bluuebunny/crossref_metadata_2025 huggingface dataset:
Illegal Evictions? Overwriting Possession and Orality with Law's Violence inCambodia
Authors: Springer Simon
Published: September 2012

The unfolding of a juridico‐cadastral system in present‐dayCambodia is at odds with local understandings of landholding, which are entrenched in notions of community consensus and existing occupation. The discrepancy between such orally recognized antecedents and the written word of law have been at the heart of the recent wave of dispossessions that has swept across the country.Contrathe standard critique that corruption has set the tone, this paper argues that evictions inCambodia are often literally underwritten by the articles of law. Whereas ‘possession’ is a well‐understood and accepted concept inCambodia, a cultural basis rooted in whatJamesC.Scott refers to as ‘orality’, coupled with a long history of subsistence agriculture, semi‐nomadic lifestyles, barter economies and – until recently – widespread land availability have all ensured that notions of ‘property’ are vague among the country's majority rural poor. In drawing a firm distinction between possessions and property, where the former is premised upon actual use and the latter is embedded in exploitation, this paper examines how proprietorship is inextricably bound to the violence of law.
Gender, Generation and the Experiences of Farm Dwellers Resettled in the Ciskei Bantustan, South Africa, ca 1960–1976
Authors: Evans Laura
Published: September 2012

This paper examines the experiences of farm dwellers resettled in rural townships in the Ciskei Bantustan during the decades of the 1960s and 1970s. Drawing on the oral testimonies of elderly residents of Sada and Ilinge townships, the paper shows how gendered and generational inequalities within households were crucial factors shaping individuals' experiences of resettlement from the farms. The paper engages with an older literature that regarded the abolition of labour tenancy and linked resettlement programmes as the final stage of farm tenants' proletarianization. It highlights the problems of this linear narrative, and argues that men and women experienced and understood this process in radically different ways. Male labour migration and the remnants of farm paternalism meant that while resettlement cemented the status of migrant men, for women and non‐migrant men this process was characterized by contradiction: on the one hand, escape from the spatial hegemonies of farm paternalism and, on the other, heightened economic exposure.
Comparative Cost‐Effectiveness of Interventions to Improve Medication Adherence after Myocardial Infarction
Authors: Ito Kouta , Shrank William H. , Avorn Jerry , Patrick Amanda R. , Brennan Troyen A. , Antman Elliot M. , Choudhry Niteesh K.
Published: September 2012

Objective

To evaluate the comparative cost‐effectiveness of interventions to improve adherence to evidence‐based medications among postmyocardial infarction (MI) patients.

Data Sources/Study Setting

Cost‐effectiveness analysis.

Study Design

We developed aMarkov model simulating a hypothetical cohort of 65‐year‐old post‐MIpatients who were prescribed secondary prevention medications. We evaluated mailed education, disease management, polypill use, and combinations of these interventions. The analysis was performed from a societal perspective over a lifetime horizon. The main outcome was an incremental cost‐effectiveness ratio (ICER) as measured by cost per quality‐adjusted life year (QALY) gained.

Data Collection/Extraction Methods

Model inputs were extracted from published literature.

Principal Findings

Compared with usual care, only mailed education had both improved health outcomes and reduced spending. Mailed education plus disease management, disease management, polypill use, polypill use plus mailed education, and polypill use plus disease management cost were $74,600, $69,200, $133,000, $113,000, and $142,900 perQALYgained, respectively. In an incremental analysis, only mailed education had anICERof less than $100,000 perQALYand was therefore the optimal strategy. Polypill use, particularly when combined with mailed education, could be cost effective, and potentially cost saving if its price decreased to less than $100 per month.

Conclusions

Mailed education and a polypill, once available, may be the cost‐saving strategies for improving post‐MImedication adherence.
Editors and Researchers Beware: Calculating Response Rates in Random Digit Dial Health Surveys
Authors: Martsolf Grant R. , Schofield Robert E. , Johnson David R. , Scanlon Dennis P.
Published: September 2012

Objective

To demonstrate that different approaches to handling cases of unknown eligibility in random digit dial health surveys can contribute to significant differences in response rates.

Data Source

Primary survey data of individuals with chronic disease.

Study Design

We computed response rates using various approaches, each of which make different assumptions about the disposition of cases of unknown eligibility.

Data Collection

Data were collected via telephone interviews as part of the Aligning Forces for Quality (AF4Q) consumer survey, a representative survey of adults with chronic illnesses in 17 communities and nationally.

Principal Findings

We found that various approaches to estimating eligibility rates can lead to substantially different response rates.

Conclusions

Health services researchers must consider strategies to standardize response rate reporting, enter into a dialog related to why response rate reporting is important, and begin to utilize alternate methods for demonstrating that survey data are valid and reliable.
Effects of similarity of life goals, values, and personality on relationship satisfaction and stability: Findings from a two‐wave panel study
Authors: ARRÁNZ BECKER OLIVER
Published: September 2012

Using data from the German Family Panel (pairfam; n = 3,674 heterosexual couples), this study examines the impact of partners’ individual levels and dyadic similarity concerning life goals, values, and personality traits on relationship satisfaction and union dissolution. Controlling for partners’ individual characteristics and for relationship duration, it was found that similarity on specific dimensions and stereotype‐adjusted profile correlations exerted significant yet small positive effects on both partners’ relationship satisfaction. These effects largely translated into beneficial indirect effects on union dissolution 1 year later (Wave 2, n = 2,820). Moderator analyses indicated the existence of some effect heterogeneity across relationship duration and types. Generally, partners’ respective individual characteristics appeared to predict relationship outcomes better than dyadic similarity measures.
New concepts in pharmacological efficacy at 7TM receptors: IUPHAR Review 2
Authors: Kenakin Terry
Published: September 2012

The present‐day concept of drug efficacy has changed completely from its original description as the property of agonists that causes tissue activation. The ability to visualize the multiple behaviours of seven transmembrane receptors has shown that drugs can have many efficacies and also that the transduction of drug stimulus to various cellular stimulus–response cascades can be biased towards some but not all pathways. This latter effect leads to agonist ‘functional selectivity’, which can be favourable for the improvement of agonist therapeutics. However, in addition, biased agonist potency becomes cell type dependent with the loss of the monotonic behaviour of stimulus–response mechanisms, leading to potential problems in agonist quantification. This has an extremely important effect on the discovery process for new agonists since it now cannot be assumed that a given screening or lead optimization assay will correctly predict therapeutic behaviour. This review discusses these ideas and how new approaches to quantifying agonist effect may be used to circumvent the cell type dependence of agonism. This article, written by a corresponding member of the International Union of Basic and Clinical Pharmacology Committee on Receptor Nomenclature and Drug Classification (NC‐IUPHAR), reviews our current understanding of the interaction of ligands with seven transmembrane receptors. Further information on these pharmacological concepts is being incorporated into the IUPHAR/BPS database GuideToPharmacology.org.

Linked Articles

This article is the second in a series of reviews on pharmacological themes commissioned by NC‐IUPHAR and accompanies the long‐standing series of articles on pharmacological nomenclature published in Pharmacological Reviews. For a listing of all publications of NC‐IUPHAR see http://www.iuphar‐db.org/nciupharPublications.jsp. Pharmacological Reviews articles on the principles and terminology of functional selectivity for GPCRs and on the principles of allosterism are being prepared for publication in early 2013.
Aerobic exercise reduces oxidative stress and improves vascular changes of small mesenteric and coronary arteries in hypertension
Authors: Roque Fernanda R , Briones Ana M , García‐Redondo Ana B , Galán María , Martínez‐Revelles Sonia , Avendaño Maria S , Cachofeiro Victoria , Fernandes Tiago , Vassallo Dalton V , Oliveira Edilamar M , Salaices Mercedes
Published: September 2012

Background and Purpose

Regular physical activity is an effective non‐pharmacological therapy for prevention and control of hypertension. We investigated the effects of aerobic exercise training in vascular remodelling and in the mechanical and functional alterations of coronary and small mesenteric arteries from spontaneously hypertensive rats (SHR).

Experimental Approach

Normotensive Wistar Kyoto (WKY), SHR and SHR trained on a treadmill for 12 weeks were used to evaluate vascular structural, mechanical and functional properties.

Key Results

Exercise did not affect lumen diameter, wall thickness and wall/lumen ratio but reduced vascular stiffness of coronary and mesenteric arteries from SHR. Exercise also reduced collagen deposition and normalized altered internal elastic lamina organization and expression of MMP‐9 in mesenteric arteries from SHR. Exercise did not affect contractile responses of coronary arteries but improved the endothelium‐dependent relaxation in SHR. In mesenteric arteries, training normalized the increased contractile responses induced by U46619 and by high concentrations of acetylcholine. In vessels from SHR, exercise normalized the effects of the NADPH oxidase inhibitor apocynin and the NOS inhibitor l‐NAME in vasodilator or vasoconstrictor responses, normalized the increased O2− production and the reduced Cu/Zn superoxide dismutase expression and increased NO production.

Conclusions and Implications

Exercise training of SHR improves endothelial function and vascular stiffness in coronary and small mesenteric arteries. This might be related to the concomitant decrease of oxidative stress and increase of NO bioavailability. Such effects demonstrate the beneficial effects of exercise on the vascular system and could contribute to a reduction in blood pressure.
The Medici judge, a bitter lawsuit, and an embezzlement: the Opera del Sacro Cingolo's bronze chapel screen at Santo Stefano, Prato
Authors: Fujikawa Mayu
Published: September 2012

The chapel screen around the Cappella del Sacro Cingolo in Santo Stefano, Prato, was an important artistic project, since such a monumental bronze work necessitated a great quantity of costly material, not to mention the extensive amount of labour required for its casting. Maso di Bartolomero and other artists who worked on the screen are quite rightly credited for their artistic achievements, but in this paper, the Opera del Sacro Cingolo's crucial behind‐the‐scenes contributions are shown to be of equal significance. The Opera consisted of Pratese citizens who were dedicated to the embellishment of their chapel, which preserved the relic of the Virgin's girdle. The organization engaged the Medici as a judge for the finished product, was assiduously occupied in a court battle, procured bronze, which was not very easy during the Renaissance, and assisted the artists with their financial problems, among many other duties. This close management of the project, which involved a number of local citizens, was intended to express their communal identity and pride in possessing the girdle. For the Medici, assisting the corporate body's artistic project was an effective means to increase their influence in the town, which Florence had conquered in 1351.
Familial Granular Cell Tumors: A Case Report and Review of the Literature
Authors: Sanford Lori J. , Gordon Shayna , Travers Jeffrey B.
Published: September 2012

Abstract:  Granular cell tumors are uncommon neoplasms postulated to derive from Schwann cells. They are histologically unique and exhibit S‐100 positivity. Pediatric occurrences are uncommon, and familial cases are rare. A limited number of familial granular cell tumors have been reported. We describe two siblings with granular cell tumors and review the relevant literature.
Empiric Antibiotics and Outcomes of Children Hospitalized with Eczema Herpeticum
Authors: Aronson Paul L. , Yan Albert C. , Mohamad Zeinab , Mittal Manoj K. , Shah Samir S.
Published: September 2012

Abstract:  Although patients with eczema herpeticum often receive antibiotics for presumed bacterial coinfection, the effect of empiric antibiotic therapy is unknown. Our objective therefore was to determine the association between empiric antibiotics and outcomes in children hospitalized with eczema herpeticum. We conducted a multicenter retrospective cohort study of 1,150 children ages 2 months to 17 years admitted with eczema herpeticum between January 1, 2001, and March 31, 2010, to 42 tertiary care children’s hospitals in the Pediatric Health Information System. All patients received antibiotics during the hospitalization. Multivariable linear regression models determined the association between empiric antibiotic therapy and the main outcome measure: hospital length of stay (LOS). There were no deaths during the study period. Receipt of empiric antibiotics was not associated with a change in the LOS on unadjusted or multivariable analysis. The class of empiric antibiotic was not associated with the LOS except for receipt of vancomycin, which was associated with a longer LOS (21% adjusted longer LOS, 95% confidence interval (CI) = 8–35%; p = 0.001). When restricted to patients with a bloodstream infection, receipt of empiric antibiotics was associated with a 51% adjusted shorter LOS (95% CI = −24 to −68%; p = 0.002). In children hospitalized with eczema herpeticum, empiric antibiotic therapy was not associated with a shorter LOS overall, but was associated with a shorter LOS in patients with a bloodstream infection. These findings highlight the importance of early recognition of systemic bacterial illness in children with eczema herpeticum. Empiric antibiotics did not affect mortality, which is low.
Effect of Olive and Sunflower Seed Oil on the Adult Skin Barrier: Implications for Neonatal Skin Care
Authors: Danby Simon G. , AlEnezi Tareq , Sultan Amani , Lavender Tina , Chittock John , Brown Kirsty , Cork Michael J.
Published: September 2012

Natural oils are advocated and used throughout the world as part of neonatal skin care, but there is an absence of evidence to support this practice. The goal of the current study was to ascertain the effect of olive oil and sunflower seed oil on the biophysical properties of the skin. Nineteen adult volunteers with and without a history of atopic dermatitis were recruited into two randomized forearm‐controlled mechanistic studies. The first cohort applied six drops of olive oil to one forearm twice daily for 5 weeks. The second cohort applied six drops of olive oil to one forearm and six drops of sunflower seed oil to the other twice daily for 4 weeks. The effect of the treatments was evaluated by determining stratum corneum integrity and cohesion, intercorneocyte cohesion, moisturization, skin‐surface pH, and erythema. Topical application of olive oil for 4 weeks caused a significant reduction in stratum corneum integrity and induced mild erythema in volunteers with and without a history of atopic dermatitis. Sunflower seed oil preserved stratum corneum integrity, did not cause erythema, and improved hydration in the same volunteers. In contrast to sunflower seed oil, topical treatment with olive oil significantly damages the skin barrier, and therefore has the potential to promote the development of, and exacerbate existing, atopic dermatitis. The use of olive oil for the treatment of dry skin and infant massage should therefore be discouraged. These findings challenge the unfounded belief that all natural oils are beneficial for the skin and highlight the need for further research.
Meta‐Analysis of Randomized, Controlled Trials Comparing Particular Doses of Griseofulvin and Terbinafine for the Treatment of Tinea Capitis
Authors: Gupta Aditya K. , Drummond‐Main Chris
Published: September 2012

Abstract:  Two oral antifungal agents, griseofulvin and terbinafine, have regulatory approval in the United States, but it is unknown whether one has superior overall efficacy. Genus‐specific differences in efficacy are believed to exist for the two agents. It is not clear at what doses and durations of treatment these differences apply. The goals of this meta‐analysis were to determine whether a statistically significant difference in efficacy exists between these agents at a given dose and duration of each in tinea capitis infections overall and to determine whether a genus‐specific difference in efficacy exists for these two treatments at a given dose and duration of each. We performed a literature search for clinically and methodologically similar randomized controlled trials comparing 8 weeks of griseofulvin (6.25–12.5 mg/kg/day) to 4 weeks of terbinafine (3.125–6.25 mg/kg/day) in the treatment of tinea capitis. A meta‐analysis was performed using the Mantel–Haenszel method and random effects model; results were expressed as odds ratios with 95% confidence intervals. Meta‐analysis of randomized controlled trials did not show a significant difference in the overall efficacy of the two drugs at the doses specified, but specific efficacy differences were observed based on the infectious species. For tinea capitis caused by Microsporum spp., griseofulvin is superior (p = 0.04), whereas terbinafine is superior for Trichophyton spp. infection (p = 0.04). Our results support species‐specific differences in treatment efficacy between griseofulvin and terbinafine and provide a clinical context in which this knowledge may be applied.
Dermoscopy for the Pediatric Dermatologist, Part II: Dermoscopy of Genetic Syndromes with Cutaneous Manifestations and Pediatric Vascular Lesions
Authors: Haliasos Elena C. , Kerner Miryam , Jaimes Natalia , Zalaudek Iris , Malvehy Josep , Lanschuetzer Christoph M. , Hinter Helmut , Hofmann‐Wellenhof Rainer , Braun Ralph P. , Marghoob Ashfaq A.
Published: September 2012

Genetic syndromes including basal cell nevus syndrome (BSNS), xeroderma pigmentosum (XP), and epidermodysplasia verruciformis (EV) predispose the individual to skin cancer. Basal cell carcinomas (BCCs) often develop in patients with BCNS and XP. One of the aims of surveillance examination in these patients is to detect BCC while the tumors are still small and easy to manage. Dermoscopy, by allowing the visualization of arborizing vessels, ovoid nests, nonaggregated blue‐gray globules, and spoke‐wheel and leaf‐like structures, can facilitate in the early detection of BCC. Patients with XP are also at risk for developing squamous cell carcinoma (SCC). Dermoscopy can assist in the early detection of these cancers by allowing the observer to visualize focal glomerular vessels, which is a common feature seen in SCC. This feature can also assist in detecting SCC developing in other syndromes such as EV and epidermolysis bullosa (EB). In addition to helping in the detection of BCC and SCC, dermoscopy can also help detect melanoma in individuals with XP and evaluate nevi developing in those with EB. This review will discuss how dermoscopy can be used in the management of patients with BSNS, XP, EV, and EB and will discuss the dermoscopic findings of vascular lesions, including pyogenic granuloma, hemangioma, port‐wine stain, and lymphangioma circumscriptum.
Propranolol Use in PHACE Syndrome with Cervical and Intracranial Arterial Anomalies: Collective Experience in 32 Infants
Authors: Metry Denise , Frieden Ilona J. , Hess Christopher , Siegel Dawn , Maheshwari Mohit , Baselga Eulalia , Chamlin Sarah , Garzon Maria , Mancini Anthony J. , Powell Julie , Drolet Beth A.
Published: September 2012

The objective of this retrospective study of patients evaluated between July 2008 and October 2011 in seven pediatric dermatology centers was to combine collective clinical experience using oral propranolol therapy in 32 infants with PHACE syndrome (Posterior fossa [brain malformations present at birth], Hemangioma [usually covering a large area of the skin of the head or neck >5 cm]; Arterial lesions [abnormalities of the blood vessels in the neck or head]; Cardiac abnormalities or aortic coarctation [abnormalities of the heart or blood vessels that are attached to the heart]; Eye abnormalities) with cervical or intracranial arterial anomalies. Patients were given an average daily dose of oral propranolol of 1.8 mg/kg divided two or three times per day for an average duration of 12.3 months. The main outcome measure was adverse neurologic events. Seven (22%) patients were categorized as being at higher risk for stroke, defined on magnetic resonance imaging as severe, long‐segment narrowing or nonvisualization of major cerebral or cervical vessels without anatomic evidence of collateral circulation, often in the presence of concomitant cardiovascular comorbidities. Only one patient developed a change in neurologic status during propranolol treatment: mild right hemiparesis that remained static and improved while propranolol was continued. An additional three patients had worsening hemangioma ulceration or tissue necrosis during therapy. This is the largest report thus far of patients with PHACE syndrome treated with propranolol. Although no catastrophic neurologic events occurred, serious complications, particularly severe ulcerations, were seen in a minority of patients, and given the sample size, we cannot exclude the possibility that propranolol could augment the risk of stroke in this population. We propose radiologic criteria that may prove useful in defining PHACE patients as being at high or standard risk for stroke. We continue to advise caution in using systemic beta‐blockers, particularly for children with vascular anomalies at higher risk for stroke. Use of the lowest possible dosage, slow dosage titration, three times per day dosing to minimize abrupt changes in blood pressure, and close follow‐up, including neurologic consultation as needed, are recommended.
Reducing Requirement Incorrectness and Coping with Its Negative Impact in Information System Development Projects
Authors: Hsu Jack Shih‐Chieh , Lin Tung‐Chin , Cheng Kuang‐Ting , Linden Lars P.
Published: September 2012

The negative impact of incorrect requirements on information system development (ISD) project performance has long been acknowledged. This study addresses the problem of incorrect requirements by proposing a model that combines the error reduction and coping concepts proposed by Field, Ritzman, Safizadeh, and Downing (2006) with the view that ISD is a knowledge‐intensive process. The model hypothesizes that when developers and users possess an understanding of each other's primary domain of knowledge, the prevention of incorrect requirements and the mitigation of the negative consequences of incorrect requirements tend to improve project performance. Data collected from 250 ISD professionals on the basis of their experiences of recently completed ISD projects confirmed all of our hypotheses. The results demonstrate that the eliciting of incorrect requirements can be reduced when users and developers possess cross‐domain understanding and when requirement analysis methodologies and techniques are available. Furthermore, the negative impact of incorrect requirements on project performance can be mitigated when developers have sufficient ISD knowledge and behavioral knowledge.
When to Mass Customize: The Impact of Environmental Uncertainty*
Authors: Liu Gensheng (Jason) , Shah Rachna , Babakus Emin
Published: September 2012

Previous research on mass customization (MC) has focused on what it is and how it is implemented. In this study we examine when MC is an appropriate strategy for firms to follow by scrutinizing the effects of three environmental uncertainty variables (demand uncertainty, competitive intensity, and supply chain complexity) on the MC–performance relationship. Specifically, we distinguish the direct effect of environmental uncertainty on MC ability and the moderation effect of environmental uncertainty on MC ability's impact on customer satisfaction. We examine six competing hypotheses using data collected from 266 manufacturing plants. Our results show that competitive intensity has a direct positive impact on MC ability. However, demand uncertainty moderates the relationship between MC ability and customer satisfaction, and the direct and positive relationship between MC ability and customer satisfaction holds only when customer demand is highly uncertain. Supply chain complexity neither has a direct relationship with MC, nor moderates the MC–performance relationship. Implications of these research findings are discussed and future research directions are identified.
Expensive Mistakes: Operational Risk in Life Insurance
Authors: Ferris Shauna
Published: September 2012

Abstract

Although insurers have developed sophisticated techniques for measuring and managing mortality risks, asset–liability mismatch, and interest rate risks, they may underestimate the potential cost of operational risks. This is a case study of an Australian life insurer, which made a series of very expensive mistakes.
The Sexual Dimorphism of the Sacro‐Iliac Joint: An Investigation Using Geometric Morphometric Techniques
Authors: Anastasiou Evilena , Chamberlain Andrew T.
Published: September 2012

The ability to correctly estimate the sex of skeletal remains is vital in forensic sciences. This article investigates the sexual dimorphism of the human sacro‐iliac joint, using geometric morphometric techniques that assess morphological characters better than the traditional approaches for recording outline shapes, which are subject to quantification and inter‐observer problems. Eight two‐dimensional landmarks were recorded from digital images of 29 female and 35 male auricular surfaces of the ilium and sacrum. The specimens were analyzed using geometric morphometric methods (Generalized Procrustes analysis, relative warp analysis, Goodall's F) and multivariate statistics (ANOVA, MANCOVA, principal component analysis, discriminant function analysis [DFA]). Both the size and shape of the analyzed structures were found to be sexually dimorphic. The DFA illustrated that when the form of both the iliac and sacral articular surface is taken as a predictor variable, 94.5% of the individuals are assigned to the correct sex. The successful sex determination obtained by the DFA makes the further study of the sacro‐iliac joint's sexual dimorphism promising.
Lamstatin – a novel inhibitor of lymphangiogenesis derived from collagen IV
Authors: Weckmann Markus , Moir Lyn Margaret , Heckman Caroline Akemi , Black Judith Lee , Oliver Brian Gregory , Burgess Janette Kay
Published: September 2012

The lymphatic system is essential for the maintenance of tissue homeostasis and immunity. Its dysfunction in disease (such as lymphangioleiomyomatosis) can lead to chylous effusions, oedema or dissemination of malignant cells. Collagen IV has six α chains, of which some of the non‐collagenous‐1 domains have endogenous anti‐angiogenic properties, however, little is known about specific endogenous anti‐lymphangiogenic characteristics. In this study we sought to investigate the expression levels of collagen IV non‐collagenous‐1 domains in lung tissue of patients with and without lymphangioleiomyomatosis to explore the hypothesis that a member of the collagen IV family, specifically the non‐collagenous domain‐1 of α5, which we named lamstatin, has anti‐lymphangiogenic properties. Levels of lamstatin detected by immunohistochemistry were decreased in lungs of lymphangioleiomyomatosis patients. We produced recombinant lamstatin in an E.coli expression system and synthesized a 17‐amino acid peptide from a theoretically identified, active region (CP17) and tested their effects in vitro and in vivo. Recombinant lamstatin and CP17 inhibited proliferation, migration and cord formation of human microvascular lung lymphatic endothelial cells, in vitro. Furthermore, lamstatin and CP17 decreased complexity and dysplasia of the tumour‐associated lymphatic network in a lung adenocarcinoma xenograft mouse model. In this study we identified a novel, direct inhibitor of lymphangiogenesis, derived from collagen IV. This may prove useful for exploring new avenues of treatment for lymphangioleiomyomatosis and metastasis via the lymphatic system in general.
Putting the population back into oral health; decoupling oral health improvement from clinical dental practice
Authors: Spencer A. John
Published: September 2012

Some 20 years ago, there was much speculation about improving oral health and the subsequent emergence of a vastly different type of clinical dental practice and visa versa. Few of the predictions have come to pass in Australia. Caries in children has somewhat rebounded, new treatment philosophies have not gained widespread adoption, and work effort in clinical dental practice remains dominated by diagnostic services, restorations and removable prosthodontics. What was behind the wayward predictions was a failure to separate the potency of ‘care’ from ability to ‘cure’ and an overestimation of the improvement in child oral health attributable to clinical dental services. If progress is to be made in improving oral health, an understanding of the mid‐ and upstream determinants of oral health needs to guide new population oral health activities. The contribution of clinical dental services to oral health should also be enhanced, but this should not divert attention from necessary population oral health activities to improve oral health.
Targeting in a population health approach
Authors: Roberts‐Thomson Kaye
Published: September 2012

There are two well described methods to improving health: an individual risk assessment approach and a whole population approach.

Objectives

This study explores the limitations of the individual approach to public health, and the success and limitations of the population approach.

Methods

A theoretical approach with examples from general and oral health will be used.

Results

However although the population approach can reduce the mean prevalence of a condition within the population it can also increase health disparities. Some groups gain disproportionally more from a population intervention and vulnerable population groups disproportionally less leading to an unjust situation. These disparities are the result of social circumstances.

Conclusions

Additional strategies targeted to vulnerable groups are therefore necessary to complement the population approach to reduce such disparities. Examples of strategies which could be used in targeting vulnerable groups will be outlined.
Social inequality in oral health
Authors: Thomson W.M.
Published: September 2012

Social inequalities in oral health are observable regardless of the population, the culture, the method of social classification or the measure of oral health or disease. They exist because of socially determined differences in opportunity, behaviours, beliefs and exposure to the myriad factors which determine our oral health. Behaviours and practices which affect oral health are embedded in the normal patterns of everyday life; those (in turn) are socially determined and differ across the continuum of social status. This presentation focuses primarily on social inequalities in incremental tooth loss because (i) it is a condition which has been shown to have the greatest effect on people's oral‐health‐related quality of life, and (ii) it is cumulative and irreversible. Most of the knowledge base on social inequalities in tooth loss comes from cross‐sectional studies; investigating the phenomenon in a birth cohort can be more informative because it allows us to determine what happens to those inequalities through the life course. Data on incremental tooth loss from a longstanding cohort study (the Dunedin Multidisciplinary Health and Development Study) are presented to illustrate the cumulative and pervasive effect of social inequalities and changes in social status between childhood and adulthood.
How will a life course framework be used to tackle wider social determinants of health?
Authors: Nicolau Belinda , Marcenes Wagner
Published: September 2012

The life course framework, proposed by Kuh and Schlomo in 1997, offers policy makers the means to understand the interaction between nature and nurture. This conceptual model illustrates how an individual's biological resources are influenced by their genetic endowment, their prenatal and postnatal development and their social and physical environment, both in early life and throughout the life course. Health is conceptualized as a dynamic process connecting biological and social elements that are affected by previous experiences and by present circumstances. Therefore, exposure at different stages of people's lives can either enhance or deplete the individual's health resources. Indeed, life course processes are of many kinds, including parent–child relationships, levels of social deprivation, the acquisition of emotional and behavioural assets in adolescence and the long‐term effects of occupational hazards and work stress. The long‐term effects of nature and nurture combine to influence disease outcomes. It is only in the last decade that theories, methods and new data have begun to be amalgamated, allowing us to further our understanding of health over the life course in ways that may eventually lead to more effective health policies and better health care. This article discusses life course concepts and how this framework can enlighten our understanding of wider social determinants of health, and provides a few examples of potential interventions to tackle their impact on health.
Interdisciplinary health promotion: a call for theory‐based interventions drawing on the skills of multiple disciplines
Authors: Newton Jonathon Timothy
Published: September 2012

Promoting the health of populations demands the adoption of a perspective exploring the societal, political, community, family and individual determinants of health. I will argue that to develop interventions to modify health‐related behaviours and health risks requires collaboration with a range of disciplines, in order to draw upon their theoretical, empirical and oftentimes political knowledge. To illustrate this thesis, I will draw upon research in three areas: improving oral health–related behaviours in individuals with periodontal disease and childhood caries; encouraging early recognition in head and neck cancer; and managing dental anxiety. Reviews of oral health education in the early 1990s suggested that approaches based on education were largely ineffective in the absence of the provision of fluoride supplementation. More recently, high‐quality research has identified simple, theory‐based interventions that can improve adherence to specific oral hygiene–related behaviours. Similarly, a range of studies have demonstrated the effectiveness of motivational interviewing for targeting caries‐related behaviours in targeted groups. Dental anxiety remains a significant barrier to the uptake of dental services, and again, by working in multi‐disciplinary teams, a proportionate and comprehensive range of interventions can be adopted to alleviate the burden of dental fear. Finally, head and neck cancer has potentially serious effects for sufferers, but often presents late for a variety of reasons. Through developing a theoretical model of help‐seeking behaviour, psychologists have been able to identify targets for interventions and work together with the healthcare team to develop these.
Water fluoridation in Victoria, Australia: The Value of National Research
Authors: Neil Andrew
Published: September 2012

Water fluoridation has become the centrepiece in dental caries prevention for the Australian population since its introduction in 1953 in Beaconsfield, Tasmania. With the notable exception until recently of Brisbane, residents of the state and territory capital cities have enjoyed the dental health benefits of this important public health initiative for at least 33 years. For many communities in rural and regional Australia, however, the introduction of water fluoridation has only commenced in relative recent years – if at all. These efforts in recent years have been greatly assisted by the research of Professor John Spencer and his colleagues at the Australian Research Centre for Population Oral Health (ARCPOH). This paper highlights some major pieces of research conducted by ARCPOH and demonstrates the application of that research to the extension of water fluoridation in Victoria.
Building the links between surveillance, research, and policy and practice – dental public health experiences in Australia
Authors: Rogers John
Published: September 2012

Objectives

To identify how to translate dental public health surveillance and broader research into policy and practice.

Methods

Via a literature review to identify both the potential uses of surveillance data and key elements in the policy making process. Then through a consideration of Australian dental public health examples to identify ways to build links between this research and policy making.

Results

The development of dental public health policy can be complex. Different notions of evidence are held by researchers and policy makers. A cultural gap divides these two groups. Translation of research into policy is more likely if an issue is moved up the policy agenda through judicial articluation of the problem with an associated policy proposal and where polictical factors are positive. If these elements exist, a policy outccome is more possible when a ‘policy window’ opens. Five ways to build the links between surveillance, research and policy and practice are to communicate across the cultural gap; be prepared for chance opportunities to transfer knowledge; undertake policy relevant research; don't abuse research evidence by making exaggerated claims; and provide timely dissemination of surveillance and research findings. Structural barriers to academics having greater engagement with policy agencies also need to be addressed.

Conclusion

Translating surveillance and broader research evidence into policy requires active management rather than expecting passive diffusion. Researchers need to understand and act on the external factors that are likely to affect the uptake of their research if they want their research to influence policy and practice.
How population‐level data linkage might impact on dental research
Authors: Slack‐Smith Linda
Published: September 2012

There is the potential for substantial gains in dental epidemiology with increasing use of population‐level data and data linkage. The advantage of population record linkage, from an epidemiological perspective, is that it is not biased and no‐one is excluded. This has important implications for human rights because generally the people who are excluded from studies or do not participate are the most marginalized. There are a number of places in the world that have high‐quality population record linkage in the area of health including Oxford, Aberdeen, Rochester, Manitoba and Scandinavia. In Western Australia, there is a unique set of databases on the entire population, which includes detailed information on all births, deaths and hospital admissions since 1980, these are linkable with many other data sets. We can now link birth and hospital admissions with population databases for characteristics such as intellectual disability and birth defects. It is even possible to link Commonwealth data with State data. It is now possible to link birth defects data and midwives data with data from the Commonwealth Pharmaceutical Benefits Scheme as a form of pharmacovigilance, to detect potential associations between medicine use in pregnancy and birth defects such as cleft lip and palate. Data linkage is increasingly available in Australia, with other states setting up systems similar to Western Australia and may offer greater insight into oral health.
Economic evaluation of preventive dental programs: what can they tell us?
Authors: Morgan Mike , Mariño Rodrigo , Wright Clive , Bailey Denise , Hopcraft Matthew
Published: September 2012

The role of public health program planners is to determine the effectiveness of public health programs, what recommendations should be made, what future initiatives should be taken, and what policies should be developed. At a basic level, to choose between competing alternatives, two characteristics of an intervention must be considered; these are its outcome and its cost. Based on cost and outcome, planners must select the option that offers the most advantages. Economic evaluation is commonly adopted by decision makers in the health sector to investigate the effectiveness of public health programs and to help plan future initiatives. Economic evaluation assists decision makers who must weigh the information it provides in the context of many and often competing options. In this way, an economic evaluation is an aid to decision making rather than the decision itself. Economic evaluation is becoming essential for informed decision making, with potential implications for public health policy and practice and for clinical practice too. While economic evaluations are commonly used in decision‐making processes about health programs, few examples exist in the oral health literature. In the case of preventive oral health programs, economic analysis is often difficult, largely because it makes demands on epidemiological and demographic data that are hard to meet. This study will address the concepts and tools required to conduct economic evaluations of prevention programs. The emphasis will be on oral health and preventive dental programs, although the concepts presented could be useful for other public health programs by practitioners and managers with the aim of producing effective and efficient oral health programs.
Shaping the next generation of ‘population oral healthers’
Authors: Treasure Elizabeth T.
Published: September 2012

Objective

The aim of this paper is to discuss the training and development needs of those people who will form the next generation working in the field of population oral health.

Method

The paper represents the personal views of the author based upon an analysis of current training programmes in a number of countries and variation in the international working conditions.

Discussion

The next generation of population oral healthers will need to be versatile in their approach to the oral health problems they encounter. The simple problems may well have been solved or have stopped improving. The future generation will work in a variety of roles: commissioning and designing services, providing and evaluating services, educating or researching. The working environment will also show considerable variation and diversity from entirely private systems through mixed economies to public systems and, of course, no system at all. Current curricula vary but tends to emphasis traditional epidemiological and statistical skills as well as service delivery. There is also some evidence that training opportunities are limited to those with clinical backgrounds. Universities continue to emphasis high quality, high impact and high financial value research as they seek to maximize income and climb international league tables. National research funding bodies are seeking to address major issues such as global warming, food security and international security. Health research appears to have a number of foci: increasingly complex biomedical research, economic and effectiveness research and the complex questions around diseases of poverty and lifestyle. Access to funding will be increasingly competitive.

Conclusions

The next generation will need to access and understand an increasing range of disciplines using a wide range of transferable and political skills as they work across a diverse range of social situations and disease states. A key issue will be the requirement for them to be adaptable and flexible as they work to improve oral health.
Transcultural dental training: addressing the oral health care needs of people from culturally diverse backgrounds
Authors: Mariño Rodrigo , Morgan Mike , Hopcraft Matthew
Published: September 2012

Australia is a culturally and linguistically diverse country with a population derived from over 140 countries and including 240 language groups. Reflecting this, there has been a significant increase in cultural diversity among undergraduate dental students. It has been recognized that in order for dental students to interact and respond effectively to the diverse cultural needs of their patients, students themselves must be aware of cultural differences and respect patients’ worldviews. In response to this challenge, dental students will need to have the theoretical knowledge to understand culturally‐influenced health behaviours as well as the ability to communicate effectively with culturally diverse patients. Currently, the culture of dental students contrasts with the patients they treat, which may in turn affect the interaction between dental students and their patients. Given this context, new graduates need both to effectively communicate with patients from diverse communities and have an understanding of culturally influenced health behaviours. It has been proposed that dental graduates need to improve their knowledge of a variety of cultural values, beliefs, practices and attitudes. The literature in the area of cultural awareness and education for oral health professionals concentrates on both exploring health professionals’ knowledge and attitudes toward transcultural care or the need for transcultural training. This paper provides an overview of the transcultural issues in oral health care which might confront dental students when treating culturally diverse patients. It will also discuss possible modifications to the dental curriculum to ensure that the future oral health workforce understands the complex health care needs of a multicultural society. This information will give planners and stakeholders an insight into the nature of the cultural issues which future dentists are likely to encounter while treating patients from diverse cultural backgrounds. This would help to establish the need to incorporate transcultural awareness modules to enhance quality of care and to respond effectively and sensitively to cultural issues.