Validation of an Oral Disease Severity Score (ODSS) tool for use in oral mucous membrane pemphigoid

Background: Mucous membrane pemphigoid (MMP) is a rare autoimmune bullous disease predominantly affecting the oral mucosa. Optimal management relies upon thorough clinical assessment and documentation at each visit. Objectives: The primary aim of this study was to validate the Oral Disease Severity Score (ODSS) for the assessment of oral involvement in MMP. We also compared its inter- and intraobserver reliability with those of the oral parts of the Mucous Membrane Pemphigoid Disease Area Index (MMPDAI), Autoimmune Bullous Skin Disorder Intensity Score (ABSIS) and Physician's Global Assessment (PGA). Methods: Fifteen patients with mild-to-moderately severe oral MMP were scored for disease severity by 10 oral medicine clinicians from four U.K. centres using the ODSS, the oral sections of MMPDAI and ABSIS, and PGA. Two clinicians rescored all patients after 2 h. Results: In terms of reliability, the interobserver ODSS total score intraclass correlation coefficient (ICC) was 0·97, MMPDAI activity 0·59 and damage 0·15, ABSIS total 0·84, and PGA 0·72. The intraobserver ICCs (two observers) for ODSS total were 0·97 and 0·93; for MMPDAI activity 0·93 and 0·70 and damage 0·93 and 0·79; for ABSIS total 0·99 and 0·94; and for PGA 0·92 and 0·94. Convergent validity between ODSS and MMPDAI was good (correlation coefficient 0·88). The mean ± SD time for completion of ODSS was 93 ± 31 s, with MMPDAI 102 ± 24 s and ABSIS involvement 71 ± 18 s. The PGA took &lt; 5 s. Conclusions: This study has validated the ODSS for the assessment of oral MMP. It has shown superior interobserver agreement over MMPDAI, ABSIS and PGA, and superior intraobserver reliability to MMPDAI. It is quick and easy to perform. What's already known about this topic?. There are no validated scoring methodologies for oral mucous membrane pemphigoid (MMP). Proposed disease activity scoring tools for MMP include the Mucous Membrane Disease Area Index (MMPDAI) and the Autoimmune Bullous Skin Disorder Intensity Score (ABSIS). The Oral Disease Severity Score (ODSS) has been validated for use in oral pemphigus vulgaris (PV). It has been shown to be reliable and sensitive in both lichen planus (LP) and MMP. What does this study add?. The ODSS has been shown to be a thorough, sensitive and reproducible, yet quick scoring tool for the assessment of oral involvement in MMP. Its versatility for use in oral PV, MMP and LP is an added advantage over other scoring methodologies. What are the clinical implications of this work?. We propose that the ODSS be used as a clinical scoring tool for monitoring activity in oral MMP in clinical practice as well as for use in multicentre studies.</p

Factors associated with dental visit and barriers to utilisation of oral health care services in a sample of antenatal mothers in Hospital Universiti Sains Malaysia

<p>Abstract</p> <p>Background</p> <p>The aims of this study were to determine factors associated with dental visit and to describe barriers to utilisation of oral health care services among antenatal mothers attending the Obstetric and Gynaecology Specialist clinic in Hospital Universiti Sains Malaysia.</p> <p>Methods</p> <p>A structured, self-administered questionnaire was used obtain information on the variables of interest pertaining to the current pregnancy from 124 antenatal mothers.</p> <p>Results</p> <p>The majority of the mothers claimed that their oral health status was good (67.0%) or very good (2.4%). On the contrary, most of them admitted of having had at least one oral health problem (59.7%) including cavitated (43.5%) and painful teeth (15.3%), bleeding gum (21.0%), and bad breath (10.5%). However, only 29% of the mothers visited dentist during the current pregnancy. Factors associated with the mothers' dental visit were exposure to oral health education before the pregnancy and awareness of relationship between poor maternal oral health and adverse pregnancy outcomes with odds ratio of 4.06 (95% CI: 1.67-9.78) and 3.57 (95% CI: 1.30-9.77) respectively. Common excuses given by most mothers include perceptions of not having any oral health problems (65.9%), long waiting time at the clinic (71.6%), and no immediate treatment given by the dentist (64.8%).</p> <p>Conclusions</p> <p>Utilisation of oral health care services among antenatal mothers was low. Mothers who reported dental visit were more likely to be those who had received oral health education before the current pregnancy and knew of the association between poor maternal oral health and adverse pregnancy outcomes. Dissatisfaction with the services rendered and perceptions of not having any oral health problems were the main barriers.</p

What do antenatal care providers understand and do about oral health care during pregnancy: a cross-sectional survey in New South Wales, Australia

BACKGROUND: There is mounting evidence to support the lack of awareness among pregnant women about health consequences and long term risks associated with poor oral hygiene during pregnancy. A recognised and important point of influence is their interaction with health professionals, particularly when receiving Antenatal Care. However, there is limited evidence about the perceptions of ANC providers in Australia toward the provision of perinatal oral healthcare. This study was undertaken to explore the knowledge, attitudes and practices of Antenatal Care (ANC) providers in New South Wales (NSW), Australia providing perinatal oral healthcare and to identify barriers to and predictors of their practices in this area. METHODS: A cross sectional survey was undertaken of ANC providers (general practitioners, obstetricians/gynaecologists and midwives) practising in NSW, Australia. Participants were recruited through their professional organisations via email, postal mail, and networking at conferences. The survey addressed the domains of knowledge, attitude, barriers and practices towards oral healthcare, along with demographics. Data was entered into SPSS software and analysed using descriptive and inferential statistics. RESULTS: A total of 393 surveys (17.6% response rate) were completed comprising 124 general practitioners, 74 obstetricians/gynaecologists and 195 midwives. The results showed limited knowledge among ANC providers regarding the impact of poor maternal oral health on pregnancy/infant outcomes. Most (99%) participants agreed that maternal oral health was important yet few were discussing the importance of oral health or advising women to visit a dentist (16.4–21.5%). Further, less than a third felt they had the skills to provide oral health advice during pregnancy. ANC providers who were more knowledgeable about maternal oral health, had training and information in this area and greater experience, were more likely to engage in practices addressing the oral health of pregnant women. CONCLUSION: The findings suggest that ANC providers in NSW are not focussing on oral health with pregnant women. ANC providers seem willing to discuss oral health if they have appropriate education/training and information in this area. Further research at a national level is required to confirm whether these findings are similar in all Australian states

Boundaries and Bridges: the influence of James Cooksey Culwick on the development of the teaching and learning of music in nineteenth century Ireland

James Cooksey Culwick (1845-1907) was born in England. Trained as chorister and organist in Lichfield Cathedral, he moved to Ireland at twenty- one and remained until his death in 1907. Although his reputation as scholar, musician and teacher was acknowledged widely during his lifetime - he received an honorary doctorate from University of Dublin (1893) - little is known about the contribution he made to music education. This paper addresses this gap in the literature and argues that it was Culwick's singular achievement to pay attention to music pedagogy at secondary level, by recognizing that music could be seen as a serious career option for girls, and by providing resources for teachers which emphasised the development of an 'art-feeling' in pupils of all abilities. In addition, he considered Irish music as an art which had significance as music first, and Irish music second, and advocated a 'laudable tolerance' for opposing views on matters of cultural identity to Ireland at the end of the nineteenth century

In hot haste.

Mode of access: Internet

Calculation of noise values at addresses around two regional airports from radar data

The "Attitudes to Aircraft Annoyance Around Airports" (5A) pilot study used focus groups and written surveys to investigate aspects of living in the area around airports and to better understand the annoyance felt by such residents at a European level. This exploratory study focused on aircraft noise impact as a key source of annoyance around three airports: Manchester International Airport, Lyon Saint-Exupéry and Bucharest and attempted to identify the importance of noise in relation to other aspects. The questionnaire was designed using stated preference techniques offering a series of hypothetical choices related to changes in frequencies of aircraft movements, during different periods of the day thereby allowing a monetary valuation to be made of one aircraft movement. In order to analyse the annoyance as a function of noise, rather than movements, it was necessary to reliably model noise data for the current situation and for each option in the Stated Preference experiments at each respondent's address. The EUROCONTROL Experimental Centre's ENHANCE tool and the Integrated Noise Model enables aircraft noise to be modelled based on actual recorded radar data. Respondents'attitude could be directly correlated to the noise created by real aircraft events at the place where the respondent experienced them. This did not prove to be possible for Bucharest due to a lack of reliable cartography. The present paper explains the use of the ENHANCE tool in this context and the methods used to determine the values of different indices for each respondent, for all hypotheses, to reach informed conclusions about personal preferences and values concerning the perception of aircraft noise and a valuation of noise and annoyance

Modelling annoyance from aircraft noise using a range of indices: Lyon and Manchester airports

Data on aircraft noise and annoyance levels were obtained for households in Manchester and Lyon as part of a study investigating the value of noise. Annoyance was assessed on a five point verbal scale consistent with international standards. Noise indices obtained included Leq, Lden, Ldn, NA65 and NA≥0. This data allowed us to look in some detail at levels of annoyance from aircraft noise and influences on levels of annoyance. In this paper we report: • The relative importance of aircraft noise amongst other factors impacting on quality of life • Annoyance from aircraft noise relative to other sources of noise • Reported disturbance of activities and other concerns with respect to aircraft noise • Variations in annoyance levels by time of day • The relationship between annoyance and perceived noise • Models using ordinal regression to explore the relationship between annoyance levels, noise indices and a range of other variables including socio-economic characteristics and contextual variables also self reported exposure to aircraft noise; perceived levels of noise and sensitivity to noise