Delays in presentations of stroke patients at the University Hospital of the West Indies

Thrombolytic therapy has been proven to be beneficial in selected patients with ischaemic strokes. Early diagnosis is paramount because there is a narrow therapeutic window for these patients to derive benefit from thrombolytics. We sought to evaluate the timing of stroke presentations at the University Hospital of the West Indies (UHWI) in order to assess the potential eligibility for definitive therapy A retrospective audit of all consecutive patients who had emergent computed tomographic (CT) scans for suspected ischaemic stroke at the UHWI was performed over a six-month period between February 2006 and July 2006. Data were extracted from the hospital records and analysed using SPSS version 12. There were 331 patients evaluated with brain CT for a clinically suspected stroke during the study period. Complete time documentation and CT scans were available for analysis in 171 patients with ischaemic strokes. The average age was 64.5 years (range +/- SD: 3-98 +/- 19.9 years) with a slight male preponderance (58% vs. 42%). There was considerable pre-hospital delay with 63% of patients presenting more than 12 hours after the onset of symptoms. There were also long inhospital delays. Only 52% of patients were assessed by a physician within an hour of presentation to hospital and only 55% of patients had CT scans completed within three hours of a physician s request. Although thrombolysis is not routinely performed for ischaemic strokes at our institution, sensitization of physicians and the general public in our setting to symptoms and signs of this disease is urgently needed to improve stroke management, whereby definitive treatment can be considered for selected patients.

Development of rat chorda tympani sodium responses: evidence for age-dependent changes in global amiloride-sensitive Na(+) channel kinetics

In rat, chorda tympani nerve taste responses to Na(+) salts increase between roughly 10 and 45 days of age to reach stable, mature magnitudes. Previous evidence from in vitro preparations and from taste nerve responses using Na(+) channel blockers suggests that the physiological basis for this developmental increase in gustatory Na(+) sensitivity is the progressive addition of functional, Na(+) transduction elements (i.e., amiloride-sensitive Na(+) channels) to the apical membranes of fungiform papilla taste receptor cells. To avoid potential confounding effects of pharmacological interventions and to permit quantification of aggregate Na(+) channel behavior using a kinetic model, we obtained chorda tympani nerve responses to NaCl and sodium gluconate (NaGlu) during receptive field voltage clamp in rats aged from 12-14 to 60 days and older (60+ days). Significant, age-dependent increases in chorda tympani responses to these stimuli occurred as expected. Importantly, apical Na(+) channel density, estimated from an apical Na(+) channel kinetic model, increased monotonically with age. The maximum rate of Na(+) response increase occurred between postnatal days 12-14 and 29-31. In addition, estimated Na(+) channel affinity increased between 12-14 and 19-23 days of age, i.e., on a time course distinct from that of the maximum rate of Na(+) response increase. Finally, estimates of the fraction of clamp voltage dropped across taste receptor apical membranes decreased between 19-23 and 29-31 days of age for NaCl but remained stable for NaGlu. The stimulus dependence of this change is consistent with a developmental increase in taste bud tight junctional Cl(-) ion permeability that lags behind the developmental increase in apical Na(+) channel density. A significant, indirect anion influence on apical Na(+) channel properties was present at all ages tested. This influence was evident in the higher apparent apical Na(+) channel affinities obtained for NaCl relative to NaGlu. This stimulus-dependent modulation of apical Na(+) channel apparent affinity relies on differences in the transepithelial potentials between NaCl and NaGlu. These originate from differences in paracellular anion permeability but act also on the driving force for Na(+) through apical Na(+) channels. Detection of such an influence on taste depends fundamentally on the preservation of taste bud polarity and on a direct measure of sensory function, such as the response of primary afferents.

Patient satisfaction and dentist evaluation of dentures in South Africa

Denture satisfaction of 100 indigent South Africans, with a mean age of 70.36 years was assessed. Patient satisfaction was compared with measures of occlusion and stability as determined by a dentist. The mean age of the upper and lower dentures was 20 and 21 years respectively. The quality and function of most of the dentures were regarded by the dentists as poor. Of the 59 per cent upper and 49 per cent lower dentures regarded as satisfactory by the elderly, only 17.5 per cent and 5 per cent respectively were evaluated as having good stability. Sixty-nine per cent of those with complete upper and lower dentures said they could eat with their dentures, while only 11 per cent of this group were rated by the dentist as having good occlusion. There existed a big discrepancy between determinants of patient satisfaction and the dentist's evaluation of good stability and occlusion, indicating that patient satisfaction encompasses qualities other than the measures used by the dentist. Once the threshold of satisfaction was achieved, ill-fitting and looseness of dentures took on lesser importance.

Tooth loss and dental caries in institutionalized elderly in Italy

An epidemiological survey of dental health status and needs was conducted in a group of 234 randomly selected institutionalized elderly people in Naples, Italy. The mean age of the patients was 81.4 yr, 71.4% were women and 28.6% men. A total of 140 (59.8%) people were totally edentulous; an additional 13.7% were edentulous in one jaw. A significant increase in prevalence of edentulousness with increasing age was recorded. 44.3% of the edentulous in both jaws wore complete dentures. The mean number of remaining sound teeth, decayed teeth and root remnants in the elderly with maxillary and mandibular natural teeth decreased with increasing age. Of the 94 dentate elderly, 29.8% had no need of dental treatment. Of all dentate patients 68.1% needed one or more dental extractions with a mean need of 3.9 per patient; 37.2% needed restorative treatment for one or more teeth with a mean need per patient of 2.9. Analysis of the results showed poor dental health in this target group and the necessity of improving the dental health services programs for the elderly living in institutions.

Why inner city mothers take their children for routine medical and dental examinations

The preventive behaviour relating to visits for dental and medical examination of 100 mothers of pre-school children was investigated. The theory of reasoned action of Fishbein and Ajzen was used to predict the intention of 100 mothers to visit doctors and dentists. The study was conducted in one of the most socially deprived wards of the London Borough of Bloomsbury. The relationship between beliefs and attitudes held by mothers on preventive dental and repeated medical visits was investigated. In younger mothers aged 16-24 years, individual attitudes and subjective norms were better predictors of intention to visit the dentist every 6 months than were the total attitude and total subjective norm scores. The prediction of intention to visit the doctor and the dentist showed a similar pattern, but the variance accounted for by intention to visit the doctor was lower. Younger mothers showed stronger attitudes associated with dental treatment outcome, whereas older mothers showed a more positive preventive dental orientation. This finding is supported by principal components analysis of both the medical and dental data. The theory of reasoned action was successfully applied, but the external variable age was a very important prediction factor. This modifying factor, in relation to Ajzen and Fishbein's theory, gives a better insight into preventive dental and medical health behaviours.

A critique of existing national dental health services systems

Dental care systems are predominantly based on the engineering and curative approach to the body, which does not necessarily improve dental health. In many western countries, including some developing countries, tooth loss is still prevalent amid sophisticated systems of dental care. The two major dental diseases, dental caries and periodontal disease, are almost entirely preventable. Against this background, a dental care system should encourage those working in it to apply known effective methods to improve and maintain the oral health of the population. The perceptions of people toward dental health have long been disregarded by the profession, to the extent that individuals are victim-blamed, irrespective of the existing socioenvironmental factors that may influence an individual's attitude towards dental services. The community must be involved in the planning and decision-making processes of any health service program to facilitate cooperation by the population in oral care.