Periodontal Status as Mediator of the Association between Socioeconomic Status and Oral Health-Related Quality of Life in Pregnant Women.

OBJECTIVE: To test periodontal status as a mediator between socioeconomic status (SES) and oral health-related quality of life (OHRQoL) in pregnant women. BASIC RESEARCH DESIGN: Secondary cross-sectional analysis of baseline data from a randomised clinical trial with 303 pregnant women. MAIN OUTCOME MEASURES: Demographic variables, SES, smoking, interproximal hygiene, and self-reported gingival bleeding were collected as independent variables. The Oral Health Impact Profile-14 was used to assess OHRQoL. The relationship between SES, periodontal status and OHRQoL was investigated in structural equation modelling. RESULTS: There was a moderate association of SES with periodontal status (standardised coefficient SC = -0.26, p⟨0.01) and number of teeth (SC = 0.24, p⟨0.01). Periodontal status and the number of teeth were also associated with OHRQoL (respectively, SC = 0.25, p⟨0.01 and SC = -0.31, p⟨0.01), but SES was only indirectly related to OHRQoL (SC = -0.17, p⟨0.01). Socioeconomic inequalities in quality of life were mainly explained by the remaining number of teeth, contributing to about 47%, and periodontal status, contributing to about 41%. CONCLUSIONS: There was no direct effect of SES on OHRQoL in pregnant women. Periodontal status and missing teeth each explained almost half of the total indirect association.

Impacts of supragingival and subgingival periodontal treatments on oral health-related quality of life.

OBJECTIVE: The aim of this study was to evaluate the impact of distinct phases of a non-surgical periodontal treatment protocol on oral health-related quality of life (OHRQoL). METHODS: Fifty-five participants (51.4 ± 9.4 years), diagnosed with both gingivitis and moderate-to-severe periodontitis, were included. Periodontal and OHRQoL (OHIP-14) data were collected before (Day 0) and after the supragingival (Day 30) and subgingival (Day 90) treatments. A linear mixed model was used. OHIP-14 scores, effect size, and ceiling and floor effects were calculated. RESULTS: The total OHIP-14 score was significantly higher at Day 0 (17.3 ± 10.5) compared to Day 30 (9.7 ± 8.3) and Day 90 (9.5 ± 7.4). Scores of all domains decreased significantly after the supragingival treatment. This response was maintained after the subgingival therapy, except in the physical pain and physical disability domains. Clinical variables were not associated with the change in OHIP scores. The effect size was 0.72 at Day 30 and 0.74 at Day 90. No ceiling and floor effect were observed. CONCLUSIONS: Perceptions on OHRQoL improved along periodontal therapy, particularly after the supragingival treatment, suggesting that this intervention might be considered important to reduce the negative impacts in oral health-related quality of life.

The association between alcohol consumption and periodontitis in southern Brazilian adults.

BACKGROUND AND OBJECTIVE: An association between alcohol consumption and periodontitis has been suggested in the literature, but the evidence is still unclear. The aim of the present study was to investigate the relationship between alcohol consumption and periodontitis in a probability sample of adults from south Brazil. MATERIAL AND METHODS: This analysis included 1115 subjects aged 18-65 years derived from a representative sample from south Brazil. Data were collected from participants from clinical examination and structured interviews. Alcohol consumption was assessed by asking participants about the usual number of drinks consumed in a week. Four categories of alcohol consumption were defined: non-drinker, ≤ 1 glass/wk, > 1 glass/wk, ≤ 1 glass/d and > 1 glass/d. Individuals with ≥ 30% teeth with periodontal attachment loss ≥ 5 mm were classified as having periodontitis. Logistic models adjusting for age, race, socioeconomic status, dental care, body mass index, self-reported diabetes and smoking were used to estimate odds ratios (OR) and confidence intervals (95% CI). RESULTS: After adjusting for co-factors, females who reported drinking > 1 glass/d were more likely to have periodontitis (OR = 3.8, 95% CI = 1.4-10.1), whereas females who reported drinking up to 1 glass/d were 50% less likely to have periodontitis (OR = 0.5, 95% CI = 0.3-0.8). No significant associations between overall alcohol intake and periodontitis were observed for males. In an exploratory analysis, wine consumption was associated with a lower likelihood of periodontitis among males (OR = 0.2, 95% CI = 0.1-0.5) but not females. CONCLUSION: The periodontal health of males and females appears to be affected differently by alcohol consumption. Moderate wine consumption may have a beneficial effect in males.

Factors associated with self-reported use of mouthwashes in southern Brazil in 1996 and 2009.

OBJECTIVE: To evaluate the association between sociodemographic factors and self-reported use of mouthwashes in a city in the south of Brazil over a time span of 13 years. METHODS: The study involves a comparison of two household surveys conducted in 1996 and 2009. Respectively, 850 and 982 households were included in each year. The mother of the family answered to a structured questionnaire to provide sociodemographic data. Self-reported use of mouthwash was evaluated in a binary manner (yes/no). Multivariate Poisson regression models were used to estimate proportion ratios (PR) and 95% confidence intervals (95% CI). RESULTS: The proportion of mouthwash use increased significantly from 10.8% to 24.2% after 13 years. The probability of using mouthwashes increased more than two times from 1996 to 2009 (PR = 2.25 95% CI 1.80-2.82). Higher probabilities for using mouthwashes were observed in households with higher income (PR = 2.63 95% CI 1.97-3.51) and in those households where the mothers had higher educational levels (PR = 1.46 95% CI 1.05-2.03). CONCLUSION: Higher family income and higher maternal educational level were associated with self-reported use of mouthwashes in a higher proportion of households.

Effect of nonsurgical periodontal therapy on serum and gingival crevicular fluid cytokine levels during pregnancy and postpartum.

BACKGROUND AND OBJECTIVE: A low-grade systemic inflammatory status originating from periodontal infection has been proposed to explain the association between periodontal disease and systemic conditions, including adverse obstetric outcomes. The aim of this study was to evaluate the effect of periodontal therapy during pregnancy on the gingival crevicular fluid and serum levels of six cytokines associated with periodontal disease and preterm birth. MATERIAL AND METHODS: A subsample of 60 women (18-35 years of age) up to 20 gestational weeks, previously enrolled in a larger randomized clinical trial, was recruited for the present study. Participants were randomly allocated to receive either comprehensive nonsurgical periodontal therapy before 24 gestational weeks (n = 30, test group) or only one appointment for supragingival calculus removal (n = 30, control group). Clinical data, and samples of blood and gingival crevicular fluid, were collected at baseline, at 26-28 gestational weeks and 30 d after delivery. The levels of interleukin (IL)-1ß, IL-6, IL-8, IL-10, IL-12p70 and tumor necrosis factor-α were analyzed by flow cytometry. RESULTS: After treatment, a major reduction in periodontal inflammation was observed in the test group, with bleeding on probing decreasing from 49.62% of sites to 11.66% of sites (p < 0.001). Periodontal therapy significantly reduced the levels of IL-1ß and IL-8 in gingival crevicular fluid (p < 0.001). However, no significant effect of therapy was observed on serum cytokine levels. After delivery, the levels of IL-1ß in the gingival crevicular fluid of the test group were significantly lower than were those in the control group (p < 0.001), but there were no significant differences between test and control groups regarding serum cytokine levels. CONCLUSION: Although periodontal therapy during pregnancy successfully reduced periodontal inflammation and gingival crevicular fluid cytokine levels, it did not have a significant impact on serum biomarkers.

[Transfer of the AGnES concept to the regular German health-care system: legal evaluation, reimbursement, qualification]. / Uberführung des AGnES-Konzeptes in die Regelversorgung: Juristische Bewertung, Vergütung, Qualifizierung.

INTRODUCTION: According to an amendment of German social security legislation, the AGnES concept of delegation of certain tasks of medical care, especially house calls, by general practitioners (GPs) to qualified practice employees (AGnES employees), will be transferred into the regular German health care system from January 2009 onward. The concept was developed to support GPs in regions with imminent gaps in primary care. METHODS: Patient data, the specifically delegated and all other activities carried out by the AGnES employees in the AGnES projects were digitally documented. Additionally, the participating GPs, AGnES employees and patients underwent a set of standardised interviews. A curriculum to qualify the AGnES employees and to define the requirements needed was developed. A legal assessment of all delegated activities was carried out, and an economical model to calculate the necessary allowance was calculated. RESULTS: In seven model projects in four federal states in Germany, 11,228 house calls were carried out involving 1,424, mostly multimorbid, patients (mean age: 78.6 years). A modular structured curriculum, considering the basic education and acquired competences, was developed. It allows for an individual qualification of the AGnES employees. The result of the legal assessment was the central relevance of the qualification of the practice employees according to the AGnES curriculum as the essential condition for carrying out the entire range of activities of the AGnES concept. The economic model revealed euro 21.58 for a house call by an AGnES employee. The underlying model referred to underserved regions. CONCLUSION: A successful transfer of the AGnES concept with a high standard of quality into regular health-care depends on several factors. Of particular importance is the specific qualification of the practice employees, which is a central legal condition for the delegation of medical tasks from GPs to AGnEs employees. A second determining factor is also an adequate reimbursement within the catalogus of the statutory health insurances.

Universality class of replica symmetry breaking, scaling behavior, and the low-temperature fixed-point order function of the Sherrington-Kirkpatrick model.

A scaling theory of replica symmetry breaking (RSB) in the Sherrington-Kirkpatrick (SK) model is presented in the framework of critical phenomena for the scaling regime of large RSB orders kappa , small temperatures T , and small (homogeneous) magnetic fields H . We employ the pseudodynamical picture [R. Oppermann, M. J. Schmidt, and D. Sherrington, Phys. Rev. Lett. 98, 127201 (2007)], where two critical points CP1 and CP2 are associated with the order function's pseudodynamical limits lim_{a-->infinity}q(a)=1 and lim_{a-->0}q(a)=0 at (T=0 , H=0 , 1kappa=0) . CP1 - and CP2 -dominated contributions to the free energy functional F[q(a)] require an unconventional scaling hypothesis. We determine the scaling contributions in accordance with detailed numerical self-consistent solutions for up to 200 orders of RSB. Power laws, scaling functions, and crossover lines are obtained. CP1 -dominated behavior is found for the nonequilibrium susceptibility, which decays like chi_{1}=kappa;{-53}f_{1}(Tkappa;{-53}) , for the entropy, which obeys S(T=0) approximately chi_{1};{2} , and for the subclass of diverging parameters a_{i}=kappa;{53}f_{a_{i}}(Tkappa;{-53}) [describing Parisi box sizes m_{i}(T) identical witha_{i}(T)T ], with f_{1}(zeta) approximately zeta and f_{a_{i}}(zeta) approximately 1zeta for zeta-->infinity , while f(0) is finite. CP2 -dominated behavior, controlled by the magnetic field H while temperature is irrelevant, is retrieved in the plateau height (or width) of the order function q(a) according to q_{pl}(H)=kappa;{-1}f_{pl}(H;{23}kappa;{-1}) with f_{pl}mid R:(zeta)mid R:_{zeta-->infinity} approximately zeta and f_{pl}(0) finite. Divergent characteristic RSB orders kappa_{CP1}(T) approximately T;{-35} and kappa_{CP2}(H) approximately H;{-23} , respectively, describe the crossover from mean field SK- to RSB-critical behavior with rational-valued exponents extracted with high precision from our RSB data. The order function q(a) is obtained as a fixed-point function q(a) of RSB flow, in agreement with integrated fixed-point energy and susceptibility distributions.

Double criticality of the Sherrington-Kirkpatrick model at T=0.

Numerical results up to the 42nd order of replica-symmetry breaking (RSB) are used to predict the singular structure of the Sherrington-Kirkpatrick spin glass at T=0. We confirm predominant single parameter scaling and derive corrections for the T=0 order function q(a), related to a Langevin equation with pseudotime 1/a. a=0 and a=infinity are shown to be two critical points for infinity-RSB, associated with two discrete spectra of Parisi block size ratios, attached to a continuous spectrum. Finite-RSB-size scaling, associated exponents, and T=0-energy are obtained with unprecedented accuracy.

Association between psychosocial factors and periodontitis: a case-control study.

OBJECTIVE: This case-control study investigated the association between life events, anxiety, and depression with periodontitis. METHODOLOGY: The study counted with 165 individuals, both sexes, 35-60 years of age. Case group included 96 individuals suffering from periodontal disease; and in control group 69 subjects with no history of periodontitis. Clinical examinations were performed by a single examiner. Psychological assessment included four inventories: Life Events Scale, Beck Anxiety Inventory, State-Trait Anxiety Inventory and Beck Depression Inventory. Bivariate and multivariate logistic regression analyses were performed to compare cases and controls. RESULTS: Mean probing depth and clinical attachment level were 3.44+/-0.80 and 4.01+/-1.61 in the case group and 1.96+/-0.19 and 0.95+/-0.50 in the control group, respectively (p<0.05). Positive association of periodontitis with age (odds ratio (OR)=1.15 95% confidence interval (CI): 1.06-1.24), male gender (OR=2.71, CI: 1.13-6.49), smoking (OR=6.05, CI: 1.67-21.94) and educational level (OR=6.49, CI: 1.14-36.95) was confirmed. Bivariate analysis did not demonstrate significant mean differences in life events, anxiety symptoms, trait or state of anxiety, or depression symptoms between cases and controls. Multivariate logistic regression, controlling for confounding factors, demonstrated no significant association between psychosocial factors and periodontal disease. CONCLUSIONS: Within the limits of this study it is possible to conclude that there was no significant association between periodontitis and the psychosocial factors analysed.

Scaling and renormalization group in replica-symmetry-breaking space: evidence for a simple analytical solution of the Sherrington-Kirkpatrick model at zero temperature.

Using numerical self-consistent solutions of a sequence of finite replica symmetry breakings (RSB) and Wilson's renormalization group but with the number of RSB steps playing a role of decimation scales, we report evidence for a nontrivial T-->0 limit of the Parisi order function q(x) for the Sherrington-Kirkpatrick spin glass. Supported by scaling in RSB space, the fixed point order function is conjectured to be q*(a)=sqrt[pi]/2 a/xi erf(xi/a) on 0 a at T =0 and xi approximately 1.13+/-0.01. Xi plays the role of a correlation length in a-space. q*(a) may be viewed as the solution of an effective 1D field theory.

Evaluation of the dentogingival area during early plaque formation.

BACKGROUND: The aims of this investigation were to evaluate the pattern of supragingival plaque formation in the dentogingival area within 96 hours after abstinence from mechanical plaque control and to clinically analyze the gingival inflammatory response observed. METHODS: Six male volunteers, 20 to 23 years of age, had their upper incisors and cuspids polished. Four independent periods of no mechanical plaque control--24, 48, 72, and 96 hours--were instituted. In each period, plaque was disclosed and standardized individual photographs were taken. Impressions were taken and replicas were analyzed by scanning electron microscopy. Gingival crevicular fluid (GCF) was collected at baseline and 96 hours. The height of the gingival papilla was measured at baseline, 24, and 96 hours. RESULTS: Results showed the presence of a plaque-free zone (PFZ) along the gingival margin up to 72 hours. After 96 hours, there was a significant reduction in the presence of PFZ in the proximal thirds of the buccal surface when compared to the other experimental periods. At the end of the study, there was a significant increase in the GCF flow as well as edema of the interdental papilla, when compared to baseline values. CONCLUSIONS: The PFZ observed during the initial phase was less apparent at the 96-hour period. At this time, there was an increase in the gingival inflammatory response, represented clinically by increased GCF flow and edema.

Density of states of disordered two-dimensional crystals with half-filled band

A diagrammatic method is applied to study the effects of commensurability in two-dimensional disordered crystalline metals by using the particle-hole symmetry with respect to the nesting vector P0 = +/-pi / a,pi / a for a half-filled electronic band. The density of electronic states (DoS) is shown to have nontrivial quantum corrections due to both nesting and elastic impurity scattering processes, and as a result the Van Hove singularity is preserved in the center of the band. However, the energy dependence of the DoS is significantly changed. A small offset from the middle of the band gives rise to the disappearance of quantum corrections to the DoS.

Stress, burnout and locus of control in German nurses.

The aim of this study was to evaluate the effects of locus of control and work-related stress on burnout in hospital staff nurses. A convenience sample of 361 staff nurses from nine units in five German hospitals were surveyed using the Maslach Burnout Inventory, the Locus of Control Questionnaire and a Work-Related Stress Inventory. Causal modeling was used to explore the moderating effect of locus of control on burnout. Results support the hypothesized model and suggest that greater work-related stress and burnout would be associated with poorer locus of control in nurses. The findings supported the notion that perceived degree of control is instrumental in enabling nurses to cope with stress and burnout.

Schwinger-Keldysh semionic approach for quantum spin systems.

We derive a path-integral Schwinger-Keldysh approach for quantum spin systems. This is achieved by means of a semionic representation of spins as fermions with imaginary chemical potential. The major simplifying feature in comparison with other representations (Holstein-Primakoff, Dyson-Maleev, slave bosons/fermions, etc.) is that the local constraint is taken into account exactly. As a result, the standard diagram technique with the usual Feynman codex is constructed. We illustrate the application of this technique for the Néel and spin-liquid states of the antiferromagnetic Heisenberg model.