Comparison of two methods in deriving a short version of oral health-related quality of life measure

Objective To compare two methods of developing short forms of the Malaysian Oral Health Impact Profile (OHIP-M) measure. Method Cross sectional data obtained using the long form of the OHIP-M was used to produce two types of OHIP-M short forms, derived using two different methods; namely regression and item frequency methods. The short version derived using a regression method is known as Reg-SOHIP(M) and that derived using a frequency method is known as Freq-SOHIP(M). Both short forms contained 14 items. These two forms were then compared in tenus of their content, scores, reliability, validity and the ability to distinguish between groups. Results Out of 14 items, only four were in common. The form derived from the frequency method contained more high prevalence items and higher scores than the form derived from the regression method. Both methods produced a reliable and valid measure. However, the frequency method produced a measure, which was slightly better in terms of distinguishing between groups. Conclusion Regardless of the method used to produce the measures, both forms performed equally well when tested for their cross-sectional psychometric properties. This record was migrated from the OpenDepot repository service in June, 2017 before shutting down

Landscapes of Pilgrimage in Medieval Britain

This thesis seeks to address the journeying context of pilgrimage within the landscapes of Medieval Britain. Using four case studies, an interdisciplinary methodology developed by the author is applied to a four different geographical and cultural areas of Britain (Norfolk, Wiltshire/Hampshire, Flintshire/Denbighshire and Cornwall), to investigate the practicalities of travel along the Medieval road network including the routes themselves, accommodation, the built environments and natural topographies encountered. An introduction, assessment of current theory and scholarship is provided, followed by an explanation of the methodology used. The four case studies are then presented (Ely to Walsingham, Salisbury to Winchester, St Asaph to Holywell, and Camelford to Bodmin). Within each case study, both the selected starting point for the pilgrimage (typically either a locale confirmed in the historical record as linked to the pilgrim destination, or a settlement of some significance within the local area and thus well connected to the route network), and the site of the saint cult itself are analysed for their growth, reaction and accommodation to the pilgrim phenomenon. Also addressed are the route networks of the county as a whole, relationships to economic centres and their impact on travel possibilities, the topography, the distribution patterns for saint dedications in parish churches within the area, material culture and the ecclesiastical built environment (for example pilgrim badges, monasteries), and the physical landscapes through which the pilgrim travels. Here, the interaction between the pilgrim and the environments through which they move is addressed. Considerations include fatigue, exertion, panoramas and way-finding, route visibility, sight lines to monuments, folklore within the landscape, and the potential echoing of Christian scriptural motifs within certain landscape types/features (e.g. wilderness and sanctuary). Within the final section of the thesis these themes are compared and expanded into the broader context of pilgrimage not only in Medieval Christendom, but within Buddhist, Hindu and Islamic religious traditions, in order to demonstrate the methodology's validity and flexibility in addressing pilgrimage holistically. Comparisons are made between the local and universal pilgrim routes in terms of material culture, landscape interaction and travel practicalities, and suggestions for future research and development of the pilgrim studies field are also provided

Validity and reliability of the Oral Impacts on Daily Performance (OIDP) frequency scale: a cross-sectional study of adolescents in Uganda

BACKGROUND: Assessing oral health related quality of life impact of mouth in adolescents is a relatively ignored area in dental research. This study aimed to examine reliability and validity of an abbreviated version of the oral impact of daily performance (OIDP) questionnaire and to analyse the interrelationship among OIDP scores, socio-demographic characteristics and oral health status in Uganda. METHOD: 1146 adolescents (mean age 15.8, response rate 87%) attending secondary schools in Kampala (urban) and Lira (rural) completed a survey instrument designed to measure subjective oral health indicators including the eight-item OIDP frequency scores. A clinical examination was conducted among 372 students (mean age 16.3, response rate 72%) and caries was assessed following the World Health Organisation criteria (1997). RESULTS: 62% of the students experienced at least one oral impact during the 6 months preceding the survey. Cronbach's alpha for the OIDP frequency items was 0.91 and the corrected item-total correlation ranged from 0.62 to 0.75. Discriminant and construct validity were demonstrated in that the OIDP scores varied systematically in the expected direction with missing teeth and self-report indicators of oral health status, respectively. Socio-demographics and dental attendance did not predict OIDP through interaction with clinical indicators but varied systematically and independently with OIDP frequency scores in the multivariate analysis. CONCLUSION: the OIDP frequency score have acceptable psychometric properties in the context of an oral health survey among Ugandan adolescents. Some evidence of the importance of social and personal characteristics in shaping adolescents' responses to oral disorders was provided

Randomised controlled trial and economic evaluation of a chest pain observation unit compared with routine care

Objectives To measure the effectiveness and cost effectiveness of providing care in a chest pain observation unit compared with routine care for patients with acute, undifferentiated chest pain. Design Cluster randomised controlled trial, with 442 days randomised to the chest pain observation unit or routine care, and cost effectiveness analysis from a health service costing perspective. Setting The emergency department at the Northern General Hospital, Sheffield, United Kingdom. Participants 972 patients with acute, undifferentiated chest pain (479 attending on days when care was delivered in the chest pain observation unit, 493 on days of routine care) followed up until six months after initial attendance. Main outcome measures The proportion of participants admitted to hospital, the proportion with acute coronary syndrome sent home inappropriately, major adverse cardiac events over six months, health utility, hospital reattendance and readmission, and costs per patient to the health service. Results Use of a chest pain observation unit reduced the proportion of patients admitted from 54% to 37% (difference 17%, odds ratio 0.50, 95% confidence interval 0.39 to 0.65, P < 0.001) and the proportion discharged with acute coronary syndrome from 14% to 6% (8%, –7% to 23%, P = 0.264). Rates of cardiac event were unchanged. Care in the chest pain observation unit was associated with improved health utility during follow up (0.0137 quality adjusted life years gained, 95% confidence interval 0.0030 to 0.0254, P = 0.022) and a saving of £78 per patient (–£56 to £210, P = 0.252). Conclusions Care in a chest pain observation unit can improve outcomes and may reduce costs to the health service. It seems to be more effective and more cost effective than routine care

Psychometric properties and the prevalence, intensity and causes of oral impacts on daily performance (OIDP) in a population of older Tanzanians

BACKGROUND: The objective was to study whether a Kiswahili version of the OIDP (Oral Impacts on Daily Performance) inventory was valid and reliable for use in a population of older adults in urban and rural areas of Tanzania; and to assess the area specific prevalence, intensity and perceived causes of OIDP. METHOD: A cross-sectional survey was conducted in Pwani region and in Dar es Salaam in 2004/2005. A two-stage stratified cluster sample design was utilized. Information became available for 511 urban and 520 rural subjects (mean age 62.9 years) who were interviewed and participated in a full mouth clinical examination in their own homes. RESULTS: The Kiswahili version of the weighted OIDP inventory preserved the overall concept of the original English version. Cronbach's alpha was 0.83 and 0.90 in urban and rural areas, respectively, and the OIDP inventory varied systematically in the expected direction with self-reported oral health measures. The respective prevalence of oral impacts was 51.2% and 62.1% in urban and rural areas. Problems with eating was the performance reported most frequently (42.5% in urban, 55.1% in rural) followed by cleaning teeth (18.2% in urban, 30.6% in rural). More than half of the urban and rural residents with impacts had very little, little and moderate impact intensity. The most frequently reported causes of impacts were toothache and loose teeth. CONCLUSION: The Kiswahili OIDP inventory had acceptable psychometric properties among non-institutionalized adults 50 years and above in Tanzania. The impacts affecting their performances were relatively common but not very severe

The influence of oral health status on speech intelligibility, articulation and quality of life of older community-dwelling people

Objective: To investigate the impact of the oral health status on speech intelligibility, articulation and quality of life of older community-dwelling people. Background To our knowledge, there have been no studies on this topic in patients aged 75 years or older. Material and methods: Thirty outpatients of a university dental clinic (median [IQR] age of 77.00 [75-82] years) participated. The OHIP-14, a dental examination, a speech intelligibility study and an articulation examination were conducted. Results: Distortions of rhotacisms and sigmatisms were most common, followed by distortions of labiodentals and apicoalveolars. Seven participants (23%) required dental treatment. Distortions of rhotacisms were lowest in participants with loss of teeth in the posterior part of the maxilla and equal in participants with edentulous maxilla and loss of teeth in the anterior part of the maxilla (P = 0.014). Labiodental distortions were lowest in participants with loss of teeth in the posterior part of the maxilla, but were higher in participants with loss of teeth in the anterior part of the maxilla and highest in participants with an edentulous maxilla (P = 0.035). People with normal mouth opening had lower percentage of labiodental distortions than people with a reduced mouth opening (P = 0.05). The proportion of participants with inadequate denture hygiene and distortions of bilabials was 71.4% compared to 10.5% for participants with adequate denture hygiene (P = 0.005). Conclusion: Dentists must consider the impact of a denture on speech, but also should be aware of other oral health factors that influence the speech and quality of life of elders

Success in periodontology: An evolutive concept

AimThe purpose of this editorial was to discuss a definition of success after periodontal therapy based on the retention of natural dentition.Materials and MethodsBased on topic and relevance, references were collected and then divided into four categories: (a) the influence of available therapeutic techniques on the definition of hopeless teeth, (b) the longâ term rate of tooth loss during supportive periodontal therapy, (c) the duration of time that the treatment outcomes may be considered stable and (d) patientsâ perception and satisfaction of periodontal therapy.ResultsPeriodontal therapy can change the prognosis of hopeless teeth, making them maintainable in the long term. The rate of tooth loss can be minimized in a way that a period of 10 years or more is needed to evaluate further periodontal breakdown. In addition, patientsâ perception and satisfaction of the treatment should be considered as the main therapeutic endpoints of the provided periodontal therapy.ConclusionsDefinition of success is linked to the available therapeutic tools. Due to the recent advancement of treatment modalities, periodontally hopeless teeth can now be treated and maintained for a long period of time with health, function and patient satisfaction.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/150541/1/jcpe13150.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/150541/2/jcpe13150_am.pd

Effectiveness and reach of a directed-population approach to improving dental health and reducing inequalities: a cross sectional study

Background Childsmile School adopts a directed-population approach to target fluoride varnish applications to 20% of the primary one (P1) population in priority schools selected on the basis of the proportion of enrolled children considered to be at increased-risk of developing dental caries. The study sought to compare the effectiveness of four different methods for identifying individuals most in need when a directed-population approach is taken. &lt;p&gt;&lt;/p&gt; Methods The 2008 Basic National Dental Inspection Programme (BNDIP) cross-sectional P1 Scottish epidemiological survey dataset was used to model four methods and test three definitions of increased-risk. Effectiveness was determined by the positive predictive value (PPV) and explored in relation to 1-sensitivity and 1-specificity. &lt;p&gt;&lt;/p&gt; Results Complete data was available on 43470 children (87% of the survey). At the Scotland level, at least half (50%) of the children targeted were at increased-risk irrespective of the method used to target or the definition of increased-risk. There was no one method across all definitions of &lt;i&gt;increased-risk&lt;/i&gt; that maximised PPV. Instead, PPV was highest when the targeting method complimented the definition of &lt;i&gt;increased-risk&lt;/i&gt;. There was a higher percentage of children at &lt;i&gt;increased-risk&lt;/i&gt; who were not targeted (1-sensitivity) when caries experience (rather than deprivation) was used to define &lt;i&gt;increased-risk&lt;/i&gt;, irrespective of the method used for targeting. Over all three definitions of &lt;i&gt;increased-risk&lt;/i&gt;, there was no one method that minimised (1-sensitivity) although this was lowest when the method and definition of &lt;i&gt;increased-risk&lt;/i&gt; were complimentary. The false positive rate (1-specificity) for all methods and all definitions of &lt;i&gt;increased-risk&lt;/i&gt; was consistently low (&#60;20%), again being lowest when the method and definition of &lt;i&gt;increased-risk&lt;/i&gt; were complimentary. &lt;p&gt;&lt;/p&gt; Conclusion Developing a method to reach all (or even the vast majority) of individuals at &lt;i&gt;increased-risk&lt;/i&gt; defined by either caries experience or deprivation is difficult using a directed-population approach at a group level. There is a need for a wider debate between politicians and public health experts to decide how best to reach those most at need of intervention to improve health and reduce inequalities. &lt;p&gt;&lt;/p&gt

Adaptively inferring human transcriptional subnetworks

Although the human genome has been sequenced, progress in understanding gene regulation in humans has been particularly slow. Many computational approaches developed for lower eukaryotes to identify cis-regulatory elements and their associated target genes often do not generalize to mammals, largely due to the degenerate and interactive nature of such elements. Motivated by the switch-like behavior of transcriptional responses, we present a systematic approach that allows adaptive determination of active transcriptional subnetworks (cis-motif combinations, the direct target genes and physiological processes regulated by the corresponding transcription factors) from microarray data in mammals, with accuracy similar to that achieved in lower eukaryotes. Our analysis uncovered several new subnetworks active in human liver and in cell-cycle regulation, with similar functional characteristics as the known ones. We present biochemical evidence for our predictions, and show that the recently discovered G2/M-specific E2F pathway is wider than previously thought; in particular, E2F directly activates certain mitotic genes involved in hepatocellular carcinomas. Additionally, we demonstrate that this method can predict subnetworks in a condition-specific manner, as well as regulatory crosstalk across multiple tissues. Our approach allows systematic understanding of how phenotypic complexity is regulated at the transcription level in mammals and offers marked advantage in systems where little or no prior knowledge of transcriptional regulation is available