Reporting of Child Abuse and Neglect by Salaried Primary Care Dentists

Mandatory reporting of child protection concerns was introduced in Ireland in December 2017 for certain professionals and individuals including all dentists. Previous to this date, Irish dentists only had an ethical obligation to report. International literature indicates that dentists see themselves as having a role in child protection. However, there appears to be a significant gap between those dentists who suspect child abuse and neglect (CAN) in a given case, and those who refer the case to the relevant authorities. The aim of this study was to investigate, prior to the introduction of mandatory reporting in the Republic of Ireland, the reporting of CAN by salaried primary care dentists and to identify any barriers to reporting. Two cross-sectional surveys using web-based anonymous questionnaires were sent to all Salaried Primary Care Dental Managers (N=17) and Senior and General Dentists (N=239) in Ireland in March 2017. 64.7% (n=11) of Managers and 28% (n=67) of dentists returned questionnaires. It was found that although, 30.8% of dentists had suspected at least one case of possible CAN over the previous 12 months, only 8.1% of the HSE dentists had formally reported at least one case of concern over the same period. There were clear barriers identified to the reporting of concerns. These barriers need to be addressed if Irish dentists are to meet their legal obligations of mandatory reporting of CAN

Effects of maternal depression on fetal health

Case Description Patient is a 27 years old pregnant (18 weeks) female with a past medical history of depression, post-traumatic stress disorder (PTSD), and military sexual trauma admitted for suicidal ideation with intent and plan. During admission, the patient refused all antidepressants after emesis on sertraline and prenatal vitamins. Patient was discharged after clinical stabilization and scheduled for follow-up outpatient. Conclusions Depression during pregnancy can have numerous adverse effects on mother as well as fetal and child development and thus treatment is of the utmost importance. Depression leads to alterations in the serotonin system and the HPA axis, as well as causes epigenetic changes to the infant glucocorticoid receptor gene. Changes in these pathways are most apparent during the second trimester and have downstream consequences leading to altered fetal heart rate variability, preterm birth, and low birth weight. Maternal depression can also lead to altered cortisol reactivity, and delayed motor and cognitive development in childhood. Furthermore, prevalence of depression varies throughout the pregnancy with depression more prevalent in the second and third trimesters. Clinical Significance Pregnant women are less likely to receive any mental health treatment for depression than their non-pregnant counterparts; 49% and 57% respectively, and screening for depression focuses on postpartum screening with few guidelines to screening during pregnancy. Due to the adverse effects on the fetus, maternal surveillance and treatment of depression during pregnancy is essential

Prevalence of overweight and obesity on the island of Ireland: results from the North South Survey of Children's Height, Weight and Body Mass Index, 2002

<p>Abstract</p> <p>Background</p> <p>Childhood obesity is emerging as a major public health problem in developed and developing countries worldwide. The aim of this survey was to establish baseline data on the prevalence and correlates of overweight and obesity among children and adolescents in the Republic of Ireland (RoI) and Northern Ireland (NI).</p> <p>Methods</p> <p>The heights and weights of 19,617 school-going children and adolescents aged between 4 and 16 years in NI and RoI were measured using standardised and calibrated scales and measures. The participants were a representative cross-sectional sample of children randomly selected on the basis of age, gender and geographical location of the school attended. Overweight and obesity were classified according to standard IOTF criteria.</p> <p>Results</p> <p>Males were taller than females, children in RoI were taller than those in NI and the more affluent were taller than the less well off. The overall prevalence of overweight and obesity was higher among females than males in both jurisdictions. Overall, almost one in four boys (23% RoI and NI) and over one in four girls (28% RoI, 25% NI) were either overweight or obese. In RoI, the highest prevalence of overweight was among 13 year old girls (32%) and obesity among 7 year old girls (11%). In NI the highest prevalence of overweight and obesity were found among 11 and 8 year old girls respectively (33% and 13%).</p> <p>Conclusion</p> <p>These figures confirm the emergence of the obesity epidemic among children in Ireland, a wealthy country with the European Union. The results serve to underpin the urgency of implementing broad intersectoral measures to reduce calorie intake and increase levels of physical activity, particularly among children.</p

Genomic Relationships, Novel Loci, and Pleiotropic Mechanisms across Eight Psychiatric Disorders

Genetic influences on psychiatric disorders transcend diagnostic boundaries, suggesting substantial pleiotropy of contributing loci. However, the nature and mechanisms of these pleiotropic effects remain unclear. We performed analyses of 232,964 cases and 494,162 controls from genome-wide studies of anorexia nervosa, attention-deficit/hyper-activity disorder, autism spectrum disorder, bipolar disorder, major depression, obsessive-compulsive disorder, schizophrenia, and Tourette syndrome. Genetic correlation analyses revealed a meaningful structure within the eight disorders, identifying three groups of inter-related disorders. Meta-analysis across these eight disorders detected 109 loci associated with at least two psychiatric disorders, including 23 loci with pleiotropic effects on four or more disorders and 11 loci with antagonistic effects on multiple disorders. The pleiotropic loci are located within genes that show heightened expression in the brain throughout the lifespan, beginning prenatally in the second trimester, and play prominent roles in neurodevelopmental processes. These findings have important implications for psychiatric nosology, drug development, and risk prediction.Peer reviewe

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Adding 6 months of androgen deprivation therapy to postoperative radiotherapy for prostate cancer: a comparison of short-course versus no androgen deprivation therapy in the RADICALS-HD randomised controlled trial

Background Previous evidence indicates that adjuvant, short-course androgen deprivation therapy (ADT) improves metastasis-free survival when given with primary radiotherapy for intermediate-risk and high-risk localised prostate cancer. However, the value of ADT with postoperative radiotherapy after radical prostatectomy is unclear. Methods RADICALS-HD was an international randomised controlled trial to test the efficacy of ADT used in combination with postoperative radiotherapy for prostate cancer. Key eligibility criteria were indication for radiotherapy after radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to radiotherapy alone (no ADT) or radiotherapy with 6 months of ADT (short-course ADT), using monthly subcutaneous gonadotropin-releasing hormone analogue injections, daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as distant metastasis arising from prostate cancer or death from any cause. Standard survival analysis methods were used, accounting for randomisation stratification factors. The trial had 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 80% to 86% (hazard ratio [HR] 0·67). Analyses followed the intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov, NCT00541047. Findings Between Nov 22, 2007, and June 29, 2015, 1480 patients (median age 66 years [IQR 61–69]) were randomly assigned to receive no ADT (n=737) or short-course ADT (n=743) in addition to postoperative radiotherapy at 121 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 9·0 years (IQR 7·1–10·1), metastasis-free survival events were reported for 268 participants (142 in the no ADT group and 126 in the short-course ADT group; HR 0·886 [95% CI 0·688–1·140], p=0·35). 10-year metastasis-free survival was 79·2% (95% CI 75·4–82·5) in the no ADT group and 80·4% (76·6–83·6) in the short-course ADT group. Toxicity of grade 3 or higher was reported for 121 (17%) of 737 participants in the no ADT group and 100 (14%) of 743 in the short-course ADT group (p=0·15), with no treatment-related deaths. Interpretation Metastatic disease is uncommon following postoperative bed radiotherapy after radical prostatectomy. Adding 6 months of ADT to this radiotherapy did not improve metastasis-free survival compared with no ADT. These findings do not support the use of short-course ADT with postoperative radiotherapy in this patient population

Duration of androgen deprivation therapy with postoperative radiotherapy for prostate cancer: a comparison of long-course versus short-course androgen deprivation therapy in the RADICALS-HD randomised trial

Background Previous evidence supports androgen deprivation therapy (ADT) with primary radiotherapy as initial treatment for intermediate-risk and high-risk localised prostate cancer. However, the use and optimal duration of ADT with postoperative radiotherapy after radical prostatectomy remains uncertain. Methods RADICALS-HD was a randomised controlled trial of ADT duration within the RADICALS protocol. Here, we report on the comparison of short-course versus long-course ADT. Key eligibility criteria were indication for radiotherapy after previous radical prostatectomy for prostate cancer, prostate-specific antigen less than 5 ng/mL, absence of metastatic disease, and written consent. Participants were randomly assigned (1:1) to add 6 months of ADT (short-course ADT) or 24 months of ADT (long-course ADT) to radiotherapy, using subcutaneous gonadotrophin-releasing hormone analogue (monthly in the short-course ADT group and 3-monthly in the long-course ADT group), daily oral bicalutamide monotherapy 150 mg, or monthly subcutaneous degarelix. Randomisation was done centrally through minimisation with a random element, stratified by Gleason score, positive margins, radiotherapy timing, planned radiotherapy schedule, and planned type of ADT, in a computerised system. The allocated treatment was not masked. The primary outcome measure was metastasis-free survival, defined as metastasis arising from prostate cancer or death from any cause. The comparison had more than 80% power with two-sided α of 5% to detect an absolute increase in 10-year metastasis-free survival from 75% to 81% (hazard ratio [HR] 0·72). Standard time-to-event analyses were used. Analyses followed intention-to-treat principle. The trial is registered with the ISRCTN registry, ISRCTN40814031, and ClinicalTrials.gov , NCT00541047 . Findings Between Jan 30, 2008, and July 7, 2015, 1523 patients (median age 65 years, IQR 60–69) were randomly assigned to receive short-course ADT (n=761) or long-course ADT (n=762) in addition to postoperative radiotherapy at 138 centres in Canada, Denmark, Ireland, and the UK. With a median follow-up of 8·9 years (7·0–10·0), 313 metastasis-free survival events were reported overall (174 in the short-course ADT group and 139 in the long-course ADT group; HR 0·773 [95% CI 0·612–0·975]; p=0·029). 10-year metastasis-free survival was 71·9% (95% CI 67·6–75·7) in the short-course ADT group and 78·1% (74·2–81·5) in the long-course ADT group. Toxicity of grade 3 or higher was reported for 105 (14%) of 753 participants in the short-course ADT group and 142 (19%) of 757 participants in the long-course ADT group (p=0·025), with no treatment-related deaths. Interpretation Compared with adding 6 months of ADT, adding 24 months of ADT improved metastasis-free survival in people receiving postoperative radiotherapy. For individuals who can accept the additional duration of adverse effects, long-course ADT should be offered with postoperative radiotherapy. Funding Cancer Research UK, UK Research and Innovation (formerly Medical Research Council), and Canadian Cancer Society

Student and Faculty Collaboration in Student Affairs

How does an institution increase student engagement when delivering co-curricular content that students sometimes view as unnecessary? Over the years, co-curricular topics such as, professional identity formation, policy awareness, academic success, awareness of institutional resources, cultivating a sense of well-being, etc. have become increasingly important. Indiana University School of Medicine (IUSM) has developed a novel approach to delivering co-curricular content that incorporates students into the creation and delivery of this content. In this session, we will discuss ways that students partner with Student Affairs in co-curricular educational programming, with a focus on personal & professional development (PPD) sessions and first-year orientation. These collaborations have fostered a greater degree of student engagement, higher levels of satisfaction with programs, and the ability to deliver content better connected to the student experience. Intentional personal and professional development education is just as vital on the path to becoming a physician as is traditional coursework. Collaborations begin during our first-year orientation, where rising M2s serve as content creators and are responsible for executing orientation in tandem with student affairs and regional campus faculty and staff. Throughout the academic year, students serve on the PPD planning committee to crowdsource topics from peers, listen to class chatter and concerns, and then work with student affairs to develop just in time sessions. These sessions focus heavily on M1 and M2 students who are in the very beginning stages of forming their professional identity. Examples include panels with upper-class students and residents, sessions with Mental Health Services, information about summer opportunities following the M1 year, creating a Step 1 study routine, and determining the right specialty. For our upper-class students, the focus shifts towards career development, residency application and Match preparation, financial security, and more. During this presentation, IUSM’s Associate Dean for Student Affairs and student panelists will discuss the evolution of these student-led initiatives at their nine-campus institution, review topics built in the curriculum, lessons learned and lead attendees in activities to develop and/or refine their own models. The session will include an interactive PowerPoint presentation, table discussions augmented with worksheets and a pair & share activity. We will conclude with an open Q & A with student panelists