The Effect of CO2 Laser Irradiation Combined with TiF4 and NaF Varnishes on Enamel Hardness: An In Vitro Study.

PURPOSE: To assess the effects of experimental titanium tetrafluoride (TiF4) varnish and commercial sodium fluoride (NaF) varnish with CO2 laser on enamel hardness. MATERIALS AND METHODS: Ninety human enamel samples were randomly assigned to one of the following groups: 1. control (no treatment) (CO); 2. NaF varnish (2.26%) (NF); 3. TiF4 varnish (2.45%) (TF); 4. CO2 laser (La); 5. NaF varnish (2.26%) with CO2 laser (NFL); 6. TiF4 varnish (2.45%) with CO2 laser (TFL). Enamel surface changes were determined by Vickers microhardness (VH) test with a load of 1000 g and a dwell time of 12 s. Each sample was indented three times. Data were analysed using one-way ANOVA and Tukey's test. RESULTS: The mean surface microhardness was 245.5 VH in the CO group, 280.3 VH in group NF, 338.7 VH group TF, 277.0 VH in group La, 345.3 VH in group NFL, and 368.0 VH in group TFL. Statistical analysis showed that groups TF, NFL, and TFL had statistically significantly higher surface hardness than the control group (p < 0.05). CONCLUSION: The microhardness of enamel treated with TiF4 varnish with or without laser irradiation was statistically significantly greater than that of the control group. Thus, using TiF4 to increase enamel surface microhardness can be recommended.

Outsourcing in Shiraz University of Medical Sciences; a before and after study.

BACKGROUND: Outsourcing is a kind of participation between public and private sector. This should be monitored and supervised to enhance the quality of outsourced services and to prevent new problems in this area. Shiraz University of Medical Sciences (SUMS) hospitals increasingly use outsourcing in recent years. OBJECTIVES: The present research aimed at comparing outsourced departments of SUMS from economic view, accessibility of services, and service quality during the years 2010-2012. METHODS: A before and after descriptive and analytical design was applied in outsourced departments of SUMS in 2014. First, 17 indicators were extracted by Delphi technique. Then, all outsourced units were assessed using economic, access to services, and quality indicators during 2010 to 2012. RESULTS: After outsourcing, in all pharmacies and dentistry units, except one, loss decreased and benefit increased from public sector viewpoint. The number of personnel for one pharmacy and two laboratories was decreased, while it remained unchanged for dentistry units. The total number of clients was increased for all pharmacies and laboratories and decreased for one dentistry unit. Patient satisfaction for pharmacies, laboratories, and dentistry units was 73.4%, 80.3%, and 78.5%, respectively. Also, employer's satisfaction from contraction was 60%, 68%, and 93.3% for pharmacies, laboratories, and dentistry units, respectively. CONCLUSION: Outsourcing as an effective strategy resulted in increase in the personnel, client, and stakeholder satisfaction. Also, it increased benefit and decreased cost for public sector. It is recommended that rules for the implementation of this strategy and monitoring the private sector should be defined.

Microleakage of an Enhanced Resin-Modified Glass Ionomer Restorative Material in Primary Molars.

OBJECTIVES: Resin composites, glass ionomers (GIs), or a combination of these materials have gradually replaced silver amalgam in pediatric dentistry. The purpose of this study was to compare the microleakage of Class II (box only) cavity restorations with ACTIVA Bioactive Restorative Glass, resin-modified GI (RMGI), and composite in primary molars. MATERIALS AND METHODS: A total of 65 primary molars with at least one intact proximal surface were selected in this in-vitro study. After debridement of each tooth, Class II (box only) cavities were prepared. Based on the type of the restorative material and the application of etching and bonding adhesives, the samples were categorized into five groups: (1) composite; (2) RMGI (Fuji II LC)+conditioner; (3) RMGI (Fuji II LC); (4) enhanced RMGI (ACTIVA Bioactive Restorative Glass)+etching/bonding; and (5) ACTIVA Bioactive Restorative Glass. The restored teeth were thermocycled for 2000 cycles. After embedding in an acrylic resin, the degree of dye penetration at axial and gingival walls was assessed using a stereomicroscope. The data were statistically analyzed by analysis of variance (ANOVA) and Tukey's test. RESULTS: Resin-based composite (RBC) Z250 showed the least microleakage, while RMGI showed maximum microleakage at axial walls. The mean degree of microleakage at gingival margins was the lowest in RBC Z250 and ACTIVA+etching/bonding groups and the highest in RMGI+conditioner and RMGI groups. CONCLUSIONS: The microleakage of ACTIVA Bioactive Restorative material in the absence or presence of etching and bonding could be comparable to the microleakage of composites.

Patient Involvement in Care and Breast Cancer Patients' Quality of Life- a Structural Equation Modeling (SEM) Approach

In cancer patients, improving the quality of life is a basic goal of treatment, with the patient ­ physician relationship as a major factor. Therefore the aim of this structural equation modeling study was to analyze the influence of patient involvement in care on quality of life in 411 breast cancer patients undergoing outpatient chemotherapy and radiotherapy. Two questionnaires were used: 1-patient-physician questionnaire, 2-EORTC QLQC-30 (to measure QOL). The structural equation model exhibited an excellent data fit (Chi-Square= 31.04 / RMSEA= 0.042), T-values for all paths with the exception of that between patient satisfaction and emotional- cognitive function, were significant. According to the findings, various aspects of the physician-patient relationship are significantly and positively associated with quality of life and increasing patient involvement in care by increasing trust and satisfaction, was associated with marked improvement. The findings of this study emphasized the importance of an effective relationship between doctor and patient as a contributing factor for improving the quality of life. Therefore it is suggested that policymakers and decision-makers active in strategic planning for the health system and physicians responsible for treatment pay more attention to developing and improving relationships with patients as an approach to improving patient outcomes, particularly with reference to quality of life.

General self-efficacy and diabetes management self-efficacy of diabetic patients referred to diabetes clinic of Aq Qala, North of Iran.

BACKGROUND: Self-efficacy is one of the factors involved in successful self-care of diabetic patients. The aim of this study was to evaluate general self-efficacy and diabetes management self-efficacy and to determine their association with glycemic control in diabetic individuals, referred to the diabetes clinic of Aq Qala city, North of Iran. METHODS: In this cross-sectional study, 251 type 2 diabetes mellitus patients were enrolled using census method. Data collection tools consisted of Sherer General Self-Efficacy Scale (SGSES) and Diabetes Management Self-Efficacy Scale (DMSES) with minor demographic adjustments and hemoglobin A1C test. Data were analyzed using descriptive statistics and analytical techniques include independent t-test, Spearman correlation coefficient and linear regression were applied for further data analysis. RESULTS: The mean and standard deviation age of subjects was 56.17 ± 10.45 years. The mean level of HbA1C of studied subject was 8.35 ± 2.02%. There was a negative correlation between age and general self-efficacy and diabetes self-efficacy while, there was a positive correlation between general self-efficacy and diabetes self-efficacy (P < 0.001). Results of the regression analysis showed that duration of the disease was the only variable which had a significant effect on the level of hemoglobin A1C (P < 0.001), so that for each year of having the disease, the level of hemoglobin A1C increased by 0.084% (CI 95% = 0.048-0.121). CONCLUSIONS: General self-efficacy and diabetes self-efficacy does not affect glycemic control in diabetic individuals. The duration of the disease is the only affecting variable on glycemic control by its worsening in diabetic individuals. Interventions are recommended to help glycemic control in individuals who are having this disease for longer periods. Moreover, further studies on the affecting factors on poor glycemic control of diabetic patients as well as the role of time variable, are recommended.