Oral health-related self-efficacy and fatalism in a regional South Australian Aboriginal population.

OBJECTIVES: To assess the psychometric properties, including face, content, criterion and known-groups validity and reliability, of scales to measure oral health-related self-efficacy and fatalism in a regional Aboriginal adult population in Australia. METHODS: Four hundred Aboriginal adults (aged 18-82 years, 67% female) completed a self-report questionnaire including items pertaining to oral health-related self-efficacy and fatalism. Structural validity was determined in exploratory factor analysis (EFA) with principal components analysis for each scale. Criterion validity was assessed between the instruments and theoretically related variables. Known-groups validity was investigated by comparing the scores in different population groups according to age, sex, education and employment. Reliability of the scales was assessed through internal consistency. RESULTS: The EFA confirmed a single factor structure for self-efficacy and fatalism scales, with Cronbach's alphas of 0.93 and 0.89 respectively. The two scales were not correlated. Oral health-related self-efficacy was associated with toothbrush ownership and brushing the previous day supporting criterion validity. Oral health-related fatalism was associated with previous extractions and perceived need for extractions also supporting criterion validity. Both measures were associated with social impact of oral health as measured by the OHIP-14, supporting their criterion validity. Mixed findings were observed in terms of known-groups validity. CONCLUSIONS: There was initial evidence that measures of oral health-related self-efficacy and fatalism displayed adequate psychometric properties in this Aboriginal community. These constructs could have implications for approaches for improving oral health among Aboriginal people.

Proteus mirabilis - a rare cause of non-HACEK Gram-negative infective endocarditis.

Infective endocarditis caused by Proteus mirabilis is strikingly rare. Here, we describe the case of an 86-year old man with five recurrent septic episodes over a period of three months associated with Proteus mirabilis bacteraemia secondary to underlying Proteus endocarditis. The final diagnosis was made based on clinical findings, blood culture results and transoesophageal echocardiogram. The patient was treated medically with 6 weeks of ceftriaxone and long-term oral ciprofloxacin. On completion of intravenous therapy the patient remained well. We performed a literature review and found this to be only the fourth confirmed case of Proteus mirabilis endocarditis successfully treated with antibiotic therapy alone. This case highlights an important but rare cause of endocarditis, reinforcing the need to consider this diagnosis in recurrent Gram-negative bacteraemia even if by an atypical organism.

A comparison of airborne bacterial fallout between orthopaedic and vascular surgery.

INTRODUCTION The objective of the study was to compare bacterial fallout during vascular prosthesis insertion and orthopaedic major joint replacement performed in conventional and laminar flow ventilation, respectively. MATERIALS AND METHODS A prospective single-centre case control study of 21 consecutive elective vascular procedures involving prosthetic graft insertion and 24 consecutive elective orthopaedic major joint replacements were tested for degree of bacterial fallout using agar settle plates. Preparation time, waiting time and total procedure duration were collected at the time of surgery, and bacterial colony counts on the agar settle plates from airborne bacterial fallout were counted after an incubation period. RESULTS Bacterial fallout count in vascular prosthetic graft insertion was 15-fold greater than in orthopaedic prosthetic joint insertion (15, (IQR 15) vs 1, (IQR 3) respectively, P < 0.0001, Wilcoxon). Waiting time and patient transfer did not significantly increase bacterial fallout counts during the procedure (P = 0.9). CONCLUSIONS Vascular surgical theatres have significantly higher bacterial fallout compared with orthopaedic theatres. This may be partly explained by orthopaedic surgery being routinely performed in laminar flow ventilation, a practice which has not been widely adopted for vascular surgery, in which prosthetic infection may also result in significant mortality and morbidity.

Oral Papillomas Associated With Felis catus Papillomavirus Type 1 in 2 Domestic Cats.

Multiple small sessile raised lesions were detected on the ventral surface of the tongue in two 13-year-old domestic cats. The lesions were incidental in both cats. Lesions from both cats appeared histologically as well-demarcated foci of markedly thickened folded epithelium that formed keratin-filled shallow cuplike structures. Large keratinocytes that contained a swollen nucleus surrounded by a clear cytoplasmic halo (koilocytes) were common, suggesting a diagnosis of a papillomavirus-induced papillomas, and papillomavirus antigen was demonstrated by immunohistochemistry. The papillomas exhibited diffuse intense cytoplasmic and nuclear immunoreactivity against cyclin-dependent kinase inhibitor 2A protein (also known as p16 or INK4a protein). Felis catus papillomavirus type 1 DNA sequences were amplified from both papillomas. The papillomas resolved in 1 cat within 3 months of diagnosis, while the papillomas were still visible 4 months after diagnosis in the other cat. This is the first evidence that these papillomas are caused by F. catus papillomavirus type 1.

Development and psychometric validation of a Health Literacy in Dentistry scale (HeLD).

BACKGROUND: Oral health literacy is emerging as a new public health challenge and poor oral health literacy is increasingly seen as an important predictor of poor oral health outcomes. Within Indigenous populations, there may be benefits to research in using a culturally acceptable, internally consistent and valid instrument to assess oral health literacy. We translated a general health literacy measure, the Health Literacy Management (HeLM) scale to make a dentally relevant scale; Health Literacy in Dentistry (HeLD). OBJECTIVE: This study describes the development and assessment of the reliability and validity of the HeLD in an Indigenous Australian population. DESIGN AND METHODS: The 29 item HeLD scale assesses the components of oral health literacy. The reliability and validity of the seven HeLD subscales were evaluated in a convenience sample of 209 Indigenous Australians with mean age 35 years (range 17-81) and of which 139 were female. RESULTS: The scale was supported by exploratory factor analysis and established seven distinct and internally consistent domains of oral health literacy: Communication, Access, Receptivity, Understanding, Utilisation, Support and Economic Barriers (Cronbach's alpha = 0.91). Discriminative ability was confirmed by HeLD associations with socio-demographic variables and self-reported health ratings in the expected direction. The convergent validity and predictive validity were confirmed by HeLD scores being significantly associated with toothbrush ownership, use of a toothbrush, time since last dental visit and knowledge of the effect of cordial on the teeth. CONCLUSIONS: The HeLD appears to be an internally valid and reliable instrument and can be used for measuring oral health literacy among rural Indigenous Australian adults.

Platelet function defects in adolescents with heavy menstrual bleeding.

Platelet function defects (PFD) are reported to occur frequently in adult women with heavy menstrual bleeding (HMB). Few studies on adolescent HMB report varying incidence rates (2-44%) for PFD. We reviewed our institutional experience in detecting and managing PFD in adolescent HMB. Postmenarchial girls and adolescents with HMB seen at our institution undergo a comprehensive bleeding disorder work-up by paediatric haematology and paediatric gynaecology providers. Whole blood platelet aggregometry (WBPA) is performed as a second tier test after excluding thrombocytopaenia, coagulation factor deficiencies and Von Willebrand disease (VWD). We retrospectively reviewed the medical records of adolescents with HMB seen between June 2009 and November 2010, as approved by the Institutional Review Board. Patient demographics, clinical features, laboratory results, therapy details and patient outcome information were analysed. Overall, 114 postmenarchial girls and adolescents with HMB were evaluated; 68 patients (59%) had WBPA study performed. Nineteen patients (28%) had at least one aggregation or secretion defect; 12 (18%) had two or more such defects. Treatment included hormonal therapy (13/19; 68%), antifibrinolytic agents (8/19; 42%) and intra-nasal DDAVP (3/19; 16%). Thirteen patients (81%) had improved outcome (median follow-up--15.6 months; range of 1-66 months). In this study, PFD were identified in nearly one-third of girls with HMB, with the majority of these having two or more defects as identified by WBPA. Further prospective studies are needed to better define the prevalence and address appropriate management of HMB and other bleeding complications of PFD in adolescents.

Pathogen spread on coupled networks: effect of host and network properties on transmission thresholds.

Human populations are interconnected through a variety of different networks. The complex interactions of diverse populations of individuals and their interconnected network structures affect the diffusion of processes through the population. For example, the different modes of transmission of HIV and TB mean that they are transmitted along very different contact networks: HIV via sexual contact and TB via respiratory contact. In addition, co-infection with HIV raises the risk of progressing to active TB and reduces the response to TB treatment, potentially causing increasing incidence of TB. Here we extend existing network theory to find the effect of multiple networks and multiple host types on epidemic thresholds. We first analyse how transmission of a pathogen via an additional network affects its epidemic threshold. We then use the theory behind branching processes to study how multiple host types in a population affect its threshold. The formulation we obtain enables modellers to determine how multiple networks and host heterogeneity (i.e. vaccination, behavioural change, mixing patterns, etc.) affect the epidemic threshold. We apply the results to the example of HIV and TB to illustrate how the interactions of the diseases can substantially alter the epidemic threshold of TB.

Reproduction in the marsupial dibbler, Parantechinus apicalis; differences between island and mainland populations.

Details of the reproductive endocrinology of the dibbler, Parantechinus apicalis, an endangered member of the Family Dasyuridae, are presented from two geographically-separated populations, living either on the mainland or on islands in Jurien Bay, Western Australia. Plasma free cortisol in males measured in the island population during 1998/9 did not differ between the breeding and non-breeding season, but during the March rut in 2000, when males died after breeding, free cortisol levels were significantly raised. Post-mating mortality in dibbler males is facultative, rather than obligatory and the cortisol data implicate the same physiological sequelae described in other dasyurids. In females, a single annual oestrus was recorded during late summer to autumn in both populations with an onset earlier by 12 days in the mainland animals. Faecal steroids excreted as progesterone metabolites (PM) and oestradiol-17ß were measured during the annual oestrous period and showed significantly higher PM concentrations in island animals. Oestradiol, although raised, was not different between the two populations. A profile of PM levels throughout gestation revealed a small peak at the time of ovulation, followed by slowly rising levels to peak 8 days before birth, indicating slow development of the corpora lutea. Using collective data, the presumptive day of ovulation could be identified, allowing the calculation of a presumptive gestation length of 45days in dibblers from mainland populations. This gestation length compares with that of a related species, Pseudantechinus macdonnellensis, reported at 45-55 days. A surprising finding is the significantly shorter gestation period of approximately 38 days in island animals compared with those from the mainland. This and other differences between reproductive parameters of island and mainland populations are discussed in the context of the 'island syndrome'.

Respondent driven sampling and community structure in a population of injecting drug users, Bristol, UK.

BACKGROUND: A 2006 respondent driven sampling (RDS) survey of injecting drug users (IDUs) in Bristol, UK, estimated 40 per 100 person years HCV incidence but in 2009 another RDS survey estimated only 10 per 100 person years incidence amongst the same population. Estimated increases in intervention exposure do not fully explain the decrease in risk. We investigate whether the underlying contact network structure and differences in the structure of the RDS trees could have contributed to the apparent change in incidence. METHOD: We analyse the samples for evidence that individuals recruit participants who are like themselves (assortative recruiting). Using an assortativity measure, we develop a Monte Carlo approach to determine whether the RDS data exhibit significantly more assortativity than is expected for that sample. Motivated by these findings, a network model is used to investigate how much assortativity and the structure of the RDS tree impacts sample estimates of prevalence and incidence. RESULTS: The samples suggest there is some assortativity on injecting habits or markers of injecting risk. The 2009 sample has lower assortativity than 2006. Simulations of RDS confirm that assortativity influences the estimated incidence in a population and the structure of RDS samples can result in bias. Our simulations suggest that RDS incidence estimates have considerable variance, making them difficult to use for monitoring trends. CONCLUSIONS: We suggest there was likely to have been a decline in risk between 2006 and 2009 due to increased intervention coverage, but the bias and variance in the estimates prevents accurate estimation of the incidence.

Planning, implementing, and evaluating a program to address the oral health needs of aboriginal children in port augusta, australia.

Aboriginal Australian children experience profound oral health disparities relative to their non-Aboriginal counterparts. In response to community concerns regarding Aboriginal child oral health in the regional town of Port Augusta, South Australia, a child dental health service was established within a Community Controlled Aboriginal Health Service. A partnership approach was employed with the key aims of (1) quantifying rates of dental service utilisation, (2) identifying factors influencing participation, and (3) planning and establishing a program for delivery of Aboriginal children's dental services that would increase participation and adapt to community needs. In planning the program, levels of participation were quantified and key issues identified through semistructured interviews. After 3.5 years, the participation rate for dental care among the target population increased from 53 to 70 percent. Key areas were identified to encourage further improvements and ensure sustainability in Aboriginal child oral health in this regional location.

Modelling the performance of isoniazid preventive therapy for reducing tuberculosis in HIV endemic settings: the effects of network structure.

Individuals living with HIV experience a much higher risk of progression from latent M. tuberculosis infection to active tuberculosis (TB) disease relative to individuals with intact immune systems. A several-month daily course of a single drug during latent infection (i.e. isoniazid preventive therapy (IPT)) has proved in clinical trials to substantially reduce an HIV-infected individual's risk of TB disease. As a result of these findings and ongoing studies, the World Health Organization has produced strong guidelines for implementing IPT on a community-wide scale for individuals with HIV at risk of TB disease. To date, there has been limited use of IPT at a community-wide level. In this paper, we present a new co-network model for HIV and TB co-epidemics to address questions about how the population-level impact of community-wide IPT may differ from the individual-level impact of IPT offered to selected individuals. In particular, we examine how the effect of clustering of contacts within high-TB incidence communities may affect the rates of re-infection with TB and how this clustering modifies the expected population-level effects of IPT. We find that populations with clustering of respiratory contacts experience aggregation of TB cases and high numbers of re-infection events. While, encouragingly, the overall population-level effects of community-wide IPT appear to be sustained regardless of network structure, we find that in populations where these contacts are highly clustered, there is dramatic heterogeneity in the impact of IPT: in some sub-regions of these populations, TB is nearly eliminated, while in others, repeated re-infection almost completely undermines the effect of IPT. Our findings imply that as IPT programmes are brought to scale, we should expect local heterogeneity of effectiveness as a result of the complex patterns of disease transmission within communities.

Immunomodulatory effects of vitamin D: implications for GVHD.

GVHD remains a major source of morbidity and mortality after allogeneic BMT. GVHD is mediated by alloreactive T cells derived from the hematopoietic graft that target host tissues. Pre-clinical models have shown that presentation of alloantigens by host DCs results in the activation of donor-derived T cells that mediate GVHD. Strategies that interfere with the Ag-presenting capacity of DCs after allogeneic transplantation may decrease the risk of developing GVHD. Vitamin D is a hormone essential for calcium metabolism that shows immunomodulatory properties. We showed that correction of vitamin D deficiency appeared to mitigate manifestations of GVHD. In pre-clinical studies, we have shown that vitamin D inhibits DC maturation, polarizes T-cell populations toward the expression of Th2 as compared with Th1 cytokines, and blunts allogeneic T-cell proliferation in response to DC stimulation. Exposure to vitamin D resulted in increased expression of IDO, an enzyme responsible for tryptophan metabolism that is upregulated in tolerizing DCs. These data suggest that exposure to vitamin D results in immature DC populations that bias toward tolerizing rather than stimulatory T-cell populations. Vitamin D may therefore have a role in the prevention of GVHD.

The efficacy of a commercial ELISA as an alternative to virus neutralisation test for the detection of antibodies to EAV.

Infection with equine arteritis virus is a notifiable disease with sporadic occurrence in the UK. As stallions may harbour the virus after infection, horses are screened for exposure by serological testing prior to breeding. The virus neutralisation test is considered the 'gold standard' serological screening test, but it is time-consuming and labour intensive; consequently there is a move towards more rapid screening methodology. In this study, a commercially available EVA antibody ELISA is assessed. The ELISA performed poorly with a specificity [corrected] of 26% and a sensitivity [corrected] of 96% in the samples analysed. It was concluded that this ELISA would be of little value for reducing sample turnaround time. The study emphasises the need for in-house validation of commercially available kits.

Public awareness of risk factors and screening for colorectal cancer in Europe.

Colorectal cancer (CRC) is the commonest site for malignancy in Europe. The Commissioner for Health wishes to promote screening for colorectal, breast and cervical cancer in Europe. The aim of this study was to assess public knowledge of CRC in Europe and likely take up of free screening. To this end 20710 members of the public from 21 European countries were interviewed by means of a regular survey amongst consumers (Omnibus survey) using 13 stem questions. Forty-eight per cent thought the population were at equal risk of CRC, only 57% were aware of age and 54% of family history as risk factors. Although 70% were aware of dietary factors, only 30% knew that lack of exercise might be a risk factor. Only 51% had knowledge of CRC screening but 75% were 'very', or 'quite interested, in taking up faecal occult blood (FOB) screening if offered free. Barriers to screening were lack of awareness of risk (31%), youth (22%) and an un-anaesthetic test (19%). There was a big cultural difference in willingness of the public to discuss bowel symptoms: there was a major barrier in Finland (91%), Britain (84%), Luxembourg (82%), Poland (81%) and Portugal (80%); less of a barrier in Spain (49%), Italy (44%) and Iceland (39%). In conclusion, the challenge of achieving high compliance for CRC screening must be a major objective amongst EU member states and non-aligned countries of Europe in the next decade, because it is known that the non-compliant group are those at greatest risk of death from CRC. This study has shown that awareness of CRC is low in Europe and that an educational programme will be essential to achieve high compliance for CRC screening as a means of reducing deaths from bowel cancer.

Envoplakin, a possible candidate gene for focal NEPPK/esophageal cancer (TOC): the integration of genetic and physical maps of the TOC region on 17q25.

Focal nonepidermolytic palmoplantar keratoderma (NEPPK), or tylosis, is an autosomal, dominantly inherited disorder of the skin that manifests as focal thickening of the palmar and plantar surfaces. In three families studied, the skin disorder cosegregates with esophageal cancer and oral lesions. New haplotype analysis, presented here, places the tylosis esophageal cancer (TOC) locus between D17S1839 and D17S785. Envoplakin (EVPL) is a protein component of desmosomes and the cornified envelope that is expressed in epidermal and esophageal keratinocytes and has been localized to the TOC region. Mutation analysis of EVPL in the three affected families failed to show tylosis-specific mutations, and haplotype analysis of three intragenic sequence polymorphisms of the EVPL gene placed it proximal to D17S1839. Confirmation of the exclusion of EVPL as the TOC gene by location was obtained by integration of the genetic and physical mapping data using radiation hybrid, YAC, BAC, and PAC clones. This new physical map will allow further identification of candidate genes underlying NEPPK associated with esophageal cancer, which may also be implicated in the development of sporadic squamous cell esophageal carcinoma and Barrett's adenocarcinoma.

The tylosis esophageal cancer (TOC) locus: more than just a familial cancer gene.

Tylosis (focal non-epidermolytic palmoplantar keratoderma; NEPPK) is associated with esophageal cancer in three families, two of which contain six or seven generations. The causative locus, the tylosis esophageal cancer (TOC) gene, has been localized to a small region on chromosome 17q25. Recent loss of heterozygosity (LOH) studies have indicated a role for the TOC gene in sporadic squamous cell esophageal cancer and Barrett's adenocarcinoma. We have now integrated genetic and physical mapping data from the TOC region, based on microsatellite markers and radiation hybrid, yeast (YAC), bacterial (BAC) and P1 artificial chromosomal (PAC) clones, and formed a partial minimal contig of one non-chimeric YAC (330 kb) and one PAC. Twenty-three candidate genes, including envoplakin (EVPL), were mapped against this contig, but only one was shown to be located within the minimal region. This physical map will allow further characterization of the region and identification of a gene implicated in both familial and sporadic squamous cell esophageal carcinoma and Barrett's adenocarcinoma.

Sequence variation in the early genes E1E4, E6 and E7 of human papilloma virus type 6.

The majority of condylomata acuminata (anogenital warts) are caused by infection with Human Papilloma Virus type 6 (HPV-6). We have sequenced the HPV-6 early genes, E1-E4, E6 and E7 from wart biopsy DNA samples sourced from the UK and USA and derived a consensus sequence for these genes and the proteins they encode. When compared to the prototype HPV-6b sequence, published over 12 years ago, the E1-E4 consensus sequence showed 3/91 (3.3%) amino acid changes, the E6 consensus sequence showed 1/150 (0.7%) changes and the E7 consensus sequence showed 1/98 (1.0%) changes. Since many of the early gene sequences from biopsy material were more similar to the HPV-6a subtype than HPV-6b, this data supports the use of HPV-6a as the HPV-6 prototype.

Implementing the Agency for Health Care Policy and Research pain management pediatric guideline in a multicultural practice setting.

This article describes the implementation, monitoring, and evaluation of a clinical practice guideline for managing pediatric patient pain. The standard of care used was the Agency for Health Care Policy and Research acute pain management guideline. It was used to assess current levels of care and to make recommendations for improvements. Information was gathered from a sample of 240 pediatric patients aged 1 week to 14 years. Recommendations for improving care are given. The guideline was found to be clinically useful as a general standard of care, but more work needs to be done to individualize care for specific populations, age groups, and cultures.

Osteosarcoma in New Zealand 1981-7: an overview.

AIMS: To examine the incidence, and results of treatment of osteosarcoma in New Zealand between 1981 and 1987. METHOD: Data was obtained from the Cancer Registry for all patients registered with osteosarcoma between 1981 and 1987. RESULTS: There were 104 patients in the study group. There was a peak incidence in the second decade with a second smaller peak in the seventh and eight decades. The overall 5 year survival rate was 29%. For the group aged under 30 years there was a 44% 5 year survival rate. Those aged over 60 years had a 3.2% 5 year survival. Survival rates were better when treated with surgery and chemotherapy and where the tumour was of the appendicular skeleton. CONCLUSION: This is a mixed group of patients. The 5 year survival rates appear to be at the lower end of the spectrum of the results reported for similar groups in other countries.