Delirium is not dementia: Delirium Awareness Day-related event at the University Hospital in Krakow

PURPOSE

To present the two-day Delirium Awareness Day-related event held at the University Hospital, Kraków, Poland.

METHODS

Activities included a lecture, a multimedia presentation, meetings with healthcare workers at their respective wards, and distribution of information posters about delirium. Local news outlets were also engaged.

RESULTS

We reached out to approximately 300 persons in the hospital itself and several thousand via TV and radio broadcasts. We prompted interdisciplinary discussions about delirium, especially concerning preventive measures. The most common questions were how to alleviate symptoms as soon as possible, with the expectation of straightforward solutions for the non-geriatrician staff. Patient distress and burden on caregivers were important topics brought-up in the discussions.

CONCLUSION

We demonstrated that our educational initiative was feasible and well-accepted among medical staff. Local media helped in building public understanding of delirium. Education about the syndrome should be one of the key societal tasks of geriatricians.

Diminished Physical Activity in Older Hospitalised Patients with and without COVID-19

Acute viral respiratory infections have proven to be a major health threat, even after the Corona Virus Disease 2019 (COVID-19) pandemic. We aimed to check whether the presence or absence of an acute respiratory infection such as COVID-19 can influence the physical activity of older hospitalised patients. We cross-sectionally studied patients aged ≥60 years, hospitalized during the pandemic in the non-COVID-19 and COVID-19 ward at the University Hospital, Kraków, Poland. Using activPAL3® technology, we assessed physical activity for 24 h upon admission and discharge. In addition, we applied the sarcopenia screening tool (SARC-F); measured the hand grip strength and calf circumference; and assessed the Modified Early Warning Score (MEWS), age-adjusted Charlson Index, SpO2%, and length of stay (LoS). Data were analysed using SAS 9.4. The mean (min, max) age of the 31 (58% women, eight with COVID-19) consecutive patients was 79.0 (62, 101, respectively) years. The daily time (activPAL3®, median [p5, p95], in hours) spent sitting or reclining was 23.7 [17.2, 24] upon admission and 23.5 [17.8, 24] at discharge. The time spent standing was 0.23 [0.0, 5.0] upon admission and 0.4 [0.0, 4.6] at discharge. The corresponding values for walking were 0.0 [0.0, 0.4] and 0.1 [0.0, 0.5]. SARC-F, admission hand grip strength, calf circumference, and LoS were correlated with physical activity upon admission and discharge (all p < 0.04). For every unit increase in SARC-F, there was a 0.07 h shorter walking time upon discharge. None of the above results differed between patients with and without COVID-19. The level of physical activity in older patients hospitalised during the pandemic was low, and was dependent on muscular function upon admission but not on COVID-19 status. This has ramifications for scenarios other than pandemic clinical scenarios.

Poor Appetite in Frail Older Persons-A Systematic Review

Anorexia of aging is a common problem in older adults. Depending on the setting, its prevalence varies from about 10% (among community-dwelling older adults) to over 30% in acute wards and nursing homes. The objective of this systematic review was to establish the prevalence of poor appetite in frail persons ≥60 years of age. We performed a literature search for studies where the prevalence of anorexia of aging among frail and pre-frail old adults was reported. 957 articles on this topic were identified. After eligibility assessment, three articles were included in the review. The studies included 4657 community-dwelling older adults. The weighted total prevalence of anorexia of aging in all the included studies was 11.3%. Among frail and pre-frail participants, loss of appetite was reported in 20.5% (weighted estimate). Overall, robust status was associated with a 63% lower probability of concomitant anorexia of ageing (OR 0.37, 95%CI 0.21-0.65, p = 0.0005). Frailty or risk of frailty are associated with more prevalent anorexia of ageing. This has potential practical implications; however, more research, especially to elucidate the direction of the relation, is needed.

A comparison of curricula at various medical schools across the world

B a c k g r o u n d: Medical education has changed in response to scientific advances and social needs. A i m: The aim of the study was to examine curricula of medical schools around the world and to observe the trends that currently dominate in medical education. M e t h o d: We have collected information on the current curricula of various medical schools using their official websites. When necessary, we supplemented the information using published articles describing the curriculum of a given medical school. R e s u l t s: Our findings reveal that medical schools demonstrate the need for constant reforms and adaptation to changing conditions worldwide. Generally, there is a tendency to integrate basic and clinical fields, to sooner establish bedside teaching, to provide less theoretical and more practical approaches to teaching, to implement more communication skills, and provide students with research training. C o n c l u s i o n s: Medical education has evolved and will continue to change with time. Medical schools introduce modifications to their curricula and share their experiences.

Adapting the OSCE to the times of the COVID-19 pandemic. A look at the e-OSCE from the students' perspective

BACKGROUND

At the Department of Medical Education, Centre for Innovative Medical Education at Jagiellonian University Medical College, a completely remote OSCE (e-OSCE) was con- ducted for the first time using the Microsoft Teams platform. 255 test takers were tasked with presenting their communication and clinical skills in order to assess clinical reasoning. A i m: Analysis of the assessment of the OSCE adaptation to the requirements of the COVID-19 pandemic at the Department of Medical Educations in the form of the e-OSCE from the students' perspective. M e t h o d s: Discussion of the OSCE modification was carried out among 6th-year medical students and graduates undergoing validation of their foreign medical degrees. In order to assess students' opinions of the e-OSCE, we used questionnaires. The Statistica 12.0 program was used to analyse the results. R e s u l t s: According to 91.57% of respondents, the e-OSCE was well-prepared. 60% of students strongly agree and 29.47% rather agree that the order of the stations was appropriate and clear. A majority of respondents rated the e-OSCE as fair. 66.32% of respondents strongly agree and rather agree that the proportions of communication and clinical skills were appropriate. The vast majority of the participants of the exam (81.05%) had enough time for individual stations. A statistically significant (p <0.0001) correlation was found between the type of classes and preparation for the e-OSCE. For 61.05% of respondents, the Laboratory Training of Clinical Skills course was the best preparation for students taking the e-OSCE. Taking into account the stressfulness of the OSCE, only 15.96% of students found the online form more stressful than the traditional (in-person) exam. C o n c l u s i o n s: The e-OSCE in students' opinions was well-organized. Informing test-takers prior to the e-OSCE about the role of invigilators assessing individual stations should be improved. The e-OSCE has been proven to be suitable for assessing a wide range of material and validating communication and clinical skills in appropriate proportions. The e-OSCE is fair according to examinees' opinion. The study proves that even in a pandemic, it is possible to prepare an online exam without exposing examiners and examinees to the dangers posed by COVID-19.

Factors associated with mortality in hospitalised, non-severe, older COVID-19 patients - the role of sarcopenia and frailty assessment

BACKGROUND

COVID-19 has affected older persons the most. The propensity to have severe COVID-19 or die of the infection was especially prevalent among older subjects with multimorbidity, frailty and sarcopenia. The aim of our study was to check which of the simple clinical biomarkers, including the assessment of muscle and frailty, would associate with the survival and the length of hospital stay in older patients with COVID-19. An additional aim was to report the influence of chronic diseases, chronic medication use, and COVID-19 signs and symptoms on the aforementioned outcome measures.

METHODS

The CRACoV study was a prospective single-center (University Hospital in Krakow, Krakow, Poland) observational study of clinical outcomes in symptomatic COVID-19 patients that required hospital treatment. We analysed data of persons aged ≥ 65 years. We assessed muscular parameters in accordance with EWGSOP2, frailty with the Rockwood Clinical Frailty Scale. We used the data of the initial and 3-month assessment. Demographic characteristics, past medical history, and baseline laboratory values were gathered as a part of routine care. We calculated sex and age, and additionally number-of-diseases adjusted odds ratios of mortality associated with studied factors and betas of the relation with these factors and the length of hospital stay.

RESULTS

The mean (standard deviation, SD) age of 163 participants (44.8% women, 14.8% died) was 71.8 (5.6) years, age range 65-89 years. One score greater SARC-F was associated with 34% (p = 0.003) greater risk of death, and 16.8 h longer hospital stay (p = 0.01). One score greater Rockwood was associated with 86% (p = 0.002) greater risk of death, but was unrelated to the length of hospital stay. Hand grip strength and dynapenia were unrelated to mortality, but dynapenia was related to longer hospital stay. Probable sarcopenia was associated with 441% (p = 0.01) greater risk of death.

CONCLUSIONS

In conclusion, the patient assessment with SARC-F and the Rockwood Clinical Frailty Scale may significantly improve the prediction of outcomes in older patients with COVID-19 and by extension might be of use in other acute severe infections. This, however, requires further research to confirm.

Disease burden in older Ukrainian refugees of war: a synthetic reanalysis of public records data

BACKGROUND

Since the Russian invasion of Ukraine on Feb 24, 2022, more than 6 million Ukrainians, including hundreds of thousands of older people, have sought safety abroad. Older people generally have a higher burden of disease than younger people and the aim of our study was to estimate this burden in older Ukrainian refugees, given the potential financial and logistical impacts on the health-care systems of receiving countries.

METHODS

On May 20, 2022, we searched the official websites of the Polish Ministry of Digitisation for data on Ukrainian refugees who had applied between Feb 24, 2022, and May 19, 2022 for a Polish personal identification number (PESEL). We extracted the number of older people (ie, of pension age, which in Ukraine is 60 years or older for men, and 55 years or older for women). We calculated the percentage of older people among these PESEL applicants then extrapolated this percentage to two groups, for which population data had been extracted from UN, WHO, and Polish Border Guards websites: refugees who had crossed into Poland but had not applied for a PESEL and refugees who had fled to neighbouring countries other than Poland. Between April 4 and May 19, 2022, we searched the Ukrainian Ministry of Health official website for data on the prevalence and incidence of various diseases in the Ukrainian population of older people. We asked the Ukrainian Ministry of Health to confirm and expand on the website data, and thereby obtained annual data for 2010-17. The ministry did not supply tuberculosis statistics, so on May 21, 2022, we searched the Ukrainian Ministry of Health website and extracted the most recent tuberculosis data, which were for 2020. We then calculated the absolute prevalence and incidence of diseases in older refugees.

FINDINGS

As of May 19, 2022, 6·3 million Ukrainians had fled their country, including 3·5 million (56%) who had entered Poland. 1 114 418 people applied for a PESEL, including 109 985 older people (91 349 Ukrainian women aged 55 years or older and 18 636 Ukrainian men aged 60 or older). We estimated that the overall number of older Ukrainian refugees was 624 690. We estimated that these older refugees have a mean of 2·5 diseases each, the most frequent of which are cardiovascular diseases, followed by gastrointestinal, respiratory, musculoskeletal, and genitourinary diseases. We estimated that the expected absolute incidence is greatest for pulmonary disorders (71 689 diagnoses), followed by cardiovascular (49 327), ocular (24 100), musculoskeletal (20 367), and genitourinary (16 836) disorders. The estimated number of new diagnoses per year was 4578 for tuberculosis and 7827 for cancer.

INTERPRETATION

Our data indicate that the disease burden of older Ukrainian refugees is considerable. Although our estimates are only approximations, they provide a basis for predicting which areas of health care will most need to be reinforced to meet the challenge of the potential financial and logistical impacts on receiving countries.

FUNDING

There was no funding source for this study.

Post-discharge pneumonia after hip arthroplasty. A population-based study of 55,842 patients in Poland

INTRODUCTION

Alloplasty is one of the most frequently performed procedures, due to its impact on the quality of life.

OBJECTIVES

The purpose of this study was to determine the incidence, risk factors, and clinical implications of post-discharge pneumonia (PNU) after hip endoprostheses in Polish adults.

PATIENTS AND METHODS

This retrospective study was conducted using the database of the National Health Fund containing data from 55,842 hip arthroplasties performed in 2017.

RESULTS

Post-discharge PNU was identified in 371 patients and accounted for 26.6% of all post-discharge infections, incidence rate of 0.7%. Multivariable analysis showed a significantly higher risk of PNU in patients aged 65 and older (OR 3.5, 95%CI 2.40-5.03), urgently admitted (OR 4.0, 95%CI 3.16-4.98), operated in winter (OR 1.7, 95%CI 1.37-2.11) and hospitalized in the intensive care unit (OR 5.9, 95%CI 3.65-9.46). Preventative factors were pre-surgery treatment in diseases of the musculoskeletal system (OR 0.7, 95%CI 0.59-0.91) and post-operative rehabilitation (both outpatient and inpatient OR 0.3, 95%CI 0.10-0.99, and OR 0.7, 95%CI 0.42-0.99, respectively). Seventy patients (18.9% of PNU cases) required inpatient PNU treatment. The in-hospital case fatality rate observed in post-discharge PNU was 21.4%.

CONCLUSIONS

PNU is one of the most common post-operative infections after hip endoprosthesis, especially in winter, requiring re-hospitalization. Efforts should be made to prepare patients in the perioperative period.

Safety of the use of Gold Nanoparticles conjugated with proinsulin peptide and administered by hollow microneedles as an immunotherapy in Type 1 diabetes

Antigen-specific immunotherapy is an immunomodulatory strategy for autoimmune diseases, such as type 1 diabetes, in which patients are treated with autoantigens to promote immune tolerance, stop autoimmune β-cell destruction and prevent permanent dependence on exogenous insulin. In this study, human proinsulin peptide C19-A3 (known for its positive safety profile) was conjugated to ultrasmall gold nanoparticles (GNPs), an attractive drug delivery platform due to the potential anti-inflammatory properties of gold. We hypothesised that microneedle intradermal delivery of C19-A3 GNP may improve peptide pharmacokinetics and induce tolerogenic immunomodulation and proceeded to evaluate its safety and feasibility in a first-in-human trial. Allowing for the limitation of the small number of participants, intradermal administration of C19-A3 GNP appears safe and well tolerated in participants with type 1 diabetes. The associated prolonged skin retention of C19-A3 GNP after intradermal administration offers a number of possibilities to enhance its tolerogenic potential, which should be explored in future studies

Teledentistry and oral health in older adults - aspects for implementation of the "Patient centric solution for smart and sustainable healthcare (ACESO)" project

P u r p o s e: Oral health and diseases are significant components of general health. However, oral health-care remains at the lowest of older patients' priorities. The inability to obtain dental care can result in progression of dental disease, leading to a diminished quality of life and overall health. Teledentistry (TD) provides an opportunity to improve the quality of oral health services. The aim of our narrative review was to analyze the usefulness of teledentistry as a part of telemedicine to improve oral health in the elderly. Materials/Methods: The PubMed database search was done for: teledentistry, oral health, oral- health related diseases, elderly, older adults. R e s u l t s: The applicability of TD has been demonstrated from children to older adults. Older adults have many obstacles in getting oral health care, including low income, lack health insurance, frailty, anxiety, depression, mobility problems or other handicaps. Available data suggests that the usefulness of TD in the provision of oral care in elderly people living in residential aged care facilities. Moreover, TD procedures were found to be as accurate as traditional face-to-face dental examinations, they was cost-effective and well accepted among patients and caregivers. C o n c l u s i o n s: TD might be a very useful tool for professional education, improving access and patient satisfaction of dental care. However, such TD modes would be difficult to widely implementation in community-dwelling older people who cannot access dental care. The ongoing "Patient centric solution for smart and sustainable healthcare (ACESO)" project will add to the intelligent oral health solutions.

Enhanced sentiment extraction architecture for social media content analysis using capsule networks

Recent research has produced efficient algorithms based on deep learning for text-based analytics. Such architectures could be readily applied to text-based social media content analysis. The deep learning techniques, which require comparatively fewer resources for language modeling, can be effectively used to process social media content data that change regularly. Convolutional Neural networks and recurrent neural networks based approaches have reported prominent performance in this domain, yet their limitations make them sub-optimal. Capsule networks sufficiently warrant their applicability in language modelling tasks as a promising technique beyond their initial usage of image classification. This study proposes an approach based on capsule networks for social media content analysis, especially for Twitter. We empirically show that our approach is optimal even without the use of any linguistic resources. The proposed architectures produced an accuracy of 86.87% for the Twitter Sentiment Gold dataset and an accuracy of 82.04% for the CrowdFlower US Airline dataset, indicating state-of-the-art performance. Hence, the research findings indicate noteworthy accuracy enhancement for text processing within social media content analysis.

Conversational Agents for Complex Collaborative Tasks

Dialogue is a very active area of research currently, both in developing new computational techniques for robust dialogue systems and in the active fielding of commercial conversational assistants such as Siri and Alexa. This paper argues that, while current techniques can be used to design effective dialogue-based systems for very simple tasks, they are unlikely to generalize to conversational interfaces that enhance human ability to solve complex tasks by interacting with AI reasoning and modeling systems. We explore some of the challenges of tackling such complex tasks and describe a dialogue model designed to meet these challenges. We illustrate our approach with examples of several implemented systems that use this framework.

The modified Peyton's approach and students' learning style

BACKGROUND

The aim of the study was to determine the predominant learning style and type of intelligence based on the VARK questionnaire and Multiple Intelligences Questionnaire respectively in second year medical students. Determining the relationship between individual preferences of students, based on their learning style and predominant type of intelligence and the perception of the modified Peyton's four-step approach used to teach cardiac auscultation.

METHODS

The opinion of participants 236 of the modified four-step approach was attained through the use of anonymous questionnaires. Using the VARK questionnaire, the participants' learning style was defined. The predominant type of intelligence was determined by the Multiple Intelligences Questionnaire.

RESULTS

The kinesthetic style was the predominant unimodal learning style in second year medical students (in Polish and international students). The most predominant type of intelligence in Polish students was visual-spatial and mathematical and logical, while in international students the predominant types were visual-spatial and mixed type of intelligence. Quantitative analysis indicated that the modified Peyton's approach is a valuable learning and teaching method for most students, independent of their predominant learning style or intelligence type. The exception was a small group of students with linguistic intelligence predominance according to the Multiple Intelligence Questionnaire, for which the Peyton method was more difficult.

CONCLUSIONS

This study proves that the modified Peyton's approach is useful and effective didactic tool and can be successfully applied to most students. This is a new learning strategy for teaching cardiac auscultation in laboratory conditions in classes for a significant majority. Due to the fact that a group of students with a predominance of linguistic intelligence more often perceived the Peyton method to be difficult, it is worth combining traditional methods with new ones in class so that all students, regardless of unimodal learning style or prevailing type of intelligence, are taught satisfactorily.

Perceptions of clinical teachers acting as examiners regarding the value of Objective Structured Clinical Examinations

OBJECTIVES

OSCE (Objective Structured Clinical Examination) is a common method of assessing clinical skills used at many universities. An important and at the same time difficult aspect of good examination preparation is obtaining a properly trained and well-motivated group of assessors. To effectively recruit and maintain cooperation with assessors, it is worth to know their opinion. The aim of this study was to investigate the opinions of teacher-examiners about OSCE and to identify the factors that could shape this opinion and influence on motivation.

METHODS

A cross-sectional study was conducted using a questionnaire on teachers who participated as OSCE examiners. This questionnaire consisted of 21 questions about their perceptions. Answers were rated in a five-point Likert-type scale. Chi-square or Fisher's exact test was used to analyze the data.

RESULTS

A total of 49 (out of 52) teachers participated in this study. Nearly 90% of examiners believed that it is fair, more than 90% that it is transparent. Despite the fact that 67% of examiners believe the examination is difficult to organize and 71% believe it is stressful for students, according to 72% of respondents the OSCE has a positive effect on learning. More than 91% of examiners believed that the OSCE is an appropriate test to assess students' skills. Opinions about examination were independent of specialty, seniority, gender or taking the OSCE as students.

CONCLUSION

Teacher-examiners viewed the OSCE as a fair and transparent examination, adequate for assessment of skills and, despite it being difficult to organize, worth doing as it is appropriate to assess practical skills and positively influences students' motivation to learn tested skills.

Incidence of metastasis to level V lymph nodes in clinically positive necks among Sri Lankan patients with oral squamous cell carcinoma

Oral squamous cell carcinoma (OSCC) remains the most common cancer among males in Sri Lanka. Metastasis to neck is a crucial prognostic factor. A modified radical/radical neck dissection including levels I -V, was performed in patients with OSCC who had a clinically positive neck (cN+). Currently, evidence suggests that sparing level V in a cN+ may be justified due to less chance of metastasis in early stages of the disease. To the best of our knowledge, the incidence of metastasis to level V in patients with cN+s has not been previously investigated in a Sri Lankan context. We aimed to determine level V lymph node metastasis and related clinicopathological indicators in cN+s in patients with OSCC. A multicentre retrospective study investigated postoperative biopsy reports of 187 patients for five years. OSCC patients with cN+s who underwent neck dissections of levels I-V were included. Only 6.4% of patients had histopathologically positive level V lymph nodes. A total of 127 lymph nodes were harvested from level V of those who showed level V positivity and out of them 68 were positive with a third of cases showing extranodal extension (ENE). The buccal mucosa (n=4) and lateral aspect of the anterior two thirds of the tongue (n=4) were the common primary sites for level V metastasis. In patients who showed positivity in levels III and IV, a considerably higher probability of level V nodes being positive was seen, which was statistically significant (p = 0.0001). We have concluded that the routine performance of a modified radical/radical neck dissection for cN+s should be stopped, as the incidence of Level V positivity is significantly low. Assessing the cN+ for N stage, status of levels III and IV, pattern of invasion, differentiation, and the site may be used instead as predictors for level V positivity.

The modified Peyton approach in the teaching of cardiac auscultation

BACKGROUND

The aim of the study was to evaluate the usefulness of the modified Peyton's four-step approach in the teaching of cardiac auscultation and to determine students' perception of Peyton's four-step approach.

METHODS

The opinion of the participants on the usefulness of the modified four-step approach was attained through the use of anonymous questionnaires, voluntarily completed by students, and on the basis of semi-structured interviews conducted with a subset of students. 187 second-year students of our 6-year long curriculum were enrolled. They attended an obligatory Laboratory Training of Clinical Skills course. The average group size was 16 students.

RESULTS

The survey findings identified that 88.1% of participants found it helpful in developing their understanding of cardiac auscultation. 89.8% of all participants claimed that the new modified four-step approach facilitated memorization. The modified Peyton's four-step method allows for better organization of classes in the opinion of 87.6% students. The advantages of the method were noticed by the majority of students.

CONCLUSIONS

The modified Peyton's four-step approach in the teaching of cardiac auscultation under laboratory conditions was perceived by students to be a comprehensible method that facilitates understanding and memorization. This approach allows for improved organization of classes. From the student's perspective this method allows one to master the technique of cardiac auscultation in the classroom, through the increased demand of the participants' attention, activity and involvement.

Modification of teaching during the COVID-19 pandemic at the Department of Medical Education of Jagiellonian University Medical College

The SARS-CoV-2 pandemic contributed to the implementation of changes in the methodology of conducting many courses at medical universities. Achieving learning outcomes was associated with self-discipline and an increased portion of students' independent work. The aim of the study is to analyze the adaptation of teaching methods to the requirements of the COVID-19 pandemic at the Department of Medical Education of Jagiellonian University Medical College. The university authorities, instructors and students made every effort not to neglect their education. The Microsoft Teams platform allowed for the efficient organization of remote classes. Lectures, activities based on dialogue, brainstorming and role-playing were conducted via the Internet. Presentations and short films were made available to students. The safety of individuals participating in classes was guaranteed by password access and an invitation sent prior to an online meeting. Remote learning allowed for the synthesis and deepening of students' knowledge, improvement of communication skills and development of clinical thinking as future doctors. The disadvantages of online education was the inability to improve practical skills, especially on phantoms, under the direct supervision of a trained instructor.

Clinical communication course and other factors affecting patient-centered attitudes among medical students

OBJECTIVES

Patient-centered care (PCC) is associated with better relationships, resulting in a decrease in symptoms, hospitalizations and health costs. However, studies analyzing factors influencing patient-centered attitudes show ambiguous results. The purpose was to assess the impact of the Clinical Communication Course (CCC) in Jagiellonian University, Cracow and other factors on Patient-Centered Attitudes (PCA) and Attitude toward Clinical Skills Learning (CSLA).

METHODS

We retrospectively compared Polish-speakers (CCC+, n = 160), English-speakers (CCCen+, n = 55) after the CCC and upperclassmen Polish-speakers without it (CCC-, n = 122). Validated questionnaires to measure PCA (Leeds Attitude Toward Concordance II and Patient-Practitioner Orientation Scale (PPOS)) and for CSLA (Communication Skills Attitude Scale with negative subscale (CSAS-N)) were used. The higher the scores, the more PCA, and negative CSLA respectively. Students completed questionnaires and answered questions regarding age, sex, motivation to study (coded as humanitarian - MotHUM, financial - MotFIN, combination - MotMIX) and considered specialization - coded as with more human contact (family medicine, psychiatry, pediatrics - SpecHUM) and others (SpecNHUM). Statistics were prepared in R.

RESULTS

CCC+ scored higher in PPOS (2.91 vs. 2.74; p = 0.003) than CCC- and higher in CSAS-N than CCCen+ (31.22 vs. 28.32; p = 0.004). In CCC+ SpecHUM scored lower than SpecNHUM in PPOS (2.65 vs. 2.94, p = 0.012). MotFIN scored higher then MotMIX in PPOS (3.01 vs. 2.7, p = 0.036). Correlations were statistically significant.

CONCLUSION

CCC improved PCA in CCC+. They showed more negative CSLA than CCCen+. Among CCC+, surprisingly, SpecNHUM presented more PCA than SpecHUM as well as MotFIN compared to MotMIX.

Inflammatory Bacteriome and Oral Squamous Cell Carcinoma

Results from microbiome studies on oral cancer have been inconsistent, probably because they focused on compositional analysis, which does not account for functional redundancy among oral bacteria. Based on functional prediction, a recent study revealed enrichment of inflammatory bacterial attributes in oral squamous cell carcinoma (OSCC). Given the high relevance of this finding to carcinogenesis, we aimed here to corroborate them in a case-control study involving 25 OSCC cases and 27 fibroepithelial polyp (FEP) controls from Sri Lanka. DNA extracted from fresh biopsies was sequenced for the V1 to V3 region with Illumina's 2 × 300-bp chemistry. High-quality nonchimeric merged reads were classified to the species level with a prioritized BLASTN-based algorithm. Downstream compositional analysis was performed with QIIME (Quantitative Insights into Microbial Ecology) and linear discriminant analysis effect size, while PICRUSt (Phylogenetic Investigation of Communities by Reconstruction of Unobserved States) was utilized for bacteriome functional prediction. The OSCC tissues tended to have lower species richness and diversity. Genera Capnocytophaga, Pseudomonas, and Atopobium were overrepresented in OSCC, while Lautropia, Staphylococcus, and Propionibacterium were the most abundant in FEP. At the species level, Campylobacter concisus, Prevotella salivae, Prevotella loeschii, and Fusobacterium oral taxon 204 were enriched in OSCC, while Streptococcus mitis, Streptococcus oral taxon 070, Lautropia mirabilis, and Rothia dentocariosa among others were more abundant in FEP. Functionally, proinflammatory bacterial attributes, including lipopolysaccharide biosynthesis and peptidases, were enriched in the OSCC tissues. Thus, while the results in terms of species composition significantly differed from the original study, they were consistent at the functional level, substantiating evidence for the inflammatory nature of the bacteriome associated with OSCC.

Social inequality in perceived oral health among Sri Lankan adolescents

OBJECTIVES

to assess socio-economic inequalities in two perceived oral health outcomes namely perceived oral health status and perceived oral impacts among adolescents in Sri Lanka.

DESIGN

A cross-sectional study where the data where collected by means of structured questionnaires to the children and their parents.

PARTICIPANTS

A total 1,225 15-year-old adolescents attending state, private and international schools in the Colombo district of Sri Lanka.

RESULTS

Inverse social gradients in perceived oral health status and perceived oral impacts were observed in relation to six socioeconomic indicators in the bivariate analyses. Adolescents from lower social positions had significantly reported more oral impacts and had rated their oral health as poor. But it was mainly the indicators of family material affluence that emerged as significant predictors of perceived oral health outcomes in the logistic regression analyses.

CONCLUSION

The study demonstrates the existence of significant social gradients in perceived oral health outcomes among adolescents from a developing country. Further studies to assess causes of social gradients in perceived oral health outcomes are recommended.

Prevalence of oral cancer and pre-cancer and associated risk factors among tea estate workers in the central Sri Lanka

BACKGROUND

To screen for oral cancer or not is being debated, but for high-risk populations with minimal access to regular dental care systematic oral examinations could provide some benefit.

METHODS

We undertook oral mucosal examinations of labourers employed in tea estate plantations in Sri Lanka. In a two-stage screening procedure, first by estate medical officers and then by visiting specialists, we examined 12 716 persons at their workplaces achieving a coverage of one-sixth of the total workforce.

RESULTS

Fourteen oral cancers and 848 subjects with oral pre-cancer (6.7%) were detected giving population prevalences of 46.1 per 1000 for leukoplakia and 16.4 per 1000 for oral submucous fibrosis. Among subjects with any oral mucosal disorder (n = 1159) proportions of current users of betel quid, smokers and alcohol use was recorded at 92%, 31% and 61% respectively. The synergistic effect of these three risk habits on the development of oral leukoplakia was evident in mixed habit groups.

CONCLUSIONS

The prevalence of oral pre-cancer in tea estate labourers was higher than estimates reported in previous studies. In the absence of state-sponsored preventive activities, it is necessary to improve the capacity of individual health practitioners and small medical centres to participate in oral health promotion and oral cancer/pre-cancer screening.

Factors associated with perceived oral health status in older individuals

AIM

To assess factors associated with perception of oral health in older individuals.

DESIGN

A cross sectional study.

SETTING

A densely populated urban area in Sri Lanka.

PARTICIPANTS

585 older adults aged 60 years and above of which 475 were living at home and 110 in institutions. The present analysis is limited to 235 subjects who were subjected to a clinical oral examination.

METHOD

The data were collected by means of an interviewer-administered questionnaire and a clinical oral examination.

RESULTS

Overall, 48% of the dentate and 42% of the edentate perceived their oral health as poor. The final model of the hierarchical logistic regression analysis for the dentate revealed that presence of retained roots, mobile teeth, >20 missing teeth and perceived need for dental care were significantly associated with poor perceived oral health status. For the edentate, perceived need for dental care, loss of taste sensation and difficulty in eating were significantly associated with poor perceived oral health status.

CONCLUSIONS

Factors associated with perceived oral health status differed between the dentate and the edentate. Clinical oral health indicators emerged as significant predictors of perceived oral health status in the dentate although the explanatory power of these indicators on perception of oral health was low.

The association between clinical oral health status and oral impacts experienced by older individuals in Sri Lanka

The aim of this study was to determine the association between clinical oral status and oral impacts experienced by older individuals in Sri Lanka. A total of 585 individuals who were above 60 years and were residents of an urban area was selected using a multistage cluster sampling combined with probability proportionate to size technique. However the present analysis is limited to 235 individuals who were subjected to a clinical oral examination. An interviewer administered Sinhala translation of the Oral Health Impact Profile-14 (OHIP-14) scale was used to assess the oral impacts experienced by the sample. An oral examination was carried out following the interview. Of the 235 subjects clinically examined 64 (27%) were edentulous. The associations between clinical parameters and oral impacts were assessed in the 171 dentate subjects. There were positive, weak but significant correlations between the number of missing teeth, the number of teeth with third degree mobility and the OHIP score. Also those who wore dentures and had halitosis had significantly higher OHIP scores than those who did not wear dentures and did not have halitosis. Logistic regression analysis revealed that 'wearing denture' and 'having halitosis' were significant predictors of the OHIP score. In conclusion, there was a weak association between clinical parameters and oral impacts experienced by these older individuals.

Prevalence of oral impacts in a Sinhala-speaking older population in urban Sri Lanka

OBJECTIVES

To assess the impact of oral conditions on the quality of life in an urban older population in Sri Lanka.

DESIGN

A cross-sectional study where the data were collected by means of an interviewer-administered questionnaire.

PARTICIPANTS

A total of 585 Sinhala speaking older adults aged 60 years and above who were residents of a densely populated urban area. Of the 585, 475 were living at home and 110 were living in institutions.

OUTCOME MEASURES

Psycho-social and functional impacts of oral conditions were assessed using the Sinhalese translation of the OHIP-14 scale.

RESULTS

25% of subjects had experienced one or more impacts due to their oral conditions fairly often or very often during the preceding 6 months. Multiple impacts were reported by 17% of the subjects. The most commonly experienced impact item was "uncomfortable to eat" (17%). The mean OHIP score was 0.8 +/- 1.8. The prevalence of oral impacts and the OHIP scores were significantly associated with age, perceived oral health status, perceived need for dental care and dental visiting patterns. Those who visited a dentist during the past 12 months reported significantly more impacts than those who did not visit.

CONCLUSIONS

Oral impacts that affected the quality of life were relatively common in this sample of older individuals.

Validation of a Sinhalese translation of the Oral Health Impact Profile-14 for use with older adults

OBJECTIVE

To test the psychometric properties of a Sinhalese translation of the OHIP-14 scale for use among older adults in Sri Lanka.

DESIGN

A cross-sectional survey. The English version of the OHIP-14 was translated in to Sinhalese, pre-tested and subsequently administered to the subjects by a trained interviewer.

SETTING

Moratuwa--a densely populated urban area in the Western province of Sri Lanka.

SUBJECTS

585 individuals aged 60 years and above.

MAIN OUTCOME MEASURES

Reliability of the translated scale was assessed in terms of internal consistency using Cronbach's alpha. Construct validity was evaluated by examining the associations between perceived oral health status, perceived need for dental care and the OHIP scores.

RESULTS

Cronbach's alpha of the translated scale was 0.93. Corrected item-total correlation coefficients ranged from 0.53-0.80. The highly significant associations between perceived oral health status, perceived need for dental care and the OHIP scores support the construct validity of the translated scale.

CONCLUSION

The Sinhalese translation of the OHIP-14 is a valid and reliable instrument to measure oral health related quality of life in older adults of Sri Lanka.

Telephone counselling in psychiatry

AIM OF STUDY

To study the description of callers using a telephone helpline to improve support to patients in between appointments.

METHOD

This includes creating a helpline in the department and getting psychiatrists, medical officers, psychologists and social workers trained to man this line during office hours. Information from callers were recorded and analysed using SPSS for MS Windows version 6.0.

RESULTS

The callers were mainly females calling about personal problems, namely psychiatric symptoms and sleep difficulties. Half were given specialist appointments and one-fifth were discharged after telephone counselling.

CONCLUSIONS

Telephone counselling is useful in clarifying medical instructions and supporting psychiatric patients in between outpatient appointments.

Amineptine and midazolam dependence

A case report of a patient with amineptine and midazolam dependence is presented. A literature search was done for other cases of amineptine abuse and their presentations and medical investigations are compared. This is the first locally reported case of amineptine abuse and highlights the fact that amineptine is a potential drug of abuse.

Sexuality of women with carcinoma of the cervix

Interviews regarding sexual function were conducted with patients suffering from cervical cancer and who were previously sexually active. Eighty-Seven patients who were treated surgically were compared with 40 patients who had radiotherapy. Both groups had reduced sexual activity and decreased sexual enjoyment although the post-radiotherapy group fared worse. Reasons for not having sexual relations were explored and most cited decreased libido and poor physical condition rather than fear of cancer transmission through sexual activity.

VACUOLAR-TYPE H+-TRANSLOCATING ATPases IN PLANT ENDOMEMBRANES: SUBUNIT ORGANIZATION AND MULTIGENE FAMILIES

Acidification of endomembrane compartments by the vacuolar-type H+-translocating ATPase (V-ATPase) is vital to the growth and development of plants. The V-ATPase purified from oat roots is a large complex of 650x10(3 )Mr that contains 10 different subunits of 70, 60, 44, 42, 36, 32, 29, 16, 13 and 12x10(3 )Mr. This set of ten polypeptides is sufficient to couple ATP hydrolysis to proton pumping after reconstitution of the ATPase into liposomes. Unlike some animal V-ATPases, the purified and reconstituted V-ATPase from oat is directly stimulated by Cl-. The peripheral complex of the ATPase includes the nucleotide-binding subunits of 70 and 60x10(3 )Mr and polypeptides of 44, 42, 36 and 29x10(3 )Mr. Six copies of the 16x10(3 )Mr proteolipid together with three other polypeptides are thought to make up the integral sector that forms the H+-conducting pathway. Release of the peripheral complex from the native membrane completely inactivates the pump; however, the peripheral subunits can be reassembled with the membrane sector to form a functional H+ pump. Comparison of V-ATPases from several plants indicates considerable variations in subunit composition. Hence, several forms of the V-ATPase may exist among, and probably within, plant species. At least four distinct cDNAs encode the 16x10(3 )Mr proteolipid subunit in oat. Multiple genes could encode different subtypes of the H+ pump that are regulated by the developmental stage and physiological function specific to the cell or tissue type.

Primary structures of Arabidopsis calmodulin isoforms deduced from the sequences of cDNA clones

Complementary DNA (cDNA) clones encoding calmodulin isoforms were isolated from an Arabidopsis leaf lambdagt10 library by screening with cloned barley calmodulin cDNA probes. Two cDNAs, one a 626-base pair partial-length clone (ACaM-1) and one a 1400-base pair full-length clone (ACaM-2), encode calmodulin polypeptides that differ by four conservative amino acid substitutions. None of the amino acid sequence differences occur within the four Ca(2+)-binding domains of the proteins. Whereas the deduced amino acid sequences of the two Arabidopsis calmodulin isoforms share 97% identity, the nucleotide sequences encoding the two isoforms share 87% sequence identity. Most of these nucleotide sequence differences (80%) occur in codon wobble positions. ACaM-1 and ACaM-2 both hybridize with a distinct set of restriction fragments of Arabidopsis total DNA, indicating that they were derived from transcripts of separate genes; these genes are single- or very low-copy in the Arabidopsis genome. Both cDNAs hybridize to messenger RNA (mRNA) species of 0.8 kilobases that are expressed to a greater extent in developing siliques compared with leaves, flowers, and stems. Northern blot and polymerase chain reaction assays both indicate that ACaM-1 mRNA is more highly expressed than ACaM-2 mRNA in developing siliques. The steady-state levels of both isoform mRNAs increase as a result of touch stimulation; the kinetics and extent of increase are comparable for the two mRNAs.