Probing problems and priorities in oral health (care) among community dwelling elderly in the Netherlands: a mixed method study

Background: Complex dentitions and decline in adequate oral hygiene in elderly may lead to poor oral health. This may have impact on their general health, wellbeing and quality of life. With increased longevity, the problems and needs in oral health of community dwelling elderly lead to changes in oral health care needs. We identified and prioritized problems and needs in oral health of community dwelling elderly. Methods: The problems and needs in oral health of community dwelling elderly were elicited during focus groups and interviews. The list of problems and needs derived thereof was presented to 97 elderly who prioritized these. Results: Overall, older people appeared to be satisfied with their current oral health, and the maintenance and care for their oral health. Cost of care was identified as a major problem in general. There are differences in current perceived problems and needs and problems and needs anticipated for the future. Perceived current problems and needs concern dental care provision and knowledge on oral health of professionals and patients. For anticipated future problems and needs the importance of daily oral care by caregivers was prioritised, while emphasis was placed on fear of losing autonomy. Conclusion: It is important to take the perspectives and expectations of elderly into account in policy and planning of future oral health care practice, because these differ from the perspectives of dental professionals

Insufficient evidence for routine use of thromboprophylaxis in ambulatory patients with an isolated lower leg injury requiring immobilization: Results of a meta-analysis

Background: : There are no generally accepted guidelines for the prevention of venous thromboembolism (VTE) in ambulatory patients requiring immobilization after an isolated lower leg injury. Our objective was to evaluate the effectiveness and safety of pharmacological interventions for preventing VTE in these patients. Study Design: : Meta-analysis of randomized controlled trials. Materials and Methods: : We searched PubMed/Medline, EMBASE and the Cochrane Central Register of Controlled Trials for trials with random allocation of thromboprophylaxis, notably low molecular weight heparin (LMWH) versus no prophylaxis or placebo, in ambulatory patients with below-knee or lower leg (including the knee joint) immobilization. Outcome was analyzed using MIX to calculate the pooled risk ratio/relative risk (RR) for each outcome, along with its 95% confidence interval (CI). Results: : The RR of asymptomatic deep vein thrombosis (DVT) was 0.66 (95% CI 0.44; 1.02) for below-knee immobilization and 0.51 (95% CI 0.37; 0.70) for lower leg immobilization. Low molecular weight heparin versus no prophylaxis or placebo was evaluated. The incidence of symptomatic DVT and PE was too low to show any statistically significant difference between thromboprophylaxis and controls in both groups. Although only one adverse bleeding event was considered to bemajor, the RR for any adverse bleeding event was 1.94 (95% CI 1.03; 3.67). Conclusion: : There is insufficient evidence to warrant routine use of thromboprophylaxis in ambulatory patients with below-knee or lower leg immobilization after an isolated lower leg injury. The incidence of symptomatic VTE is too low to show a relevant clinical benefit from thromboprophylaxis

Associations of pain intensity and pain-related disability with psychological and socio-demographic factors in patients with temporomandibular disorders:A cross-sectional study at a specialised dental clinic

The study assessed whether psychological and socio-demographic factors, including somatisation, depression, stress, anxiety, daytime sleepiness, optimism, gender and age, are associated with pain intensity and pain-related disability in patients with temporomandibular disorders (TMDs). In total, 320 TMD patients were involved in the study. The psychological status of each patient was assessed with questionnaires, including the Symptom Checklist-90 (SCL-90), Epworth Sleeping Scale (ESS), stress questionnaire and Life Orientation Test-Revised (LOT-R). TMD pain, including pain intensity and pain-related disability, was assessed with characteristic pain intensity (CPI) and disability points scales. The associations of psychological and socio-demographic factors with pain intensity and pain-related disability were assessed through logistic regression analyses. Higher pain intensity was significantly associated with more severe anxiety (P = 0·004), more severe somatisation (P < 0·001), more severe depression (P < 0·001), more severe stress (P = 0·001) and lower optimism (P = 0·025) in univariate regression analyses. However, multiple regression analysis showed that only somatisation was significantly associated with pain intensity (P < 0·001). Higher pain-related disability was significantly associated with more severe anxiety (P < 0·001), more severe somatisation (P < 0·001), more severe depression (P < 0·001), more severe stress (P < 0·001) and lower optimism (P = 0·003) in univariate regression analyses. However, multiple regression analysis showed that only depression was significantly associated with pain-related disability (P = 0·003). Among the psychological and socio-demographic factors in this study, somatisation was the best predictor of pain intensity, while depression was the best predictor of pain-related disability