Development and validation of a national clinical pharmacy competency framework for hospital pharmacists in Austria: a multi-method study.

BACKGROUND: Despite the publication of a European wide competency framework for hospital pharmacy by the European Association of Hospital Pharmacist (EAHP) in 2017, not all countries have adopted and implemented such a framework. AIM: This study aimed to develop and validate a bespoke national hospital pharmacy competency framework for Austria that supports the hospital pharmacy workforce development. METHOD: A multi-method study was carried out in three phases. (I) A systematic literature review across 48 websites of healthcare-related associations and six scientific databases was conducted, identifying competency frameworks, guidelines and related documents. (II) Extracted behaviour competencies were reviewed for contextual national appropriateness by three researchers prior to mapping against the "Patient Care and Clinical Pharmacy Skills" domain of European Common Training Framework (CTF). (III) Validation of the resultant draft clinical skills competency framework took place by an expert panel (n = 4; Austrian Association of Hospital Pharmacists (AAHP) board members) discussion. Reporting of findings is aligned with the recommendations for reporting Competency Framework Development in health professions (CONFERD-HP guidelines) and the PRISMA 2020 checklist. RESULTS: The systematic review (SR) resulted in 28 frameworks, guidelines and related documents and the identification of 379 behaviour competencies, with nineteen mapped to the "Patient Care and Clinical Pharmacy Skills" domain of the CTF (after removal of duplicates). Expert panel discussion resulted in suggested changes to ensure contextual national appropriateness. CONCLUSION: This study resulted in the development and validation of the first clinical national pharmacy competency framework for Austria. Future studies should focus on political and practical structures necessary for its successful implementation.

Back pain prevalence in adolescent athletes.

The research aimed to investigate back pain (BP) prevalence in a large cohort of young athletes with respect to age, gender, and sport discipline. BP (within the last 7 days) was assessed with a face scale (face 1-2 = no pain; face 3-5 = pain) in 2116 athletes (m/f 61%/39%; 13.3 ± 1.7 years; 163.0 ± 11.8 cm; 52.6 ± 13.9 kg; 4.9 ± 2.7 training years; 8.4 ± 5.7 training h/week). Four different sports categories were devised (a: combat sports, b: game sports; c: explosive strength sport; d: endurance sport). Analysis was described descriptively, regarding age, gender, and sport. In addition, 95% confidence intervals (CI) were calculated. About 168 (8%) athletes were allocated into the BP group. About 9% of females and 7% of males reported BP. Athletes, 11-13 years, showed a prevalence of 2-4%; while prevalence increased to 12-20% in 14- to 17-year olds. Considering sport discipline, prevalence ranged from 3% (soccer) to 14% (canoeing). Prevalences in weight lifting, judo, wrestling, rowing, and shooting were ≥10%; in boxing, soccer, handball, cycling, and horse riding, ≤6%. 95% CI ranged between 0.08-0.11. BP exists in adolescent athletes, but is uncommon and shows no gender differences. A prevalence increase after age 14 is obvious. Differentiated prevention programs in daily training routines might address sport discipline-specific BP prevalence.

[Tendinopathies of the Lower Extremities in Sport--Diagnostics and Therapy]. / Tendinopathien der unteren Extremität im Sport--Diagnostik und Therapie.

Tendinopathies are frequently the cause of chronic, load-dependent complaints of the lower extremity. Commonly, the large tendons of the ankle and knee joints are affected, especially the Achilles and patellar tendons. Repeated overuse in sports and/or daily activities is assumed as the aetiology. Besides the clinical examination including a comprehensive anamnesis of pain and training/loading, sonographic imaging has a high training/loading relevance for the diagnosis of tendon pathologies of the lower extremity. Training concepts are considered in first line as the treatment of choice. A combination with physical therapy interventions can be useful. In cases of a more severe pathology and long-standing complaints multimodal therapeutic options should be employed. The use of surgical treatment procedures should only be taken into account in case of failed response to conservative treatment.

The application of Gadopentate-Dimeneglumin has no impact on progression free and overall survival as well as renal function in patients with monoclonal plasma cell disorders if general precautions are taken.

OBJECTIVES: The current analysis investigated the prognostic significance of gadopentetate dimeglumine on survival and renal function in patients with monoclonal plasma cell disorders. METHODS: In this study 263 patients who had received gadopentetate dimeglumine within a prospective trial investigating dynamic contrast-enhanced magnetic resonance imaging (MRI) were compared with 335 patients who had undergone routine, unenhanced MRI. RESULTS: We found no significant prognostic impact of the application of contrast agent on progression-free survival in patients with either monoclonal gammopathy of undetermined significance, smouldering or symptomatic myeloma and no significant prognostic impact on overall survival in patients with symptomatic myeloma. Since renal impairment is a frequent complication of myeloma, and decreased renal function is associated with a higher risk of complications in patients receiving contrast agents, we evaluated the impact of contrast agent on renal function after 1 year. In the present analysis the only significant adverse impact on kidney function occurred in symptomatic myeloma patients who already had impaired renal parameters at baseline. Here, the renal function did not recover during therapy, whereas it did so in patients with normal or only slightly impaired renal function. CONCLUSION: If general recommendations are adhered to, gadopentetate dimeglumine can be safely applied in patients with monoclonal plasma cell disease.

Peripheral monocytes of obese women display increased chemokine receptor expression and migration capacity.

CONTEXT: The activation of peripheral immune cells and the infiltration of immune cells into adipose tissue in obesity are implicated in the development of type 2 diabetes mellitus. OBJECTIVE: The aim of the study was to compare peripheral immune cells from obese and normal-weight women with regard to composition of immune cell subpopulations, surface expression of the chemokine receptors (CCRs) CCR2, CCR3, CCR5, and CXCR3 (chemokine (C-X-C motif) receptor 3) and cell-intrinsic migration capacity. DESIGN: This was a case-control study. SETTING: The study was conducted at a university clinical study center. PATIENTS: Obese females and normal-weight females were included for fluorescence-activated cell sorting analysis and migration assays. MAIN OUTCOME MEASURES: Peripheral blood mononuclear cells were prepared from fasting blood samples and used for fluorescence-activated cell sorting analysis and migration assays. RESULTS: An increase in the percentages of CD14(+)CD16(+) monocytes was observed in obese subjects compared with controls. The CCR profile of monocytes differed significantly in the obese state; in particular, CCR2 levels were increased. In addition, a higher chemotactic activity of monocytes from obese subjects was observed in a migration assay, which was associated with both insulin resistance and CCR2 expression. CONCLUSION: Our results suggest that the enhanced intrinsic migratory capacity of peripheral monocytes in obese women may be due to the increased CCR expression, further supporting a link between peripheral immune cell dysfunction and obesity.

The challenge of a 2-year follow-up after intervention for weight loss in primary care.

BACKGROUND: Many weight loss programmes show short-term success, but long-term data in larger studies are scarce, especially in community settings. Attrition is common and complicates the interpretation of long-term outcomes. OBJECTIVE: To investigate 2-year outcomes and explore issues of attrition and missing data. SUBJECTS: A total of 772 overweight and obese adults recruited by primary care practices in Australia, Germany and the UK and randomised to a 12-month weight loss intervention delivered in a commercial programme (CP) or in standard care (SC). MEASUREMENT: Weight change from 0-24 and 12-24 months including measured weights only and measured and self-reported weights, using last observation carried forward (LOCF), baseline observation carried forward (BOCF), completers-only and missing-at-random (MAR) analyses. RESULTS: A total of 203 participants completed the 24-month visit. Using measured weights only, there was a trend for greater 24-month weight loss in CP than in SC, but the difference was only statistically significant in the LOCF and BOCF analyses: LOCF: -4.14 vs -1.99 kg, difference adjusted for centre -2.08 kg, P<0.001; BOCF: -1.33 vs -0.74 kg, adjusted difference -0.60 kg, P=0.032; completers: -4.76 vs -2.99 kg, adjusted difference -1.53 kg, P=0.113; missing at random: -3.00 vs -1.94 kg, adjusted difference -1.04 kg, P=0.150. Both groups gained weight from 12-24 months and weight regain was significantly (P<0.001) greater for CP than for SC in all analysis approaches. Inclusion of self-reported weights from a further 138 participants did not change the interpretation of the findings. CONCLUSION: Initial weight loss was poorly maintained during the no-intervention follow-up, but both groups did have lower weight over the 24 months. Attrition was high in both groups, and assumptions about missing data had considerable impact on the magnitude and statistical significance of treatment effects. It is vital that trials on weight loss interventions consider the plausibility of these differences in an analytical approach when interpreting research findings and comparing data between studies.

[Weight reduction: evaluation of the possibilities in primary care and patient satisfaction. Results from a weight reduction trial]. / Gewichtsreduktion: Evaluation der Möglichkeiten auf hausärztlicher Versorgungsebene und der Patientenzufriedenheit. Ergebnisse einer Gewichtsreduktionsstudie.

BACKGROUND: Commercial weight loss programs offer support to overweight and obese patients to reduce excess bodyweight. Many patients seek advice for weight loss from their general practitioners. PATIENTS AND METHODS: In the framework of a randomized controlled 1-year trial the effectiveness and safety of a commercial weight loss program was compared with a primary care intervention. At the end of the trial the participating general practitioners and study participants were asked to answer specific questions about their offered weight loss management. This paper relates to the German study part (268 participants, 40 general practitioners). RESULTS: More than half of the general practitioners reported to offer a dietary concept which varied strongly across general practitioners. About one third of the general practitioners considered commercial weight loss programs as an alternative to support weight reduction. Participants reported that they considered weight loss advice by their general practitioners as helpful. But patients in the commercial weight loss program assessed the advice as more positive and achieved twice as much weight loss as patients in the primary care intervention. CONCLUSION: Evaluated commercial weight loss programs can be effective and safe alternatives for general practitioners to achieve weight loss in overweight and obese patients.

Accessing genotype by environment interaction using within- and across-country test-day random regression sire models.

First-lactation test-day (TD) milk records of Luxembourg and Tunisian Holsteins were analysed for evidence of genotype by environment interaction (G x E). The joint data included 730 810 TD records of 87 734 cows and 231 common sires. Random regression TD sire models with fourth-order Legendre polynomials were used to estimate genetic parameters via within- and across-country analyses. Daily heritability estimates of milk yield from within-country analysis were between 0.11 and 0.32, and 0.03 and 0.13 in Luxembourg and Tunisia, respectively. Heritability estimates for 305-day milk yield and persistency (defined as the breeding value for milk yield on DIM 280 minus the breeding value on DIM 80) were lower for Tunisian Holsteins compared with the Luxembourg population. Specifically, heritability for 305-day milk yield was 0.16 for within- and 0.11 for across-country analyses for Tunisian Holsteins and 0.38 for within- and 0.40 for across-country analyses for Luxembourg Holsteins. Heritability for apparent persistency was 0.02 for both within- and across-country analyses for Tunisian Holsteins and 0.08 for within- and 0.09 for across-country analyses for Luxembourg Holsteins. Genetic correlations between the two countries were 0.50 for 305-day milk yield and 0.43 for apparent persistency. Moreover, rank correlations between the estimated breeding values of common sires for 305-day milk yield and persistency, estimated separately in each country, were low. Low genetic correlations are evidence for G x E for milk yield production while low rank correlations suggest different rankings of sires in both environments. Results from this study indicate that milk production of daughters of the same sires depends greatly on the production environment and that importing high merit semen for limited input systems might not be an effective strategy to improve milk production.

Environmental sensitivity for milk yield in Luxembourg and Tunisian Holsteins by herd management level.

Milk production data of Luxembourg and Tunisian Holstein cows were analyzed using herd management (HM) level. Herds in each country were clustered into high, medium, and low HM levels based on solutions of herd-test-date and herd-year of calving effects from national evaluations. Data from both populations included 730,810 test-day (TD) milk yield records from 87,734 first-lactation cows. A multi-trait, random regression TD model was used to estimate (co)variance components for milk yield within and across country HM levels. Additive genetic and permanent environmental variances of TD milk yields varied with management level in Tunisia and Luxembourg. Additive variances were smaller across HM levels in Tunisia than in Luxembourg, whereas permanent environmental variances were larger in Tunisian HM levels. Highest heritability estimates of 305-d milk yield (0.41 and 0.21) were found in high HM levels, whereas lowest estimates (0.31 and 0.12, respectively) were associated with low HM levels in both countries. Genetic correlations among Luxembourg HM levels were >0.96, whereas those among Tunisian HM levels were below 0.80. Respective rank orders of sires ranged from 0.73 to 0.83 across Luxembourg environments and from 0.33 to 0.42 across Tunisian HM levels indicating high re-ranking of sires in Tunisia and only a scaling effect in Luxembourg. Across-country environment analysis showed that estimates of genetic variance in the high, medium, and low classes of Tunisian environments were 45, 69, and 81% lower, respectively, than the estimate found in the high Luxembourg HM level. Genetic correlations among 305-d milk yields in Tunisian and Luxembourg HM environments ranged from 0.39 to 0.79. The largest estimated genetic correlation was found between the medium Luxembourg and high Tunisian HM levels. Rank correlations for common sires' estimated breeding values among HM environments were low and ranged from 0.19 to 0.39, implying the existence of genotype by environment interaction. These results indicate that daughters of superior sires in Luxembourg have their genetic expression for milk production limited under Tunisian environments. Milk production of cows in the medium and low Luxembourg environments were good predictors of that of their paternal half-sisters in the high Tunisian HM level. Breeding decisions in low-input Tunisian environment should utilize semen from sires with daughters in similar production environments rather than semen of bulls proven in higher management levels.

Genotype x environment interaction for milk yield in Holsteins using Luxembourg and Tunisian populations.

Test-day (TD) milk yield records of first-lactation Holstein cows in Luxembourg and Tunisia were analyzed using within-and between-country random regression TD models. Edited data used for within-country analysis included 661,453 and 281,913 TD records in Luxembourg and Tunisia, respectively. The joint data included 730,810 TD records of 87,734 cows and 231 common sires. Both data sets covered calving years 1995 to 2006. Fourth-order Legendre polynomials for random effects and a Gibbs sampling method were used to estimate variance components of lactation curve parameters in separate and joint analyses. Genetic variances of the first 3 coefficients from Luxembourg data were 46 to 69% larger than corresponding estimates from the Tunisian data. Inversely, the Tunisian permanent environment variances for the same coefficients were 52 to 65% larger than the Luxembourg ones. Posterior mean heritabilities of 305-d milk yield and persistency, defined as estimated breeding values (EBV) at 280 days in milk-EBV at 80 days in milk, from between-country analysis were 0.42 and 0.12 and 0.19 and 0.08 in Luxembourg and Tunisia, respectively. Heritability estimates for the same traits from within-country analyses, mainly from the Tunisian data, were lower than those from the joint analysis. Genetic correlations for 305-d milk yield and persistency between countries were 0.60 and 0.36. Product moment and rank correlations between EBV of common sires for 305-d milk yield and persistency from within-country analyses were 0.38 and 0.41 and 0.27 and 0.26, respectively. Differences between genetic variances found in both countries reflect different milk production levels. Moreover, low genetic and rank correlations suggest different ranking of sires in the 2 environments, which implies the existence of a genotype x environment interaction for milk yield in Holsteins.

Genetic diversity and joint-pedigree analysis of two importing Holstein populations.

Genetic diversity and relatedness between 2 geographically distant Holstein populations (in Luxembourg and Tunisia) were studied by pedigree analysis. These 2 populations have similar sizes and structures and are essentially importing populations. Edited pedigrees included 140,392 and 151,381 animals for Tunisia and Luxembourg, respectively. To partially account for pedigree completeness levels, a modified algorithm was used to compute inbreeding. The effective numbers of ancestors were derived from probabilities of gene origin for the 2 populations of cows born between 1990 and 2000. The 10 ancestors with the highest contributions to genetic diversity in the cow populations accounted for more than 32% of the genes. Eight of these 10 ancestors were the same in both populations. The rates of inbreeding were different in the 2 populations but were generally comparable to those found in the literature for the Holstein breed. Average inbreeding coefficients per year, estimated from the data, ranged from 0.91 and 0.50 in 1990 to 3.10 and 2.12 in 2000 for the Tunisian and Luxembourg populations, respectively. Genetic links have also strengthened with time. Average additive relationships between the 2 populations were as high as 2.2% in 2000. Results suggest that it would be possible to investigate genotype by environment interactions for milk traits using the Tunisian and Luxembourg dairy populations.

Prediction of daily milk, fat, and protein production by a random regression test-day model.

Test-day genetic evaluation models have many advantages compared with those based on 305-d lactations; however, the possible use of test-day model (TDM) results for herd management purposes has not been emphasized. The aim of this paper was to study the ability of a TDM to predict production for the next test day and for the entire lactation. Predictions of future production and detection of outliers are important factors for herd management (e.g., detection of health and management problems and compliance with quota). Because it is not possible to predict the herd-test-day (HTD) effect per se, the fixed HTD effect was split into 3 new effects: a fixed herd-test month-period effect, a fixed herd-year effect, and a random HTD effect. These new effects allow the prediction of future production for improvement of herd management. Predicted test-day yields were compared with observed yields, and the mean prediction error computed across herds was found to be close to zero. Predictions of performance records at the herd level were even more precise. Discarding herds enrolled in milk recording for <1 yr and animals with very few tests in the evaluation file improved correlations between predicted and observed yields at the next test day (correlation of 0.864 for milk in first-lactation cows as compared with a correlation of 0.821 with no records eliminated). Correlations with the observed 305-d production ranged from 0.575 to 1 for predictions based on 0 to 10 test-day records, respectively. Similar results were found for second and third lactation records for milk and milk components. These findings demonstrate the predictive ability of a TDM.

Insulin-like growth factor 1 receptor mRNA expression and autophosphorylation in human myometrium and leiomyoma.

Uterine leiomyomas are the most common tumors of the genital tract. Growth factors seem to be implicated in the development of leiomyoma. The aim of this study was to determine insulin-like growth factor 1 receptor (IGF-1-R) mRNA levels and IGF-1-R tyrosine kinase activity in normal myometrium and leiomyoma. Plasma membranes of myometrium and leiomyoma of 14 women subjected to hysterectomy were prepared, and samples were incubated in the absence or presence of recombinant human IGF-1 to assess the tyrosine kinase activity (Western blot). Reverse-transcriptase polymerase chain reaction with specific primers for IGF-1-R was used to determine IGF-1-R mRNA levels. IGF-1-R mRNA levels in myometrium (0.8216 +/- 0.096) and in leiomyoma (0.7905 +/- 0.136) were not statistically significantly different (p = 0.648). The degree of IGF-1-R autophosphorylation stimulated by recombinant IGF-1 was not different in myometrium (1.020 +/- 0.120) and leiomyoma (1.620 +/- 0.656) either (p = 0.075). There was no difference in IGF-1-R expression and IGF-1-R autophosphorylation between normal myometrium and leiomyoma.

Permeability characteristics of bovine and human dentin under different pretreatment conditions.

In order to use bovine dentin instead of human dentin for in vitro adhesion and cytotoxicity tests the permeability characteristics of human and bovine dentin should be similar. In the present study hydraulic conductance (Lp) and diffusional water flux (J5) of human and bovine dentin slices were compared. The permeability experiments were performed in a split chamber using tritiated water in physiological saline. Lp and Js of bovine dentin were 0.7- to 2.4-fold and 1.1- to 3.5-fold that of human dentin (not statistically significant). For human and bovine dentin Lp and Js increased with etching and showed an inverse linear relationship (r > or = 0.7) with dentin thickness. The variability of bovine data was low (perfusion = 30%, diffusion = 22%) and about half that of the human data. In conclusion bovine dentin near the cementoenamel junction seems to be a suitable alternative for coronal human dentin for in vitro tests with respect to transdentinal permeability characteristics.

On the cause of mental retardation in Down syndrome: extrapolation from full and segmental trisomy 16 mouse models.

Down syndrome (DS, trisomy 21, Ts21) is the most common known cause of mental retardation. In vivo structural brain imaging in young DS adults, and post-mortem studies, indicate a normal brain size after correction for height, and the absence of neuropathology. Functional imaging with positron emission tomography (PET) shows normal brain glucose metabolism, but fewer significant correlations between metabolic rates in different brain regions than in controls, suggesting reduced functional connections between brain circuit elements. Cultured neurons from Ts21 fetuses and from fetuses of an animal model for DS, the trisomy 16 (Ts16) mouse, do not differ from controls with regard to passive electrical membrane properties, including resting potential and membrane resistance. On the other hand, the trisomic neurons demonstrate abnormal active electrical and biochemical properties (duration of action potential and its rates of depolarization and repolarization, altered kinetics of active Na(+), Ca(2+) and K(+) currents, altered membrane densities of Na(+) and Ca(2+) channels). Another animal model, the adult segmental trisomy 16 mouse (Ts65Dn), demonstrates reduced long-term potentiation and increased long-term depression (models for learning and memory related to synaptic plasticity) in the CA1 region of the hippocampus. Evidence suggests that the abnormalities in the trisomy mouse models are related to defective signal transduction pathways involving the phosphoinositide cycle, protein kinase A and protein kinase C. The phenotypes of DS and its mouse models do not involve abnormal gene products due to mutations or deletions, but result from altered expression of genes on human chromosome 21 or mouse chromosome 16, respectively. To the extent that the defects in signal transduction and in active electrical properties, including synaptic plasticity, that are found in the Ts16 and Ts65Dn mouse models, are found in the brain of DS subjects, we postulate that mental retardation in DS results from such abnormalities. Changes in timing and synaptic interaction between neurons during development can lead to less than optimal functioning of neural circuitry and signaling then and in later life.

Treatment of acute low back pain in Wisconsin: results of the State Medical Society's Medical Outcomes Research Project.

BACKGROUND: Acute low back pain is the fifth most common reason for physician visits. Multiple treatment options are available, but not all physicians and patients are satisfied with the results. This study evaluated treatment outcomes from patients' perspectives using standardized measures. METHODS: 368 patients with acute low back pain were enrolled in the study. Only 128 participants (35%) completed all 4 health outcome questionnaires (administered at baseline, 6 weeks, 3 months, and 1 year). RESULTS: Most participants reported improved health at 1-year follow-up,, with the most significant gains achieved by 3 months. However, 40% were not satisfied with their outcome. Patients with radicular low back pain scored lower on health outcome measures than patients without radicular symptoms. CONCLUSION: A sizeable percentage of patients with acute low back pain progress to chronic pain despite therapeutic intervention. Patients with radiculopathy may require nonstandard treatment to avoid unfavorable outcomes.

Ts65Dn mouse, a Down syndrome model, exhibits elevated myo-inositol in selected brain regions and peripheral tissues.

myo-Inositol is elevated in the Down syndrome (DS; trisomy 21) brain and may play a role in mental retardation. In the present study, we examined brain regions and peripheral tissues of Ts65Dn mouse, a recently characterized genetic model of DS, for abnormal myo-inositol accumulation. A GC/MS technique was used to quantitate myo-inositol and other polyol species (ribitol, arabitol, xylitol, and 1,5-anhydrosorbitol) in tissues from the Ts65Dn mice and control diploid mice. myo-Inositol was found to be elevated in frontal cortex, hippocampus, and brain stem but not in cerebellum of the Ts65Dn mouse. Among peripheral organs examined, liver and skeletal muscle were found to excessively accumulate myo-inositol. In all tissues, concentrations of polyol internal controls were normal. The Ts65Dn mouse is useful to study the possible effect of elevated myo-inositol on cellular processes.

Localization on a physical map of the NKC-linked Cmv1 locus between Ly49b and the Prp gene cluster on mouse chromosome 6.

The Cmv1 locus controls NK cell-mediated resistance to infection with murine CMV. Our recent genetic analysis of backcross mice demonstrated that the NK gene complex (NKC)-linked Cmv1 locus should reside between the Ly49 and Prp gene clusters on distal mouse chromosome 6. We have aligned yeast artificial chromosome (YAC) inserts in a contig spanning the interval between the Ly49 and Prp gene clusters. This YAC contig includes 13 overlapping YAC inserts that span more than 2 megabases (Mb) in C57BL/6 (B6) mice. Since we have identified genomic clones that span the Ly49-Prp gene region, we hypothesize that at least one should contain the Cmv1 locus. To narrow the Cmv1 critical region, we developed novel NKC genetic markers and used these to genotype informative backcross and intra-NKC recombinant congenic mouse DNA samples. These data suggest that Cmv1 resides on a single YAC insert within an interval that corresponds to a physical distance of approximately 390 kb. This high resolution, integrated physical and genetic NKC map will facilitate identification of Cmv1 and other NKC-linked loci that regulate NK cell-mediated immunity.

Factors which are associated with dental decay in the older individual.

OBJECTIVES: To improve reliability of salivary bacterial cultures as a surrogate for plaque levels of cariogenic bacterial species by reporting the salivary CFUs of these organisms as a function of the number of teeth. DESIGN: Cross-sectional collection of data in a convenience sample of adults over 60 years of age. SETTING: Hospital Dental clinic, University bacteriology laboratory. SUBJECTS: 523 older dentate subjects, average age 70, including 412 subjects who were in an independent living status and 111 in a dependent-living situation. MAIN OUTCOME MEASURES: Subjects were examined for decay and the presence of salivary factors including the levels of S. mutans, lactobacilli, yeast and other bacteria. The salivary levels of the bacteria were adjusted for the number of teeth in the mouth, and the resultant values were entered into multivariable logistic regression models along with clinical and other salivary parameters. RESULTS: Mutans streptococci levels reported as CFUs/ml saliva per tooth were significantly associated with coronal surface decay, and lactobacilli, reported in a similar way, were significantly associated with root surface decay. Salivary levels of yeasts, which had previously been associated with decay in this population, were no longer significant using this construct. CONCLUSIONS: This construct of reporting salivary bacteriological data as a function of tooth number and per ml saliva could improve the reliability of bacteriological data obtained in epidemiological studies investigating the role of bacteria in dental decay in the elderly.