Oral Inflammation, Tooth Loss, Risk Factors, and Association with Progression of Alzheimer’s Disease

Periodontitis is a polymicrobial chronic inflammatory disease of tooth-supporting tissues with bacterial etiology affecting all age groups, becoming chronic in a subgroup of older individuals. Periodontal pathogens Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola are implicated in the development of a number of inflammatory pathologies at remote organ sites, including Alzheimer’s disease (AD). The initial inflammatory hypothesis proposed that AD hallmark proteins were the main contributors of central nervous system (CNS) inflammation. This hypothesis is expanding to include the role of infections, lifestyle, and genetic and environmental factors in the pathogenesis of AD. Periodontal disease (PD) typifies a condition that encompasses all of the above factors including pathogenic bacteria. These bacteria not only are the source of low-grade, chronic infection and inflammation that follow daily episodes of bacteremia arising from everyday tasks such as brushing, flossing teeth, chewing food, and during dental procedures, but they also disseminate into the brain from closely related anatomical pathways. The long-term effect of inflammatory mediators, pathogens, and/or their virulence factors, reaching the brain systemically or otherwise would, over time, prime the brain’s own microglia in individuals who have inherent susceptibility traits. Such susceptibilities contribute to inadequate neutralization of invading agents, upon reaching the brain. This has the capacity to create a vicious cycle of sustained local inflammatory milieu resulting in the loss of cytoarchitectural integrity and vital neurons with subsequent loss of function (deterioration in memory). The possible pathways between PD and AD development are considered here, as well as environmental factors that may modulate/exacerbate AD symptoms

Development and Evaluation of an Automated Algorithm to Estimate the Nutrient Intake of Infants from an Electronic Complementary Food Frequency Questionnaire

Background: We previously validated a four-day complementary food frequency questionnaire (CFFQ) to estimate the nutrient intake in New Zealand infants aged 9-12 months. However, manual entry of the CFFQ data into nutritional analysis software was time-consuming. Therefore, we developed an automated algorithm and evaluated its accuracy by comparing the nutrient estimates with those obtained from the nutritional analysis software.Methods: We analysed 50 CFFQ completed at 9- and 12-months using Food Works nutritional analysis software. The automated algorithm was programmed in SAS by multiplying the average daily consumption of each food item by the nutrient content of the portion size. We considered the most common brands for commercially prepared baby foods. Intakes of energy, macronutrients, and micronutrients were compared between methods using Bland-Altman analysis.Results: The automated algorithm did not have any significant bias for estimates of energy (kJ) (MD 15, 95% CI -27, 58), carbohydrate (g) (MD -0.1, 95% CI -1.2,1.0), and fat (g) (-0.1, 95% CI -0.3,0.1), but slightly underestimated intake of protein (MD -0.4 g, 95% CI -0.7,-0.1), saturated fat, PUFA, dietary fibre, and niacin. The algorithm provided accurate estimates for other micronutrients. The limits of agreement were relatively narrow.Conclusion: This automated algorithm is an efficient tool to estimate the nutrient intakes from CFFQ accurately. The small negative bias observed for few nutrients was clinically insignificant and can be minimised. This algorithm is suitable to use in large clinical trials and cohort studies without the need for proprietary software

Thresholds for hypoglycaemic screening-a cause for concern?

The new Framework for Practice highlights the limited evidence for our current clinical practice (1). It is helpful in emphasising the importance of accurate measurement of glucose concentrations, listening to the concerns of parents and acknowledging that untreated hypoglycaemia can have devastating longterm consequences. However we have the following concerns: Screening thresholds The Framework recommends lowering a commonly accepted screening threshold in infants considered to be at risk of hypoglycaemia to a level that at any other time of life would be considered harmful. It fails to acknowledge the differences between screening and diagnostic thresholds; something neonatologists are very familiar with in the management of babies with jaundice. Phototherapy is provided to many babies with bilirubin levels well below a harmful level to prevent a harmful level being reached. Screening interventions are intended to prevent harmful events. Such thresholds will inevitably mean many individuals are treated ‘unnecessarily’ to avoid the risk of significant harm. In 2000 Cornblath et al published guidance on ‘operational thresholds’ in keeping with the current BAPM framework (2). However, and possibly reflecting concerns about the lack of evidence for the safety of this lower operational threshold, in 2017 in the UK, >80% of neonatal units still used <2.6mmol/ as their defined hypoglycaemic threshold (3). A threshold of <2.6mmol/l provides an opportunity for intervention before damaging neuroglycopaenia occurs

Can better management of periodontal disease delay the onset and progression of Alzheimer’s disease?

A risk factor relationship exists between periodontal disease and Alzheimer’s disease (AD) via tooth loss, and improved memory following dental intervention. This links the microbial contribution from indigenous oral periodontal pathogens to the manifestation of chronic conditions, such as AD. Here, we use Porphyromonas gingivalis infection to illustrate its effect on mental health. P. gingivalis infection, in its primary sub-gingival niche, can cause polymicrobial synergy and dysbiosis. Dysbiosis describes the residency of select commensals from the oral cavity following co-aggregation around the dominant keystone pathogen, such as P. gingivalis, to gain greater virulence. The initial process involves P. gingivalis disturbing neutrophil mediated innate immune responses in the healthy gingivae and then downregulating adaptive immune cell differentiation and development to invade, and subsequently, establish new dysbiotic bacterial communities. Immune responses affect the host in general and functionally via dietary adjustments caused by tooth loss. Studies from animals orally infected with P. gingivalis confirm this bacterium can transmigrate to distant organ sites (the brain) and contribute towards peripheral and intracerebral inflammation, and compromise vascular and microvascular integrity. In another study, P. gingivalis infection caused sleep pattern disturbances by altering glial cell light/dark molecular clock activity, and this, in turn, can affect the clearance of danger associated molecular patterns, such as amyloid-beta, via the glymphatic system. Since, P. gingivalis can transmigrate to the brain, and modulate organ-specific inflammatory innate and adaptive immune responses, this paper explores whether better management of indigenous periodontal bacteria could delay/prevent the onset and/or progression of dementia

The role of the school nurse in protecting children and young people from maltreatment: An integrative review of the literature

Objectives. This review aims to describe the role of the school nurse in protecting children and young people from maltreatment by examining the international literature. Child maltreatment is a prevalent issue in global society today and includes physical, emotional and sexual abuse, neglect and exploitation. School nurses are ideally placed to identify and work with children and young people who are at risk of maltreatment through their regular contact with the school community. Design. Integrative literature review incorporating thematic analysis. Data Sources. Electronic databases British Nursing Database, Cumulative Index of Nursing and Allied Health Literature, Medline, PsycInfo, Cochrane Library Database for Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL). Search Terms: Role, School Nurse, Child Maltreatment. Review Methods. Initial title and abstract review of 444 studies resulted in 78 studies for full text review. Additional search strategies identified one relevant study. Inclusion and exclusion criteria were employed as follows; (1) study published in the English language, (2) peer-reviewed, (3) primary research, (4) inclusion of school nurses (or equivalent role internationally) in the study sample, and (5) a focus on the role of school nurses in preventing child maltreatment. Studies were appraised using the Critical Appraisal Skills Programme tool for qualitative studies and the Strengthening the Reporting of Observational Studies in Epidemiology checklist for mixed-methods and quantitative studies. Findings from the studies were identified, summarised and organised into a summary table, before being analysed thematically. Results. 21 studies met inclusion and quality criteria and were included in the review. Key themes that emerged from the analysis were; supporting the child and family, detective work, working with other professionals, training and supervision, barriers to protecting children and young people from maltreatment and trust. Conclusion. International literature highlights the variety of activities that school nurses may undertake in daily practice to protect children and young people from maltreatment. Several challenges to this role are identified, including time management and building relationships with children and young people. Recommendations for practice and further research are made

Exploring the challenges of using electronic health record systems in nursing research

Background. Electronic health records (EHRs) provide an interesting potential data set for nursing research. However, they can present challenges when collecting data, as EHR systems are not designed with research in mind. Aim. To present an example of collecting data using EHRs that was conducted as part of a study of the role of the school nurse in safeguarding children. Discussion. Data were successfully obtained from EHR systems to understand school nursing caseloads and interventions with vulnerable children and young people. Major limitations included variances in EHR systems, such as different nomenclature for interventions. These limitations were addressed by reviewing organisational guidance on record-keeping and through a working knowledge of the different EHR systems. Conclusion. Conducting research using EHRs has provided important learning about the potential of this type of data and the promise they hold for future research. Implications. for practice Organisations willing for existing data to be used in research might consider embedding pathways for collecting data that are easy for potential researchers to navigate. EHR systems need to be sensitive to research, but not at the expense of efficiency in clinical practice

Bypassing the requirement for aminoacyl-tRNA by a cyclodipeptide synthase enzyme

C. J. H. and C. M. C. are funded by the Wellcome trust (210486/Z/18/Z), ES is funded by the Cunningham trust (PhD-CT-18-41).Cyclodipeptide synthases (CDPSs) produce a variety of cyclic dipeptide products by utilising two aminoacylated tRNA substrates. We sought to investigate the minimal requirements for substrate usage in this class of enzymes as the relationship between CDPSs and their substrates remains elusive. Here, we investigated the Bacillus thermoamylovorans enzyme, BtCDPS, which synthesises cyclo(L-Leu–L-Leu). We systematically tested where specificity arises and, in the process, uncovered small molecules (activated amino esters) that will suffice as substrates, although catalytically poor. We solved the structure of BtCDPS to 1.7 Å and combining crystallography, enzymatic assays and substrate docking experiments propose a model for how the minimal substrates interact with the enzyme. This work is the first report of a CDPS enzyme utilizing a molecule other than aa-tRNA as a substrate; providing insights into substrate requirements and setting the stage for the design of improved simpler substrates.Publisher PDFPeer reviewe

Preparation of chemical gradients on porous silicon by a dip coating method

Melbourne, VI