Bariatric surgeons' views on pre-operative factors associated with improved health-related quality of life following surgery.

Bariatric surgery is an effective treatment for severe obesity, affording significant improvements in weight loss and health-related quality of life. However, bariatric surgeons' views on whether certain pre-operative factors predict improvements in post-operative health-related quality of life, and if so, which ones, are largely unknown. This cross-sectional survey study examined the views of 58 bariatric surgeons from Australia and New Zealand. A total of 18 factors were selected for exploration based on their mention in the literature. Participants rated the extent to which they thought these pre-operative factors would improve post-operative health-related quality of life. Responses showed that bariatric surgeons held diverse perspectives and revealed a lack of consensus regarding "predictive" factors. Generally, respondents agreed that better than average health literacy, higher socioeconomic status, good physical and psychological health, and positive social support were predictors of improved health-related quality of life following surgery. However, poor eating behaviours, smoking, and the use of alcohol or other substances were deemed negative predictors. Interestingly, aside from higher socioeconomic status, good psychological health, and positive social support, none of the aforementioned views aligned with existing literature. This study offers an initial insight into bariatric surgeons' views on the influence of different pre-operative factors on post-operative health-related quality of life. The array of views identified suggests that there may be an opportunity for medical education, but the findings warrant caution due to the sample size. Replication with a larger survey may be useful, especially as predicted health-related quality of life outcomes could guide decisions regarding surgical (non)progression.

Bilateral Distal Tibial Stress Fracture in a Triathlete.

Stress fractures are common injuries in athletes. They result from excessive, repetitive loads on the normal bone which can cause an imbalance between bone resorption and formation, because during periods of intense exercise, bone formation lags behind bone resorption. The most common locations for stress fractures are weight-bearing bones of the lower extremities. This kind of injuries can easily be missed because they usually do not follow an acute injury in a fit young athlete, and plain radiographs usually appear normal. In this paper, a case of an amateur triathlete who suffered from a bilateral distal tibial stress fracture is presented. Key words: stress fracture, tibia, bilateral, distal tibia.

Gender Differences in Dental Anxiety and Medical Fear in Croatian Adolescents.

OBJECTIVES: The aim of this study was to differentiate anxious from nonanxious adolescents and evaluate gender differences in anxiety with respect to previous negative dental and medical experiences. The purpose was also to evaluate a causative relationship between child medical fear and dental anxiety. STUDY DESIGN: This study sampled 113 Croatian adolescents from 15 to18 years of age. Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) was used for the assessment of child dental anxiety regarding visits to the dentist and receiving dental treatment. A modified version of Child Medical Fear Questionnaire (CMFQ-M) was used for evaluation of child medical fear related to medical treatment and doctors in general. RESULTS AND CONCLUSION: The results showed significantly higher dental anxiety (CFSS-DS) and medical fear (CMFQ-M) in adolscent girls (p<0,001) as compared to adolescent boys. A significantly strong correlation between medical fear and dental anxiety in adolescent girls was proved by Pearson's correlation coefficient (p < 0,01). In this study, CMFQ-M and CFSS-DS questionnaires were standardized in the Croatian adolescent population and proved reliable in the estimation of anxious behaviour with respect to specific medical and dental situations.

New toothpaste to deal with dentine hypersensitivity: double-blind randomized controlled clinical trial.

OBJECTIVES: The purpose was to evaluate a combined effect of active ingredients contained in new toothpaste in reducing dentine hypersensitivity. METHODS: The tested toothpaste contained active ingredients potassium nitrate (5.00%) and zinc citrate (0.50%). Pain to water stimulus and blowing air was reported on hypersensitive teeth and measured using the VAS (Visual Analogue Scale). The degree of pain to water stimulus was detected after each subject drank a few sips of water which was boiled to the room temperature. Data were collected on each subject's dental history. RESULTS: A significant reduction in dentine hypersensitivity (26-29% after 2 weeks versus 40% after 4 weeks) was detected in the tested group. The controls also showed significant reduction to both stimuli, but at lower rate. A statistically significant difference to blowing air and water stimuli showed the highest impact for the tested group after 4 weeks (P = 0.033, P = 0.006). CONCLUSION: This study supports the efficacy of the tested toothpaste in reducing the phenomenon of dentine hypersensitivity after 4 weeks of usage.

What general medicine students of University of Rijeka know about dental avulsion?

INTRODUCTION: Injuries of decidouos and premanent teeth can be rather hard, esspecially in combinatin if they involve adjacent supportive tissue. Among all injuries, the loss of the teeth is considered the most stressful for both a child and its parents. Tooth injury usually involves soft tissue damage, which means severe bleeding. As parents often look for help from their family general practitioners, it is very important that general practitioner is acquainted with the first aid in order to preserve the tooth and enable further skeletal development. MATERIALS AND METHODS: This study was carried out in the form of a questionnaire, which was distributed among general medical students at the Medical studies of the Faculty of Medicine of the University of Rijeka, Croatia. The study included 86 pre-doctoral students of the 3rd, 4th and 5th years of studies. The questionnaire consisted of 23 questions, which were related to demographics, personal experience in treating dental injuries, theoretical knowledge about dental injuries and their interest in additional training on the subject. RESULTS: The results showed that only 32.6% of the students heard of 'tooth avulsion'. Replacement of the avulsed tooth in its original position in the jaw was considered by 77.6% of the students. In their entire education, 84.9% students didn't acquire any knowledge about dental injuries. CONCLUSION: The study showed that medical students have very poor knowledge about dental injuries. Also, the vast majority of the students were neither informed nor educated about it during their studies.

Indicators of dental anxiety in children just prior to treatment.

OBJECTIVES: We evaluated the relationship between child dental anxiety and selected child and parental characteristics. STUDY DESIGN: Children and their parents were interviewed at the New York University, College of Dentistry, Pediatric Dentistry Clinic. The Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) evaluated child self-reported anxiety; the Modified Dental Anxiety Scale (MDAS) measured self-reported parental anxiety when the parent received dental treatment. RESULTS: Ninety-three children and their parents completed the questionnaires. Mean CFSS-DS scores were higher for girls than boys (32.5 vs. 26.3, p=0.003) and for children whose accompanying parents had MDAS scores of 11+ vs. ≥ 11 (32.8 vs. 26.6, p=0.001). There was little difference in mean CFSS-DS scores among those aged 6-10 yrs. vs. 11-14 yrs. (30.1 vs. 29.3). Significant correlations were found between CFSS-DS and both gender (Spearman's rho, rs=0.31) and MDAS scores (rs=0.33), but not between CFSS-DS and child age (rs=-0.05). Controlling simultaneously for gender, MDAS score and child age, a high CFSS-DS score (38+ vs. ≥ 38) was positively associated with girls (ORadj=3.76, 95% CI: 1.13-12.54) and an MDAS score of ≤ 15 vs. ≥ 11 (ORadj=2.50, 0.73-8.54), but weakly and inversely associated with age (ORadj=0.80, 0.25-2.52). CONCLUSION: Child gender and parental anxiety are indicators of child dental anxiety.

Urethral Lengthening in metoidioplasty (female-to-male sex reassignment surgery) by combined buccal mucosa graft and labia minora flap.

OBJECTIVES: To develop a technique for urethral reconstruction using a combined labia minora flap and buccal mucosa graft. Urethral lengthening is the most difficult part in female transsexuals and poses many challenges. METHODS: From April 2005 to February 2008, 38 patients (aged 19-53 years) underwent single-stage metoidioplasty. The technique starts with clitoral lengthening and straightening by division of both clitoral ligaments dorsally and the short urethral plate ventrally. The buccal mucosa graft is quilted to the ventral side of the corpora cavernosa between the native orifice and the tip of the glans. The labia minora flap is dissected from its inner surface to form the ventral aspect of the neourethra. All suture lines are covered by the well-vascularized subcutaneous tissue originating from the labia minora. The labia majora are joined in the midline and 2 silicone testicular implants are inserted to create the scrotum. The neophallus is covered with the remaining clitoral and labial skin. RESULTS: The median follow-up was 22 months (range 11-42). The median neophallic length was 5.6 cm (range 4-9.2). The total length of the neourethra was 9.4-14.2 cm (median 10.8). Voiding while standing was reported by all 38 patients, and temporary dribbling and spraying were noted by 12. Two fistulas and one urethral erosion resulted from the testicular implant and required secondary revision. CONCLUSIONS: A combined buccal mucosa graft and labia minora flap present a good choice for urethral reconstruction in female-to-male transsexuals, with minimal postoperative complications.

One-stage repair of severe hypospadias using combined buccal mucosa graft and longitudinal dorsal skin flap.

AIM OF THE STUDY: Urethral reconstruction in severe hypospadias presents a great challenge. We evaluated a method of combining longitudinal dorsal island skin flap and buccal mucosa graft to create a neourethra in the most severe hypospadias. Our aim was to repair the most difficult cases in a one-stage procedure. METHODS: Between January 2003 and July 2007, 23 patients (aged from 9 to 26 months) underwent repair of severe hypospadias (18 penoscrotal and 5 scrotal forms). The short urethral plate is divided in all cases and the remaining curvature was repaired by dorsal plication. The buccal mucosa graft is harvested and fixed to the ventral side of corpora cavernosa to form the first half of the neourethra. A longitudinal dorsal island skin flap is created and buttonholed ventrally. It is sutured to the buccal mucosa graft to form the neourethra. An abundant flap pedicle is fixed laterally to cover all the suture lines of the neourethra. Penile skin reconstruction is done using available penile skin. RESULTS: The mean follow-up was 27 (range 11-66) months. Satisfactory results were achieved in 20 patients. There were two urethral fistula and one temporary distal urethral stricture. CONCLUSION: A combined longitudinal island skin flap and buccal mucosa graft could be a good choice for single-stage urethral reconstruction in the repair of the most severe hypospadias.

[Dental anxiety and needle phobia in children. A relationship?]. / Angst voor tandheelkundige behandeling en naaldangst bij kinderen. Een verband?

This cross-sectional study aimed at explaining the nature of needle phobia and its relationship in dental phobic children with evidence on age-related differences. The patient sample included randomly selected patients and an group of referred anxious children. The children were divided into three age groups and arranged into three anxiety groups. Needle phobia was demonstrated to be age-related, but should be considered as a separate phenomenon, being not specific for dental anxiety.

Developmental changes in dental anxiety in a normative population of Dutch children.

AIM: The aim of this study was to ascertain age and gender related differences that contribute to dental anxiety and to find relations with early onset of child dental anxiety in a population of 4-11 years old Dutch children. MATERIALS AND METHODS: The study was conducted among 2,865 patients (48.2% girls) aged between 4 and 11 years old. The sample included a normative (n = 2,153) and an anxious group of children (n = 712), who were referred to the Special Dental Care Clinic in Amsterdam because of manifested dental phobia. Children were divided into three age groups (4-6, 7-9 and 10-11 years). Dental anxiety was assessed using the Children Fear Survey Schedule-Dental Subscale. Three levels of dental anxiety were used: low (CFSS-DS = 15-25), moderate (CFSS-DS = 26-36) and high (CFSS-DS above 37). Only children with CFSS-DS scores above 37 were considered dentally phobic. STATISTICS: Statistical analysis was performed in Statistics for Windows 10. RESULTS: In the total group a significantly higher level of dental anxiety was found among girls (p = 0.004; t = -3.262). There was a considerably lower number of dentally phobic boys (7.1%) and girls (9.2%) in the older group compared with the younger (51.8%, 52.8% respectively). One way Anova results revealed a statistically significant age related difference between the oldest and the youngest as well as the middle-aged groups (p < 0.001, p = 0.001). In general dental anxiety was explained better in the younger than in the older group. The regression analysis accounted for a higher percentage of the explained variance. CONCLUSIONS: The study confirmed the highest level of dental anxiety was present at 4 years of age and an overall decrease in dental anxiety occurred as children became older. In different age groups, dental anxiety seems to be related to different aspects of dentistry, indicating the causes shift from simple initial stimuli to more complex events.

Surface quality of Cerec CAD/CAM ceramic veneers treated with four different polishing systems.

AIM: To achieve satisfactory aesthetic appearance of ceramic veneers food debris retention and plaque formation, resulting in possible irritation of surrounding tissues, should be avoided. It is, therefore, necessary to decrease the roughness of ceramic surfaces as much as possible. The aim of this study was to evaluate surface roughness of ceramic veneers after polishin15038787 g with four different techniques. METHODS: Twenty veneers were fabricated using Cerec 2 CAD/CAM method (Sirona AG, Bensheim, Germany) from Cerec VITA MARK II ceramic blocks (Vita Zahnfabrik, Bad Säckingen, Germany) and cemented onto prepared extracted teeth. Veneers were divided into 4 groups of 5 specimens and polished with 4 different techniques: 1. Sof-lex discs grit 150, 360, 600, 1200 (3M, St. Paul, MN, USA); 2. Hawe brushes (Hawe Neos Dental, Bioggio, Switzerland); 3. Hawe brushes and diamond paste Diabrill (Oralia Dental GmbH, Kostanz, Germany); 4. Politip-P rubber cups (Vivadent, Schaan, Liechtenstein). Surface profile was measured using Perthometer Perthen S8P 4.5 (Feinprüf Perthen GmbH, Goettingen, Germany) profilometer. STATISTICS: Data were analysed using ANOVA with Tukey HSD test. RESULTS: Sof-lex discs revealed significant statistical differences for Rz, Ra, Rk, Rpk values (p=0.0002) (Rz=2.92 mm; Ra=0.462 mm; Rk=1.098 mm; Rpk=0.472 mm). Values for Rvk were statistically significant only for rubber cups with diamond paste (p=0,002) (Rvk 4=3.04 mm). Rvk values for all other techniques were not statistically significant (Rvk 1=1.148 mm; Rvk 2=1.936 mm; Rvk 3=2.18 mm). CONCLUSION: The best surface smoothness was achieved with Sof-lex discs polishing system. All other methods are clinically acceptable. Selection of polishing technique should be made according to geometric construction of the polishing instrument and possibility of reaching various restoration areas with the polishing instrument.

Reliability and validity of measures used in assessing dental anxiety in 5- to 15-year-old Croatian children.

AIM: The aim of the study was to evaluate reliability and validity of different questionnaires and predict related causes, as concomitant factors in assessing different aspects of children's dental anxiety. STUDY DESIGN: Children were interviewed on dental anxiety, dispositional risk factors and satisfaction with the dentist after dental treatment had been accomplished. Parents were interviewed on dental anxiety as well. METHODS: The study population included 165 children (91 boys) aged 5 to 15 years, referred to a university dental clinic by general dental practitioners because of a history of fear and uncooperative behaviour during previous dental visits. Children were treated by two dentists, both experienced in treating fearful children. STATISTICS: Statistical analysis was performed in Statistics for Windows, Release 5.5 and Release 7.5. Pearson's correlation coefficients were calculated for validity and Cronbach alpha for reliability of the measures. Spearman Brown prophecy formula was used for correction of the alpha scores. Results The children's total average CFSS-DS score was 27.02, with no significant difference with respect to gender. The highest Cronbach alpha scores regarding reliability were obtained for the S-DAI, the CFSS-DS and the PDAS. Pearson's correlations regarding validity presented significant correlations between the CMFQ, the CDAS and the S-DAI, between the OAS, the CDAS and the S-DAI, as well as between the OAS and the DVSS-SV. CONCLUSION: Previous negative medical experience had significant influence on children's dental anxiety, supporting Rachman's conditioning theory. Anxious children were more likely to show behaviour problems (aggression) and more introvert in expressing their judgement regarding the dentist. Both the S-DAI and the CFSS-DS, which were standardized in the Croatian population sample, showed the highest reliability in assessment of children's dental anxiety.

Factors predicting a child's dental fear.

The aim of the present study was to determine and assess the variables most involved in the etiology of a child's dental fear. The study was performed on a sample of 89 children aged from 5.5 to 12.5 years and their mothers. The sample comprised 37 children with experience of dental trauma (19 boys and 18 girls) and 52 children without experience of dental trauma (28 boys and 24 girls). Corah Dental Anxiety Scale (DAS) was applied to evaluate the level of the child's (CDAS) and mother's (MDAS) dental anxiety. Broome's Child Medical Fear Questionnaire (CMFQ) was used to assess the child's fear of medical treatment. Hollingshead Two Factor Index of Social Position (ISP) was calculated to assess socio-economic status of the family. Cluster analysis differentiated one group of dentally anxious children with the highest level of maternal anxiety (MDAS = 14.44) and the lowest socio-economic status (ISP = 41.94). Another group of extremely anxious children (CDAS = 14.31) showed the highest fear of medical treatment (CMFQ = 22.08) and rather low socio-economic status. One group represented children with the lowest CDAS (5.63), lowest MDAS (8.46), and lowest CMFQ (13.54). Linear regression analysis showed high correlation between previous traumatic medical experiences and a child's dental anxiety using the linear model CDAS' = b0 + b1 x CMFQ. The analysis revealed that a child's dental fear mostly depends on early negative medical experience, while material dental anxiety and socio-economic circumstances seem to be of less importance.

Hypohidrotic ectodermal dysplasia: dental features and carriers detection.

Ectodermal dysplasia is a heterogeneous condition characterized by affected ectodermal structures, among which the teeth and skin with its derivatives (hair sweat glands) are the most frequent. The aim of this work is to present the analysis of dental traits in five families (affected boys and their mothers) with hypohidrotic ectodermal dysplasia (HED), and to evaluate the importance of orofacial and dental findings in the determination of female HED gene carriers. Hypodontia (oligodontia) was found in all the patients. The mothers, gene carriers, had either hypodontia or a reduced size of teeth with a particular morphological, peg shape. In patients with hypohidrotic ectodermal dysplasia the deciduous second molar teeth were mostly affected by taurodontism. The characteristic dental finding in heterozygous females of the mandibular peg shaped incisors and canines, as well as of hypodontia or peg shaped upper lateral incisors can be used as a reliable criterion for the detection of HED gene carriers.

[Intrauterine development of newborns of mothers with diabetes mellitus]. / Intrauterini rast novorodencadi majki sa diabetes mellitusom.

The examination of 170 babies born to diabetic mothers revealed that the body weight of these children was by a significant percent higher than that of other babies of the corresponding gestation age. Hypertrophic babies are born more frequently to mothers with manifest diabetes than to those with gestation diabetes. In mothers with the long-lasting disease accompanied by vascular lesions, retardation of the intrauterine fetal growth may occur. In order to improve the condition of these infants, their mothers should be constantly supervised during pregnancy and they should be prescribed adequate diet and therapy. Diabetic mothers also require greater care at delivery and a more liberal attitude towards the application of the cesarean section in order to prevent hypoxia and obstetric traumas of the infant.