The Value of the Sequential Organ Failure Assessment (SOFA) Score and Serum Lactate Level in Sepsis and Its Use in Predicting Mortality.

Background and objective Sepsis is a major health burden that leads to significant morbidity and mortality. Early diagnosis and severity prediction using various scoring systems can reduce the mortality rate, particularly in developing nations. There are two aims of this study. One is to evaluate the prognostic accuracy of the Sequential Organ Failure Assessment (SOFA) score and serum lactate levels in patients with sepsis to predict mortality. The other aim is to evaluate the relationship between the SOFA score and lactate so that we may be able to use lactate as a surrogate predictor of organ dysfunction and mortality in sepsis. Methods An observational prognostic accuracy study was conducted in the Department of General Surgery, Intensive Care Unit (ICU), Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India, between 1 July 2021 and 1 October 2022. We selected 128 patients, calculated their SOFA and lactate levels, and divided them into survivors and non-survivors according to their outcomes after seven days of assessment. The SOFA score and serum lactate levels were assessed as predictors of mortality, and their correlation was studied. Results We observed a significant decreasing trend in the value of the mean SOFA, maximum SOFA, mean lactate, and maximum lactate among survivors, whereas an increasing trend for the same was observed in non-survivors. The receiver operating characteristic (ROC) analysis showed the best diagnostic accuracy of the mean lactate (area under the curve {AUC}=0.996, 95% confidence interval {CI}=0.964-1.00, p≤0.0001). The maximum lactate (AUC=0.987, 95% CI=0.949-0.999, p≤0.0001) and mean SOFA scores (AUC=0.986, 95% CI=0.948-0.999, p≤0.0001) were good at predicting the mortality in sepsis. A slightly lower diagnostic accuracy was found for the maximum SOFA score (AUC=0.969, 95% CI=0.923-0.992, p≤0.0001). There was a strong correlation between the mean lactate and the mean SOFA with a correlation coefficient of 0.883 and p=0.0001. A good correlation was found between maximum lactate and maximum SOFA too (correlation coefficient=0.873, p≤0.0001). Conclusion This study highlights the different predictors of mortality in the patients with sepsis. The maximum lactate was the most accurate in predicting mortality in sepsis. It also demonstrates how serum lactate, due to its strong correlation with the SOFA score, can be used in its place to predict mortality in sepsis and organ dysfunction.

Effect of Socioeconomic Status on Teeth and Dental Care - Evidence from a Population-based Study in Indonesia.

PURPOSE: Education is well-known as a determinant of oral health and dental behaviours in high-income countries, but much less is known for countries with lower incomes. This study aimed to identify the extent to which education affects oral health and dental behaviours in Indonesia. MATERIALS AND METHODS: This study used data from the Indonesian Basic Health Survey 2013. From this nationally representative sample of 945,057 people 5-100 years old, a series of mixed-effects Poisson regression models that accounted for sampling weights estimated the effect of educational attainment on edentulism, dental care utilisation, and toothbrushing behaviour. RESULTS: Consistent educational gradients were found for all outcomes and across all model specifications. People without a formal educational degree had a 1.03 (95% CI: 1.03-1.04) times higher risk of not utilising any dental care, a 3.15 (95% CI: 2.47-4.02) times higher risk of being edentulous, and a 15.6 (95% CI: 12.76-19.02) times higher risk of having low toothbrushing frequency than people having a university degree or higher. CONCLUSIONS: Stark and consistent educational gradients were observed in the dentate status, dental services utilisation, and toothbrushing in Indonesia. Educational inequalities were much larger for toothbrushing behaviours than for dental care utilisation. Intervention points for health policy should urgently prioritise public health interventions to promote overall educational attainment, preventive services, and dental care targeted at those with lower educational attainment.

Economic evaluations in the treatment and evaluation of patients with periodontal disease: A critical review.

AIM: To evaluate the types and quality of reporting of economic evaluations carried out in the clinical management of periodontal disease over 32 years from 1987 to 2019. MATERIAL AND METHODS: A systematic search of articles from 1987 to 2019 was conducted using PubMed, Web of Science, The Cochrane Central Register of Controlled Trials, Health Technology Assessment Database and Embase. The quality of the economic evaluations was assessed based on the Consolidated Health Economic Evaluation Reporting Standard checklist. Due to considerable between-study heterogeneity, a meta-analysis was not performed. RESULTS: Twenty one publications were included. 11 studies used cost-effectiveness analysis, five used cost-minimization analysis, four used cost-utility analysis and two used cost-benefit analysis. Comparators, choice of health outcomes, estimating resources and costs were fully reported in all studies. Many studies had inadequate reporting in terms of estimating resources and costs, choice of health outcomes, characterizing heterogeneity and study perspective. CONCLUSIONS: There has been an increase in health economics studies in the field of clinical periodontology over the past decade. Several studies did not report study perspective, and the health outcomes chosen were not relevant for some studies. Future studies should follow an economic evaluation checklist for high-quality reporting and consistency.

Brief Report: Psychometric Properties of the Ability in Behavior Assessment and Interventions for Teachers-Revised (ABAIT-R).

Given the importance of competencies in functional behavior assessment (FBA) and behavioral interventions among teachers for managing problem behaviors among children with autism spectrum disorder (ASD) and other developmental disabilities, a previously reported ability in behavior assessment and interventions for teachers (ABAIT) needed improvements in the multiple-choices by adding a 'don't know' option. This study reports on the psychometric properties of this revised scale (ABAIT-R) among 102 special educators assessed using Rasch models. It was found that the model had good fit and a wide spread of difficulties (3.63 to - 2.60). ABAIT-R had good targeting (over 85%) and high reliability (0.79). The assumptions of the model were met recommending sufficiency for the use of summated score from ABAIT-R among teachers.

Psychometric properties of the Child Oral-care Performance Assessment Scale.

OBJECTIVES: This study aimed to assess the psychometric properties of Child Oral-care Performance Assessment Scale (COPAS). METHODS: Items for the instrument were developed and pilot tested. This questionnaire was implemented in the Australian National Child Oral Health Study 2012-2014, whose aims included the assessment of oral care performance. This nationally representative sample of 23 538 respondents with complete data was divided into five groups: a main validation group and four cross-validation groups, using blocked randomization. Two scales were constructed, full scale with 37 items (COPAS) and a partial scale with a subset of 31 items (COPAS-Partial). Internal consistency was assessed using Cronbach's alpha. Construct validity was assessed using correlation coefficients, and structural validity was ascertained in the main validation group and confirmed in the cross-validation groups using structural equation models. RESULTS: Cronbach's alpha for COPAS was 0.95, and for COPAS-Partial was 0.94. The convergent validity of global satisfaction with oral care and the subscales was r = 0.29-0.51, and that with the overall scales was r = 0.59 for COPAS and r = 0.59 for COPAS-Partial. COPAS (Root mean squared error of approximation (RMSEA) = 0.06, Comparative fit index (CFI) = 0.90, Tucker-Lewis index (TLI) = 0.89, and Coefficient of determination(COD) = 0.99) and COPAS-Partial (RMSEA = 0.07, CFI = 0.91, TLI = 0.90, COD = 0.97) had adequate fit. Structural invariance was present (P-value = 0.97). CONCLUSION: There was acceptable structural validity, construct validity and internal consistency in the models tested for COPAS and COPAS-Partial. COPAS has potential use in the evaluation of the delivery of dental services to children.

Development and Validation of the Ability in Behavior Assessment and Interventions for Teachers Using Delphi Technique and Rasch Analysis.

Functional Behavior Assessment (FBA) and behavior interventions have been effective in the management of challenging behavior among children with developmental disabilities including autism spectrum disorders. Research suggests the need for valid measurement instruments for verifying, calibrating and scoring competence in FBA and behavior interventions. The validation for the Ability in Behaviour Assessment and Interventions for Teachers (ABAIT) adopted the Delphi method for developing consensus followed by the application of Rasch Measurement Model (RMM). RMM among 292 special educators reported appropriate infit (0.84-1.11), outfit (0.94-1.05), and item separation reliability (0.99), though some items reported low point-biserial correlation. The ABAIT was developed with expert consensus and was found to have a suitable fit with RMM.

Critical review of willingness to pay for clinical oral health interventions.

OBJECTIVES: This critical review aimed to identify, consolidate and evaluate the quality of Willingness to Pay (WTP) studies applied to clinical contexts in the field of dentistry. METHODS: PubMed and Web of Science databases were systematically searched for relevant publications. Screening and data extraction was then performed. Primary literature in English-language were included to assess the WTP for oral health interventions, when the valuations were applied to a clinical measure. Twenty-six publications met the inclusion criteria. RESULTS: WTP was elicited mainly via face-to-face interviews (13 publications) and questionnaires (12 publications). The majority (24) of publications selected an out-of-pocket payment vehicle. Eleven publications adopted a bidding method, nine publications adopted an open-ended format, and the remaining six studies adopted a payment card or choice method. Pre-testing was reported in only nine publications, and few studies accounted for starting point bias. Eight of 11 publications found that higher incomes were associated with higher WTP values. The female gender, a younger age and higher education levels were associated with a higher WTP in select studies. CONCLUSIONS: Only a small minority of the studies used strategies to avoid well documented biases related to WTP elicitation. Cost versus benefit of many clinical scenarios remain uninvestigated. CLINICAL SIGNIFICANCE: WTP studies in dentistry may benefit from pre-testing and the inclusion of a script to minimise hypothetical bias. They may also be better conducted face-to-face and via a shuffled payment card method. Income levels, and potentially education levels, gender and age, should be assessed for their influence on WTP values.

Testing reliability and validity of oral impacts on daily performances for Chinese-speaking elderly Singaporeans.

OBJECTIVE: To cross-culturally adapt the oral impacts on daily performance (OIDP) and assess its reliability and validity on Chinese-speaking community dwelling elderly Singaporeans. BACKGROUND: There are no previous reports of valid oral health-related quality of life instruments for elderly Singaporeans or perceived conditions associated with impacts reported in OIDP among the Singaporean elders. METHODS: The OIDP was translated from English to Chinese and then back translated. The OIDP questionnaire along with questions related to overall quality of life and self-rated dental health was administered to 202 Chinese-speaking elderly Singaporeans by trained interviewers, and it was repeated after 1 month. Test-retest reliability was assessed using intraclass correlation coefficient; internal consistency was established using Cronbach's alpha, and construct validity using correlation coefficients with self-reported oral health-related and global quality of life measures. In addition, Kruskal-Wallis tests assessed differences in the OIDP score between different subjective health and global quality of life groups. RESULTS: The median age of participants was 75 years. About 19% reported oral impacts and difficulty eating was the most prevalent oral impact. Internal consistency was good with a Cronbach's alpha of 0.75, and the intraclass correlation coefficient was 0.75 (0.67-0.81). OIDP was significantly correlated with all measures of self-reported oral health and global ratings of quality of life, with correlation coefficients ranging between 0.15 and 0.52. Groups with worse perceptions about their health and quality of life had significantly higher OIDP scores. CONCLUSION: The OIDP showed successful reliability and validity for its use among Chinese-speaking older Singaporeans.

Assessment of hupu gum for its carrier property in the design and evaluation of solid mixtures of poorly water soluble drug - rofecoxib.

There are no reports about the pharmaceutical applications of hupu gum (HG). Hence the present study was undertaken to test its suitability in the dissolution enhancement of poorly water soluble drug. Rofecoxib (RFB) was taken as model drug. For comparison solid mixtures were prepared with carriers such as poly vinyl pyrrolidone (PVP), sodium starch glycollate (SSG) and guar gum (GG). Physical mixing (PM), co-grinding (CG), kneading (KT) and solvent evaporation (SE) techniques were used to prepare the solid mixtures, using all the carriers in different carrier and drug ratios. The solid mixtures were characterized by powder X-ray diffraction (XRD) and Fourier-transformed infrared spectroscopy (FTIR). There was a significant improvement in the dissolution rate of solid mixtures of HG, when compared with the solid mixtures of other carriers. There was an increase in dissolution rate with increase in concentration of HG upto 1:1 ratio of carrier and drug. No drug-carrier interaction was found by FTIR studies. XRD studies indicated reduction in crystallinity of the drug with increase in HG concentration. Hence HG could be a useful carrier for the dissolution enhancement of poorly water soluble drugs.

The construction of a "population problem" in colonial India, 1919-1947.

This article examines the construction of a "population problem" among public health officials in India during the inter-war period. British colonial officials came to focus on India's population through their concern with high Indian infant and maternal mortality rates. They raised the problem of population as one way in which to highlight the importance of dealing with public health at an all-India basis, in a context of constitutional devolution of power to Indians where they feared such matters would be relegated to relative local unimportance. While they failed to significantly shape government policy, their arguments in support of India's 'population problem' nevertheless found a receptive audience in the colonial public sphere among Indian intellectuals, economists, eugenicists, women social reformers and birth controllers. The article contributes to the history of population control by situating its pre-history in British colonial public health and development policy and outside the logic of USA's Cold War strategic planning for Asia.

Factors affecting early childhood caries among WIC-enrolled children in Linn County, Iowa.

PURPOSE: The purpose of this study was to examine the factors associated with early childhood caries (ECC) among children enrolled in 3 centers offering Iowa Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) services in Linn County, Iowa. METHODS: Data pertaining to dental caries and its determinants were collected for 115 children. Bivariate and multivariable analyses were conducted concerning outcome variables of ECC and having greater than 50 colony-forming units (CFUs) of salivary mutans streptococcus (>50 CFUs). RESULTS: The final logistic regression model for factors associated with ECC found that children with presence of visible plaque were 2.78 times more likely to have ECC (odds ratio [OR]=3.78, 95% confidence interval [CI]=1.41-10.16) and children were 0.13 times more likely to have ECC (OR=1.13, 95% CI=1.04-1.26) for each increase of one month in age. A final logistic model concerning greater than 50 CFUs showed that the children with presence of plaque on any maxillary incisor were 2.39 times more likely to have greater than 50 CFUs (OR=3.39, 95% CI=1.28-8.96) and the children were 0.61 times more likely to have greater than 50 CFUs with an increase in cariogenicity of sippy cup contents by 1 level (OR=1.61, 95% CI=1.03-2.50). CONCLUSIONS: Presence of visible plaque on maxillary incisors was associated with increased risk for presence of early childhood caries. The presence of visible plaque on any maxillary incisor and more cariogenicity of sippy cup contents were associated with having more than 50 CFUs.