The healing of dental extraction sockets in insulin-dependent diabetic patients: a prospective controlled observational study.

BACKGROUND: The aim of this study was to determine whether there was a difference in delayed healing following dental extractions for insulin-dependent diabetics as compared to non-diabetic patients. METHODS: Prospective patients referred to the Adelaide Dental Hospital exodontia clinic for dental extractions were recruited into two groups: Known insulin-dependent diabetics and healthy non-diabetics. All had a random blood glucose level (BGL). Delayed healing cases were identified, and statistical evaluation was performed. RESULTS: There were 56 insulin-dependent diabetic patients (BGL 10.03, range 4.9-26) and 49 non-diabetic, age- and sex-matched patients. Seven patients (12.5%) in the study group showed delayed healing following extraction, while only four patients (8.2%) in the control group suffered delayed healing. This difference was not statistically significant. Two of the study group developed postextraction infections, requiring incision, drainage and antibiotics. CONCLUSION: The study shows that Type 1 and insulin-dependent Type 2 diabetic patients, if well controlled, tend to heal up well following dental extractions but with a small but not statistically different rate of postextraction complications including infection. This is contrary to what is usually taught. Clinicians should take great care with management of insulin-dependent diabetic patients, as compared to non-insulin dependent diabetics or non-diabetic patients.

Assessing the alignment of sexual and natural selection using radiomutagenized seed beetles.

A major unsolved question in evolutionary biology concerns the relationship between natural and sexual selection. Sexual selection might augment natural selection, for example if mutations that harm female fecundity also reduce male mating success. Conversely, sexual selection might favour traits that impair naturally selected fitness components. We induced detrimental mutations in Callosobruchus maculatus beetles using X-ray irradiation and then experimentally measured the effect of precopulatory sexual selection on offspring number and survival rate. Sexual selection treatment had a negative effect on egg-to-adult survivorship, although the number of progeny reaching adulthood was unaffected, perhaps because eggs and juveniles that failed to develop lessened competition on the survivors. We hypothesize that the negative effect of sexual selection arose because sexually competitive males transmitted a smaller nuptial gift or carried alleles that conferred reduced survival. Although we found no evidence that sexual selection on males can purge alleles that are detrimental to naturally selected fitness components, such benefits might exist in other environmental or genetic contexts.

Polyandrous females found fitter populations.

Multiple mating by females (polyandry) requires an evolutionary explanation, because it carries fitness costs in many species. When mated females disperse alone to a new habitat, their offspring may have no option but to mate with their siblings and incur inbreeding depression. However, some of the offspring of polyandrous females may only be half siblings, reducing inbreeding depression when isolated groups of siblings only have each other as mates. We investigated this putative benefit of polyandry over monandry by initiating multiple genetically isolated populations of Callosobruchus maculatus beetles, each founded by a single female, who received a complete ejaculate from either one or two males. The early generations had comparable fitness, but the F4 and F5 descendants of doubly inseminated females were more numerous and had higher egg-to-adult survival than the descendants of singly inseminated females. This fitness benefit was of similar magnitude whether beetles were reared on their standard food plant, or on a less favourable food source. Our results suggest that polyandrous females produce fitter descendants in inbred founder populations and therefore that polyandry may affect movement ecology and invasion biology.

Security aspects of Grid-based digital mammography.

OBJECTIVES: The principal aim of the eDiaMoND project is to develop a prototype Grid infrastructure to support the needs of the breast care community. The prototype system is but one major deliverable of the project; the other is a blueprint document that describes how a system such as eDiaMoND might be deployed throughout the United Kingdom to support the NHS Breast Screening Programme. A key consideration of both the prototype and the blueprint is security. In this paper we address some of the generic security issues faced by projects such as eDiaMoND. We also indicate how these problems are being overcome within our project. METHODS: In order to fully understand the security issues faced by the project a review of current initiatives within the NHS was performed. The work of the NHS Information Authority was found to be particularly significant. Also reviewed was BS7799, the British Standard for the deployment of security systems and processes. Finally, modelling of the proposed prototype was performed using methods proposed by the e-Science Security Task Force, in particular the method proposed by Flechais and Sasse. RESULTS AND CONCLUSIONS: It is felt that the issues of security surrounding the eDiaMoND project are sufficiently generic that the eHealth community can consider and criticise the work described. It is hoped that this will enable the eHealth community to move forwards with a common agenda.

Saving children--an audit system to assess under-5 health care.

OBJECTIVE: To develop and pilot an audit system usable by medical officers in peripheral hospitals for deaths of children under 5 years to: (i) identify and classify all causes of deaths; and (ii) to identify substandard care and missed opportunities for intervention and to classify these as modifiable factors. SETTING: The four public sector hospitals in Mafikeng health region in North West province. METHOD: An action research methodology was used. The system for classifying under-5 deaths was based on the International Classification of Diseases 10 (ICD-10), but modified for practical application in peripheral hospitals. Each death was analysed at a mortality meeting and factors related to the family, administration or actions or omissions by health care workers that could have contributed to the death were recorded. These factors were later grouped and categorised. During the last month of the pilot participating health care workers evaluated the audit system and completed a semi-structured questionnaire. STUDY PERIOD: 1 November 2000-31 October 2001. RESULTS: Two hundred and thirty-nine under-5 deaths occurred and were discussed during 61 mortality meetings. A workable system to identify and classify causes of deaths and modifiable factors occurring within the health system was developed and tested. A simple, user-friendly one-page data sheet encompassing the whole audit was developed. Overall the health care workers were positive about the mortality meetings and were confident that the classification systems developed could be applied in other peripheral hospitals. CONCLUSION: The audit system (called the Under-5 Health Care Problem Identification Programme (U5PIP)), was piloted under normal service conditions and is usable and acceptable for peripheral hospitals.

Why children die: an under-5 health care survey in Mafikeng region.

OBJECTIVE: To describe causes of under-5 deaths occurring in the health care system in Mafikeng region and modifiable factors related to these deaths. DESIGN: A prospective descriptive study. SETTING: The four public sector hospitals in Mafikeng health region in North West province (Gelukspan, Zeerust-Lehurutshe, Thusong, and Mafikeng Provincial Hospital). METHODS: This study of under-5 deaths used and piloted the Under-5 health care Problem Identification Programme. STUDY PERIOD: 1 November 2000-31 October 2001. RESULTS: Two hundred and thirty-nine under-5 deaths occurred in the health system. The case fatality rate for the total of 4 226 under-5 admissions was 5.7%. Seventy-four per cent of the under-5 deaths occurred during the first year of life; 31% during the first 24 hours in hospital. The main causes of death were lower respiratory tract infections (31.4%), AIDS (21.3%) and sepsis (13.4%). When adding all causes of death and contributing conditions, 61.9% were AIDS- or HIV-related. Eighty-three per cent of cases had administrative modifiable factors, 67% had modifiable factors at primary care level, 47% during admission/emergency care in hospital, and 55% during routine care. CONCLUSIONS: Priority problems identified in this study were case management of lower respiratory tract infections, failure to thrive, and insufficient documentation of patient care. As most under-5 deaths in this study were HIV/AIDS-related, it is an urgent necessity to expand effective programmes to prevent mother-to-child transmission and HIV infection in adults and to advocate comprehensive treatment programmes for HIV/AIDS.

Teachers' ratings of the communication abilities of their deaf students.

In this study, teachers' ratings of the speech intelligibility and receptive communication ability of 15 severely deaf and 15 profoundly deaf students using five methods of communication were compared with the students' scores on tests of these receptive communication methods. The teachers' ratings generally were lower than the test scores, and examination of the correspondence between ratings and test measures revealed a low level of association between the two. Only the correlation between ratings and test results for fingerspelling had an acceptable level of statistical significance. Teachers' ratings appeared to underestimate students' tested communicative abilities in all communication modes, a situation that could engender self-fulfilling prophecies of poor performance. It would therefore be useful to have relatively quick, reliable, valid procedures available for teachers to assess their students' communication competencies with the various manual and oral components of communication. Several such procedures are suggested.

The receptive communication abilities of deaf students under oral, manual, and combined methods.

Two groups of severely and profoundly deaf students aged 10 to 17 years were tested on their abilities to choose, from a set of four pictures, the one matching a sentence presented on videotape under 11 different communication conditions. The communication conditions involved individual and combined presentations of lipreading, listening, fingerspelling, and signed English. Severely deaf students scored higher than profoundly deaf students under all conditions except those that involved signed English, where the profoundly deaf group scored as high as the severely deaf group. All the students scored higher under conditions that involved audition, including lipreading plus audition, than under audition alone. The discussion of the results highlights methodological problems that made it difficult to interpret some previous studies in this area. Practical implications of the results for both oral education of the deaf and simultaneous communication are also discussed.

Teachers' use of simultaneous communication. Effects on the signed and spoken components.

We examined the correspondence between spoken and signed English when used simultaneously by teachers in Australia to determine whether the difficulties reported with other systematic sign systems are also relevant for the Australasian version. The teachers, all experienced in working with deaf students, were found to be more than 90% accurate in reproducing on their hands what they were saying, but at some cost to the oral aspects of the simultaneous communication. We also discuss the implications of the findings for the use of simultaneous communication with deaf students.

Conversational strategies of teachers using three methods of communication with deaf children.

Teacher control over conversations with deaf pupils using oral/aural only, signed English or cued speech communication, was related to pupil response, including taking initiative in conversations, misunderstanding the teacher, and length of contributions to the conversation. As teacher control over the conversation and repair of "wrong" contributions increased, pupil initiative and length of contribution decreased and misunderstanding of teachers increased. Different methods of teacher communication produced few differences in response; those that did occur mostly favored pupils of teachers using signed English. Few significant differences were found in the distribution of different types of conversational moves among teachers using the different methods of communication.

A programme to promote breast feeding in a socio-economically disadvantaged area of Cape Town, Republic of South Africa.

PIP: 169 mothers with infants under 6 weeks who attended the Local Authority Child Health Clinic in a socioeconomically disadvantaged area of Cape Town, South Africa, were interviewed in a study of infant feeding practices. Data was obtained on ages of infant of mother, place of birth, i.e., home, hospital, or midwife obstetrics unit, number of previous pregnancies and live children, last birth interval, method used for feeding the infant, reasons for introducing bottle or discontinuing breast, and age of the infant when contact was first made with Local Authority. On the basis of the interview, infants were classified as either breastfed, i.e., exclusively except for water given in a bottle or bottle fed, i.e., receiving no breast milk at all, or mixed fed, i.e., part breast and part bottle. Of the 89 mothers who fulfilled the criteria for breastfeeding, 80 were interviewed 6 weeks later. At the 1st interview, 89 of the 169 babies (52.7%) were being breastfed, 28 (16.6%) were receiving bottle feeds only, and 52 (30.7%) a mixture of both. When 80 of the breastfeeding mother were interviewed for the 2nd time 6 weeks later, 40 were still giving breast milk alone and 5 were not breastfeeding at all. Further analysis showed that the major decrease in the practice of breastfeeding occurred in the first 2 weeks of life, after which there was a slow but steady decline. The reasons given for introducing bottle feeding both before and after 6 weeks were "insufficient quantity" or "poor quality" milk. Other significant problems reported included local breast complications and return to work. The maternal age, parity, and interval between pregnancies did not appear to influence the choice of feeding practice. Approximately 2 years after a program was introduced to give increased support and education to mothers from health personnel a survey similar to the 1st study was undertaken in the same area. Socioeconomic, age range, and other demographic characteristics were similar and the questionnaire constant. At the 1st interview, 94 (75.8%) of the 124 mothers were still breastfeeding, a significant increase from the 1st survey. This trend continued when the 94 mothers who were originally breastfeeding were interviewed for the 2nd time, 6 weeks later. 48, 38.7% of the original number interviewed, were still breastfeeding in comparison with the previous study. The study showed a significant increase in breastfeeding rate.^ieng

An anthropometric study of young schoolchildren in an area of Cape Town.

A survey of the weights and heights of 896 Sub A (Grade I) schoolchildren was carried out in a working-class area of Cape Town where education is compulsory. Twenty-four per cent of all children were under the National Center for Health Statistics 5th percentile for weight and 20% were under that for height. The children under 7 1/2 years of age were felt to be truly representative of the community as a whole. For this group the proportions below the 5th percentile were 22% for weight and 18% for height. This relatively favourable picture is compared with earlier studies.

Early discharge from maternity units in Cape Town.

A total of 323 mothers was interviewed at home about 12 days after early discharge (within 48 hours after delivery) from maternity hospitals and midwife obstetric units. Their views concerning antenatal care, delivery and contraceptive advice were obtained as well as details about their problems at home with themselves and their babies. It is concluded that early discharge of suitably selected mothers and babies is safe.

Serum antibody levels after immunization with trivalent oral poliovirus vaccine.

The antibody titres to the polioviruses after three doses of trivalent oral poliovirus vaccine were assessed in 77 Coloured children aged 3-9 months. Neutralizing antibody titres of 1 in 10 or greater to all three types were found in 59 (77%) of all children. The remaining 18 children lacked demonstrable antibody to one or more of the polioviruses. Antibody to types 1 and 3 was most commonly lacking. The possible reasons for the failure of vaccination in so many children is discussed. Studies of the effect of further doses of vaccine on serum antibody levels are recommended.

Breast feeding in Cape Town.

An interview survey of infant feeding practices was conducted among the mothers of 126 infants, aged 3-4 1/2 months, attending local authority clinics in two subeconomic residential areas of Cape Town. It was found that while at 1 month only 19% of the infants were wholly bottle-fed, at the age of 3-4 1/2 months this proportion was 60%, and only 14% were fully breast-fed. The factors found to be significantly associated with the cessation of breast feeding were young maternal age and maternal employment. A downward trend in the prevalence of breast feeding continues--despite the efforts of health services. Recommendations to promote breast feeding are made.