Socioeconomic Status and Toothbrushing in Indigenous and Non-Indigenous Australian Children

INTRODUCTION

Dental caries in children is a multifactorial and complex condition. Toothbrushing helps maintain good oral hygiene and delivers fluoride. However, determinants of toothbrushing could vary based on Indigenous status.

OBJECTIVE

This study aimed to assess the association between socioeconomic status and adequate toothbrushing practice (brushing twice or more a day) in Indigenous and non-Indigenous Australian children.

METHODS

Data were acquired from the National Child Oral Health Survey (NCOHS) 2012 to 2014. NCOHS administered questionnaires to parents of a representative sample of 24,215 Australian children aged 5 to 14 y recruited using a complex sampling method. Data on the frequency of toothbrushing and socioeconomic status were collected through the questionnaires. Statistical analysis was conducted progressively from bivariate to multivariable regression modeling, stratified by Indigenous status.

RESULTS

Just over half of Indigenous children and over two-thirds of non-Indigenous children reported adequate toothbrushing. The prevalence of adequate brushing (twice or more a day) was 42% (95% confidence interval [CI], 1.10-1.84) higher among children with an overseas-born parent than those with Australian-born parents. Among non-Indigenous children, sex and age, parents' country of birth, number of children in the family, and other family socioeconomic indicators (education, income, private health insurance) were associated with adequate toothbrushing. The prevalence of adequate brushing was 1.09 (95% CI, 1.03-1.15) and 1.15 (95% CI, 1.10-1.21) times higher when their parent possessed vocational training and tertiary education, respectively, compared to those children whose parents had school-level education.

CONCLUSIONS

There were differences in patterns of socioeconomic disparities for toothbrushing practices between Indigenous and non-Indigenous Australian children.

KNOWLEDGE TRANSFER STATEMENT

To promote positive toothbrushing practices in children, dental clinicians and public health professionals must be aware of the determinants of toothbrushing practices. Socioeconomic disparities in toothbrushing frequency were more apparent in non-Indigenous children. These results will help develop population-specific interventions that tackle the determinants to help improve oral hygiene behavior in Indigenous and non-Indigenous children.

MO973PRE-IMPLANTATION BIOPSY FINDINGS AND IMPACT ON LIVE DONOR KIDNEY TRANSPLANT RECIPIENT OUTCOMES - A SINGLE CENTRE STUDY

Background and Aims

Live donor kidney transplantation remains the mainstay of renal replacement therapy in Sri Lanka. The basic universal pre surgical investigations, human leucocyte antigen (HLA) matching and cross matching are routinely performed, however due to high rates chronic kidney disease (CKD) as well as increasing numbers of, chronic kidney disease unknown etiology (CKDu) in Sri Lanka, there is a possibility of subclinical kidney disease being present in donor kidneys which go undiagnosed. A study of pre-implantation biopsy along with follow-up outcomes of kidney transplant recipients is conducted to identify presence of subclinical kidney disease in a Sri Lankan cohort of patients.

Method

We collected thirty three (33) live donor pre-implantation biopsies during 4 consecutive months in 2020 as well as 1 month follow-up data. This is part of an ongoing follow-up study which is conducted at National Hospital, Kandy, Sri Lanka.

Results

Thirty three (33) live donor recipients and their pre-implantation renal biopsy samples were studied. The mean age of the study participants’ was 37.6 (SD 12.5, range 13 - 59) years. A predominant number of male patients were in the sample (n=21, 63.6%). Underlying aetiology of end stage renal disease (ESRD), was predominantly due to chronic hypertension (39.3%; n=13) and diabetic kidney disease (21.2%, n=7) accounting for nearly 60% of the study participants. Among the 33 live donors 1st degree, 2nd degree and non-relative donors were 54.4% (n=18), 18.2% (n=6) and 27.3% (n=9) respectively. Pre-implantation renal biopsy results reported 36.4% (n=12) with abnormal biopsy findings including chronic interstitial nephritis (n=4, 12.1%), interstitial fibrosis (n=6, 18.18%) and acute tubular necrosis (n=2, 6%). Follow-up revealed delayed graft function occurring in 18.2% (n=6) of recipients with 50% (n=3) of them showing abnormalities in the pre-operative donor biopsy sample. At one month follow-up, 48.5% (n=16) reported complications which included graft failure 3% (n=1), all-cause mortality 3% (n=1), acute rejection 39.4% (n=13) and infections 24.2% (n=8). Overall, 37.5% (n=6) of these recipients had abnormal donor biopsy findings, however no significant statistical association was identified.

Conclusion

Our study identified subclinical kidney disease in donor kidneys despite standard pre-transplant screening. Even though, statistically not significant, recipients with abnormal pre-implantation biopsy findings had adverse short term post-transplant complications.

Foxes (Vulpes vulpes) as sentinels for parasitic zoonoses, Toxoplasma gondii and Trichinella nativa, in the northeastern Canadian Arctic

Outbreaks of Toxoplasma gondii and Trichinella spp. have been recurring for decades among Inuit of Nunavik, northeastern Canada. Contact with wildlife has been identified as a risk factor for Inuit exposure to T. gondii, but reservoirs have yet to be confirmed based on direct detection of DNA or organism. Similarly, little is known about the occurrence of Trichinella spp. in wildlife species of Nunavik other than walrus (Odobenus rosmarus) and bears (Ursus americanus, Ursus maritimus). Foxes (Vulpes vulpes) were targeted as possible sentinels for T. gondii and Trichinella spp. because of their high trophic position within the Arctic food chain as carnivorous scavengers. A total of 39 red foxes were sampled from four communities in southern and western Nunavik between November 2015 and September 2016. For the first time in wildlife, a novel magnetic capture DNA extraction and real-time PCR technique was used to isolate and detect T. gondii DNA from the heart and brain of foxes. A double separatory funnel digestion method followed by multiplex PCR was used to recover and genotype larvae of Trichinella spp. from tongues of foxes. Seroprevalence based on detection of antibodies to T. gondii was 41% (95% CI: 27-57%) using a commercially available modified agglutination test (MAT). Detection of DNA of T. gondii and larvae of Trichinella nativa (T2) occurred in 44% (95% CI: 28-60%) and 36% (95% CI: 21-51%) of foxes, respectively. Coinfection with both T. nativa and T. gondii occurred among 23% (95%CI: 13-38%) of foxes which can be attributed to co-transmission from prey and scavenged species in their diet. There was only moderate agreement between T. gondii serology and direct detection of T. gondii DNA using the MC-PCR technique (Kappa test statistic: 0.321), suggesting that using both methods in tandem can increase the sensitivity of detection for this parasite. These findings show that foxes are good sentinels for circulation of parasitic zoonoses in terrestrial northern ecosystems since they are highly exposed, show measurable indicators of infection and do not serve as exposure sources for humans.

Evidence for Toxoplasma gondii in migratory vs. nonmigratory herbivores in a terrestrial arctic ecosystem

It is currently unclear how Toxoplasma gondii (Nicolle and Manceaux, 1908) persists in arctic tundra ecosystems in the absence of felid definitive hosts. To investigate potential transmission routes of T. gondii in a terrestrial arctic food web, we collected samples from two migratory herbivores, Ross’s Geese (Chen rossi (Cassin, 1861)) and Lesser Snow Geese (Chen caerulescens (L., 1758)), and from two resident herbivores, Nearctic brown lemmings (Lemmus trimucronatus (Richardson, 1825)) and collared lemmings (Dicrostonyx groenlandicus (Traill, 1823)), trapped at Karrak Lake, Nunavut, Canada. Antibodies were detected in 76 of 234 (32.4%) serum samples from Ross’s Geese and 66 of 233 (28.3%) serum samples from Lesser Snow Geese. We did not detect T. gondii antibodies in filter-paper eluate tested from thoracic fluid samples collected from 84 lemmings. We did not detect T. gondii DNA in brain tissue from these lemmings. Although a small sample size, our findings suggest that lemmings in this terrestrial arctic ecosystem are not exposed to, or infected with, the parasite. This suggests that oocysts are not introduced into the terrestrial arctic ecosystem at Karrak Lake via freshwater runoff from temperate regions. This study demonstrated that live adult arctic-nesting geese are exposed to T. gondii and therefore migratory herbivorous hosts are potential sources of T. gondii infection for predators in terrestrial arctic ecosystems.

Failure Strengths of Composite Additions and Repairs

Purpose

When adding composite to a cured composite restoration, the intent is to achieve the same failure strength as the original restorative material. This study evaluated the failure strengths of added or repaired composite using various chemical and/or mechanical surface treatments.

Methods

Failure strengths were determined using a four-point bending test. Beam-shaped specimens were fabricated by adding new composite to cured composite (Filtek Supreme Ultra). The cured composites were either fresh or aged seven days (N=10-14). The composite surfaces were left unground or were ground before treatment with various combinations of roughening, acid etching, silane, and dental adhesives (conventional Adper SingleBond Plus or new multimode Scotchbond Universal) and/or tribochemistry (CoJet system). Monolithic composite specimens were the control. Failure strengths were statistically analyzed using one-way analysis of variance and the Fisher protected least significant difference (α=0.05).

Results

Failure strengths (mean ± standard deviation) when composite was added to unground freshly cured composites (111±25 MPa) and aged composites using a new multimode adhesive with (102±22 MPa) or without (98±22 MPa) tribochemical treatment were not significantly lower than the monolithic specimens (122±23 MPa). Grinding the surfaces of freshly cured composite significantly reduced failure strength, either with (81±30 MPa) or without (86±31 MPa) use of conventional adhesive. Failure strengths of aged composites were also significantly lower (51±21 MPa with SingleBond Plus), even after tribochemical treatment (71±29 MPa with SingleBond Plus; 73±35 MPa with Silane-Visiobond).

Conclusions

Using a new multimode adhesive when adding composite to freshly cured or aged composite substrates recovered the failure strength to that of the original monolithic composite.

Cost-effective diagnosis of male oxidative stress using the nitroblue tetrazolium test: useful application for the developing world

Seminal oxidative stress plays an important role in male factor infertility (MFI), worldwide. A study was thus undertaken for the first time to establish seminal reactive oxygen species (ROS) as a clinical marker of MFI in a cohort of Sri Lankan males. The nitro blue tetrazolium (NBT) assay for ROS estimation and modified Endtz test for detecting leucocytes were carried out on semen samples (N = 102) of subfertile males. Age-matched individuals (N = 30) with proven past paternity served as controls. Significantly higher ROS production was evident in individuals with asthenozoospermia and unexplained infertility (Mann-Whitney U-test, P = 0.000), than in the fertile and the other subfertile groups tested. Receiver operating characteristic plot analysis established cut-off points of 40.57 and 42.02 μg formazan/10(7) spermatozoa for ROS to distinguish fertile males from asthenozoospermics (71.4% sensitivity: 70% specificity; AUC = 0.82), and from unexplained infertile males (74.1 % sensitivity: 73.3% specificity; AUC = 0.85) respectively. As ROS appear to be a potential marker of male infertility, it is imperative to validate this test as a simple, cost-effective hence a widely accessible diagnostic tool to be included in MFI investigations in the developing world.

Internal-external percutaneous transhepatic biliary drainage for malignant biliary obstruction: a retrospective analysis

When percutaneous transhepatic biliary drainage (PTBD) is required for the management of malignant biliary obstruction, the local policy favours the use of internal-external drains. Regular planned drain exchanges are scheduled, and patients have open access back into the system to minimise complications. The aim of this study was to evaluate the success and complication rate of this method for the palliation of malignant biliary obstruction. The hospital records of 43 consecutive patients who underwent PTBD for malignant biliary obstruction at a single institution between 1 February 2004 and 31 January 2006 were reviewed. Outcomes were examined until January 2008. Biliary decompression was achieved in all 43 patients. The level of obstruction was defined as distal in 24 patients and perihilar in 19 patients. There was one procedure-related death. There were 91 routine outpatient drain exchanges performed at a median interval of 45 (range 21-64) days. Overall, 24/43 patients encountered 80 discrete complications related to biliary drainage. Fifty-two non-scheduled drain exchanges (accounting for 65% of all complications) were performed on an outpatient basis. Fourteen patients were readmitted on a median of one (range 1-3) occasion for a median duration of 3 (range 1-12) days. Median survival was 71 (range 7-850) days. PTBD can be performed with low mortality, but long-term morbidity remains high despite an aggressive approach to maintaining biliary patency. Providing patients with an open-access service means the majority of complications can be dealt with on an outpatient basis.

A prospective trial comparing the Holland nail with the dynamic hip screw in the treatment of intertrochanteric fractures of the hip

We compared the outcome of patients treated for an intertrochanteric fracture of the femoral neck with a locked, long intramedullary nail with those treated with a dynamic hip screw (DHS) in a prospective randomised study. Each patient who presented with an extra-capsular hip fracture was randomised to operative stabilisation with either a long intramedullary Holland nail or a DHS. We treated 92 patients with a Holland nail and 98 with a DHS. Pre-operative variables included the Mini Mental test score, patient mobility, fracture pattern and American Society of Anesthesiologists grading. Peri-operative variables were anaesthetic time, operating time, radiation time and blood loss. Post-operative variables were time to mobilising with a frame, wound infection, time to discharge, time to fracture union, and mortality. We found no significant difference in the pre-operative variables. The mean anaesthetic and operation times were shorter in the DHS group than in the Holland nail group (29.7 vs 40.4 minutes, p < 0.001; and 40.3 vs 54 minutes, p < 0.001, respectively). There was an increased mean blood loss within the DHS group versus the Holland nail group (160 ml vs 78 ml, respectively, p < 0.001). The mean time to mobilisation with a frame was shorter in the Holland nail group (DHS 4.3 days, Holland nail 3.6 days, p = 0.012). More patients needed a post-operative blood transfusion in the DHS group (23 vs seven, p = 0.003) and the mean radiation time was shorter in this group (DHS 0.9 minutes vs Holland nail 1.56 minutes, p < 0.001). The screw of the DHS cut out in two patients, one of whom underwent revision to a Holland nail. There were no revisions in the Holland nail group. All fractures in both groups were united when followed up after one year. We conclude that the DHS can be implanted more quickly and with less exposure to radiation than the Holland nail. However, the resultant blood loss and need for transfusion is greater. The Holland nail allows patients to mobilise faster and to a greater extent. We have therefore adopted the Holland nail as our preferred method of treating intertrochanteric fractures of the hip.

Poisoning due to Abrus precatorius (jequirity bean)

The management of a patient with poisoning due to ingestion of the jequirity bean (Abrus precatorius) is presented. The clinical features of this case included pulmonary oedema and hypertension; this has not been recorded previously in the literature associated with jequirity bean poisoning.

Comparison of iodophor and alcohol pledgets with the Medi-Flex blood culture prep kit II for preventing contamination of blood cultures

Iodophor and alcohol pledgets were compared with the Medi-Flex Prep Kit II for skin disinfection before venipuncture. Of 12,367 blood cultures collected, 6,362 were done with conventional pledgets and 6, 005 were done with Medi-Flex kits. Contamination occurred in 351 of 6,362 blood cultures (5.5%; range, 3.7 to 8.1%) with conventional pledgets versus 328 of 6,005 (5.5%; range, 3.5 to 7.5%) with Medi-Flex kits.

The role of atrial vessels in aortic root and mitral valve operations

BACKGROUND

For the last 90 years, several authors have focused on studying the blood supply to the conduction system in the human heart. However, an important gap has been maintained between this topic and cardiac surgical procedures when they should have been closely matched. This paper is aimed at clarifying the morphology of the conduction system and its blood supply and assessing its role in cardiac surgical procedures.

METHODS

Twenty human hearts were dissected after antegrade and retrograde injection. After dissection, different surgical procedures were simulated. Finally, we assessed the damage that these procedures might have caused either to the conduction system or to the vessels supplying it.

RESULTS

Kügel's artery, the right superior descending artery, and the sinoatrial node artery were found to be harmed by the surgical procedures performed. In all these cases, these vessels were supplying part of the conduction system.

CONCLUSIONS

All the vascular structures described in the paper play a very important role in the blood supply to the conduction system, and they become vulnerable during aortic root and mitral valve surgical procedures.

Retrograde venography and colour Doppler imaging of a popliteal venous aneurysm

Popliteal venous aneurysms are rare and usually manifest with formation of thrombus and embolization to the lungs. The radiological features of a popliteal venous aneurysm, without thrombus, initially identified by ultrasound with colour Doppler imaging and further investigated with retrograde venography is described.

Indirect estimation of infant mortality trends: simulation tests on the Feeney method

The methods developed by Griffith Feeney for the indirect estimation of infant mortality are reviewed and tested using simulated data. It is concluded that the proposed method provides excellent results if all the specified conditions are satisfied. "The 'short-cut' method usually applied is appropriate only when the age-pattern of mortality is of (or close to) the Brass type. The more general method involving the solution of a complex equation will otherwise have to be used." By "simulating ideal situations where the method should otherwise work, the article shows the type and level of error that results when the age-pattern of mortality does not correspond to that of the model. The non-respect of other assumptions means a risk of further error but the crucial assumption is that which concerns mortality." (summary in FRE, ITA)