Impact of resilience and environmental stress on burnout of students in public and private dental schools in Western Saudi Arabia.

Background: Dental students' burnout has been repeatedly reported in the literature; however, there is little information about the contributing factors in different contexts and settings. Aims: This study aimed to investigate the correlation between burnout among undergraduate dental students and sociodemographic (specifically gender), psychological (resilience), and structural factors (dental environment stress). Subjects and Methods: An online cross-sectional survey questionnaire was distributed among a convenience sample of 500 undergraduate Saudi dental students. The survey included questions about sociodemographic factors (gender, level of education, academic achievement, type of school [public or private], and living arrangements). The study also included items that allowed assessment of students' burnout using the Maslach Burnout Inventory (MBI) and assessment of student environmental stress and resilience using the Dental Environment Stress Scale (DESS) and the Brief Resilience Scale (BRS). Descriptive statistics, univariate, and linear regression analyses were performed. Results: The response rate was 67% (male = 119, female = 216). Univariable analysis showed that gender, level of education, and DESS and BRS scores correlated significantly (P <.05) with MBI scores. Adjusted multiple linear regression lends further support to that the MBI scores negatively correlated with the BRS score but positively correlated with the DESS score (ß = -0.29, P <.001; ß = 0.44, P <.001, respectively). Conclusions: Within the limitations of this study, the findings demonstrated that increases in resilience correlated significantly with decreases in burnout and increases in environmental stress correlated significantly with increases in burnout among dental students. However, gender had no influence on burnout.

Inflammation and Thymus Ageing.

The thymus is primarily responsible for T cell production. However, it begins to recede in size and function, from early in life. This decreased generation of naive T cells during normal thymus ageing, or linked with pathology (i.e. chronic inflammation), leads to reduced T cell specificities, peripheral T cell imbalances, and higher susceptibilities to infections. Various clinical strategies for thymus and T cell recovery have been investigated, although no effective clinical treatments for the reconstitution of peripheral T cell diversity in severe immune deficiencies are available. The recent identification of thymic epithelial progenitor cells (TEPC) in the adult thymus will enable investigations into a new generation of therapies focused on regenerating the thymic microenvironment for diverse specificity T cell reconstitution in the elderly. The specific mechanisms underlying TEPC activation are still being investigated. Recent data point to an important role of the intrathymic transforming growth factor-ß (TGF-ß) circuitry. Although dual actions of this cytokine have been reported in the immune system, TGF-ß signaling is transiently activated in hematopoietic stem and progenitor cells during hematopoietic regeneration. This review investigates the current strategies for thymus reactivation to replenish the peripheral T cell repertoire and potentially reverse the age-related inflammatory milieu.

Identifying and prioritising areas of child dental service need: a GIS-based approach.

AIM: To identify and prioritise areas of high need for dental services among the child population in metropolitan Western Australia. DESIGN: All children hospitalised due to an oral-condition from 2000 to 2009, at metropolitan areas of Perth were included in the analysis of a 10-year data set. QGIS tools mapped the residential location of each child and socioeconomic data in relation to existing services (School Dental Service clinics). RESULTS: The tables and maps provide a clear indication of specific geographical areas, where no services are located, but where high hospital-admission rates are occurring, especially among school-age children. The least-disadvantaged areas and areas of high rates of school-age child hospital-admissions were more likely to be within 2km of the clinics than not. More of high-risk-areas (socio-economically deprived areas combined with high oral-related hospital admissions rates), were found within 2km of the clinics than elsewhere. CONCLUSION: The application of GIS methodology has identified a community's current service access needs, and assisted evidence based decision making for planning and implementing changes to increase access based on risk.

Radionuclide therapy and integrated protocols for bone metastases.

Bone metastases are responsible for most of the morbidity and mortality associated with solid malignant tumors, occurring in about 65-70% of the patients with advanced breast or prostate cancer. The pathophysiology of skeletal metastasis is a complex process that involves several biologic process leading to cellular invasion, adhesions and stimulation of osteoclasts and osteoblasts with the mediation of several factors including cytokines, serine proteases and tumor-derived factors. The clinical management of pain from bone metastasis, which is mostly due to indirect stimulation of sensory nerve endings by cytokines and other biologically-active compounds released locally in response to the presence of tumor cells in the bone marrow, includes several options that can be used either alone or in varying combinations, such as analgesic drugs, chemo- or hormonal therapy, bisphosponates, external beam radiation therapy, and surgery. Bone-seeking radiopharmaceuticals play an important role in the treatment of pain caused by multiple blastic or mixed-type skeletal lesions; they have in general a favorable toxicity profile and a high rate of overall clinical benefit, although they may differ in terms of duration of pain palliation and suitability for repeat treatments. The palliative effect can be attributed to the radiation targeted to the bone marrow space, and the overall average response ranges between about 45-80%, with complete response in 10-30% of the cases. In selected clinical conditions, radionuclide therapy can also constitute an effective systemic treatment beyond bone pain palliation, and a synergistic anti-tumour effect can be expected by the combination with other agents, such as chemotherapy or bisphosphonates. This review summarizes the current experience with bone-seeking radiopharmaceuticals used for bone pain palliation, focusing on indications, patients' selection, efficacy and toxicity. Finally, the available data on combination therapies showing encouraging results as to potential anti-tumor efficacy are also reviewed.

Evaluation of bone mineral density in children with perinatal brachial plexus palsy: effectiveness of weight bearing and traditional exercises.

PURPOSE: (1) To investigate any evidence of bone mineral density (BMD) changes in children with Perinatal Brachial Plexus Palsy (PBPP). (2) To detect any relationship between these changes and the child age, weight, height, BMI, power index, gender, ethnicity, and the side affected. (3) To determine any possible effects of a designed weight bearing exercise program and the traditional one upon BMD of those children. STUDY DESIGN: Randomized single blind controlled trial. METHOD: A convenience sampling strategy was used to obtain 45 children with unilateral PBPP. Their ages ranged from 3 to 10 years. They were randomly divided to three equal groups. Groups were, then, randomly assigned to either interventions [Weight Bearing Exercises Program (WBEP) or Traditional Exercises Program (TEP)] or to the control treatment. Dual Energy X-Ray Absorptiometry (DXA) was used to evaluate BMD for all children at entry and approximately after six months treatment period. RESULTS: We detected significant low entry level measurements of all BMD parameters of the affected side when compared to that of the unaffected sides (p=0.000). The mean value of the entry level calculated Z score for the affected side of all study children was equal to -1.12 ± 0.327 being in the osteopenic risk range. Furthermore, thirty children (66.7%) recorded less than (-1) Z score being in this risky range. Also, we recorded a significant improvement of all BMD parameters of the affected side after treatment in favor of the WBEP group when compared to that of the control and TEP groups (p=0.02, p=0.03 respectively for the affected both bones BMD parameter). CONCLUSIONS: BMD is significantly reduced in PBPP children. The retardation of bone accrual increases as the child height and weight decreases and the degree of paralysis increases. WBEP significantly promoted BMD improvement when compared to the TEP.

Odontogenic myxofibroma synchronous with primary angiosarcoma of the spleen.

Odontogenic myxofibroma of the temporomandibular joint (TMJ) is a rare tumour; moreover, primary splenic angiosarcoma (PAS) in paediatric patients is extremely rare. We report on a 15-year-old boy who presented with right TMJ swelling and subsequently developed epigastric and right upper quadrant pain. The TMJ swelling proved to be odontogenic myxofibroma and the abdominal pain was a result of primary splenic angiosarcoma with hepatic metastasis. We report for the first time the synchronous presentation of PAS and odontogenic myxofibroma in a paediatric patient, and we describe the radiological features along with the histological diagnosis and clinical outcome. Uptake in (18)F-2-fluoro-2-deoxy-D-glucose positron emission tomography is also described for the first time for both these tumours.

Molecular staging of the sentinel lymph node in melanoma patients: correlation with clinical outcome.

BACKGROUND: This study was designed to determine the debated prognostic significance of reverse transcriptase-polymerase chain reaction (RT-PCR) positivity in melanoma patients' sentinel lymph node (SLN) negative by conventional histopathology (PATH). PATIENTS AND METHODS: Patients with primary stage I-II cutaneous melanoma underwent radioguided sentinel lymphadenectomy. Their SLNs were assessed for tyrosinase (Tyr) and melanoma antigens recognized by T-cells (MART-1) mRNA expression using RT-PCR, in parallel with hematoxylin and eosin staining and immunohistochemistry. Tyr and MART-1 expression in the SLNs were correlated with PATH assay results, standard prognostic factors, time to progression and overall survival. RESULTS: Twenty-three of the 124 patients (18.5%) had positive SLNs by both PATH and RT-PCR (PATH+/PCR+). Sixteen patients (13%) were negative by PATH and positive by RT-PCR (PATH-/PCR+). Eighty-five patients (68.5%) had SLNs that were negative by both PATH and RT-PCR (PATH-/PCR-). At a median follow-up of 30 months, recurrence rates among the three cohorts were statistically different (PATH+/PCR+, 60%; PATH-/PCR+, 31%; PATH-/PCR-, 9.4%). Seven of 23 (30%) and two of 16 (12.5%) patients died in the PATH+/PCR+ and PATH-/PCR+ SLN groups, respectively, whereas no patient died in the PATH-/PCR- SLN group. CONCLUSIONS: RT-PCR is more sensitive than PATH to detect SLN metastases and it is a reliable predictor of disease relapse in stage I-II melanoma patients.

Attitude, practice and needs for continuing medical education among primary health care doctors in asir region.

OBJECTIVES: Assess the attitude and practice of Primary Health Care (PHC) physicians in Aseer region, their educational needs and recommendations to establish a continuing medical education program (CMEP) to address these needs. METHODS: This study was carried out during the first half of 1999 in Aseer region, Saudi Arabia. A self-administered questionnaire was distributed to all PHC physicians in Aseer region. The questionnaire explored socio-demographic characteristics, scientific background, the attitude towards CME, the current method for medical updating, the barriers to CME, and the topics requested for a future CMEP. RESULTS: There were a total of 383 PHC physicians in Aseer region, 86% of whom responded to this questionnaire. Of these 76.1% were Arabs, 91.2% were married, 26.3% had post-graduate qualifications and 68.6% had had no experience in the PHC field prior to arriving in Saudi Arabia. Most respondents showed a positive attitude toward CME. Nearly two-thirds (64.4%) had adequate time for CME, 86.7% allocated time for CME, and 64.4% were ready to participate as tutors in CMEP. Suggestions were given by 49.6% for establishing a CMEP in the region. The most popular methods practiced for CME were reading medical journals (79.8%) and medical textbooks (53.8%), and attending training courses (39.6%). The medical subjects that were identified as needed were emergency medicine (24.5%), pediatrics (20.8%), internal medicine (20%), and obstetrics/ gynecology (18.7%). However, 75.2% also indicated that computer literacy was a practice requirement, 57.7 and 54.1% thought designing diabetes and hypertension management programs were vital, and 41.7% said learning how to design a PHCC action plan was essential. CONCLUSION: PHC physicians in Aseer region had a positive attitude towards selective CMEP. They needed CMEP but felt its content should be in line with their practice needs.