MasterOnline Periodontology and Implant Therapy-revisited after seven years: A case study of the structures and outcomes in a blended learning CPD

INTRODUCTION

There is a great need for postgraduate training and continuing professional development (CPD), specifically in the field of periodontology. Despite the plenty of periodontal CPDs, there is a lack of information about the performance of CPDs in a blended learning setting. This study is a case study of the structures and outcomes in a blended learning CPD programme in periodontology, the MasterOnline Periodontology and Implant Therapy hosted by the University of Freiburg's Dental School.

MATERIAL AND METHODS

The structures of the blended learning CPD were analysed with the aims to (i) make explicit how various innovative educational methods and ICT tools can be successfully applied to a Web-supported postgraduate periodontology training programme, (ii) identify the programme's impact on learning transfer in students' dental practices and (iii) identify other outcomes, synergies and any changes required during the existence. Using qualitative interviewing, the various types of learning transfer and elements of the study programme that foster transfer could be exemplified.

RESULTS

A period of 7 years was analysed. In this duration, 50 students successfully graduated to a master of science. Qualitative interviews were performed with six students and four teachers affirming the learning transfer in a blended learning setting.

CONCLUSIONS

This case study shows that blended learning can be a successful approach for CPD in dentistry.

Brain serotonin 2A receptor binding: relations to body mass index, tobacco and alcohol use

Manipulations of the serotonin levels in the brain can affect impulsive behavior and influence our reactivity to conditioned reinforcers. Eating, tobacco smoking, and alcohol consumption are reinforcers that are influenced by serotonergic neurotransmission; serotonergic hypofunction leads to increased food and alcohol intake, and conversely, stimulation of the serotonergic system induces weight reduction and decreased food/alcohol intake as well as tobacco smoking. To investigate whether body weight, alcohol intake and tobacco smoking were related to the regulation of the cerebral serotonin 2A receptor (5-HT(2A)) in humans, we tested in 136 healthy human subjects if body mass index (BMI), degree of alcohol consumption and tobacco smoking was associated to the cerebral in vivo 5-HT(2A) receptor binding as measured with (18)F-altanserin PET. The subjects' BMI's ranged from 18.4 to 42.8 (25.2+/-4.3) kg/m(2). Cerebral cortex 5-HT(2A) binding was significantly positively correlated to BMI, whereas no association between cortical 5-HT(2A) receptor binding and alcohol or tobacco use was detected. We suggest that our observation is driven by a lower central 5-HT level in overweight people, leading both to increased food intake and to a compensatory upregulation of cerebral 5-HT(2A) receptor density.

New insights into the biology of cytokinin degradation

A survey of recent results is presented concerning the role of cytokinin degradation in plants, which is catalyzed by cytokinin oxidase/dehydrogenase (CKX) enzymes. An overview of Arabidopsis CKX gene expression suggests that their differential regulation by biotic and abiotic factors contributes significantly to functional specification. Here, we show using reporter gene and semiquantitative RT-PCR analyses regulation of individual CKX genes by cytokinin, auxin, ABA, and phosphate starvation. Partially overlapping expression domains of CKX genes and cytokinin-synthesizing IPT genes in meristematic tissues and endo-reduplicating cells lend support for a locally restricted function of cytokinin. On the other hand, their expression in vascular tissue suggests a function in controlling transported cytokinin. Recent studies led to a model for the biochemical reaction mechanism of CKX-mediated catalysis, which was refined on the basis of the three-dimensional enzyme structure. Last but not least, the developmental functions of CKX enzymes are addressed. The recent identification of the rice OSCKX2 gene as an important novel breeding tool is highlighted. Together the results corroborate the relevance of metabolic control in determining cytokinin activity.

Impact of psychotherapeutic support on gastrointestinal cancer patients undergoing surgery: survival results of a trial

BACKGROUND/AIMS

The impact of psychotherapeutic support on survival time in patients with gastrointestinal cancer undergoing surgery was studied.

METHODOLOGY

A randomized controlled trial was conducted in cooperation with the Departments of General Surgery and Medical Psychology, University Hospital of Hamburg, Germany. Two hundred and seventy-one consenting patients with a preliminary diagnosis of cancer of the esophagus, stomach, liver/gallbladder, pancreas or colon/rectum were stratified by gender and randomly assigned to a control group that received standard care, as provided on the surgical wards, or to an experimental group that received formal psychotherapeutic support in addition to routine care during the hospital stay. Patients in both groups completed the EORTC-Quality of Life questionnaire pre-operatively, post-operatively, and at 3, 6, 12, and 24 months following surgery. Date of death, if applicable, was also recorded. Unadjusted and adjusted survival analyses were performed.

RESULTS

Kaplan-Meier survival curves demonstrated better survival for the experimental group than for the control group. The unadjusted significance level for group differences was p = 0.002 for survival up to 2 years. Cox regression models that took TNM Staging or the Residual Tumor Classification into account also found significant differences at the 2-year follow-up. Secondary analyses found that most of the differences in favor of the experimental group occurred in females and in patients with stomach, pancreatic, primary liver or colorectal cancer.

CONCLUSIONS

The results of this study indicate that patients with gastrointestinal cancer, particularly those who are female and those who undergo surgery for stomach, pancreatic, primary liver or colorectal cancer, benefit from a formal program of psychotherapeutic support in terms of survival.

[Deliveries at a department of surgery during a 10-year period]

In order to see whether the pattern of referral of pregnant women, intervention during labour and transport of neonates had changed over a 10-year period, we investigated these variables in the women who gave birth at our department of surgery in 1978, 1981 and 1988. The numbers of women were 790, 630 and 697 respectively for the three years, and the corresponding numbers of neonates transferred to the neonatal unit were 56, 44 and 53 respectively. The frequencies of risk pregnancies increased from 20% in 1978 to 37.7% in 1999, (p < 10(-6) and the frequency of primiparity increased from 43% to 51.2% over the same period (p < 10(-5)). More women underwent elective caesarean section due to an increased number of breech presentation in nulliparous women (p < 10(-3)). The frequency of induction of labour decreased from 21.7% to 16.5% (p < 10(-6)). The perinatal mortality ranges between 0% to 0.48% during the 10 years, and the rates of transfer of neonates to the neonatal unit were unchanged (7.1-7.6%). It is concluded that changes in referral and composition of the population had no influence on the incidence of acute intervention in labour or rate of neonatal transfer.

Which types of perinatal events are predictable? A look at a risk score model

This study describes the association of a risk factor model for complicated delivery, perinatal morbidity and perinatal mortality with each of various types of delivery complications, types of perinatal morbidity and causes of perinatal mortality. The material comprises a total cohort, 4,066 pregnant women with singletons in a Danish county, and their newborn infants, of whom 494 (12%) had clinical morbidity during the first 5 days of life; 28 (0.7%) died perinatally. A set of 20 risk factors, identifiable before pregnancy, at any time during the pregnancy or at term, was devised by joining existing models for prediction of complicated delivery and of perinatal morbidity and mortality. Metabolic and disproportion-related events were well predicted by the model, inertia-related ones less so, and placental conditions not at all, except for abruption. All types of neonatal morbidity (except sepsis) were well predicted, as were deaths. The strongest predictors of perinatal death were signs of hydramnios (RR = 16.1) and growth retardation (RR = 7.2). The 20 risk factors affected 43% of the population, predicting 57% of the unfavorable perinatal events.

Antenatal and perinatal conditions correlated to handicap among 4-year-old children

The purpose of this study was to investigate the impact of maternal prepregnancy and pregnancy-related risk factors, complicated delivery, and perinatal morbidity on subsequent handicaps in children. We surveyed a birth cohort of 4102 mothers and 4138 children in Frederiksborg County, Denmark. Maternal risk factors were defined according to guidelines published by the Danish National Board of Health, and perinatal morbidity and handicaps according to World Health Organization guidelines. The incidence of handicaps: (cerebral palsy, mental retardation [mild and severe], epilepsy, severe defects of vision and hearing); was 44 of 4038 children (twins and neonatal deaths were excluded). A combination of three or more maternal risk factors was found to be a predictor of risk for children with later handicaps; the incidence of handicaps was 11 times higher than in mothers with no risk factors. Eleven percent of all mothers had three or more risk factors and they had 43% of the handicapped children. Multiparity increased the risk in all risk categories. Of complications at delivery, intrapartum asphyxia, as evident from Apgar scores of less than 7 at 1 minute and less than 10 at 10 minutes in particular, was a strong predictor of a later handicap. Premature rupture of membranes for more than 24 hours was also significantly associated with later handicaps. Perinatal morbidity was correlated with a later handicap. The perinatal complication most strongly associated with later handicaps was low birthweight. Forty-eight percent of the affected children had a birthweight of less than 2500 gm and were small for gestational age. We conclude that the incidence of handicaps could possibly be reduced if the causes of the following maternal risk factors were identified and, if possible, eliminated: previous delivery of a child with a birthweight less than 2500 gm, previous delivery of a stillborn child, repeated abortions, severe infection during pregnancy, intrauterine growth retardation, and preterm delivery. Improved intrapartum diagnosis and prevention of asphyxia and treatment of children born with low Apgar scores would reduce the incidence of handicaps, as would intervention to prevent premature rupture of the membranes of more than 24 hour's duration.

The unborn and newborn child. I. Risk factors predicting complicated delivery in a general population of 4,102 women

Among the 56 risk factors (RF) in pregnant women, used by the Danish National Board of Health, those that can predict complicated delivery (CD) were identified. The significance of parity, maternal age, social class and civil status was also analysed. The material comprises a Danish county cohort of 4,102 deliveries. The 56 original RFs affected 56% of the population. Women (8.8%) with twin pregnancy, fetus in breech, footling and transverse lie, or having an elective cesarean section were analysed separately. The incidence of CD was otherwise 39%. Of all the women, 8.7% had only prepregnancy RFs with a CD rate of 52%; 19.2% had only pregnancy RFs other than special conditions mentioned with a CD rate of 52%; 3.6% had both prepregnancy and pregnancy RFs with a CD rate of 62%. When the special conditions separately analysed were included, 14 RFs of the original 56 were found to predict complicated delivery. These affected 40% of the population. Primiparity was also a RF. The conceptional age of a primipara raised the odds in favor of CD by a factor 1.09 for each year. Social class and civil status were of no significance for CD.

The unborn and newborn child. II. Risk factors predicting perinatal morbidity and mortality in 4,138 infants

In this study, antenatal risk factors (RF) predicting perinatal morbidity and mortality (PMM) were identified among 56 RFs defined by the Danish National Board of Health. The association with parity, age, social class, civil status, complicated delivery was also analysed. The RFs predicting complicated delivery have been described in Part I (1). All events, both prenatal and during the perinatal period, in 4,138 infants borne by 4,102 women in an entire Danish district were analysed. The frequency of perinatal mortality was 0.8% and of perinatal morbidity, 12.7%. The original 56 RFs affected 56% of the population. Fourteen 'new' RFs among the original 56 RFs predicted PMM and affected 27% of the population. The prepregnancy RFs affected 4.5% of all women with singleton pregnancies and their infants had a PMM rate of 21%; the pregnancy RFs affected 18.1%, the PMM rate being 25%; 3.4% had both prepregnancy and pregnancy RFs, their PMM rate was 41%. Twin pregnancies occurred in 0.9%, with a PMM rate of 47%. Apart from these groups, the PMM rate was only 8%. Parity, social class and civil status were of no significance for PMM. Some delivery complications, termed labor RFs, raised the odds of PMM by a factor of 1.92.

The prevalence of female urinary incontinence and reasons for not seeking treatment

The prevalence of urinary incontinence in women aged 18 years and over was investigated by carrying out a telephone interview of 851 women randomly selected from the Dunedin electoral register. Two hundred and sixty seven (31%) of the women interviewed had some degree of incontinence in the preceding 12 months and 142 (17%) had had regular incontinence (two or more episodes of leakage per month). Daily incontinence occurred in approximately 5% of the women sampled with 2.3% being incontinent more than once per day or being continually incontinent. Only one third of those with regular incontinence had sought medical help for their problem. The commonest reasons for this were that either the incontinence was not seen as abnormal (81%) or there was a low expectation of benefit from treatment (10%). Thus there needs to be improved awareness that incontinence is treatable and that medical and surgical treatment options are available.

The unborn and the newborn child. Present obstetric risk grouping fails to predict complicated labour and neonatal morbidity

An epidemiologic analysis is presented of 4,102 women to a birth cohort in Frederiksborg County. The purpose is to evaluate the predictive value of pregnancy risk groups (R) present before labour for complicated delivery (CD) and neonatal morbidity (NM). The risk factors defining R comply with the Danish National Board of Health Recommendations. R included 56%. By primary risk group (PR) is understood women only with complicating factors at the onset of pregnancy, by secondary risk group (SR) women only with complicating factors occurring during pregnancy. The tertiary risk group (TR), which includes women with a complication which with certainty implies CD, was excluded. PR and SR were significant regression variables evaluated by CD and NM. Primiparae had a higher frequency of CD than multiparae, both in the no-risk group (N-R) and in the R, but not evaluated by NM. Primiparity, thus, was a risk factor for CD. NM correlated with CD in the form of severe risk conditions for both the mother and child during delivery. Evaluated by CD and NM, the predictive value of belonging to R was 46% and 16%, and the predictive value of belonging to N-R was 69% and 93%, which suggests that a re-evaluation of the risk factors is required.

The caries-preventive effect of a fluoride varnish in the fissures of the first permanent molar

The aim of the present study was to assess the caries-preventive effect of topical application of Duraphat on the occlusal surface of newly erupted first permanent molars. A base-line examination was performed on children aged 5 years and 9 months. The children were randomly divided into a Duraphat group and a control group. In accordance with the anatomy of the fissure system, the molars were divided into shallow and deep fissures, respectively. From the time of eruption, 381 molars were examined every 3rd month during 24 months. Duraphat was applied every 6th month, altogether four times. The results showed that in the Duraphat group 35% of the fissures were decayed compared with 80% in the control group. Caries reduction amounted to 56%, and the caries-preventive effect was found in molars with shallow and deep fissures.