Incidence and risk factors for respiratory tract bacterial colonization and infection in lung transplant recipients.

To evaluate incidence of and risk factors for respiratory bacterial colonization and infections within 30 days from lung transplantation (LT). We retrospectively analyzed microbiological and clinical data from 94 patients transplanted for indications other than cystic fibrosis, focusing on the occurrence of bacterial respiratory colonization or infection during 1 month of follow-up after LT. Thirty-three percent of patients developed lower respiratory bacterial colonization. Bilateral LT and chronic heart diseases were independently associated to a higher risk of overall bacterial colonization. Peptic diseases conferred a higher risk of multi-drug resistant (MDR) colonization, while longer duration of aerosol prophylaxis was associated with a lower risk. Overall, 35% of lung recipients developed bacterial pneumonia. COPD (when compared to idiopathic pulmonary fibrosis, IPF) and higher BMI were associated to a lower risk of bacterial infection. A higher risk of MDR infection was observed in IPF and in patients with pre-transplant colonization and infections. The risk of post-LT respiratory infections could be stratified by considering several factors (indication for LT, type of LT, presence of certain comorbidities, and microbiologic assessment before LT). A wider use of early nebulized therapies could be useful to prevent MDR colonization, thus potentially lowering infectious risk.

Subjective and objective social status: associations with psychosocial predictors and oral health.

OBJECTIVE: While social status and health have been investigated, there is less focus on the effects of objective and subjective social status and psychosocial factors. This study aimed to investigate oral health impacts by subjective social status (SSS) and psychosocial predictors stratified by subjective social status. METHODS: A random cross-sectional sample of 45-54-year old South Australians was surveyed in 2004-05. Oral health impact was assessed using OHIP-14. Socio-economic status was determined using objective (income) and subjective (McArthur scale) measures. Psychosocial variables comprised social support, health self-efficacy, coping and affectivity. RESULTS: Responses were collected from 986 persons (response rate=44.4%). Lower SSS was more frequently observed in the low (70.2%) than high-income group (28.5%). Lower SSS was associated (p⟨0.05) with lower education, social support, health competence, and coping, but higher negative affect within income groups. The interaction of SSS and income showed OHIP was consistently lower at high SSS regardless of higher or lower income, but at low SSS, OHIP was higher (p⟨0.05) in the lower than higher income group. CONCLUSIONS: SSS was associated with income. Their interaction indicated low SSS in combination with low income was associated with higher oral health impacts.

Social Inequities in Access to Dental Care in Australian Adults over Time.

INTRODUCTION: Social inequities in dental caries are reflected by both inequities in the social structures that contribute to disease severity and inequities in the provision of dental care. This study aimed to describe social differentials in the dental caries experience among Australian adults across a 13-y period and to examine if the highest magnitude of oral health inequities persisted across dental caries prevalence (decayed teeth [DT]) or its management (missing teeth [MT], filled teeth [FT]). METHODS: Data were from 2 population-based cross-sectional surveys of Australian adult oral health conducted in 2004-2006 (National Survey of Adult Oral Health-1 [NSAOH-1], n = 5,505) and 2017-2018 (NSAOH-2, n = 5,022). In each survey, representative samples of adults were obtained through a 3-stage, stratified sample design within metropolitan and regional areas in each state/territory. Clinical outcomes included the prevalence and mean of DT, MT, FT, and DMFT. Equivalized household income was grouped into approximately quartiles from low to high. RESULTS: Across all income quartiles, the mean DT and % DT >0 was higher in NSAOH-2 than in NSAOH-1. The increase in prevalence was highest in the third highest income group (prevalence difference [PD] = 8.4, from 24.1 to 32.5). Similarly, % MT >0 was lower in NSAOH-2 than in NSAOH-1 across all income groups, with the decrease most marked for the lowest income group (PD = -6.5, from 74.1 to 67.8). Across all income quartiles, % FT >0 was lower in NSAOH-2 than in NSAOH-1. The decrease was the most marked for the lowest income group (PD = -8.9, from 81.1 to 72.2). CONCLUSION: The findings confirm that although oral health inequities decreased for the most extreme management outcome of dental caries (MT), inequities increased for experience of that disease (DT) and the more conservative management of dental caries (FT). For all D, M, and F components (DMFT), inequities between the lowest and highest household income groups increased from 2004-2006 to 2017-2018. KNOWLEDGE TRANSFER STATEMENT: This study found that social inequities in oral health (experience of untreated dental caries and missing teeth) increased between the most socially advantaged and disadvantaged groups between 2004-2006 and 2017-2018. This suggests that models of dental service provision in Australia are increasingly benefitting those who can afford and access the care and who arguably need the services less than their less socially advantaged counterparts do.

Impact of a nursing information system in clinical practice: a longitudinal study project.

BACKGROUND: The implementation of adequate clinical information systems helps to deal with the immense flow of health data to ensure the continuity of care and access to a safe and high-quality healthcare system. Currently there is an increasing awareness of the importance of evaluating and measuring the impact of such systems in clinical practice. Implementations often fail, due to inadequate interaction between technology and human elements. METHODS: This article describes a research project aimed at evaluating the impact of a clinical nursing information system (CNIS), called Professional Assessment Instrument (PAI), in clinical practice. The study will evaluate PAI Quality, Nurses Satisfaction, PAI Use, Nurses and Environment Characteristics, Net Benefits and Nurses' Experiences related to the PAI use. A theoretical model developed for this research will guide the study. A quali-quantitative longitudinal design will be performed involving two hospitals over a 9-month period. To measure different dimensions that affect the success/failure of CNIS we will use different tools/ methods of data collection (questionnaires, psychometric tools, surveys and focus groups). EXPECTED RESULTS: This study will evaluate the impact of a CNIS in hospitals providing an overview of the factors which can help and hinder the implementation of an information system. CONCLUSIONS: The results of the study will support interventions to improve and implement clinical information systems designed to computerize nursing data, with positive effects on public health and research in general, providing further evidence for health policy.

Population Impact of Sugar-Sweetened Beverages on Dental Caries and Overweight/Obesity in Australian Children.

KNOWLEDGE TRANSFER STATEMENT: The reported findings greatly consolidated evidence of detrimental effects of sugars intake on child oral health and overweight and obesity, some of the most prevalent chronic conditions in children. Evidence on population impact of sugars intake is directly informative to policy makers and the public about the potential impact of population-based programs targeting sugars intake to prevent dental caries and overweight and obesity.

RoboticAssisted (RATS) versus Video-Assisted (VATS) lobectomy: A monocentric prospective randomized trial.

INTRODUCTION: The study aim is to compare Video-Assisted (VATS) and Robotic-Assisted (RATS) lobectomy in the effort to identify advantages and limits of robotic procedures considering the high costs and specific surgeon training. MATERIALS AND METHODS: This is a monocentric prospective randomized trial in which patients suitable for mini-invasive lobectomy were randomized 1:2 in two groups: Group A, RATS (25 patients), and Group B, VATS (50 patients). The two groups were compared in terms of perioperative and postoperative results with a mean follow up of 37.9 (±10.9) months. RESULTS: We observed a significant reduction of pleural effusion on day 1 (140 ml vs 214, p = 0.003) and day 2 (186 vs 321, p = 0.001) for group A. The Visual Analogue Scale (VAS) showed significantly lower pain in the 1st p.o. day in group A (0,92 vs 1,17, p = 0,005). Surgery time in Group B was significantly lower (160 min vs 180, p = 0.036), but had a higher onset of atrial fibrillation and other cardiac arrhythmias (0/25 vs 9/50, p = 0.038). The OS and DFS were similar between the two groups (95.5 % vs 93.1 %, and 95.5 % vs 89.7 %, respectively). Furthermore, no statistical difference in the evaluation of quality of life during follow-up was found. CONCLUSIONS: The RATS approach, although burdened by higher surgical costs, constitutes a valid alternative to VATS; as it determines a lower inflammatory insult, with a consequent reduction in pleural effusion, less post-operative pain and cardiological comorbidities for the patient, it can potentially determine the shortening in hospitalization. In addition, RATS allows accurate lymph node dissection, which permit to reach results that are not inferior to VATS in terms of long-term outcomes.

Lung resection for non-small cell lung cancer after prophylactic coronary angioplasty and stenting: short- and long-term results.

AIM: Recent studies have reported a high incidence of perioperative in-stent trombosis with myocardial infarction (MI), in patients undergoing non-cardiac surgery, early after coronary angioplasty and stenting. The short and long-term results of surgery for non-small cell lung cancer (NSCLC) after prophylatic coronary angioplasty and stenting were analyzed. METHODS: Prospective collected data were examined for postoperative complications and long-term survival in 16 consecutive patients who underwent mayor lung resection for NSCLC after prophylactic coronary angioplasty and stenting for significant coronary artery disease , from 2001 to 2008. One and two non-drug-eluting stents were placed in 75% or (25% of the patient, respectively. All patients had four weeks of dual antiplatelet therapy, that was discontinued 5 days prior to surgery and replaced by low molecular weight heparin. Patients were keep sedated and intubated overnight, according to our protocol. RESULTS: There were no postoperative deaths nor MI. A patient experienced pulmonary embolism with moderate troponin release and underwent coronary angiography that showed patency of the stent. Two patients developed postoperative bleeding complications haemothorax requiring a re-thoracotomy in 1, gastric bleeding requiring blood transfusion in 1. At the mean follow-up of 30 months (range 3-95), none of the patients showed evidence of myocardial ischemia, while 5 (31%) patients died, mostly (N.=4) due to distant metastasis. The five-year survival rate was 53%. CONCLUSION: In contrast to previous reports, lung resection after prophylactic coronary angioplasty and stenting is a safe and effective treatment for NSCLC and myocardial ischemia. The application of a refined protocol could be the key factor for improved results.

Access to dental care barriers and poor clinical oral health in Australian regional populations.

BACKGROUND: This paper investigated the associations between oral health with behavioural, demographic, periodontitis risk, financial and access to dental care barriers and compared the results in three Australian regional areas. METHODS: Data were obtained from the Australian National Study of Adult Oral Health (2017-18). Oral health status was measured using DMFT-score, and mean numbers of decayed, missing or filled teeth and periodontitis prevalence using the Center for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) Periodontal Classification. The analysis included these dependent variables by three regional areas, seven socio-demographic variables, two periodontal disease risk factors, two preventive dental behaviours, two barriers to dental care and three access to dental care variables. RESULTS: Of the 15,731 people interviewed, 5,022 were examined. There was no significant difference in periodontitis prevalence between the regions. All the socio-demographic characteristics, periodontal disease risk factors and preventive dental behaviours were significantly associated with at least one of the dental caries indicators. In multivariable analysis, there was no significant association between regional location with any of the four clinical dental caries variables. CONCLUSION: Poorer oral health outside major cities was associated with household income, education level, higher smoking, usual reason for and frequency of dental visiting.

Inequality and Inequity in the Use of Oral Health Services in Australian Adults.

OBJECTIVE: Social determinants drive disparities in dental visiting. This study aimed to measure inequality and inequity in dental visiting among Australian adults. METHODS: Data were obtained from the National Study of Adult Oral Health (2017 to 2018). Participants were Australian adults aged ≥30 y. The outcome of interest was dental visiting in the last 12 mo. Disparity indicators included education and income. Other sociodemographic characteristics included age, gender, Indigenous status, main language, place of birth, residential location, health card and dental insurance status, and individual's self-rated and impaired oral health. To characterize inequality in dental service use, we examined bivariate relationships using indices of inequality: the absolute and relative concentration indexes and the slope and relative indexes of inequality. Inequalities were depicted through concentration curves. Indirect standardization with a nonlinear model was used to measure inequity. RESULTS: A total of 9,919 Australian adults were included. Bivariate analysis showed a gradient by education and income on dental visiting, with 48% of those with lowest educational attainment/income having not visited a dentist in the last 12 mo. The concentration curves showed pro-low education and pro-poor income inequalities. All measures of absolute and relative indices were negative, indicating that from the bottom to the top of the socioeconomic ladder (education and income), the prevalence of no dental visiting decreased: absolute and relative concentration index estimates were approximately 2.5% and 5.0%, while the slope and relative indexes of inequality estimates were 14% to 18% and 0.4%, respectively. After need standardization, the group with the highest education or income had almost 1.5-times less probability of not having a dental visit in the previous year than those with the lowest education or income. CONCLUSION: The use of oral health services exhibited socioeconomic inequalities and inequities, disproportionately burdening disadvantaged Australian adults. KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by policy makers when planning a dental labor force in relation to the capacity of supply dental services to 1) reduce the inequality and inequity in the use of oral health services and 2) meet identified oral health needs across the Australian population, which is important for preventive dental care.

"HRCT predictors of GGO surgical resection: Histopathological and molecular correlation in the era of lung sparing surgery".

OBJECTIVES: Ground-glass pulmonary opacities (GGOs) are increasingly encountered in routine clinical practice and an accurate differentiation between benign and malignant lesions is crucial. The aim of this study is to evaluate the relationship between radiological features and the actual biological behavior of these nodules. The secondary endpoint is to identify any radiological predictors able to choose the type of surgical resection and the extent of lymphadenectomy. MATERIALS AND METHODS: This single-center retrospective study included all patients, who underwent high resolution computed tomography (HRCT) and surgical resection for GGOs between 2010 and 2020. Histopathological sampling focused on lesion size, histology, growth pattern, amount of lepidic component, percentage of ground-glass (GG), grade of tumor and proliferation index (Ki67). RESULTS: In 56 patients enrolled, 65 lesions (15 pure GG and 50 part-solid) were resected (44 lobectomies, 9 anatomical segmentectomies, 12 wedge resections). A direct significant correlation was found between: the GG at HRCT and the amount of lepidic component (p < 0.0001; R = 0.305), the tumor grading and the lepidic component at HRCT (p = 0.003), the percentage of GG and the expression of Ki67 (p = 0.016), the lepidic percentage and the expression of Ki67 (p = 0.004; R = 0.223). A total of 609 lymph-nodes were removed (stations N1 and N2) and histopathological analysis was negative for nodal involvement in all cases. CONCLUSION: Pure and part-solid GGOs could benefit from less invasive and lung sparing surgery with just nodal sampling. These would reduce surgical complications and guarantee a better quality of life for the patient. The major limitations are the number of patients and the lack of a longer follow-up.

Treatment of late tracheomediastinal fistula following diagnostic mediastinoscopy treated by multiple pedicled muscle flaps.

During mediastinoscopy in a 38-year-old woman, there was uncontrolled bleeding that required a sternal split. One month later, chest and neck CT scan demonstrated tracheomediastinal fistula. The patient underwent urgent operation. Repair of the tracheal defect was accomplished using a pedicled right sternohyoid muscle; the right sternocleidomastoid muscle was used to separate the trachea from the innominate artery and the left pectoralis major muscle was used to fill the anterior mediastinal space. The postoperative course was uneventful. One month later, another CT scan demonstrated complete resolution. Careful use of coagulation during mediastinoscopy is of paramount importance to avoid thermal injury to the trachea. This case also underlines the importance of a good knowledge of the anatomy of the skeletal muscles of the chest wall and adjacent regions.

Oral health changes among Indigenous and non-Indigenous Australians: findings from two national oral health surveys.

BACKGROUND: Historically, Indigenous Australians experienced poorer oral health than non-Indigenous Australians. We aimed to ascertain if Indigenous Australian oral health improved relative to non-Indigenous oral health between the 2004-06 and 2017-18 National Surveys of Adult Oral Health (NSAOH). METHODS: Both NSAOHs were population-based cross-sectional surveys of Australian adults aged 15 years or more. In both surveys, representative samples of adults were drawn through a three-stage, stratified sample design within metropolitan and regional areas in each state/territory. Frequencies of Indigenous and non-Indigenous self-reported and clinical oral health variables were ascertained, and differences were calculated between the 2004-06 and 2017-18 NSAOHs. Ninety-five per cent confidence intervals were calculated and weights were used to account for the complex sampling methodology of both surveys. RESULTS: In 2004-06, 229 Indigenous and 13 882 non-Indigenous Australians provided self-report data, and 87 and 5418 of these had dental examinations, respectively. In 2017-18, 334 Indigenous and 15 392 non-Indigenous Australians provided self-report data, and 84 and 4937 of them had dental examinations respectively. Between the surveys, relative to their non-Indigenous counterparts, Indigenous Australians experienced greater levels of: inadequate dentition (4.2%), experience of toothache (4.8%), problem-based dental attendance (4.5%) and 1+ teeth decayed, missing or filled (4.4%). CONCLUSIONS: The gap between poor self-reported and clinical oral health between Indigenous and non-Indigenous Australians was greater in the more recent survey.

Pleural granuloma mimicking malignancy 42 years after slurry talc injection for primary spontaneous pneumothorax.

BACKGROUND: Talc poudrage is considered a safe pleurodesis technique to improve the results of video-assisted thoracoscopic surgery in cases of primary spontaneous pneumothorax (PSP). METHODS: We report the case of a patient with left pleural pseudo-nodular plaque and a high metabolic rate upon PET scan suspected for malignancy, occurring 42 years after slurry talc injection for conservative treatment of PSP. The patient presented with coughing, chest pain and weight loss. Thoracotomy was required to obtain a diagnosis and perform a complete pleurectomy. RESULTS: Histology was conclusive for pleural talc granuloma. CONCLUSIONS: Indications and possible complications of talc use in young patients with PSP, and the management of possible consequent pleural lesions suspected for malignancy, need to be investigated.

Dental services provided by dentists in Australia.

OBJECTIVES: To examine the efect of age and gender on dental services provided by dentists in Australia, and compare with previous estimates across the period 1983-1984 to 2013-2014. METHODS: Data were collected by mailed survey from a random sample of Australian dentists. Private sector dentists were the focus of the analysis. Data were weighted to the age and sex distribution of Australian practising dentists. RESULTS: The analysis was based on service logs collected from n = 211 dentists. Adjusted results (rate ratio, 95% CI) showed male dentists had higher endodontic rates (1.7, 1.0-2.9) than female dentists. Dentists aged 40-49 years had higher restorative rates (1.6, 1.1-2.2) but lower preventive rates (0.5, 0.3-0.9) than those aged 20-29 years. Diagnostic services were lower for dentists aged 40-49 to 60+ years (0.8, 0.6-0.9), while denture services were higher for dentists aged 40-49 (11.1, 2.5-48.5) to 60+ years (6.4, 1.2-33.3). Crowns were higher for dentists aged 40-49 (2.4, 1.0-5.6) and 50-59 years (2.9, 1.3-6.6). Diagnostic and preventive services were consistently higher across 1983-1984 to 2013-2014. CONCLUSIONS: Younger dentists provided higher rates of diagnostic and preventive services. Over a 30-year period, there was a consistent trend towards higher provision of diagnostic and preventive services.

Private Dental Care Benefits Non-Indigenous Children More Than Indigenous Children.

INTRODUCTION: Various arrangements for funding health care facilities can have different levels of performance of care provision on different groups of people. Such differential performance of oral care is not previously known concerning Indigenous communities. OBJECTIVE: This study aimed to assess the effect of visiting a public or private dental care facility on the performance of oral care experienced by Indigenous versus non-Indigenous children in Australia. METHODS: Data from the National Child Oral Health Survey were used with a representative sample of children from all the states and territories of Australia. The performance of oral care was measured with the Child Oral Care Performance Assessment Scale (COPAS), which contains 37 items from 9 domains (Effective, Appropriate, Efficient, Responsive, Accessible, Safe, Continuous, Capable, and Sustainable) with a score ranging from 0 to 148. Mixed effects models that accounted for stratum and sampling weights were used for the stratified analyses (Indigenous vs. non-Indigenous) that assessed the effect of public versus private care on the COPAS. Relative excess risk due to interaction was calculated to assess effect modification. RESULTS: Among the Indigenous children, private care was similar to public care (regression coefficient [RC] = -1.27, 95% CI = -9.5 to 6.97), whereas private care was higher than public care among non-Indigenous children (RC = 4.60, 95% CI = 3.67 to 6.18). This trend was similar among the 9 domains of the COPAS as well, except for Effectiveness, which was similar for private and public facilities among non-Indigenous children (RC = -0.03, 95% CI = -0.29 to 0.23). Based on the continuous COPAS score, effect modification was 4.46 (95% CI = 0.11 to 8.82) on the additive scale and 1.06 (1.01, 1.13) on the multiplicative scale. The relative excess risk due to interaction reported an excess chance of 1.17 (95% CI = 0.01 to 0.33), which was consistent with the stratified analyses and effect modification measured with the continuous score. CONCLUSION: Thus, this study found a higher performance of oral care in private care locations among non-Indigenous children versus Indigenous children. KNOWLEDGE TRANSFER STATEMENT: The findings caution policy makers and other stakeholders that moving oral care from public to private care facilities can increase the inequity faced by Indigenous children in Australia.

Impact of hepatitis B vaccination in children born to HBsAg-positive mothers: a 20-year retrospective study.

BACKGROUND: Preventive measures remain the best approach to control the spread of hepatitis B virus (HBV) infection. PATIENTS AND METHODS: To evaluate the effectiveness of vaccination against HBV, we conducted a 20-year retrospective study on 100 subjects, born to hepatitis B surface antigen (HBsAg)-positive mothers, who had received postexposure prophylaxis at the Clinic of Infectious Diseases (Siena University, Italy) during 1984-2004. All patients were tested for the presence of HBsAg, anti-HBs and anti-HB core antigen (anti-HBc). RESULTS: Two subjects (2%) acquired the infection as shown by the presence of anti-HBc. Of the 98 patients who did not acquire the infection, 62 of these (63.3%) had an anti-HBs concentration considered protective (> or =10 mIU/ml). The percentage of protected subjects decreased in relation to time from vaccination with a significant reduction (p = 0.009) of anti-HBs geometric mean titre (GMT) after 5 years, which reached the level of 10 mIU/ml after about 15 years. No patients without protective concentration have acquired the infection as of today. Only 12% of the HBsAg-positive mothers were followed in specialized structures after pregnancy, reflecting the scarce knowledge of the problem in the general population. CONCLUSION: Our data, while confirming the effectiveness of anti hepatitis B vaccination, highlight the need for postvaccination follow-up, particularly in high-risk categories, to prolong protection, through booster doses if necessary. We show, moreover, the importance of maintaining active surveillance in the territory to improve follow-up to chronic carriers and to sensitize families.

Association of urgent dental care with subjective oral health indicators and psychosocial impact.

UNLABELLED: Pressures on public dental services require new approaches to managing demand. OBJECTIVE: To identify possible predictors of urgency of clinically assessed emergency dental care using self-reported oral health indicators. DESIGN AND METHODS: This study was a prospective study examining associations between patient reports of oral health indicators and psychosocial impact of oral disorders and a clinical determination of a hierarchy of urgency of emergency dental care. The data set comprised a random sample of 839 eligible adults presenting to nine public dental clinics across South Australia and New South Wales for emergency dental care. All participants held a government health concession card and were aged 18+ years and had a minimum of six natural teeth. Significant associations between self-reported oral health indicators and psychosocial impacts and a normative clinical assessment of urgency of emergency dental care were examined by means of binary logistic regression analysis in order to develop prediction models. Prediction of the urgency of emergency dental care was based on the assessment of two models--Model 1: urgency of care = <48 hours vs. 2+ days, Model 2: urgency of care = 2-7 days vs. 8+ days. RESULTS: Some 35.8%, 34.8% and 29.4% of respondents were classified by the assessing dentist as requiring dental care within 48 hours, 2-7 days and 8+ days respectively. For Model 1, difficulty sleeping all the time (OR = 4.8, CI = 3.0-8.0), pain in the jaw when opening wide (OR=2.4, CI=1.6-3.7), having a broken filling (OR = 1.7, C1 = 1.1-2.4), having a loose tooth (OR = 2.4, CI = 1.5-3.8), bleeding gums (OR = 0.7, CI = 0.5-1.0) and being dentally anxious (OR = 1.5, CI = 1.0-2.3) had a statistically significant association with needing to be seen within 48 hours. For Model 2, factors significantly associated with an urgency of care in the period 2-7 days included experience of toothache (OR = 2.6, CI = 1.6-4.3), pain in teeth with hot food or fluids (1.9, CI = 1.2-2.9), bleeding gums (OR = 2.0, CI = 1.3-3.2), having a broken filling (OR = 2.1, CI = 1.2-3.5), difficulty sleeping all the time (OR = 2.9, CI=1.4-6.4), and being concerned about the appearance of teeth or mouth very often (OR=0.3, CI = 0.1-0.7). CONCLUSION: This study has identified a pertinent set of self-reported oral health indicators that can be used to predict the urgency of emergency dental care.

Predicting relative need for urgent dental care.

OBJECTIVE: To develop prediction models of the relative need for care to differentiate between urgent and not urgent individuals presenting for emergency dental care. DESIGN AND METHODS: Data were collected from 839 adults presenting to public dental clinics across South Australia (SA) and New South Wales (NSW) for emergency dental care. Prediction of the urgency of emergency dental care was based on the assessment of two binary logistic regression models - Model 1: urgency of care=<48 hours vs. 2+ days, Model 2: urgency of care=2-7 days vs. 8+ days. Subsequently predictive equations for urgency of emergency dental care were developed using binary logistic regression analysis. The models incorporated subjective oral health indicators (i.e., experience of pain or other oral symptoms) and measures of psychosocial impact of oral disorders (i.e., difficulty sleeping and being worried about the appearance/health of one's teeth or mouth). RESULTS: The cut-off point for the prediction of urgency was defined as a probability value > or =0.40 and > or =0.50 for Model 1 and Model 2 respectively. These cut-off values were chosen as they produced test results that were consistent with the proportions of patients falling into various urgency categories derived from dentist's assessment of urgency. Model 1's sensitivity was 58%, specificity 77% and positive predictive value (PPV) 59%. Model 2's sensitivity was 75%, specificity 65% and PPV 71%. CONCLUSIONS: These models of relative need may be useful tools for the screening of urgent dental care and for allocating priority among patients presenting for emergency dental care.

Public dental service utilization among adults in South Australia.

BACKGROUND: Longitudinal patterns of public dental service use may reflect access issues to public dental care services. Therefore, patterns of dental service use among South Australian adult public dental patients over a 3(1/2)-year period were examined. METHODS: Public dental patients (n = 898) initially receiving a course of emergency dental care (EDC) or general dental care (GDC) at baseline were followed for up to 3(1/2) years. Patient clinical records were accessed electronically to obtain information on dental visits and treatment received at those visits. RESULTS: Some 70.7 per cent of EDC and 51.3 per cent of GDC patients returned for dental treatment post-baseline. EDC patients returned within a significantly shorter time period post-baseline, received significantly more courses of care and were visiting more frequently than GDC patients. A greater proportion of EDC patients received oral surgery, restorative, endodontic and prosthodontic services, but fewer received periodontic services. EDC patients received significantly more oral surgery and fewer preventive services per follow-up year, on average, than GDC patients. Large proportions of EDC (52.4 per cent) and GDC (63.8 per cent) patients who returned sought emergency care post-baseline. CONCLUSIONS: Patients appeared to be cycling through emergency dental care because of lack of access to general care services, highlighting access problems to public dental care.

Pleuroparenchymal fibroelastosis (PPFE) associated with giant cell arteritis: A coincidence or a novel phenotype?

Pleuroparenchymal fibroelastosis (PPFE) is a rare interstitial lung disease characterized by the fibrotic thickening of subpleural and parenchymal areas of the upper lobes. It may be both idiopathic or secondary to infections, interstitial lung diseases and/or drug exposure. Often PPFE patients report recurrent lower respiratory tract infections, suggesting that repeated inflammatory alterations induced by pulmonary infections may contribute to the development/progression of PPFE. Here, we report for the first time the case of a patient affected by Giant cell Arteritis with histologically proven PPFE. The lung involvement in GCA is rare and interstitial lung diseases are usually reported as an uncommon clinical manifestation of GCA. Our patient is probably the first case presenting PPFE associated with GCA and we wonder if this is a real associative disease or a coincidence perhaps, secondary to drug effects.