Effectiveness of an oral health education intervention among 6-12-year-old children: A cluster randomized controlled trial.

OBJECTIVES: Literature on the effectiveness of theory-based oral health education on the oral hygiene of children is limited. We aimed to determine the effectiveness of an health behaviour theory-based school oral health education intervention on 1) oral hygiene and 2) oral health-related knowledge, attitude and practices among 6-12-year-old children in Kerala, India. METHODS: Cluster randomized controlled trial. Sixteen class divisions (clusters) were randomized into intervention and control groups of 225 and 228 children respectively. Primary and secondary outcomes were plaque score as measured using the simplified oral hygiene index (OHI-S) and oral health-related knowledge, attitude and practices respectively. The intervention group received structured oral health education classes for three months and materials including pamphlets. Children in the control group were not given the classes or materials. RESULTS: Post-intervention OHI-S scores in the intervention group and control groups were 1.65 and 2.17 respectively (difference = -0.52, 95%CI -0.86, -0.18). All the secondary outcomes improved in the intervention group compared to the control group. CONCLUSIONS: The intervention improved the oral hygiene status, oral health-related knowledge, attitude and practices of the children. Longer term follow-up and economic appraisal are needed to help policymakers plan and develop OHEI based on health behaviour theories.

Variation in urban snow quality indicated by three seasonal sampling surveys conducted in Luleå (Sweden) within a span of 27 years.

Concentrations of total suspended solids (TSS), trace metals (Cu, Cd, Cr, Zn, Cd, Pb), Na and 16 US EPA priority PAHs in urban snow were studied in the City of Luleå in Northern Sweden. Snow was sampled at six central urban and suburban sites with various traffic intensities, in three sampling surveys (1994-95, 2002-03, 2020-21), repeated for three ages of the urban snow cover of 40, 80, and 120 days, respectively. The older data, from the 1994-95 and 2002-03 surveys, were obtained from the existing literature. The concentrations and mass loads of TSS and most trace metals studied (Zn, Cu, Pb, and Cd) varied with time. TSS, Zn, and Cu showed slightly higher concentrations and mass loads in the 2003 (TSS avg = 2300 µg/L, Zn avg = 620 µg/L and Cu avg = 250 µg/L) and 2021 (TSS avg = 1500 µg/L, Zn avg = 530 µg/L and Cu avg = 220 µg/L) sampling surveys, compared to the 1995 survey (TSS avg = 620 µg/L, Zn avg = 240 µg/L and Cu avg = 97 µg/L). However, no evident trend was observed between the 2003 and 2021 sampling surveys. The highest concentrations of Pb and Cd were observed in snow samples from the 1994-95 sampling survey (Pb max = 570 µg/L, Cd max = 4.6 µg/L). Results indicated higher concentrations of the pollutants studied in the city centre, compared to the residential suburbs, and in areas with heavier traffic, where concentrations of metals correlated well with traffic intensity. Fractionation analysis of trace metals indicated that Zn, Cu and Pb occurred mostly in the particulate-bound phase (>0.45 µm) containing the most of Zn, Cu, and Pb mass, at 80, 84 and 94% of the total, respectively. Over 50% of the dissolved phase of Zn and Cu was in the truly dissolved fraction (<3000 MWCO). Concentrations of PAHs also increased with traffic intensity, with pyrene being the most frequently detected PAH, likely because of the strength of sources and various physical processes influencing the snowbanks development and causing spatial and temporal variations in pollutant concentrations.

The impact of tax policies on living organ donations in the United States.

In an effort to increase living organ donation, fifteen states passed tax deductions and one a tax credit to help defray potential medical, lodging and wage loss costs between 2004 and 2008. To assess the impact of these policies on living donation rates, we used a differences-in-differences strategy that compares the pre- and postlegislation change in living donations in states that passed legislation against the same change in those states that did not. We found no statistically significant effect of these tax policies on donation rates. Furthermore, we found no evidence of any lagged effects, differential impacts by gender, race or donor relationship, or impacts on deceased donation. Possible hypotheses to explain our findings are: the cash value of the tax deduction may be too low to defray costs faced by donors, lack of public awareness about the existence of these policies, and that states that were proactive enough to pass tax policy laws may have already depleted donor pools with previous interventions.

Pesticide residues in fresh fruits imported into the United Arab Emirates.

Pesticides are a major public health issue connected with excessive use because they negatively impact health and the environment. Pesticide toxicity has been connected to various human illnesses by means of pesticide exposure in direct or indirect ways. A total of 4513 samples of imported fresh fruits were collected from Dubai ports between 2018 to 2020. Their contamination by pesticides was evaluated using gas chromatography combined with mass spectrometry (GC-MS/MS) and liquid chromatography-mass spectrometry (LC-MS/MS). The display of monitoring results was based on the Maximum Residue Limit (MRL) standard as per the procedures of the European Union. Eighty-one different pesticide residues were detected in the tested fruit samples. In 73.2% of the samples, the pesticide levels were ≥ MRL, while 26.8% were > MRL standards. Chlorpyrifos, carbendazim, cypermethrin, and azoxystrobin were the most frequently detected pesticides in more than 150 samples. Longan (81.4%) and rambutan (66.7%) showed the highest number of imported samples with multiple pesticide residues > MRL. These results highlight the need to continuously monitor pesticide residues in fruits, particularly samples imported into the United Arab Emirates (UAE). Fruit samples with residues > MRL are considered unfit for consumption and prevented from entering commerce in the UAE.

Management of isolated splenic injuries after blunt trauma: an institution's experience over 6 years.

Forty-two patients with traumatic blunt splenic injuries were admitted over a six year period. Vehicular-related collisions and fall from height accounted for the injuries in 38 (90.5%) of them. Eleven (26.2%) underwent immediate surgery (7 splenectomy and 4 splenorrhaphy), while the remaining 31 patients were treated nonoperatively of which 3 underwent angio-embolisation. Twenty seven patients had either grade III or IV splenic injuries. Operative management was more likely in patients with lower haemoglobin or with more severe splenic injury. Nonoperative management can be adopted in patients with blunt isolated splenic injuries but operative management is still indispensable in certain instances.

Response of phytoplankton community and size classes to green Noctiluca bloom in the northern Arabian Sea.

A comprehensive analysis on the phytoplankton ecology with special reference to different phytoplankton size classes was carried out at green Noctiluca scintillans (hereafter Noctiluca) bloom and non-bloom locations in offshore waters of the northern Arabian Sea. At the bloom locations, green Noctiluca represented a dense mono-specific proliferation with average cell density of 10.16 ±â€¯5.806 × 104 cells-L-1 and relative abundance share of 98.63%. Active photosynthesis through prasinophytic endosymbiont was depicted from net community production magnitude reaching 85.26 mgC/m3/Day under low prey abundance. Parallel swarming of Porpita porpita, a voracious copepod feeder signified the competitive advantage of Noctiluca to have the phytoplankton prey. Average concentration of picophytoplankton biomass was eleven times lower in surface waters of non-bloom stations in comparison to bloom. Higher N:P ratio in subsurface waters of non-bloom stations signified non-utilization of nitrogenous nutrients. Green Noctiluca bloom onset subsequent to diatom rich conditions was evident from spatio-temporal ocean colour satellite imageries.

Financial Impact of Incidental Radiologic Findings During Living Kidney Donor Evaluation.

Living kidney donor (LKD) transplantation is an important alternative for the end-stage renal disease population and is preferred due to superior outcomes when compared with dialysis or deceased donor transplantation. LKD evaluation includes a computed tomography angiogram (CTA) for assessment of renal and renovascular anatomy. Incidental nonrenal findings are frequently noted during the CTAs, and these may have variable clinical significance. These incidental findings lead to further testing, procedures, and referrals, which incur additional cost. We conducted a retrospective analysis of the incidental findings noted during CTA of 632 LKDs evaluated at our institution from 2008 to 2013. All extrarenal findings were categorized as pulmonary, hepatic, pancreatic-biliary, adrenal, bowel, gynecologic, and miscellaneous. Further testing, diagnostic procedures, referrals, and management were determined based on chart review. Our results showed that there were 525 extrarenal incidental findings in 632 potential living donors. Appropriate clinical follow-up was required in 20% at an additional cost of US dollars (USD) 63,035. Additional cost per incidental finding requiring follow-up was USD 407 ± 818. The median cost for follow-up was USD 168 (168-317). The detection of findings during imaging leads to apprehension for the donor and contribute to additional costs. Appropriate counseling is warranted prior to evaluation of the LKD.

An intelligent tutoring system for trauma management (Trauma-Teach): a preliminary report.

Trauma-Teach is an interactive software for tutoring surgical trainees on medical trauma management procedures. Users of the system interact with a virtual patient suffering from trauma injuries. The task of the user is to stabilise the virtual patient, discover the underlying injuries and decide on an appropriate management plan. Artificial intelligence techniques are used to simulate the patient's pulmonary and cardiovascular systems in real time, determine the responses and results of treatments and diagnostics accordingly, model the patient deterioration if wrong actions are taken, and give a measure of reality to the system by selecting actual trauma cases from the hospital's database.

Insulin-like growth factor 1 enhances renal function in a patient with chronic renal failure on peritoneal dialysis.

Insulin-like growth factor 1 (IGF1) has been shown to improve renal function in healthy subjects, as well as those with chronic renal failure. To our knowledge, IGF1 has not been shown to be efficacious in patients who were already undergoing dialysis. We present the case of a 70-year-old woman with end-stage renal disease (ESRD) and overt uremic symptoms treated with IGF1 after peritoneal dialysis was discontinued because of complications. There was a significant improvement in her inulin clearance during the course of treatment. The patient remained well and did not require dialytic support for 19 weeks. Although further data are necessary, we believe this case shows that IGF1 may be a short-term alternative to dialysis in patients with ESRD.

Hepatocyte growth factor inhibits apoptosis after ischemic renal injury in rats.

Several studies have determined that growth factors, including hepatocyte growth factor (HGF), have a crucial role in the regenerative process of renal tubules after ischemic or toxic insult. Recent research has ascertained that as well as necrotic cell death, there is evidence of apoptosis after an acute renal injury. We attempted to determine the effect of HGF on apoptosis after ischemic renal injury in rats. We administered HGF or vehicle to 12 rats after ischemic insult and compared them with 6 sham-operated controls. Rats were killed at 48 hours, and histopathologic assessments were performed on the renal tissue. The microscale autoradiographic method was used for qualitative analysis of DNA fragmentation. This method was chosen over the widely used ethidium bromide-staining method because it increases the sensitivity of detection of apoptotic DNA. Terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick end labeling histopathologic staining was used to identify apoptosis in situ. Apoptotic changes were clearly shown by electron microscopy in vehicle-treated animals. Despite showing profound evidence of tubular necrosis, apoptotic changes were markedly reduced in HGF-treated animals compared with vehicle-treated animals. DNA-laddering analysis further confirmed the antiapoptotic effect of HGF. To our knowledge, this is the first in vivo illustration of the inhibitory activity of a growth factor on apoptosis in the setting of tubular necrosis. The role of apoptosis in the setting of acute renal failure has not been elucidated; thus, additional research is necessary to determine the significance of these findings.

Acute renal failure: prevention and nondialytic therapy.

Acute renal failure (ARF) is a common illness with significant associated mortality and morbidity. Despite the advent of renal replacement therapy and the advancement in dialytic technology, the mortality of ARF has not significantly changed in the last 30 years. The cost of treating acute renal failure with the available therapies inflicts a tremendous financial burden on the health care system. The majority of patients with acute renal failure have multiple etiologies which are frequently iatrogenic. Physicians frequently underestimate the level of renal dysfunction in patients and therefore interventions to curb or treat renal failure are delayed. It is clear that ARF can be averted with more vigilance and early interventions. No pharmacological agent has yet been approved for the treatment of acute renal failure. Several substances are in the various stages of animal and human trials. Until one becomes available for use in the treatment of renal failure, it is clear that prevention is the principal element in the management of ARF. The purpose of this review is to discuss the various risk factors for acute renal failure, methods of prevention, and pharmacological interventions that may be beneficial in the treatment of ARF.

Elevated blood pressure in men accompanying patients to the obstetrician's office.

Hypertension is common and leads to increased mortality among adults; yet, one-third of hypertensive adults in the United States are unaware of their condition. The purpose of this study was to determine the frequency of unrecognized elevated blood pressure (BP) in men accompanying pregnant women to the obstetrician's office. Blood pressure measurements were offered to men accompanying pregnant women to four obstetrics practices in St. Louis, Missouri. Age, race, history of hypertension, and relationship to the pregnant woman were also recorded. A total of 191 men participated in the study. Participants' ages ranged from 15 to 69 years, with a mean of 27 years. Elevated BP (> 140/90 mm Hg) was detected in 40 men (21%). Only 5% of men with an elevated BP were aware of a prior history of elevated BP. We conclude that the obstetrician's office provides a good opportunity for initial screening for hypertension in men. Follow-up is necessary to determine the accuracy of the diagnosis.

On the notion of a "subtle phonetic deficit" in fluent/posterior aphasia.

Phonetic investigations in the past decade or so have reported instances of a "subtle phonetic deficit" in the fluent aphasias, thereby challenging the traditional dichotomy of a motoric deficit characterizing the nonfluent aphasias and a selection deficit characterizing the fluent aphasias. This paper critically reviews the acoustic, physiological, and perceptual studies which have attempted to examine this phenomenon. These investigations have been evaluated in terms of differences in subject populations, task demands, subjects' performance, and problematic interpretations. Suggestions are offered for an experimental design which can help us operationalize this term and help us to better understand the speech production deficit in fluent aphasic patients.

Management delays for early gastric cancer in a country without mass screening.

BACKGROUND/AIMS: To examine the symptoms of early gastric cancer and the time scale of management delays in a country without a mass screening program. METHODOLOGY: Retrospective review of 44 patients with early gastric cancer. RESULTS: Epigastric pain (63.3%) and gastrointestinal hemorrhage (27.3%) were the main symptoms found. Total delay was made up of patient delay (48.6%), doctor delay (25.5%) and treatment delay (25.9%). Median patient delay (from symptom onset to medical consult) was 30 days (inter-quartile range 2 to 365). Patient delay of more than 6 months was associated with patients aged 50 and younger (P = 0.04) and those presenting with pain (P = 0.05). Median doctor delay (consult to diagnosis) was 21 days (1 to 35) and median treatment delay (diagnosis to surgery) was 8 days (2 to 21). Doctor delay of more than 6 months was associated with a negative gastroscopy or barium meal in the previous 12 months (P = 0.03). CONCLUSIONS: The detection of early gastric cancer at the symptomatic-detectable stage is possible and this potential window for diagnosis can be more than 1 year for up to one third of cases. Efforts to reduce management delays should be aimed at public education and improving the quality and accessibility of endoscopic evaluation.

Acute decompression sickness in compressed air workers exposed to pressures below 1 bar in the Singapore Mass Rapid Transit project.

The Singapore Mass Rapid Transit (MRT) project started compressed air work in Oct 1984. Eleven km of underground tunnels out of 20 km were built using this method. Cases of decompression sickness (DCS) arising from compressed air work are rare with working pressures less than 1 bar gauge. However, there were 10 cases of DCS in the MRT project who were exposed to less than 1 bar pressure. The authors present their clinical features and attempt to explain the observations in relation to theories of bubble nuclei formation, gas loading and rate of decompression. The formation of bubble micronuclei are correlated with physical factors like heavy exertion, and the use of vibrating tools. The concept of extremely long tissue half-times in the absorption of nitrogen in the body is discussed as a contributory factor to the development of DCS under 1 bar.

Decompression sickness in the Singapore Mass Rapid Transit Project.

In the Singapore Mass Rapid Transit Project (MRT), 11 km of underground tunnels were built using compressed air. 1,737 compressed air workers (CAWs) were employed in the project. They underwent 188,538 man decompressions at the various compressed air worksites. 160 CAWs developed Type I decompression sickness (DCS) and 4 developed Type II DCS. This gave an overall incidence of 0.087%. The adoption of strict medical selection, strict adherence to decompression procedures and the provision for acclimatization of newstarters contributed greatly to this low incidence. Prompt treatment of DCS accounted for the low relapse rate. The clinical presentation of DCS is discussed here. Prevention of DCS by worksite environmental and work-practice monitoring are advocated.

Effects of sleep deprivation on naval seamen: II. Short recovery sleep on performance.

Twenty male naval volunteers, aged 18 to 20 years, with 12 to 14 years of education, underwent a total sleep deprivation experiment on board a Republic of Singapore Navy landing ship in the South China Sea for a period of 42-102 hours. The sleep group comprised eight volunteers who dropped out at the 44th-46th h of the experiment and were randomly assigned to a 2 or 4 h sleep regime. The rest served as sleep-deprived controls. Neurobehavioural performance tests, profile of mood state and the Stanford Sleepiness Scale were applied 6 hourly starting from 6.00 am on the first experimental day. No thresholds were observed in the performance of tests related to manual tasks and subjective feeling, including naval tasks, mood and sleepiness scale during the sleep deprivation experiment. However, thresholds were observed in the performance of tests requiring cognitive and perceptive skills, including the grooved peg board, trail making, sea-shore rhythm, addition, digit span, digit symbol, flicker fusion and dynamometer tests. Performances in these tests were observed to deteriorate only after approximately 30 h of sleep deprivation. The Z score for the non-threshold tests (Z-N) deteriorated from -0.01 at the start of the experiment to 1.25 at the 42nd h of the experiment just before the imposed sleep and improved to 0.81 at the 48th h of the experiment just after the imposed sleep; and the Z score for the threshold tests (Z-T) varied from -0.07 at the start to 0.49 just before sleep (at the 42nd h) and to continuously deteriorate to 0.83 just after sleep (at the 48th h).(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of sleep deprivation on performance of Naval seamen: I. Total sleep deprivation on performance.

Sleep deprivation leads to impairment in performance, loss of efficiency and deterioration in mood states such as tension, depression, aggression, fatigue, confusion and vigour. These can be detrimental to combat readiness and could contribute to "battle stress". In the present study, a homogeneous group of 20 seamen under total sleep deprivation was rated 6 hourly with the Stanford Sleepiness Scale (SSS), Profile of Mood States (POMS) and a battery of performance tests including the trail making, grooved peg board, digit span, digit symbol, sea-shore rhythm, flicker fusion, dynamometer and naval tasks. With the exception of the trail making test and naval tasks, the test performance was observed to correlate significantly (P < 0.05) with the SSS. A higher sleepiness score was associated with a poorer performance in test scores. On the time trends of sleep deprivation on the performance tests measured, a dip in performance was observed in all the tests at 42 hours of sleep deprivation and continuous deterioration of performance was observed after 72 hours of sleep deprivation. The cognitive, vigilance, mood and sleepiness tests were substantially affected by sleep deprivation. Greater effect was observed in tests that involved cognition, speed and precision and smaller effect was observed in routine tasks that involved gross manual movement. The decrease in performance observed at 42 hours of sleep deprivation was 5.9 standard deviation from initial values for SSS; 3.9 for sea-shore rhythm, 3.0 for grooved peg board; 2.6 for dynamometer; 2.4 for mood; 1.8 for digit span; 1.6 for trail making and digit symbol; 1.0 for naval tasks and addition; and 0.9 for flicker fusion.(ABSTRACT TRUNCATED AT 250 WORDS)

Tolerability and efficacy of single dose diethylcarbamazine (DEC) alone or co-administration with Ivermectin in the clearance of Wuchereria bancrofti microfilaraemia in Pondicherry, South India.

The tolerability and efficacy of single dose DEC (12mg/kg body weight) or co-administration of DEC (6mg/kg body weight) with Ivermectin (200 or 400 mcg/kg of body weight) was studied in 60 asymptomatic W. bancrofti microfilariae (Mf) carriers following a double blind randomized design. The drugs were tolerated well. The incidence of adverse reactions of DEC (85.0%), DEC + Ivermectin 200mcg (95.0%) and DEC + Ivermectin 400mcg (100%) did not vary significantly (P>0.05). The mean score of adverse reaction intensity due to DEC + Ivermectin 200mcg (1.41) was significantly higher compared to DEC (0.61) (P<0.05). However, there was no significant difference between and DEC +Ivermectin 400mcg (0.89) and DEC + Ivermectin 200mcg (1.41) and DEC + Ivermectin 400mcg and DEC. The major adverse reactions were fever, headache and myalgia in all groups. The incidence and intensity of the adverse reactions were maximum between 24 to 48 hours of post therapy. The haematological and biochemical parameters did not vary significantly between pre and 7-day post therapy values in any of the study groups (P>0.05). Efficacy was measured in terms of proportion of cases clearing microfilaraemia completely and reduction in geometric mean parasite density in comparison to pre therapy levels. At the end of one year, DEC with Ivermectin 400mcg group showed significantly higher efficacy in complete clearance of Mf (94.4%) than that of DEC with Ivermectin 200mcg (60.0%) or DEC alone (52.6%) (P<0.05). However, no significant difference was observed in reduction of geometric mean Mf density (99.9%, 99.7%, 99.5% respectively). In all the groups, the tolerability and efficacy of the drugs were independent of host age and gender.

Prospective phase II study of the efficacy of transcutaneous electrical nerve stimulation in post-radiation patients.

AIMS: To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) delivered using an extra-oral device in patients with radiation-induced xerostomia. MATERIALS AND METHODS: Thirty oral cavity and oropharyngeal cancer patients post-adjuvant (n = 26) or definitive radiotherapy (n = 4) were enrolled in this study. The TENS electrode pads were placed externally on the skin overlying the parotid glands. Unstimulated whole saliva was collected for 5 min into graduated tubes using the low forced spitting method. The TENS unit was then activated and stimulated saliva was collected for an additional 5 min. The difference between unstimulated and stimulated saliva output was measured using the paired t-test. Linear regression was used to determine factors significantly influencing the improvement in salivary output. RESULTS: Twenty-nine of 30 patients showed increased saliva flow during stimulation. A statistically significant improvement in saliva production (P < 0.05) during stimulation was noted. The mean unstimulated saliva flow was 0.056 ml/min and the mean stimulated saliva flow was 0.12 ml/min with a median increase of 0.06 ml/min. The interval to the application of TENS after radiotherapy significantly influenced the improvement in salivary flow. CONCLUSION: Extra-oral application of TENS is effective in increasing the whole salivary flow in most of the post-radiated oral cavity/oropharyngeal cancer patients with xerostomia. TENS therapy may be useful as an effective supportive treatment modality in post-radiated oral cancer patients.