The relationship of tooth shade and skin tone and its influence on the smile attractiveness.

OBJECTIVE: The purpose of this clinical study was to determine if skin tone and tooth color had the same influence on smile attractiveness. MATERIALS AND METHODS: A woman's smile photograph was digitally manipulated to create a range of images with varying colors. The skin shade was modified to create four tones (p1: light, p2: light medium, p3: medium dark, p4: dark) using the L'Oreal True Illusion shade as a guide. The tooth shade was modified in four different tones: A1, A2, A3, A4 using the VITAPAN Classical shade guide to produce 16 images. A sample of 328 participants rated each image for attractiveness by means of a visual analog scale (VAS). Comparison among groups was performed with a 2-way ANOVA adjusted for multiple comparisons with the Bonferroni test (α = .05). RESULTS: Image (p3-a1) showed the highest VAS values, while image (p1-a4) obtained the lowest, (Bonferroni Test: a1 vs a2, a3, a4 P < .001; p3 vs p1, p2, p4 P < .001). Analysis performed for age, sex, level of education, and laypeople/dentists were not statistically significant (P > .05). CONCLUSIONS: Variations in tooth and skin tone can significantly influence the perception of smile attractiveness. In the tested conditions, a brighter tooth shade significantly affected the attractiveness of the smile independently from skin tone. CLINICAL SIGNIFICANCE: Understanding patient and dentist perception of the attractiveness of a smile with the important role-played by skin tone, may help clinicians to better identify teeth shade, helping delivery of tailored prostheses and esthetic restorations.

Prognostic value for mortality of the new FADOI-COMPLIMED score(s) in patients hospitalized in medical wards.

BACKGROUND: Recently we defined a user-friendly tool (FADOI-COMPLIMED scores-FCS) to assess complexity of patients hospitalized in medical wards. FCS-1 is an average between the Barthel Index and the Exton-Smith score, while FCS-2 is obtained by using the Charlson score. The aim of this paper is to assess the ability of the FCS to predict mortality in-hospital and after 1-3-6-12-months. In this perspective, we performed comparisons with the validated Multidimensional Prognostic Index (MPI). METHODS: It is a multicenter, prospective observational study, enrolling patients aged over 40, suffering from at least two chronic diseases and consecutively admitted to Internal Medicine departments. For each patient, data from 13 questionnaires were collected. Survival follow-up was conducted at 1-3-6-12 months after discharge. The relationships between cumulative incidences of death with FCS were investigated with logistic regression analyses. ROC curve analyses were performed in order to compare the predictiveness of the logistic models based on FCS with respect to those with MPI taken as reference. RESULTS: A cohort of 541 patients was evaluated. A 10-point higher value for FCS-1 and FCS-2 leads to an increased risk of 1-year death equal to 25.0% and 27.1%, respectively. In case of in-hospital mortality, the relevant percentages were 63.1% and 15.3%. The logistic model based on FCS is significantly more predictive than the model based on MPI (which requires an almost doubled number of items) for all the time-points considered. CONCLUSIONS: Assessment of prognosis of patients has the potential to guide clinical decision-making and lead to better care. We propose a new, efficient and easy-to-use instrument based on FCS, which demonstrated a good predictive power for mortality in patients hospitalized in medical wards. This tool may be of interest for clinical practice, since it well balances feasibility (requiring the compilation of 34 items, taking around 10 minutes) and performance.

What Quality and Safety of Care for Patients Admitted to Clinically Inappropriate Wards: a Systematic Review.

BACKGROUND: In countries with public health system, hospital bed reductions and increasing social and medical frailty have led to the phenomenon of "outliers" or "outlying hospital in-patients." They are often medical patients who, because of unavailability of beds in their clinically appropriate ward, are admitted wherever unoccupied beds are. The present work is aimed to systematically review literature about quality and safety of care for patients admitted to clinically inappropriate wards. METHODS: We performed a systematic review of studies investigating outliers, published in peer-reviewed journals with no time restrictions. Search and screening were conducted by two independent researchers (MLR and ER). Studies were considered potentially eligible for this systematic review if aimed to assess the quality and/or the safety of care for patients admitted to clinically inappropriate units. Our search was supplemented by a hand search of references of included studies. Given the heterogeneity of studies, results were analyzed thematically. We used PRISMA guidelines to report our findings. RESULTS: We collected 17 eligible papers and grouped them into six thematic categories. Despite their methodological limits, the included studies show increased trends in mortality and readmissions among outliers. Quality of care and patient safety are compromised as patients and health professionals declare and risk analysis displays. Reported solutions are often multicomponent, stress early discharge but have not been investigated in the control group. CONCLUSIONS: Published literature cannot definitely conclude on the quality and safety of care for patients admitted to clinically inappropriate wards. As they may represent a serious threat for quality and safety, and moreover often neglected and under valued, well-designed and powered prospective studies are urgently needed.

Single tooth anesthesia versus conventional anesthesia: a cross-over study.

OBJECTIVES: The aim of the present study was to compare an electronic device, the Wand Injection System (Milestone Scientific Livingstone), with conventional anesthesia in terms of the following: pain sensation during anesthetic injection; effectiveness in achieving adequate anesthesia for a complete painless dental treatment; post-operative discomfort; and patient's anxiety toward dental treatment. MATERIALS AND METHODS: Eighty adults from 18 to 70 years were enrolled in this cross-over study. Each patient served as his/her own control being subject to two anesthesia techniques: conventional and Single Tooth Anesthesia (STA) performed with the Wand. A split-mouth design was adopted in which each tooth undergoing conservative restorative or endodontic treatment received anesthesia with both techniques at 1-week interval. Before anesthetic administration, the patients' anxiety levels were determined. Physiological parameteres were measured before, during, and after the two injection procedures, and the Visual Analogue Scale (VAS) was used to assess pain of injection, discomfort, and anesthetic efficacy. Differences in assessment of pain's injection, discomfort, anesthetic efficacy, vital parameters (heart rate, blood pressure, and oxygen saturation), and state anxiety levels were analyzed using Student's t test (p value < 0.001). RESULTS: The mean injection pain and post-operative discomfort ratings with Wand were lower than those with conventional syringe (p = 0.022 and p < 0.001, respectively). No differences were found in the assessment of anesthetic efficacy. Blood pressure and heart rate mean values were lower during the anesthesia performed with the Wand than with the conventional syringe (p < 0.001). The anxiety level was higher during the first appointment, independently from the device used for the injections. CONCLUSION: The STA technique resulted in lower pain, discomfort, and lower intensity of physiological parameters. CLINICAL RELEVANCE: Single Tooth Anesthesia could be an efficacious alternative to conventional procedures.

Percentage of Gutta-percha-filled Areas in Canals Obturated by 3 Different Techniques with and without the Use of Endodontic Sealer.

INTRODUCTION: This study had 2 purposes: to compare the Microseal, continuous wave, and Thermafil techniques and to compare the same techniques with and without endodontic sealer. METHODS: Ninety extracted mandibular premolars were allocated into 6 groups obturated with Microseal (Analytic, Glendora, CA) and sealer (Mseal), Microseal without sealer (Mnoseal), System B (EIE Analytic Technology, Orange, CA) and sealer (SBseal), System B without sealer (SBnoseal), Thermafil (Dentsply, Tulsa Dental, Tulsa, OK) and sealer (Tseal), and (Tnoseal) Thermafil without sealer (Tnoseal). The teeth were sectioned at 1 and 3 mm from the apex. The total area of each canal segment was measured, and the areas were converted to the percentage of gutta-percha-filled areas, sealer-filled areas, and void areas. Data obtained were statistically elaborated using the t test (P ≤ .01). RESULTS: At 1 mm, SBseal produced a higher VA than Mseal and Tseal. At 3 mm, Tseal produced a lower VA than Mseal and SBseal, whereas Mseal produced a lower VA than SBseal (P > .01). At 1 mm, Tnoseal produced a significantly higher VA than Mnoseal and SBnoseal (P = .001). At 3 mm, Tnoseal produced a higher VA than Mnoseal and SBnoseal (P = .01). Tnoseal produced a significantly higher VA than Tseal both at 1 mm (P = .001) and 3 mm (P = .001). CONCLUSIONS: Endodontic space filling is traditionally provided by sealer and gutta-percha. In this study's conditions, gutta-percha alone showed better filling at both 3 mm and 1 mm in the Microseal and System B techniques. Considering the limits of our study, we can affirm that endodontic techniques using sealer could counteract thermoplasticized gutta-percha progression.

O emprego de linguagens acessíveis para alunos com deficiência visual em aulas de Óptica / Using accessible language with students with visual impairment when studying optics

O presente artigo encontra-se inserido dentro de um estudo que busca compreender as principais alternativas para a inclusão de alunos com deficiência visual no contexto do ensino de física. Focalizando aulas de óptica, analisa as viabilidades comunicacionais entre licenciandos e discentes com deficiência visual. Para tal, enfatiza as estruturas empírica e semântico-sensorial das linguagens utilizadas, indicando fatores geradores de acessibilidade às informações veiculadas. Recomenda, ainda, alternativas que visam dar condições à participação efetiva do discente com deficiência visual no processo comunicativo, das quais se destacam: a identificação da estrutura semântico-sensorial dos significados veiculados, o conhecimento da história visual do aluno, a utilização de linguagens de estrutura empírica tátil-auditiva interdependente em contextos interativos, bem como, a exploração das potencialidades comunicacionais das linguagens constituídas de estruturas empíricas fundamental auditiva, e auditiva e visual independentes.

This paper is part of a broader study aiming to understand the main alternatives for including students with visual impairments in the context of teaching physics. It analyzes the feasibility of communication between future physics teachers and their students with visual impairments during classes on optics. To this end, the study emphasizes empirical and semantic-sensorial structures of language that need to be used, indicating factors that enable access to information the teacher means to impart. Alternatives are recommended in order to enable students with visual impairments to participate as fully as possible in the communicative process. Among them we emphasize: the identification of semantic-sensorial structures; understanding the student's visual history; using interdependent empirical tactile-audio language structures in interactive contexts, as well as exploring communicational potentialities of languages made up of empirical structures that are primarily hearing or that have independent audio and visual structures.

Co-morbidity does not reflect complexity in internal medicine patients.

Internal medicine patients are mostly elderly; they have multiple co-morbidities, which are usually chronic, rather than self-limiting or acute diseases. Neither administrative indicators nor co-morbidity indexes, though validated in elderly patients, are able to completely define these "complex" patients or to allow physicians to correctly "cope" with them. For the complex patients found in internal medicine wards, internists need not only to find the best diagnosis and treatment, but also to apply a complex intervention (i.e., a comprehensive assessment and both continuous and multi-disciplinary care) in order to maintain their health and ability to function and to prevent or delay disability, frailty, and displacement from home and community. The aim of this review is to underscore the differences between the concepts of co-morbidity and complexity, to discuss instruments for their measurement, and to highlight related implications, areas of uncertainty, and the responsibilities of internists in the assessment and management of inpatients of their wards. The conclusion we come to is that it is mandatory to shift from a finance/administrative-based management system to a clinical process model (clinical governance) driven by the quality of the medical outcome and the cost of achieving that outcome. From a "complexity theory" standpoint, patient-centered care and collaboration can be seen as simple rules that guide desirable behaviors in a complex system. By exploring the real complexity of our patients, we exercise the holistic, anthropologic medicine of the person that is internal medicine.

The assessment of complexity in internal medicine patients. The FADOI Medicomplex Study.

BACKGROUND: Although the number of elderly people is progressively increasing in the world, old and very old patients have been under-represented and understudied in trials evaluating the efficacy of chronic illness management models. The usual hospital indicators and practice guidelines do not consider the effects of complexity - co-morbidity, social support, functional and cognitive status, patient adherence to therapy, risk of adverse drug reactions - in these subjects. The aim of this observational, multi-centric cohort study was to carefully assess factors contributing to the complexity of care for patients admitted to internal medicine wards. This was done by evaluating the severity of disease and degree of stability at admission, co-morbidity, age-related impairments, and the need for discharge planning plus post-discharge support. METHODS: A total of 386 patients from 11 internal medicine wards in Emilia-Romagna and Marche, Italy, enrolled in a given week were evaluated. At admission, the following variables were recorded: demographic characteristics, medical history, global clinical-social prognostic evaluation, co-morbidity, severity of illness, presence of shock or hemodynamic instability, coma, and frequencies and causes of unscheduled hospital re-admission. RESULTS: Cancer, congestive heart failure, pneumonia, stroke, and chronic obstructive pulmonary disease were the most frequent primary diagnoses. The complexity of our case study was characterized by several concomitant diseases. Over 50% of the patients were considered severe or more than severe, and over 20% extremely severe, with very high co-morbidity indices and illness severity scores. Some 55% of our patients were in need of partial or total care; 10% had some speech impairment, and 63% needed in-home health care after hospital discharge. CONCLUSIONS: The increasing numbers of elderly patients admitted to internal medicine departments suggests the need for a chronic illness management model, integrating gerontological and geriatric care to improve outcomes. For effective care, future protocols need to take a multi-dimensional, interdisciplinary approach to these patients and to develop a coordinated, integrated plan for treatment and long-term follow-up.

Ensino de conceitos físicos de termologia para alunos com deficiência visual: dificuldades e alternativas encontradas por licenciandos para o planejamento de atividades / Future high school teachers' difficulties and alternatives found to planning thermology activities designed for students with visual impairments

Relatamos aqui resultados parciais de um estudo que analisou o desempenho de futuros professores quando, durante o desenvolvimento de uma disciplina de Prática de Ensino de Física, foram solicitados a planejar, elaborar e ministrar, em situações reais de sala de aula, tópicos de ensino de termologia a uma turma de estudantes, dentre os quais se incluíam alunos com deficiência visual. Os dados coletados mostram que as principais dificuldades apresentadas pelos futuros professores referem-se à abordagem do conhecer fenômenos físicos como dependente do ver. Por outro lado, como alternativas, os futuros professores mostraram criatividade em superar atitudes passivas relativas à problemática educacional considerada e a elaboração de estratégias metodológicas destituídas da relação conhecer/ver.

The present article reports partial outcomes of a study that aimed to verify future High School teachers' performance. A group of undergraduates were taking a course called "Teaching Practice" where they were required to plan, elaborate and teach, in classroom settings, topics relating to thermology to a class which included students with visual impairments. Data that was collected showed that, on the one hand, the main difficulties presented by future Physics High School teachers were related to the approach to understanding phenomena in physics in a visually dependent way. On the other hand, these future teachers demonstrated creativity in overcoming passive attitudes relative to this educational problem and were able to develop methodological strategies unhindered by the knowing/seeing relation.

Prevalence estimates for chronic diseases in Italy: exploring the differences between self-report and primary care databases.

BACKGROUND: The aim of this study was to describe population and primary care morbidity and to examine how the differences vary across the diseases and are influenced by patients' demographic characteristics. METHODS: A comparison of the prevalence of four chronic conditions for 432747 patients from the Health Search Database (HSD) and 119799 individuals from a Health Interview Survey was carried out. A linear regression was performed to study the associations between age and difference in morbidity. RESULTS: Similar prevalence was found for diabetes and hypertension, whereas for chronic obstructive pulmonary disease (COPD) and gastroduodenal ulcer lower HSD prevalence was reported. Among females, age was always associated with morbidity difference. Among males, significant associations were found only for COPD (R2 = 0.81; p = 0.001) and gastroduodenal ulcer (R2 = 0.93; p < 0.001). CONCLUSIONS: The difference between population and primary care morbidity is affected by disease under investigation and patients' demographic characteristics. Therefore, in choosing the more cost-effective approach to collect data such evidence should be taken into account, and results should be interpreted with great caution.

Exploring patient- and doctor-related variables associated with antibiotic prescribing for respiratory infections in primary care.

OBJECTIVE: To assess patient- and doctor-related variables leading physicians to prescribe antibiotics or parenteral antibiotics for acute respiratory infections (ARIs) and to describe the variability as well as the appropriateness of antibiotic use and its predictive factors in general practice. METHODS: We conducted a cross-sectional study among patients aged 15-85 years with a diagnosis of ARIs, using information from 469 GPs from the Health Search Database. Diagnoses were linked with antibiotic prescriptions and other patients and doctor-related variables. Available scientific evidence was used to establish the appropriateness of first-choice antibiotic treatment. Frequency analyses and logistic regressions were used to identify variables associated with antibiotic use and appropriateness. RESULTS: On 67,761 cases of ARIs, antibiotics were prescribed in 63.2%, varying from 80.9% for acute bronchitis to 43.9% for croup, influenza and common cold. Significant associations with antibiotic use were found for geographic location and number of patients under care. The use of diagnostic tests significantly lowered the risk. Geographic location and living in an urban area were associated with parenteral antibiotic use. Amoxicillin (16.7%) and amoxicillin-clavulanate (17.9%) were the most common antibiotics prescribed. Appropriateness was reported in 39.0% of cases, with geographic location, physician's gender and diagnostic tests being the factors more predictive of appropriate antibiotic use. CONCLUSIONS: There is still excessive antibiotic use for ARIs. Its overuse is influenced by the physicians' characteristics and by the environment in which they practice, whilst diagnostic tests might reduce inappropriateness. Therefore, effective strategies for changing diagnostic and therapeutic behaviour are needed.

AIDS: Manifestaçäo primária ocular; relato de um caso / AIDS: primary ocular manifestation; report of a case

Paciente com episódios de conjuntivite que respondia bem ao tratamento local, recidivando em espaço de tempo bastante pequeno. Associado ao quadro ocular, uma gripe persistente