showed that the disease was also more severe in the native Manitoba children.