Joint trajectories of disease activity, and physical and mental health-related quality of life in an inception lupus cohort.

OBJECTIVES: To examine for latent patterns of SLE disease activity trajectories that associate with specific latent patterns of health-related quality of life (HRQoL; Medical Outcomes Study Short Form-36), and to determine baseline predictors of class membership. METHODS: In this retrospective longitudinal inception cohort of 222 SLE adults over 10 years, trajectories of three outcomes were studied jointly: Short Form-36 physical (PCS) and mental (MCS) component summaries and adjusted mean SLEDAI-2000 (AMS). Group-based joint trajectory modelling was used to model latent classes; univariable and multivariable analyses were used to identify predictors of class membership. RESULTS: Four latent classes were identified: Class 1 (C1) (24%) had moderate AMS, and persistently low PCS and MCS; C2 (26%) had low AMS, moderate PCS and improved then worsened MCS; C3 (38%) had moderate AMS, and persistently high PCS and MCS; and C4 (11%) had high AMS, moderate-low PCS and improving MCS. Baseline older age was associated with lower HRQoL trajectories. Higher AMS trajectories did not associate with a particular pattern of HRQoL trajectory. A higher prevalence of fibromyalgia (44% in C1) was associated with worse HRQoL trajectories. Disease manifestations, organ damage and cumulative glucocorticoid were not differentially distributed across the latent classes. CONCLUSION: High disease activity did not necessarily associate with low HRQoL. More patients with worse HRQoL trajectories had fibromyalgia. Older age at diagnosis increased the probability of belonging to a class with low HRQoL trajectories. The care of SLE patients may be improved through addressing fibromyalgia in addition to disease activity.

Canadian Rheumatology Association Recommendations for the Assessment and Monitoring of Systemic Lupus Erythematosus.

OBJECTIVE: To develop recommendations for the assessment of people with systemic lupus erythematosus (SLE) in Canada. METHODS: Recommendations were developed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. The Canadian SLE Working Group (panel of Canadian rheumatologists and a patient representative from Canadian Arthritis Patient Alliance) was created. Questions for recommendation development were identified based on the results of a previous survey of SLE practice patterns of members of the Canadian Rheumatology Association. Systematic literature reviews of randomized trials and observational studies were conducted. Evidence to Decision tables were prepared and presented to the panel at 2 face-to-face meetings and online. RESULTS: There are 15 recommendations for assessing and monitoring SLE, with varying applicability to adult and pediatric patients. Three recommendations focus on diagnosis, disease activity, and damage assessment, suggesting the use of a validated disease activity score per visit and annual damage score. Strong recommendations were made for cardiovascular risk assessment and measuring anti-Ro and anti-La antibodies in the peripartum period and conditional recommendations for osteoporosis and osteonecrosis. Two conditional recommendations were made for peripartum assessments, 1 for cervical cancer screening and 2 for hepatitis B and C screening. A strong recommendation was made for annual influenza vaccination. CONCLUSION: These are considered the first guidelines using the GRADE method for the monitoring of SLE. Existing evidence is largely of low to moderate quality, resulting in more conditional than strong recommendations. Additional rigorous studies and special attention to pediatric SLE populations and patient preferences are needed.

OHEP: an oral health education program for mothers of newborns.

INTRODUCTION: The purposes of the study were to determine (a) the knowledge base of mothers of newborns on oral health for newborns and young infants and (b) the effectiveness of an oral health education program provided to mothers of newborns prior to discharge from the postpartum unit. METHODS: Ninety-four mothers of healthy newborns on a postpartum unit were randomized to the treatment or control group. A pretest was administered to each mother to assess the mother's knowledge of infant oral health. The treatment intervention was a DVD designed collaboratively by an interprofessional team of nurse practitioners and dental faculty to educate the mothers on oral health care for their newborns. The control intervention was a DVD on newborn nutrition. All participants received routine newborn nursery discharge instructions by the postpartum nurses and physicians. Follow-up appointments were scheduled 6 and 12 months later for administration of the posttest to the mothers and for oral health assessments of the infants. RESULTS: Pretest questionnaire results revealed that most mothers lacked knowledge about oral health care for infants and young children, especially concerning vertical transmission of streptococcus mutans through food-sharing practices. In addition, 28.4% of the mothers were not aware of the benefits of fluoride as a prevention strategy for dental caries. A significant no-show rate for the planned follow-up visits in the dental clinic hindered our plans to evaluate the effectiveness of the oral health educational program on prevention of dental white spots or decay when the study infants were 6 and 12 months old, respectively. DISCUSSION: The knowledge deficit of mothers of newborns regarding oral health care for infants may be one of the contributing factors to the high prevalence rate of dental caries in children younger than 71 months. An oral health educational program provided to mothers on the postpartum unit prior to discharge from the hospital may help increase mothers' knowledge about oral health care and prevention of dental caries in infants and young children.

Deliberate self-harm in adolescent psychiatric outpatients in Singapore: prevalence and associated risk factors.

INTRODUCTION: Deliberate self-harm (DSH) is frequently seen in adolescents with a range of mental health problems. The prevalence and features of DSH vary among different countries and settings. This study examines the prevalence of self-harm in a sample of adolescents seen at a psychiatric outpatient clinic in Singapore. METHODS: Information regarding self-harm, as well as its associated demographic and clinical risk factors, was extracted from the clinical records of 542 consecutive, new patients, aged 12-19 years, who presented between 2006 and 2010. RESULTS: DSH was reported in 23.6% of patients, and was positively associated with the female gender (odds ratio [OR] 4.54), mood disorders (OR 4.58), adjustment disorders (OR 3.41) and regular alcohol use (OR 4.80). However, there was no association with parental marital status, anxiety disorder, habitual smoking or family history of psychiatric illness. CONCLUSION: DSH is a significant clinical problem that may be influenced by biological and clinical factors. Adolescents presenting with DSH should be examined for mood and alcohol use disorders.

Oral health findings in athletes with intellectual disabilities at the NYC Special Olympics.

This study collected data to describe the oral health in Special Olympics athletes with intellectual disabilities from New York City, using the standardized Special Olympics, Special Smiles protocol. A total of 664 self-selected athletes with intellectual disabilities were screened between 2005 and 2008. A standardized form was used for data collection. Screenings were performed using available light or flashlight, tongue depressor, and disposable mirror. Oral hygiene, reports of oral pain, untreated caries, missing and filled teeth were recorded. The majority of the athletes were 20 years of age or older (52%). Of the examined athletes, 9% reported oral pain, 8% needed urgent care, 28% had untreated caries, 60% had filled teeth, and 32% had signs of gingival disease. Mouthguards were recommended for 26% of athletes. Our findings offer an initial evaluation of the oral health of Special Olympics athletes with intellectual disabilities in New York City. Results showed high preventive and restorative oral health needs in the Special Olympics population.