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

Evaluating knowledge exchange in interdisciplinary and multi-stakeholder research

Interdisciplinary and multi-stakeholder research is increasingly being promoted and implemented to enhance understanding of global environment change, identify holistic policy solutions, and assist implementation. These research activities are social processes aiming to enhance the exchange and translation of knowledge. Emphasis on the design and management of knowledge exchange is increasing, but learning about how to do this better is hampered by lack of conceptual development and appropriate methods to evaluate complex and multifaceted knowledge exchange processes. This paper therefore develops principles for the evaluation of knowledge exchange in interdisciplinary, multi-stakeholder environmental change research. The paper is based on an analysis of 135 peer-reviewed evaluations of knowledge exchange from diverse disciplines. The results indicate strong relationships between the field of study (e.g. health care, environmental management), the way knowledge and knowledge exchange were conceptualised and implemented, the approach used for the evaluation, and the outcomes being evaluated. A typology of seven knowledge exchange evaluations is presented to guide discussions about the underlying assumptions of different approaches to knowledge exchange and its evaluation. Five principles for knowledge exchange evaluation are also identified: (i) design for multiple end users; (ii) be explicit about why a particular approach to knowledge exchange is expected to deliver its outcomes; (iii) evaluate diverse outcomes; (iv) use evaluations as part of the process of delivering knowledge exchange; and (v) use mixed methods to evaluate knowledge exchange. We conclude that a catch-all approach to evaluation is neither appropriate nor desirable. Instead, approaches that focus on understanding the underlying processes of knowledge exchange, assess the relative contribution of other factors in shaping outcomes in addition to knowledge exchange, and that involve multiple stakeholders in implementing evaluations, will be the most appropriate for evaluating knowledge exchange in interdisciplinary global environmental change research. © 2014 Elsevier Ltd