Influence of socioeconomic factors on pregnancy outcome in women with structural heart disease

OBJECTIVE: Cardiac disease is the leading cause of indirect maternal mortality. The aim of this study was to analyse to what extent socioeconomic factors influence the outcome of pregnancy in women with heart disease.  METHODS: The Registry of Pregnancy and Cardiac disease is a global prospective registry. For this analysis, countries that enrolled ≥10 patients were included. A combined cardiac endpoint included maternal cardiac death, arrhythmia requiring treatment, heart failure, thromboembolic event, aortic dissection, endocarditis, acute coronary syndrome, hospitalisation for cardiac reason or intervention. Associations between patient characteristics, country characteristics (income inequality expressed as Gini coefficient, health expenditure, schooling, gross domestic product, birth rate and hospital beds) and cardiac endpoints were checked in a three-level model (patient-centre-country).  RESULTS: A total of 30 countries enrolled 2924 patients from 89 centres. At least one endpoint occurred in 645 women (22.1%). Maternal age, New York Heart Association classification and modified WHO risk classification were associated with the combined endpoint and explained 37% of variance in outcome. Gini coefficient and country-specific birth rate explained an additional 4%. There were large differences between the individual countries, but the need for multilevel modelling to account for these differences disappeared after adjustment for patient characteristics, Gini and country-specific birth rate.  CONCLUSION: While there are definite interregional differences in pregnancy outcome in women with cardiac disease, these differences seem to be mainly driven by individual patient characteristics. Adjustment for country characteristics refined the results to a limited extent, but maternal condition seems to be the main determinant of outcome

Rising rural body-mass index is the main driver of the global obesity epidemic in adults

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.Peer reviewe

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Non-invasive imagistic investigations of repaired IPS Empress e.max all ceramic crowns

The present study is proposing to investigate through non-invasive techniques, the quality of repaired of all-ceramic crowns with ceramic material. 20 all-ceramic crowns made with IPS e.max Empress System. The ceramic component was removed with a grinding instrument from the buccal-incisal of each crown. The ceramic veneer was removed in order to simulate the fracture of the ceramic supra-structure. Defect's size was approximately 3Ã?3mm for all the specimens. In some cases the incisal margin was also removed. All the crowns were repaired with ceramic material VM7 (Vita) after the manufacturer's instructions. The repaired area was investigated through imagistic and also non-invasive techniques. The involved investigation systems are analyzing macroscopic and microscopic the repaired area. Optical Coherence Tomography Time Domain and X ray. Optical Coherence Tomography is an optical microscope which can scan the surface and deep layers of the investigated interface. X ray is useful in detecting macroscopic defects and gaps into the material mass. The quality of the repaired defects may be evaluated and some clinical indications can be made

Imagistic evaluation of direct dental restoration: En face OCT versus SEM and microCT

There are several methods known which are used to assess the quality of direct dental restorations, but most of them are invasive. These lead to the destruction of the probes and often no conclusion could be drawn in respect to the existence of any microleakage in the investigated areas of interest. Optical tomographic techniques are of particular importance in the medical imaging field, because these techniques can provide non-invasive diagnostic images. Using an en-face version of OCT, we have recently demonstrated real time thorough evaluation of quality of dental fillings. The purpose of this in vitro study was to validate the en face OCT imagistic evaluation of direct dental restoration by using scanning electron microscopy (SEM) and microcomputer tomography (μCT). Teeth after several treatment methods are imaged in order to detect material defects and to asses the marginal adaptation at the dental hard tissue walls. SEM investigations evidenced the nonlinear aspect of the interface between the filling material and the buccal and lingual walls in some samples. The results obtained by μCT revealed also some material defects inside the fillings and at the interfaces with the rootcanal walls. The advantages of the OCT method consist in non-invasiveness and high resolution. En face OCT investigations permit to visualize a more complex stratificated structure at the interface filling material/dental hard tissue and in the apical region

Qualitative study of repaired metal ceramic crowns

The purpose of this study is to investigate the reparation of metal ceramic crowns with ceramic mass. 30 metal ceramic crowns which restore the upper first central incisor (2.1) were divided in three groups. Each group was repaired with a different ceramic material. Group 1- In Line (Ivoclar Vivadent) ceramic, the second group was repaired with D. Sign (Ivoclar Vivadent) and for the last group was used VMK. Master (Vita). All the repaired crowns were investigated through imagistic non-invasive methods. The metallic infrastructure of the samples was made from Ni-Cr alloy and the porcelain mass was Kiss (D. Sign). Defects were made on the buccal surface of each crown. The ceramic mass and the opaque were removed and the metallic infrastructure was exposed. Size defects has 3Ã?3mm and it is situated on incise and 1/3 medium buccal surface. The defect was made with a green grinding instrument under air-water cooling. All the samples were conditioned and repaired with ceramic mass. The reparations were investigated with two noninvasive imagistic methods Rx and Optical Coherence Tomography Time Domain in order to detect de reparation's defects. The investigation methods may spot the presence or absence defects localized at the interface between the two materials and those localized in the ceramic mass

En face OCT imagistic evaluation and laser microspectral analysis for assessing microleakage at the prosthetic interfaces

The microleakage at the prosthetic interface, for example between the metallic framework and the veneering part of the fixed partial prostheses (FPP's) is a common problem in dentistry. Optical tomographic techniques are of particular importance in the medical imaging field, because these techniques can provide non-invasive diagnostic images. En-face OCT is preferred for microscopy as it can provide real time images with similar orientation as that of microscopy images. The purpose of this study is to detect and analyze the possible defects at the interface of several FPP's using en face optical coherence tomography (efOCT) and laser microspectral analysis, a method which allows to investigate small quantities of materials of around 0.1 μg and to establish the content of atoms and molecules and to perform semi-quantitative and quantitative analysis. By this method it is possible to establish trace elements, i. e. with concentration of ppm (parts per million). The advantages of the OCT method consist in non-invasiveness and high resolution. En face OCT investigations permit to visualize a more complex stratified structure at the interface metallic framework/veneering material

SEM and microCT validation for en face OCT imagistic evaluation of endodontically treated human teeth

Successful root canal treatment is based on diagnosis, treatment planning, knowledge of tooth anatomy, endodontic access cavity design, controlling the infection by thorough cleaning and shaping, methods and materials used in root canal obturation. An endodontic obturation must be a complete, three-dimensional filling of the root canal system, as close as possible to cemento-dentinal junction, without massive overfilling or underfilling. There are several known methods which are used to assess the quality of the endodontic sealing, but most are invasive. These lead to the destruction of the samples and often no conclusion could be drawn in respect to the existence of any microleakage in the investigated areas of interest. Using an time domain en-face OCT system, we have recently demonstrated real time thorough evaluation of quality of root canal fillings. The purpose of this in vitro study was to validate the en face OCT imagistic evaluation of endodontically treated human teeth by using scanning electron microscopy (SEM) and microcomputer tomography (μCT). SEM investigations evidenced the nonlinear aspect of the interface between the endodontic filling material and the root canal walls and materials defects in some samples. The results obtained by μCT revealed also some defects inside the root-canal filling and at the interfaces between the material and the root canal walls. The advantages of the OCT method consist in non-invasiveness and high resolution. In addition, en face OCT investigations permit visualization of the more complex stratified structure at the interface between the filling material and the dental hard tissue