bluuebunny/crossref_metadata_2025 huggingface dataset:
The influence of population oral health on the dental team
Authors: Robinson Peter G. , Dyer Thomas A. , Teusner Dana
Published: September 2012

This presentation focuses on the use of dental therapists as substitutes for dentists in the provision of some aspects of dental care. Our premise is that the use of therapists is a ‘good thing’ if it delivers a higher quality service. The care that may be provided by therapists is appropriate to population needs. They have been used to increase access to care in a number of countries by supplementing the volume and reach of services, which enhances equity. Therapists are socially acceptable where they are integrated into existing dental systems, but concerted work may be necessary to increase their acceptability if their use is to be introduced or expanded elsewhere. There is no reason to suspect that therapists offer less effective care than dentists, and available data are compatible with this view. More data may be required to lend political support for their greater use. The efficiency of teams is sensitive to the way in which they are organized and funded. Substitution of dentists by therapists within small dental teams creates complexities and costs that reduce efficiency. Conversely, where therapists can work with relative independence, diagnosing and treating patients without direct supervision, then efficiency may be high. Despite opportunities for improving the quality of care, the main barrier for increasing their use is the dental profession. Dental organizations tend to act as guilds, preventing or restricting the deployment of therapists. Dental public health practitioners therefore have a role as advocates for their greater use. At present, the use of therapists does not appear to be influenced by the health of the population.
The revival of water fluoridation in the state of New South Wales, Australia, in the 21st century
Authors: Sivaneswaran Shanti
Published: September 2012

The State of New South Wales (NSW) in Australia has over half a century of experience with water fluoridation. Yass was the first town to be fluoridated in 1956 and Sydney in 1968, and by the late 1970s, approximately 90% of NSW was fluoridated. However, since then, there have been no new fluoridation schemes. In NSW under the Fluoridation of Public Water Supplies Act 1957, the decision to fluoridate rests with local government authorities (councils). Since 2004, the NSW Health Department has been proactive in promoting and extending water fluoridation to unfluoridated rural communities in an attempt to reduce oral health inequalities. This has resulted in 20 councils implementing fluoridation, increasing population coverage of water fluoridation from 90% in 2004 to 96% in 2012. When the remaining 16 councils that have been gazetted to fluoridate implement fluoridation, approximately 98% of NSW residents will have access to fluoridated water. This article provides an overview of the framework used to extend water fluoridation to many rural communities in New South Wales in the 21st century.
The future for oral health surveillance
Authors: Steele Jimmy
Published: September 2012

Objectives

To take an overview of the history and future of oral health surveillance.

Methods

A brief review of the history and policy context of national surveys and equivalent large surveys of oral health and their objectives followed by an analysis of their fitness for modern purpose.

Results and Conclusion

The quality of oral health surveillance has improved immeasurably since the first attempts in the early 1960s, but national and regional surveys are still hampered by a lack of clarity about their purpose. The data they collect and describe are potentially invaluable and have the major advantages of being both robust and relatively straightforward to interpret and explain to policy makers. A greater clarity of purpose both from researchers and those who commission research would allow better use of data and a greater understanding of the limitations of surveillance. The international research community have a role to play in establishing and sharing best practice globally.
Measuring the oral health of populations
Authors: Mejia Gloria C.
Published: September 2012

Objectives

This article provides a conceptual base for population oral health measurement and argues that problems associated with particular indices are subject to the basic issues of knowing what to measure and the level of measurement required to address the object of study and provide clear information about the health of the population as a whole.

Methods

Alternative approaches to caries measurement are presented using data from South Australian children attending the school dental services during 2007.

Results

While threshold selection of case definitions depicted different profiles of the same population, the inclusion of non‐cavitated lesions did not alter the general disease profile of the population.

Conclusions

The types of measures used depend on the purpose, nature of the data, and conceptualization of the phenomenon, and should continually refer to the population level. In population oral health, controversies surrounding outcome measures, such as caries indices, are moving away from addressing core issues to narrowing mechanistic views. Fundamental deliberations should include the valuation of health states, clearly defining health and disease and distinguishing between disease, determinants and the impacts of disease.
Revolution in the provision of dental services in the UK
Authors: Tickle Martin
Published: September 2012

The National Health Service (NHS) in England provides a comprehensive dental service funded largely from taxation but supplemented by co‐payments.

Objectives

This paper provides a historical overview of NHS dental services and some personal reflections on the main challenges over the next five years.

Methods

A narrative review of the literature and some subjective observations and comments.

Results

In 2006 there was a radical change to NHS dental sservices in England; central budgets were capped and general dental practitioners. Dentists who were previously paid on a fee‐for‐item basis moved to a new contract that required them to hit activity targets to maintain their historical income. This contract was unpopular with dentists and has been criticized for not improving access or quality. A new dental contract has been promised based on capitation. Against this background significant issues have to be addressed including: a rapidly growing gap in between demand and resources and a need to make substantial cost savings across the whole of the NHS; a significant decline in dental need; inequalities in utilisation of dental services; and provision of treatments of doubtful effectiveness.

Conclusion

The NHS dental healthcare system faces significant challenges and consideration needs to be given to the consequences of a focus on need rather than demand. Logically this would require a needs‐based resource allocation formula and a needs‐based approach to service and workforce planning. A move to a needs‐led service is a political decision with associated political risks.
Influencing public policy on oral health
Authors: Lewis Jenny M
Published: September 2012

Objectives

In policy studies, an enduring research question is why some issues are taken seriously while others never become a central focus of policy making. This study aims to analyse the predecision stage of policy making and examines the position of oral health on the broader health policy agenda.

Methods

A study of networks of influence in health policy in the state of Victoria (Australia) is used to examine the health policy agenda, and the position of oral health within the broader health policy agenda. Social network concepts were used to structure the data collection. Nominations of influential people were collected using a snowball method, followed by interviews with a selection of those nominated.

Results

Combining an assessment of who is seen to be influential with an examination of the issues they are interested in provides insights into how influence helps shape the policy agenda and how this changes over time.

Conclusions

The study describes how oral health might become more central to the health policy agenda through deliberate strategies to change the network structure.
Changes in the messenger RNA expression levels of Bcl‐2 family members and caspase‐8 and ‐3 in porcine ovarian follicles during follicular atresia
Authors: Fu Yanhui , Lin Fei , Liu Honglin
Published: September 2012

Follicular atresia is mainly modulated by the mitochondrial apoptotic pathway, which is regulated primarily by interactions between pro‐ and anti‐apoptotic genes at the mitochondrial level. The Bcl‐2 family members (e.g. Bak, Bax, Bid, Bim, Bcl‐xL, Bcl‐2 and Mcl‐1), caspase‐8 and ‐3 play a crucial role in the mitochondrial apoptotic pathway. In this study, we used single follicles to measure the messenger RNA (mRNA) expression levels of Bak, Bax, Bid, Bim, Bcl‐xL, Bcl‐2, Mcl‐1, caspase‐8 and caspase‐3 in healthy (H), early atretic (EA), and progressed atretic (PA) porcine follicles by quantitative real‐time RT‐PCR. Follicular atresia was assessed based on morphology and the ratio of progesterone to 17β‐estradiol. Our results indicate weak mRNA expression of Bim, Bid, Mcl‐1 and Bcl‐2 in the H group and significantly increased expression in the EA and PA groups (P < 0.01). The expression levels of Bak, caspase‐3 and Bcl‐xL were low in the H and EA groups and increased in the PA group (P < 0.01). Finally, the expression of Bax and caspase‐8 rose gradually with the progression of follicular atresia. Our findings indicate the mRNA expression levels of both pro‐apoptotic genes (Bak, Bax, Bid, Bim, caspase‐8 and caspase‐3) and anti‐apoptotic genes (Bcl‐xL, Bcl‐2 and Mcl‐1) were increased in the follicles during atresia in porcine ovaries. We propose that the increase in anti‐apoptotic gene transcription may prevent apoptosis by protecting against the effects of pro‐apoptotic gene expression. However, alterations in the balance of pro‐ and anti‐apoptotic gene expression may lead to follicular atresia.
Peliosis hepatis: A mimicker of hepatic tumors
Authors: Zhou Bo , Yan Sheng , Zheng Shusen
Published: September 2012

Peliosis hepatis (PH) is a rare benign liver lesion, characterized by the presence of multiple blood‐filled cavities and marked dilation of the hepatic sinusoids throughout the hepatic parenchyma. It is often confirmed after the liver resection or liver biopsy. In the present study, we report a case of a 41‐year‐old woman who presented with a asymptomatic right hepatic mass. The imaging findings of the mass, including computed tomography and magnetic resonance imaging, showed centrifugal progression of enhancement during the portal and delayed phases. Because of the possibility of hepatic malignancy, partial resection of the liver was performed. The final pathological diagnosis was PH. By referring to the relevant literature, we conclude that, as a result of insignificant clinical manifestation and imaging features, PH should be kept in mind for patients with hepatic mass.
Job satisfaction and perceived autonomy for nurse practitioners working in nurse‐managed health centers
Authors: Pron Ann Linguiti
Published: September 2012

Purpose

More primary care providers are needed to deliver health care to Americans living in poverty and those soon to be insured under the Affordable Care Act. Nurse practitioners (NPs) in nurse‐managed health centers (NMHCs) are poised to meet this need. This research study examined the characteristics of NPs working in NMHCs and measured job satisfaction and perceived level of autonomy. No studies about job satisfaction or autonomy for NPs working in NMHCs had been previously reported.

Data sources

This descriptive, quantitative study surveyed primary care NPs working in NMHCs that are part of the National Nursing Centers Consortium (NNCC). NP e‐mail addresses were obtained from NNCC center directors. Of 198 NPs invited to the electronic survey, 99 completed the Misener Nurse Practitioner Job Satisfaction Scale, demographic questionnaire, questions about perceived autonomy, and whether they would recommend working in an NMHC. Participants came from 16 states and 46 NMHCs.

Conclusions

NPs working in NMHCs have job satisfaction, perceive their role as autonomous, and are satisfied with the autonomy they have.

Implications for practice

NMHCs can provide access to primary health care for many Americans. More NPs may choose employment in NMHCs for job satisfaction and autonomy.
A description of barriers and facilitators to childhood vaccinations in the military health system
Authors: Connors John , Arushanyan Elena , Bellanca Gregory , Racine Ruth , Hoeffler Andrew , Delgado Allan , Gibbons Susanne
Published: September 2012

Purpose: To perform a literature review of barriers to and facilitators of parents’ decisions to have their children vaccinated. Both differences and similarities between the civilian sector and the military health system (MHS) were explored.

Data sources: Articles and documents were identified from the following databases: CINAHL, PubMed, Defense Technical Information Center (DTIC), ISI, and Google Scholar. Reference lists from articles were reviewed.

Conclusions: Common themes identified in the civilian sector and the MHS included an electronic registry, care access issues, provider characteristics, and child illness. Several themes served as a barrier in one system while being a facilitator in the other, such as provider characteristics. Literature addressing the MHS and factors affecting vaccine coverage is scant; however, a large disparity in vaccination coverage exists between the MHS and the civilian sector.

Implications: The theme of provider characteristics was seen as a barrier in both systems; a better understanding of this theme (i.e., provider effectiveness at interacting with parents) would benefit primary care practice. An electronic vaccine registry and targeted education and media campaign used to facilitate vaccinations in the MHS should be piloted in the civilian sector. Additionally, future studies should be performed on identified themes in the MHS.
Performance evaluation of representative Wildfowl & Wetlands Trust constructed wetlands treating sewage
Authors: Dong Yu , Scholz Miklas , Mackenzie Sally
Published: September 2012

Data collected from five Wildfowl & Wetlands Trust constructed wetland systems offering a range of styles and inflow water types between 2005 and 2009 were examined and compared to identify long‐term trends in nutrient removal. Ammonia‐nitrogen concentrations were reduced between 31.9 and 96.8%. In contrast, the concentrations of nitrate‐nitrogen and total oxidised nitrogen in the effluent exceeded the influent in many of the systems. Reduction in ortho‐phosphate‐phosphorus and total phosphorous were between −10.5 and 87.6%, and between 6.9 and 92.5%, respectively. Removal efficiencies of biochemical oxygen demand were between 0.0 and 87.3%, and reductions of total suspended solids ranged from −249.3 to 57.6%. Ammonia‐nitrogen reduction was effective during summer. Long‐term nitrogen removal has been efficient and consistent. However, phosphorous reduction was only sufficient during the early stages of operation, and generally declined as the wetland aged.
Vegetation Indices, Remote Sensing and Forest Monitoring
Authors: Huete Alfredo R.
Published: September 2012

With increasing threats and pressure exerted on Earth’s forest resources, there are greater demands for more quantitative, timely, and accurate information on their state, functioning, and sustainability. Satellite remote sensing offers an effective way of measuring and monitoring vast forest areas in a consistent and robust manner. This complements ground forest surveys and overcomes the spatial limitations of in situ sampling of forest biophysical properties. Among the various remote sensing tools used in characterizing forests, spectral vegetation indices (VIs) are widely adopted for monitoring forest states and canopy processes. In this article I provide a brief overview on VI applications and advances made in the assessment and monitoring of forest biophysical states, functioning, phenology, and disturbance. I also address current and future challenges, demands, and limitations of VIs for long term forest monitoring and applications in climate science, hydrology, and biogeochemistry.
Towards an Affective Smoking Geography
Authors: Tan Qian Hui
Published: September 2012

Smoking is an inherently affective and sensuous spatial practice. However, an assessment of the existing literature reveals that an affectual‐sensual account of smoking bodies is sorely lacking. For this reason, this paper makes a case for the analytical purchase of an affectively attuned approach towards smoking bodies and spaces on three fronts: (i) Affections, actions and atmospheres; (ii) sensual affects; (iii) stigmatizing affects. In so doing, I expound on how an interest in affect can enrich the theoretical ambit of smoking geographies beyond its current mould.
Carbon and Nitrogen Export from Semiarid Uplands to Perennial Rivers: Connections and Missing Links, San Pedro River, Arizona, USA
Authors: Meixner Thomas , Brooks Paul , Hogan James , Soto Carlos , Simpson Scott
Published: September 2012

Investigations of biogeochemical processes in semiarid environments have largely focused on either plot studies in the uplands or on in‐stream and near stream reaction or transport studies. Recent research permits us to synthesize a conceptual model of how uplands and riparian systems are linked in semiarid climates specific to the San Pedro River basin in Arizona. These studies have demonstrated significant export of both dissolved and sediment associated carbon and nitrogen from the uplands into the channel network of semiarid river systems. Likewise research has demonstrated that riparian areas are biogeochemically active, with the potential to rapidly respire inputs of organic matter, releasing carbon back to the atmosphere and inorganic nitrogen into the water column or back to the atmosphere through denitrification. For the San Pedro, a total of more than 80% of both carbon and nitrogen export from the uplands that is observed in small catchments is not observed at the larger river system scale, indicating that this carbon and nitrogen must be either stored, taken up by vegetation or returned to the atmosphere at scales between the small catchment (1–1000 ha) and large river systems scale (∼320,000 ha). In summary, existing research shows that the uplands contribute significant amounts of material into the stream and near stream zone, and that this imported material influences nutrient conditions in aquatic systems. These conclusions point out significant gaps in developing a complete understanding of the reactions of carbon and nitrogen as material is transported from the uplands through ephemeral and perennial channel networks.
Xanthogranulomatous cholecystitis: A clinicopathological study of its association with gallbladder carcinoma
Authors: Zhuang Peng Yuan , Zhu Ming Jie , Wang Jian Dong , Zhou Xue Ping , Quan Zhi Wei , Shen Jun
Published: September 2012

Objectives

To determine the distribution of macrophages (MΦ) in both xanthogranulomatous cholecystitis (XGC) and gallbladder carcinoma (GBC) and to analyze the association between XGC and GBC.

Methods

From January 2009 to June 2011, 110 patients with gallbladder diseases, including 35 with GBC, 45 with XGC and 30 with chronic cholecystitis (CC), were enrolled. Immunohistochemistry stain and real‐time polymerase chain reaction using oncogenes (BCL‐2, c‐Myc) and anti‐oncogene genes (p53, p21) were performed, serum expressions of tumor marker (CA19‐9, CA724 and CA242) were also conducted. MΦ were used to determine their potential role in the carcinogenesis of GBC.

Results

BCL‐2 and c‐Myc expressions gradually increased among CC, XGC and GBC (P = 0.032 and P = 0.020, respectively); while p53 and p21 were similar in the three groups (P = 0.167 and P = 0.122, respectively). Serum BCL‐2 and c‐Myc were significantly correlated with their tissue levels; in terms of serum tumor markers, which gradually increased among CC, XGC and GBC, however, CA242 and CA724 were both negative in XGC but positive in GBC. Furthermore, gradually increasing MΦ counts were observed among CC, XGC and GBC groups; c‐Myc and CA724 were independent predictors for the differentiation of XGC and GBC.

Conclusions

XGC is an uncommon inflammatory condition distinct from CC and may be associated with the precancerous nature of GBC for its upregulated oncogenes and MΦ biology. c‐Myc and CA724 were independent predictors for the differentiation of XGC and GBC.
Encouraging early preventive dental visits for preschool‐aged children enrolled in Medicaid: using the Extended Parallel Process Model to conduct formative research
Authors: Askelson Natoshia M. , Chi Donald L. , Momany Elizabeth , Kuthy Raymond , Ortiz Cristina , Hanson Jessica D. , Damiano Peter
Published: September 2012

Objective: Preventive dental visits for preschool‐aged children can result in better oral health outcomes, especially for children from lower income families. Many children, however, still do not see a dentist for preventive visits. This qualitative study examined the potential for the Extended Parallel Process Model (EPPM) to be used to uncover potential antecedents to parents' decisions about seeking preventive dental care.

Methods: Seventeen focus groups including 41 parents were conducted. The focus group protocol centered on constructs (perceived severity, perceived susceptibility, perceived self‐efficacy, and perceived response efficacy) of the EPPM. Transcripts were analyzed by three coders who employed closed coding strategies.

Results: Parents' perceptions of severity of dental issues were high, particularly regarding negative health and appearance outcomes. Parents perceived susceptibility of their children to dental problems as low, primarily because most children in this study received preventive care, which parents viewed as highly efficacious. Parents' self‐efficacy to obtain preventive care for their children was high. However, they were concerned about barriers including lack of dentists, especially dentists who are good with young children.

Conclusions: Findings were consistent with EPPM, which suggests this model is a potential tool for understanding parents' decisions about seeking preventive dental care for their young children. Future research should utilize quantitative methods to test this model.
Dental usage under changing economic conditions
Authors: Manski Richard J. , Moeller John F. , Chen Haiyan , Schimmel Jody , St. Clair Patricia A. , Pepper John V.
Published: September 2012

Objective: The purpose of this article is to examine the relationship between changes in household finances (wealth and income) and changes in dental utilization at the onset of the recent recession in a population of older Americans.

Methods: Data from the Health and Retirement Study (HRS) were analyzed for US individuals aged 51 years and older during the 2006 and 2008 waves of the HRS. We estimated logistic models of a) starting and b) stopping dental use between 2006 and 2008 survey periods as a function of changes in household wealth and income, controlling for other potentially confounding covariates.

Results: We found that only when household wealth falls by 50 percent or more were older adults less likely to seek dental care. Changes in household income and other changes in household wealth were not associated with changes in dental utilization among this population.

Conclusions: Older Americans' dental care utilization appeared to be fairly resilient to changes in household finances; only when wealth fell by 50 percent or more did individuals decrease dental use. This finding might extend to other health‐care services that are preventive, routine, and relatively inexpensive.
Validation of the Parental‐Caregiver Perceptions Questionnaire: agreement between parental and child reports
Authors: Barbosa Taís de Souza , Gavião Maria Beatriz Duarte
Published: September 2012

Objectives:

To test the validity and reliability of Brazilian Portuguese version of the Parental‐Caregiver Perceptions Questionnaire (P‐CPQ) (Aim 1) and to assess the agreement between parents and children concerning the child's oral health‐related quality of life (OHRQoL) (Aim 2).

Methods:

The P‐CPQ and the Brazilian Portuguese versions of the Child Perceptions Questionnaires (CPQ8‐10 and CPQ11‐14) were used. Objective 1 addressed in the study that involved 210 (validity and internal reliability) and 20 (test–retest reliability) parents and Objective 2 in the study that involved 210 pairs of parents and children. Construct validity was calculated using the Spearman's correlation and the Mann–Whitney/Kruskal–Wallis tests. Reliability was determined using Cronbach's alpha and intraclass correlation coefficient (ICC). Agreement between overall and subscale scores derived from the P‐CPQ and CPQ was assessed in comparison and correlation analyses.

Results:

The P‐CPQ discriminated among the categories of malocclusion and dmft. The P‐CPQ showed good construct validity, good internal consistency reliability, and excellent test–retest reliability. There was systematic under‐ and overreporting in parents' assessments for younger and older children, respectively. However, the magnitude of the directional differences was just small. At individual level, agreement between parents and children was excellent. However, it ranged from excellent to moderate or substantial in subscales for CPQ8‐10 and CPQ11‐14 groups, respectively.

Conclusions:

The Portuguese version of P‐CPQ is valid and reliable. Some parents have limited knowledge about child OHRQoL. Given that parental and child reports measure different realities concerning the child's OHRQoL, information provided by parents can complement the child's evaluation.
Planting the seeds of success: CT‐guided gold seed fiducial marker placement to guide robotic radiosurgery
Authors: Patel Aashish , Khalsa Bhavraj , Lord Bryce , Sandrasegaran Kumar , Lall Chandana
Published: September 2012

Fiducial marker (FM)‐guided stereotactic body radiation therapy (SBRT) allows for precise targeting and delivery of radiation to a tumor site. In this article, we briefly discuss SBRT, provide examples to describe CT‐guided FM placement to guide SBRT, and discuss some of the associated risks and benefits. This article serves as a pictorial review for body imagers and interventional radiologists who perform CT‐guided procedures and interpret diagnostic studies for oncology patients. CT‐guided FMs were placed in patients who were appropriate candidates for SBRT. One week following placement, patients underwent diagnostic CT and/or MR examinations in order to include the FM data in the development of a treatment plan. From October 2007–November 2009, a total of 89 patients were implanted with FMs. Sites of implantation included lung, liver, bone, chest and abdominal wall, and peritoneum/retroperitoneum. Complications included pneumothorax and FM migration. Twenty‐one patients (33%) with lung FM placement experienced at least a small pneumothorax and 6 patients (9%) required thoracostomy tubes. FM migration occurred in 5 patients (8%) with lung placement. SBRT provides a safer and more effective alternative to conventional radiotherapy, and CT‐guided FM implantation of tumor sites increases the precision of SBRT. Technical improvements in FM placement can limit the complications associated with the procedure and further enable highly localized tumor therapy.
MDCT angiography of the major congenital anomalies of the extracranial arteries: Pictorial review
Authors: Saade Charbel , Bourne Roger , Wilkinson Mark , Brennan Patrick C
Published: September 2012

Multidetector computed tomographic angiography is becoming the modality of choice for evaluation of the supra‐aortic circulation in acute stroke imaging. Variations of the supra‐aortic circulation, in particular of the extracranial arteries, are common. This article aims to provide a pictorial description of the variant anatomy of the aortic arch and extracranial arteries. Knowledge of the presence and clinical relevance of normal variants such as anomalies, duplications and embryological persistence plays a clinically relevant role in the diagnosis and management of neurological and surgical conditions, particularly as we enter an era of increasing extracranial intervention.
Influence of High Fat Diet Feeding for 20 Weeks on Lower Urinary Tract Function in Mice
Authors: AIZAWA Naoki , HOMMA Yukio , IGAWA Yasuhiko
Published: September 2012

Objectives: We investigated the possible changes in lower urinary tract function in mice fed a high fat diet (HFD).

Methods: Male C57BL/6J mice were divided into two different feed groups: normal diet (ND) and HFD (n = 16 in each). The body weight, blood glucose level and voiding frequency/volume (FV) relations (for 24 h) were measured every 4 weeks. At 25 weeks old, blood pressure and heart rate, cystometry and isolated detrusor smooth muscle function were measured. After the experiments, serum fat level was measured.

Results: The body weight and blood glucose level of the HFD group were significantly higher than those of the ND group after 9 weeks old. In the FV measurements, the mean voided volume was not significantly different between the two groups, although voiding frequency, total voided volume and water intake volume in the HFD group were significantly lower than those in the ND group. At 25 weeks old, the mean heart rate in the HFD group was significantly higher than that in the ND group, but no significant difference in the blood pressure was observed. None of the cystometric parameters analyzed showed significant differences between the two groups. The contractile response to either carbachol or high K+ was not significantly different, whereas the contractile response to electrical field stimulation was significantly higher in the HFD group. In the HFD group, the mean total cholesterol level was significantly higher.

Conclusion: The present results suggest that HFD‐feeding for 20 weeks in mice unlikely affects bladder function even though it induced diabetes, hyperlipidemia and tachycardia.
A spectral and Bayesian approach for analysis of fluctuations and synchrony in ecological datasets
Authors: Lindström Tom , Sisson Scott A. , Håkansson Nina , Bergman Karl‐Olof , Wennergren Uno
Published: September 2012

Autocorrelation within ecological time series and synchrony between them may provide insight into the main drivers of observed dynamics.

We here present methods that analyse autocorrelation and synchrony in ecological datasets using a spectral approach combined with Bayesian inference.

To exemplify, we implement the method on dendrochronological data of the pedunculate oak (Quercus robur). The data consist of 110 years of growth of 10 live trees and seven trees that died during a synchronized oak death in Sweden in c. 2002–2007. We find that the highest posterior density is found for a noise colour of tree growth of γ ≈ 0·95 (i.e. ‘pink noise’) with little difference between trees, suggesting climatic variation as a driving factor. This is further supported by the presence of synchrony, which we estimate based on phase‐shift analysis. We conclude that the synchrony is time‐scale dependent with higher synchrony at larger time‐scales. We further show that there is no difference between the growth patterns of the alive and dead tree groups. This suggests that the trees were driven by the same factors prior to the synchronized death.

We argue that this method is a promising approach for linking theoretical models with empirical data.
Encounters with immigrant customers: perspectives of Danish community pharmacy staff on challenges and solutions
Authors: Mygind Anna , Espersen Sacha , Nørgaard Lotte Stig , Traulsen Janine M
Published: September 2012

Objectives

To explore the challenges that Danish community pharmacy staff encounter when serving non-Western immigrant customers. Special attention was paid to similarities and differences between the perceptions of pharmacists and pharmacy assistants.

Methods

A questionnaire was distributed to one pharmacist and one pharmacy assistant employed at each of the 55 community pharmacies located in the five local councils in Denmark with the highest number of immigrant inhabitants.

Key findings

The total response rate was 76% (84/110). Most respondents found that the needs of immigrant customers were not sufficiently assessed at the counter (n = 55, 65%), and that their latest encounter with an immigrant customer was less satisfactory than a similar encounter with an ethnic Danish customer (n = 48, 57%) (significantly more pharmacists than assistants: odds ratio, OR, 3.19; 95% confidence interval, CI, 1.27–8.04). Forty-two per cent (n = 35) perceived that immigrant customers put pressure on pharmacy staff resources, while 27% (n = 23) found that the immigrant customer group make work more interesting. More pharmacists than assistants agreed on the latter (OR, 3.43; 95% CI, 1.04–11.33). Within the past 14 days, 86% (n = 72) experienced that their advice and counselling were not understood by immigrant customers, whereas 49% (n = 41) experienced lack of understanding by ethnic Danes; and 30% (n = 25) had consciously refrained from counselling an immigrant, whereas 19% (n = 16) had done so with an ethnic Dane. Use of under-aged children as interpreters during the past month was reported by 79% of respondents. Regarding suggestions on how to improve encounters with immigrant customers, most respondents listed interventions aimed at patients, general practitioners and pharmaceutical companies.

Conclusions

Community pharmacy staff report poorer quality in their encounters with immigrant customers, including sub-optimal counselling and frequent use of under-aged children as interpreters. Our study also reveals certain differences across personnel groups, which may be explained by differences in level of education.
Secular changes in BMI and the associations between risk factors and BMI in children born 29 years apart
Authors: Williams S. M. , Taylor R. W. , Taylor B. J.
Published: September 2012

What is already known about this subject

Factors associated with children's body mass index (BMI) include parents’ BMIs, birth weight, maternal smoking, sleep duration and television watching.

Few studies have attempted to quantify either changes in the association between risk factors and BMI or the contribution of changes in the risk factors to increases in BMI over a generation.

What this study adds

The magnitude of the association between most risk factors and children's BMIs has not changed over a 29‐year period.

Increases in the population level of mothers’ body mass index (BMI) explains ∼20% of the increase in children's BMI whereas the smaller increase in fathers’ BMI contributes only 6%.

Maternal smoking, despite the decrease in prevalence, contributes ∼17%.

Objective

Using two cohorts born 29 years apart in Dunedin, New Zealand we aim to examine changes in risk factors and their associations with body mass index (BMI) at ages 3 and 7 years, and estimate their contribution to the secular changes in BMI at age 7 years.

Methods

Birth weight and anthropometric measures at ages 3, 5 and 7 years were obtained for 974 participants in the Dunedin Multidisciplinary Health and Development Study (DMHDS), born in 1972–1973, and 241 in the Family Lifestyle, Activity, Movement and Eating Study (FLAME), born in 2001–2002. Information about maternal age, education and smoking in pregnancy, as well as breastfeeding, children's television time and time in bed, was obtained by questionnaire.

Results

The increase in BMI over the 29‐year period was 0.84 (95% CI 0.61, 1.06) kg m−2 at age 7. A 1‐unit difference in the mother's BMI was associated with a 0.06 (0.03, 0.08) kg m−2 difference in offspring in both studies; the 3.4 (2.8, 4.0) kg m−2 increase in the mothers’ BMIs accounts for a change of 0.19 kg m−2 in the children's BMI. The much smaller generational increase in fathers’ BMI (0.7 kg m−2) correspondingly had a more limited effect on change in child BMI over time (0.06 kg m−2). Although smoking in pregnancy decreased by 15% (8, 21) its association with BMI increased from 0.20 (−0.01, 0.42) in the DMHDS cohort to 1.24 (0.76, 1.71) kg m−2 in the FLAME cohort, contributing 0.18 kg m−2 to the increase in children's BMI.

Conclusions

Societal factors such as higher maternal BMI and smoking in pregnancy contribute most to the secular increase in BMI, with changes in behavioural factors, including sleep and television viewing, having little effect in this setting.
WHO European Childhood Obesity Surveillance Initiative 2008: weight, height and body mass index in 6–9‐year‐old children
Authors: Wijnhoven T. M. A. , van Raaij J. M. A. , Spinelli A. , Rito A. I. , Hovengen R. , Kunesova M. , Starc G. , Rutter H. , Sjöberg A. , Petrauskiene A. , O'Dwyer U. , Petrova S. , Farrugia Sant'Angelo V. , Wauters M. , Yngve A. , Rubana I.‐M. , Breda J.
Published: September 2012

What is already known about this subject

Overweight and obesity prevalence estimates among children based on International Obesity Task Force definitions are substantially lower than estimates based on World Health Organization definitions.

Presence of a north–south gradient with the highest level of overweight found in southern European countries.

Intercountry comparisons of overweight and obesity in primary‐school children in Europe based on measured data lack a similar data collection protocol.

What this study adds

Unique dataset on overweight and obesity based on measured weights and heights in 6–9‐year‐old children from 12 European countries using a harmonized surveillance methodology.

Because of the use of a consistent data collection protocol, it is possible to perform valid multiple comparisons between countries.

It demonstrates wide variations in overweight and obesity prevalence estimates among primary‐school children between European countries and regions.

Background

Nutritional surveillance in school‐age children, using measured weight and height, is not common in the European Region of the World Health Organization (WHO). The WHO Regional Office for Europe has therefore initiated the WHO European Childhood Obesity Surveillance Initiative.

Objective

To present the anthropometric results of data collected in 2007/2008 and to investigate whether there exist differences across countries and between the sexes.

Methods

Weight and height were measured in 6–9‐year‐old children in 12 countries. Prevalence of overweight, obesity, stunting, thinness and underweight as well as mean Z‐scores of anthropometric indices of height, weight and body mass index were calculated.

Results

A total of 168 832 children were included in the analyses and a school participation rate of more than 95% was obtained in 8 out of 12 countries. Stunting, underweight and thinness were rarely prevalent. However, 19.3−49.0% of boys and 18.4−42.5% of girls were overweight (including obesity and based on the 2007 WHO growth reference).The prevalence of obesity ranged from 6.0 to 26.6% among boys and from 4.6 to 17.3% among girls. Multi‐country comparisons suggest the presence of a north–south gradient with the highest level of overweight found in southern European countries.

Conclusions

Overweight among 6–9‐year‐old children is a serious public health concern and its variation across the European Region highly depends on the country. Comparable monitoring of child growth is possible across Europe and should be emphasized in national policies and implemented as part of action plans.
Parental perceptions of and concerns about child's body weight in eight European countries – the IDEFICS study
Authors: Regber S. , Novak M. , Eiben G. , Bammann K. , De Henauw S. , Fernández‐Alvira J. M. , Gwozdz W. , Kourides Y. , Moreno L. A. , Molnár D. , Pigeot I. , Reisch L. , Russo P. , Veidebaum T. , Borup I. , Mårild S.
Published: September 2012

What is already known about this subject

Parents of children with overweight and obesity tend to underestimate their children's weight.

Most studies show no association between parental education level and accurate parental perception of a child's weight category.

Studies show no consistent relationship between parental weight perception and the child's gender.

What this study adds

Parental underestimation of children's weight category for children in the overweight and obesity categories was found across eight European countries.

Regional differences indicated a more accurate parental weight perception in Northern and Central Europe.

A high proportion of parents in Southern Europe were concerned about future underweight or overweight in their children.

Objectives

To evaluate parental perceptions of and concern about child's body weight and general health in children in a European cohort.

Design

Cross‐sectional multi‐centre study in eight European countries.

Participants

16 220 children, ages 2–9 years.

Methods

Parents completed a questionnaire regarding children's health and weight and concern about overweight and underweight. Objective children's weight categories from the International Obesity Task Force were used. Logistic regression models were utilized to identify predictors of accurate weight perception.

Results

Parental weight perception corresponded overall to children's mean body mass index (BMI) z‐scores, with important exceptions. About one‐third of the total indicated concern about underweight, paradoxically most often parents of children in the overweight or obesity categories. In 63%, parents of children in the overweight category marked ‘proper weight’. The strongest predictor for accurate parental weight perception for children with overweight and obesity was BMI z‐score (odds ratio [OR] = 7.2, 95% confidence interval [CI] 6.1–8.7). Compared to Southern Europe, ORs for accurate parental weight perception were 4.4 (95% CI 3.3–6.0) in Northern Europe and 3.4 (95% CI 2.7–4.2) in Central Europe.

Conclusion

Parents of children categorized as being overweight or obese systematically underestimated weight. Parents differed regionally regarding accurate weight perception and concern about overweight and underweight.
Laser beam measurement of abdominal sagittal diameter in obese children: a validation study
Authors: Flodmark C.‐E. , Shen W. , Punyanitya M. , Leander P. , Lanke J. , Pietrobelli A.
Published: September 2012

What is already known about this subject

Sagittal diameter (SAD), i.e. the mid height of the abdomen when lying down, has been reported to correlate to visceral fat, insulin resistance and cardiovascular risk factors in adults.

SAD seems to be the best anthropometric predictor of cardiovascular risk, and also of more importance than waist circumference (WC) in adults.

There has been no validation studies comparing SAD measured with anthropometric tools (e.g. ruler) to measurements made with more exact devices such as magnetic resonance imaging (MRI) in pediatric age.

What this study adds

This new reliable method is ideal for children due to limited body contact and no radiation.

It is accurate, less expensive than MRI, and also easier to perform than measuring WC.

It is easily available for screening purposes making future epidemiological studies possible evaluating health risks related to regional distribution of abdominal tissue.

Objectives

Sagittal diameter (SAD) has been reported to correlate to visceral fat and cardiovascular risk factors. SAD is measured with the individual lying down, halfway between the lower rib margin and the iliac crest; it represents the mid‐height of the abdomen. The aim of this study was to validate SAD measured using a recently‐developed laser beam device (SADLDB) against SAD measured using MRI (SADMRI).

Methods

Of 48 obese children (25 boys, 23 girls) aged 9–11 years on the waiting list for obesity treatment, 34 agreed to a baseline measurement, which was followed by repeated measurements 6 and 12 months later in 31 and 22 children respectively. MRI was used to examine SADMRI at 5 cm above (SADMRI,cra) and below (SADMRI,cau) the mid plane of the L4‐5 intervertebral disc.

Results

Each of the differences SADLBD – SADMRI,cau and SADLBD – SADMRI,cra was subjected to a repeated‐measurements ANOVA; the visit did not have a statistically significant effect in either case (p = 0.19 and p = 0.72, respectively). The difference SADLBD – SADMRI,cau was 1.50 on average (p < 0.0001; CI 1.26–1.74) while the corresponding figure for SADLBD – SADMRI,cra was 1.26 (p < 0.0001; CI 1.04–1.49). Regression of the difference on the mean gave slopes of –0.09 (p = 0.25) and –0.04 (p = 0.57) respectively. Prediction of SADMRI from SADLDB can be performed in different ways: by means of linear regression or by means of an additive correction.

Conclusions

Thus, this laser device can be used instead of MRI to estimate SAD by using a simple correction.
Acceleration in the care of older adults: new demands as predictors of employee burnout and engagement
Authors: Kubicek Bettina , Korunka Christian , Ulferts Heike
Published: September 2012

Aim

This paper introduces the concept of acceleration‐related demands in the care of older adults. It examines these new demands and their relation to cognitive, emotional, and physical job demands and to employee well‐being.

Background

Various changes in the healthcare systems of Western societies pose new demands for healthcare professionals' careers and jobs. In particular today's societal changes give rise to acceleration‐related demands, which manifest themselves in work intensification and in increasing requirements to handle new technical equipment and to update one's job‐related knowledge. It is, therefore, of interest to investigate the effects of these new demands on the well‐being of employees.

Design

Survey.

Method

Between March–June 2010 the survey was conducted among healthcare professionals involved in care of older adults in Austria. A total of 1498 employees provided data on cognitive, emotional, and physical job demands and on acceleration‐related demands. The outcome variables were the core dimensions of burnout (emotional exhaustion and depersonalization) and engagement (vigour and dedication).

Results

Hierarchical regression analyses show that acceleration‐related demands explain additional variance for exhaustion, depersonalization, vigour, and dedication when controlling for cognitive, emotional, and physical demands. Furthermore, acceleration‐related demands associated with increasing requirements to update one's knowledge are related to positive outcomes (vigour and dedication). Acceleration‐related demands associated with an increasing work pace are related to negative outcomes such as emotional exhaustion.

Conclusion

Results illustrate that new demands resulting from social acceleration generate potential challenges for on‐the‐job learning and potential risks to employees' health and well‐being.
End‐of‐Life Care and Dying: Issues Raised by Staff Supporting Older People with Intellectual Disability in Community Living Services
Authors: Wiese Michele , Stancliffe Roger J. , Balandin Susan , Howarth Glennys , Dew Angela
Published: September 2012

Background

The aim of this study was to explore the current status of end‐of‐life care and dying of people with intellectual disability based on the experiences of staff in community living services.

Materials and Methods

Focus groups and individual interviews were conducted, guided by grounded theory methodology.

Results

The current status of end‐of‐life care and dying comprised five key ‘issues’: knowledge of dying, ethical values, the where of caring, the how of caring and post‐death caring. These issues occurred in relationship with ‘partners’, including the dying person, other clients, fellow staff, family, external health services and the coroner.

Conclusions

End‐of‐life care represents a complex interaction between the care issues and the partners involved in care. Despite this complexity, staff were committed to the provision of end‐of‐life care.