Minimal intervention dentistry: part 5. Ultra-conservative approach to the treatment of erosive and abrasive lesions.

The therapeutic management of tooth wear lesions does not require the removal of diseased tissue. Nevertheless, diverse etiological factors may be associated with the condition and they could be difficult to eliminate; this has to be considered when planning therapy. Interceptive procedures should be reserved for such situations while regular monitoring is recommended for other cases, in accordance with advice provided for using the Basic Erosive Wear Examination (BEWE). Direct and indirect adhesive procedures with composite resins allow treatment of most clinical situations, including even extensive restorations. The possibility of managing subsequent interventions should be considered when planning the initial therapeutic approach.

Minimal disease activity for rheumatoid arthritis: A preliminary definition

Agreement on response criteria in rheumatoid arthritis (RA) has allowed better standardization and interpretation of clinical trial reports. With recent advances in therapy, the proportion of patients achieving a satisfactory state of minimal disease activity (MDA) is becoming a more important measure with which to compare different treatment strategies. The threshold for MDA is between high disease activity and remission and, by definition, anyone in remission will also be in MDA. True remission is still rare in RA; in addition, the American College of Rheumatology definition is difficult to apply in the context of trials. Participants at OMERACT 6 in 2002 agreed on a conceptual definition of minimal disease activity (MDA): "that state of disease activity deemed a useful target of treatment by both the patient and the physician, given current treatment possibilities and limitations." To prepare for a preliminary operational definition of MDA for use in clinical trials, we asked rheumatologists to assess 60 patient profiles describing real RA patients seen in routine clinical practice. Based on their responses, several candidate definitions for MDA were designed and discussed at the OMERACT 7 in 2004. Feedback from participants and additional on-site analyses in a cross-sectional database allowed the formulation of 2 preliminary, equivalent definitions of MDA: one based on the Disease Activity Score 28 (DAS28) index, and one based on meeting cutpoints in 5 out the 7 WHO/ILAR core set measures. Researchers applying these definitions first need to choose whether to use the DAS28 or the core set definition, because although each selects a similar proportion in a population, these are not always the same patients. In both MDA definitions, an initial decision node places all patients in MDA who have a tender joint count of 0 and a swollen joint count of 0, and an erythrocyte sedimentation rate (ESR) no greater than 10 mm. If this condition is not met: center dot The DAS28 definition places patients in MDA when DAS28

Influence of environmental variability and age on the body condition of small pelagic fish in the Gulf of Lions

Endogenous and environmental variables are fundamental in explaining variations in fish condition. Based on more than 20 yr of fish weight and length data, relative condition indices were computed for anchovy and sardine caught in the Gulf of Lions. Classification and regression trees (CART) were used to identify endogenous factors affecting fish condition, and to group years of similar condition. Both species showed a similar annual cycle with condition being minimal in February and maximal in July. CART identified 3 groups of years where the fish populations generally showed poor, average and good condition and within which condition differed between age classes but not according to sex. In particular, during the period of poor condition (mostly recent years), sardines older than 1 yr appeared to be more strongly affected than younger individuals. Time-series were analyzed using generalized linear models (GLMs) to examine the effects of oceanographic abiotic (temperature, Western Mediterranean Oscillation [WeMO] and Rhone outflow) and biotic (chlorophyll a and 6 plankton classes) factors on fish condition. The selected models explained 48 and 35% of the variance of anchovy and sardine condition, respectively. Sardine condition was negatively related to temperature but positively related to the WeMO and mesozooplankton and diatom concentrations. A positive effect of mesozooplankton and Rhone runoff on anchovy condition was detected. The importance of increasing temperatures and reduced water mixing in the NW Mediterranean Sea, affecting planktonic productivity and thus fish condition by bottom-up control processes, was highlighted by these results. Changes in plankton quality, quantity and phenology could lead to insufficient or inadequate food supply for both species.

Are self-administered or minimal therapist contact psychotherapies an effective treatment for irritable bowel syndrome (IBS): a systematic review.

OBJECTIVE: Irritable bowel syndrome is a highly prevalent gastrointestinal condition that is known to be associated with maladaptive psychological coping and is extremely costly to the health-care system. Psychotherapy has been found to improve both physical and psychological symptoms in IBS. However, it is unknown whether 'no therapist' or 'minimal therapist' contact self-help psychotherapy programs are effective treatments for IBS. Thus, this paper aims to determine whether 'no therapist' or 'minimal therapist' contact self-help psychotherapy programs are effective treatments for IBS. METHODS: A search of PubMed, SCOPUS, Cochrane Library, and Ebscohost research databases was conducted without language or date restriction in July 2012. RESULTS: Nine relevant publications were included in the final review, all of which were randomized controlled trials (RCTs) and included an intervention that was primarily self-administered. It was found that 'no therapist' contact self-help programs are likely to have poor results due to lack of engagement in the program, whilst 'minimal therapist' contact programs appear to produce positive results in terms of symptom relief. Trends towards 'minimal therapist' contact self-help programs having a positive impact on quality of life (QOL) and psychological outcomes were evident. CONCLUSION: 'Minimal therapist' contact psychotherapy programs have the potential to reduce healthcare seeking behaviour and potentially reduce healthcare costs. However, further studies need to be conducted to confirm this effect as there is poor standardisation in the measurements of the available studies.