Dimensions of oral health related quality of life measured by EQ-5D+ and OHIP-14

BACKGROUND: The aims of the study were to compare the dimensions of oral-health-related quality-of-life measured by a generic health state measure, the EuroQol, and a specific oral health measure, the Oral Health Impact Profile. METHODS: Data were collected in 2001–02 from a random sample of South Australian dentists using mailed self-complete questionnaires. Dentists recorded the diagnosis of dental problems and provided patients with self-complete questionnaires to record the nature, severity and duration of symptoms using the EuroQol (EQ-5D+) and 14-item version of the Oral Health Impact Profile (OHIP-14) instruments. RESULTS: Data were available from 375 patients (response rate = 72%). The EuroQol items of mobility, self care and usual activities formed a separate cluster of variables, as did anxiety/depression and cognition, while pain clustered with items from the OHIP physical pain subscale. OHIP items tended to form clusters consistent with the subscales of social disability, physical disability, physical pain, functional limitation and psychological discomfort. The OHIP handicap items clustered between the OHIP social disability and physical disability subscales. The OHIP psychological disability items split between the social disability and psychological discomfort subscales. CONCLUSIONS: The observed clusters of variables empirically supported most of the conceptual dimensions of the OHIP. Both instruments covered symptom experience of pain indicating overlapping domains. However there was partial separation of the generic and specific items, EuroQol covered daily activities such as self-care and usual activities and OHIP covered oral health-specific aspects of functional limitation and physical disability as well as psychological and social aspects of disability and handicap

The Role Body-Esteem Plays in Impairment Associated with Hair-Pulling and Skin Picking in Adolescents

Trichotillomania (hair pulling disorder, HPD) and pathological skin picking (PSP) are associated with significant rates of psychosocial impairment and distress. Little research has addressed the physical consequences and associated impairment in youth (e.g., poor body-esteem). The present study explores the relationship between body-esteem, skin picking (SP), and pulling-related impairment in a sample of adolescents with primary HPD. Ninety four adolescents who pull their hair, 40 of whom also pick their skin, were recruited via internet-sampling as part of the Child and Adolescent Trichotillomania Impact Study (CA-TIP). All youth and a parent completed anonymous questionnaires online assessing psychiatric symptoms, repetitive behaviors, and psychosocial impairment, among other variables. Appearance-based body-esteem was not found to be predictive of more severe psychosocial impairment in these youth. However, SP, in combination with HPD, contributed to worse appearance-based body-esteem above and beyond symptoms of HPD alone. The current study suggests that psychosocial functioning in youth with HPD is less impacted by body-esteem or pulling than other factors (e.g., depression and anxiety), and that SP contributes to lowered body-esteem. These findings suggest the importance of addressing body-esteem in case conceptualization for youth with both HPD and SP. Further research is required to confirm these suggestions

Effect of vibration on the shear strength of impacted bone graft in revision hip surgery

Aims: Studies on soil mechanics have established that when vibration is applied to an aggregate, it results in more efficient alignment of particles and reduces the energy required to impact the aggregate. Our aim was to develop a method of applying vibration to the bone impaction process and assess its impact on the mechanical properties of the impacted graft. Methods: Phase 1. Eighty bovine femoral heads were milled using the Noviomagus bone mill. The graft was then washed using a pulsed lavage normal saline system over a sieve tower. A vibration impaction device was developed which housed two 15V DC motors with eccentric weights attached inside a metal cylinder. A weight was dropped onto this from a set height 72 times so as to replicate the bone impaction process. A range of frequencies of vibration were tested, as measured using an accelerometer housed in the vibration chamber. Each shear test was then repeated at four different normal loads so as to generate a family of stress-strain curves. The Mohr-Coulomb failure envelope from which the shear strength and interlocking values are derived was plotted for each test. Phase 2. Experiments were repeated with the addition of blood so as to replicate a saturated environment as is encountered during operative conditions. Results Phase 1. Graft impacted with the addition of vibration at all frequencies of vibration showed improved shear strength when compared to impaction without vibration. Vibration at sixty Hertz was displayed the largest effect and was found to be significant. 3 Phase 2. Graft impacted with the addition of vibration in a saturated aggregate displayed lower shear strengths for all normal compressive loads than that of impaction without vibration. Conclusions Civil engineering principles hold true for the impaction bone grafting procedure. In a dry aggregate the addition of vibration may be beneficial to the mechanical properties of the impacted graft. In our system the optimal frequency of vibration was 60 Hz. Under saturated conditions the addition of vibration is detrimental the shear strength of the aggregate. This may be explained by the process of liquefaction

Geographic Variation in Informed Consent Law: Two Standards for Disclosure of Treatment Risks

We analyzed 714 jury verdicts in informed consent cases tried in 25 states in 1985–2002 to determine whether the applicable standard of care (“patient” vs. “professional” standard) affected the outcome. Verdicts for plaintiffs were significantly more frequent in states with a patient standard than in states with a professional standard (27 percent vs. 17 percent, P = 0.02). This difference in outcomes did not hold for other types of medical malpractice litigation (36 percent vs. 37 percent, P = 0.8). The multivariate odds of a plaintiff’s verdict were more than twice as high in states with a patient standard than in states with a professional standard (odds ratio = 2.15, 95% confidence interval = 1.32–3.50). The law’s expectations of clinicians with respect to risk disclosure appear to vary geographically

Positive and negative affect and oral health-related quality of life

BACKGROUND: The aims of the study were to assess the impact of both positive (PA) and negative affect (NA) on self-reported oral health-related quality of life and to determine the effect of including affectivity on the relationship between oral health-related quality of life and a set of explanatory variables consisting of oral health status, socio-economic status and dental visiting pattern. METHODS: A random sample of 45–54 year-olds from metropolitan Adelaide, South Australia was surveyed by mailed self-complete questionnaire during 2004–05 with up to four follow-up mailings of the questionnaire to non-respondents (n = 986 responded, response rate = 44.4%). Oral health-related quality of life was measured using OHIP-14 and affectivity using the Bradburn scale. Using OHIP-14 and subscales as the dependent variables, regression models were constructed first using oral health status, socio-economic characteristics and dental visit pattern and then adding PA and NA as independent variables, with nested models tested for change in R-squared values. RESULTS: PA and NA exhibited a negative correlation of -0.49 (P < 0.01). NA accounted for a larger percentage of variance in OHIP-14 scores (3.0% to 7.3%) than PA (1.4% to 4.6%). In models that included both PA and NA, PA accounted for 0.2% to 1.1% of variance in OHIP-14 scores compared to 1.8% to 3.9% for NA. CONCLUSION: PA and NA both accounted for additional variance in quality of life scores, but did not substantially diminish the effect of established explanatory variables such as oral health status, socio-economic status and dental visit patterns

Examining the diversity of MRCS examiners

Acknowledgements The authors would like to acknowledge Gregory Ayre from the Intercollegiate Committee for Basic Surgical Examinations for his support during this project. Funding Royal College of Surgeons of Edinburgh, Royal College of Surgeons of Ireland. Royal College of Physicians and Surgeons of Glasgow and Royal College of Surgeons of England.Peer reviewedPublisher PD

Responsibility loadings for dental services by general dentists

Extent: 6p.BACKGROUND: Responsibility loadings determine relative value units of dental services that translate services into a common scale of work effort. The aims of this paper were to elicit responsibility loadings for a subset of dental services and to relate responsibility loadings to ratings of importance of the components of responsibility. METHODS: Responsibility loadings and ratings of components of responsibility were collected using mailed questionnaires from a random sample of Australian private general practice dentists in 2007 (response rate = 77%). RESULTS: Median responsibility loadings were 1.25 for an initial oral examination and for a 3+-surface amalgam restoration, 1.50 for a simple extraction and for root canal obturation (single canal), and 1.75 for subgingival curettage (per quadrant). Across the five services coefficients from a multivariate logit model showed that ratings of importance of knowledge (0.34), dexterity (0.24), physical effort (0.28) and mental effort (0.48) were associated with responsibility loadings (P < 0.05). CONCLUSIONS: The elicited median responsibility loadings showed agreement with previous estimates indicating convergent validity. Components of responsibility were associated with loadings indicating that components can explain and predict responsibility aspects of dental service provision.David S. Brennan and A. John Spence