Parents' experiences of participating in health-promoting activities at a family centre for preschool children in Sweden.

In Sweden, the family centre is a meeting place for families in a neighbourhood. It is a place for families to meet and exchange experiences and is a confidence-filled place for preschool children to play and develop. The staff at the family centre collaborate on early prevention strategies to promote health. Since 2014, the Public Dental Health Service in Södra Ryd, Skövde, has been a collaborative partner with the family centre. OBJECTIVES: To explore and describe the parents' experiences of participating in health-promoting activities at the family centre. BASIC RESEARCH DESIGN: A qualitative design based on interviews, analysed using a phenomenograpic approach. PARTICIPANTS: Six focus groups with two to six participants in each group. RESULTS: Three themes, all describing parents' experiences of visiting the family centre, emerged in the analysis. The themes were as follows; "Social fellowship", "A secure place" and "A learning environment". Each theme contained three categories, which represent the parents' different conceptions. CONCLUSIONS: The present study showed that the parents who visit the family centre found that the collaboration is perceived as positive and has many benefits. The participants found that the family centre is an institution that increases social interaction. Furthermore, meeting dental professionals in an arena outside the clinic creates confidence and makes people feel secure. Parents also learn both from the staff and from each other. According to these findings, the family centre is a suitable arena to work on health-promotion activities.

Experience of collaboration at a family centre for preschool children in Sweden.

In 2014, the Public Dental Health Service in Södra Ryd, Skövde, started a collaboration at the local family centre with the aim of performing health-promoting activities. Personnel at the family centre can play an important role in promoting children's health, including oral health, by testing preventive guidance. OBJECTIVES: To describe the personnel's experience of collaboration. BASIC RESEARCH DESIGN: Qualitative interviews with transcripts analysed using the phenomenographic approach. PARTICIPANTS: Seven staff with experience of collaboration. All were female, aged 34-62 and were dental nurses, child health-care nurses, preschool teacher or family centre co-ordinators. RESULTS: Three themes describing personnel's experience of collaboration at the family centre emerged: Collaboration produces an holistic approach, Co-location creates added value and Working methods result in development. Each theme was represented by three to four categories that represent different conceptions of collaboration at a family centre. CONCLUSIONS: The staff had found that the way of working was positive, mainly because it gave an increased overall view and that the co-location created added value. It also created development through mutual learning and new methods. However, it took time to establish collaboration and required permissive leadership.

Caries prevalence in Swedish 20-year-olds in relation to their previous caries experience.

BACKGROUND/AIM: There are few studies of caries development and caries-related factors from early age to young adulthood. The aim of the present study is to analyse caries prevalence in 20-year-olds in relation to their previous caries experience. METHOD: Oral health from 3 to 20 years of age was followed longitudinally in a cohort of 499 individuals. The clinical and radiographic incidence of caries and restorations in 494 20-year-olds was related to caries data at 3, 6 and 15 years of age. RESULTS: Twenty-six per cent of the 20-year-olds were caries-free. The mean number of initial and manifest lesions and restorations (Di + mFS) was 5.8. Initial lesions comprised 40% of the Di + mFS. Of the occlusal surfaces of molars and premolars, 12 and 4%, respectively, had manifest caries or restorations. Compared with individuals who had been caries-free during childhood (primary dentition) and adolescence, those with a history of caries activity while growing up had statistically significantly more approximal lesions at the age of 20 (DmFSa 0.6 vs. DmFSa 4.6, respectively). Those with manifest caries during childhood but caries-free at 15 years had a low caries prevalence at 20 years of age (DmFSa 1.3). Few new lesions developed after age 15. However, 50% of initial lesions at this age had progressed to manifest lesions at age 20. CONCLUSION: There is a relationship between caries prevalence at age 20 and early caries experience.

Caries in adolescence - influence from early childhood.

OBJECTIVE: To analyse the relationship between caries determinants in early childhood and caries prevalence in proximal surfaces in adolescents at the age of 15 years. METHODS: The present longitudinal study is part of a series of surveys of oral health in 671 children followed from 1 to 15 years of age. Data were selected from examinations, interviews and questionnaires at 1, 3 and 6 years and bitewing radiographs at 15 years of age. Uni- and multivariable logistic regression analyses were performed to identify caries-related determinants. The outcome variable was carious lesions and fillings (DFa) in approximal tooth surfaces at 15 years of age. Statistical comparisons were made between caries-free teenagers, DFa = 0 and teenagers with DFa > 0, DFa ≥ 4 and DFa ≥ 8, respectively. RESULTS: In the final logistic regression analyses, caries experience at 6 years and mother's self-estimation of her oral health care as being less good to poor remained statistically significant and were related to caries in all three caries groups (i.e. DF > 0, ≥4 and ≥8) at 15 years of age. The consumption of sweets at 1 year remained statistically significant, with a caries experience of DF ≥ 4 and ≥ 8. The variables 'parents born abroad' and female gender were statistically significantly associated with DFa ≥ 4 and DFa ≥ 8, respectively. Furthermore, infrequent toothbrushing habits at 3 years of age and failure to attend the examination at 1 year were statistically significantly associated with caries at 15 years in the univariable analyses. CONCLUSION: Early caries experience, consumption of sweets at an early age and mother's self-estimation of her oral health care as being less good to poor are associated with approximal caries in adolescents. The study indicates that caries determinants identified during early childhood have a strong impact on approximal caries in adolescence.

Security swipe cards and scanners are a potential reservoir for hospital-acquired infection.

INTRODUCTION: Hospital-acquired infections complicate 10% of hospital admissions resulting in increased morbidity, mortality and cost to hospitals. Most hospitals issue doctors with plastic swipe cards that function as electronic keys to access clinical areas. The card is handled many times a day, often before direct patient contact. The aim of this study was to determine if swipe cards harbour potentially harmful bacteria. SUBJECTS AND METHODS: On a single day, doctors working in the surgical directorate completed a questionnaire to determine their pattern of swipe card use. Cards were inoculated onto agar plates and incubated for 48 h under standard laboratory conditions, following which the number of colony forming units (CFUs) cultured from each card was determined. Representative colonies were sampled and sub-cultured for staphlococcal, enterococcal, coliform and pseudomonad species. Isolated bacterial pathogens were tested for antimicrobial sensitivity. Swipe-card scanners were swabbed for microbiological culture on the same day. RESULTS: All cards were colonised with environmental bacteria (mean, 73 CFU). Of cards, 21% were contaminated with pathogenic bacteria including Staphylococcus aureus (5.1%), Pseudomonas putida (2.6%), and coliform species (12.8%). The pattern of card use did not significantly affect the amount of bacterial contamination, but infrequent use of the card and keeping the card in a pocket or wallet was associated with higher levels of contamination. Environmental bacteria were cultured from 88% of card scanners, the highest counts coming from scanners in main theatres and the day-surgery unit. CONCLUSIONS: Doctors' swipe cards are contaminated with, and may therefore be a reservoir for, pathogenic bacteria implicated in hospital-acquired infection.

Macular thickness decreases with age in normal eyes: a study on the macular thickness map protocol in the Stratus OCT.

BACKGROUND/AIM: Retinal and retinal nerve fibre layer (RNFL) thinning with age have been described in histological studies. In vivo techniques like optical coherence tomography (OCT) have shown thinning of optic nerve RNFL and the retina in specific areas. One would expect thinning of the total macula, but so far, no correlation with the quantitative OCT macular map tool and age has been found. METHODS: Sixty-seven healthy individuals underwent three repeated scans in both eyes with the macular thickness map protocol in the Stratus OCT. That protocol divides the macula area into nine ETDRS fields. The RNFL was measured in one specific location close to the optic disc. Correlations between retinal, RNFL thickness, macular volume and age were determined. RESULTS: We found a statistically significant negative relationship between retinal thickness and age for all ETDRS areas, total macular volume and RNFL thickness. Retinal thickness decreased by 0.26-0.46 microm, macula volume 0.01 mm(3) and RNFL 0.09 microm per year. CONCLUSION: Retinal thickness within the area covered by the macular map significantly decreases with age. In the area examined in the papillomacular bundle, 20% of the retinal thinning is due to the RNFL, and 80% is due to thinning of other layers of the retina.

Oral hygiene and parent-related factors during early childhood in relation to approximal caries at 15 years of age.

The aim was to investigate whether oral hygiene habits and parent-related factors, recorded in early childhood, have a predictive value in relation to approximal caries experience (including initial caries lesions) at the age of 15 years (n = 568). Data were selected from examinations, interviews and questionnaires at 1 and 3 years and bitewing radiographs at 15 years. Four levels of cut-off points for the statistical analysis were used: DFa = 0, > 0, > or = 4 and > or = 8. In the final logistic regression analyses, mother's self-estimation of her oral health care being less good remained statistically significant and predicted a caries experience of DFa > 0 at 15 years. The following four variables predicted DFa > or = 4: (1) female gender, (2) plaque on maxillary incisors at 1 year, (3) mother's self-estimation of her oral health care being less good and (4) father being less satisfied with his social situation. Two variables predicted DFa > or = 8: (1) toothbrushing with fluoride toothpaste just once a day, and (2) father being less satisfied with his social situation. Furthermore, children who failed to attend the examination at 1 year of age had 6.95 +/- 5.36 (mean +/- SD) DFa at 15 years compared with 3.10 +/- 3.85 for children who were examined at 1 year of age (p < 0.01). To conclude, factors explaining good dental health at 15 years of age pertained to both children and parents. Thus, it seems that good oral hygiene habits, established in early childhood, provide a foundation for a low experience of approximal caries in adolescents.

Regulation of allergen-induced bone marrow eosinophilopoiesis: role of CD4+ and CD8+ T cells.

BACKGROUND: The mechanisms of the distant stimulation of the bone marrow (BM) after airway allergen exposure remain largely obscure. T cells have been implicated in allergic airway inflammation but their role in allergen-induced BM eosinophilopoiesis is poorly understood. The aim of this study was to determine the role of CD4(+) and CD8(+) T cells in allergen-induced BM eosinophilopoiesis. METHODS: Ovalbumin (OVA)-sensitized wild type (WT), CD4 knockout (CD4-/-) and CD8 knockout (CD8-/-) mice were exposed intranasally to OVA or saline. Bromo-deoxyuridine (BrdU) was used to label newly produced cells. Bone marrow, blood and bronchoalveolar lavage (BAL) were sampled 24 h after the final exposure. Immunostaining for newly produced eosinophils (i.e. BrdU(+)/MBP(+)) and BM eosinophil progenitor [CD34(+)/CD45(+)/interleukin-5 (IL-5)Ralpha(+)] cells was performed. RESULTS: The number of newly produced BM eosinophils (BrdU(+)/MBP(+) cells) was significantly reduced in allergen exposed CD4-/- or CD8-/- mice compared with allergen exposed WT mice, which was followed by a subsequent decrease in newly produced blood and airway eosinophils. Furthermore, BM eosinophil progenitors were significantly reduced in allergen exposed CD4-/- and CD8-/- mice compared with WT mice. Finally, serum IL-5 and Bronchoalveolar lavage fluid eotaxin-2 levels were abolished in allergen exposed CD4-/- mice to levels seen in saline exposed WT mice. CONCLUSIONS: These data suggests that both CD4(+) and CD8(+) T cells have a regulatory role in allergen-induced BM eosinophilopoiesis, whereas CD4(+) T cells are obligatory for allergen-induced airway eosinophilia. The subsequent traffic of eosinophils to the airways is likely to be at least partly regulated by a CD4(+) T-cell-dependent local airway eotaxin-2 production.

Prevalence of approximal caries in posterior teeth in 15-year-old Swedish teenagers in relation to their caries experience at 3 years of age.

The aim of the present investigation was to study the prevalence of approximal caries lesions and fillings in posterior teeth at 15 years of age in a prospectively followed Swedish population (n = 568), with special reference to their caries experience at the age of 3 years. Only approximal surfaces were recorded, since all children in the Community of Jönköping have had fissure sealing performed on all caries-free permanent molars. At 15 years of age, the mean number of approximal tooth surfaces with initial caries lesions (D(i)a), manifest caries lesions and fillings (D(m)Fa) and total caries experience and fillings (D(i + m)Fa)--recorded on bitewing radiographs--was 2.78 , 0.45 and 3.23, respectively. One third of the adolescents had no approximal caries or fillings; the D(i)a constituted 86% of the D(i + m)Fa. Children with manifest caries at 3 years of age had a higher risk of developing approximal caries in their permanent teeth than caries-free children at the same age (41 vs. 17%). Furthermore, children who were caries-free at 3 years of age were more likely to remain caries-free at 15 years of age compared to children with manifest caries (37 vs. 17%). All these differences were statistically significant (p < 0.001). Additionally, early childhood caries experience (developed before 3 years of age) had a greater predictive value than late childhood caries experience (developed between 3 and 6 years of age) concerning approximal caries at 15 years of age.

A prospective, randomized clinical study on the effects of an amine fluoride/stannous fluoride toothpaste/mouthrinse on plaque, gingivitis and initial caries lesion development in orthodontic patients.

The aim of this study was to examine the effect of combined use of a toothpaste/mouthrinse containing amine fluoride/stannous fluoride (AmF/SnF2; meridol) on the development of white spot lesions, plaque, and gingivitis on maxillary anterior teeth in orthodontic patients. A prospective, randomized, double-blind study with 115 orthodontic patients (42 males and 73 females, average age 14.4 years, drop outs 18) was designed. Group A (50) brushed twice daily with an AmF/SnF2 toothpaste (1400 ppm F) and rinsed every evening with an AmF/SnF2 solution (250 ppm F). Group B (47) brushed twice daily with a sodium fluoride (NaF) toothpaste (1400 ppm F) and rinsed every evening with a NaF solution (250 ppm F). Visible plaque index (VPI), gingival bleeding index (GBI) and white spot lesion index (WSL) were recorded on the six maxillary anterior teeth at bonding and after debonding, and evaluated with t tests. In group A no significant differences between bonding and debonding were recorded for WSL (1.02 +/- 0.08 versus 1.05 +/- 0.13, P = 0.14), VPI (0.10 +/- 0.21 versus 0.12 +/- 0.21, P = 0.66) or GBI (0.13 +/- 0.21 versus 0.16 +/- 0.22, P = 0.47), whereas statistically significant differences were found in group B between bonding and debonding for WSL (1.00 +/- 0.02 versus 1.08 +/- 0.17, P = 0.01), VPI (0.06 +/- 0.13 versus 0.17 +/- 0.25, P = 0.01) and GBI (0.06 +/- 0.12 versus 0.16 +/- 0.21, P = 0.01). The increase in lesions on the upper anterior teeth was 4.3 per cent in group A and 7.2 per cent in group B. It was concluded that the combined use of an AmF/SnF2 toothpaste/mouthrinse had a slightly more inhibitory effect on white spot lesion development, plaque and gingivitis on maxillary anterior teeth during fixed orthodontic treatment compared with NaF.

Analysis of mean retinal transit time from fluorescein angiography in human eyes: normal values and reproducibility.

OBJECTIVE: To evaluate three different techniques to quantify retinal blood flow transit times in normal human eyes from fluorescein angiograms. SUBJECTS AND METHODS: Fluorescein angiograms were recorded on two different occasions in 18 normal individuals with a scanning laser ophthalmoscope. The angiograms were digitized (5 frames per second) and the images were aligned. Mean transit times (MTT) were analysed with a newly developed technique based on an impulse-response analysis (MTTIR) and again with the conventional technique (MTTSLOPE). Arterio-venous passage times (AVP) were also calculated. RESULTS: At the first determination, mean values (SD) for MTTIR, MTTSLOPE, and AVP were 3.22 (0.78), 4.88 (1.86), and 1.46 (0.57) seconds, respectively. Detection of an increase of 25% with a power of 80% requires groups of 12, 86 and 17 individuals for the three techniques, respectively. CONCLUSIONS: Mean transit time is a well-defined physiological parameter. The technique based on impulse-response analysis allows for analysis of even badly defined dye curves. We found this technique to be superior to the conventional technique in terms of reproducibility.

The efficacy and safety of unfixed and fixed combinations of latanoprost and other antiglaucoma medications.

Adjunctive therapy for the management of glaucoma is commonly used. Unfixed combinations of the prostaglandin analog latanoprost and other glaucoma medications have been demonstrated to effectively lower intraocular pressure (IOP). The range of reported additional reductions in IOP compared to a monotherapy baseline are as follows: latanoprost-timolol (13-37%), latanoprost-pilocarpine 2% (7-14%), latanoprost and carbonic anhydrase inhibitors (15-24.1%), and latanoprost and dipivefrin (15-28%). There is a fixed combination of latanoprost (0.005%) and timolol (0.5%) that has been investigated in Phase III trials in Europe and the United States. In these trials, it was noted that the efficacy of the fixed combination was superior to either of the monotherapy components. After 12 months of follow-up of patients on fixed combination, there was no evidence of long-term drift. The new formulation appears to be safe and does not demonstrate any more side effects than either of the components. The convenience of a fixed combination may enhance patient compliance. Unfixed combination therapy with latanoprost and other antiglaucoma medications and the fixed combination formulation of latanoprost and timolol provide an effective and safe option for lowering IOP in glaucoma patients.

The effect on intraocular pressure of latanoprost once or four times daily.

AIMS: To compare the effect on intraocular pressure (IOP) of latanoprost applied once daily with four times daily and to study if the difference persisted when treatment changed to once daily. METHODS: IOP was followed in 28 healthy volunteers in a double masked randomised 52 day study. Latanoprost 50 microg/ml was administered once daily in one eye and four times daily in the other during 2 weeks. Subsequently both eyes received one daily drop for 2 weeks. After another 3 weeks without treatment, a single drop was instilled in each eye. RESULTS: The IOP reduction on days 2 and 3 was greater in the eyes treated with four daily doses (p<0.01). During the following period there were no statistically significant differences between the eyes. After 3 weeks without treatment the IOP was lower than pretreatment (p<0.001). A single dose of latanoprost on day 50 resulted in a similar decrease in IOP in both eyes. Transient photophobia, mild flare, and/or a few cells occurred in 15 subjects. Two subjects were withdrawn because of photophobia and/or signs of anterior uveitis. CONCLUSION: Latanoprost four times daily caused an IOP reducing effect which was similar to once daily dosing, except for the first 2 days of treatment when it was more effective. Transient photophobia, cells, and flare were common during the four dose regimen, but resolved spontaneously without cessation of treatment.

Ocular blood flow and retinal metabolism in abyssinian cats with hereditary retinal degeneration.

PURPOSE: To investigate if retinal blood flow decreases with progression of the disease in Abyssinian cats with progressive retinal atrophy (PRA), to examine if the choroidal blood flow was affected by the disease, and to determine the uptake of glucose and formation of lactate in the outer retina. METHODS: Local blood flow in different parts of the eye was determined with radioactive microspheres, in 9 normal cats and in 10 cats at different stages of PRA. Three blood flow determinations were made in each animal, during control conditions, after IV administration of indomethacin and after subsequent administration of N(omega)-nitro-L-arginine (L-NA). Blood samples from a choroidal vein and a femoral artery were collected to determine the retinal formation of lactate and uptake of glucose. RESULTS: In Abyssinian cats with PRA (n = 10), the retinal blood flow was significantly (P < or = 0.01) lower than in normal cats (n = 9) during control conditions, 6.4 +/- 1.7 compared with 14.1 +/- 1.9 g min(-1) x (100 g)(-1). The vascular resistance in the iris and ciliary body was significantly higher in the cats at a late stage of PRA, both compared with normal cats and to cats at an early stage of the disease, whereas the choroidal vascular resistance was not significantly affected. Indomethacin had no effect on ocular blood flows in normal cats, but in cats with PRA, iridal blood flow was more than doubled after indomethacin. The retinal formation of lactate was significantly (P < or = 0.001) lower in cats with PRA than in normal cats, 0.111 +/- 0.035 (n = 8) compared with 0.318 +/- 0.024 (n = 8) micromol x min(-1). The uptake of glucose was not significantly different in cats with PRA. CONCLUSIONS: Retinal blood flow is severely decreased in Abyssinian cats at a late stage of retinal degeneration, whereas the choroidal microcirculation is not significantly affected by the disease. At a late stage of retinal degeneration, vascular resistance in the iris is significantly increased, which at least in part could be caused by cyxlooxygenase products.

Comparison of retinal transit times and retinal blood flow: a study in monkeys.

PURPOSE: To determine the correlation between transit times of retinal blood flow calculated from fluorescein angiograms and retinal blood flow determined by the microsphere method. METHODS: Two fluorescein angiograms were obtained in each eye of six monkeys, followed by determination of retinal blood flow with labeled microspheres. Angiograms in 10 eyes were analyzed for mean transit time (MTT) and arteriovenous passage time (AVP). MTT was determined in two ways: from dye curves reconstructed by extrapolation of semilogarithmic plots of the recorded curves (MTT(slope)) and by a new technique based on an impulse-response analysis (MTT(ir)). RESULTS: Mean values (+/-SD) for retinal blood flow in 10 eyes were 23.2 +/- 6.9 mg/min. Corresponding values for MTT(ir), MTT(slope), and AVP were 2.22 +/- 0.38, 4.89 +/- 5.89, and 1.08 +/- 0.14 seconds. There was a weak, but not statistically significant, correlation between retinal blood flow and MTT(ir) (r = -0.60, P = 0.06) but no useful correlation between retinal blood flow and either MTT(slope) or AVP. CONCLUSIONS: The relationship between retinal blood flow and transit times determined from fluorescein angiograms is weak. Of the three transit parameters tested, MTT(ir), determined with the recently developed impulse-response technique, had the best correlation with retinal blood flow. Further studies are needed to determine the ability of these transit parameters to detect a change in retinal blood flow and the possibility that transit times may provide useful clinical information unrelated to absolute values of retinal blood flow.

Measurement of ocular blood flow.

Many of these techniques have been adapted to investigate hemodynamic alterations, not only in glaucoma, but in diverse disorders such as diabetic retinopathy, macular degeneration, retinal dystrophies, and nonglaucomatous optic neuropathies. However, each of these techniques has limitations and there is not a single methods that provides comprehensive measurements for all the ocular tissues. Our enhanced understanding of ocular vascular anatomy has helped to direct our hemodynamic investigations of the various vascular beds within the eye. However, many of the techniques have lacked validation (reproducibility and accuracy) prior to clinical implementation. Understanding the limitations and the theoretical assumptions of each of these techniques will allow more prudent application in the clinical arena in the future.