An analysis of nutrient facts labels of pediatric multi-vitamin and mineral supplements: Is there a risk of overexposure?

BACKGROUND

Voluntary and mandatory fortification of pediatric foods, along with widespread consumption of dietary supplements have resulted in an increased proportion of children with excessive micronutrient intake.

AIM

This study aimed to analyze the proportion of pediatric dietary supplements that exceed the Recommended Dietary Allowance (RDA) and Tolerable Upper Limit for the individual micronutrients. We further identified the proportion of supplements with large amounts of micronutrients that were marketed through child-friendly and parent-geared promotional language and graphics on the packaging.

METHODS

The nutrient facts label on pediatric supplement packages sold by three large retail pharmacy chains was analyzed for micronutrient content. Labels were examined for the presence of trademarked or generic cartoon characters and parent-geared health promotional statements.

RESULTS

More than a third and almost a fifth of the samples contained vitamin A and niacin respectively in amounts equivalent to or above the established tolerable upper limit for one- to three-year-old children. A major proportion of these supplements had child-friendly and parent-targeted promotional language on the package.

CONCLUSION

The potential for pediatric supplements as a source for excessive micronutrient consumption underscores the need for parents and health care professionals to use nutrition labels as a valuable tool to prevent micronutrient toxicity.

Listening to older adults: community consultation on a new dental service

BACKGROUND

Increased life expectancy, retention of a natural dentition often heavily restored, and increasing risks of oral disease mean that older people have particular dental needs and yet uptake of care is low. A new health and wellbeing centre in south London offering student-delivered care has been built to serve the local community. Community views could informed the planning of acceptable care for older people.

OBJECTIVE

To explore the views and expectations of older adults towards dental services and ascertain how a new dental centre may best provide dental care.

RESEARCH DESIGN

This qualitative study used in-depth and triad interviews to explore the views of older people. Purposive sampling of local centres/groups for older adults was undertaken and all willing clients interviewed. Interviews were audio recorded, transcribed and analysed using Framework Methodology with emerging themes categorised according to Maxwell's six descriptors of quality.

RESULTS

Nine sessions (five triad and four in-depth interviews) involving 17 older adults were conducted in local day centres. Barriers to dental care were largely related to fear, cost, transport, lack of perceived need and the attitude of clinicians. Outcomes related to acceptability featured highly in a dental service for older adults; the overarching principles of 'delivering mutual benefit' for students and older people, 'experiencing warm humanity' and 'restoring dignity and worth' were central to their views of quality care. The importance of clinicians, whether student or staff, delivering person centred care with warm humanity was dominant: comprising 'welcoming', 'valuing', 'listening' 'communicating' and 'caring' for older adults to enhance relationships and contributing to 'restoring dignity and worth'.

CONCLUSION

Community engagement identified a willingness amongst older adults to utilise dental services where mutual benefit was perceived and, importantly, there were low barriers to care and a warm humanity was exhibited.

An evidence-based assessment of primary care needs in an economically deprived urban community

BACKGROUND

As healthcare and longevity improve and fertility rates decline, we see a demographic shift towards a predominantly elderly population. Because ageing brings its own physiological changes and complications, the need arises for practical and feasible approaches in providing the healthcare required by this population. With government strategy promoting enhanced community-based healthcare, the development of primary care infrastructure should reflect population needs.

AIMS

To describe the profile of older patients attending a general practice in an underprivileged urban setting, specifically initial medical presentation, referrals for secondary care, and the medicines prescribed to them. To thereby enhance our understanding of the primary care requirements of elderly people in this setting.

METHODS

The anonymised records of an older patient cohort (n=427, age>55 years) that presented to a General Practice over a 12-month period were retrospectively analysed to determine the nature of the clinical encounters, subsequent referral patterns and drugs prescribed.

RESULTS

There were 3,448 discrete clinical encounters (mean=8.0 per patient), predominantly for respiratory conditions, leading to 401 issued scripts and to 216 patients being referred for secondary care. Women were referred more often than men. There was a notable need for specialised dietary advice and drug prescribing was often complex.

CONCLUSION

This study provides evidence of primary care needs in an economically deprived area of an Irish city highlighting the complexity of associated prescribing and secondary care referrals in this setting.

So how do you see our teaching? Some observations received from past and present students at the Maurice Wohl Dental Centre

This study explores student perceptions of clinical teaching delivered at the Maurice Wohl Dental Centre, King's College London Dental Institute. An on-line survey together with two paper-based questionnaires were used to invite three immediate past cohorts of final-year dental students to reflect and comment on their experiences during their year of attendance. Supporting data from current student focus group and face-to-face interviews were also included in the study. The principal findings from these triangulated methodologies were that the overwhelming majority of students felt they got on very well with their teachers. The development of a positive professional relationship with the teacher appeared to motivate students to work better. Teaching thought to be overly didactic and authoritarian would not be well received. The principal teaching style identified at the Centre was considered to be supportive and nurturing, encouraging a self-motivated and reflective approach to clinical practice.

An assessment of oral health promotion programmes in the United Kingdom

BACKGROUND

Improving oral health and reducing tooth decay is a key area for action, both in the United Kingdom (UK) and overseas. The World Health Organization (WHO) has highlighted the unique advantage schools have in promoting oral health.

AIM

We summarise current oral health promotion strategies in the United Kingdom and estimate the spread of their use as well as their impact on oral health and influence on the oral health-related knowledge and behaviour in a patient population.

METHODS

A structured overview of published papers, government publications, official government websites and policy reports. A cross-sectional study of patients referred for a tooth extraction in one dental surgery in south-east London. Statistical methods consisted of logistic and ordinal regressions to model the likelihood of exposure to oral health promotion and of obtaining higher levels of knowledge of oral health issues, respectively. Linear regression was used to model the level of oral health and knowledge of oral health issues.

RESULTS

We found three main promotion programmes, namely, National Healthy Schools (NHS), Sure Start and Brushing for life plus a small number of local initiatives. Sure Start targets disadvantaged areas, but is limited. In our observational study, 34% of the patients reported exposure to a settings-based oral health education programme: Sure Start (5%), NHS (7%) and other (22%). This exposure was not influenced by age or gender, but an association with education was detected. Although oral health promotion was not found to influence the actual knowledge of oral health issues, it was found to influence some oral health-related attitudes and perceptions.

CONCLUSIONS

Participation in an oral health promotion programme was found to be significantly associated with the patients' education, their belief that they can prevent oral disease and the subjective perception of their own oral health. The WHO principles need to be embedded across all schools to achieve a true national oral health promotion programme for the United Kingdom. The National Healthy Schools programme provides the perfect platform.

The effect of increasing sodium fluoride concentrations on erosion and attrition of enamel and dentine in vitro

OBJECTIVES

To investigate the effect of an aqueous sodium fluoride solution of increasing concentration on erosion and attrition of enamel and dentine in vitro.

METHODS

Enamel and dentine sections from caries-free human third molars were polished flat and taped (exposing a 3 mm x 3 mm area) before being randomly allocated to 1 of 5 groups per substrate (n=10/gp): G1 (distilled water control); G2 (225 ppm NaF); G3 (1450 ppm NaF); G4 (5000 ppm NaF); G5 (19,000 ppm NaF). All specimens were subjected to 5, 10 and 15 cycles of experimental wear [1 cycle=artificial saliva (2h, pH 7.0)+erosion (0.3% citric acid, pH 3.2, 5 min)+fluoride/control (5 min)+attrition (60 linear strokes in artificial saliva from enamel antagonists loaded to 300 g)]. Following tape removal, step height (SH) in mum was measured using optical profilometry.

RESULTS

When the number of cycles increased the amount of tooth surface loss increased significantly in enamel and dentine after attrition and erosion and for dentine after attrition. Attrition and erosion resulted in greater surface loss than attrition alone after 15 cycles of experimental wear of enamel. 5000 ppm and 19,000 ppm sodium fluoride solutions had a protective effect on erosive and attritional enamel tooth wear in vitro, however no other groups showed significant differences.

CONCLUSIONS

The more intensive the fluoride regime the more protection was afforded to enamel from attrition and erosion. However, in this study no such protective effect was demonstrated for dentine.

The impact of visible dental decay on social judgements: comparison of the effects of location and extent of lesion

BACKGROUND

Previous research has established that people can make social judgements about someone else based on the condition of that person's teeth. The characteristics of visible tooth decay, with respect to the effect on such social judgements, have not, however, been subject to extensive investigation. This study sought to determine whether the position of visible decay and/or the extent of the lesion are determining factors in such social judgements of each other.

METHOD

In a between subjects design, 100 young people were randomly divided into 4 groups of 25 and each group shown a differently computer-modified photograph of the same person. Extent and location of the lesion were varied systematically. Participants were asked to rate the person in the photograph with respect to intellectual ability, social competence and psychological adjustment. The scores from those questions were analysed with one way analysis of variance (ANOVA) then Tukey's HSD where ANOVA revealed significant differences.

RESULTS

The data confirmed previous studies that have shown that poor dental condition is highly correlated with perceived poor social performance and intellectual ability. Further, the data showed that with respect to the constructs of intellectual ability, extraversion and care for one's personal appearance, a more central position of caries is more predictive of poor social judgements than just the presence of visible decay, or even twice the amount of decay. We discuss the possible evolutionary and ontological reasons for making social judgements that are influenced by a person's dental health as well as considering the implications of our findings for dentists.

Portable digital assistants (PDAs) in dentistry: part II--pilot study of PDA use in the dental clinic

AIM

To describe a simple technical evaluation of the access, security issues and uses of wireless networked PDAs in a dental clinic and report a pilot study investigating students' educational use of PDAs to access a Virtual Learning Environment (VLE) in a dental clinic.

OBJECTIVES

To undertake a technical evaluation of wireless networking to PDAs focusing on security issues, robustness of the system and accessibility particularly to educational resources. To evaluate the impact of using a PDA on undergraduate students in the dental clinic and at home.

DESIGN

Part II describes the technical and educational evaluation of PDAs used by one group of 12 undergraduate fourth year students in the Primary Dental Care clinic. A cross over trial of six students with PDAs and six without was carried out during one semester of 12 weeks.

METHODS

Technical issues such as secure internet access using wireless connectivity were addressed. An assessment of the general and educational use and the students' attitudes towards using PDAs was undertaken using online questionnaires and focus group discussions.

RESULTS

Over 90% of participants wanted PDAs as part of their dental kit. The potential of PDA use in dental training was demonstrated by a good to excellent response by over 75% of participants to having access to online support materials, particularly videos, being able to make notes for individual study and to keep a diary of their commitments to teaching sessions. Recreational use included a 100% good to excellent response to playing games and keeping a diary.

CONCLUSION

The PDA proved to be a convenient and versatile mode of access to online education. Technical solutions enabled a substantial proportion of the functionality of WebCT (Web Course Tools) to be accessed by the students in a clinical environment. Both novice and experienced users were able to appreciate the use of the PDA and the less able considered that their ICT skills had improved. However, further research is needed to determine how students use a range of new technologies in their undergraduate programmes. The Dental Institute plans to recommend that all students will use this device in the future throughout their five-year curriculum, and the scoping of the implications of this recommendation is underway.

Portable Digital Assistants (PDAs) in dentistry: Part I

AIM

To provide a basic understanding of the features of a portable digital assistant (PDA) and how it may be useful for the general dental practitioner.

OBJECTIVES

To outline the various types, functions and applications of a PDA and suggest its use for the dental professional now and in the future. To enable appreciation of the technology and educational evaluation carried out in the pilot study reported in Part II.

DESIGN

Part I is a descriptive account of the use and function of the PDA in dentistry and its potential for the future.

METHOD

A review of the literature was carried out drawing on evidence from general healthcare and assessments of portable computing aids evaluated in a dentally related setting. RESULTS Choosing a PDA for use in dental practice is complex but should be based on the user's needs mapped to key features, size and cost of the device.

CONCLUSION

No ideal customisable mobile digital solution currently exists but evidence from general healthcare use suggests that there are valuable features that can aid the general dental practitioners such as personal management and point of source assistance.

The Anglo-Italian collaboration: a report of the first steps in implementing the Bologna Declaration

This report summarises the accomplishments of King's College London and Università degli Studi di Brescia in establishing an Anglo-Italian Collaboration. The aim was to develop areas of enterprise in clinical practice, teaching and research that reflected the principles of the Bologna Declaration.

Three dimensional OCT images from retina and skin

We demonstrate the functionality of an en-face optical coherence tomography (OCT) system with images from the retina and skin. En-face images collected at different depths are subsequently used to reconstruct a 3D volume of the tissue. The reconstruction allows software inferred OCT longitudinal images at any transversal position in the stack. The position in depth in the stack before creating longitudinal OCT images is also adjustable, offering a valuable guidance tool for exploring the 3D volume of the tissue. This is illustrated by Quick time movies showing either depth or lateral exploration along one of two possible different directions in the stack of transversal OCT images. Sufficient accuracy of the volume rendered is obtained in 20 seconds when the system operates at 2 frames a second. The system, equipped with the 3D rendering feature acts as a valuable diagnostic tool allowing "peeling off" of transversal and longitudinal biologic material to investigate different internal features.

The relationship between Universal Dental Anchorage System (UDA) pins and the dental pulp chamber, in vitro

PURPOSE OF STUDY

The Universal Dental Anchorage (UDA) System incorporates the use of pins inserted into enamel and dentine to retain a pontic. The pins are placed horizontally into teeth in the region of the contact area and so are potentially placed close to the dental pulp. This study aims to investigate and measure this relationship to assess if the pulp may be placed at risk during pin hole preparation or UDA pin placement.

METHODS

Teeth were assessed radiographically and pins placed according to manufacturer's instructions. The teeth were subsequently sectioned through the pin position and measurements from the pin tip to the pulp chamber made at 4X magnification.

RESULTS

In the majority of the teeth the pins were in close proximity to the pulp chamber (mean +/- sd = 0.8 +/- 0.7 mm). Two pins were in direct communication with the pulp chamber. Seven pins were separated from the pulp chamber by only 0.1-0.5 mm and six pins by 0.6-1.0 mm. Three pins were more than 1.0 mm from the pulp chamber.

CONCLUSION

The results suggest that the use of 2.1 mm UDA pins would, in many cases, represent a risk to pulpal health.

The single unit, single retainer, cantilever resin-bonded bridge

Resin-bonded restorations have many advantages over conventional alternatives. Advances in adhesive technology together with a better understanding of the clinical function of such restorations have allowed resin-bonded bridges to play an important role in everyday clinical practice. This paper highlights the role and importance of the single abutment, single pontic cantilever resin-bonded bridge. Clinical experience might suggest that the cantilever design offers a viable alternative to other designs. Furthermore, the paper suggests that when cantilever resin-bonded bridges fail initially, re-bond often leads to predictable long-term success. Factors such as patient selection, abutment preparation, retainer design and the aesthetic limitations of resin-bonded bridges are also discussed. The authors can claim that further clinical studies are necessary to identify exactly what factors influence the success of cantilever and other resin-bonded designs.

Interactive display of volumetric data by Fast Fourier Projection

This article describes a new algorithm for reprojection of volumetric data, called Fast Fourier Projection (FFP), which is one to two orders of magnitude faster than conventional methods such as ray casting. The theoretical basis of the new method is developed in a unified mathematical framework encompassing slice imaging and conventional volumetric reprojection methods. Software implementation is discussed in detail. The article closes with an account of experience with a prototype FFP implementation, and applications of the technique in medical visualization.

Fast Fourier projection for MR angiography

We have developed a technique called fast Fourier projection which rapidly produces projections through images and is particularly useful for generating MR angiograms. Based on the projection-slice theorem of Fourier transform theory, this method extracts planes from three-dimensional spatial frequency space and computes projections at arbitrary viewing angles by two-dimensional inverse Fourier transformation. Typical computation times are on the order of 1 s per projection. This performance makes possible interactive selection of optimal projection directions for visualizing the desired vasculature in single or stereo-pair angiographic images and drastically reduces the time required to generate sequences of projections for display in movie loops compared to the conventional ray-casting approach. The method is easily implemented on off-line workstations or directly on MRI computer systems.