HEALTHY LIFESTYLES FOR HEALTHY GUMS Towards the implementation of lifestyle modifications to improve oral and general health

Unhealthy lifestyles are at the root of the global burden of non-communicable diseases, which account for approximately 41 million deaths (71%) globally each year. Unhealthy lifestyle behaviours, such as poor nutrition, physical inactivity, alcohol/tobacco use, poor sleep quality, and high psychological stress, constitute the multiple determinants of “health” together with genetics, environment, and access to medical care. Over the past several years, there has been an increased interest in evaluating the benefit of adhering to healthier lifestyle behaviours in the development of morbidity and mortality. From a biological standpoint, the detrimental impact of unhealthy lifestyles on systemic health may be mainly ascribed to the induction of a state of low-grade systemic inflammation and to the overproduction of reactive oxygen species, leading to oxidative stress. Evidence is still scarce about the independent and the combined effects of lifestyles on periodontitis onset, severity, and treatment outcomes. Therefore, the aim of the present PhD project was to investigate the association between lifestyles, both independently and combined, and periodontal diseases using cross-sectional and longitudinal study designs. The thesis includes results from different research studies. Chapters 1 and 3 are based on observational evidence collected from a University-based sample regarding the association between adherence to Mediterranean diet, physical activity level, perceived stress, and sleep quality. Chapter 2 analysed the divergent association between leisure-time and occupational physical activity with periodontitis using a nationally representative sample of the US population. Chapter 4 analysed the dose-response relationship between the number of healthy lifestyles and periodontitis in two large-scale epidemiological studies from the US and the UK. Finally, Chapter 5 shows experimental data deriving from a case-series of participants from the same population with periodontitis and analysis of pre-post non-surgical periodontal therapy

Service user involvement in the evaluation of psycho-social intervention for self-harm: a systematic literature review

Background: The efficacy of interventions and treatments for self-harm is well researched. Previous reviews of the literature have highlighted the lack of definitively effective interventions for self-harm and have highlighted the need for future research. These recommendations are also reflected in clinical guidelines published by the National Institute for Health and Clinical Excellence (NICE, 2004) which also call for service user involvement in studies of treatment efficacy. Aims: A systematic review was undertaken to determine i) what contributions service users have made to the evaluation of psychosocial interventions ii) by what methods have service users been involved iii) in what ways could service user involvement supplement empirical evidence for interventions

Reprint of “The Single-Case Reporting Guideline In BEhavioural interventions (SCRIBE) 2016: explanation and elaboration”

There is substantial evidence that research studies reported in the scientific literature do not provide adequate information so that readers know exactly what was done and what was found. This problem has been addressed by the development of reporting guidelines which tell authors what should be reported and how it should be described. Many reporting guidelines are now available for different types of research designs. There is no such guideline for one type of research design commonly used in the behavioral sciences, the single-case experimental design (SCED). The present study addressed this gap. This report describes the Single-Case Reporting guideline In BEhavioural interventions (SCRIBE) 2016, which is a set of 26 items that authors need to address when writing about SCED research for publication in a scientific journal. Each item is described, a rationale for its inclusion is provided, and examples of adequate reporting taken from the literature are quoted. It is recommended that the SCRIBE 2016 is used by authors preparing manuscripts describing SCED research for publication, as well as journal reviewers and editors who are evaluating such manuscripts.Published versio

An evaluation of the quality of statistical design and analysis of published medical research : results from a systematic survey of general orthopaedic journals

Background: The application of statistics in reported research in trauma and orthopaedic surgery has become ever more important and complex. Despite the extensive use of statistical analysis, it is still a subject which is often not conceptually well understood, resulting in clear methodological flaws and inadequate reporting in many papers. Methods: A detailed statistical survey sampled 100 representative orthopaedic papers using a validated questionnaire that assessed the quality of the trial design and statistical analysis methods. Results: The survey found evidence of failings in study design, statistical methodology and presentation of the results. Overall, in 17% (95% confidence interval; 10–26%) of the studies investigated the conclusions were not clearly justified by the results, in 39% (30–49%) of studies a different analysis should have been undertaken and in 17% (10–26%) a different analysis could have made a difference to the overall conclusions. Conclusion: It is only by an improved dialogue between statistician, clinician, reviewer and journal editor that the failings in design methodology and analysis highlighted by this survey can be addressed

Risk attitudes in medical decisions for others: an experimental approach

The aim of this paper is to investigate how risk attitudes in medical decisions for others vary across health contexts. A lab experiment was designed to elicit the risk attitudes of 257 medical and nonmedical students by assigning them the role of a physician who must decide between treatments for patients. An interval regression model was used to estimate individual coefficients of relative risk aversion, and an estimation model was used to test for the effect of type of medical decision and experimental design characteristics on elicited risk aversion. We find that (a) risk attitudes vary across different health contexts, but risk aversion prevails in all of them; (b) students enrolled in health‐related degrees show a higher degree of risk aversion; and (c) real rewards for third parties (patients) make subjects less risk‐averse. The results underline the importance of accounting for attitudes towards risk in medical decision making.Ministerio de Ciencia y Tecnología and FEDER, Grant numbers: ECO2012‐3648, ECO2013‐43526‐R, ECO2015‐65031‐R and ECO2015‐65408‐R; Junta de Andalucía, Grant number: SEJ‐0499

How Do We Know It Works? Approaches to the Evaluation of Complementary Medicine

Complementary medicine is a term used to cover a vast array of treatment procedures as wide ranging as aroma therapy, iridology, acupuncture, homeopathy and osteopathy. It is sometimes known as alternative or even folk medicine. These complementary therapies exist because people find them helpful. Research must, therefore, be directed at asking 'Who?' ,. 'What?', and 'How?'. In the following chapter ways of answering these questions are examined. Emphasis is given to the need for a variety of different research strategies and tactics. A preliminary outline of an overall approach which would hold together the strands in a fruitful way is proposed, based on facet Meta-Theory. In considering the emerging research prospect for the study of complementary medical practice it is important to clarify some initial premises. These provide a framework within which to consider a great variety of research possibilities. They also point towards areas of study that might not otherwise be apparent

Pseudoreplication invalidates the results of many neuroscientific studies

Background: Pseudoreplication occurs when observations are not statistically independent, but treated as if they are. This can occur when there are multiple observations on the same subjects, when samples are nested or hierarchically organised, or when measurements are correlated in time or space. Analysis of such data without taking these dependencies into account can lead to meaningless results, and examples can easily be found in the neuroscience literature.\ud \ud Results: A single issue of Nature Neuroscience provided a number of examples and is used as a case study to highlight how pseudoreplication arises in neuroscientific studies, why the analyses in these papers are incorrect, and appropriate analytical methods are provided. 12% of papers had pseudoreplication and a further 36% were suspected of having pseudoreplication, but it was not possible to determine for certain because insufficient information about the analysis was provided.\ud \ud Conclusions: Pseudoreplication undermines the conclusions from statistical analysis of data, and it would be easier to detect if the sample size, degrees of freedom, the test statistic, and precise p-values are reported. This information should be a requirement for all publications

Paying for Quality: Understanding and Assessing Physician Pay-for-Performance Initiatives

Reviews the structure, prevalence, measurement issues, perception, and impact of current quality incentive programs, and discusses how much and under what circumstances they will improve quality of care. Includes descriptions of select programs

Hypnosis for acute procedural pain: a critical review

Clinical evidence for the effectiveness of hypnosis in the treatment of acute procedural pain was critically evaluated based on reports from randomized controlled clinical trials (RCTs). Results from the 29 RCTs meeting inclusion criteria suggest that hypnosis decreases pain compared to standard care and attention control groups and that it is at least as effective as comparable adjunct psychological or behavioral therapies. In addition, applying hypnosis in multiple sessions prior to the day of the procedure produced the highest percentage of significant results. Hypnosis was most effective in minor surgical procedures. However, interpretations are limited by considerable risk of bias. Further studies using minimally effective control conditions and systematic control of intervention dose and timing are required to strengthen conclusions