Delays and Factors Related to Cessation of Generalized Convulsive Status Epilepticus.

Introduction. This study was designed to identify the delays and factors related to and predicting the cessation of generalized convulsive SE (GCSE). Methods. This retrospective study includes 70 consecutive patients (>16 years) diagnosed with GCSE and treated in the emergency department of a tertiary hospital over 2 years. We defined cessation of SE stepwise using clinical seizure freedom, achievement of burst-suppression, and return of consciousness as endpoints and calculated delays for these cessation markers. In addition 10 treatment delay parameters and 7 prognostic and GCSE episode related factors were defined. Multiple statistical analyses were performed on their relation to cessation markers. Results. Onset-to-second-stage-medication (p = 0.027), onset-to-burst-suppression (p = 0.005), and onset-to-clinical-seizure-freedom (p = 0.035) delays correlated with the onset-to-consciousness delay. We detected no correlation between age, epilepsy, STESS, prestatus period, type of SE onset, effect of the first medication, and cessation of SE. Conclusion. Our study demonstrates that rapid administration of second-stage medication and early obtainment of clinical seizure freedom and burst-suppression predict early return of consciousness, an unambiguous marker for the end of SE. We propose that delays in treatment chain may be more significant determinants of SE cessation than the previously established outcome predictors. Thus, streamlining the treatment chain is advocated

Validation of Questionnaires in Screening for Restorative Treatment Need among 15-, 21-, and 40-year olds

Publisher Copyright: © 2022 Dental Hypotheses.Introduction: This cross-sectional study aims to investigate the association between three age-specific questionnaires in three age groups and restorative dental treatment need. Materials and methods: Three separate questionnaires were designed on etiology of dental caries in different age groups. Randomly selected 15- (n = 36), 21- (n = 21), and 40-year-old (n = 45) subjects answered these questionnaires. Responses were compared to restorative treatment need (DT) according to the clinical oral examination, which calibrated examiner performed. Results: Responses to questionnaires were only indicative in prediction of restorative treatment need at individual level. Kappa values for 15-, 21-, and 40-year olds, between responses and restorative treatment need were 0.01, 0.44, and 0.33, respectively. Conclusion: The need for restorative care could plausible be screened with a questionnaire among the 21- and 40-year olds, but not among 15-year olds in a country with low caries prevalence. Further development of questionnaires and studies are needed.Peer reviewe

Burden of suspected epileptic seizures on emergency services:a population-based study

Abstract Background and purpose: Patients with acute epileptic seizures form a large patient group in emergency neurology. This study aims to determine the burden caused by suspected epileptic seizures at different steps in emergency care. Methods: A retrospective, cross-sectional, population-based (>1,000,000 inhabitants), 4-year (2015–2018) study was conducted in an urban setting with a single dispatch centre, a university hospital-affiliated emergency medical service (EMS), and five emergency departments (EDs). The study covered all adult (≥16 years old) emergency neurology patients receiving medical attention due to suspected epileptic seizures from the EMS and EDs and during hospital admissions in the Helsinki metropolitan area. Results: Epileptic seizures were suspected in 14,364 EMS calls, corresponding to 3.3% of all EMS calls during the study period. 9,112 (63.4%) cases were transported to hospital due to suspected epileptic seizures, and 3368 (23.4%) were discharged on the scene. 6969 individual patients had 11,493 seizure-related ED visits, accounting for 3.1% of neurology- and internal medicine-related ED visits and 4607 hospital admissions were needed with 3 days’ median length of stay (IQR=4, Range 1-138). Male predominance was noticeable at all stages (EMS 64.7%, EDs 60.1%, hospital admissions 56.2%). The overall incidence was 333/100,000 inhabitants/year for seizure-related EMS calls, 266/100,000 inhabitants/year for ED visits and 107/100,000 inhabitants/year for hospital admissions. Total estimated costs were 6.8 million €/year, corresponding to 0.5% of all specialized healthcare costs in the study area. Conclusions: Patients with suspected epileptic seizures cause a significant burden on the health care system. Present-day epidemiological data are paramount when planning resource allocation in emergency services

General- and oral-health-related predisposing factors for interrupting military service in the Finnish defence forces

Abstract Introduction: Finland’s security policy relies heavily on its own independent national defense, which is based on conscription. In 2011, 26,492 conscripts started their military service in Finland. Of these, 1,706 interrupted their military service and 191 changed to civilian service. Conscripts who interrupt their service seem to have an increased tendency to smoking, alcohol consumption, and taking snuff, which previous studies suggest to have strong associations with the need for restorative dental treatment and with lower socioeconomic status. The aim of this study was to compare the general and oral health habits between Finnish conscripts who interrupt their service and those who completed their military service and to find out what general- and oral-health-related factors could be used in predicting interruption of service. Methods: The study population consisted of 13,819 conscripts taking an oral examination during the service. Of these, 8,449 answered a computer-based anamnestic questionnaire and 264 interrupted their service. Predisposing factors on the anamnestic questionnaire for interrupting military service were evaluated by using a binary logistic regression model. The statistically significant factors were selected to form a sum variable which finally consisted of seven predisposing questions. Odds ratio (OR) values and 95% confidence intervals were calculated for each question and for the sum variable. Predictive accuracy was assessed by area under the receiver-operating curve. Results: The most obvious predisposing factor among those who interrupted their service compared to the reference group was lack of weekly physical exercise (OR = 5.80). The risk for interruption of military service was 68.6 times higher in cases where a subject exhibited six predisposing factors out of seven compared to those who had none. Conclusion: As a conclusion, a set of statistically chosen anamnestic questions could help identify conscripts who have an increased risk of interruption of military service in addition to a risk of dental problems

Association of dental fear with caries status and self-reported dentition-related well-being in Finnish conscripts

Abstract The main aim of this cross-sectional study was to examine the prevalence of dental fear among Finnish conscripts. Other aims were to study the association between dental fear and cariological status as well as their self-reported, dentition-related well-being. The study material consisted of 13,564 men and 255 women conscripts who underwent oral examinations. Of those, 8713 responded to a computer-based questionnaire. The mean number of decayed teeth (DT) was used in analyses for cariological status. Self-reported dental fear, dentition-related well-being and regular check-ups were analysed. Data were analysed with cross tables, Pearson Chi-Square tests, Fisher’s exact test and binary logistic regressive analysis. High dental fear or finding dental visits very scary was associated with DT > 2 both among women (14.6%, when DT = 0; 33.3%, when DT > 2) and men conscripts (2.3% and 10.8%, respectively). In addition, those reporting that dental health had a negative impact on their well-being and had no regular check-ups were more likely to need cariological treatment than the rest. A high education level, both one’s own and parental, was a protective factor for restorative treatment need in male conscripts. The findings of this study support the concept of a vicious cycle of dental fear and dental caries. A preventive, interactive way of work by dental teams would most likely be beneficial for dental health, avoiding the development of dental fear, and dentition-related well-being

Validation of Questionnaires in Screening for Restorative Treatment Need among 15-, 21-, and 40-year olds

Publisher Copyright: © 2022 Dental Hypotheses.Introduction: This cross-sectional study aims to investigate the association between three age-specific questionnaires in three age groups and restorative dental treatment need. Materials and methods: Three separate questionnaires were designed on etiology of dental caries in different age groups. Randomly selected 15- (n = 36), 21- (n = 21), and 40-year-old (n = 45) subjects answered these questionnaires. Responses were compared to restorative treatment need (DT) according to the clinical oral examination, which calibrated examiner performed. Results: Responses to questionnaires were only indicative in prediction of restorative treatment need at individual level. Kappa values for 15-, 21-, and 40-year olds, between responses and restorative treatment need were 0.01, 0.44, and 0.33, respectively. Conclusion: The need for restorative care could plausible be screened with a questionnaire among the 21- and 40-year olds, but not among 15-year olds in a country with low caries prevalence. Further development of questionnaires and studies are needed.Peer reviewe

The association between dental caries and physical activity, physical fitness, and background factors among Finnish male conscripts

Abstract Studies on measured physical fitness and oral health are sparse. The aim of this study was to investigate the associations between self-reported physical activity and measured physical fitness and oral health of young men. The study population consisted of 13,564 Finnish male conscripts who had mandatory clinical oral examinations and physical fitness tests at the beginning of military service in 2011. Finally, around 10,800 conscripts had physical fitness test outcomes available and a total of 8552 conscripts answered a computer-based questionnaire on background factors. Decayed Tooth (DT) and Decayed, Missing, or Filled Tooth (DMFT) indices, outcomes of surveys and fitness tests were used in analyses by cross-tabulation and multivariable logistic regression model (odds ratios [OR] with 95% confidence interval [CI]) were calculated. Regularly exercising conscripts had a reduced need for dental restorative treatment than those reporting no physical activity (p < 0.0001). The proportion of participants with sound dentition (DT = 0) increased steadily with increasing physical activity (39.0–59.4%). Good measured physical fitness was a protective factor against increased dental restorative treatment need. A low prevalence of smoking and low use of alcohol and energy drinks were associated with frequent exercise, whereas consumption of sport drinks and snuff use were common among those who exercised frequently. Good measured physical fitness and self-reported physical activity are associated with reduced caries burden. There is a need for information about the harms of tobacco products and the benefits of a healthy diet, even for the increased energy needs of the physically active

Can health kiosks be used to identify oral health care needs?:a pilot study

Abstract Objective: The aim of this study was to investigate the reliability of digital imaging for detecting restorative treatment need among individuals in their 20s by comparing the outcome of digital imaging with clinical caries findings at the patient level. Material and methods: Five intraoral clinical daylight and digital fluorescence images were taken extraorally of 21 patients. A clinical examination was then performed by a trained and calibrated dentist. Additionally, the patients answered a multiple-choice questionnaire about their health habits. The images were analysed and caries findings were recorded. For statistical analysis, sensitivity and specificity were calculated. Results were shown as ROC curves and AUC values. All analyses were done using SPSS (version 24.0, Chicago, IL). Results: Caries lesions were most often detected in molars and least often in canines. When using the clinical status as gold standard, digital imaging gave an AUC value of 0.617, whereas the outcome by questionnaire gave an AUC value of 0.719. When using the combined outcome of digital imaging and the questionnaire, the AUC value was 0.694 with clinical validation. Conclusions: It can be concluded that health kiosks may help to reduce the number of patients waiting for dental treatment; more specifically, the questionnaire with individual feedback may provide a new instrument for providing instructions for homecare online. However, the camera system must be developed further, and dentists and dental hygienists require training to analyse the images