Domestic violence against children detected and managed in the routine of dentistry - A systematic review.

The domestic violence against children (DVAC) interferes in the psychological development leading to sequels that manifest and persist up to the adulthood. The physical evidences of domestic violence are more easily observed in the orofacial complex, becoming eventually detected by dentists. The present systematic literature review aimed to investigate the perception, knowledge and attitude of dentists towards the detection and management of DVAC cases. A systematic search was performed in 6 databases: PubMed, ScienceDirect, LILACS, SciELO, GoogleScholar, and OpenGrey. Cross-sectional articles assessing the perception, knowledge, and attitude of dentists facing potential cases of DVAC were selected. No restriction of language, time, and publication status was considered. The search resulted in 1.024 articles, of which 18 fit the eligibility criteria. The knowledge for detecting cases of DVAC obtained during the undergraduation course was classified by the dentists (in 39% of the articles) as "insufficient". When suspecting of cases involving domestic violence, most of the dentists (in 77.75% of the articles) considered reporting to the competent authorities. However, the dentists are not sure about who these authorities are (in 31.25% of the articles). More attention must be given to the Forensic education in Dentistry. Specifically, proper training is necessary to support the dentists on the detection and management of pediatric patients under domestic violence. Systematic Review Registration Number: PROSPERO CRD42015026747 (http://www.crd.york.ac.uk/PROSPERO).

Diagnostic tests for tuberculous pleural effusion.

The investigation of pleural effusion has been greatly assisted by advancements in pleural fluid analysis. In the case of tuberculous pleural effusion, diagnosis traditionally requires the demonstration of acid fast bacilli in the pleural space using microbiological or histological techniques. In recent years, there has been progress in pleural fluid analysis in suspected tuberculous effusions, with particular interest in adenosine deaminase and interferon-γ. These individual tests are quite sensitive and specific; however, data are sparse on the benefits that multiple-parameter testing may have when analysed in combination. We reviewed the literature to investigate the evidence for multiple-parameter testing, both biochemical and clinical, in the evaluation of tuberculous effusion.

A systematic approach to the investigation and diagnosis of a unilateral pleural effusion.

Fluid in the pleural space is a common sequela of a wide range of diseases which may be pulmonary, pleural or extrapulmonary. As the differential diagnosis is wide, a systematic approach to investigation and diagnosis is recommended. This review highlights the important features and recommendations for the investigation of a unilateral pleural effusion, a common condition encountered by the general physician. The aim of this study was to assist with a speedy diagnosis of the underlying pathology, using appropriate investigative techniques, while minimising the use of invasive procedures.

Guidelines on the diagnosis and treatment of pulmonary non-tuberculous mycobacteria infection.

While the prevalence of Mycobacterium tuberculosis continues to decline in the developed world, the same cannot be said for non-tuberculous mycobacteria (NTM). These organisms are increasing in incidence and prevalence throughout the world. This is probably because of a combination of increased exposure, improved diagnostic methods and an increase in the prevalence of risk factors that predispose individuals to infection. Considerable confusion can arise in determining in the wide range of species whether an isolated NTM is in fact a contaminant or a pathogenic organism when isolated in sputum or bronchoalveolar lavage. This confusion combined with increasing requests for advice on the treatment of disease has led to the development of guidelines to assist the clinician in diagnosing and treating infection accurately.

Equivalent efficacy and safety of a new HFA-134a formulation of BDP compared with the conventional CFC in adult asthmatics.

The present study demonstrates the equivalent efficacy for BDP 500 microg bid given via MDI with the new HFA-134a propellant (Chiesi Farmaceutici S.p.A., Parma) compared to a conventional CFC propellant (Becotide, Allen & Hanburys, UK). One hundred and sixteen adult patients with stable mild to moderate asthma (FEV1 > or = 60% of predicted normal) entered a 2-week run-in period where they maintained their own inhaled corticosteroids and were then assigned to a 12-week treatment with the test drug in a randomized, multicentre, double-blind, double-dummy, parallel-group design. Ninety-one patients completed the study period. Morning and evening peak expiratory flow rate (PEFR), use of rescue salbutamol, number of daytime and nighttime asthma attacks, number of nighttime awakenings, and clinical symptoms were recorded daily by patients on a diary card. Pulmonary function tests (FEV1, FVC, PEFR, MEF50 and FEF25) were completed at study entry, at the start of treatment and every 2 weeks thereafter. Morning (08.00-10.00 AM) serum cortisol was measured at the start and at the end of treatment. Adverse events were collected for the total study period. Equivalence between groups was demonstrated for the primary end-point morning PEFR, as well as for evening PEFR and FEV1 (the 95% CI of the treatments' difference was within the 5% of the LSM of BDP CFC). The other secondary pulmonary function tests measured at the clinic visit showed a satisfactory asthma control, albeit without statistically significant differences between groups. Decreases in the use of rescue salbutamol and in clinical symptoms were also reported in both groups, with no differences between them. Adverse events were reported in 81.4% of patients in the BDP HFA group and in 82.5% in the CFC group. There were 73 and 59 adverse drug reactions in the two groups, respectively; the difference was mainly due to differences in taste. No drug-related serious adverse events were reported in either group. No difference was seen for morning serum cortisol between baseline and end of treatment, or between groups. In conclusion, the BDP-HFA 134a formulation proved to be statistically equivalent to the standard BDP CFC product over 12 weeks in adult patients with mild to moderate asthma.

Eradication of house dust mite from homes of atopic asthmatic subjects: a double-blind trial.

BACKGROUND: House dust mite (HDM) allergens can accumulate to very high levels in homes. From the observed sensitivity of HDMs to heat and their allergens to steam, a novel treatment of furnishings has been developed. OBJECTIVE: We sought to determine whether combined steam and heat treatment of home furnishings reduced asthmatic patients' bronchial hyperreactivity (BHR) and lowered HDM antigen loads. METHODS: The homes of 30 asthmatic subjects aged 18 to 45 years were randomly allocated into 3 groups. In groups 1 and 2 mattresses and duvets were treated with hot air (110 degrees C), followed by steam and then heat again. All their carpets were steam cleaned. Group 2 also had a special ventilation system installed above each patient's bedroom. The homes of subjects in group 3 were sham treated. Neither patient nor laboratory staff was aware of the types of treatment. Der p 1 and 2 levels in the household dust from the lounge, bedroom carpet, and beds were determined before and after treatment and then at 6 and 12 months. BHR, measured by using histamine PD(20) values, was recorded during the 4-week run-in period and at 3, 6, 9, 12 months after treatment. RESULTS: Active heat-steam treatment of homes caused a sustained reduction of Der p 1 (P =.003) and Der p 2 (P =.001) compared with no change in sham-treated group 3 homes. Patients whose homes were treated showed a 4-fold reduction in BHR at 9 months in group 1 and throughout the posttreatment period in group 2. No change was observed in the asthmatic subjects whose homes were not treated. These improvements were sustained for 12 months in the homes with bedroom ventilation units. CONCLUSIONS: A single treatment of home furnishings reduced mite allergen load to below the risk level for sensitization and improved the asthmatic patients' BHR by 4-fold.

Male and female differences in reports of women's heterosexual initiation and aggression.

Previous work that compared male and female reports of women's heterosexual initiation and aggression is replicated. It was hypothesized that men's reports of women's sexual initiation and aggression would be significantly greater than women's self-report of sexual initiation and aggression in the most recent sample. Of the 24 questionnaire items, 12 of the 17 specifically designed to assess sexual initiation or aggression demonstrated significant reporting differences. For every questionnaire item, except "mutually consenting contact," men reported women initiating sexual contact more often than women self-reported. In addition, comparisons were made to determine the level of agreement between the results of this study and a previous study in which the same comparisons were made with a different sample. It was hypothesized that the identical questionnaire items would demonstrate significant gender-based reporting differences in both samples. This hypothesis was mostly supported with 11 items showing a significant difference in both samples. In both samples, males reported receiving female initiation and aggression more frequently than females reported giving. Logistic regression results supported a difference in perception of women's sexual initiation based on gender of respondent. In both samples men see women's initiation as less conforming to traditional social norms for women and more aggressive than women do. Gender role expectations and social desirability may influence male and female perceptions of female heterosexual initiation and aggression in a way that contributes to significant differences in reporting.

Postural changes of the cervical spine in patients with nontoxic goiter.

PURPOSE: To investigate differences in cervical spine posture and range of motion and self-reported neck pain and headache between patients with nontoxic goiter compared with a matched control group. DESIGN: An observational, controlled, blinded study. SETTING: The ambulatory outpatient facility of a university hospital. PARTICIPANTS: Twenty-five nontoxic goiter patients and 25 matched nongoiterous control subjects from the Department of Endocrinology. INTERVENTION: Participants were X-rayed from a lateral position in neutral, full flexion and full extension, and the radiographs were evaluated by a blinded examiner for anterior head carriage, maximal flexion, maximal extension and the extent and severity of any degenerative changes in the cervical spine. The degree of postural neck muscle tenderness was evaluated by a blinded rheumatologist using a validated Total Tenderness Score system. In addition, the two groups were compared for their self-reported frequency of neck pain and headaches. RESULTS: A significant increase in anterior head carriage was found among the goiter patients (p = .01), together with a corresponding decrease in flexion (p = .01), whereas the corresponding increase in extension was not statistically significant (p = .16). A higher prevalence of headaches was found in the goiter group (p = .06), but there was no difference in neck muscle tenderness (p = .40) or frequency of neck problems (p = .40) between the groups. The severity of degenerative changes in the cervical spine (p = .22) and the number of vertebral levels with degenerative changes (p = .13) were similar in the two groups. CONCLUSIONS: Goiters of > 100 g seem to alter the posture of the cervical spine, possibly resulting in a tendency for more frequent headaches. The changes do not seem to cause more neck pain, muscle tenderness or degeneration of the cervical spine.

The emergency medical services system response to a commercial airliner incident at the very remote location of Shemya, Alaska.

INTRODUCTION: A multiple patient incident involving a commercial airliner is a challenge for any community EMS system. When the community is on a remote island in the North Pacific Ocean, where there is no hospital and only a small clinic staffed by just one physician and several nurses and technicians, the challenge is much greater. The incident described herein necessitated providing emergency care at the airport, and at the same time, activating a response capability from hundreds of miles away to transport the patients to definitive care. The situation was compounded further by the fact that most of those injured spoke little or no English. This paper reviews the events that occurred and the lessons learned. OBJECTIVE: To identify the events that occurred when a commercial airliner, with more than 250 passengers and crew aboard, experienced an in-flight "upset" that resulted in many being injured. What was learned may help other areas be better prepared for such events. STUDY POPULATION: A commercial airliner incident that occurred in April, 1993 resulted in the need for emergency medical care at the remote island location of Shemya, Alaska initially, and fixed-wing transport of the injured to definitive care in Anchorage, Alaska, USA, which is about 1,300 miles (2,130 km) from Shemya. METHODS: A case review methodology was used that included interviews with key persons involved in the response to this incident to learn first-hand what occurred; by review of the National Transportation Safety Board (NTSB), reports, and by having agencies involved in the event review draft report materials to ensure accuracy. RESULTS: This study showed how a remote site with a small cadre of medically trained personnel could organize and effectively provide initial emergency care for > 200 persons, and have them transported more than a thousand miles to definitive care. CONCLUSIONS: Valuable lessons were learned from this incident that may help other areas be better prepared, particularly in remote areas, for large multiple patient events.

College students' high-risk sexual behavior following alcohol consumption.

This study is a follow-up to a previous study assessing the relationship of alcohol consumption as a disinhibitor to high-risk sexual behavior. Results are based on survey data from 1,902 students attending 12 colleges. Sexual behaviors occurring after people had "let themselves drink more than normal in order to make it easier for them to have sex with someone" were assessed. At least once in the past year, 33.2% of the men and 17.4% of the women had met this criterion. In those instances, 76.3% of the men and 77.1% of the women initiated condom use for vaginal intercourse. Results are discussed in relation to partners' compliance following condom initiation and preventing the spread of HIV disease.

PIP: Several researchers have associated moderate amounts of alcohol ingestion with increased sexual arousal and decreased sexual inhibition. 4000 questionnaires were distributed to undergraduate students at 12 colleges of various sizes and types across the US in a study of whether and how often college students consume alcohol to make it easier for them to have sex with someone. Both public and private educational institutions were represented. Although 2412 questionnaires were returned, 510 students failed to identify their gender. Study findings are therefore based on data from only 1902 students. 59.6% of the sample was male, 89.3% were age 24 years and under, 89.5% single, 97.3% heterosexual, 77.9% White, and 59.6% Catholic or Protestant. 91.3% had three or fewer sex partners in the past year and 58.3% came from families headed by executives. At least once in the past year, 33.2% of men and 17.4% of women drank more alcohol than normal to make it easier for them to have sex with someone else. In those instances, 76.3% of men and 77.1% of women initiated condom use for vaginal intercourse, 67.4% of the men and 76.3% of women used them, and 38.6% of the men and 12.9% of the women had experiences with people that they had just met or who were acquaintances. Multiple regression analysis found no significant difference for condom use during anal intercourse or vaginal intercourse with different types of partners. Other researchers have reported much lower rates of condom use among similar populations, suggesting that the reported condom use rates in this study are probably a high estimate of actual use.

A comparative analysis of the emergency medical services and rescue responses to eight airliner crashes in the United States, 1987-1991.

INTRODUCTION: Crashes involving commercial airliners stress emergency medical services (EMS) and rescue operations to performance far in excess of everyday activities, and special adaptations of everyday responses need to be implemented. Fortunately, these events are infrequent and usually do not occur more than once in any location. The responses that occur must be highly coordinated and efficient. Little is known about the responses to such events. This study examines the EMS and rescue responses associated with eight recent crashes involving commercial airliners in the United States. OBJECTIVE: To identify common factors for which alterations in responses may enhance the survival and decrease the morbidity to victims involved in commercial aviation crashes. STUDY POPULATION: Eight commercial airliner crashes in the United States from 1987 through 1991. METHODS: Case review using: 1) press and media accounts; 2) U.S. National Transportation and Safety Board testimony and reports; and 3) structured interviews with airport, fire, EMS, and hospital personnel. Data were collated and common factors identified for the cases. Findings are classified into: 1) conditions at the crash sites; 2) initial responses; 3) scene management; 4) scene status; 5) patient transport; 6) hospital responses; and 7) preplanning exercises. RESULTS: Common factors that impaired responses for which some remediation is possible include: 1) new methods for training including computerized simulations; 2) improvements in rescue-extrication equipment and supplies; 3) stored caches of EMS equipment and supplies at airports; 4) ambulance transport capabilities; and 5) augmentation of patient transport capabilities. CONCLUSIONS: Many lessons can be learned through structured studies of commercial aircraft crashes. These findings suggest that simple and relatively inexpensive modifications may enhance all levels of emergency responses to such events.

Changes in the telephone calling patterns of adolescent girls.

It is commonly believed that adolescent girls now call adolescent boys on a regular basis and this represents a change in behavior from previous generations. The purpose of this study was to test the hypothesis that during the last 40 years the incidence has increased. A sample of current students from a Southern urban commuter university was interviewed to determine their telephone use patterns. The changes in calling behavior among this sample indicates a transition period between a time when adolescent girls perceived their parents as disapproving of their calling boys (they placed few calls) to a time when adolescent girls perceived their parents as approving (they evidenced many such calls). Based on the current age of respondents, the transition period was calculated to be from 1964 to 1981. The results are discussed in relation to changes in adolescent female gender roles in the United States beginning in 1964.

Superior vena caval obstruction managed by the Gianturco Z Stent.

Twenty patients with superior vena caval obstruction (SVCO) due to malignancy were managed using the Gianturco Z Stent. Three patients had adjunctive thrombolysis. The primary clinical success was 90% (18/20 patients). Thirteen patients were free of SVCO to death or follow-up without re-intervention (primary patency = 65%). Three patients had re-intervention for recurrent symptoms, two successfully (secondary long-term patency = 75%). Stenting of the SVC is a valuable, under-used technique for the symptomatic relief of superior vena caval obstruction.