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Miyagami T, Nishizaki Y, Imada R, Yamaguchi K, Nojima M, Kataoka K, Sakairi M, Aoki N, Furusaka T, Kushiro S, Yang KS, Morikawa T, Tohara H, Naito T. Dental Care to Reduce Aspiration Pneumonia Recurrence: A Prospective Cohort Study. Int Dent J 2024; 74:816-822. [PMID: 38220512 PMCID: PMC11287086 DOI: 10.1016/j.identj.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/04/2023] [Accepted: 11/13/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Aspiration pneumonia has a high recurrence rate, and oral care by dentists has been found effective in preventing its onset; however, this has not been evaluated using prospective studies. Therefore, we conducted a prospective study to evaluate the effectiveness of professional oral care by dentists in reducing aspiration pneumonia recurrence in older adult patients. METHODS In this prospective cohort study, we evaluated a dental oral care intervention, using a historical control group (control group). It was conducted at a single-centre regional core hospital in Japan that serves a large number of patients aged older than 80 years. Patients who were hospitalised for aspiration pneumonia were included in this study. During the study period (1 April 2021 to 31 March 2022), the clinical group received weekly professional cleaning by a dentist and the control group received standard oral care by a nurse as usual from 1 April 2020 to 31 March 2021. The dentist oral care group received weekly professional oral care from a dentist and was followed prospectively for 1 year. A Kaplan-Meier analysis was used to evaluate the timing of recurrent aspiration pneumonia or death. A Cox proportional hazards model was used to obtain a hazard ratio and determine the 95% confidence intervals. RESULTS There were 91 participants in the clinical group and 94 in the control group. The mean age of participants was 85 years, and 75 (40.5%) were female. The recurrence rate was 27.5% in the clinical group and 44.7% in the control group (P = .005). Professional cleaning by a dentist reduced the risk of recurrence of aspiration pneumonia by approximately 50% (adjusted hazard ratio, 0.465; 95% confidence interval, 0.278-0.78). CONCLUSIONS Professional cleaning by a dentist was associated with a lower rate of aspiration pneumonia recurrence than nurse-provided conventional oral care.
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Affiliation(s)
- Taiju Miyagami
- Department of General Medicine, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Yuji Nishizaki
- Department of General Medicine, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan; Division of Medical Education, Juntendo University School of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan.
| | - Ryoko Imada
- Dysphagia Rehabilitation, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima Bunkyo-ku, Tokyo, Japan
| | - Kohei Yamaguchi
- Dysphagia Rehabilitation, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima Bunkyo-ku, Tokyo, Japan
| | - Masanori Nojima
- Center for Translational Research, The Institute of Medical Science, The University of Tokyo, Shirokanedai Minato-ku, Tokyo, Japan
| | - Koshi Kataoka
- Division of Medical Education, Juntendo University School of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Mizuki Sakairi
- Department of General Medicine, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Nozomi Aoki
- Department of General Medicine, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Takayuki Furusaka
- Department of General Medicine, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Seiko Kushiro
- Department of General Medicine, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Kwang-Seok Yang
- Department of General Medicine, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Toru Morikawa
- Department of General Medicine, Nara City Hospital, Higashikideracho, Nara, Japan
| | - Haruka Tohara
- Dysphagia Rehabilitation, Department of Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Yushima Bunkyo-ku, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, Hongo, Bunkyo-Ku, Tokyo, Japan
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Ozaki K, Tohara H, Baba M, Teranaka S, Kawai Y, Komatsumoto S. A Dentist-Led Oral Care System Can Prevent Stroke-Associated Pneumonia: The Effects of Early Intervention by Dental Team. J Multidiscip Healthc 2023; 16:2937-2945. [PMID: 37795380 PMCID: PMC10546933 DOI: 10.2147/jmdh.s415572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/07/2023] [Indexed: 10/06/2023] Open
Abstract
Background Our facility's dental team consists of a full-time dentists and dental hygienists who work exclusively in the wards to implement best practices in oral healthcare. We executed the dental care system (DCS) that includes lectures and practical training for nurses conducted by dentists and dental hygienists, the introduction to oral assessment, standardization of oral care procedures, a process for nurses to request the dental team, and early bedside oral screening conducted by the dental team. This study investigated the DCS's effects on the incidence of stroke-associated pneumonia (SAP). Methods This single-center retrospective cohort study included 2,771 acute stroke patients who were newly hospitalized between April 1, 2012, and March 31, 2020. The 8-year period was divided into four phases at two-year intervals as follows: Pre (N=632), Post-1 (N=642), Post-2 (N=716), and Post-3 (N=781). Pre was prior to DCS practice. Post-1 was an early introduction to DCS. Post-2 simplified dental team requests from nurses, and Post-3 added bedside oral screening within 72 hours of admission by the dental team. Statistical analysis was performed using the Cochran-Armitage trend test, followed by multivariate logistic regression. Results A decrease in SAP rates was observed across the four groups (P<0.0001). Logistic regression analysis revealed a significant difference for respiratory disease (odds ratio 7.74, 95% confidence interval 5.49-10.90), hypertension (2.28, 1.39-3.73), cardiac failure (1.72, 1.04-2.85), and diabetes (1.59, 1.11-2.26), 3-digit code on the Japan coma scale (3.57, 2.53-5.05 [reference ≤2-digit code]), age ≥90 years (2.34, 1.15-4.77 [reference 18-59 years]), male (1.86, 1.31-2.67), and the Post-1 (0.49, 0.31-0.76 [reference Pre]), Post-2 (0.38, 0.25-0.61 [reference Pre]), and Post-3 (0.24, 0.15-0.40 [reference Pre]) periods. Conclusion The suppression of SAP is effectively achieved through early intervention and education of nurses by dental professionals.
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Affiliation(s)
- Kenichiro Ozaki
- Department of Physical Medicine and Rehabilitation, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
- Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Haruka Tohara
- Dysphagia Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Mikoto Baba
- Department of Physical Medicine and Rehabilitation, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
| | - Satoshi Teranaka
- Department of Physical Medicine and Rehabilitation, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Yosuke Kawai
- Department of Physical Medicine and Rehabilitation, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
- Gerodontology and Oral Rehabilitation, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo, Tokyo, Japan
| | - Satoru Komatsumoto
- Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
- Fujita Health University, Toyoake, Aichi, Japan
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Ebrahimi V, Rastegar-Moghaddam SH, Mohammadipour A. Therapeutic Potentials of MicroRNA-126 in Cerebral Ischemia. Mol Neurobiol 2023; 60:2062-2069. [PMID: 36596965 DOI: 10.1007/s12035-022-03197-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/23/2022] [Indexed: 01/05/2023]
Abstract
Stroke is a leading cause of death and disability worldwide. It is among the most common neurological disorders with an 8-10% lifetime risk. Ischemic stroke accounts for about 85% of all strokes and damages the brain tissue via various damaging mechanisms. Following cerebral ischemia, the disrupted blood-brain barrier (BBB) leads to cerebral edema formation caused by activation of oxidative stress, inflammation, and apoptosis, targeting primarily endothelial cells. Activation of the protective mechanisms might favor fewer damages to the neural tissue. MicroRNA (miR)-126 is an endothelial cell-specific miR involved in angiogenesis. MiR-126 orchestrates endothelial progenitor cell functions under hypoxic conditions and could inhibit ischemia-induced oxidative stress and inflammation. It alleviates the BBB disruption by preventing an augment in matrix metalloproteinase level and halting the decrease in the junctional proteins, including zonula occludens-1 (ZO-1), claudin-5, and occludin levels. Moreover, miR-126 enhances post-stroke angiogenesis and neurogenesis. This work provides a therapeutic perspective for miR-126 as a new approach to treating cerebral ischemia.
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Affiliation(s)
- Vahid Ebrahimi
- Department of Anatomical Sciences, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | | | - Abbas Mohammadipour
- Department of Anatomy and Cell Biology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. .,Applied Biomedical Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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Moldvai J, Orsós M, Herczeg E, Uhrin E, Kivovics M, Németh O. Oral health status and its associated factors among post-stroke inpatients: a cross-sectional study in Hungary. BMC Oral Health 2022; 22:234. [PMID: 35701775 PMCID: PMC9195382 DOI: 10.1186/s12903-022-02259-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/30/2022] [Indexed: 11/11/2022] Open
Abstract
Background Post-stroke inpatients are at risk of poor oral health for a number of reasons. The aim of this study was to assess the oral health status of post-stroke patients and also to explore the factors that may influence it. Methods This cross-sectional study was organised at National Institute for Medical Rehabilitation in Hungary. Altogether 410 post-stroke patients were enrolled in the survey. Personal medical history and functional assessment was obtained from the final medical reports of the patients. The clinical examination and data collection were conducted according to the World Health Organization (2013) criteria. Socio-demographic background and behaviours related to oral health were assessed using a questionnaire. The dental status was explained by the number of Decayed, Missing and Filled Teeth (DMFT). The association of socio-demographic factors, stroke and functional assessment with oral health status and behaviour was evaluated. Chi-square test, Fisher’s exact test, Welch test, Mann–Whitney U test, Kruskal–Wallis test, ANOVA model and correlation analysis were used to analyse our data. The level of significance was set at p < 0.05. Results Mean age of stroke patients was 59.21(Standard Deviation [SD] 14.74) years. Mean DMFT score was 20.13 (8.08), including 3.28 (4.24) decayed teeth, 15.02 (10.29) missing teeth and 1.83 (2.94) filled teeth score. Factors that influenced the oral health status were gender, age, occupational status, level of education, type and risk factors for stroke. Significant correlation was found between the Functional Independence Measure and oral health-related behaviours with patients brushing their teeth once a month showing the lowest value. Conclusion According to the results, low socio-demographic and economic status, low level of education and the Functional Independence Measure score, unemployment, the combination of risk factors for stroke and residual dysfunctions are associated with poor oral health status. The data indicate that a series of changes are needed, for special attention and care in oral health for patients who have had a stroke. Based on the findings of this research, a new model of prevention and care can be developed, with an interdisciplinary collaboration, to promote the quality of life of these individuals. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02259-2.
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Affiliation(s)
- Júlia Moldvai
- Department of Community Dentistry, Faculty of Dentistry, Semmelweis University, Szentkirályi str. 40, Budapest, 1088, Hungary.
| | - Mercédesz Orsós
- Department of Community Dentistry, Faculty of Dentistry, Semmelweis University, Szentkirályi str. 40, Budapest, 1088, Hungary
| | - Eszter Herczeg
- Department of Rehabilitation Post-Stroke, National Institute for Medical Rehabilitation, Budapest, Hungary
| | - Eszter Uhrin
- Department of Community Dentistry, Faculty of Dentistry, Semmelweis University, Szentkirályi str. 40, Budapest, 1088, Hungary
| | - Márton Kivovics
- Department of Community Dentistry, Faculty of Dentistry, Semmelweis University, Szentkirályi str. 40, Budapest, 1088, Hungary
| | - Orsolya Németh
- Department of Community Dentistry, Faculty of Dentistry, Semmelweis University, Szentkirályi str. 40, Budapest, 1088, Hungary
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