Impact of Antenatal Care on Perinatal Outcomes in New South Wales, Australia: A Decade-Long Regional Perspective

Low birth weight (LBW) and preterm birth are adverse perinatal outcomes that pose a significant risk to a child's healthy beginning. While antenatal care (ANC) is an established intervention for pregnancy care, little is understood about how the number and timing of ANC visits can impact these adverse health outcomes. This study aimed to examine the impact of the number and timing of ANC visits on LBW and preterm birth in a regional setting. A decade-long perinatal dataset related to singleton live births that took place in the Southern New South Wales Local Health District (SNSWLHD) was utilized. The outcomes of interest were LBW and preterm birth, and the exposure variables were based on the Australian pregnancy guidelines on the number and timing of ANC visits. A multivariable logistic regression was performed to measure the association between outcome and exposure while adjusting for potential confounders. A greater level of protection against LBW and preterm birth was observed among mothers who had an adequate number of visits, with early entry (first trimester) into ANC. The protective effect of an adequate number of ANC visits against LBW and preterm birth among mothers with late entry into ANC (third trimester) was found to be statistically non-significant.

[Importance of early identification of a deep neck abscess]

Treatment of odontogenic infections, such as drainage of submucosal abscesses, should be carried out by the dental practitioner. However, when an odontogenic infection deteriorates into a deep neck abscess, treatment should be carried out by the oral maxillofacial surgeon. Based on two cases, this article describes the clinical presentation, course, and necessary treatment of a deep neck abscess. It also points out that timely recognition of the disease is key in treatment. In any case of delay, there is a possibility for fast deterioration by complications, such as airway obstruction, development of descending necrotizing mediastinitis, or sepsis. Oral health practitioners play an important role in early identification of a deep neck abscess. This article proposes recommendations for dentists when to suspect a deep neck infection, which could be useful in quick and adequate referral to an OMF surgeon.

[The dentogenic inflammation, diagnosis, course and treatment]

Inflammation begins as a response of the immune system to an external, harmful stimulus. This stimulus can be chemical, mechanical or bacterial in nature. The inflammatory response is necessary to create optimal conditions for healing. In case of pulpitis, a peri-apical granuloma, peri-coronitis or periodontitis, complaints arise as a result of an inflammatory reaction. With further progression, such as an infiltrate or a submucosal abscess, the bacteria will eventually invade the tissues and develop an infection. Given the high prevalence of dental diseases, oral health care providers are regularly confronted with the consequences of dentogenic inflammation and subsequent infections. Each specific stage of dentogenic inflammation presents symptoms that are important for making the correct diagnosis. This is important in applying the optimal dental, surgical or medical treatment.

[A human bite wound caused a severe life threatening infection]

Within 24 hours after a human bite trauma, a 34-year-old male patient became septic and ended up at an intensive care unit. The combination of a local damage of the skin or mucosa, aggressive micro-organisms, local host factors, and some bad luck resulted in necrotizing fasciitis for this patient. This is a very rapid progressive infection which can spread via fat tissue and the muscle fascia. The occurrence of extensive necrosis releases a lot of cytokines and acute-phase proteins, resulting in a systemic reaction. The consequential vasodilatation makes it necessary for the heart to pump harder in order to maintain the circular volume. The patient will soon become septic and hemodynamically unstable. This can also lead to multiple organ failure with potentially fatal consequences. Because necrotizing fasciitis can be caused by commensal bacteria, even young healthy patients are at risk for this invasive life threatening disease. Early recognition of the clinical manifestations can prevent a fatal outcome.

[Inflammation and infection: cellular and biochemical processes]

The terms inflammation and infection are often used interchangeably. Technically this is incorrect. Inflammation is defined as the body's response to a potentially damaging stimulus. Infection involves tissue invasion by microorganisms. An inflammatory reaction will be provoked when infection occurs in an otherwise healthy patient. Inflammation can be recognized clinically by 5 cardinal signs: rubor (redness), calor (warmth), tumor (swelling), dolor (pain), and functio laesa (loss of function). These clinical signs can be explained by the biochemical and cellular processes activated during the inflammatory response. Rubor and calor are the result of local vasodilation. Tumor, dolor and functio laesa result from extravasation of blood plasma, white blood cells, and inflammatory mediators. Pulpitis is an example of inflammation; a periapical abscess is an example of infection.

Critical appraisal of patient-specific implants for secondary post-traumatic orbital reconstruction

In orbital reconstruction, a patient-specific implant (PSI) may provide accurate reconstruction in complex cases, since the design can be tailored to the anatomy. Several design options may be embedded, for ease of positioning and precision of reconstruction. This study describes a cohort of 22 patients treated for secondary orbital reconstruction with a PSI; one patient received two PSI. The preoperative clinical characteristics and implant design options used are presented. When compared to preoperative characteristics, the postoperative clinical outcomes showed significant improvements in terms of enophthalmos (P < 0.001), diplopia (P < 0.001), and hypoglobus (P = 0.002). The implant position in all previous reconstructions was considered inadequate. Quantitative analysis after PSI reconstruction showed accurate positioning of the implant, with small median and 90th percentile deviations (roll: median 1.3°, 90th percentile 4.6°; pitch: median 1.4°, 90th percentile 3.9°; yaw: median 1.0°, 90th percentile 4.4°; translation: median 1.4 mm, 90th percentile 2.7 mm). Rim support proved to be a significant predictor of roll and rim extension for yaw. No significant relationship between design options or PSI position and clinical outcomes could be established. The results of this study show the benefits of PSI for the clinical outcomes in a large cohort of secondary post-traumatic orbital reconstructions.

Surgical instrument to improve implant positioning in orbital reconstruction: a feasibility study

Adequate positioning of an orbital implant during orbital reconstruction surgery is essential for restoration of the pre-traumatised anatomy, but visual appraisal of its position is limited by the keyhole access and protruding soft tissues. A positioning instrument that attaches to the implant was designed to provide feedback outside the orbit. The goal of this study was to evaluate the accuracy of placement with the instrument and compare it with the accuracy of placement by visual appraisal. Ten orbits in five human cadaver heads were reconstructed twice: once using visual appraisal and once using the instrument workflow. No significant improvement was found for the roll (5.8° vs 3.4°, respectively, p=0.16), pitch (2.1° vs 1.5°, p=0.56), or translation (2.9 mm vs 3.3 mm, p=0.77), but the yaw was significantly reduced if the instrument workflow was used (15.3° vs 2.9°, p=0.02). The workflow is associated with low costs and low logistical demands, and may prevent outliers in implant positioning in a clinical setting when intraoperative navigation or patient-specific implants are not available.

Smoking Cessation during the Second Half of Pregnancy Prevents Low Birth Weight among Australian Born Babies in Regional New South Wales

Smoking during pregnancy is a modifiable risk behavior of adverse health outcomes including low birth weight (LBW), and LBW is a key marker of newborns immediate and future health. This study aimed to examine the association between smoking cessation during the second half of pregnancy and LBW among babies born in Southern New South Wales Local Health District (SNSWLHD). Routinely collected perinatal data on singleton live births for the period 2011–2019 in five public hospitals of SNSWLHD were utilized. Multivariate logistic regression models were fitted to examine the association between smoking cessation during the second half of pregnancy and LBW. Analyses showed that mothers who ceased smoking during the second half of pregnancy were 44% less likely to have LBW babies (adjusted odds ratio (aOR) = 0.56; 95% confidence interval (CI): 0.34, 0.94) compared to those who continued smoking throughout pregnancy. Mothers who reported an average daily dose of 1–10 or >10 cigarettes during the second half of pregnancy were significantly more likely to have babies with LBW than those who ceased smoking during the second half of pregnancy. Early identification of smoking behavior and promotion of smoking-cessation intervention for risk populations including pregnant women within the older age bracket (35–49 years) is imperative to reduce LBW.

An international study of public contact with people who have an intellectual disability

BACKGROUND

People with intellectual disability (ID) are often socially isolated, and many experience stigma and discrimination. Increased contact with the general public is thought to overcome prejudices. This large-scale international study had three main aims: to determine the type and frequency of contact that the general public has with people with ID; to identify the personal characteristics of those who have greater contact; and to examine the public's level of comfort at the prospect of having contact with people with ID.

METHOD

Self-completed online questionnaires were administered to nationally representative panels of respondents in 17 countries; totally 24 504 persons. Multivariate analyses were used to identify respondents more likely to have had frequent personal contact with persons with ID from those with infrequent or no contact and those respondents who were most comfortable at meeting a person with ID.

RESULTS

Internationally around one in four of the general population reports having frequent personal contact with people who have an ID although this varied from 7% in Japan to 46% in Panama. The principal forms of contact were through friendships, neighbours or extended family members. Over all countries, volunteering and engagement with Special Olympics were the two main predictors of frequent personal contact followed by employment in the education, health or social care field, being a parent of children under 18 years, playing sports and being employed. People who reported frequent personal contact were also more comfortable at meeting a person with ID.

CONCLUSIONS

This international dataset provides a baseline against which public contact can be compared across countries and changes monitored over time. The findings suggest ways in which greater contact can be promoted and making the public more comfortable at meeting people with ID.

The targeting of preschoolers, children, adolescents and adults by the Canadian food and beverage industry on television: a cross-sectional study

Unhealthy food advertising can negatively impact children's food preferences and nutritional health. In Canada, only companies participating in the self-regulatory Children's Food and Beverage Advertising Initiative (CAI) commit to limiting unhealthy food advertising to children. We analyzed food advertising from 182 Canadian television stations in 2018. A principal component analysis explored patterns of advertising by 497 food companies and their targeting of preschoolers, children, adolescents, and adults. Chi-square analyses tested differences in the volume of advertising between target age groups by heavily advertising food companies and by CAI-participating and non-participating companies. In 2018, Maple Leaf Foods, Boulangerie St-Méthode, Exceldor Foods, Goodfood Market and Sobeys advertised most frequently during preschooler-programming. General Mills, Kellogg's, the Topps Company, Parmalat and Post Foods advertised most frequently during child-programming, while Burger King, McDonald's, General Mills, Kellogg's and Wendy's advertised most frequently during adolescent-programming. CAI-participating companies were responsible for over half of the food advertising broadcast during programs targeted to children (55%), while they accounted for less than half of the food advertising aired during programs targeting preschoolers (24%), adolescents (41%) and adults (42%). Statutory food advertising restrictions are needed to limit food companies' targeting of young people on television in Canada. Novelty: Advertising from fast food restaurant chains dominated television programming targeted to adolescents in 2018. Advertising from breakfast cereal, candy, and snack manufacturers dominated television programming targeted at children in 2018. Over 100 Canadian and transnational companies contravened broadcast restrictions on advertising to preschoolers in 2018.

Mitochondrial DNA damage as a potential biomarker of LRRK2 kinase activity in LRRK2 Parkinson's disease

Leucine-rich repeat kinase 2 (LRRK2) is a promising therapeutic target for the treatment of Parkinson's disease (PD) and LRRK2 kinase inhibitors are currently being tested in early phase clinical trials. In order to ensure the highest chance of success, a biomarker-guided entry into clinical trials is key. LRRK2 phosphorylation, and phosphorylation of the LRRK2 substrate Rab10, have been proposed as target engagement biomarkers for LRRK2 kinase inhibition. However, a pharmacodynamic biomarker to demonstrate that a biological response has occurred is lacking. We previously discovered that the LRRK2 G2019S mutation causes mitochondrial DNA (mtDNA) damage and is LRRK2 kinase activity-dependent. Here, we have explored the possibility that measurement of mtDNA damage is a "surrogate" for LRRK2 kinase activity and consequently of kinase inhibitor activity. Mitochondrial DNA damage was robustly increased in PD patient-derived immune cells with LRRK2 G2019S mutations as compared with controls. Following treatment with multiple classes of LRRK2 kinase inhibitors, a full reversal of mtDNA damage to healthy control levels was observed and correlated with measures of LRRK2 dephosphorylation. Taken together, assessment of mtDNA damage levels may be a sensitive measure of altered kinase activity and provide an extended profile of LRRK2 kinase modulation in clinical studies.

A New Conducting Copolymer Bearing Electro-Active Nitroxide Groups as Organic Electrode Materials for Batteries

To reduce the amount of conducting additives generally required for polynitroxide-based electrodes, a stable radical (TEMPO) is combined with a conductive copolymer backbone consisting of 2,7-bisthiophene carbazole (2,7-BTC), which is characterized by a high intrinsic electronic conductivity. This work deals with the synthesis of this new polymer functionalized by a redox nitroxide. Fine structural characterization using electron paramagnetic resonance (EPR) techniques established that: 1) the nitroxide radicals are properly attached to the radical chain (continuous wave EPR) and 2) the polymer chain has very rigid conformations leading to a set of well-defined distances between first neighboring pairs of nitroxides (pulsed EPR). The redox group combined with the electroactive polymer showed not only a very high electrochemical reversibility but also a perfect match of redox potentials between the de-/doping reaction of the bisthiophene carbazole backbone and the redox activity of the nitroxide radical. This new organic electrode shows a stable capacity (about 60 mAh g^-1 ) and enables a strong reduction in the amount of carbon additive due to the conducting-polymer skeleton.

[Acute respiratory distress in a frail older patient: spontaneous tooth aspiration]

A 68-year-old man presented at the emergency room with acute difficulty breathing. On account of recent subarachnoidal haemorrhage the patient was a resident of a care facility, and was also being treated for acute bronchitis there. Radiographic imaging of the lungs revealed a tooth with crown and pontic to have been inhaled. The tooth was surgically removed. After 3 weeks in the intensive care unit, the patient died of aspiration pneumonia. Spontaneous tooth aspiration is rare, yet it can have fatal consequences in vulnerable older patients. Aspiration of a foreign body may lead to injury and infection of the trachea and lungs. In order to determine the correct diagnosis in patients with acute respiratory distress, adequate and targeted diagnostics is essential; especially in older patients with multimorbidity and polypharmacy. Sarcopenia, dysphagia, a decrease in functional chewing units and decreased sensation of the palate increase the risk of choking in patients. In addition, dysphagia and poor oral health are known to be strongly associated with aspiration pneumonia. Healthcare providers should pay more attention to oral health in frail older patients.

[The importance of triage in dental trauma. De differences between the hospital and dental practice]

In dental trauma, the first thought is often: 'Where is that tooth?' And, of course, it is certainly true that fast repositioning is beneficial for the prognosis of the tooth. Nevertheless, it is extremely important to focus on the condition of the patient before focussing on the treatment. A structured approach is mandatory for optimal diagnosis and treatment. This includes possible concomitant injuries such as neurotrauma. The principle of initial screening of the severity of the injury is called triage. There is a clear difference in the severity of injuries of patients with dental trauma presenting themselves in hospital or the dental practice. In hospital there are protocols for primary care; these principles can be applied in the dental practice as well.

Managing junctional haemorrhage in the combat environment

Tactical combat casualty care and the application of extremity tourniquets have saved lives in combat. In the modern combat environment junctional injuries are common and difficult to treat. Recently, junctional tourniquets have emerged as a potential solution to this problem. Junctional tourniquets can be used as an adjunct to persistent haemorrhage despite application of conventional tourniquets or in the persistently hypotensive casualty. Surgeons must have an approach to receiving patients with junctional tourniquets in place in the operating room. The algorithms presented allow for an evidence-based and command-driven implantation of junctional tourniquets as part of tactical combat casualty care.

Implant-oriented navigation in orbital reconstruction part II: preclinical cadaver study

In orbital reconstruction, the acquired position of an orbital implant can be evaluated with the aid of intraoperative navigation. Feedback of the navigation system is only obtained after positioning of the implant: the implant's position is not tracked in real time during positioning. The surgeon has to interpret the navigation feedback and translate it to desired adjustments of the implant's position. In a previous study, a real-time implant-oriented navigation approach was introduced and the system's accuracy was evaluated. In this study, this real-time navigation approach was compared to a marker-based navigation approach in a preclinical set-up. Ten cadavers (20 orbital defects) were reconstructed twice, by two surgeons (total: 80 reconstructions). Implant positioning was significantly improved in the real-time implant-oriented approach in terms of roll (2.0° vs. 3.2°, P=0.03), yaw (2.2° vs. 3.4°, P=0.01) and translation (1.3mm vs. 1.8mm, P=0.005). Duration of the real-time navigation procedure was reduced (median 4.5 min vs. 7.5 min). Subjective appreciation of the navigation technique was higher for real-time implant-oriented navigation (mean 7.5 vs. 9.0). Real-time implant-oriented navigation feedback provides real-time, intuitive feedback to the surgeon, which leads to improved implant positioning and shortens duration of the navigation procedure.

[Maxillary osteonecrosis after denosumab treatment]

A 58-year-old patient with a history of intravenous use of denosumab was referred to the department of oral and maxillofacial surgery with inadequate recovery after a series of extractions. During physical and radiological examination, several sites of exposed necrotic bone with purulent discharge were seen, and the maxilla appeared fractured at the level of Le Fort 1. Treatment consisted of intravenous administration of antibiotics with consecutive sequestrectomy of the maxilla under general anaesthesia. While Medication Related Osteonecrosis of the Jaw (MRONJ) is most commonly seen in patients treated with bisphosphonates, in the past decade, it has become apparent that other types of medication, most notably denosumab, can cause comparable disorders. Treatment of MRONJ strongly depends on the stage the disease is in. In patients with a history of denosumab or bisphosphonate use (administered either intravenously or orally in combination with corticosteroids), abnormal radiological findings, or developing osteonecrosis, referral to a department of oral and maxillofacial surgery is recommended.

The use of cranial resection templates with 3D virtual planning and PEEK patient-specific implants: A 3 year follow-up

PURPOSE

The aim of this study was to evaluate the accuracy of resection templates in cranioplasties in order to facilitate a one-stage resection and cranial reconstruction.

PATIENTS AND METHODS

In three cases, cranial resections were combined with direct reconstructions using the principles of computer-aided design, manufacturing, and surgery. The precision of the resection template was evaluated through a distance map, comparing the planned and final result.

RESULTS

The mean absolute difference between the planned and actual reconstructed contour was less than 1.0 mm. After 3 years, no clinical signs of infection or rejection of the implants were present. The computed tomography scans showed no irregularities, and the aesthetic results remained satisfactory.

CONCLUSION

One-stage resection and cranial reconstruction using a resection template, control template, and a prefabricated patient-specific implant of poly(ether-ether-ketone) (PEEK) proved to be a viable and safe method.

Clinical outcomes in the treatment of unilateral condylar fractures: a cross-sectional study

The treatment of mandibular condyle fractures has been the subject of considerable discussion, especially whether open or closed treatment should be used. There is a need for practical,evidence-based guidelines, and both objective and subjective parameters should be measured. To date, fewstudies have considered clinically relevant subjective parameters. This study was performed to evaluate the outcomes of the treatment of condylar fractures using the Mandibular Function Impairment Questionnaire (MFIQ) and the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and to compare the outcomes of open and the closed treatment. Patients with condylar fractures and at least 1year of follow-up were examined. These patients completed the MFIQ and other questionnaires, and were examined according to the DC/TMD. Seventy-four of 171 eligible patients participated in this study. The mean MFIQ score was 10.70 (standard error 2.9) in the open group and 4.96 (standard error 1.3) in the closed group (P=0.023), an outcome in favour of the closed treatment group. Examination according to the DC/TMD did not reveal a significant prevalence of TMD complaints. Closed treatment appears to be a safe and appropriate modality for most unilateral condylar fractures. Although the open group in general showed similar outcomes, this treatment should be reserved for limited indications.

Associations between birth size and later height from infancy through adulthood: An individual based pooled analysis of 28 twin cohorts participating in the CODATwins project

BACKGROUND

There is evidence that birth size is positively associated with height in later life, but it remains unclear whether this is explained by genetic factors or the intrauterine environment.

AIM

To analyze the associations of birth weight, length and ponderal index with height from infancy through adulthood within mono- and dizygotic twin pairs, which provides insights into the role of genetic and environmental individual-specific factors.

METHODS

This study is based on the data from 28 twin cohorts in 17 countries. The pooled data included 41,852 complete twin pairs (55% monozygotic and 45% same-sex dizygotic) with information on birth weight and a total of 112,409 paired height measurements at ages ranging from 1 to 69 years. Birth length was available for 19,881 complete twin pairs, with a total of 72,692 paired height measurements. The association between birth size and later height was analyzed at both the individual and within-pair level by linear regression analyses.

RESULTS

Within twin pairs, regression coefficients showed that a 1-kg increase in birth weight and a 1-cm increase in birth length were associated with 1.14-4.25 cm and 0.18-0.90 cm taller height, respectively. The magnitude of the associations was generally greater within dizygotic than within monozygotic twin pairs, and this difference between zygosities was more pronounced for birth length.

CONCLUSION

Both genetic and individual-specific environmental factors play a role in the association between birth size and later height from infancy to adulthood, with a larger role for genetics in the association with birth length than with birth weight.