Long-Term Outcome and Prognostic Factors of Juvenile Dermatomyositis: A Multinational, Multicenter Study of 490 Patients

Objective. To investigate the long-term outcome and prognostic factors of juvenile dermatomyositis (DM) through a multinational, multicenter study.Methods. Patients consisted of inception cohorts seen between 1980 and 2004 in 27 centers in Europe and Latin America. Predictor variables were sex, continent, ethnicity, onset year, onset age, onset type, onset manifestations, course type, disease duration, and active disease duration. Outcomes were muscle strength/endurance, continued disease activity, cumulative damage, muscle damage, cutaneous damage, calcinosis, lipodystrophy, physical function, and health-related quality of life (HRQOL).Results. A total of 490 patients with a mean disease duration of 7.7 years were included. At the cross-sectional visit, 41.2-52.8% of patients, depending on the instrument used, had reduced muscle strength/endurance, but less than 10% had severe impairment. Persistently active disease was recorded in 41.2-60.5% of the patients, depending on the activity measure used. Sixty-nine percent of the patients had cumulative damage. The frequency of calcinosis and lipodystrophy was 23.6% and 9.7%, respectively. A total of 40.7% of the patients had decreased functional ability, but only 6.5% had major impairment. Only a small fraction had decreased HRQOL. A chronic course, either polycyclic or continuous, consistently predicted a poorer outcome. Mortality rate was 3.1%.Conclusion. This study confirms the marked improvement in functional outcome of juvenile DM when compared with earlier literature. However, many patients had continued disease activity and cumulative damage at followup. A chronic course was the strongest predictor of poor prognosis. These findings highlight the need for treatment strategies that enable a better control of disease activity over time and the reduction of nonreversible damage.

Conditioning factors of the success of population policies: the cases of El Salvador and Costa Rica

Includes bibliography

Predictive factors of post-discharge surgical site infections among patients from a teaching hospital

Introduction Surgical site infections (SSIs) often manifest after patients are discharged and are missed by hospital-based surveillance. Methods We conducted a case-reference study nested in a prospective cohort of patients from six surgical specialties in a teaching hospital. The factors related to SSI were compared for cases identified during the hospital stay and after discharge. Results Among 3,427 patients, 222 (6.4%) acquired an SSI. In 138 of these patients, the onset of the SSI occurred after discharge. Neurological surgery and the use of steroids were independently associated with a greater likelihood of SSI diagnosis during the hospital stay. Conclusions Our results support the idea of a specialty-based strategy for post-discharge SSI surveillance.

Antimicrobial photodynamic therapy in rat experimental candidiasis: evaluation of pathogenicity factors of Candida albicans

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Influence of professional experience on detection and treatment decision of occlusal caries lesions in primary teeth

To evaluate the influence of examiner's clinical experience on detection and treatment decision of caries lesions in primary molars. Design Three experienced dentists (Group A) and three undergraduate students (Group B) used the International Caries Detection and Assessment System (ICDAS) criteria and bitewing radiographs (BW) to perform examinations twice in 77 primary molars that presented a sound or carious occlusal surface. For the treatment decision (TD), the examiners attributed scores, analyzing the teeth in conjunction with the radiographs. The presence and the depth of lesion were validated histologically, and reproducibility was evaluated. The sensitivity, specificity, accuracy, and area under the ROC curve values were calculated for ICDAS and BW. The associations between ICDAS, BW, and TD were analyzed by means of contingency tables. Results Interexaminer agreement for ICDAS, BW, and TD were excellent for Group B and moderate for Group A. The two groups presented similar and satisfactory performance for caries lesion detection using ICDAS and BW. In the treatment decision, Group A was shown to have a less invasive approach than Group B. Conclusion The examiner's experience was not determinant for the clinical and radiographic detection of occlusal lesions in primary teeth but influenced the treatment decision of initial lesions.

Prevalence and possible risk factors of peri-implantitis: a concept review

The purpose of this review is to estimate the prevalence of peri-implantitis, as well as to determine possible risk factors associated with its development in patients treated with oral implants. Although implant therapy has been identified as a successful and predictable treatment for partially and fully edentulous patients, complications and failures can occur. Peri-implantitis is considered a biologic complication that results in bone loss around implants and may lead to implant treatment failure. A great variation has been observed in the literature regarding the prevalence of peri-implantitis according to the diagnostic criteria used to define peri-implantitis. The prevalence ranges from 4.7 to 43% at implant level, and from 8.9 to > 56% at patient level. Many risk factors that may lead to the establishment and progression of peri-implantitis have been suggested. There is strong evidence that presence and history of periodontitis are potential risk factors for peri-implantitis. Cigarette smoking has not yet been conclusively established as a risk factor for peri-implantitis, although extra care should be taken with dental implant in smokers. Other risk factors, such as diabetes, genetic traits, implant surface roughness and presence of keratinized mucosa still require further investigation. Peri-implantitis is not an uncommon complication following implant therapy. A higher prevalence of peri-implantitis has been identified for patients with presence or history of periodontal disease and for smokers. Until now, a true risk factor for peri-implantitis has not been established. Supportive maintenance program is essential for the long-term success of treatments with oral implants. The knowledge of the real impact of peri-implantitis on the outcome of treatments with oral implants as well as the identification of risk factors associated to this inflammatory condition are essential for the development of supportive maintenance programs and the establishment of prevention protocols.

Photodynamic inactivation of virulence factors of Candida strains isolated from patients with denture stomatitis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Building Leadership: The Knowledge of Principals in Creating Collaborative Communities of Professional Learning

Research literature is replete with the importance of collaboration in schools, the lack of its implementation, the centrality of the role of the principal, and the existence of a gap between knowledge and practice--or a "Knowing-Doing Gap." In other words, there is a set of knowledge that principals must know in order to create a collaborative workplace environment for teachers. This study sought to describe what high school principals know about creating such a culture of collaboration. The researcher combed journal articles, studies and professional literature in order to identify what principals must know in order to create a culture of collaboration. The result was ten elements of principal knowledge: Staff involvement in important decisions, Charismatic leadership not being necessary for success, Effective elements of teacher teams, Administrator‘s modeling professional learning, The allocation of resources, Staff meetings focused on student learning, Elements of continuous improvement, and Principles of Adult Learning, Student Learning and Change. From these ten elements, the researcher developed a web-based survey intended to measure nine of those elements (Charismatic leadership was excluded). Principals of accredited high schools in the state of Nebraska were invited to participate in this survey, as high schools are well-known for the isolation that teachers experience--particularly as a result of departmentalization. The results indicate that principals have knowledge of eight of the nine measured elements. The one that they lacked an understanding of was Principles of Student Learning. Given these two findings of what principals do and do not know, the researcher recommends that professional organizations, intermediate service agencies and district-level support staff engage in systematic and systemic initiatives to increase the knowledge of principals in the element of lacking knowledge. Further, given that eight of the nine elements are understood by principals, it would be wise to examine reasons for the implementation gap (Knowing-Doing Gap) and how to overcome it.

Access to healthcare services for tuberculosis: analysis of patient satisfaction

Tuberculosis remains a pubic health challenge. Uncountable efforts are made to control the disease, and patient treatment and accessibility to healthcare can hinder reaching a cure. The objective of this article is to analyze the satisfaction of tuberculosis patients regarding tuberculosis control services. This is an epidemiological, prospective study, using both a quantitative and qualitative approach. Data were collected using a semi-structured questionnaire. Participants included 77 patients. The quantitative data were positively evaluated, and the qualitative data permitted an understanding of the patients' experience regarding their accessibility and treatment. Aspects such as the criteria for performing Directly Observed Treatment and the proximity of the healthcare facility to the patients' residence affected their satisfaction, which implies the need to reorganize healthcare services in order to provide more appropriate care to tuberculosis patients.