Shorter Telomere Length Is Associated With Older Age, Poor Sleep Hygiene, and Orthopedic Injury, but Not Mild Traumatic Brain Injury, in a Cohort of Canadian Children.

BACKGROUND: Predicting recovery following pediatric mild traumatic brain injury (mTBI) remains challenging. The identification of objective biomarkers for prognostic purposes could improve clinical outcomes. Telomere length (TL) has previously been used as a prognostic marker of cellular health in the context of mTBI and other neurobiological conditions. While psychosocial and environmental factors are associated with recovery outcomes following pediatric mTBI, the relationship between these factors and TL has not been investigated. This study sought to examine the relationships between TL and psychosocial and environmental factors, in a cohort of Canadian children with mTBI or orthopedic injury (OI). METHODS: Saliva was collected at a postacute (median 7 days) timepoint following injury to assess TL from a prospective longitudinal cohort of children aged 8 to 17 years with either mTBI (n = 202) or OI (n = 90), recruited from 3 Canadian sites. Questionnaires regarding psychosocial and environmental factors were obtained at a postacute follow-up visit and injury outcomes were assessed at a 3-month visit. Univariable associations between TL and psychosocial, environmental, and outcome variables were assessed using Spearman's correlation. Further adjusted analyses of these associations were performed by including injury group, age, sex, and site as covariates in multivariable generalized linear models with a Poisson family, log link function, and robust variance estimates. RESULTS: After adjusting for age, sex, and site, TL in participants with OI was 7% shorter than those with mTBI (adjusted mean ratio = 0.93; 95% confidence interval, 0.89-0.98; P = .003). As expected, increasing age was negatively associated with TL (Spearman's r = -0.14, P = .016). Sleep hygiene at 3 months was positively associated with TL (adjusted mean ratio = 1.010; 95% confidence interval, 1.001-1.020; P = .039). CONCLUSION: The relationships between TL and psychosocial and environmental factors in pediatric mTBI and OI are complex. TL may provide information regarding sleep quality in children recovering from mTBI or OI; however, further investigation into TL biomarker validity should employ a noninjured comparison group.

Investigation of The Omaha System for dentistry.

OBJECTIVE: Today, dentists and hygienists have inadequate tools to identify contributing factors to dental disease, diagnosis of disease or to document outcomes in a standardized and machine readable format. Increasing demand to find the most effective care methodologies make the development of further terminologies for dentistry more urgent. Preventive care is the focus of early efforts to define best practices. We reviewed one possibility with a history of public health documentation that might assist in these early efforts at identifying best practices. METHODS: This paper examines, through a survey of dentists, the Omaha System Problem Classification Scheme. The survey requested that dentists rate the usefulness of knowing about specific signs and symptoms for each of the 42 problems within the Problem list of the Omaha System. RESULTS: Using a weighted scoring system, 22 of the 42 problems received over 50% of the possible maximum score and 30 of the 42 problems received at least 25% of the possible points. CONCLUSION: These findings suggests that further evaluation of The Omaha System, may be useful to dentistry. At a minimum, the survey provides additional information about non-physiological problems, signs, and symptoms that may be appropriate for documentation purposes within an electronic health record (EHR) used in dentistry.