Use of safety syringes for administration of local anaesthesia among a sample of UK primary care dental professionals.

Aim: To identify the current usage of SSDs in UK primary care dentistry. Method: A cross-sectional survey was administered to delegates at the 2017 British Dental Association (BDA) Conference and Exhibition in Manchester, and at the 2017 BDA Scottish Conference and Exhibition in Glasgow. The survey covered a range of questions relating to sharps injuries and use of traditional and safety syringes for delivery of local anaesthesia. Statistical analyses were conducted using SPSS Version 22 (IBM Corp., 2013) and included chi-square and Fisher's exact tests. Results: Seven hundred and ninety-six delegates participated, of whom 396 (49.7%) were using safety syringes for delivery of local anaesthesia. Of the 166 participants who had experienced a sharps injury in the past year, 76 (45.8%) worked in facilities that most commonly used SSDs for delivery of local anaesthesia. Conclusion: Our results indicate that a significant number of dental practices in our sample have not adopted SSDs and suggest sharps injuries are still being sustained in some practices using SSDs. Further epidemiological research is required to provide strong evidence for the effectiveness of SSDs and reasons why SSDs have not been fully adopted in UK primary dental care

Il Sistema di Gestione della Sicurezza sul Lavoro (SGSL) sul modello UNI-INAIL ed il Safety Management System (SMS) in ambito aeroportuale a confronto.

In seguito all’emanazione del Decreto Legislativo n. 81 del 9 aprile 2008, l’adozione di un ’SGSL rappresenta una notevole opportunità per le aziende in termini di gestione e contenimento dei rischi aziendali Il presente lavoro analizza e mette a confronto due sistemi di gestione, il Safety Management System, che risponde ad una norma cogente imposta dall’Enac per le società di gestione aeroportuali, ed il Sistema di Gestione della salute e Sicurezza sul Lavoro sul modello delle linee guida UNI-INAIL, mettendo in risalto i diversi punti in comune e i margini di miglioramento di entrambi. Le differenze principali tra i due sistemi risiedono nell’obiettivo che si prefiggono di raggiungere, nell’approccio alla definizione della politica e degli obiettivi. L’obiettivo che l’SMS si prefigge è analizzare e modificare le attività lavorative al fine di assicurare principalmente l’incolumità degli utenti coinvolti nelle operazioni aeroportuali, mentre il SGSL mira a definire un sistema di gestione orientato alla sicurezza sul lavoro. Nel presente studio si giunge alla conclusione che i due sistemi potrebbero essere integrati all’interno di realtà aziendali quali società di gestione aeroportuali, compagnie aeree o aziende a rischio di incidente rilevante. Dal confronto visto emerge una proposta: nella prospettiva di emettere una norma certificabile da parte di un ente accreditato, perché non integrare le due linee guida anche alla luce delle esperienze positive acquisita in questi anni di sperimentazione

Examining the Effect of Physician Language on Physician Impressions

Previous research provides evidence that stigma can be perpetuated through language with consequences for well-being and quality of care. For example, providers who use stigmatizing language transmit bias toward patients with implications for care provided by other healthcare professionals. The current work extends upon this research by investigating perceptions of physicians who use stigmatizing or humanizing language. The current work sought to document the negative consequences of providers’ indelicate language on impressions of the provider, thereby motivating thoughtful language choices. To this end, the current work experimentally manipulated the language (stigmatizing, identity-first and destigmatizing, person-first) that hypothetical providers used to describe individuals with substance use disorder and examined participants’ judgments of the providers (likeability and positive behavioral intentions). We predicted that the provider using stigmatizing, identity-first language would elicit more negative responses than the provider using destigmatizing, person-first language. However, the results provided no support for this hypothesis; instead, we observed only an effect of the vignette content: participants had more positive perceptions of the physician who spoke first, compared to the physician who spoke second. Although the current work did not observe significant effects of language, past work indicates the importance of empathy, warmth, and respect from providers for patient well-being and outcome. We suggest directions for improving upon the current study, as well as possible topics for future research that may aid in understanding these important antecedents of inclusive and successful patient-physician interactions

Y chromosome microdeletions in infertile men with idiopathic oligo- or azoospermia

About 30–40% of male infertility is due to unknown reasons. Genetic contributions to the disruption of spermatogenesis are suggested and amongst the genetic factors studied, Y chromosome microdeletions represent the most common one. Screening for microdeletions in AZFa, b and c region of Y chromosome showed a big variation among different studies. The purpose of this study was to investigate the prevalence of such deletions in Saudi men. A total of 257 patients with idiopathic oligo- or azoospermia were screened for Y chromosome microdeletions by 19 markers in AZF region. Ten (3.9%) patients had chromosomal rearrangements, six of them showed sex chromosome abnormalities and four patients had apparently balanced autosomal rearrengements. Eight of the remaining 247 patients (3.2%) with a normal karyotype and no known causes of impaired spermatogenesis had Y chromosome microdeletions. Among these, six patients had deletions in AZFc region, one case had a deletion in AZFb and another had both AZFa and AZFc deletions. In conclusion, our study shows that Y chromosome microdeletions are low in our population. We also report for the first time a case with unique point deletions of AZFa and AZFc regions. The lower frequency of deletions in our study suggest that other genetic, epigenetic, nutritional and local factors may be responsible for idiopathic oligo- or azoospermia in the Saudi population

Cross-sectional survey of a sample of UK primary care dental professionals' experiences of sharps injuries and perception of access to occupational health support

Background: The 2013 Sharps Regulations were introduced to minimise the risk of sharps injuries and blood borne virus transmission throughout healthcare. Occupational health (OH) services are pivotal for helping employers implement these regulations. Despite this, no research has been conducted on the prevalence of sharps injuries, underreporting of injuries or access to OH among primary care dental professionals in the UK since 2013. Aim: To estimate the prevalence of sharps injuries, the level of underreporting and of self-reported access to an OH service both for the care of sharps injuries and for general health and wellbeing. Method: A cross-sectional survey was administered at the 2017 British Dental Association (BDA) Conference and Exhibition in Manchester, and at the 2017 BDA Scottish Conference and Exhibition in Glasgow. The survey covered questions relating to sharps injuries and OH support. Statistical analyses were conducted using SPSS Version 22 (IBM Corp., 2013). Results: A total of 796 delegates participated, of whom 166 (20.8%) had experienced a sharps injury in the past year and 58 (35%) did not report the incident. Of the participants, 190 (23.9%) reported no, or uncertain, access to OH support. Most respondents' practices had a sharps safety policy (771; 96.9%), but fewer (611; 76.8%) had received training on the prevention of sharps injuries and neither policy nor training were associated with incident reporting. Conclusion: Despite the introduction of the sharps regulations, sharps injuries and underreporting of injuries remain prevalent among those practising in primary dental care. Our results also suggest that there are significant shortfalls in OH support, at a time when changes to guidance on health clearance and management of BBV infected healthcare workers, in addition to sharps injury management, increase the need for such services

Internet-based treatment for PTSD reduces distress and facilitates the development of a strong therapeutic alliance: a randomized controlled clinical trial

BACKGROUND: The present study was designed to evaluate the efficacy of an internet-based therapy (Interapy) for Posttraumatic Stress Disorder (PTSD) in a German speaking population. Also, the quality of the online therapeutic relationship, its development and its relevance as potential moderator of the treatment effects was investigated. METHOD: Ninety-six patients with posttraumatic stress reactions were allocated at random to ten sessions of Internet-based cognitive behavioural therapy (CBT) conducted over a 5-week period or a waiting list control group. Severity of PTSD was the primary outcome. Secondary outcome variables were depression, anxiety, dissociation and physical health. Follow-up assessments were conducted at the end of treatment and 3 months after treatment. RESULTS: From baseline to post-treatment assessment, PTSD severity and other psychopathological symptoms were significantly improved for the treatment group (intent-to-treat group x time interaction effect size d = 1.40). Additionally, patients of the treatment condition showed significantly greater reduction of co-morbid depression and anxiety as compared to the waiting list condition. These effects were sustained during the 3-months follow-up period. High ratings of the therapeutic alliance and low drop-out rates indicated that a positive and stable therapeutic relationship could be established online. Significant improvement of the online working alliance in the course of treatment and a substantial correlation between the quality of the online relationship at the end of treatment and treatment outcome emerged. CONCLUSION: Interapy proved to be a viable treatment alternative for PTSD with large effect sizes and sustained treatment effects. A stable and positive online therapeutic relationship can be established through the Internet which improved during the treatment process. TRIAL REGISTRATION: Australian Clinical Trials Registry ACTRN012606000401550

Prospective assessment of Y-chromosome microdeletions and reproductive outcomes among infertile couples of Japanese and African origin

BACKGROUND: To compare the frequency of Y-chromosome microdeletions in Japanese and African azoospermic and oligozoospermic men and describe embryo characteristics and reproductive outcome following in vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI). METHODS: Our study was performed prospectively at two centers, a private IVF clinic and a university hospital. Japanese and African (Tanzanian) men with nonobstructive azoospermia (NOA) and oligozoospermia (concentration < 5 × 10(6 )/ml) were evaluated for Y-chromosome microdeletions (n = 162). Of the 47 men with NOA, 26 were Japanese and 21 were Africans. Of the 115 men with oligozoospermia, 87 were Japanese and 28 were Africans. Reproductive outcomes of patients with Y-chromosome microdeletions were then compared with those of 19 IVF+ICSI cycles performed on couples with Y-chromosome intact males/tubal factor infertility which served as a control group. RESULTS: Seven azoospermic and oligozoospermic patients had Y-chromosome deletions; the total number of deletions in the AZFc region was five. There was only one deletion in the AZFa region and one complete deletion involving all three regions (AZFa, b, and c) within AZF. In our study population, microdeletion frequency among Japanese men was 6.2% (95% CI, 4.25% – 14.45%), whereas no deletions were identified in the African group (95% CI, 0.0% – 7.27%). The difference between the two groups was not statistically significant, however. Embryos derived from ICSI utilizing sperm with Y-chromosome microdeletion showed reduced rates of fertilization, blastocyst development, implantation, and pregnancy compared to the Y-chromosome intact group, although these observed differences were not statistically significant. CONCLUSION: The observed frequency of Y-chromosome microdeletion was 6.2% among Japanese azoospermic and oligozoospermic males; no microdeletions were identified among our African study patients. In this population of couples undergoing IVF+ICSI, there was no statistically significant difference in embryo characteristics or pregnancy outcome between patients with Y-chromosome microdeletion and those with an intact Y-chromosome

Neurogenic bladder: etiology and assessment

A review of the various causes of neurologic impairment to the lower urinary tract in children was the aim of this presentation. The emphasis was on diagnosis, pathophysiology, and treatment that strive to maintain as normal a function as possible in order to achieve eventual urinary continence and health of the upper urinary tract. The latest principles based on the most up to date evidence are promulgated but with an eye towards historical prospective. The reader should gain an adequate understanding of various disorders that comprise this condition and feel comfortable with proposing options for management when faced with the responsibility of caring for an affected child