Social Disadvantage and Multimorbidity Including Oral Conditions in the United States

Existing studies on multimorbidity have largely excluded oral diseases in multimorbidity prevalence estimates. The reason behind this is somewhat unclear, as chronic oral conditions are highly prevalent, affecting over half the global population. To address this gap, we examined the relationship between social disadvantage and multimorbidity, stratifying by the inclusion and exclusion of oral conditions. For participants aged 30 y and over (n = 3,693), cross-sectional analysis was carried out using the US National Health and Nutrition Survey (2013-2014). Multimorbidity was defined as having 2 or more chronic conditions. Five medical conditions were examined: diabetes, asthma, arthritis, cardiovascular disease, and depression, as well as 4 oral health conditions: caries, periodontal disease, number of teeth, and edentulousness. Education and income poverty ratio were selected as measures of social disadvantage. Multimorbidity prevalence estimates according to social disadvantage were analyzed on an absolute and relative scale using inverse probability treatment weighting (IPTW), adjusting for age, sex, and ethnicity. The inclusion of oral health conditions in the assessment of multimorbidity increased the overall prevalence of multimorbidity from 20.8% to 53.4%. Findings from IPTW analysis demonstrated clear social gradients for multimorbidity estimates stratified by the exclusion of oral conditions. Upon inclusion of oral conditions, the prevalence of multimorbidity was higher across all social groups for both education and income. Stratifying by the inclusion of oral conditions, the mean probability of multimorbidity was 27% (95% confidence interval [CI], 23%-30%) higher in the low-education group compared to the high-education group. Similarly, the mean probability of multimorbidity was 44% (95% CI, 40%-48%) higher in the low-income group. On a relative scale, low education was associated with a 1.52 times (95% CI, 1.44-1.61) higher prevalence of multimorbidity compared to high education. Low income was associated with a 2.18 (95% CI, 1.99-2.39) higher prevalence of multimorbidity. This novel study strongly supports the impact of chronic oral conditions on multimorbidity prevalence estimates.

Effect of Copayment on Dental Visits: A Regression Discontinuity Analysis

Despite their prevalence and burdens, oral diseases are neglected in universal health coverage. In Japan, a 30% copayment (out of pocket) by the user and a 70% contribution by Japan’s universal health insurance (JUHI) are required for dental and medical services. From the age of 70 y, an additional 10% is offered by JUHI (copayment, 20%; JUHI, 80%). This study aimed to investigate the effect of cost on dental service use among older adults under the current JUHI system. A regression discontinuity quasi-experimental method was used to investigate the causal effect of the JUHI discount policy on dental visits based on cross-sectional data. Data were derived from the 2016 Japan Gerontological Evaluation Study. This analysis contained 7,161 participants who used JUHI, were aged 68 to 73 y, and responded to questions regarding past dental visits. Analyses were controlled for age, sex, number of teeth, and equalized household income. Mean ± SD age was 72.1 ± 0.79 y for the discount-eligible group and 68.9 ± 0.78 y for the noneligible group. During the past 12 mo, significantly more discount-eligible participants had visited dental services than noneligible participants (66.0% vs. 62.1% for treatment visits, 57.7% vs. 53.1% for checkups). After controlling for covariates, the effect of discount eligibility was significant on dental treatment visits (odds ratio [OR], 1.36; 95% CI, 1.32 to 1.40) and dental checkups (OR, 1.49; 95% CI, 1.44 to 1.54) in the regression discontinuity analysis. Similar findings were observed in triangular kernel-weighted models (OR, 1.38 [95% CI, 1.34 to 1.44]; OR, 1.52 [95% CI, 1.47 to 1.56], respectively). JUHI copayment discount policy increases oral health service utilization among older Japanese. The price elasticity for dental checkup visits appears to be higher than for dental treatment visits. Hence, reforming the universal health coverage system to improve the affordability of relatively inexpensive preventive care could increase dental service utilization in Japan.

Single-Shot Multi-keV X-Ray Absorption Spectroscopy Using an Ultrashort Laser-Wakefield Accelerator Source

Single-shot absorption measurements have been performed using the multi-keV x rays generated by a laser-wakefield accelerator. A 200 TW laser was used to drive a laser-wakefield accelerator in a mode which produced broadband electron beams with a maximum energy above 1 GeV and a broad divergence of ≈15  mrad FWHM. Betatron oscillations of these electrons generated 1.2±0.2×10^{6}  photons/eV in the 5 keV region, with a signal-to-noise ratio of approximately 300∶1. This was sufficient to allow high-resolution x-ray absorption near-edge structure measurements at the K edge of a titanium sample in a single shot. We demonstrate that this source is capable of single-shot, simultaneous measurements of both the electron and ion distributions in matter heated to eV temperatures by comparison with density functional theory simulations. The unique combination of a high-flux, large bandwidth, few femtosecond duration x-ray pulse synchronized to a high-power laser will enable key advances in the study of ultrafast energetic processes such as electron-ion equilibration.

Impact of Dental Diseases on Quality-Adjusted Life Expectancy in US Adults

Comparing the burden of dental conditions to other health outcomes provides useful insight for public policy. We aimed to estimate quality-adjusted life expectancy (QALE) loss due to dental conditions in the US adult population. Social inequalities in QALE loss by dental conditions were also examined. Data from 3 cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES waves 2001 to 2002, 2003 to 2004, and 2011 to 2012) were pooled and analyzed. The average age of study participants ( n = 9,445) was 48.4 y. Disutility scores were derived from self-rated health and the numbers of physically unhealthy days, mentally unhealthy days, and days with activity limitation, employing a previously published algorithm. The associations between the disutility scores and the numbers of decayed teeth, missing teeth, and periodontitis were examined by multiple linear regression stratified by age groups (20–39, 40–59, and ≥60 y), adjusted for other covariates (age, sex, wave fixed effect, educational attainment, smoking, and diabetes). The QALE loss due to dental conditions at the age of 20 was estimated using life tables. Decayed and missing teeth, but not periodontitis, were associated with a larger disutility score. The coefficient for decayed teeth was larger among the older population, whereas that of missing teeth was smaller among them. The estimated QALE loss was 0.43 y (95% confidence interval [CI], 0.28–0.59), which reached 5.3% of QALE loss (8.15 y; 95% CI, 8.03–8.27) due to overall morbidity. There were clear social gradients in QALE loss by dental conditions across the life course, and people with high school or less education had 0.32 y larger QALE loss in total compared with people with college or more education. This study suggests that improvements in people’s dental health may yield substantial gains in population health and well-being. The necessity of more comprehensive public health strategies is highlighted.

Sarcoidosis extent relates to molecular variability

The molecular basis of sarcoidosis phenotype heterogeneity and its relationship to effective treatment of sarcoidosis have not been elucidated. Peripheral samples from sarcoidosis subjects who participated in a Phase II study of golimumab [anti-tumour necrosis factor (TNF)-α] and ustekinumab [anti-interleukin (IL)-12p40] were used to measure the whole blood transcriptome and levels of serum proteins. Differential gene and protein expression analyses were used to explore the molecular differences between sarcoidosis phenotypes as defined by extent of organ involvement. The same data were also used in conjunction with an enrichment algorithm to identify gene expression changes associated with treatment with study drugs compared to placebo. Our analyses revealed marked heterogeneity among the three sarcoidosis phenotypes included in the study cohort, including striking differences in enrichment of the interferon pathway. Conversely, enrichments of multiple pathways, including T cell receptor signalling, were similar among phenotypes. We also identify differences between treatment with golimumab and ustekinumab that may explain the differences in trends for clinical efficacy observed in the trial. We find that molecular heterogeneity is associated with sarcoidosis in a manner that may be related to the extent of organ involvement. These findings may help to explain the difficulty in identifying clinically efficacious sarcoidosis treatments and suggest hypotheses for improved therapeutic strategies.

Face Detection in Natural Scenes

The first task of any face processing system is detection of the face. We studied how the human visual system achieves face detection using a 2AFC task in which subjects were required to detect a face in the image of a natural scene. Luminance noise was added to the stimuli and performance was measured as a function of orientation and orientation bandwidth of the noise.

Sensitivity levels and the effects of orientation bandwidth were similar for horizontally and vertically oriented noise. Performance was reduced for the smallest orientation bandwidth (5.6°) noise but sensitivity did not decrease further with increasing bandwidth until a point between 45° and 90°. The results suggest that important information may be oriented close to the vertical and horizontal. To test whether the results were specific to the task of face detection the same noise was added to the images in a man-made natural decision task. Equivalent levels of noise were found to be more disruptive and the effect of orientation bandwidth was different.

The results are discussed in terms of models of face processing making use of oriented filters (eg Watt and Dakin, 1993 Perception22 Supplement, 12) and local energy models of feature detection (Morrone and Burr, 1988 Proceedings of the Royal Society of London B235 221 – 245).

Child oral health in migrant families: A cross-sectional study of caries in 1-4 year old children from migrant backgrounds residing in Melbourne, Australia

Early Childhood Caries (ECC) is the most common, preventable disease of childhood. It can affect children's health and wellbeing and children from migrant families may be at greater risk of developing ECC.

OBJECTIVE

To describe ECC in children from migrant families, and explore possible influences.

BASIC RESEARCH DESIGN

Cross-sectional analysis of caries data collected as baseline data for an oral health promotion study.

PARTICIPANTS

The analysis sample included 630 1-4 year-old children clustered within 481 Iraqi, Lebanese and Pakistani families in Melbourne, Australia.

METHOD

Child participants received a community-based visual dental examination. Parents completed a self-administered questionnaire on demographics, ethnicity, and oral health knowledge, behaviour and attitudes.

MAIN OUTCOME MEASURE

Child caries experience. Bivariate associations between oral health behaviours and ethnicity were tested for significance using chi-square. Multivariate logistic regression analyses were performed to identify associations with ECC, adjusting for demographic variables and accounting for clustering by family.

RESULTS

Overall, 34% of children in the sample experienced caries (both non-cavitated and cavitated). For all caries lesions, parent' length of residence in Australia, consumption of sweet drinks and parental education remained as independent predictors of child caries experience. Adding sugar to drinks was an additional risk factor for cavitation. Ethnicity was associated with some individual oral health behaviours suggesting cultural influences on health, however the relationship was not independent of other predictors.

CONCLUSION

Culturally competent oral health promotion interventions should aim to support migrant families with young children, and focus on reducing sweet drink consumption.

The Interplay between socioeconomic inequalities and clinical oral health

Oral health inequalities associated with socioeconomic status are widely observed but may depend on the way that both oral health and socioeconomic status are measured. Our aim was to investigate inequalities using diverse indicators of oral health and 4 socioeconomic determinants, in the context of age and cohort. Multiple linear or logistic regressions were estimated for 7 oral health measures representing very different outcomes (2 caries prevalence measures, decayed/missing/filled teeth, 6-mm pockets, number of teeth, anterior spaces, and excellent oral health) against 4 socioeconomic measures (income, education, Index of Multiple Deprivation, and occupational social class) for adults aged ≥21 y in the 2009 UK Adult Dental Health Survey data set. Confounders were adjusted and marginal effects calculated. The results showed highly variable relationships for the different combinations of variables and that age group was critical, with different relationships at different ages. There were significant income inequalities in caries prevalence in the youngest age group, marginal effects of 0.10 to 0.18, representing a 10- to 18-percentage point increase in the probability of caries between the wealthiest and every other quintile, but there was not a clear gradient across the quintiles. With number of teeth as an outcome, there were significant income gradients after adjustment in older groups, up to 4.5 teeth (95% confidence interval, 2.2-6.8) between richest and poorest but none for the younger groups. For periodontal disease, income inequalities were mediated by other socioeconomic variables and smoking, while for anterior spaces, the relationships were age dependent and complex. In conclusion, oral health inequalities manifest in different ways in different age groups, representing age and cohort effects. Income sometimes has an independent relationship, but education and area of residence are also contributory. Appropriate choices of measures in relation to age are fundamental if we are to understand and address inequalities.

Summary of the IADR Cariology Research Group Symposium, Barcelona, Spain, July 2010: new directions in cariology research

Caries remains the most prevalent noncontagious biofilm-mediated disease in humans. It is clear that the current approaches to decrease the prevalence of caries in human populations, including water fluoridation and school-based programs, are not enough to protect everyone. The scientific community has suggested the need for innovative work in a number of areas in cariology, encompassing disease etiology, epidemiology, definition, prevention, and treatment. In this symposium, two of these areas, dealing specifically with etiological aspects of caries were discussed: (1) systematic research on caries risk assessment using population-based cohort techniques, and (2) genetic studies to identify genes and genetic markers of diagnostic, prognostic, and therapeutic value. This paper summarizes these presentations.

Remote Interactions in Contour Detection

A series of experiments were carried out examining factors influencing the ability to detect contour structure within noise. In each experiment the observers' task was to detect a target embedded in a field of 900 random gabors. The target was defined as one or more pairs of aligned gabors separated by a small distance. When the pairs are placed randomly in the image, but with the same orientation, detection is poor, requiring 20 pairs to be present for performance to be good. When the pairs are aligned to be consistent with a single straight contour, detection is very good even for just 3 or 4 pairs. This effect occurs despite the distance between the pairs being considerably larger than the average distance between the elements in the background and background gabors filling the gaps along the line. To examine potential cues to the grouping process underlying the enhancement in performance, the relationships between the elements within a pair and between the pairs in the image were manipulated. The effect of changing the similarity of orientation, contrast, and disparity of the gabors within each pair and between pairs was measured. Results suggest that detection is optimal only for targets that are in a straight line. Performance is relatively unaffected by contrast, although having the same contrast within a pair is better than opposite contrast. There is no effect of contrast difference between pairs. There is small evidence of disparity differences affecting performance.

The quantitative genetic basis of sex ratio variation in Nasonia vitripennis: a QTL study

Our understanding of how natural selection should shape sex allocation is perhaps more developed than for any other trait. However, this understanding is not matched by our knowledge of the genetic basis of sex allocation. Here, we examine the genetic basis of sex ratio variation in the parasitoid wasp Nasonia vitripennis, a species well known for its response to local mate competition (LMC). We identified a quantitative trait locus (QTL) for sex ratio on chromosome 2 and three weaker QTL on chromosomes 3 and 5. We tested predictions that genes associated with sex ratio should be pleiotropic for other traits by seeing if sex ratio QTL co-occurred with clutch size QTL. We found one clutch size QTL on chromosome 1, and six weaker QTL across chromosomes 2, 3 and 5, with some overlap to regions associated with sex ratio. The results suggest rather limited scope for pleiotropy between these traits.

The prevalence and severity of dental pain in 14-15 year old Brazilian schoolchildren

OBJECTIVE

To assess the prevalence and severity of dental pain and associated factors in Brazilian schoolchildren.

METHODS

The study was a cross-sectional survey conducted in Recife, Brazil. The data were collected through questionnaires, personal interviews and clinical dental examinations of a random sample of 14-15 years old schoolchildren. The prevalence of dental pain and its characteristics were recorded using standard measures of pain. Dental caries, dental trauma and dental plaque were assessed using WHO criteria. Multiple logistic and ordinal polytomous regression were used to assess which factors were associated with the dental pain outcomes.

RESULTS

1,052 individuals participated in the study. The prevalence of reported toothache in schoolchildren in the last six months was 33.6% (31.1-36.8, 95% CI). The fully adjusted regression models showed a significant relationship between lower social class, later birth order, failure at school and attendance at the dentist only when in trouble with both the prevalence and severity of dental pain. The major predictor of the prevalence and severity of pain was pattern of dental attendance (p<0.001).

CONCLUSIONS

The prevalence of toothache in 14-15 years old schoolchildren was high. The major predictor of the prevalence and severity of pain was the pattern of dental attendance.

Epidemiology of bovine brucellosis in Northern Ireland between 1990 and 2000

Between 1990 and 2000, 317 herds of cattle in Northern Ireland were identified as being seropositive to Brucella abortus, and 68 per cent of them were attributed to transmission from neighbouring herds or to local spread. Of particular significance were three primary outbreaks in 1997, which resulted in significant secondary and tertiary spread. Three spatial clusters were identified, corresponding to two of the primary outbreaks, and the herd density and within-herd spread were highest in the largest cluster. Abortions in an infected herd and the disease-risk status of the disclosure test were positively associated with an increased within-herd prevalence.

164 EFFECT OF ACCUMULATION OF LIPIDS DURING IN VITRO CULTURE ON BOVINE BLASTOCYST YIELD AND FETAL DEVELOPMENT

Previous research has shown that increased embryo lipid content, through culture in the presence of serum, is associated with reduced blastocyst yield and quality; provision of antioxidants ameliorates the effects of lipid accumulation (McEvoy et al. Reprod. Fertil. Dev. 16, 200). The present study extended these observations to assessment of fetal development from blastocysts which had accumulated lipid in vitro. Bovine oocytes, aspirated from abattoir-derived ovaries, were matured and fertilized using standard procedures. Cleaved zygotes were assigned to culture (5% CO2; 5% O2; 90% N2; 38.5°C) in four treatments: (1) synthetic oviductal fluid containing 0.3% bovine serum albumin and amino acids (SOF); (2) SOF plus supplementary bovine lipoproteins (2%, SOFLP); (3) SOF plus the antioxidant Trolox® (100 μM; 6-hydroxy-2,5,7,8-tetramethylchromane-2-carboxylic acid, Sigma-Aldrich Co., Inc., Irvine, UK; SOFT); and (4) SOF plus lipoproteins and Trolox (SOFLPT). Blastocysts were synchronously transferred to recipient cattle (day 7; 23/treatment) together with a control group (n = 21) of artificially inseminated (AI) cattle. Reproductive tracts were recovered on Day 70 and fetal total and organ weights recorded. Data were analyzed by ANOVA (with fetal sex as covariate) and chi-square analyses. Culture in the presence of lipoproteins increased blastocyst total fatty acids (mean ± SD) from 98 ± 9.7 to 124 ± 7.3 ng/blastocyst. Blastocyst yields (%; 23 batches of ovaries) were reduced (P = 0.002) by inclusion of lipoproteins in culture (SOF, 22.0 ± 8.20; SOFLP, 16.4 ± 8.57; SOFT, 22.8 ± 9.03; SOFLPT, 24.2 ± 7.30) unless Trolox was present. Blastocyst grade was poorer (P < 0.001) after culture in the presence of lipoproteins irrespective of the presence of Trolox (SOF, 2.4 ± 0.43; SOFLP, 2.6 ± 0.45; SOFT, 2.4 ± 0.47; SOFLPT, 2.6 ± 0.40). Pregnancy rates (Day 70) were greater (P < 0.001) for AI (91%) than culture (26%) but were not affected by culture treatment. Although there were no differences in fetal weights between AI and IVC fetuses, SOFLP fetuses (Table 1) were lighter, had smaller relative liver weights, and had greater crown-rump length-to-weight ratios than other IVC fetuses. Therefore, IVC in conditions that increased blastocyst lipid content without adequate antioxidant protection reduced blastocyst yield and influenced fetal development. Table 1. Fetal weights (g) and relative liver weights (g/kg) and crown-rump lengths (CRL, mm/g) at day 70 SAC receives financial support from SEERAD.

The facilitating factors and barriers influencing change in dental practice in a sample of English general dental practitioners

AIM

The objective of this study was to investigate the barriers and facilitators to change in dental practices among a sample of general dental practitioners (GDPs) from three regions of England.

METHOD

In-depth face-to-face interviews with 60 GDPs were undertaken. The sample was selected from a group of 317 GDPs who had completed a questionnaire in the first phase of this study. The participants were selected to reflect diversity regarding the number and extent of self-reported changes reported in the questionnaire, and personal and practice characteristics. Of the 92 attempted contacts, 60 (65%) of the interviews were successfully completed. The interview schedule formed the basis of the interview. All the interviews and notes were transferred on to NUD*IST QSR version 4, a qualitative analysis package.

RESULTS

No single factor was identified as being more important than another in facilitating change. The main facilitators for change were: financial factors, regular patient attendance, particularly a core patient group, staff loyalty, having regular staff meetings and open communication and having access to peer support. The main barriers to change were the reverse of the facilitators plus not having a financial stakehold in the practice.

CONCLUSIONS

A range of factors were identified as influencing change in general dental practice. These include GDPs' attitudes and experience of change, patient factors, organisational issues, contact with peers and access to appropriate training courses.

The prevalence and nature of recent self-reported changes in general dental practice in a sample of English general dental practitioners

OBJECTIVE

To determine the extent and types of change in seven domains of dental practice in a sample of English general dental practitioners (GDPs).

METHODS

A postal questionnaire was sent to 561 GDPs on the dental lists of three health authorities in diverse regions of England. Information collected included demographic details on personal and practice characteristics, self-rating of amount of change in the seven domains of practice and factors influencing change.

RESULTS

The response rate was 60%. Fifty-six per cent of the sample were under 40 years old. Over a third of respondents reported "changing a lot or completely" certain clinical activities, practice management arrangements and practice amenities. The highest self-reported level of change was in clinical activities. Of the GDPs who reported changing their clinical activities, 56% reported an increase in preventive care, followed by crown and bridge (44%), periodontics (44%) and endodontics (43%). Practice management rated second in the mean rank scores for self-reported change. The main changes reported were the introduction of computer systems and employment of practice managers. A sizeable percentage (66%) reported increasing the amount of information they provided to patients and the time spent discussing care. Quality assurance activities were the area of practice least likely to have changed over a 5-year period. Over half the sample reported not being involved in any quality assurance activities in the previous 5 years. Those respondents who were younger, had a postgraduate qualification and earned more than 20% of their income from private practice reported higher levels of change.

CONCLUSIONS

General dental practitioners' work patterns are dynamic and appear to be responding to changing needs and demands on their service. The main changes were in the types of clinical procedures being carried out. The low prevalence of changes reported in auditing and peer review activities needs to be investigated further.

143DIETARY CARBOHYDRATES AND LIPIDS AFFECT IN VITRO EMBRYO PRODUCTION FOLLOWING OPU IN HEIFERS

The superstimulation protocol of Blondin et al. (2002; Biol. Reprod. 66, 38–43) produces cumulus-oocyte complexes (COCs) of high developmental competence for IVP. Using a similar protocol we assessed the affects of alterations in oocyte donor carbohydrate and lipid metabolism during ovarian stimulation on the production and viability of blastocysts in vitro. A 2×2 factorial experiment offered two diets: Fiber (F) and Starch (S) alone (0) or with 6%w/w (6) protected lipid (calcium soaps of fatty acids). Thirty-two heifers ranked by body condition score (scale: 1=thin, 5=obese) were allocated within score to one of the 4 treatments: F0, F6, S0 and S6. COCs were collected 5 days after estrus by OPU for lipid analysis. Ovarian stimulation (4 doses of FSH (9mg NIADDK oFSH) given 12h apart) commenced 2 days later. COCs were collected 40h after the last FSH injection. GnRH (0.012mg Buserelin) was administered i.v. 6h prior to OPU. A second period of ovarian stimulation and OPU then followed. Following IVM/IVF, zygotes were cultured in SOF with 0.3%w/v fatty acid-free BSA under oil (38.8°C, 5% CO2, 5% O2, 90% N) until Day 8 of development, when blastocysts were subjected to total cell counts and TUNEL analysis. Data were analyzed by ANOVA. Neither follicles aspirated (25.9±1.87) nor oocytes recovered (12.1±0.92) differed between treatments. Total fatty acids in plasma were greater (P&lt;0.001) for the F than for the S diets and increased with the inclusion of protected lipid (0.75, 1.82, 0.50 and 1.39μgmL−1 for F0, F6, S0 and S6, respectively; SED=0.076). The dietary lipid-induced increase in plasma fatty acids was reflected in an increase (P&lt;0.05) in total fatty acids within the oocyte (70.4, 74.7, 69.9 and 78.4 ng/oocyte; SED=3.41). Retrospective analysis by body condition indicated that S diets reduced (P=0.006) blastocyst yields in thin heifers and reduced (P=0.02) cleavage rates in fat heifers (Table 1). Blastocyst yields were lower (P=0.1) for fat heifers on the F0 diet. Total cell numbers were greater for thin heifers on S0 than F0 diet. TUNEL-positive cells averaged 4.2±0.48% and did not differ between treatments. In conclusion, modification of oocyte donor carbohydrate and lipid metabolism prior to OPU can influence IVP outcome in a complex manner dependent on body composition. Supported by Defra and The Perry Foundation. Table 1 In vitro blastocyst yields and total cell numbers

Evidence-based dentistry: an overview of the challenges in changing professional practice

A great deal of effort and resources are currently being directed at developing an evidence-based approach to healthcare delivery. The success of the evidence-based movement will depend upon the provision of necessary support to help GDPs achieve change. This paper aims to give an overview of current knowledge on what types of interventions are most effective at changing health professionals' clinical practices. Barriers to change are highlighted and the implications for the development of evidence-based dentistry are considered. Further research on organisational, social and personal influences affecting the application of evidence-based practice is necessary.

Oral health promotion evaluation--time for development

Increasing emphasis is now being placed upon the evaluation of health service interventions to demonstrate their effects. A series of effectiveness reviews of the oral health education and promotion literature has demonstrated that many of these interventions are poorly and inadequately evaluated. It is therefore difficult to determine the effectiveness of many interventions. Based upon developments from the field of health promotion research this paper explores options for improving the quality of oral health promotion evaluation. It is essential that the methods and measures used in the evaluation of oral health promotion are appropriate to the intervention. For many oral health promotion interventions clinical measures and methods of evaluation may not be appropriate. This paper outlines an evaluation framework which can be used to assess the range of effects of oral health promotion programmes. Improving the quality of oral health promotion evaluation is a shared responsibility between researchers and those involved in the provision of programmes. The provision of adequate resources and training are essential requirements for this to be successfully achieved.

Obesity, NIDDM, Adipogenesis and Insulin Resistance - IBC's Ninth International Conference

Approximately 70 representatives from industry and academia attended IBC's Ninth International Conference on Obesity, NIDDM, Adipogenesis and Insulin Resistance. It was characterized by intense and in-depth presentations on topics ranging from the costs (both human and financial) associated with obesity and diabetes and their complications to the use of animal models and progress in the identification/characterization of new drugs and/or drug targets. The conference was divided into three, distinct sessions, each of between six and eight talks, including an opening keynote address by Dr Susan Jebb on the etiology and implications of obesity treatment.

Photoassembly of the manganese cluster and oxygen evolution from monomeric and dimeric CP47 reaction center photosystem II complexes

Isolated subcomplexes of photosystem II from spinach (CP47RC), composed of D1, D2, cytochrome b(559), CP47, and a number of hydrophobic small subunits but devoid of CP43 and the extrinsic proteins of the oxygen-evolving complex, were shown to reconstitute the Mn(4)Ca(1)Cl(x) cluster of the water-splitting system and to evolve oxygen. The photoactivation process in CP47RC dimers proceeds by the same two-step mechanism as observed in PSII membranes and exhibits the same stoichiometry for Mn(2+), but with a 10-fold lower affinity for Ca(2+) and an increased susceptibility to photodamage. After the lower Ca(2+) affinity and the 10-fold smaller absorption cross-section for photons in CP47 dimers is taken into account, the intrinsic rate constant for the rate-limiting calcium-dependent dark step is indistinguishable for the two systems. The monomeric form of CP47RC also showed capacity to photoactivate and catalyze water oxidation, but with lower activity than the dimeric form and increased susceptibility to photodamage. After optimization of the various parameters affecting the photoactivation process in dimeric CP47RC subcores, 18% of the complexes were functionally reconstituted and the quantum efficiency for oxygen production by reactivated centers approached 96% of that observed for reconstituted photosystem II-enriched membranes.

An alarming lack of public awareness towards oral cancer

OBJECTIVE

To determine public awareness and knowledge of oral cancer in Great Britain.

DESIGN

The respondents were selected according to a systematic probability sample designed to be representative of all adults in Great Britain (GB). The overall design was similar to previous omnibus surveys carried out by National Opinion Poll (NOP). The survey was carried out in ten regions of GB in September 1995 and was commissioned by the Health Education Authority (HEA).

SUBJECTS AND METHODS

A random sample of 1,894 members of the public over the age of 16 years were asked in face-to-face interviews their knowledge relating to cancer, with particular reference to oral cancer, its causes and those at high risk and general attitudes to cancer.

RESULTS

Oral cancer was one of the least heard of cancers by the public with only 56% of the participants being aware, whereas 96% had heard of skin cancer, 97% lung cancer and 86% cervical cancer. There was a 76% awareness of the link between smoking and oral cancer but only 19% were aware of its association with alcohol misuse. Whereas 94% agreed that early detection can improve the treatment outcome, a disheartening 43% believed that whether a person developed a cancer or not was a matter of chance and therefore was unavoidable.

CONCLUSIONS

This survey highlights a general lack of awareness among the public about mouth cancer and a lack of knowledge about its causation especially the excess risk associated with alcohol.

RECOMMENDATIONS

There is a clear need to inform and educate the public in matters relating to the known risk factors associated with oral cancer. A media campaign informing the public about oral cancer is clearly required. The need for the reduction in the incidence of oral cancer should be included in 'Our healthier nation' targets. An overall health promotion strategy to reduce cancers should include oral cancer as a priority. In addition the European Code against Cancer which aims to improve prevention, the early detection of oral cancer and the necessity for fast track referral should be made more widely known. Recognition of oral cancer in local strategies for oral health should be encouraged.

Inequalities in oral health: a review of the evidence and recommendations for action

Reducing inequalities in health has become one of the main health policy issues in the late 1990s. The Labour Government set up an independent inquiry into inequalities in health under Sir Donald Acheson to make recommendations on approaches to reducing health inequalities. This paper reviews the evidence on inequalities in oral health in Britain. Dramatic improvements in dental health in children and young adults have taken place in the past 30 years. The levels of caries in permanent teeth of children is low. Widening inequalities in oral health however exist between social classes, regions of England, and among certain minority ethnic groups in pre-school children. The main social class and minority ethnic differences in dental caries is in pre-school children. Wide district and regional differences also exist in prevalence of caries in young children. The area differences relate very strongly to deprivation. In adults the differences in decay experience is less unequal than in children but there are marked social class inequalities in edentulousness. Dental caries decreased in all social classes in the United Kingdom. The main causes of the inequalities are differences in patterns of consumption of non milk extrinsic sugars and fluoridated toothpaste. Improvements in oral health that have occurred over the last 30 years have been largely a result of fluoride toothpaste and social, economic and environmental factors. Oral health inequalities will only be reduced through the implementation of effective and appropriate oral health promotion policy. Treatment services will never successfully tackle the underlying cause of oral diseases.

UBI4, the polyubiquitin gene of Saccharomyces cerevisiae, is a heat shock gene that is also subject to catabolite derepression control

Carbon and nitrogen regulation of UBI4, the stress-inducible polyubiquitin gene of Saccharomyces cerevisiae, was investigated using a UBI4 promoter-LacZ fusion gene (UBI4-LacZ). Expression of this gene in cells grown on different media indicated that the UBI4 promoter is more active during growth on respiratory than on fermentable carbon sources but is not subject to appreciable control by nitrogen catabolite repression. UBI4-LacZ expression was virtually identical in cells having constitutively high (ras2, sra1-13) or constitutively low (ras2) levels of cyclic AMP-dependent protein kinase activity, indicating that this kinase does not exert a major influence on UBI4 expression. Catabolite derepression control of the UBI4 promoter was confirmed by measurements of UBI4-LacZ expression in hap mutant and wild-type strains before and after transfer from glucose to lactate. Mutagenesis of the perfect consensus for HAP2/3/4 complex binding at position -542 resulted in considerable reduction of UBI4 promoter derepression with respiratory adaptation in HAP wild-type cells and abolished the reduced UBI4-LacZ derepression normally seen when aerobic cultures of the hap1 mutant are transferred from glucose to lactate. This HAP2/3/4 binding site is therefore a major element contributing to catabolite derepression of the UBI4 promoter, although data obtained with hapl mutant cells indicated that HAP1 also contributes to this derepression. The HAP2/3/4 and HAP1 systems are normally found to activate genes for mitochondrial (respiratory) functions. Their involvement in mediating higher activity of the UBI4 promoter during respiratory growth may reflect the contribution of UBI4 expression to tolerance of oxidative stress.

Psychophysical Discrimination of Spatial Structure in Natural Images

We report a series of experiments in which subjects were required to make spatial discriminations about naturally obtained images, as follows. Subjects were shown two natural images on a computer screen, side by side and for a period of 500 ms. Subjects were then shown, on a separate part of the computer screen, a small patch of one of the images selected at random. Subjects were required to decide which of the two full images the patch comes from, and whereabouts in that image it is taken from. They indicated their response by clicking the mouse cursor at the appropriate point on the screen.

The proportion of trials on which the subjects selected the correct image and the accuracy of the spatial position of their correct responses were calculated. These two measures independently indicate the general discriminability of the two image sets, and the extent to which the spatial layout of the image has been perceived. By comparing response accuracy for images that are from different sets (such as mountain or town scenes) with response accuracy when the two images are from the same set it is possible to establish the image properties that underlie coarse scene apprehension. By using sets of images that are perhaps best described as being natural textures (such as patterns of foliage or rock surface) it is possible to measure the extent to which texture is processed spatially. Our results are interpreted in the light of statistical differences between the image sets that we have used.

Statistical Analysis of Spatial Structure in Natural Images

When a sample of natural images is taken and compared with a set of noise images, the two are obviously distinguishable. Even when the noise images are set to have the same power spectral characteristics as the natural images, there is no doubt which is a normal image and which is a noise image. In the study to be reported, we have examined the nature of the spatial characteristics of natural images that allow them to be so discriminated from noise images.

The approach is to process large sets of images belonging to various categories through mechanisms that have some similarities to known operations in biological visual systems. Thus, the images are filtered at various spatial scales and at various orientations; the filter outputs are combined into local energy maps; and features are detected in such processed images. The result of these calculations is the distribution of values of some parameter which describes a particular image characteristics for each set of images. Parameters that could support adequate discrimination between two sets of images, for example natural images and noise images, will have largely non-overlapping distributions.

In practice it is found that no simple parameters can distinguish obviously different sets of images, but parameters that encapsulate spatial patterns, especially those related to non-accidental image properties, can do so. It is concluded that filter outputs must be followed by nontrivial spatial operations. Suggestions are made as to what are the most plausible.