Evaluating adherence to American College of Obstetricians and Gynecologists guidelines at the first obstetric visit.

OBJECTIVE: This is a prospective observational cohort study with the objective of assessing adherence to the American College of Obstetricians and Gynecologists guidelines regarding the first prenatal visit and determining what patient and provider factors are associated with high adherence in a faculty obstetric clinic at an academic medical center. METHODS: The American College of Obstetricians and Gynecologists guidelines recommend addressing 72 topics early in prenatal care. A research assistant observed the first prenatal encounter and noted which topics were discussed during the visit. Patient and clinic characteristics were also collected. The primary outcome was the percentage of topics covered at each visit. After analyzing all encounters, patient encounters that scored above the median score were compared with encounters scoring below the median using bivariate comparisons with respect to patient and clinic characteristics. A multivariable Poisson regression model with robust error variance was performed on characteristics with a p value of ⩽0.2. RESULTS: Fifty-one patient encounters met inclusion criteria and the median score for topics covered was 74%. Patients with chronic disease were more likely to have a higher percentage of topics covered (odds ratio 1.67, 95% confidence interval: 0.91-3.09). Patients who completed a prenatal questionnaire were also more likely to have a higher percentage (odds ratio 2.28, 95% confidence interval: 1.00-5.15) as well as patients who had nurse-led education integrated into their visit during (odds ratio 1.82, 95% confidence interval: 1.19-2.78). Patient satisfaction had no correlation with the number of topics covered. CONCLUSION: The number of topics to cover at the first prenatal visit has expanded creating challenges for patients and providers. Integration of prenatal questionnaires and nurse-led education has the potential to address gaps in antenatal care.

Breastmilk influences development and composition of the oral microbiome.

Background: Human microbiomes assemble in an ordered, reproducible manner yet there is limited information about early colonisation and development of bacterial communities that constitute the oral microbiome. Aim: The aim of this study was to determine the effect of exposure to breastmilk on assembly of the infant oral microbiome during the first 20 months of life. Methods: The oral microbiomes of 39 infants, 13 who were never breastfed and 26 who were breastfed for more than 10 months, from the longitudinal VicGeneration birth cohort study, were determined at four ages. In total, 519 bacterial taxa were identified and quantified in saliva by sequencing the V4 region of the bacterial 16S rRNA genes. Results: There were significant differences in the development of the oral microbiomes of never breastfed and breastfed infants. Bacterial diversity was significantly higher in never breastfed infants at 2 months, due largely to an increased abundance of Veillonella and species from the Bacteroidetes phylum compared with breastfed infants. Conclusion: These differences likely reflect breastmilk playing a prebiotic role in selection of early-colonising, health-associated oral bacteria, such as the Streptococcus mitis group. The microbiomes of both groups became more heterogenous following the introduction of solid foods.

The undergraduate research experience as a vehicle for employability development-The student participants speak.

The employability of science graduates if of key concern. Employers report that STEM graduates lack appropriate employability skills and work experience, and science graduates take longer to find full-time work than graduates from many other programs. Undergraduate research experience (URE) is an important pedagogy that involves student immersion in a professional research environment-as such it provides an opportunity for science students to develop their understanding of the world of work, and of their own developing employability. In this study, we examine students' reflections on their URE learnings and their resultant perceived employability. We ask whether students understand the value of the URE as an employability development vehicle and consider what can be done to improve the employability learnings from the URE. The results show that students articulate multiple learnings from their UREs, but they struggle to translate these learnings into an employability or non-research-work context. We conclude that UREs are important opportunities to learn about work in science, but that URE students would benefit from URE curriculum components that foreground the way UREs can help develop students' employability. The insights from this study can help inform and refine future URE programs to improve their efficacy as vehicles to benefit graduate employability.

Stevens-Johnson Syndrome in Children: Consider Monitoring for Bronchiolitis Obliterans.

We reviewed patients with Stevens-Johnson syndrome (SJS) evaluated at Children's Hospital Colorado and investigated the occurrence of bronchiolitis obliterans (BO). Approximately 9% of patients with SJS developed BO. Pediatricians should consider monitoring patients with SJS for BO, especially those with recurrent SJS and patients treated with mechanical ventilation.

Risk Factors for Severe COVID-19 in Children.

BACKGROUND: There are limited pediatric data regarding severe COVID-19 disease. Our study aims to describe the epidemiology and identify risk factors for severe COVID-19 disease in children. METHODS: This is a retrospective cohort study among children with positive SARS-CoV-2 PCR from March to July 2020 at Children's Hospital Colorado. Risk factors for severe disease were analyzed as defined by hospital admission, respiratory support, or critical care. Univariable and multivariable analyses were conducted. RESULTS: Among 454 patients identified with SARS-CoV-2, 191 (42.1%) were females, median age 11 years. Fifty-five percent of all patients identified as Hispanic compared with 29% among all hospital visits in 2019 (P < 0.0001). In multivariable analyses, age 0-3 months or >20 years [adjusted odds ratio (aOR), 7.85; P < 0.0001 and aOR, 5.1; P = 0.03, respectively], preterm birth history (aOR, 3.7; P = 0.03), comorbidities [including immunocompromise (aOR, 3.5; P = 0.004), gastrointestinal condition (aOR, 2.7; P = 0.009), diabetes (aOR, 6.6; P = 0.04), asthma (aOR, 2.2; P = 0.04)], and specific symptoms at presentation were predictors for admission. Age 0-3 months or >20 years, asthma, gastrointestinal condition, and similar symptoms at presentation were also predictors for respiratory support. Elevated C-reactive protein was associated with the need for critical care with median of 17.7 mg/dL (IQR, 5.3-22.9) versus 1.95 mg/dL (IQR, 0.7-5.5) among patients requiring critical versus no critical care (OR, 1.2; P = 0.02). CONCLUSIONS: Extremes of age, comorbid conditions, and elevated CRP are predictors of severe disease in children. Findings from this study can inform pediatric providers and public health officials to tailor clinical management, pandemic planning, and resource allocation.

Health promotion competencies for promoting child-oral health: Victorian multidisciplinary workforce perspectives.

ISSUE ADDRESSED: Population oral health (OH) improvements depend on successful, coordinated execution of oral health promotion (OHP) programs by both oral and general health professionals with key competencies (skills, abilities, knowledge and values). This study explored multidisciplinary professionals' perspectives of the competencies required for the successful implementation of a community-based OHP program called Smiles 4 Miles (S4M) in early childhood settings in Victoria, Australia. METHODS: Convenience sampling was used to recruit multidisciplinary professionals working in the S4M early childhood health promotion program in Victoria. Semi-structured focus groups were conducted with program managers/coordinators (n = 26) from 21 S4M sites and the state-wide program coordination team (n = 5). Focus groups explored OHP competency needs, capacity to promote child OH and strategies for enhancing OHP competencies. The competencies identified through focus groups were then compared to the International Union for Health Promotion and Education (IUHPE) competencies framework. RESULTS: Strategies to enhance individual and organisational OHP competencies included intersectoral collaborations; working in multidisciplinary teams; support networks and partnerships; sharing skills and expertise between health professionals. The OHP competencies identified by the participants were consistent with key IUHPE domains including ethical values and health promotion knowledge base underpinning, enabling change, advocacy for health, mediating through partnerships, communication, leadership, assessment, planning, implementation, evaluation and research. CONCLUSION: A multidisciplinary workforce based in community settings can play key and complementary roles in OHP and widen avenues for oral disease prevention. SO WHAT?: Integrated collaborative workforce models involving multidisciplinary professionals beyond the OH sector can more effectively support efforts to address the burden of oral disease.

Nutrition and oral health in early childhood: associations with formal and informal childcare.

OBJECTIVE: To examine associations between childcare type and nutrition and oral health indicators. DESIGN: Cross-sectional data extracted from a longitudinal birth cohort. Parent-completed FFQ and questions regarding oral health and childcare use. The associations between childcare type, classified into four groups: parent care only (PCO), formal childcare only (FCO), informal childcare only (ICO) or combination of care (F&I), and nutrition and oral health indicators were examined. SETTING: Home and childcare. PARTICIPANTS: Families with children aged 3 years (n 273) and 4 years (n 249) in Victoria, Australia. RESULTS: No associations were observed between childcare type and core food/beverage consumption or oral health indicators. For discretionary beverages, compared with children receiving PCO at age 3 years, children in FCO or F&I were less likely to frequently consume fruit juice/drinks (FCO: adjusted OR (AOR) 0·41, 95 % CI 0·17, 0·96, P = 0·04; F&I: AOR 0·32, 95 % CI 0·14, 0·74, P = 0·008). At age 4 years, children receiving FCO or ICO were less likely to consume sweet beverages frequently compared with children receiving PCO: fruit juice/drink (ICO: AOR 0·42, 95 % CI 0·19, 0·94, P = 0·03; FCO: AOR 0·35, 95 % CI 0·14, 0·88, P = 0·03) and soft drink (ICO: AOR 0·23, 95 % CI 0·07, 0·74, P = 0·01; FCO: AOR 0·14, 95 % CI 0·03, 0·76, P = 0·02). CONCLUSIONS: Associations between childcare type and discretionary beverage intake were observed. Investigation into knowledge, attitudes and activities in formal and informal childcare settings is required to explore different health promotion practices that may influence nutrition and oral health.

Cytokine signature of inflammation mediated by autoreactive Th-cells, in calf muscle of claudicating patients with Fontaine stage II peripheral artery disease.

Peripheral artery disease (PAD), a severe atherosclerotic condition primarily of the elderly, afflicts 200 million individuals, worldwide, and is associated with lower extremity myopathy. Circulating markers of inflammation have been linked to risk and severity of PAD but the contribution of local inflammation to myopathy remains unknown. We evaluated, by ELISA, calf muscle of PAD patients (N = 23) and control subjects (N = 18) for local expression of inflammatory cytokines including Granulocyte/Monocyte Colony-Stimulating Factor (GM-CSF), Interleukin 17A (IL-17A), Interferon ϒ (IFN-ϒ), tumor necrosis factor α (TNF-α), and Interleukin 6 (IL-6). One or more of these cytokines were expressed in nineteen patients and 2 controls and coordinated expression of GM-CSF, IL-17A, IFN-ϒ, and TNF-α, a signature of activated, MHC Class II dependent autoreactive Th-cells, was unique to 11 patients. GM-CSF is the central driver of tissue-damaging myeloid macrophages. Patients with this cytokine signature had a shorter (P= 0.017) Claudication Onset Distance (17 m) compared with patients lacking the signature (102 m). Transforming Growth Factor ß1 (TGFß1) and Chemokine Ligand 5 (CCL5) were expressed coordinately in all PAD and control muscles, independently of GM-CSF, IL-17A, IFN-ϒ, TNF-α, or IL-6. TGFß1 and CCL5 and their gene transcripts were increased in PAD muscle, consistent with increased age-associated inflammation in these patients. Serum cytokines were not informative of muscle cytokine expression. We have identified a cytokine profile of autoimmune inflammation in calf muscles of a significant proportion of claudicating PAD patients, in association with decreased limb function, and a second independent profile consistent with increased "inflammaging" in all PAD patients.

Identifying predictors of early childhood caries among Australian children using sequential modelling: Findings from the VicGen birth cohort study.

OBJECTIVES: The aim of this birth cohort study was to identify concurrent associations between early childhood caries and putative risk and protective factors. METHODS: Data were collected in seven waves over five years. The study outcome measure, d3-6mfs, was modelled in a set of sequential negative binomial regressions that introduced the variables in steps starting from health determinants most distal to the child and ending with the more proximal ones. The goodness of fit of each model at each step was tested using the quasi-likelihood under independence model criterion (QIC). A final model included all significant factors identified in the sequential modelling. Bacterial composition of the child's saliva was determined by 16S RNA gene sequencing. RESULTS: Overall, 467 children (48.6 % female) participated, of whom 419 (89.7 %) had at least one follow-up visit after baseline. Of the 419 children included in the analyses, 133 (31.7 %) had their saliva samples sequenced for microbiomic determination. Independent protectors of surface cavitation included water fluoridation, and older age of mothers. Risk for d3-6mfs was significantly higher among children whose mothers were current smokers (IRR 3.29, 95 % CI 1.09-9.88, p = 0.034), children who went to bed with a bottle (IRR 2.67, 95-6.88, p = 0.041) and whose saliva sample sequencing over time showed higher percentages of Streptococcus mutans (IRR 1.39, 95 % CI 1.11-1.74, p = 0.005). Model fit was mostly improved by child's proximal variables. Household and mother covariates did not substantially improve model fit. CONCLUSION: This analysis highlights the relevance and importance of child-proximal risk factors in childhood dental cavitation. CLINICAL SIGNIFICANCE: The study findings inform clinical decision making for the management of early childhood caries at both the individual and population level. At an individual and family level these risk factors should be incorporated into caries risk assessment tools for more precise identification of risk and evidence-informed interventions by health professionals.

Family-centred oral health promotion through Victorian child-health services: a pilot.

Maternal and Child Health Services (MCHS) provide ideal settings for oral disease prevention. In Victoria (Australia), child mouth-checks (Lift-the-Lip) and oral health promotion (OHP) occur during MCHS child visits. This study trialled Tooth-Packs (OHP resources, toothbrushes, toothpastes) distribution within MCHS to (i) assess the impacts of Tooth-Packs distribution on child and family oral health (OH) behaviours and knowledge, including Maternal and Child Health Nurses (MCHN) child referral practices to dental services, and (ii) determine the feasibility and acceptability of incorporating Tooth-Packs distribution into MCHN OHP practices. A mixed-methods evaluation design was employed. MCHN from four high-needs Victorian Local Government Areas distributed Tooth-Packs to families of children attending 18-month and/or 24-month MCHS visits (baseline). Families completed a questionnaire on OH and dietary practices at baseline and 30-month follow-up. Tooth-Packs distribution, Lift-the-lip mouth-checks and child OH referrals were conducted. Guided discussions with MCHN examined intervention feasibility. Overall, 1585 families received Tooth-Packs. Lift-the-lip was conducted on 1493 children (94.1%). Early childhood caries were identified in 142 children (9.5%) and these children were referred to dental services. Baseline to follow-up behavioural improvements (n = 230) included: increased odds of children having ever seen an OH professional (OR 28.0; 95% CI 7.40-236.88; p < 0.001), parent assisted toothbrushing twice/day (OR 1.76; 95% CI 1.05-3.00; p = 0.030) and toothpaste use >once/day (OR 2.82; 95% CI 1.59-5.24; p < 0.001). MCHN recommendations included distribution of Tooth-Packs to at-risk children <12-months of age. MCHS provide an ideal setting to enable timely family-centred OHP intervention and adoption of good OH behaviours at an early age.

Natural history of dental caries: Baseline characteristics of the VicGen birth cohort study.

BACKGROUND: Early-life dental caries is a major global health problem. Children's first dental visit is recommended at 2 years age. The VicGeneration (VicGen) oral health birth cohort study aims to understand the multifactorial nature of early childhood caries. This report describes the baseline characteristics of children in the VicGen study. METHODS: We merged data between the first (at birth) and fourth waves (18 month age) to assess dental caries among children (primary outcome) and other oral diseases (secondary outcomes) employing t tests, chi-square tests, Fisher's exact tests, and Cochran-Mantel-Haenszel tests using IBM-SPSS(v25). RESULTS: Most children lived in metros with two-parent families. Most guardians were women graduated from high school. Twenty-seven of 389 (6.94%) 18-month-old children experienced dental caries. More children living in rural areas (vs. urban) experienced caries. Females were more likely to experience caries (OR: 2.16). Several children had other oral health problems. In early life, children's oral examination was conducted by midwives, breastfeeding/lactation consultants, hospital nurses, speech pathologists, and breastfeeding clinic staff. CONCLUSION: VicGen baseline characteristics show that almost 7% of the 18-month-old children experienced caries. There is a need to advance children's recommended first dental visit date and to train early-life healthcare professionals about oral diseases.

Feasibility and development of a cariogenic diet scale for epidemiological research.

BACKGROUND: Diet cariogenicity plays a major role as both a protective and risk factor in the development of early childhood caries (ECC). AIM: Develop a scale measuring the cariogenicity of foods and beverages and employ it to describe the cariogenicity of young children's diets and predict dental caries outcomes. DESIGN: Scores of cariogenicity and consumption frequency were applied to food frequency questionnaire (FFQ) collected from an Australian children's cohort study with three time-points of data. One-way ANOVA, with post hoc Tukey test compared mean cariogenic scale measured at 18 months between the subsample of children with caries classification at age 5 years. RESULTS: At 6 months, children's mean cariogenic score was 10.05, increasing to 34.18 at 12 and 50.00 at 18 months. Mean cariogenic scale score at 18 months was significantly higher in children with advanced disease at 5 years (mean scale score: 59.0 ± 15.9) compared to those that were healthy (mean score 47.7 ± 17.5, P = 0.007) or had mild-moderate disease (mean score 48.2 ± 17.3, P = 0.008). CONCLUSIONS: The cariogenic diet scale provides a useful indication of the increasing cariogenicity of children's diets with age and highlights the incorporation of discretionary choice foods and beverages into the diets of young children much earlier than nutritionally recommended.

A systematic review to assess the methodological quality of studies on measurement properties for caries risk assessment tools for young children.

BACKGROUND: At present, there are numerous caries risk assessment tools (CRATs) being promoted for disease management. However, the evidence to inform CRAT selection is unclear. AIM: This review aimed to assess the strength of evidence to inform the selection of CRATs for children ages 6 years and less. DESIGN: MEDLINE was the principal search database for this review. Other key databases, the reference lists of included articles, known cariology literature and experts were also consulted. Peer-reviewed papers describing CRATs and their development methodology were included. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist guided the quality assessment. The reporting of the key measurement properties (reliability, validity and responsiveness) informed the quality assessment. RESULTS: The search resulted in ten papers, reporting on eight different CRATs. The identified CRATs were: Caries Management By Risk Assessment (CAMBRA), Cariogram, National University of Singapore CRAT (NUS-CRAT), MySmileBuddy, Dundee Caries Risk Assessment Model, University of North Carolina Risk Assessment Models, University of Michigan pediatric dental clinic caries risk assessment sheet and American Academy of Pediatric Dentistry (AAPD) CRAT. Common across all CRATs was the lack of information to determine the levels of evidence for the measurement properties of reliability and construct validity. Studies on tools that were assessed as having strong evidence for content validity, identified the relevant risk factors for caries in the population being studied, before developing and testing their respective CRATs. CONCLUSIONS: The evidence to inform the selection of current CRATs for children is mostly yet to be established. Overall, the NUS-CRAT studies reported the most information to inform the assessment of its measurement properties and as a result this tool attained a higher quality rating than other CRATs studied. This article is protected by copyright. All rights reserved.

The influence of medical school on career choice: A longitudinal study of students' attitudes toward a career in general surgery.

BACKGROUND: Less than 80% of general surgery (GS) residency positions are filled by graduates from allopathic, U.S. medical schools. The aim of this study was to gauge students' interest in pursuing GS throughout their medical school matriculation and explore students' changing perceptions of the specialty. METHODS: Students at two medical schools were surveyed annually for 4 years. Survey responses regarding interest were compared to actual NRMP match results. RESULTS: Interest in a GS career was highest at the outset of medical school and declined steadily during the program, which was similar at both schools, including a positive effect on interest from the surgical clerkship. CONCLUSIONS: Our findings suggest that experiences during medical school impact students' perceptions of GS; specifically, lifestyle, work environment, and the length of training discouraged pursuit of GS. Perception of a GS's lifestyle and the educational environment are both highly modifiable factors that could increase interest in general surgery amongst graduates.

Model for prioritization of Graduate Medical Education funding at a university setting - Engagement of GME committee with the Clinical Enterprise.

BACKGROUND: Funding for graduate medical education (GME) is becoming scarce and is likely to worsen. There is a higher degree of accountability and return on investment demanded from public funds dedicated to GME. Academic centers (AC) partnered with clinical enterprises (CE) are finding it increasingly difficult to retain sustainable funding streams for GME activities. METHODS: To develop and implement a novel algorithmic funding model at one AC in symbiotic partnership with the CE for all 50 GME programs with nearly 500 residents. RESULTS: A new GME Finance and Workforce Committee was convened which was tasked with developing the novel algorithmic financial model to prioritize GME funding. Early outcomes measures that were monitored consisted of: satisfaction of all stakeholders and financial savings. CONCLUSIONS: The model was presented to all the stakeholders and was well received and approved. Early signs, demonstrated AC and CE satisfaction with the model, financial savings and increased efficiency. This GME funding model may serve as a template for other academic centers with tailored modifications to suit their local needs, demands and constraints.

Cluster randomised trial of a school-community child health promotion and obesity prevention intervention: findings from the evaluation of fun 'n healthy in Moreland!

BACKGROUND: Multi-level, longer-term obesity prevention interventions that focus on inequalities are scarce. Fun 'n healthy in Moreland! aimed to improve child adiposity, school policies and environments, parent engagement, health behaviours and child wellbeing. METHODS: All children from primary schools in an inner urban, culturally diverse and economically disadvantaged area in Victoria, Australia were eligible for participation. The intervention, fun 'n healthy in Moreland!, used a Health Promoting Schools Framework and provided schools with evidence, school research data and part time support from a Community Development Worker to develop health promoting strategies. Comparison schools continued as normal. Participants were not blinded to intervention status. The primary outcome was change in adiposity. Repeated cross-sectional design with nested longitudinal subsample. RESULTS: Students from twenty-four primary schools (clusters) were randomised (aged 5-12 years at baseline). 1426 students from 12 intervention schools and 1539 students from 10 comparison schools consented to follow up measurements. Despite increased prevalence of healthy weight across all schools, after 3.5 years of intervention there was no statistically significant difference between trial arms in BMI z score post-intervention (Mean (sd): Intervention 0.68(1.16); Comparison: 0.72(1.12); Adjusted mean difference (AMD): -0.05, CI: -0.19 to 0.08, p = 0.44). Children from intervention schools consumed more daily fruit serves (AMD: 0.19, CI:0.00 to 0.37, p = 0.10), were more likely to have water (AOR: 1.71, CI:1.05 to 2.78, p = 0.03) and vegetables (AOR: 1.23, CI: 0.99 to 1.55, p = 0.07), and less likely to have fruit juice/cordial (AOR: 0.58, CI:0.36 to 0.93, p = 0.02) in school lunch compared to children in comparison schools. More intervention schools (8/11) had healthy eating and physical activity policies compared with comparison schools (2/9). Principals and schools highly valued the approach as a catalyst for broader positive school changes. The cost of the intervention per child was $65 per year. CONCLUSION: The fun n healthy in Moreland! intervention did not result in statistically significant differences in BMI z score across trial arms but did result in greater policy implementation, increased parent engagement and resources, improved child self-rated health, increased fruit, vegetable and water consumption, and reduction in sweet drinks. A longer-term follow up evaluation may be needed to demonstrate whether these changes are sustainable and impact on childhood overweight and obesity. CLINICAL TRIAL REGISTRATION: ACTRN12607000385448 (Date submitted 31/05/2007; Date registered 23/07/2007; Date last updated 15/12/2009).

Trends in the match rate and composition of candidates matching into categorical general surgery residency positions in the United States.

BACKGROUND: The aim of this study was to analyze the trends in the proportion of students from various educational backgrounds who matched into categorical general surgery (GS) residency positions. METHODS: National Resident Matching Program reports (1994 to 2014) were analyzed, and regression was used to estimate the trends for each group. RESULTS: The match rate into GS-categorical residency has remained stable; however, since 1994, we witnessed a 13% decrease in US seniors matching into GS. This has corresponded to proportional increases in matches for US citizens from international medical schools (US IMG, 1350%) and a 62% increase for non-US citizen international medical graduates (non-US IMG) into GS. In comparison, US IMG matches into all first-year postgraduate positions increased by 468%, whereas non-US IMG matches decreased by 15%. CONCLUSIONS: The stable match rates into categorical GS residencies are not because of US seniors but rather because of a rise in the number of IMGs. In contrast to the decreased reliance on non-US IMGs in all other specialties, GS is accepting a larger proportion of non-US IMGs.

Developing a model to assess community-level risk of oral diseases for planning public dental services in Australia.

BACKGROUND: Poor oral health is a chronic condition that can be extremely costly to manage. In Australia, publicly funded dental services are provided to community members deemed to be eligible-those who are socio-economically disadvantaged or determined to be at higher risk of dental disease. Historically public dental services have nominally been allocated based on the size of the eligible population in a geographic area. This approach has been largely inadequate for reducing disparities in dental disease, primarily because the approach is treatment-focused, and oral health is influenced by a variety of interacting factors. This paper describes the developmental process of a multi-dimensional community-level risk assessment model, to profile a community's risk of poor oral health. METHODS: A search of the evidence base was conducted to identify robust frameworks for conceptualisation of risk factors and associated performance indicators. Government and other agency websites were also searched to identify publicly available data assets with items relevant to oral diseases. Data quality and analysis considerations were assessed for the use of mixed data sources. RESULTS: Several frameworks and associated indicator sets (twelve national and eight state-wide data collections with relevant indicators) were identified. Determination of the system inputs for the Model were primarily informed by the World Health Organisation's (WHO) operational model for an Integrated Oral Health-Chronic Disease Prevention System, and Australia's National Oral Health Plan 2004-2013. Data quality and access informed the final selection of indicators. CONCLUSIONS: Despite limitations in the quality and regularity of data collections, there are numerous data sources available that provide the required data inputs for community-level risk assessment for oral health. Assessing risk in this way will enhance our ability to deliver appropriate public oral health care services and address the uneven distribution of oral disease across the social gradient.

Transforming growth factor-beta 1 produced by vascular smooth muscle cells predicts fibrosis in the gastrocnemius of patients with peripheral artery disease.

BACKGROUND: Lower leg ischemia, myopathy, and limb dysfunction are distinguishing features of peripheral artery disease (PAD). The myopathy of PAD is characterized by myofiber degeneration in association with extracellular matrix expansion, and increased expression of transforming growth factor-beta 1 (TGF-ß1; a pro-fibrotic cytokine). In this study, we evaluated cellular expression of TGF-ß1 in gastrocnemius of control (CTRL) and PAD patients and its relationship to deposited collagen, fibroblast accumulation and limb hemodynamics. METHODS: Gastrocnemius biopsies were collected from PAD patients with claudication (PAD-II; N = 25) and tissue loss (PAD-IV; N = 20) and from CTRL patients (N = 20). TGF-ß1 in slide-mounted specimens was labeled with fluorescent antibodies and analyzed by quantitative wide-field, fluorescence microscopy. We evaluated co-localization of TGF-ß1 with vascular smooth muscle cells (SMC) (high molecular weight caldesmon), fibroblasts (TE-7 antigen), macrophages (CD163), T cells (CD3) and endothelial cells (CD31). Collagen was stained with Masson Trichrome and collagen density was determined by quantitative bright-field microscopy with multi-spectral imaging. RESULTS: Collagen density increased from CTRL to PAD-II to PAD-IV specimens (all differences p < 0.05) and was prominent around microvessels. TGF-ß1 expression increased with advancing disease (all differences p < 0.05), correlated with collagen density across all specimens (r = 0.864; p < 0.001), associated with fibroblast accumulation, and was observed exclusively in SMC. TGF-ß1 expression inversely correlated with ankle-brachial index across PAD patients (r = -0.698; p < 0.001). CONCLUSIONS: Our findings support a progressive fibrosis in the gastrocnemius of PAD patients that is caused by elevated TGF-ß1 production in the SMC of microvessels in response to tissue hypoxia.