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.

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.

Dynamic Inefficiency in an Overlapping Generation Economy with Pollution and Health Costs

Revised 2008-08.-- Published as an article in: Journal of Public Economic Theory (2008), 10(4), 563-594.

2007 Annual Report: Hydrologic Conditions in Baseflow Reaches Pursuant to Conditions 14 and 15, Santa Lucia Preserve, Monterey County, California

This report presents the results of the 2007 baseflow condition surveys of the four major streams flowing through Santa Lucia Preserve- Las Garzas, Portrero, San Jose, and San Clemente Creeks. This report has been prepared for the Santa Lucia Conservancy and is primarily intended for the staff of Monterey County and California Department of Fish and Game, in accordance with the baseflow monitoring and reporting requirements outlined in County Conditions 14 and 15. The scope of this report is limited to the presentation and evaluation of existing baseflow conditions as required by Conditions 14 and 15, and is not intended as a comprehensive analysis. However, data presented here are an important part of the long term data set that will be used for future in depth watershed analyses. (Document contains 13 pages & 14 figs)

1998 warmwater fish survey of Vancouver Lake, Clark County

The Vancouver Lake warmwater fish population was sampled during the fall of 1998. Vancouver Lake is a large lake, connected directly to the Columbia River through the Lake River to the north and the constructed flushing channel on the eastern shore. A total of 16 species of fish were encountered, mostly warmwater game fish with a few seasonal visitors. The lake has suffered from water quality problems, and during the 1970s, it was dredged, and a channel was created to aid in increasing the water turnover rate, effectively connecting both ends of the lake to the Columbia River. As there is direct access to the Columbia River, managing this lake as a closed system may prove difficult. It is of our opinion that it may be a more effective use of resources to increase the anglers access to the available resources through providing improved boat launch access, and fish habitat structure throughout the lake. Additionally, educating the public about the how-to's of common carp angling could possibly open up additional resources not commonly utilized by the public. (Document pdf contains 38 pages)

Evaluation of the quantity and quality of the water resources of Volusia County, Florida

This report amplifies and refines some of the data already issued covering the water resources of Volusia County, which were published as Report of Investigations No. 21. The work in the report was accomplished as a cooperative program between the Department of Natural Resources, the U. S. Geological Survey and the Board of County Commissioners of Volusia County. Volusia County is almost totally dependent upon the water which falls upon the county and has a recharge area contained along the western portion and the central portions of the county. Excellent water is produced in the areal recharge and it is anticipated that this data will expand the existing knowledge of the water resources to permit the development of a great capacity for existing utilities and to offset and solve some of the problems now in the area. (PDF has 71 pages.)

Wastewater treatment plant inspection program, fiscal year 2006 and 2007 data report

This data report includes the results from Alachua County Environmental Protection Department’s inspections of wastewater treatment plants (WWTP) within Alachua County during the 2006 and 2007 fiscal years (October 2005 – September 2007). Groundwater monitoring data provided to the Florida Department of Environmental Protection Department by the WWTP operators is included for those treatment plants that are required to submit this information (PDF has 44 pages.)

Spatial and temporal analysis of bottlenose dolphin strandings in South Carolina, 1992-2005

This CD contains summary data of bottlenose dolphins stranded in South Carolina using a Geographical Information System (GIS) and contains two published manuscripts in .pdf files. The intent of this CD is to provide data on bottlenose dolphin strandings in South Carolina to marine mammal researchers and managers. This CD is an accumulation of 14 years of stranding data collected through the collaborations of the National Ocean Service, Center for Coastal Environmental Health and Biomolecular Research (CCEHBR), the South Carolina Department of Natural Resources, and numerous volunteers and veterinarians that comprised the South Carolina Marine Mammal Stranding Network. Spatial and temporal information can be visually represented on maps using GIS. For this CD, maps were created to show relationships of stranding densities with land use, human population density, human interaction with dolphins, high geographical regions of live strandings, and seasonal changes. Point maps were also created to show individual strandings within South Carolina. In summary, spatial analysis revealed higher densities of bottlenose dolphin strandings in Charleston and Beaufort Counties, which consist of urban land with agricultural input. This trend was positively correlated with higher human population levels in these coastal counties as compared with other coastal counties. However, spatial analysis revealed that certain areas within a county may have low human population levels but high stranding density, suggesting that the level of effort to respond to strandings is not necessarily positively correlated with the density of strandings in South Carolina. Temporal analysis revealed a significantly higher density of bottlenose dolphin strandings in the northern portion of the State in the fall, mostly due to an increase of neonate strandings. On a finer geographic scale, seasonal stranding densities may fluctuate depending on the region of interest. Charleston Harbor had the highest density of live bottlenose dolphin strandings compared to the rest of the State. This was due in large part to the number of live dolphin entanglements in the crab pot fishery, the largest source of fishery-related mortality for bottlenose dolphins in South Carolina (Burdett and McFee 2004). Spatial density calculations also revealed that Charleston and Beaufort accounted for the majority of dolphins that were involved with human activities. 1

Prioritizing county-level well-being: Moving toward assessment of Gulf Coast counties impacted by the Deepwater Horizon Industrial Disaster

To develop a portfolio of indicators and measures that could best measure changes in the social, economic, environmental and health dimensions of well-being in coastal counties we convened a group of experts March 8-9, 2011 in Charleston, SC, U.S.A. The region of interest was of the northern Gulf of Mexico, specifically, those coastal counties most impacted during the explosion and subsequent oil spill from the Macondo Prospect wellhead during the summer of 2010. Over the course of the two-day workshop participants moved through presentations and facilitated sessions to identify and prioritize potential indicators and measures deemed most valuable for capturing changes in well-being related to changes in or disruption of ecosystem services. The experts reached consensus on a list of indicators that are now being operationalized by NOAA researchers. The ultimate goal of this research project is to determine whether a meaningful set of social and economic indicators can be developed to document changes in well-being that occur as a result of changes in ecosystem services. The outcomes and outputs from the workshop that is the subject of this report helped us to identify high-quality indicators useful for measuring well-being.

Recommendations on the effects of aquaculture on public health

The paper presents some recommendations on the effects of aquaculture on all persons affected by and involved in aquaculture, and to other users of waters in [which] aquatic organisms are farmed or which are affected by aquaculture: the farm workers, handlers and processors, sellers and consumers of aquaculture products.

Emergency department crowding: prioritising quantified crowding measures using a Delphi study.

AimsEmergency department (ED) crowding has been associated with a number of negative health outcomes, including unnecessary deaths, increased waiting times and a decrease in care quality. Despite the seriousness of this issue, there is little agreement on appropriate crowding measures to assess crowding effects on ED operations. The objective of this study was to prioritise a list of quantified crowding measures that would assess the current state of a department.MethodsA three round Delphi study was conducted via email and an Internet based survey tool. The panel consisted of 40 professionals who had exposure to and expertise in crowding. Participants submitted quantified crowding measures which, through three rounds, were evaluated and ranked to assess participant agreement for inclusion.ResultsThe panel identified 27 measures of which eight (29.6%) reached consensus at the end of the study. These measures comprised: (1) ability of ambulances to offload; (2) patients who leave without being seen or treated; (3) time until triage; (4) ED occupancy rate; (5) patients' total length of stay in the ED; (6) time to see a physician; (7) ED boarding time; and (8) number of patients boarding in the ED.ConclusionsThis study resulted in the identification of eight quantified crowding measures, which present a comprehensive view of how crowding is affecting ED operations, and highlighted areas of concern. These quantified measures have the potential to make a considerable contribution to decision making by ED management and to provide a basis for learning across different departments.

Theory and practice in strategic planning for health information systems

Bradshaw, K. & Urquhart, C. (2005). Theory and practice in strategic planning for health information systems. In: D. Wainwright (Ed.), UK Academy for Information Systems 10th conference 2005, 22-24 March 2005 (CD-ROM). Newcastle upon Tyne: Northumbria University.