Dental Health and Mortality in People With End-Stage Kidney Disease Treated With Hemodialysis: A Multinational Cohort Study

Background Dental disease is more extensive in adults with chronic kidney disease, but whether dental health and behaviors are associated with survival in the setting of hemodialysis is unknown. Study Design Prospective multinational cohort. Setting & Participants 4,205 adults treated with long-term hemodialysis, 2010 to 2012 (Oral Diseases in Hemodialysis [ORAL-D] Study). Predictors Dental health as assessed by a standardized dental examination using World Health Organization guidelines and personal oral care, including edentulousness; decayed, missing, and filled teeth index; teeth brushing and flossing; and dental health consultation. Outcomes All-cause and cardiovascular mortality at 12 months after dental assessment. Measurements Multivariable-adjusted Cox proportional hazards regression models fitted with shared frailty to account for clustering of mortality risk within countries. Results During a mean follow-up of 22.1 months, 942 deaths occurred, including 477 cardiovascular deaths. Edentulousness (adjusted HR, 1.29; 95% CI, 1.10-1.51) and decayed, missing, or filled teeth score ≥ 14 (adjusted HR, 1.70; 95% CI, 1.33-2.17) were associated with early all-cause mortality, while dental flossing, using mouthwash, brushing teeth daily, spending at least 2 minutes on oral hygiene daily, changing a toothbrush at least every 3 months, and visiting a dentist within the past 6 months (adjusted HRs of 0.52 [95% CI, 0.32-0.85], 0.79 [95% CI, 0.64-0.97], 0.76 [95% CI, 0.58-0.99], 0.84 [95% CI, 0.71-0.99], 0.79 [95% CI, 0.65-0.95], and 0.79 [95% CI, 0.65-0.96], respectively) were associated with better survival. Results for cardiovascular mortality were similar. Limitations Convenience sample of clinics. Conclusions In adults treated with hemodialysis, poorer dental health was associated with early death, whereas preventive dental health practices were associated with longer survival

Capacità economica, capacità contributiva e "minimo vitale"

Una riflessione sul principio di capacità contributiva nell'ordinamento fiscale italiano e sul c.d. minimo vital

Linking high-resolution geomorphic mapping, sediment sources, and channel types in a formerly glaciated basin of northeastern Alto-Adige/Sudtirol, Italy

To characterize channel-network morphodynamics and response potential in the Gadria-Strimm basin (14.8 km^2) we conduct a concerted effort entailing: (i) high-resolution mapping of landforms, channel reaches, and sediment sources; and (ii) historical evolution of colluvial channel disturbance through sequential aerial photosets (1945-59-69-82-90-00-06-11). The mapping was carried out via stereographic inspection of aerial photographs, examination of 2.5-m gridded DTM and DSM, and extensive field work. The study area is a formerly glaciated basin characterized by peculiar landform assemblages imposed by a combination of tectonic and glacial first-order structures. The most striking feature in Strimm Creek is a structurally-controlled valley step separating an upper hanging valley, dominated by periglacial and fluvial processes, and a V-notched lower part in which lateral colluvial channels are directly connected to Strimm\u2019s main stem. In Gadria Creek, massive kame terraces located in proximity of the headwaters provide virtually unlimited sediment supply to frequent debris-flow activity, making this sub-catchment an ideal site for monitoring, hence studying the mechanics of these processes. Preliminary results point to a high spatial variability of the colluvial channel network, in which sub-sectors have remained consistently active during the study period while others have become progressively dormant with notable forest re-growth. In an attempt to link sediment flux to topography and substrate type, future work will involve photogrammetric analysis across the sequential aerial photosets as well as a morphometric/geomechanical characterization of the surficial materials

Gastric histology and function tests in Italian patients with dermatitis herpetiformis

Gastric mucosal histology and function were evaluated in 57 Italian subjects with dermatitis herpetiformis (DH), by means of multiple endoscopic biopsies, gastrin and pepsinogen I (Pg I) serum levels, and parietal cell antibodies (PCA). One hundred and forty-nine patients with nonulcer dyspepsia served as reference population for the prevalence of atrophic gastritis of the body. Seventeen DH patients (30%) and 23 controls (15.4%) showed atrophic gastritis of the body mucosa (p less than 0.05). Nine of the DH patients with atrophic gastritis of the body also had atrophic changes in the antrum. Six patients, all with severe atrophic gastritis, had high gastrin levels and PCA; five of these six also had low Pg I levels. We found an increased prevalence of abnormal indirect function tests among patients with atrophic gastritis is due to the younger age of the patients in our series. Thus, atrophic gastritis can be detected early on a histologic basis, but functional impairment occurs later, as the mucosal damage increases in severity