Occupational Exposure to Knee Loading and the Risk of Osteoarthritis of the Knee: A Systematic Review and a Dose-Response Meta-Analysis

BACKGROUND: Osteoarthritis of the knee is considered to be related to knee straining activities at work. The objective of this review is to assess the exposure dose-response relation between kneeling or squatting, lifting, and climbing stairs at work, and knee osteoarthritis. METHODS: We included cohort and case–control studies. For each study that reported enough data, we calculated the odds ratio (OR) per 5,000 hours of cumulative kneeling and per 100,000 kg of cumulative lifting. We pooled these incremental ORs in a random effects meta-analysis. RESULTS: We included 15 studies (2 cohort and 13 case–control studies) of which nine assessed risks in more than two exposure categories. We considered all but one study at high risk of bias. The incremental OR per 5,000 hours of kneeling was 1.26 (95% confidence interval 1.17–1.35, 5 studies, moderate quality evidence) for a log-linear exposure dose-response model. For lifting, there was no exposure dose-response per 100,000 kg of lifetime lifting (OR 1.00, 95% confidence interval 1.00–1.01). For climbing, an exposure dose-response could not be calculated. CONCLUSION: There is moderate quality evidence that longer cumulative exposure to kneeling or squatting at work leads to a higher risk of osteoarthritis of the knee. For other exposure, there was no exposure dose-response or there were insufficient data to establish this. More reliable exposure measurements would increase the quality of the evidence.

Oral manifestations of hospitalized cirrhotic at Shaikh Zayed hospital, Lahore: a pilot study

Background: in Pakistan cirrhosis has reached alarming proportions due to spread of HCV and HBV viruses. Some of the oral manifestations of cirrhosis have been found to exhibit geographically variability. There is no research available on the oral health of these patients in Pakistan and their specific oral problems are not known

Objectives: this study examined a cohort of cirrhotic patients admitted at Shaikh Zayed hospital Lahore to assess their oral health status and needs

Materials and methods: thirty consecutive patients admitted with diagnosis of cirrhosis were examined for oral health status. Extra oral examination included any visible lesions or abnormalities on the face, head or neck region, lymph node enlargement and TMJ dysfunction. Intra oral examination included measurement of caries [DMFT] and periodontal disease level [CPITN], oral mucosal lesions, prosthetic status and prosthetic needs of the patients. All findings were recorded on the standard WHO oral health survey form

Results: the oral health of this cohort was poor compared to the general population. Xerostomia [20%], papillary atrophy [1 00%], oral Melanosis [90%], petechieal hemaorrhages [26%] and glossitis [53%] were found prevalent in the sample. Two females had oral lichen planus and one of the patients had oral ulceration. DMFT score [Mean=5.7] was not different from national average [Mean=8.02]. Periodontal disease was more severe than general population. Less than 21% of the sample wore prostheses and over 50% needed one. TMJ dysfunction was common but fewer patient complained of the condition that the number of patients with clinical signs

Conclusions: oral health of cirrhotic population is worse than general population and they have significant oral health needs. Further research is required to investigate this relationship. Effective oral health educatior of patients' and physicians' is required to reduce the burden of oral disease thus mproving quality of life for these patients

Periodontal infection: a potential risk factor for p re-term delivery of Low birth weight [PLBW] babies

Pre-term delivery of low-birth-weight [PLBW] babies is considered a major peri-natal problem in many countries and is contributing substantially to infant mortality and to childhood handicap. There is a reported incidence of pre-term delivery of low-birth-weight [PLBW] babies of 37% of all live births in Pakistan, which has a tremendous impact on health care system in this community. The prevalence of periodontal disease in Pakistan is also very high in all age groups and women of child bearing age [18-34 years] are no exception. Recent studies indicate periodontal infection as a potential independent risk factor for PLBW, and is considered to be 7 times more likely to be associated than any other risk factors. Several postulated mechanisms have been reviewed, including the virulence effects and role of asymptomatic bacteraemia, focusing on the bacterial load in periodontium facilitating its transmission from oral cavity to the uterus. The indication that periodontal disease is a potential risk factor for the delivery of PLBW; a high level of periodontal disease in women of child bearing age and similar high level of PLBW babies in country, calls for further longitudinal investigations that validate a causal relationship between periodontal infection and pre-term delivery of LBW babies in Pakistan. A review of literature and preliminary communication for a planned study is presented

Approaches to primary oral health care

Primary health care approach has become a core concept for World Health Organization since 1977. This concept is based on universal access to care; Commitment to health equity; Community participation in health agendas; and inter-sectoral approaches to health. Many developing countries have in the recent past attempted to define and specify the contents of primary oral health care. However, there is no gold standard that can be applied universally. It is therefore imperative that each country determines its own model of primary oral health care in accordance to the perceived needs of its population and the resources available to address these needs. The burden of oral disease particularly caries and periodontal disease in Pakistan is particularly severe in vulnerable populations and public health capacity for provision of oral health care is dilute and not integrated with PHC. The current situation with huge unmet treatment needs, the striking inequality in delivery systems and the virtual non-existence of an adequate community oriented prevention calls for a turn towards an oral care system that meets the principles of primary health care [PHC]. Based on the existing evidence this paper attempts to take up Oral Health Sector of Pakistan as a case for Primary Health Care Approach, define contents of care and suggest innovations to improve access to this care. These innovations can then be field tested to recommend an appropriate model for primary oral health care in the country

Periodontal infection: a potential risk factor for pre-term delivery of low birth weight [PLBW] babies

Pre-term delivery of low-birth-weight [PLBW] babies is considered a major peri-natal problem in many countries and is contributing substantially to infant mortality and to childhood handicap. There is a reported incidence of pre-term delivery of low-birth-weight [PLBW] babies of 37% of all live births in Pakistan, which has a tremendous impact on health care system in this community. The prevalence of periodontal disease in Pakistan is also very high in all age groups and women of child bearing age [18-34 years] are no exception.Recent studies indicate periodontal infection as a potential independent risk factor for PLBW, and is considered to be 7 times more likely to be associated than any other risk factors. Several postulated mechanisms have been reviewed, including the virulence effects and role of asymptomatic bacteraemia, focusing on the bacterial load in periodontium facilitating its transmission from oral cavity to the uterus.The indication that periodontal disease is a potential risk factor for the delivery of PLBW; a high level of periodontal disease in women of child bearing age and similar high level of PLBW babies in country, calls for further longitudinal investigations that validate a causal relationship between periodontal infection and pre-term delivery of LBW babies in Pakistan. A review of literature and preliminary communication for a planned study is presented

Evaluation of problems related to malpractice and professionalism in islamabad area - a study

In many developing countries of the world where dental health care facilities by college I university trained personnel are limited, or very expensive the poor segments of the society go to unqualified persons [known as quacks] to get dental treatment

Quack is an untrained person who has learnt dentistry either by assisting a dental surgeon or inherited it from his family and later on adopted it as a profession. The treatment provided by them is often far below the normal set standards for sterilization and therefore the chances of a patient being exposed to life threatening conditions such as Hepatitis B, C and AIDS at their end is far more than at the hands of a qualified dental practitioner

The following questionnaire based survey maps the current situation of dental quacks in the urban [65%] and rural [35%] sectors of Federal Area [Islamabad], in terms of their methods of sterilization adopted and their treatment modalities. The main aim was to evaluate problems related to malpractice and professionalism. A diverse range of sterilization methods ranging from autoclaving to the use of plain water irrigation was observed. The opinion of the general public was also sought for, revealing varied ideas from suggesting courses for quacks in order to improve their quality of work to completely banning quackery

This malpractice [Quackery] is harming the public confidence in dentistry and also causing degeneration in professional ethics. Health regulatory authorities should be concerned about the increasing number of complaints about the unconventional health care issues

Tea as a source of dietary fluoride in Pakistan

OBJECTIVE: Exposure to fluoride in the modern world has expanded far beyond the degree envisaged by the fluoride pioneers of 60 years ago, who dealt exclusively with fluoride in drinking water. Given that increasing numbers of people are consuming beverages instead of water, fluoride intake should also consider the different beverages consumed and their fluoride content. This study was conducted to assess the levels of fluoride in 11 different varieties of tea available in Pakistan. Materials and This study was conducted with ten different brands and an unbranded variety of tea. Samples were prepared for each brand of tea and were subdivided into 4 groups comprising tea brewed for I min and 3 min. and boiled for 1 min and 3 min. A total of 44 tea infusion samples comprising of 4 samples of each brand were evaluated for their fluoride content. To measure fluoride concentration, a dual range fluoride ion selective tester was used. Leaching of fluoride on brewing ranged from 1.6 ppm to 4.3. A concentration range of 2.8 and 10.7 ppm was observed when the tea leaves were boiled in water. The results of this preliminary study indicate that tea can be considered as an effective vehicle for fluoride delivery and an additional source of dietary fluoride in Pakistan

Decision-making for a national program of community fluoride use in Pakistan

The use of fluorides for caries prevention is well established. However, a co-ordinated approach to the delivery of fluoride on a community and individual basis is necessary to ensure the efficient use of resources and a maximum reduction in dental caries. It is necessary that appropriate use of fluorides in the local context be identified. This paper discusses appropriate delivery mechanism of fluoride in Pakistan