Medical microbiology in dentistry

МИКРОБИОЛОГИЯСТОМАТОЛОГИЯСТОМАТОГНАТИЧЕСКИЕ БОЛЕЗНИУЧЕБНЫЕ ПОСОБИЯВключены разделы с информацией о наиболее распространенных стоматологических болезнях, ассоциированных с инфекциями, их патогенезе, лабораторной диагностике, профилактике и лечении

A Review of the External Validity of Clinical Trials with Beta-Blockers in Heart Failure

This is an open-access article distributed under the terms of the Creative Commons CC-BY-NC 3.0 License.Background: Beta-blockers (BBs) are the mainstay prognostic medication for all stages of chronic heart failure (CHF). There are many classes of BBs, each of which has varying levels of evidence to support its efficacy in CHF. However, most CHF patients have one or more comorbid conditions such as diabetes, renal impairment, and/or atrial fibrillation. Patient enrollment to randomized controlled trials (RCTs) often excludes those with certain comorbidities, particularly if the symptoms are severe. Consequently, the extent to which evidence drawn from RCTs is generalizable to CHF patients has not been well described. Clinical guidelines also underrepresent this point by providing generic advice for all patients. The aim of this review is to examine the evidence to support the use of BBs in CHF patients with common comorbid conditions. Methods: We searched MEDLINE, PubMed, and the reference lists of reviews for RCTs, post hoc analyses, systematic reviews, and meta-analyses that report on use of BBs in CHF along with patient demographics and comorbidities. Results: In total, 38 studies from 28 RCTs were identified, which provided data on six BBs against placebo or head to head with another BB agent in ischemic and nonischemic cardiomyopathies. Several studies explored BBs in older patients. Female patients and non-Caucasian race were underrepresented in trials. End points were cardiovascular hospitalization and mortality. Comorbid diabetes, renal impairment, or atrial fibrillation was detailed; however, no reference to disease spectrum or management goals as a focus could be seen in any of the studies. In this sense, enrollment may have limited more severe grades of these comorbidities. Conclusions: RCTs provide authoritative information for a spectrum of CHF presentations that support guidelines. RCTs may provide inadequate information for more heterogeneous CHF patient cohorts. Greater Phase IV research may be needed to fill this gap and inform guidelines for a more global patient population

Psychosocial Functioning in the Elderly: An Assessment of Self-concept and Depression

The aim of this study was to explore the relationship between self-concept and depression in elderly people living in Residential Aged Care (RAC) settings. Forty-five residents, comprising 17 males and 28 females (M = 82.64 years, SD = 8.38 years), were recruited from 10 low-care, RAC facilities in Melbourne, Australia. Participants completed the Geriatric Depression Scale – Short Form and the Tennessee Self Concept Scale: 2. The results revealed that all self-concept domains were significantly lower in RAC residents in comparison to norms drawn from community dwelling samples (p < 0.05). Moreover, a significant inverse relationship between depression and self-concept domains (p < 0.05) was observed in RAC residents, with 28.8% of the variance in depression scores accounted for by Physical Self Concept. These findings identify self-concept, particularly physical self-concept, as an important predictor of psychosocial well-being in elderly RAC residents. Further research is needed to examine the efficacy of psychosocial and rehabilitative interventions to optimise self-concept in RAC residents.El objetivo de este estudia fue explorar la relación entre el autoconcepto y la depresión en las personas de edad avanzada que residen en residencias destinadas al cuidado de este tipo de personas. Cuarenta y cinco residentes de esta clase de residencias de bajo cuidado en Melbourne, Australia, 17 hombres y 28 mujeres, (M = 82.64 años, SD = 8.38 años) fueron incluidos. Los participantes completaron la forma corta de la escala de depresión geriátrica y la escala de autoconcepto de Tennessee: 2. Los resultados revelaron que todos los ítems relacionados al autoconcepto fueron significativamente bajos en las residencias mencionadas en comparación a las medias de muestras de habitantes de casas particulares (p < 0.05). Además, una relación inversa y significativa entre la depresión y el autoconcepto (p < 0.05) fue observado en los residentes del primer tipo de vivienda mencionada, con un 28.8% de varianza en los puntajes de depresión obtenidos para el autoconcepto físico. Estos hallazgos identifican el autoconcepto, particularmente el físico, como un importante síntoma de bienestar psicológico en los adultos mayores de residencias especiales destinadas a su cuidado. Es necesaria investigación posterior para examinar la eficacia de las intervenciones de rehabilitación y psicosociales para optimizar el autoconcepto en este tipo de población

Funcionamiento psicosocial en los ancianos: una evaluación del autoconcepto y la depresión

The aim of this study was to explore the relationship between self-concept and depression in elderly people living in Residential Aged Care (RAC) settings. Forty-five residents, comprising 17 males and 28 females (M = 82.64 years, SD = 8.38 years), were recruited from 10 low-care, RAC facilities in Melbourne, Australia. Participants completed the Geriatric Depression Scale – Short Form and the Tennessee Self Concept Scale: 2. The results revealed that all self-concept domains were significantly lower in RAC residents in comparison to norms drawn from community dwelling samples (p &lt; 0.05). Moreover, a significant inverse relationship between depression and self-concept domains (p &lt; 0.05) was observed in RAC residents, with 28.8% of the variance in depression scores accounted for by Physical Self Concept. These findings identify self-concept, particularly physical self-concept, as an important predictor of psychosocial well-being in elderly RAC residents. Further research is needed to examine the efficacy of psychosocial and rehabilitative interventions to optimise self-concept in RAC residents.El objetivo de este estudia fue explorar la relación entre el autoconcepto y la depresión en las personas de edad avanzada que residen en residencias destinadas al cuidado de este tipo de personas. Cuarenta y cinco residentes de esta clase de residencias de bajo cuidado en Melbourne, Australia, 17 hombres y 28 mujeres, (M = 82.64 años, SD = 8.38 años) fueron incluidos. Los participantes completaron la forma corta de la escala de depresión geriátrica y la escala de autoconcepto de Tennessee: 2. Los resultados revelaron que todos los ítems relacionados al autoconcepto fueron significativamente bajos en las residencias mencionadas en comparación a las medias de muestras de habitantes de casas particulares (p &lt; 0.05). Además, una relación inversa y significativa entre la depresión y el autoconcepto (p &lt; 0.05) fue observado en los residentes del primer tipo de vivienda mencionada, con un 28.8% de varianza en los puntajes de depresión obtenidos para el autoconcepto físico. Estos hallazgos identifican el autoconcepto, particularmente el físico, como un importante síntoma de bienestar psicológico en los adultos mayores de residencias especiales destinadas a su cuidado. Es necesaria investigación posterior para examinar la eficacia de las intervenciones de rehabilitación y psicosociales para optimizar el autoconcepto en este tipo de población

Patient self-management in chronic heart failure – establishing concordance between guidelines and practice

&nbsp;Chronic heart failure (CHF) is a progressive and debilitating disease with a broad symptom profile, intermittently marked by periods of acute decompensation. CHF patients are encouraged to self-manage their illness, such as adhering to medical regimens and monitoring symptoms, to optimise health outcomes and quality of life. In so doing, patients are asked to collaborate with their health service providers with regard to their care. However, patients generally do not self-manage well, even with specialist support. Moreover, self- management interventions are yet to demonstrate morbidity or mortality benefits. Social network approaches to self-management consider the availability and mobilisation of all resources, beyond those of only the patient and healthcare providers. Used in conjunction with e-health platforms, social network approaches may offer a means by which to optimise self-management programmes of the future

Depression and cardiovascular disease : a clinical review

Cardiovascular disease (CVD) and depression are common. Patients with CVD have more depression than the general population. Persons with depression are more likely to eventually develop CVD and also have a higher mortality rate than the general population. Patients with CVD, who are also depressed, have a worse outcome than those patients who are not depressed. There is a graded relationship: the more severe the depression, the higher the subsequent risk of mortality and other cardiovascular events. It is possible that depression is only a marker for more severe CVD which so far cannot be detected using our currently available investigations. However, given the increased prevalence of depression in patients with CVD, a causal relationship with either CVD causing more depression or depression causing more CVD and a worse prognosis for CVD is probable. There are many possible pathogenetic mechanisms that have been described, which are plausible and that might well be important. However, whether or not there is a causal relationship, depression is the main driver of quality of life and requires prevention, detection, and management in its own right. Depression after an acute cardiac event is commonly an adjustment disorder than can improve spontaneously with comprehensive cardiac management. Additional management strategies for depressed cardiac patients include cardiac rehabilitation and exercise programmes, general support, cognitive behavioural therapy, antidepressant medication, combined approaches, and probably disease management programmes

Companion Animals in Thailand: Human Factors that Predict Sterilization of Cats and Dogs

The prevalence of companion animal caregiving was estimated, and demographic and psychosocial factors that predict sterilization behaviors in caregivers in Thailand were identified. Thai nationals ( n= 494) were recruited by random for the Culture and Human-Animal Interactions ( chai) telephone survey. The results showed 74% of respondents had a cat and/or a dog (60% dogs, 23% cats); 22% of dogs and 19% of cats were sterilized. Logistic Regression analyses revealed positive attitudes toward desexing, and the perception that important others would endorse this practice best predicted sterilization practices. For caregivers with unsterilized companions, Hierarchical Multiple Regression analyses revealed perceived capability to sterilize, positive attitudes toward desexing, and perceived normative pressure to sterilize accounted for 35% and 45% of the variance in intentions to sterilize dogs and cats, respectively. Culturally sensitive initiatives targeting negative attitudes, enhancing normative pressure, and increasing perceived personal agency to sterilize may improve sterilization rates in Thailand

The relationship between phobic anxiety and 2-year readmission after acute coronary syndrome : What is the role of heart rate variability?

Objective Phobic anxiety is a risk factor for poor prognosis following Acute Coronary Syndrome (ACS). A psychophysiological marker of vagal function, autonomic dysfunction may play a critical role in this relationship. The aim of the study was two-fold: to assess whether phobic anxiety was characterised by autonomic dysfunction (heart rate variability) in the short (1-month) and longer term (12-months) following ACS, and (ii) to quantify the extent to which HRV parameters modified the effect of phobic anxiety on all-cause hospital readmission over 2 years. Methods The ADVENT study followed 416 ACS patients. At 1-month following discharge (T0), phobic anxiety and autonomic functioning were assessed using the Crown Crisp Index (CCI) and 11 indices of heart rate variability (HRV), respectively. HRV was measured again at 12-months (T1) (n = 359). Hospital readmission (all cause) was derived from an audit of hospital records by two medically trained research fellows. Generalised linear modelling (GLM) was used to first determine the association between CCI score at T0 and HRV parameters at T0 and T1. Binary logistic regression was used to measure the relationship between CCI scores and readmission (yes/no) and the extent to which HRV parameters modified this effect. Results CCI scores were associated with 7 of the 11 indices of HRV: Average RR (ms), SDRR (ms), RMSSD (ms), SDSD (ms), pRR50 (%), LF Powers (ms2) and HF Powers (ms2) at T0 but not T1. CCI scores at T0 significantly predicted likelihood of readmission to hospital in the subsequent 2 year period. No parameter of HRV at T0 modified this effect. Limitations We were unable to provide adjudicated major adverse coronary events outcome data, or account for changes in medication adherence, diet or physical activity. Conclusions While phobic anxiety is associated with both reduced vagal function in the short term after an ACS event and 2 year all cause readmission, HRV does not appear to be the pathway by which phobic anxiety drives this outcome