The Association between Educational Achievements, Career Aspirations, Achievement Motives and Oral Hygiene Behavior among Dental Students of Udaipur, India

Background: There are several factors which influence oral hygiene behavior of an individual. Educational achievements, career aspirations and achievement motives of individuals are some of those factors. The objective of this study was to investigate whether educational achievements, career aspirations and achievement motives have associations with oral hygiene behavior among dental students of Udaipur, India.Methods: A descriptive cross-sectional study was conducted among all (n=200) 1st year dental students from all dental colleges of Udaipur City, India. Self-administered structured questions were used to assess their educational achievements, career aspirations and oral hygiene behavior (OHB). Achievement motives were assessed using Achievement Motive Scale developed by Lang and Fries (2006). Chi-square test and multivariate logistic regression tests were used in data analysis. Confidence level and level of significance were set at 95% and 5% respectively.Results: Students with better educational achievements undergone regular dental check-up (30.48%) (p=0.03) and used other oral hygiene aids (90.24%) (p=0.01). Tooth brushing frequency, time and replacement time of tooth brush were found to be significantly associated with career aspiration (p=0.007; p=0.002; p=0.00 respectively). Achievement motives did not have statistically significant association with oral hygiene behavior.Conclusion: Educational achievements and career aspirations appear to be associated with oral hygiene behavior of young dental students. Students with higher career aspirations practiced better oral hygiene behavior. There was no significant relationship between achievement motives and oral hygiene behavior.Keywords: Educational achievements, career aspirations, achievement motives, oral hygiene

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND: The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. METHODS: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. FINDINGS: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). INTERPRETATION: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. FUNDING: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

Background: The EMPA KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population. Methods: EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110. Findings: Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5–2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62–0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16–1·59), representing a 50% (42–58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1). Interpretation: In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease. Funding: Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council

A new algorithm for adaptive flow control in interconnected local area networks

The authors develop a simple model for window flow control in homogeneous local area networks (LANs) interconnected by a media-access-layer bridge. Analysis of the model demonstrates that for each set of parameters values there is an optimal window that maximises the good throughput of virtual circuits interconnected via the bridge. Using this model the authors develop an adaptive window flow control algorithm that gives significantly better performance than an algorithm that is being considered for standardisation for interconnected token ring LANs

The theory of reasoned action in describing tongue cleaning adherence among college going students of India: a model guided study

Background. Just mere brushing of teeth is not enough for maintaining good oral health. Regular cleaning of tongue is equally important for maintaining good oral hygiene and to escape social embarrassment and personal discomfort, which could arise as a result of halitosis. Objective. To test the variables of Theory of Reasoned Action to explain the behavior of tongue cleaning among college going students of Udaipur city, Rajasthan, India. Material and methods. A descriptive cross-sectional survey was conducted amongst 756 college going students of Udaipur city, India using an online self-administered structured questionnaire which was designed based on our study objectives. Logistic regression analysis and structural equation modelling (SEM) were employed for statistical analysis. Confidence level and level of significance were set at 95% and 5% respectively. Results. Logistic regression analysis showed that with one unit increase in subjective norm, the tongue cleaning behavior odds increased significantly by 1.124. Also, the tongue cleaning behavior odds was 1.77 times significantly greater among those brushing their teeth twice a day than those brushing once a day. Structural Equation modelling also evidenced the significant direct effect of subjective norm on tongue cleaning behavior (β = 0.2, p≤0.05). Conclusion. Our results highlighted the importance of subjective norms in espousing tongue cleaning preventive behaviour habit. It is thus recommended to highpoint the role of significant others in changing tongue cleaning behaviour

Utilization of services and referrals through dental outreach programs in rural areas of India. A two year study

Background. Oral health care services are often sparse and inconsistent in India therefore it is often difficult for poor people to get access to the oral health care services. The approach by dental institutions with the help of community outreach programs is a step ahead in overcoming this situation. Objectives. The study was conducted to evaluate the number of patients, disease pattern and the services provided in the outreach programmes and also effectiveness of patient referral. Methods. A retrospective study was conducted and the data were obtained from records of outreach programs conducted, in last 2 years by Pacific Dental College and Hospital. The data were analysed using descriptive statistics for the computation of percentages Chi-square test was applied to know the association of effectiveness of referral with age and gender. Confidence level and level of significance was fixed at 95% and 5% respectively. Results. A total of 22982 individuals in the age group of 4-80 years attended the outreach program. Dental caries (42.3%), periodontal diseases (63.2-69.0%) and dental fluorosis (33.7-35.0%) were commonly observed diseases. Effectiveness of referral was significantly high among the middle age adults and females (P<0.05). The effectiveness of referral was highly improved in 2013 after establishment of certain guidelines and strategies. Conclusion. The approaches by dental institutions with the help of community outreach programs can spread awareness and disseminate treatment and thereby enhancing access to care and eliminating access to care within the rural communities