The role of school-based dental programme on dental caries experience in Yogyakarta Province, Indonesia

Objectives. To assess the effectiveness of a school-based dental programme (SBDP) in controlling caries by measuring the relationship between the SBDP performance and caries experience in children aged 12 in Yogyakarta Province, Indonesia, by taking into account influencing factors. Methods. A cross-sectional survey was undertaken of 1906 children participating in SBDPs. Four SBDPs were chosen by good and poor performances in urban and rural areas. Caries was assessed using WHO criteria whereas behaviour and socio-demographic factors were collected using a questionnaire administered to the children. Results. The decayed, missed, and filled teeth (DMFT) of children in good SBDPs (2.8 +/- 2.4) was lower than that of the counterparts (3.8 +/- 3.4). From path analysis using a structural equation model (SEM), place of residence (OR = 4.0) was shown to have a strongest direct relationship to caries experience, whereas SBDP performance showed no direct relationship. At the same time, SBDP performance was significantly related to frequencies of dental visits (OR = 0.3), sugar consumption (OR = 0.8), and tooth brushing (OR = 3.2), which in turn are interrelated with place of residence, gender, and mother's education. Conclusions. The study suggests that the differences in DMFT of children in good and poor performance SBDPs were caused by relation to social factors rather than by relation to oral health service activities

Risk reclassification analysis investigating the added value of fatigue to sickness absence predictions

Prognostic models including age, self-rated health and prior sickness absence (SA) have been found to predict high (a parts per thousand yen30) SA days and high (a parts per thousand yen3) SA episodes during 1-year follow-up. More predictors of high SA are needed to improve these SA prognostic models. The purpose of this study was to investigate fatigue as new predictor in SA prognostic models by using risk reclassification methods and measures. This was a prospective cohort study with 1-year follow-up of 1,137 office workers. Fatigue was measured at baseline with the 20-item checklist individual strength and added to the existing SA prognostic models. SA days and episodes during 1-year follow-up were retrieved from an occupational health service register. The added value of fatigue was investigated with Net Reclassification Index (NRI) and integrated discrimination improvement (IDI) measures. In total, 579 (51 %) office workers had complete data for analysis. Fatigue was prospectively associated with both high SA days and episodes. The NRI revealed that adding fatigue to the SA days model correctly reclassified workers with high SA days, but incorrectly reclassified workers without high SA days. The IDI indicated no improvement in risk discrimination by the SA days model. Both NRI and IDI showed that the prognostic model predicting high SA episodes did not improve when fatigue was added as predictor variable. In the present study, fatigue increased false-positive rates which may reduce the cost-effectiveness of interventions for preventing SA

Questionnaire for usability evaluation of orthopaedic shoes: construction and reliability in patients with degenerative disorders of the foot

Objective: To develop a self-report questionnaire for patients with degenerative disorders of the foot to evaluate the usability of their orthopaedic shoes, and to assess the reproducibility and responsiveness of the instrument. Design: Development of the Questionnaire for Usability Evaluation of orthopaedic shoes was based on a literature search, structured expert interviews and a ranking procedure. A cross-sectional study was carried out to determine the reproducibility and internal consistency of the questionnaire. Setting and subjects: The study population comprised 15 patients with degenerative disorders of the foot, who had worn their orthopaedic shoes for at least 3 years and 15 patients with degenerative disorders of the foot, who had never worn orthopaedic shoes, but would receive them within 1 month. Results: Within the questionnaire 4 effectiveness items (pain, instability, callus, wounds), 1 efficiency item (putting on and taking off shoes) and 7 satisfaction items (pinch, slip, weight of shoes, cold feet, perspiration, maintenance, cosmetic appearance) were developed. All items in the questionnaire met the test-retest criteria. The smallest real difference ranged from 0.23 to 3.82 cm on a Visual Analogue Scale (10 cm). Cronbach's alpha's for the domains of pain and instability ranged from 0.70 to 0.92. Conclusion: The Questionnaire for Usability Evaluation should provide a good rationale to assess the usability of orthopaedic shoes and can be considered reliable

Reproduceerbaarheid van een Functionele Capaciteits Evaluatie bij mensen met beginnende artrose van heup en / of knie

De Isernhagen Work Systems Functionele Capaciteits Evaluatie (IWS FCE) is een performance-based test met goede psychometrische kenmerken bij gezonden en bij mensen met lage rugklachten. Doel: bepalen van de twee-daagse reproduceerbaarheid van de IWS FCE en analyseren van mogelijke bronnen van variantie bij mensen met artrose

Socioeconomic indicators and ethnicity as determinants of regional mortality rates in Slovakia

Regional differences in mortality might reflect socioeconomic and ethnic differences between regions. The present study examines the relationship between education, unemployment, income, Roma population and regional mortality in the Slovak Republic. Separately for males and females, data on standardised mortality in the Slovak population aged 20-64 years in the year 2002 were calculated for each of the 79 districts. Similarly the proportions of respondents with tertiary education, unemployed status, Roma ethnicity and income data were calculated per district. A linear regression model was used to analyse the data. Socioeconomic differences in regional mortality were found among males, but not among females. While education and unemployment rate significantly contributed to mortality differences between regions, income and the proportion of Roma population did not. The model explained 32.9% of the variance in standardised mortality rate among districts for males and 7.6% for females. Low education and high unemployment rate seems to be an indicator of regions with high mortality of male and therefore should be targeted by policy measures aimed at decreasing mortality in productive age

Inter-physician agreement on the readiness of sick-listed employees to return to work

Purpose: To determine the agreement between occupational physician (OP) ratings of an employee's readiness to return to work (RRTW). Method: Anonymized written vignettes of 132 employees, sick-listed for at least 3 weeks, were reviewed by 5 OPs. The OPs intuitively rated RRTW as the ability (knowledge and skills) and willingness (motivation and confidence) of sick-listed employees to resume work. Inter-OP percentages of agreement were calculated and Cohen's kappas (kappa) were determined to correct for agreement by chance. Results: The percentage of agreement between OPs was 57% (range 39-89%) on the ability and 63% (range 48-87%) on the willingness of sick-listed employees to resume work. The mean. was 0.14 (range from -0.21 to 0.79) for ability and 0.25 (range from -0.11 to 0.74) for willingness. The OP-rating of RRTW of employees sick-listed with mental disorders did not differ from the OP-rating of RRTW of employees with musculoskeletal disorders. Conclusion: The inter-OP agreement on intuitively rated RRTW showed a wide variability, which accentuates the need for instruments to establish an employee's RRTW and for training in giving well founded return to work recommendations

The performance of the K10, K6 and GHQ-12 to screen for present state DSM-IV disorders among disability claimants

BACKGROUND: Screening for mental disorders among disability claimants is important, since mental disorders seem to be seriously under-recognized in this population. However, performance of potentially suitable scales is unknown. We aimed to evaluate the psychometric properties of three scales, the 10- and 6-item Kessler Psychological Distress Scale (K10, K6) and the 12-item General Health Questionnaire (GHQ-12), to predict present state mental disorders, classified according to the Diagnostic and Statistical Manual of Mental Disorders, 4(th)Edition (DSM-IV) among disability claimants. METHODS: All scales were completed by a representative sample of persons claiming disability benefit after two years sickness absence (n=293). All diagnoses, both somatic and mental, were included. The gold standard was the Composite International Diagnostic Interview (CIDI 3.0) to diagnose present state DSM-IV disorder. Cronbach’s α, sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and the areas under the Receiver Operating Characteristic curve (AUC) were calculated. RESULTS: Cronbach’s alpha’s were 0.919 (K10), 0.882 (K6) and 0.906 (GHQ-12). The optimal cut-off scores were 24 (K10), 14 ( K6) and 20 (GHQ-12). The PPV and the NPV for the optimal cut point of the K10 was 0.53 and 0.89, for the K6 0.51 and 0.87, and for the GHQ-12 0.50 and 0.82. The AUC’s for 30-day cases were 0.806 (K10; 95% CI 0.749-0.862), 0.796 (K6; 95% CI 0.737-0.854) and 0.695 (GHQ-12; 95% CI 0.626-0.765). CONCLUSIONS: The K10 and K6 are reliable and valid scales to screen for present state DSM-IV mental disorder. The optimal cut-off scores are 24 (K10) and 14 (K6). The GHQ-12 (optimal cut-off score: 20) is outperformed by the K10 and K6, which are to be preferred above the GHQ-12. The scores on separate items of the K10 and K6 can be used in disability assessment settings as an agenda for an in-depth follow-up clinical interview to ascertain the presence of present state mental disorder

Staying at work with chronic nonspecific musculoskeletal pain:a qualitative study of workers' experiences

BACKGROUND: Many people with chronic nonspecific musculoskeletal pain (CMP) have decreased work ability. The majority, however, stays at work despite their pain. Knowledge about workers who stay at work despite chronic pain is limited, narrowing our views on work participation. The aim of this study was to explore why people with CMP stay at work despite pain (motivators) and how they manage to maintain working (success factors). METHODS: A semi-structured interview was conducted among 21 subjects who stay at work despite CMP. Participants were included through purposeful sampling. Interviews were audio-recorded, transcribed verbatim, and imported into computer software Atlas.ti. Data was analyzed by means of thematic analysis. The interviews consisted of open questions such as: "Why are you working with pain?" or "How do you manage working while having pain?" RESULTS: A total of 16 motivators and 52 success factors emerged in the interviews. Motivators were categorized into four themes: work as value, work as therapy, work as income generator, and work as responsibility. Success factors were categorized into five themes: personal characteristics, adjustment latitude, coping with pain, use of healthcare services, and pain beliefs. CONCLUSIONS: Personal characteristics, well-developed self-management skills, and motivation to work may be considered to be important success factors and prerequisites for staying at work, resulting in behaviors promoting staying at work such as: raising adjustment latitude, changing pain-coping strategies, organizing modifications and conditions at work, finding access to healthcare services, and asking for support. Motivators and success factors for staying at work may be used for interventions in rehabilitation and occupational medicine, to prevent absenteeism, or to promote a sustainable return to work. This qualitative study has evoked new hypotheses about staying at work; quantitative studies on staying at work are needed to obtain further evidence

Subjects with hip osteoarthritis show distinctive patterns of trunk movements during gait-a body-fixed-sensor based analysis

<p>Abstract</p> <p>Background</p> <p>Compensatory trunk movements during gait, such as a Duchenne limp, are observed frequently in subjects with osteoarthritis of the hip, yet angular trunk movements are seldom included in clinical gait assessments. Hence, the objective of this study was to quantify compensatory trunk movements during gait in subjects with hip osteoarthritis, outside a gait laboratory, using a body-fixed-sensor based gait analysis. Frontal plane angular movements of the pelvis and thorax and spatiotemporal parameters of persons who showed a Duchenne limp during gait were compared to healthy subjects and persons without a Duchenne limp.</p> <p>Methods</p> <p>A Body-fixed-sensor based gait analysis approach was used. Two body-fixed sensors were positioned at the dorsal side of the pelvis and on the upper thorax. Peak-to-peak frontal plane range of motion (ROM) and spatiotemporal parameters (walking speed, step length and cadence) of persons with a Duchenne limp during gait were compared to healthy subjects and persons without a Duchenne limp. Participants were instructed to walk at a self-selected low, preferred and high speed along a hospital corridor. Generalized estimating equations (GEE) analyses were used to assess group differences between persons with a Duchenne limp, without a Duchenne limp and healthy subjects.</p> <p>Results</p> <p>Persons with a Duchenne limp showed a significantly larger thoracic ROM during walking compared to healthy subjects and to persons without a Duchenne limp. In both groups of persons with hip osteoarthritis, pelvic ROM was lower than in healthy subjects. This difference however only reached significance in persons without a Duchenne limp. The ratio of thoracic ROM relative to pelvic ROM revealed distinct differences in trunk movement patterns. Persons with hip osteoarthritis walked at a significantly lower speed compared to healthy subjects. No differences in step length and cadence were found between patients and healthy subjects, after correction for differences in walking speed.</p> <p>Conclusions</p> <p>Distinctive patterns of frontal plane angular trunk movements during gait could be objectively quantified in healthy subjects and in persons with hip osteoarthritis using a body-fixed-sensor based gait analysis approach. Therefore, frontal plane angular trunk movements should be included in clinical gait assessments of persons with hip osteoarthritis.</p