The ability of different compositions of calcium silicate and epoxy sealers to withstand gutta percha removal via in vitro pull-out testing.

OBJECTIVE: examination of the influence of chemical composition changes on the ability of sealers to withstand a pull-out test. MATERIALS AND METHODS: Fifty distal or palatal canals of extracted teeth were prepared by Dc Taper files. The teeth were divided into five groups: AH Plus, BJM RCS, Total Fill BC,AH Plus Bioceramic and a group with Gutta Percha with no sealer added. Ten days after obturation, each cone was subjected to the "pull-out test" with the Shimadzo Universal Testing Machine until it was torn or removed from the canal. A force to Stroke graph was generated and the maximum vertex of this graph was recorded. The number of times the cone was torn or removed was recorded. RESULTS: The amount of force needed to remove or rupture the cone was significantly higher in all sealer groups compared to the AH Plus Bioceramic group. The force needed for the AH Plus group was double that needed for the AH Plus Bioceramic group 4 (1.87 ± 0.53 N vs 0.93 ± 0.48 N, respectively, P < 0.001). All of the cones (n = 10) in the AH Plus Bio Ceramic Sealer group were removed in their entirety (P = 0.01 compared to each of the other groups). CONCLUSIONS: The addition of macromolecules to epoxy sealer does not change the material's ability to withstand the pull-out test. Decreasing the amount of tri- and di-calcium silicate compounds combined with increasing amounts of zirconium oxide in a Bioceramic sealer significantly decreased the material's ability to withstand the pull-out test.

The Link Between Somatization and Dissociation and PTSD Severity in Veterans Who Sought Help From the IDF Combat Stress Reaction Unit.

INTRODUCTION: This study aimed to examine the relationships between dissociative and somatic symptoms and how they might contribute to PTSD severity among ex-soldiers who sought help from the IDF Combat Stress Reaction Unit (CSRU). MATERIALS AND METHODS: This cross-sectional study included 1,305 former compulsory, career, and reserve soldiers, who filled out self-report questionnaires on admission for evaluation at the CSRU. The study's dependent variables included two posttraumatic stress disorder measures (CAPS and PCL-5). The independent variables were the Dissociative Experience Scale and Brief Symptom Inventory. Background and service-related variables were also examined. RESULTS: Spearman correlation revealed that the higher the level of somatization is, the higher the level of PTSD via PCL and CAPS. A significant positive association was found between somatization and dissociation (r = 0.544; P < 0.001). The higher the somatization level, the more severe the dissociation. A multivariate logistic regression analysis to predict severe PTSD revealed that the longer the time elapsed from the traumatic event (OR = 1.019, P = 0.015), the higher the risk for severe PTSD. The most prominent variables were dissociation (OR = 6.420, P < 0.001) and somatization (OR = 4.792, P < 0.001). The entire model reached 40.8% of the shared variance in the regression. CONCLUSIONS: While there is direct reference to dissociation in the clinical assessment by PCL or CAPS, there is no such reference to somatization. Highly functioning combatants sometimes express their distress somatically. Our findings suggest regarding severe somatic symptoms as diagnostic criteria for PTSD.

Factors associated with self-harm behaviors during military service in the Israel Defense Forces, rates of such behaviors and their outcomes.

The military environment involves stressful situations that may trigger or aggravate suicidal behaviors, such as suicide attempts (SAs), which significantly increase the likelihood of future suicide. This cross-sectional study aims to assess risk factors for severe SAs and non-suicidal self-injury (NSSI) among Israel Defense Forces (IDF) soldiers. Data were retrieved from an IDF computerized self-harm surveillance database and were based on the criteria of the Columbia Suicide Severity Rating Scale (C-SSRS) and the Suicide Attempt Self-Injury Interview (SASII). The cohort included all 1,238 occurrences of self-harm behavior, during 2017-2021. Other investigated variables included adjustment difficulty (AD, as per IDF definition) and psychiatric diagnosis (PD) as reported by mental health officers (MHOs) during recruitment. Higher rates of adjustment difficulties were found among soldiers who had conducted NSSIs. Higher rates of previous psychiatric diagnoses were found among individuals with SAs, and their risk of dying by suicide during military service was twice as high (OR = 2.356; p < .001). If the latter also served in a combat unit, the risk was almost fourfold (OR = .3.860; p < .001). The current study demonstrates a clear difference between IDF soldiers who conduct NSSI vs. those conducting SA with regard to adjustment difficulty (as per IDF definition) and PD.

Methylphenidate use and restorative treatment needs in young adults with attention deficit hyperactivity disorder.

OBJECTIVE: To assess the effect and dose-response of methylphenidate (MP) use on the restorative treatment needs in young adults with attention deficit hyperactivity disorder. PARTICIPANTS AND METHODS: This retrospective study comprises a cohort of military recruits aged 18-25 who served for 12 to 48 months between 2005 and 2017. The medical records of 213 604 participants were assessed of which: 6875 participants with ADHD who received treatment with MP, 6729 participants with ADHD who had no prescriptions for MP, and 200 000 healthy participants. The outcome was restorative treatment needs, which served as an indicator of caries: having at least one prescription for restorative treatment during the study period. RESULTS: Frequency of prescription for restorative treatment among the treated, the untreated and the control groups was 24%, 22%, and 17%, respectively (p < .0001). On multivariate analysis, the dose-response association between MP use and the odds of having at least one restorative treatment was confirmed (OR = 1.006 for each additional 1 gr of MP; 95% CI [1.004:1.009]) CONCLUSIONS: Participants with ADHD who receive chronic treatment with MP have higher restorative treatment needs than participants with untreated ADHD and healthy participants. Our results show that chronic MP medication among young adults leads to an elevated need for restorative treatment and implies a significant impact on oral health (OH).

Translation, Transcultural Adaptation, and Validation of the Hebrew Language Version of the Orthognathic Quality of Life Questionnaire for the Assessment of Quality of Life in Orthognathic Patients.

INTRODUCTION: Dentofacial deformities impose a negative impact on quality of life (QOL). Orthognathic surgery is the main pillar of treatment for these conditions and has proven its impact on the improvement of the functional and psychosocial aspects of QOL. The Orthognathic Quality of Life Questionnaire (OQLQ), developed by Cunningham and colleagues, is a well-established instrument for assessing QOL in patients with dentofacial deformities. OBJECTIVE: The aim of this study was to perform a translation, transcultural adaptation, and validation of a Hebrew version of the OQLQ. METHODS: Transcultural adaptation was done following guidelines proposed by Beaton and colleagues resulting in a pilot study conducted on 20 patients undergoing orthognathic surgery. Internal consistency, reliability, and sensitivity were evaluated by means of Cronbach alpha, intraclass correlation coefficient (test-retest), and Wilcoxon test, respectively. Validity was assessed by comparing the OQLQ with the Hebrew version of the Oral Health Impact Scale-14 (Oral Health Impact Profile Scale-14) using the Spearman correlation test. RESULTS: Internal consistency showed a good correlation between domains and excellent test-retest reliability. Sensitivity to change was statistically significant in all but 3 questions. The Hebrew version of the OQLQ exhibited a strong correlation with Oral Health Impact Profile Scale-14 in total score and moderate to high correlations among domains. CONCLUSION: The Hebrew version of the OQLQ is a valid and reliable and specific instrument to measure QOL for Hebrew-speaking patients undergoing orthognathic surgery.

Association of Nationwide Water Fluoridation, changes in dental care legislation, and caries-related treatment needs: A 9-year record-based cross-sectional study.

OBJECTIVES: The implementation of Nationwide Water Fluoridation in Israel in 2002 led to a significant reduction in caries among children. However, this practice was discontinued in 2014 due to a change in legislation. In 2010, as part of the Israeli National Health Insurance Law, free dental care for children under 10 years of age was legislated. This policy was gradually extended to include adolescents under 18 years of age in 2018. We examined the association between these efforts and changes in the caries-related treatment needs of young adults over the course of two decades. METHODS: This cross-sectional study analyzed data on the need for dental restorations, root canal therapy, and extractions that were retrieved from dental records of 34,450 soldiers recruited into military service between 2012 and 2021. These data were cross-matched with the subjects' year of birth to determine whether the implementation of water fluoridation, dental care legislation, or both were associated with changes in the need for and provision of dental care. Sociodemographic data, including sex, age, socioeconomic cluster (SEC), intellectual capability score (ICS), body mass index, and place of birth, were also extracted. RESULTS: A multivariate generalized linear model (GLM) revealed that male sex, older age, low ICS, and low SEC were significant predictors for greater caries-related treatment needs (P < 0.001). Our findings indicated that subjects exposed to fluoridated water during their childhood had significantly lower rates of caries-related treatment, regardless of access to free dental care. CONCLUSION: Mandatory water fluoridation was associated with significantly lower caries-related treatment needs while national dental health legislation providing free dental care to children and adolescents was not. Therefore, we suggest that water fluoridation should be continued to maintain the observed reduction in treatment needs. CLINICAL SIGNIFICANCE: Our findings provide support for the effectiveness of water fluoridation in preventing caries, whereas the impact of free dental care programs focused on clinical intervention remains to be determined.

Risk factors for injuries along an infantry commanders course.

To determine the influence of prevention programme on somatosensory ability in combat soldiers during 14-weeks of an infantry commanders course, two cohorts were recruited (INT-group, n = 196; CONT-group, n = 169). Soldiers were tested pre-and post-course for anthropometric measurements, proprioceptive ability, dynamic postural balance, and filled CAIT questionnaire. The INT-group performed injury prevention exercises and the CONT-group continued with their routine physical fitness lessons. All musculoskeletal injuries were recorded along the course. In the CONT-group 24.2% and in the INT-group 19.9% suffered injury during the course. The rates of injuries were not significantly different between groups (χ2(1) = .677 p = .411). Previous injury (OR = 3.349, 95% CI = 1.283-8.740), pre-course BMI (OR = 1.216, 95% CI = 1.064-1.389), and pre-course proprioception ability (OR = .870, 95% CI = .810-.935) were factors associated with injury in the CONT-group. Pre-course proprioception ability (OR = .769, 95% CI = .699-.846) and pre-course CAIT score (OR = .087, 95% CI = .027-.276) were factors in the INT-group. Soldiers who received injury prevention exercises had a similar prevalence of total musculoskeletal injuries as those who did not receive these exercises. Risk factors for injuries were different in the two groups.

Predictors of Emotional Distress in Combat Military Flight Engineers.

OBJECTIVE: Exposure to distressing sights (DSs) during combat missions may cause emotional distress. The present study aimed to investigate the association between exposure to DSs involving severe injuries and fatalities during rescue missions and emotional distress, in Israeli Air Force (IAF) helicopter flight engineers (FEs). METHODS: Cross-sectional design using self-report questionnaires. The independent variables included demographics, personal, and military variables-exposure to DSs throughout a whole career service. The dependent variables included Depression (Beck Depression Inventory); State-Trait Anxiety Inventory; Post-traumatic stress disorder (PTSD Checklist-PCL-5); Somatization (Patient Health Questionnaire); Maslach Burnout Inventory; and Coping Strategies (The Brief COPE). The variables PTSD, depression, and anxiety were examined twice: once as dichotomous variables according to the pathology cutoff point and again as a continuous variable to reveal the intensity of symptoms. RESULTS: Participants were 106 IAF helicopter FEs (mean age = 39.32, SD = 8.75). Linear regression revealed that initial exposure to distressing battlefield sights (i.e., exposure to severe injuries and fatalities) was a predictor of depression symptoms. Career service FEs aged 31-40 were found to be at the highest risk of emotional distress, with a predictive factor for anxiety symptoms. Use of nonadaptive coping strategies was found to predict depressive symptoms, anxiety symptoms, and post-traumatic stress symptoms. CONCLUSION: A significant association was found between exposure to DSs involving severe injuries and fatalities during rescue missions and anxiety, depression, somatization, and burnout. This population is generally perceived as tough and resilient, and this study has a unique contribution in identifying its vulnerabilities. Psychological intervention is crucial after participating in such missions.

Israeli soldiers' intentions and actions toward seeking mental health help: Barriers and facilitators.

BACKGROUND: While military settings may increase psychological distress, soldiers frequently avoid seeking professional help. This study aimed to examine barriers and facilitators associated with intentions to seek help and actually seeking help from a mental health officer (MHO) and how these differ among soldiers who had sought help in the past and those who had not. METHOD: This cross-sectional study included 263 combat and noncombat soldiers. The Health Belief Model and the Help-Seeking Model were the theoretical framework used to map the potential variables associated with soldiers' decision to seek help. RESULTS: Stigma and administrative barriers were found to be significant barriers to both the intention to seek help and actually consulting an MHO. These findings were more definitive among combat soldiers. The belief in the effectiveness of mental health treatment was positively associated with the intention to seek help. Positive associations were found between well-being, perceived seriousness of one's condition, and belief in the effectiveness of mental health care and intention to seek MHO help. Distress and self-concealment were positively associated with actual consultation with an MHO. Public stigma about seeking help was associated with both the intention to seek mental health assistance and actually consulting an MHO. CONCLUSION: Military commanders should make an effort to make soldiers feel safe to seek mental health assistance by creating a supportive organizational atmosphere to reduce the stigma associated with mental health care.

Contributing Factors to Israeli Soldiers' Adaptation to Military Noncombat Positions.

OBJECTIVE: Adjusting to a military environment is a complex process, with unique demands and various stressors placed on conscripts. In this study, we examined the unique and combined contribution of the independent variables that constitute an individual soldier's personal resources-the meaningfulness of the military role and the match between expectations and the job itself; cognitive flexibility; social support; and seeking help from a mental health officer (MHO)-to the adaptation (dependent variable) of noncombat soldiers to military service. METHOD: The study group comprised 200 Israel Defense Forces noncombat soldiers aged 18-23 years (Meanage = 20.046 years, SD = 0.951). Of them, 107 (53.3%) had consulted a MHO. The remaining soldiers who had not consulted an MHO (n = 93, 46.5%) served as the comparison group. Research tools included the work and meaning questionnaire, the Cognitive Flexibility Scale, the Medical Outcomes Study (social support) questionnaire, and adaptation to the army questionnaire. RESULTS: Adaptation to service was found to relate positively to the meaningfulness of the military role, cognitive flexibility, and social support. Social support partially mediated the relation between cognitive flexibility and adaptation to service. Additionally, soldiers who had consulted an MHO had lower levels of cognitive flexibility and social support, and they adapted less well to service compared to the comparison group. CONCLUSIONS: The study indicates that soldiers who seek help have lower resources. Additional personal and environmental variables that contribute to the adjustment of soldiers in noncombat positions were also identified.

Military mental health professionals' suicide risk assessment and management before and after experiencing a patient's suicide.

OBJECTIVE: This study examines the association between a patient's suicide and the therapist's suicide risk assessment (SRA) and suicide risk management (SRM) of patients, following the occurrence. METHOD: SRA values range from "absence of suicidality" to "immediate suicidal intent to die". SRM consists of therapists' written recommendations. Rates of the various SRA and SRM values in therapists' evaluations were assessed 6-months prior to the suicide and at the two three- and six-month time-points thereafter. RESULTS: Of the 150 soldiers who died by suicides, 30 (20%) visited 50 military therapists in the 6 months preceding their deaths. Using Wilcoxon signed rank test, lower SRA rates of "threatens suicide" were found 2 months after a patient's suicide. Regarding SRM, the mean rates for "recommendations for psychotherapy treatment" were higher at the two (p = 0.022) and the 3 month time-points (p = 0.031) after a suicide. CONCLUSIONS: The SRA findings may indicate therapists' fear of treating suicidal patients, causing them to overlook patients' non-prominent suicide-risk indicators. In SRM, the higher rate of recommendations for additional therapy sessions rather than military release or referrals to other therapists may relate to over-caution and attempts to control the patient's therapy ensuring it's done properly.

The Influence of a 14-Week Infantry Commanders Courses on the Achilles Tendon and Patellar Tendon Structure.

INTRODUCTION: Alternated tendon structure may raise stress to the musculoskeletal structures and may increase the potential for overuse injury. Screening the tendon structure of soldiers pre- and post-participation in a strenuous combat course is essential. The aim of the present study was to investigate the influence of a 14-week infantry commanders courses on the Achilles tendon (AT) structure and patellar tendon (PT) structure in combat soldiers. MATERIALS AND METHODS: Ninety-eight participants from an infantry commanders course were screened pre- and post-course for the AT and PT structures, using ultrasonographic tissue characterizaton (UTC) imaging to capture a 3D structure of four echo-type fibers (I-IV). RESULTS: In both tendons, the mean relative frequency of echo-type I fibers significantly decreased from pre- to post-testing, with a significant increase in the relative frequency of echo-types II, III, and IV fibers. In the AT, 60.2% of the subjects showed positive differences (between pre- and post-testing in the echo-type III + IV fiber ("worsened" tendon structure), whereas in the PT, 92.2% of the subject showed an increased frequency. No significant correlation (r = 0.108; P = .324) was found between the differences of echo-type III + IV fibers of the AT and that of the PT. CONCLUSIONS: Loads to the musculoskeletal structures along the combat course increased the mean relative frequency of the "reduced" echo-type fibers (III + IV) in both the AT structure and the PT structure. Yet, whereas in the AT around 40% of the soldiers showed an improved tendon structure along the course, in the PT less than 10% of the soldiers showed that improvement. Soldiers and commanders should be aware of the different influence of the loading exercises along the course on the AT and on the PT structure, as "reduced" tendons structure might put the soldiers at higher risk for injury in the future.

Orthopedic screws insertion simulation with immediate feedback enhances surgical skill.

BACKGROUND: Screw insertion to bones is a fundamental skill in orthopedic, spine and cranio-maxillofacial surgery. Applying the correct tightening torque is critical when compressing and fixating bone fragments. Overtightening yields in plastic deformation of the bone and destruction of the screw-bone interface, damaging the construct's stability. The surgeon is required to achieve sufficient hold and compression without stripping the bone. Several studies have investigated these skills, demonstrating much potential to enhance the future surgeons' capabilities. This study presents a novel training module, combining direct tightening followed by deliberate striping with immediate feedback suggested to enhance the surgeon's tactile perception and improve skill. METHODS: A prospective single-blinded cohort study was run. Twenty surgeons from various disciplines, excluding orthopedic and maxillo-facial surgeons, were trained using an orthopedic screws insertion model, comprised of synthetic bones. Training sessions considered inserting 40 screws into normal and osteoporotic bone models, experiencing deliberate stripping of the screws and feedback for their performance in three different sessions. FINDINGS: Success rate increased between sessions - by 24% to 48% in normal bone, and by 37% to 52% in osteoporotic bone. Stripping rate decreased between sessions - by 37.5% to 18.5% in normal bone, and by 29% to 14% in osteoporotic bone. Average ratio between tightening torque and maximum possible torque before bone stripping improved gradually and consistently from 67.3% to 81.6% in normal bone (p < 0.001), and slightly from 76.4% to 77.5% in osteoporotic bone (p = 0.026). INTERPRETATION: Immediate feedback with deliberate stripping and external feedback using a digital torque measuring screwdriver may improve cortical screw insertion technique in the surgeons' community.

SOS teeth with advanced caries and sociodemographic indicators, health-related habits and dental attendance patterns: data from the Dental, Oral, Medical Epidemiological (DOME) nationwide records-based study.

BACKGROUND: "SOS teeth" are teeth that need to be treated first, and represent dental teeth with deep caries seen clinically and radiographically which may require root canal treatment or extraction. The aims of the present research were to study the associations of SOS teeth with: socio-demographic parameters, dental attendance patterns, health-related habits among young to middle-aged adults. METHODS: This cross-sectional records-based research analyzed data from the Dental, Oral, Medical Epidemiological (DOME) repository that captures comprehensive socio-demographic, medical, and dental databases of a nationwide sample of 132,529 records of dental attendees to military dental clinics for 1 year aged 18 to 50 years. RESULTS: SOS teeth had a significant positive association in the multivariate analysis with male sex [OR 1.137, 95% Confidence Interval (CI): 1.079-1.199], rural versus urban Jewish locality [OR 1.748 (1.082-2.825)], and consumption of sweetened beverages [OR 1.415 (1.337-1.496)]. SOS teeth retained significant negative associations (protective parameter) with academic [OR 0.647 (0.592-0.708)] and technicians (OR 0.616 (0.556-0.682)] compared to high school education, high [OR 0.437 (0.401-0.476)], and medium (OR 0.648 (0.598-0.702)] versus low socio-economic status, urban non-Jewish versus urban Jewish locality [OR 0.746 (0.693-0.802)], Asia (OR 0.658 (0.452-0.959)], North America (OR 0.539 (0.442-0.658)] and Israel [OR 0.735 (0.686-0.788)] versus western Europe birth countries. CONCLUSIONS: Health authorities should be familiar with this profile of the patient who is vulnerable to SOS teeth and formulate policies and allow the appropriate implementation of strategies in those in high-risk populations.

Can Achilles and patellar tendon structures predict musculoskeletal injuries in combat soldiers?

Aiming to investigate whether Achilles tendon (AT) structure and patellar tendon (PT) structure are risk factors for musculoskeletal injuries in combat soldiers, 168 participants were recruited from an infantry commander's course. The AT and PT were examined pre-course using UTC to capture the structure of four echo-type fibers (I-IV). All injuries were assessed by military physicians pre-course and throughout the 14-week course. Soldiers who were injured during the course had a significantly higher pre-course prevalence of AT and PT echo-type III and echo-type IV compared to soldiers that were not injured during the course. Variables that were found to be associated with injured/non-injured participants were echo-type III + IV of the PT (OR = 1.44, 95% CI = 1.24-1.68) and echo-type III of the AT (OR = 1.69, 95% CI = 1.35-2.12). ROC analyses showed that the best model, exhibiting both high sensitivity and low specificity, was that participants with PT echo-type III + IV > 10% or AT echo-type III >8.5% had the highest risk of being injured during the course. In conclusions, the tendon structure at the beginning of high-intensity activity or physical training program might be a risk factor for subsequent injury during the course. Soldiers and high-level athletes should be aware of the cutoff points for fiber types in tendon structure that might put them at high risk for future injury. At-risk soldiers/athletes should be provided with an intervention program before they start their training program, with the aim of improving the tendon structure and preventing subsequent injury.

Incidence of injuries and factors related to injuries in combat soldiers.

INTRODUCTION: Musculoskeletal injuries to the lower extremities are major factors contributing to drop out from military tasks. The aim of the present study was to determine the incidence of musculoskeletal injuries and the parameters that differentiate between the soldiers who incurred these injuries and those who did not along 14 weeks of an infantry commanders course. METHODS: One-hundred and sixty-eight participants were recruited from an infantry commanders course. The soldiers were tested before (pre), in the middle (middle) and at the end (last) of the course for anthropometric measurements, proprioceptive ability and dynamic postural balance (DPB), and filled out an ankle stability questionnaire (Cumberland Ankle Instability Tool (CAIT). A physiotherapist followed and recorded all musculoskeletal injuries incurred by the participants during the course. RESULTS: Fifty-eight participants out of the 168 (34.5%) reported some pain/injury. Time effects were found for body mass index, DPB asymmetry, DPB in posterior-medial (P-M) direction and proprioception ability. Injury effects were found for DPB asymmetry, DPB in P-M direction, CAIT and proprioception ability. An interaction was found for proprioception ability. The Cox regression showed that the variables that are mostly effecting injuries were pretesting proprioception ability, DPB asymmetry and CAIT. CONCLUSIONS: More than one out of three participants incurred musculoskeletal injuries, with deficits in proprioception ability, DPB and ankle stability in pretesting as major factors contributing to injuries. Further studies should look at the effect of specific exercises such as proprioception, DPB and ankle stability exercises for prevention and treatment of musculoskeletal injuries among combat soldiers.

SOS Teeth: First Priority Teeth with Advanced Caries and Its Associations with Metabolic Syndrome among a National Representative Sample of Young and Middle-Aged Adults.

"SOS teeth" are defined as the first priority teeth for treatment, that have distinct cavitation reaching the pulp chamber or only root fragments are present. These are teeth with severe morbidity, that may require pulp capping, root canal treatment, or extraction, and therefore should be treated first. The study aims to explore whether or not a metabolic syndrome (MetS) is associated with SOS teeth. To that end, we performed across-sectional records-based study of a nationally representative sample of 132,529 military personnel aged 18-50 years, who attended the military dental clinics for one year. The mean number of SOS had no statistically significant association with: smoking (p = 0.858), alcohol consumption (p = 0.878), hypertension (p = 0.429), diabetes mellitus (p = 0.866), impaired glucose tolerance (p = 0.909), hyperlipidemia (p = 0.246), ischemic heart disease (p = 0.694), S/P myocardial infarction (p = 0.957), obstructive sleep apnea (p = 0.395), fatty liver (p = 0.074), S/P stroke (p = 0.589), and S/P transient ischemic attack (p = 0.095) and with parental history of: diabetes (p = 0.396)], cardiovascular disease (p = 0.360), stroke (p = 0.368), and sudden death (p = 0.063) as well as with any of the medical auxiliary examinations (p > 0.05). Cariogenic diet was positively associated with SOS teeth (p < 0.001). We conclude that SOS teeth had no statistically significant association with MetS components or with conditions that are consequences or associated with MetS. The only statistically significant parameter was a cariogenic diet, a well-known risk factor for caries and MetS.

The Dental, Oral, Medical Epidemiological (DOME) Study: Protocol and Study Methods.

OBJECTIVES: To develop and present the methods utilized for the Dental, Oral, Medical Epidemiological (DOME) study. METHODS: The DOME is an electronic record-based cross-sectional study, that was conducted to measure the dental, periodontal, and oral morbidities and their associations with systemic morbidities, among a nationally representative sample of young to middle-aged adults military personnel from the IDF (Israel Defense Forces). To that end, we developed a strict protocol including standardized terminology, data collection, and handling. RESULTS: Data for the DOME study was derived simultaneously from three electronic records of the IDF: (1) a central demographic database, (2) the dental patient record (DPR), and (3) the medical computerized patient record (CPR). The established DOME repository includes socio-demographic, dental and medical records of 132,354 young to middle-age military personnel from the IDF, who attended the dental clinics during the year 2015. Records of general military personnel (N > 50,000), with no recorded dental visits during the study period, served as a control group regarding all other parameters except dental. The DOME study continues and is currently collecting longitudinal data from the year 2010 until 2020. The IDF employs a standardized uniform administrative and clinical work-up and treatment protocols as well as uniform computerized codes. We describe the standardized definitions for all the parameters that were included: socio-demographics, health-related habits, medical and dental attendance patterns, and general and dental health status. Multicollinearity analysis results of the sociodemographic and medical study parameters are presented. CONCLUSION: Standardized work-up and definitions are essential to establish the centralized DOME data repository to study the extent of dental and systemic morbidities and their associations.

Caries prevalence among 18 years old, an epidemiological survey in Israel.

BACKGROUND: There is a lack of evidence on caries prevalence among 18 years old Israeli young adults with only a scarce evidence regarding this index age group. In the last few years dental care policy in Israel underwent substantial changes and a major reform in dental services was led by the Israeli Ministry of Health, including coverage of dental care for children by the state. In addition, a cessation of community water fluoridation was in a debate. The objective of the current study was to describe prevalence of caries among 18 years old Israeli young adults and to evaluate possible associations with personal and demographic variables. METHODS: The study was a cross sectional clustered survey. Participants were recruited to the study at their first day of military service. Participants completed a questionnaire for personal and demographic data, including: age, country of birth, education, and current smoking status. Then participants underwent clinical evaluation included DMFT and caries free rates. No radiographic evaluation was included in the current study. Univariate and multivariate statistical analysis were performed. RESULTS: A total of 702 participants were included in the study, 58.4% were males. Their mean age was 19.03 ± 0.65 years, 91.3% of the participants were born in Israel. Mean DMFT was 1.95 ± 2.67, and 46.7% (n = 328) were caries free. Higher DMFT score was significantly associated with participant's parents' education, country of birth, and smoking status. Lower caries free rates were significantly associated with participant's parents' education, and smoking status. After linear regression for total DMFT, all variables were significant predictors to higher DMFT, except father's education, while logistic regression for caries free, only mother's education was found to be a significant predictor. CONCLUSIONS: The current study presents encouraging low DMFT levels. Participants in this study were not included in the dental care services reform, and did enjoy the benefits of water fluoridation, enabling the results to play an important baseline data for future reference. Additionally, results should be considered when planning intervention programs for at risk groups. TRIAL REGISTRATION: This study was registered in ClinicalTrials.gov (Identifier No. NCT02958891 , November 8th, 2016) and was approved by the IDF Institutional Review Board (#1524-2015).

Intubation using the gum-elastic bougie while wearing personal protective equipment.

OBJECTIVE: To determine whether application of a gum-elastic bougie (GEB), a visual stylet used to improve success rates of difficult intubations, reduces the time, and number of attempts to achieve successful intubation while wearing personal protective equipment (PPE). DESIGN: A randomized cross-over study comparing orotracheal intubations performed on an AirMan® Mannequin, using either a semirigid stylet or a GEB, while wearing an active hood with a charcoal impregnated suit and butyl rubber gloves. SETTING: Simulation training field of the Israel Defense Force Medical Corps. PARTICIPANTS: 27 military physicians and 23 paramedics (PMs). INTERVENTIONS: Comparing intubation with and without using the GEB while wearing PPE. MAIN OUTCOME MEASURE(S): Airway (AW) control was considered successful if the "lungs" of the mannequin ex-panded during bag ventilation. Three unsuccessful attempts or a procedure exceeding 60 seconds were regarded as a failure. Correlations between parameters of self-assessment of skills and successful intubation were also determined. RESULTS: With the GEB, success rate was lower (82 percent versus 100 percent, p = 0.002), more attempts were needed (1.4 ± 0.7 versus 1.0 ± 0.2, p = 0.005) and time-to-achieve AW control was longer (43.6 ± 14.6 sec-onds versus 23.1 ± 10.5 seconds, P < 0.001) than without it. Participants with high self-assessment of GEB-assisted AW management skills needed less attempts to perform successful intubation with GEB than participants with low self-assessment (1.0 ± 0.0 versus 1.4 ± 0.8, p = 0.001), but not less time to achieve it. CONCLUSIONS: While donning PPE, the use of GEB (versus semirigid stylets) did not reduce the time or the number of attempts necessary to achieve successful intubation.