Periodontal and dental health and oral self-care among adults with diabetes mellitus.

ABSTRACT Bakhshandeh, Soheila. Periodontal and dental health and oral self-care among adults with diabetes mellitus. Department of Oral Public Health, Institute of Dentistry, Faculty of Medicine, University of Helsinki, Helsinki, Finland. 2011. 49 pp. ISBN 978-952-10-7193-5(paperback). The aim of the present study was to assess oral health and treatment needs among Iranian adults with diabetes according to socio-demographic status, oral hygiene, diabetes related factors, and to investigate the relation between these determinants and oral health. Moreover, the effect of an educational oral health promotion intervention on their oral health and periodontal treatment needs was studied. The target population comprised adults with diabetes in Tehran, Iran. 299 dentate patients with diabetes, who were regular attendants to a diabetic clinic, were selected as the study subjects. Data collection was performed through a clinical dental examination and self-administered structured questionnaire. The questionnaire covered information of the subject s social background, medical history, oral health behaviour and smoking. The clinical dental examinations covered the registration of caries experience (DMFT), community periodontal index (CPI) and plaque index (PI). The intervention provided the adults with diabetes dental health education through a booklet. Reduction in periodontal treatment needs one year after the baseline examination was used as the main outcome. A high prevalence of periodontal pockets among the study population was found; 52% of the participants had periodontal pockets with a pocket depth of 4 to 5 mm and 35% had periodontal pockets with pocket depth of 6 mm or more. The mean of the DMFT index was 12.9 (SD=6.1), being dominated by filled teeth (mean 6.5) and missing teeth (mean 5.0). Oral self-care among adults with diabetes was inadequate and poor oral hygiene was observed in more than 80% of the subjects. The educational oral health promotion decreased periodontal treatment needs more in the study groups than in the control group. The poor periodontal health, poor oral hygiene and insufficient oral self-care observed in this study call for oral health promotion among adult with diabetes. An educational intervention showed that it is possible to promote oral health behaviour and to reduce periodontal treatment needs among adults with diabetes. The simplicity of the model used in this study allows it to be integrated to diabetes programmes in particular in countries with a developing health care system.

Oral health, smoking and adolescence

The present cross-sectional study examined the effect of smoking on oral health in a birth cohort of 15 to 16-year-old Finnish adolescents. The hypothesis was that oral health parameters were poorer among smoking than non-smoking subjects and that a tobacco intervention program could be effective among the adolescents. The study was conducted in the Kotka Health Center, Kotka, Finland. Altogether 501 out of 545 subjects (15- to 16-year-old boys [n = 258] and girls [n = 243]) were clinically examined in 2004 and 2005. The sample frame was a birth cohort of all subjects in 1989 and 1990, living in Kotka. A structured questionnaire was also filled in by the participants to record their general health and health habits, such as smoking, tooth brushing, and medication used. The participants were classified into nonsmokers, current smokers, and former smokers. Subgingival pooled plaque samples were taken and stimulated salivary samples were also collected. The subjects were asked from which of seven professional groups (doctors, school nurses, dental nurses, general nurses, dentists, teachers and media professionals) they would prefer to receive information about tobacco. The two most popular groups they picked up were dentists and school nurses. Current smokers (n=127) were then randomly assigned into three groups: the dentist group (n =44), the school-nurse group (n =42), and the control group (n =39). The intervention was based on a national recommendation of evidence based guidelines by The Finnish Medical Society Duodecim ( 5A counseling system). Two months after the intervention, a second questionnaire was sent to the smokers in the intervention groups. Smoking cessation, smoking quantity per week, and self-rated addiction for smoking (SRA) were recorded. The results were analyzed using the R-statistical program. The results showed that 15% of the subjects had periodontitis. Smokers (25%) had more periodontitis than non-smokers (66%) (p < 0.001). Smoking boys (24%) also had more caries lesions than non-smokers (69%) (p < 0.001), and they brushed their teeth less frequently than non-smokers. Smoking significantly impaired periodontal health of the subjects, even when the confounding effects of plaque and tooth brushing were adjusted. Smoking pack-years, intensified the effects of smoking. Periodontal bacteria Prevotella nigrescens, Prevotella intermedia, Tannerella forsythia and Treponema denticola were more frequently detected among the smokers than non-smokers, especially among smoking girls. Smoking significantly decreased the values of both the salivary periodontal biomarkers MMP-8 (p=0.04) and PMN elastase (p=0.02) in boys. The effect was strengthened by pack years of smoking (MMP-8 p=0.04; elastase p0.01). Of those who participated in the intervention, 19 % quit smoking. The key factors associated with smoking cessation were best friend`s influence, nicotine dependence and diurnal type. When the best friend was not a smoker, the risk ratio (RR) of quit smoking after the intervention was 7.0 (Cl 95% 4.6 10.7). Of the diurnal types, the morning people seemed to be more likely to quit (RR 2.2 [Cl 95% 1.4 3.6]). Nicotine dependence also elicited an opposite effect: those who scored between 3 and 5 dependence scores were less likely to quit. In conclusion, smoking appears to be a major etiological risk factor for oral health. However, the early signs of periodontal disease were mild in the subjects studied. Based on the opinions of the adolescent s, dental professionals may have a key position in their smoking cessation. The harmful effects of smoking on oral health could be used in counselling. Best friend`s influence, nicotine dependence and diurnal type, all factors associated with smoking cessation, should be taken more carefully into account in the prevention programs for adolescents.

Rotorcraft research in India: recent developments

Purpose - The purpose of this paper is to discuss published research in rotorcraft which has taken place in India during the last ten years The helicopter research is divided into the following parts health monitoring smart rotor design optimization control helicopter rotor dynamics active control of structural response (ACSR) and helicopter design and development Aspects of health monitoring and smart rotor are discussed in detail Further work needed and areas for international collaboration are pointed out Design/methodology/approach - The archival journal papers on helicopter engineering published from India are obtained from databases and are studied and discussed The contribution of the basic research to the state of the art in helicopter engineering science is brought out Findings - It is found that strong research capabilities have developed in rotor system health and usage monitoring rotor blade design optimization ACSR composite rotor blades and smart rotor development Furthermore rotorcraft modeling and analysis aspects are highly developed with considerable manpower available and being generated in these areas Practical implications - Two helicopter projects leading to the advanced light helicopter and light combat helicopter have been completed by Hindustan Aeronautics Ltd These helicopter programs have benefited from the basic research and also provide platforms for further basic research and deeper industry academic collaborations The development of well trained helicopter engineers is also attractive for international helicopter design and manufacturing companies The basic research done needs to be further developed for practical and commercial applications Originality/value - This is the first comprehensive research on rotorcraft research in India an important emerging market manufacturing and sourcing destination for the industry

Oral health and kidney disease with emphasis on diabetic nephropathy

Chronic kidney disease (CKD) is a worldwide health problem, with adverse outcomes of cardiovascular disease and premature death. The ageing of populations along with the growing prevalence of chronic diseases such as diabetes and hypertension is leading to worldwide increase in the number of CKD patients. It has become evident that inflammation plays an important role in the pathogenesis of atherosclerosis complications. CKD patients also have an increased risk of atherosclerosis complications (including myocardial infarction, sudden death to cardiac arrhythmia, cerebrovascular accidents, and peripheral vascular disease). In line with this, oral and dental problems can be an important source of systemic inflammation. A decline in oral health may potentially act as an early marker of systemic disease progression. This series of studies examined oral health of CKD patients from predialysis, to dialysis and kidney transplantation in a 10-year follow-up study and in a cross-sectional study of predialysis CKD patients. Patients had clinical and radiographic oral and dental examination, resting and stimulated saliva flow rates were measured, whilst the biochemical and microbiological composition of saliva was analyzed. Lifestyle and oral symptoms were recorded using a questionnaire, and blood parameters were collected from the hospital records. The hypothesis was that the oral health status, symptoms, sensations, salivary flow rates and salivary composition vary in different renal failure stages and depend on the etiology of the kidney disease. No statistically significant difference were seen in the longitudinal study in the clinical parameters. However, some saliva parameters after renal transplantation were significantly improved compared to levels at the predialysis stage. The urea concentration of saliva was high in all stages. The salivary and plasma urea concentrations followed a similar trend, showing the lowest values in kidney transplant patients. Levels of immunoglobulin (Ig) A, G and M all decreased significantly after kidney transplantation. Increased concentrations of IgA, IgG and IgM may reflect disintegration of the oral epithelium and are usually markers of poor general oral condition. In the cross-sectional investigation of predialysis CKD patients we compared oral health findings of diabetic nephropathy patients to those with other kidney disease than diabetes. The results showed eg. more dental caries and lower stimulated salivary flow rates in the diabetic patients. HbA1C values of the diabetic patients were significantly higher than those in the other kidney disease group. A statistically significant difference was observed in the number of drugs used daily in the diabetic nephropathy group than in the other kidney disease group. In the logistic regression analyses, age was the principal explanatory factor for high salivary total protein concentration, and for low unstimulated salivary flow. Poor dental health, severity of periodontal disease seemed to be an explanatory factor for high salivary albumin concentrations. Salivary urea levels were significantly linked with diabetic nephropathy and with serum urea concentrations. Contrary to our expectation, however, diabetic nephropathy did not seem to affect periodontal health more severely than the other kidney diseases. Although diabetes is known to associate with xerostomia and other oral symptoms, it did not seem to increase the prevalence of oral discomfort. In summary, this series of studies has provided new information regarding the oral health of CKD patients. As expected, the commencement of renal disease reflects in oral symptoms and signs. Diabetic nephropathy, in particular, appears to impart a requirement for special attention in the oral health care of patients suffering from this disease.

Identification of collagenolytic MMP networks as potential biomarkers in progressive chronic periodontitis subjects and MMP-8 null allele model

Chronic periodontitis results from a complex aetiology, including the formation of a subgingival biofilm and the elicitation of the host s immune and inflammatory response. The hallmark of chronic periodontitis is alveolar bone loss and soft periodontal tissue destruction. Evidence supports that periodontitis progresses in dynamic states of exacerbation and remission or quiescence. The major clinical approach to identify disease progression is the tolerance method, based on sequential probing. Collagen degradation is one of the key events in periodontal destructive lesions. Matrix metalloproteinase (MMP)-8 and MMP-13 are the primary collagenolytic MMPs that are associated with the severity of periodontal inflammation and disease, either by a direct breakdown of the collagenised matrix or by the processing of non-matrix bioactive substrates. Despite the numerous host mediators that have been proposed as potential biomarkers for chronic periodontitis, they reflect inflammation rather than the loss of periodontal attachment. The aim of the present study was to determine the key molecular MMP-8 and -13 interactions in gingival crevicular fluid (GCF) and gingival tissue from progressive periodontitis lesions and MMP-8 null allele mouse model. In study (I), GCF and gingival biopsies from active and inactive sites of chronic periodontitis patients, which were determined clinically by the tolerance method, and healthy GCF were analysed for MMP-13 and tissue inhibitor of matrix metalloproteinases (TIMP)-1. Chronic periodontitis was characterised by increased MMP-13 levels and the active sites showed a tendency of decreased TIMP-1 levels associated with increments of MMP-13 and total protein concentration compared to inactive sites. In study (II), we investigated whether MMP-13 activity was associated with TIMP-1, bone collagen breakdown through ICTP levels, as well as the activation rate of MMP-9 in destructive lesions. The active sites demonstrated increased GCF ICTP levels as well as lowered TIMP-1 detection along with elevated MMP-13 activity. MMP-9 activation rate was enhanced by MMP-13 in diseased gingival tissue. In study (III), we analysed the potential association between the levels, molecular forms, isoenzyme distribution and degree of activation of MMP-8, MMP-14, MPO and the inhibitor TIMP-1 in GCF from periodontitis progressive patients at baseline and after periodontal therapy. A positive correlation was found for MPO/MMP-8 and their levels associated with progression episodes and treatment response. Because MMP-8 is activated by hypochlorous acid in vitro, our results suggested an interaction between the MPO oxidative pathway and MMP-8 activation in GCF. Finally, in study (IV), on the basis of the previous finding that MMP-8-deficient mice showed impaired neutrophil responses and severe alveolar bone loss, we aimed to characterise the detection patterns of LIX/CXCL5, SDF-1/CXCL12 and RANKL in P. gingivalis-induced experimental periodontitis and in the MMP-8-/- murine model. The detection of neutrophil-chemoattractant LIX/CXCL5 was restricted to the oral-periodontal interface and its levels were reduced in infected MMP-8 null mice vs. wild type mice, whereas the detection of SDF-1/CXCL12 and RANKL in periodontal tissues increased in experimentally-induced periodontitis, irrespectively from the genotype. Accordingly, MMP-8 might regulate LIX/CXCL5 levels by undetermined mechanisms, and SDF-1/CXCL12 and RANKL might promote the development and/or progression of periodontitis.

Simulation of potential and electric field across faulty ceramic disc insulator string

Ceramic/Porcelain insulators are widely used in power transmission lines to provide mechanical support for High voltage conductors in addition to withstand electrical stresses. As a result of lightning, switching or temporary over voltages that could initiate flashover under worst weather conditions, and to operate within interference limits. Given that the useful life in service of the individual insulator elements making up the insulator strings is hard to predict, they must be verified periodically to ensure that adequate line reliability is maintained at all times. Over the years utilities have adopted few methods to detect defective discs in a string, subsequently replacement of the faulty discs are being carried out for smooth operation. But, if the insulator is found to be defective in a string at some location that may not create any changes in the field configuration, there is no need to replace to avoid manpower and cost of replacement. Due to deficiency of electric field data for the existing string configuration, utilities are forced to replace the discs which may not be essentially required. Hence, effort is made in the present work to simulate the potential and electric field along the normal and with faults induced discs in a string up to 765 kV system voltages using Surface Charge Simulation Method (SCSM). A comparison is made between simulated results, experimental and field data and it was found that the computed results are quite acceptable and useful.

Cost effective campaigning in social networks

Campaigners are increasingly using online social networking platforms for promoting products, ideas and information. A popular method of promoting a product or even an idea is incentivizing individuals to evangelize the idea vigorously by providing them with referral rewards in the form of discounts, cash backs, or social recognition. Due to budget constraints on scarce resources such as money and manpower, it may not be possible to provide incentives for the entire population, and hence incentives need to be allocated judiciously to appropriate individuals for ensuring the highest possible outreach size. We aim to do the same by formulating and solving an optimization problem using percolation theory. In particular, we compute the set of individuals that are provided incentives for minimizing the expected cost while ensuring a given outreach size. We also solve the problem of computing the set of individuals to be incentivized for maximizing the outreach size for given cost budget. The optimization problem turns out to be non trivial; it involves quantities that need to be computed by numerically solving a fixed point equation. Our primary contribution is, that for a fairly general cost structure, we show that the optimization problems can be solved by solving a simple linear program. We believe that our approach of using percolation theory to formulate an optimization problem is the first of its kind. (C) 2016 Elsevier B.V. All rights reserved.

Strategies for increasing freshwater fish production in the Green Revolution Programme

Sources of fish and fishery products in Nigeria were reviewed. The problems of various agencies involved in freshwater fish production in Nigeria were also analysed, such problems included shortage of manpower, inadequate training for personnel, shortage of funds, lack of infrastructures, among others

Relevance of the programmes of the federal fisheries schools to Nigeria's fishing industry

Nigeria's three federal fisheries schools are administered by three autonomous research institutes located in Lagos, New Bussa, and Maiduguri. The schools were established at different periods to train the required manpower for Nigeria's fishing industry which has remained predominantly artisanal since its inception in 1942 as a Second World War exigency. Despite the establishment of the schools, the industry's manpower is still being dominated by non-nationals especially in the capture fisheries sub-sector. The common features of the schools include the apparent insensitivity of their programmes to the industry's dynamic manpower needs; the absence of coordination of their programmes by a national body which would have ensured that the schools are able to communicate with one another and are willing to act and share a purpose. The need and the methodology for a change of emphasis from the on-going training of extension agents and officers to that of fishing operatives and technicians to enable Nigeria effectively harness her local fish resources towards self-sufficiency is highlighted.

Modern aquaculture practices for increased fish production in Nigeria

Various modern aquaculture practices applied in fish production especially in Asia are reviewed. The vast Nigerian aquatic medium of numerous water bodies like rivers, streams, lakes reservoirs, flood plains, irrigation canals, coastal swamps offer great potentials for aquaculture production, if optimally utilized. Constraints to modernization of aquaculture in Nigeria among other factors are: 1) a serious shortage of trained manpower; 2) lack of knowledge on profitability of aquaculture as an industry; 3) limited availability of fund (or capital); 4) non-recognition of indigenous trained aquaculture personnel; 5) inadequate data base on the biology and ecological requirements of endemic fish species with aquaculture potentials; 6) insufficient data on production and management techniques; and 7) lack of rational aquaculture development planning. Recommendations are made towards combating these constraints

Investment prospects of fish farming in the Jos-Plateau, Nigeria

The investment prospects of fish farming in the Jos-Plateau, Nigeria, strategically located in about the centre of the country are discussed with special reference to its numerous abandoned mine lakes and the tripartite role of government, universities and individuals. In the Jos-Plateau, about 17.0 km super(2) is covered by these disused mine lakes, making up about 20-30% of the area covered. In such enterprise, problems commonly encountered, like population growth and government planning policies, fish demand and supply, manpower, feed and seed availability, preservation, processing and marketing are discussed. Inspite of these, prospects still abound with regards to land-use of these numerous disused mine lakes and feed availability based on the principles of using both industrial and farm by-products for fish culture, processing and marketing. These potentials, if properly harnessed, will help to supplement the protein insufficiency in the diet of the populace. In this regard, proposals on the economics of production and sales, strategies for achieving these development goals, cost-benefit analysis and their implications in further development of fish culture are discussed

Investment in the training of technologists for commercial aquaculture

The protein shortage in Nigeria is noted and the role of aquaculture (=fish farming) as a complement in increasing the dwindling food supply is registered. In addition, the manpower shortage especially in the technology cadre is noted and attributed to the lack of co-ordination and standard curricula especially in aquaculture. An inventory of tasks performed in the aquaculture industry was taken and these were classified and validated, then their final priority level was used to assess which ones were critical, important or desirable and which ones would result in disaster or not with inadequate mastery. Based on the above, recommendations are made that all critical and important tasks be included in the teaching curriculum for aquaculture in both theory and practicals: while it is advocated that all tasks listed be undertaken in fish farm operations. This will raise the competence of technologists to run the commercial aquaculture projects

Utilization of non-piscine pituitary extract in the breeding of Clarias gariepinus

The use of synthetic and non-synthetic hormones have been reported in different regions with the recommendation of different doses. The adaptability of these findings have however not been very successful due to the high cost of building and maintaining hatchery, high cost of synthetic hormone (when available) and high level manpower required. It is obvious that adaptive research in the past ten years in developing countries like Nigeria have been geared towards utilization of resources that are equally effective but cheap and ready to come by. This paper reports the utilization of the pituitary extract of bull frog (Rana adspersa) and the toad (Bufo regularis) in the induced breeding of the African catfish, Clarias gariepinus. The extraction and dosage are discussed alongside the preliminary rearing of fries in outdoor hatchery tanks. Human chorionic gonadotrophin (HCG) and Clarias pituitary extracts were used as control

The role of communication in the management of Nigeria's capture fisheries resources

Development and management indices identified in the capture fishery resources focus on stock management, freshwater and marine pollution by organic and inorganic compounds including silting, plankton sustainability, fishing methods, biological productivity, energy cycles, ornamental fish and sanctuaries. The issue of post-harvest handling and processing is also discussed. The paper also identifies fisheries sectorial problems at the artisanal and industrial level both at sea and at shore, in the processing plant, infrastructure, manpower and marketing issues. The paper suggests that advocacy should be incorporated into extension and communication programme ensuring some changes in attitudes of all stakeholders in the fisheries game. The paper concludes stating that policy makers should stop paying lip-service to the fisheries sub-sector and should create a separate Ministry for Fisheries

Comportamento do titânio comercialmente puro obtido por diferentes processamentos submetidos a soluções fluoretadas

O objetivo deste estudo in vitro foi analisar o comportamento superficial do titânio comercialmente puro (grau 2 ASTM) usinado e obtido pelo processamento de metalurgia do pó sob a ação de diferentes soluções fluoretadas, através da análise do grau de corrosão em microscopia óptica (MO) e da rugosidade superficial. Além disso, o estudo se propôs a comparar essas análises com os resultados obtidos com o titânio fundido da dissertação de mestrado de Barros (2004). Todas as amostras receberam procedimento metalográfico padrão e foram divididas em grupos: Gr.1- saliva artificial com pH 7.0 (controle), Gr.2- gel de flúor fosfato acidulado a 1,23% com pH 3.5, Gr.3- gel de NaF a 2% com pH 6.5, Gr.4- solução de NaF a 0,05% com pH 4.0 e Gr.5- solução de NaF a 0,05% com pH 7.5. As amostras foram expostas a estas soluções por 1, 4, 8 e 16 min, intercaladas com imersão em saliva artificial por 24 h, e depois foram observadas em MO e MEV, a cada intervalo de tempo. As imagens em MO, 100x, foram classificadas através de escores de 0 a 4, conforme o grau de corrosão. A rugosidade foi analisada utilizando o parâmetro Ra. Os resultados da análise de MO foram tratados estatisticamente pelo teste qui-quadrado e da rugosidade pelo teste F de Snedecor e de Bonferroni (p<0,05). Nos três tipos de amostras, o Gr2 apresentou a corrosão mais severa, e os Gr.4 e 5 apresentaram os menores graus de corrosão. Entretanto, nas amostras usinadas o Gr5 apresentou uma corrosão menos acentuada em relação ao Gr4. No Gr3 houve um aumento da corrosão em função do tempo, sendo que as amostras fundidas mostraram este aumento mais rapidamente. Houve um aumento significativo na rugosidade superficial no Gr.2 nos três tipos de amostras. Nos diversos grupos, os valores de rugosidade superficial das amostras fundidas foram significantemente maiores que os das usinadas e as de metalurgia do pó. Os autores concluíram que as soluções fluoretadas de uso odontológico são danosas às superfícies do titânio fundido, usinado e metalurgia do pó, principalmente as soluções com alta concentração de fluoreto.