MasterOnline Periodontology and Implant Therapy-revisited after seven years: A case study of the structures and outcomes in a blended learning CPD.

INTRODUCTION: There is a great need for postgraduate training and continuing professional development (CPD), specifically in the field of periodontology. Despite the plenty of periodontal CPDs, there is a lack of information about the performance of CPDs in a blended learning setting. This study is a case study of the structures and outcomes in a blended learning CPD programme in periodontology, the MasterOnline Periodontology and Implant Therapy hosted by the University of Freiburg's Dental School. MATERIAL AND METHODS: The structures of the blended learning CPD were analysed with the aims to (i) make explicit how various innovative educational methods and ICT tools can be successfully applied to a Web-supported postgraduate periodontology training programme, (ii) identify the programme's impact on learning transfer in students' dental practices and (iii) identify other outcomes, synergies and any changes required during the existence. Using qualitative interviewing, the various types of learning transfer and elements of the study programme that foster transfer could be exemplified. RESULTS: A period of 7 years was analysed. In this duration, 50 students successfully graduated to a master of science. Qualitative interviews were performed with six students and four teachers affirming the learning transfer in a blended learning setting. CONCLUSIONS: This case study shows that blended learning can be a successful approach for CPD in dentistry.

Mental distress and personality in women undergoing GnRH agonist versus GnRH antagonist protocols for assisted reproductive technology.

STUDY QUESTION: Do mental distress and mood fluctuations in women undergoing GnRH agonist and GnRH antagonist protocols for assisted reproductive technology (ART) differ depending on protocol and the personality trait, neuroticism? SUMMARY ANSWER: ART treatment did not induce elevated levels of mental distress in either GnRH antagonist or agonist protocols but neuroticism was positively associated with increased mental distress, independent of protocols. WHAT IS KNOWN ALREADY: ART treatment may increase mental distress by mechanisms linked to sex hormone fluctuations. General psychological characteristics, such as personality traits indexing negative emotionality, e.g. neuroticism, are likely to affect mental distress during ART treatment. STUDY DESIGN, SIZE, DURATION: A total of 83 women undergoing their first ART cycle were consecutively randomized 1:1 to GnRH antagonist (n = 42) or GnRH agonist (n = 41) protocol. The study population was a subgroup of a larger ongoing Danish clinical randomized trial and was established as an add-on in the period 2010-2012. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women in the GnRH antagonist protocol received daily injections with recombinant follicle-stimulating hormone, Puregon(®) and subcutaneous injections with GnRH antagonist, Orgalutran(®). Women in the GnRH agonist protocol received nasal administration of the GnRH agonist, Synarela(®) and subcutaneous injections with FSH, Puregon(®). The study design did not allow for a blinding procedure. All women self-reported the Profile of Mood States, the Perceived Stress Scale, the Symptom Checklist-92-Revised, and the Major Depression Inventory questionnaires, at baseline, at ART cycle day 35, on the day of oocyte pick-up, and on the day of hCG testing. Also, a series of Profile of Mood States were reported daily during pharmacological treatment to monitor mood fluctuations. The personality trait Neuroticism was assessed at baseline by the self-reported NEO-PI-R questionnaire. MAIN RESULTS AND THE ROLE OF CHANCE: ART did not induce within- or between-protocol changes in any of the applied measures of mental distress. However, the GnRH antagonist protocol was associated with more pronounced median mood fluctuations during the stimulation phase (antagonist, 11.0 SD, [IQR = 21.1-6.1]; agonist, 8.9 SD, [IQR = 11.3-5.7], P = 0.025). This association became non-significant after applying a Bonferroni-Holm correction. Neuroticism was highly positively associated with increased levels of mental distress throughout treatment independent of protocols (all P-values <0.006), and cross-sectional analysis revealed that women with high or low Neuroticism scores at baseline showed a significant trend towards lower chances of a positive pregnancy test (P-value =0.028). LIMITATIONS, REASONS FOR CAUTION: Information on prognostic factors such as preceding length of infertility, number of retrieved oocytes and number of prior insemination treatments was not accounted for in the analyses. The stratification of protocols by age in the subgroups of women included in this study was suboptimal. Women with prior or current use of antidepressant medication were excluded from our study. WIDER IMPLICATIONS: Our results imply that mental distress emerging during ART treatment is not causally linked to hypogonadism per se or to the choice of protocol. Rather, our data highlight the potential importance of (i) rapid increases in ovarian steroids and (ii) addressing personality traits indexing negative emotionality, i.e. Neuroticism, in women undergoing ART treatment, to optimize both emotional adjustment and, possibly, the chances of obtaining pregnancy. STUDY FUNDING/COMPETING INTERESTS: The Danish Research Council for Independent Research and MSD, Denmark kindly supported the study. The authors declare no competing financial interests. TRIAL REGISTRATION NUMBER: EudraCT - 2008-005452-24.

Does Harm Avoidance mediate effects of recollected parental bonding on mental distress in adulthood?

BACKGROUND: Adverse early life conditions such as perceived low quality of parental bonding increase vulnerability to stress and psychopathology in adulthood. However, the mechanisms by which perceptions of parental bonding translate into vulnerability are unclear and remain sparsely investigated in healthy populations. We proposed a model, in which the personality trait Harm Avoidance would mediate effects of recollected parental bonding during the first sixteen years of life on measures of perceived stress and mental distress severity in adulthood. METHOD: Five-hundred-eighteen adults (65.1 % women), aged 18-53years, completed questionnaires of parental bonding, perceived stress, trait Harm Avoidance, and severity of mental distress. Direct and indirect effects mediated through trait Harm Avoidance were examined in a structural equation model. RESULTS: Under the causal assumptions of our proposed model, indirect effects of trait Harm Avoidance mediated the relationship between parental overprotection and severity of mental distress, while significantly attenuating the direct effects of parental care on severity of mental distress. Moreover, indirect effects of trait Harm Avoidance significantly attenuated the direct effects of parental overprotection and care on perceived stress. CONCLUSION: In this large sample of mentally healthy adults, recollected parental bonding was significantly associated with levels of perceived stress and severity of mental distress. The results from our proposed model further suggest that trait Harm Avoidance may be a developmental link, by which the quality of recollected parental bonding in childhood translates into adult vulnerability to stress and mental distress.

Cerebral serotonin transporter binding is inversely related to body mass index.

Overweight and obesity is a health threat of increasing concern and understanding the neurobiology behind obesity is instrumental to the development of effective treatment regimes. Serotonergic neurotransmission is critically involved in eating behaviour; cerebral level of serotonin (5-HT) in animal models is inversely related to food intake and body weight and some effective anti-obesity agents involve blockade of the serotonin transporter (SERT). We investigated in 60 healthy volunteers body mass index (BMI) and regional cerebral SERT binding as measured with [(11)C]DASB PET. In a linear regression model with adjustment for relevant covariates, we found that cortical and subcortical SERT binding was negatively correlated to BMI (-0.003 to -0.012 BP(ND) unit per kg/m(2)). Tobacco smoking and alcohol consumption did not affect cerebral SERT binding. Several effective anti-obesity drugs encompass blockade of the SERT; yet, our study is the first to demonstrate an abnormally decreased cerebral SERT binding in obese individuals. Whether the SERT has a direct role in the regulation of appetite and eating behaviour or whether the finding is due to a compensatory downregulation of SERT secondary to other dysfunction(s) in the serotonergic transmitter system, such as low baseline serotonin levels, remains to be established.

Brain serotonin 2A receptor binding: relations to body mass index, tobacco and alcohol use.

Manipulations of the serotonin levels in the brain can affect impulsive behavior and influence our reactivity to conditioned reinforcers. Eating, tobacco smoking, and alcohol consumption are reinforcers that are influenced by serotonergic neurotransmission; serotonergic hypofunction leads to increased food and alcohol intake, and conversely, stimulation of the serotonergic system induces weight reduction and decreased food/alcohol intake as well as tobacco smoking. To investigate whether body weight, alcohol intake and tobacco smoking were related to the regulation of the cerebral serotonin 2A receptor (5-HT(2A)) in humans, we tested in 136 healthy human subjects if body mass index (BMI), degree of alcohol consumption and tobacco smoking was associated to the cerebral in vivo 5-HT(2A) receptor binding as measured with (18)F-altanserin PET. The subjects' BMI's ranged from 18.4 to 42.8 (25.2+/-4.3) kg/m(2). Cerebral cortex 5-HT(2A) binding was significantly positively correlated to BMI, whereas no association between cortical 5-HT(2A) receptor binding and alcohol or tobacco use was detected. We suggest that our observation is driven by a lower central 5-HT level in overweight people, leading both to increased food intake and to a compensatory upregulation of cerebral 5-HT(2A) receptor density.

Oatp-associated uptake and toxicity of microcystins in primary murine whole brain cells.

Microcystins (MCs) are naturally occurring cyclic heptapeptides that exhibit hepato-, nephro- and possibly neurotoxic effects in mammals. Organic anion transporting polypeptides (rodent Oatp/human OATP) appear to be specifically required for active uptake of MCs into hepatocytes and kidney epithelial cells. Based on symptoms of neurotoxicity in MC-intoxicated patients and the presence of Oatp/OATP at the blood-brain-barrier (BBB) and blood-cerebrospinal-fluid-barrier (BCFB) it is hypothesized that MCs can be transported across the BBB/BCFB in an Oatp/OATP-dependent manner and can induce toxicity in brain cells via inhibition of protein phosphatase (PP). To test these hypotheses, the presence of murine Oatp (mOatp) in primary murine whole brain cells (mWBC) was investigated at the mRNA and protein level. MC transport was tested by exposing mWBCs to three different MC-congeners (MC-LR, -LW, -LF) with/without co-incubation with the OATP/Oatp-substrates taurocholate (TC) and bromosulfophthalein (BSP). Uptake of MCs and cytotoxicity was demonstrated via MC-Western blot analysis, immunocytochemistry, cell viability and PP inhibition assays. All MC congeners bound covalently and inhibited mWBC PP. MC-LF was the most cytotoxic congener followed by -LW and -LR. The lowest toxin concentration significantly reducing mWBC viability after 48 h exposure was 400 nM (MC-LF). Uptake of MCs into mWBCs was inhibited via co-incubation with excess TC (50 and 500 microM) and BSP (50 microM). MC-Western blot analysis demonstrated a concentration-dependent accumulation of MCs. In conclusion, the in vitro data support the assumed MC-congener-dependent uptake in a mOatp-associated manner and cytotoxicity of MCs in primary murine whole brain cells.

The effect of birthweight upon insulin resistance and associated cardiovascular risk factors in adolescence is not explained by fetal growth velocity in the third trimester as measured by repeated ultrasound fetometry.

AIMS/HYPOTHESIS: Smallness for gestational age (SGA) is associated with increased risk of developing components of the metabolic syndrome. Although SGA can imply intrauterine growth restriction (IUGR), more information is required to link specific fetal growth patterns to adult outcomes. METHODS: We examined the impact of fetal growth velocity during the third trimester (FGV) vs birthweight for gestational age on early markers of the metabolic syndrome in 123 healthy men and women (mean age 17.5 years) born at term. FGV was determined by ultrasound measurements. RESULTS: After correction for confounders including current BMI, SGA was significantly associated with raised basal plasma insulin (+19% above appropriate for gestational age), homeostasis model assessment of insulin resistance (+21%), cholesterol:HDL-cholesterol ratio (+13%) and systolic BP (+4.8%) (all p < 0.05). Furthermore SGA was associated with increased fat mass (+9.6%) and trunk-fat per cent (+6.8%) and with reduced lean body mass as determined by dual-energy X-ray absorptiometry scans (-4.1% below appropriate for gestational age) (all p < 0.05). In contrast, IUGR in the third trimester was associated only with an elevated cholesterol:HDL-cholesterol ratio (+11% above not-IUGR). CONCLUSIONS/INTERPRETATION: In the present study, FGV did not explain the impact of birthweight upon the metabolic phenotype in adolescence. This suggests that fetal growth prior to the third trimester or postnatal catch-up growth plays a more important role.

New insights into the biology of cytokinin degradation.

A survey of recent results is presented concerning the role of cytokinin degradation in plants, which is catalyzed by cytokinin oxidase/dehydrogenase (CKX) enzymes. An overview of Arabidopsis CKX gene expression suggests that their differential regulation by biotic and abiotic factors contributes significantly to functional specification. Here, we show using reporter gene and semiquantitative RT-PCR analyses regulation of individual CKX genes by cytokinin, auxin, ABA, and phosphate starvation. Partially overlapping expression domains of CKX genes and cytokinin-synthesizing IPT genes in meristematic tissues and endo-reduplicating cells lend support for a locally restricted function of cytokinin. On the other hand, their expression in vascular tissue suggests a function in controlling transported cytokinin. Recent studies led to a model for the biochemical reaction mechanism of CKX-mediated catalysis, which was refined on the basis of the three-dimensional enzyme structure. Last but not least, the developmental functions of CKX enzymes are addressed. The recent identification of the rice OSCKX2 gene as an important novel breeding tool is highlighted. Together the results corroborate the relevance of metabolic control in determining cytokinin activity.

Dental pulp capping: effect of Emdogain Gel on experimentally exposed human pulps.

AIM: To investigate the effect of Emdogain Gel (Biora AB, Malmo, Sweden), consisting of a enamel matrix derivative (EMD) in a propylene glycol alginate (PGA) vehicle, on experimentally exposed human pulps and to register postoperative symptoms. METHODOLOGY: Nine pairs of contralateral premolars scheduled for extraction on orthodontic indications were included. Following a superficial pulp amputation performed with a small (016) diamond bur, either EMDgel or a mix of calcium hydroxide and sterile saline was placed at random in contact with the pulp wound. The subjects made records of symptoms and were also interviewed about pain/discomfort by a blinded examiner. After 12 weeks the teeth were extracted, prepared and subjected to light microscopic examination in which the inflammation and newly formed hard tissue in the pulp were analysed. Immunohistochemistry was performed using affinity-purified rabbit anti-EMD polyclonal antibodies. RESULTS: Postoperative symptoms were less frequent in the EMDgel-treated than in the calcium hydroxide-treated teeth, especially during the first six weeks. In the EMDgel-treated teeth, new tissue partly filled the space initially occupied by the gel and hard tissue was formed alongside the exposed dentine surfaces and in patches in the adjacent pulp tissue. EMD was detected in the areas where new hard tissue had been formed. The wound area of the EMDgel-treated teeth exhibited inflammation in the majority of the teeth whereas less inflammation was seen in the calcium hydroxide-treated teeth where the hard tissue was formed as a bridge. CONCLUSIONS: In the EMDgel-treated teeth, postoperative symptoms were less frequent and the amount and pattern of hard tissue formation were markedly different than in the teeth treated with calcium hydroxide. However, the operative procedure and the formulation with EMD in a PGA vehicle do not seem to be effective for the formation of a hard tissue barrier.

Impact of psychotherapeutic support on gastrointestinal cancer patients undergoing surgery: survival results of a trial.

BACKGROUND/AIMS: The impact of psychotherapeutic support on survival time in patients with gastrointestinal cancer undergoing surgery was studied. METHODOLOGY: A randomized controlled trial was conducted in cooperation with the Departments of General Surgery and Medical Psychology, University Hospital of Hamburg, Germany. Two hundred and seventy-one consenting patients with a preliminary diagnosis of cancer of the esophagus, stomach, liver/gallbladder, pancreas or colon/rectum were stratified by gender and randomly assigned to a control group that received standard care, as provided on the surgical wards, or to an experimental group that received formal psychotherapeutic support in addition to routine care during the hospital stay. Patients in both groups completed the EORTC-Quality of Life questionnaire pre-operatively, post-operatively, and at 3, 6, 12, and 24 months following surgery. Date of death, if applicable, was also recorded. Unadjusted and adjusted survival analyses were performed. RESULTS: Kaplan-Meier survival curves demonstrated better survival for the experimental group than for the control group. The unadjusted significance level for group differences was p = 0.002 for survival up to 2 years. Cox regression models that took TNM Staging or the Residual Tumor Classification into account also found significant differences at the 2-year follow-up. Secondary analyses found that most of the differences in favor of the experimental group occurred in females and in patients with stomach, pancreatic, primary liver or colorectal cancer. CONCLUSIONS: The results of this study indicate that patients with gastrointestinal cancer, particularly those who are female and those who undergo surgery for stomach, pancreatic, primary liver or colorectal cancer, benefit from a formal program of psychotherapeutic support in terms of survival.

Ontogeny of T cell tolerance to peripherally expressed antigens.

Transgenic expression of the influenza virus hemagglutinin (HA) in the pancreatic islet beta cells of InsHA mice leads to peripheral tolerance of HA-specific T cells. To examine the onset of tolerance, InsHA mice were immunized with influenza virus A/PR/8 at different ages, and the presence of nontolerant T cells was determined by the induction of autoimmune diabetes. The data revealed a neonatal period wherein T cells were not tolerant and influenza virus infection led to HA-specific beta cell destruction and autoimmune diabetes. The ability to induce autoimmunity gradually waned, such that adult mice were profoundly tolerant to viral HA and were protected from diabetes. Because cross-presentation of islet antigens by professional antigen-presenting cells had been reported to induce peripheral tolerance, the temporal relationship between tolerance induction and activation of HA-specific T cells in the lymph nodes draining the pancreas was examined. In tolerant adult mice, but not in 1-week-old neonates, activation and proliferation of HA-specific CD8(+) T cells occurred in the pancreatic lymph nodes. Thus, lack of tolerance in the perinatal period correlated with lack of activation of antigen-specific CD8(+) T cells. This work provides evidence for the developmental regulation of peripheral tolerance induction.

[Deliveries at a department of surgery during a 10-year period]. / Fødsel på kirurgisk afdeling i en tiårsperiode.

In order to see whether the pattern of referral of pregnant women, intervention during labour and transport of neonates had changed over a 10-year period, we investigated these variables in the women who gave birth at our department of surgery in 1978, 1981 and 1988. The numbers of women were 790, 630 and 697 respectively for the three years, and the corresponding numbers of neonates transferred to the neonatal unit were 56, 44 and 53 respectively. The frequencies of risk pregnancies increased from 20% in 1978 to 37.7% in 1999, (p < 10(-6) and the frequency of primiparity increased from 43% to 51.2% over the same period (p < 10(-5)). More women underwent elective caesarean section due to an increased number of breech presentation in nulliparous women (p < 10(-3)). The frequency of induction of labour decreased from 21.7% to 16.5% (p < 10(-6)). The perinatal mortality ranges between 0% to 0.48% during the 10 years, and the rates of transfer of neonates to the neonatal unit were unchanged (7.1-7.6%). It is concluded that changes in referral and composition of the population had no influence on the incidence of acute intervention in labour or rate of neonatal transfer.

Which types of perinatal events are predictable? A look at a risk score model.

This study describes the association of a risk factor model for complicated delivery, perinatal morbidity and perinatal mortality with each of various types of delivery complications, types of perinatal morbidity and causes of perinatal mortality. The material comprises a total cohort, 4,066 pregnant women with singletons in a Danish county, and their newborn infants, of whom 494 (12%) had clinical morbidity during the first 5 days of life; 28 (0.7%) died perinatally. A set of 20 risk factors, identifiable before pregnancy, at any time during the pregnancy or at term, was devised by joining existing models for prediction of complicated delivery and of perinatal morbidity and mortality. Metabolic and disproportion-related events were well predicted by the model, inertia-related ones less so, and placental conditions not at all, except for abruption. All types of neonatal morbidity (except sepsis) were well predicted, as were deaths. The strongest predictors of perinatal death were signs of hydramnios (RR = 16.1) and growth retardation (RR = 7.2). The 20 risk factors affected 43% of the population, predicting 57% of the unfavorable perinatal events.

Antenatal and perinatal conditions correlated to handicap among 4-year-old children.

The purpose of this study was to investigate the impact of maternal prepregnancy and pregnancy-related risk factors, complicated delivery, and perinatal morbidity on subsequent handicaps in children. We surveyed a birth cohort of 4102 mothers and 4138 children in Frederiksborg County, Denmark. Maternal risk factors were defined according to guidelines published by the Danish National Board of Health, and perinatal morbidity and handicaps according to World Health Organization guidelines. The incidence of handicaps: (cerebral palsy, mental retardation [mild and severe], epilepsy, severe defects of vision and hearing); was 44 of 4038 children (twins and neonatal deaths were excluded). A combination of three or more maternal risk factors was found to be a predictor of risk for children with later handicaps; the incidence of handicaps was 11 times higher than in mothers with no risk factors. Eleven percent of all mothers had three or more risk factors and they had 43% of the handicapped children. Multiparity increased the risk in all risk categories. Of complications at delivery, intrapartum asphyxia, as evident from Apgar scores of less than 7 at 1 minute and less than 10 at 10 minutes in particular, was a strong predictor of a later handicap. Premature rupture of membranes for more than 24 hours was also significantly associated with later handicaps. Perinatal morbidity was correlated with a later handicap. The perinatal complication most strongly associated with later handicaps was low birthweight. Forty-eight percent of the affected children had a birthweight of less than 2500 gm and were small for gestational age. We conclude that the incidence of handicaps could possibly be reduced if the causes of the following maternal risk factors were identified and, if possible, eliminated: previous delivery of a child with a birthweight less than 2500 gm, previous delivery of a stillborn child, repeated abortions, severe infection during pregnancy, intrauterine growth retardation, and preterm delivery. Improved intrapartum diagnosis and prevention of asphyxia and treatment of children born with low Apgar scores would reduce the incidence of handicaps, as would intervention to prevent premature rupture of the membranes of more than 24 hour's duration.

The unborn and newborn child. I. Risk factors predicting complicated delivery in a general population of 4,102 women.

Among the 56 risk factors (RF) in pregnant women, used by the Danish National Board of Health, those that can predict complicated delivery (CD) were identified. The significance of parity, maternal age, social class and civil status was also analysed. The material comprises a Danish county cohort of 4,102 deliveries. The 56 original RFs affected 56% of the population. Women (8.8%) with twin pregnancy, fetus in breech, footling and transverse lie, or having an elective cesarean section were analysed separately. The incidence of CD was otherwise 39%. Of all the women, 8.7% had only prepregnancy RFs with a CD rate of 52%; 19.2% had only pregnancy RFs other than special conditions mentioned with a CD rate of 52%; 3.6% had both prepregnancy and pregnancy RFs with a CD rate of 62%. When the special conditions separately analysed were included, 14 RFs of the original 56 were found to predict complicated delivery. These affected 40% of the population. Primiparity was also a RF. The conceptional age of a primipara raised the odds in favor of CD by a factor 1.09 for each year. Social class and civil status were of no significance for CD.

The unborn and newborn child. II. Risk factors predicting perinatal morbidity and mortality in 4,138 infants.

In this study, antenatal risk factors (RF) predicting perinatal morbidity and mortality (PMM) were identified among 56 RFs defined by the Danish National Board of Health. The association with parity, age, social class, civil status, complicated delivery was also analysed. The RFs predicting complicated delivery have been described in Part I (1). All events, both prenatal and during the perinatal period, in 4,138 infants borne by 4,102 women in an entire Danish district were analysed. The frequency of perinatal mortality was 0.8% and of perinatal morbidity, 12.7%. The original 56 RFs affected 56% of the population. Fourteen 'new' RFs among the original 56 RFs predicted PMM and affected 27% of the population. The prepregnancy RFs affected 4.5% of all women with singleton pregnancies and their infants had a PMM rate of 21%; the pregnancy RFs affected 18.1%, the PMM rate being 25%; 3.4% had both prepregnancy and pregnancy RFs, their PMM rate was 41%. Twin pregnancies occurred in 0.9%, with a PMM rate of 47%. Apart from these groups, the PMM rate was only 8%. Parity, social class and civil status were of no significance for PMM. Some delivery complications, termed labor RFs, raised the odds of PMM by a factor of 1.92.

The prevalence of female urinary incontinence and reasons for not seeking treatment.

The prevalence of urinary incontinence in women aged 18 years and over was investigated by carrying out a telephone interview of 851 women randomly selected from the Dunedin electoral register. Two hundred and sixty seven (31%) of the women interviewed had some degree of incontinence in the preceding 12 months and 142 (17%) had had regular incontinence (two or more episodes of leakage per month). Daily incontinence occurred in approximately 5% of the women sampled with 2.3% being incontinent more than once per day or being continually incontinent. Only one third of those with regular incontinence had sought medical help for their problem. The commonest reasons for this were that either the incontinence was not seen as abnormal (81%) or there was a low expectation of benefit from treatment (10%). Thus there needs to be improved awareness that incontinence is treatable and that medical and surgical treatment options are available.

The unborn and the newborn child. Present obstetric risk grouping fails to predict complicated labour and neonatal morbidity.

An epidemiologic analysis is presented of 4,102 women to a birth cohort in Frederiksborg County. The purpose is to evaluate the predictive value of pregnancy risk groups (R) present before labour for complicated delivery (CD) and neonatal morbidity (NM). The risk factors defining R comply with the Danish National Board of Health Recommendations. R included 56%. By primary risk group (PR) is understood women only with complicating factors at the onset of pregnancy, by secondary risk group (SR) women only with complicating factors occurring during pregnancy. The tertiary risk group (TR), which includes women with a complication which with certainty implies CD, was excluded. PR and SR were significant regression variables evaluated by CD and NM. Primiparae had a higher frequency of CD than multiparae, both in the no-risk group (N-R) and in the R, but not evaluated by NM. Primiparity, thus, was a risk factor for CD. NM correlated with CD in the form of severe risk conditions for both the mother and child during delivery. Evaluated by CD and NM, the predictive value of belonging to R was 46% and 16%, and the predictive value of belonging to N-R was 69% and 93%, which suggests that a re-evaluation of the risk factors is required.

The caries-preventive effect of a fluoride varnish in the fissures of the first permanent molar.

The aim of the present study was to assess the caries-preventive effect of topical application of Duraphat on the occlusal surface of newly erupted first permanent molars. A base-line examination was performed on children aged 5 years and 9 months. The children were randomly divided into a Duraphat group and a control group. In accordance with the anatomy of the fissure system, the molars were divided into shallow and deep fissures, respectively. From the time of eruption, 381 molars were examined every 3rd month during 24 months. Duraphat was applied every 6th month, altogether four times. The results showed that in the Duraphat group 35% of the fissures were decayed compared with 80% in the control group. Caries reduction amounted to 56%, and the caries-preventive effect was found in molars with shallow and deep fissures.