Are educating and promoting interventions effective in oral health?: A systematic review

OBJECTIVE

It is estimated that about 20%-25% of the world's population are suffering from periodontal diseases or severe gum diseases. This requires appropriate interventions. For the development of effective and evidence-based programmes tailored to the target group, the aim of this review was to survey to the effectiveness of oral health education and promotion interventions in the relevant groups of people.

METHODS

The electronic databases including PubMed, EMBASE, Web of science and Cochrane Library were searched for English language studies between 2010 and (January-December) 2016. To assess the quality of articles, the checklist was used that includes 19 items. Studies were selected based on PICOs criteria, and finally, 16 studies were entered in our study.

RESULTS

A total of 16 articles were selected, classified into two groups (A and B groups), so that group A with short-term effects includes improving knowledge, attitudes, self-efficacy, oral health behaviour (toothbrushing and flossing), theoretical constructs (perceived susceptibility, perceived severity and perceived behavioural control) which consists of 15 articles and group B with long-term effects includes improving decayed teeth, plaque, calculus and bleeding which consists of six articles.

CONCLUSION

Approximately, this study supports effectiveness of all oral health education and promotion interventions, especially in short-term outcomes. Regarding the importance of long-term and short-term outcomes for oral health education and promotion programmes, These interventions could be performed in the future with several target groups including family and teachers.

Severe Anemia and Helicobacter Pylori Infection in school age Children; A case reports

BACKGROUND

Iron-deficiency anemia is a widespread public health problem with major consequences for human health especially, children. However, in a fraction of patients an underlying cause is never found during routine investigation. Recent studies have suggested an association between Helicobacter pylori (H. Pylori) infection and iron-deficiency anemia.

CASE PRESENTATION

Here is reported four school aged children (two male, two female) with refractory severe iron-deficiency anemia associated H. Pylori gastritis. Mean age of the patients was 13.62 years old and they were admitted with chief complaints of abdominal, chest pain weakness, headache and respiratory distress. Mean hemoglobin level in patients was 6.2 g/dl with persistence to iron therapy. After the diagnosis and therapy of H. pylori infection, clinical complaints, hemoglobin level and iron profiles were being normal and they gained weight.

CONCLUSION

This study suggests screening of H. pylori infection and appropriate treatment in any case of refractory moderate to severe iron-deficiency anemia, especially with clinical manifestations of gastrointestinal tract in children.

Seroprevalence of Hepatitis B, Hepatitis C and Human Immunodeficiency Viruses among Thalassemia Patients in West North of Iran

BACKGROUND

Thalassemia patients that are conventionally treated by a regular transfusion regimen are exposed to blood born viral infections.The aim of this study was to investigate the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV), and human Immunodeficiency virus (HIV) among all multitransfused thalassemia patients in west north of Iran.

MATERIAL AND METHODS

A retrospective study was conducted in February 2014, on 32 patients in Urmia, suffering from transfusion dependent thalassemia were admitted to Motahari and Emam Khomeini hospitals. Patients' medical records were studied for HBs antigen and seropositivity for HCV, and HIV antibodies.

RESULTS

Out of 32transfusion dependent thalassemia patients aged between 5-17years, 18 (56.25%) and14 (43.75%) were male and female, respectively. All of them were found seronegative for HBs antigen, HCV, and HIV antibodies.

CONCLUSION

It seems that screening of blood products is efficient in Urmia, capital of West Azarbaijan, Iran for prevention of blood born viral infections.

Cardiac and Hepatic T2*-Weighted Magnetic Resonance Imaging in Transfusion Dependent Hemoglobinopathy in North West of Iran

BACKGROUND

Iron overload is the main transfusion related side effects in patients with transfusion dependent hemoglobinopathies. Severe iron deposition in tissues leads to organ dysfunction. Many organs can be affected such as heart, liver, and endocrine organs. Cardiac failure and liver fibrosis are the consequent of Iron overload in transfusion dependent hemoglobinopathy. Magnetic Resonance Imaging (MRI) is a safe, noninvasive, and accurate method for the assessment of iron deposition in different tissues. This study assessed iron levels in liver and heart of the patients with transfusion dependent hemoglobinopathies.

MATERIALS AND METHODS

The studied population consisted of 12 patients (7 male and 5 female) with transfusion dependent hemoglobinopathies, aged between 10-18 years old. Then, Cardiac and liver T2*- weighted magnetic resonance imaging (MRI) were obtained.

RESULTS

In current study, 1patient (8.33%) had severe, 2 patients (16.66%) had moderate and 2(16.66%) had mild cardiac iron deposition. Out of 12 patients, 1 had severe iron deposition in liver (8.33%), 5(41.66%) and 4(33.33%) had moderate and mild hepatic iron deposition, respectively. Differences between Hepatic and cardiac iron levels were not significant between males and females (p>0.05).

CONCLUSION

Since cardiac and liver iron levels were higher than normal in most of the study group, checking ferritin level and liver function test and also echocardiography in shorter intervals (each 3 months) in involved group is suggested instead of checking routinely in 6 month intervals in patients with transfusion dependent hemoglobinopathies.

Bone density in transfusion dependent thalassemia patients in Urmia, Iran

BACKGROUND

Patients with thalassemia major and intermedia are susceptible to osteopenia and osteoporosis. The mechanism of osteoporosis in these patients is multifactorial. Transfusion related iron overload in endocrine organs leads to impaired growth hormone secretion, diabetes mellitus, hypothyroidism, hypoparathyroidism, lack of sex steroids and vitamin D deficiency that contribute to impairment in achieving an adequate bone mass .The aim of this study was assessment of frequency of bone loss in patients with thalassemia major and intermedia in Urmia City of West Azerbaijan, Iran.

MATERIALS AND METHODS

In this cross sectional descriptive study,10 patients (lower than 18 y/o)with transfusion dependent thalassemia attending to Motahari and Emam Khomeini hospitals in Urmia city of Iran were enrolled and scanned for Bone Mineral Density (BMD) starting at around 10 years old.

RESULTS

Tenatients (6 male and 4 female) with transfusion dependent thalassemia (β-thalassemia major and intermedia) aged 13to 17 years in Urmia city of Iran were enrolled. Mean age of patients was 15.1±.37year old. Among them, 8 patients (80%)had low BMD and2 of them (20%) had normal BMD in lumbar spine. Only 30% of patients had low BMD in the neck of femur.

CONCLUSION

We should perform annual BMD in patients with thalassemia major and intermedia and hemoglobin H disease in age of higher than 8 year old and treat low BMD with administration of bisphosphonate, calcium and vitamin D supplements. Medical consultation with a rheumatologist and /or an endocrinologist should be performed in these patients. Changing lifestyle with mild daily exercise, adequate calcium containing foods, avoiding heavy activities, stop smoking, iron chelation therapy in adequate dosage, early diagnosis and treatment of endocrine insufficiency and regular blood transfusions can help to achieve an optimal bone density in these patients.

Nutritional intervention on malnutrition in 3-6 years old rural children in Qazvin Province, Iran

Malnutrition is one of the major causes of mortality and morbidity in children. Not only include acute effects on children's health, but also it has long-term effects on their cognitive development and economic growth in the society. Wasting (weight for height with Z<-1) is one of the malnutrition indices in children. The aim of this study was to determine the effect of a cooked meal for 175 days on the anthropometric indices of weight, height and weight for height (wasting) of 3-6 years old children in all the rural nursery of Qazvin province, in Iran. In this interventional study, 2385 children (48.8% female and 51.2% male) were recruited. Data were collected by a census in 2010. The children were received a cooked meal based on 360 +/- 20 kcal energy, 17% protein, 53% carbohydrate and 30% fat per day for 175 days at lunch time. The anthropometric indices were collected before and after the intervention. The results were analyzed using paired t-test by SPSS V.16 software. Prevalence of wasting (mild and moderate) and (sever malnutrition) after intervention reduced from 14.2 and 0.95-12.6 and 0.5%, respectively (p < 0.05). Receiving a cooked meal significantly decreased wasting (15.2-13.2%) in all children (p < 0.05). Nutritional intervention with cooked meal for 175 days had significant reduction in wasting in all children.

Effect of Cu2+/Al3+ mole ratio on structure of Cu – Al bimetallic nanoparticles prepared by radiation induced method

Cu–Al bimetallic nanoparticles were synthesized by gamma irradiation technique in aqueous solutions containing metal chlorides as precursors, polyvinyl alcohol (PVA) as a capping agent, isopropanol as a radical scavenger, and distilled water as a solvent. The Cu–Al bimetallic nanoparticles were characterized by transmission electron microscopy (TEM), UV-visible absorption spectrometry, powder X-ray diffractometer (XRD), and Energy-dispersive X-ray spectroscopy (EDX). The TEM, XRD, EDX, and absorption analyses confirmed the formation of core-shell structure of Cu–Al bimetallic nanoparticles at lower Cu2+/Al3+ mole ratio, and the formation of Cu–Al alloy nanoparticles at higher Cu2+/Al3+ mole ratio. The TEM analysis for particle size and size distribution revealed that the average particle size of Cu–Al bimetallic nanoparticles decreased with the increase of absorbed dose. It may be explained due to the competition between nucleation and aggregation processes in the formation of metallic nanoparticles under irradiation.

Treatment of steroid and cyclosporine-resistant idiopathic nephrotic syndrome in children

Steroid-resistant nephrotic syndrome (SRNS) in children carries a significant risk of progression to end-stage renal failure (ESRF). We report a two-step protocol adapted in children with SRNS. Thirty-seven SRNS were treated with cyclosporine A (CyA) in association with prednisolone (alternate day) for 6 months (first-step treatment). Twelve patients (32.4%) went into complete remission, and 2 (5.4%) got partial remission. The other 23 cases who were steroid and CyA resistant entered a second-step treatment with withdrawing steroids, with CyA (5 mg/kg/day) in association with mycophenolate mofetil (MMF) 30 mg/kg/day for 6 months. Complete remission was observed in 11 cases (47.82%) and partial remission in 2 cases (8.7%). After two steps of treatment, 27/37 children went into total remission. In steroid and CyA-resistant INS, the association of MMF with CyA was able to induce remission in about half cases without relevant side effects.

The effects of low calorie diet with soy protein on cardiovascular risk factors in hyperlipidemic patients

Serum lipid abnormalities are an established risk factor for cardiovascular disease in hyperlipidemic patients. Because of the side effect of long-term medications in these patients, soy protein, as a part of healthy diet, may improve their lipid profile. The purpose of this study was to determine the effect of soy protein with low-calorie diet on lipid profiles in hyperlipidemic patient. Fifty two hyperlipidemic patients of both sex and age range of 25-65 years were participated. The patients received low-calorie diet based on 1400 kcal energy 18% protein, 24% fat and 58% carbohydrate per day for 4 weeks. The treatment group received low-calorie diet including (30 g day(-1)) of soy protein. Blood samples were obtained after an overnight (12 h) fasting period before the study and in the last day of the intervention period. Anthropometric indices and levels of serum triacylglycerol, total cholesterol, low-density lipoprotein and high-density lipoprotein were measured before and after the intervention. In groups, weight, body mass index, waist and hip circumferences were significantly reduced (p<0.05) after four weeks. In comparison with control group, the results of treatment of soy protein with low-calorie diet showed that at the end of 4th week serum low-density lipoprotein was significantly (p<0.05) decreased while an insignificant reduction was seen in total cholesterol. This study suggest that soy protein with low calorie diet for 4 weeks treatment may be safe and effective alternative therapy for diminished the cardiovascular risk factors in hyperlipidemic patients.

Prevalence of Rotavirus, Adenovirus, and Astrovirus Infections among Patients with Acute Gastroenteritis in, Northern Iran

BACKGROUND

The aim of the study was to determine the incidence of non-bacterial acute gastroenteritis associated with diarrheal diseases in Mazandaran Province, northern Iran.

METHODS

A total of 400 symptomatic cases from patients with acute gastroenteritis from Mazandaran Province in Iran were screened using EIA method for the presence of rotavirus, adenovirus and astrovirus during 2005-2006. Chi-square tests were used for testing relationships between different variables.

RESULTS

Rotavirus, adenovirus and astrovirus were detected in 62%, 2.3%, and 3% of samples, respectively. The maximum rate of rotaviruses was detected in the <1-year-old age group, while minimum rate was found in the 10 years and older age group. Astrovirus and adenovirus were detected predominantly in the 2-5-year-old age group of children, with a prevalence of 8.3% and 3.5% respectively. All studied viral gastroenteritis peaked in the winter, and minimum rate were found in summer.

CONCLUSION

Our statistical analyzes indicated that viral gastroenteritis, especially Rota-viral, had the highest number of occurrences in colder seasons notably in winter and more frequently were observed among younger children.

Prediction of dietary flavonol consumption from fasting plasma concentration or urinary excretion

OBJECTIVES

to predict flavonols content of the habitual diets of free-living subjects from urine and plasma concentrations of flavonols.

DESIGN

Ten type 2 diabetic patients (five male, five female), mean age 60 (s.e.m. 7) y and BMI 30.2 (s.e.m. 3.5) kg/m2 were treated in a random crossover design for a 2 week period on either a low flavonoid diet or on the same diet supplemented at one of two high flavonols levels (total 77.3 or 110.4 mg/day) provided by supplements of 1500 ml tea daily and 400 g fried white onion in olive oil with and without tomato ketchup and herbs.

SETTING

Glasgow Royal Infirmary, University of Glasgow, Scotland.

MAIN OUTCOME MEASURES

Fasting plasma concentration, urine concentration and 24 h excretion of quercetin, isorhamnetin, kaempferol and myricetin.

RESULTS

Plasma flavonol concentration (r=0.750, P=0.001), 24 h urine concentration (r=0.847, P=0.001) and 24 h urine excretion (r=0.728, P=<0.001) were all highly significantly related to dietary intake and gave similar estimates of intakes. Fasting plasma flavonols concentrations on habitual diets ranged from 0 to 43.7 ng/ml mean. Regression equations were constricted: total flavonols intake r=0.74, P<0.001 and quercetin intake r=0.744, P<0. 001. From these equations, flavonol intakes from habitual diets were estimated at 17-50, mean 35 mg/day. Of this, 91% was from quercetin.

CONCLUSIONS

Dietary flavonols are absorbed and appear in plasma and urine as potential biomarkers in concentrations related quantitatively to intake. Estimation of dietary intake from plasma or urine concentrations appears possible.

SPONSORSHIP

Rank Prize Funds and Rank Foundation of the Department of Human Nutrition; Ministry of Health and Medical Education, IR Iran. European Journal of Clinical Nutrition (2000) 54, 143-149

Dietary flavonols protect diabetic human lymphocytes against oxidative damage to DNA

Diabetic patients have reduced antioxidant defenses and suffer from an increased risk of free radical-mediated diseases such as coronary heart disease. Epidemiological evidence has suggested that antioxidant dietary flavonoids may protect against heart disease, but a biological effect has yet to be demonstrated directly in humans. In this study, 10 stable type 2 diabetic patients were treated for 2 weeks on a low-flavonol diet and for 2 weeks on the same diet supplemented with 76-110 mg of flavonols (mostly quercetin) provided by 400 g of onions (and tomato sauce) and six cups of tea daily. Freshly collected lymphocytes were subjected to standard oxidative challenge with hydrogen peroxide, and DNA damage was measured by single-cell gel electrophoresis. Fasting plasma flavonol concentrations (measured by high-performance liquid chromatography) were 5.6 +/- 2.9 ng/ml on the low-flavonol diet and increased 12-fold to 72.1 +/- 15.8 ng/ml on the high-flavonol diet (P < 0.001). Oxidative damage to lymphocyte DNA was 220 +/- 12 on an arbitrary scale of 0-400 U on the low-flavonol diet and 192 +/- 14 on the high-flavonol diet (P = 0.037). This decrease was not accounted for by any change in the measurements of diabetic control (fasting plasma glucose or fructosamine) or by any change in the plasma levels of known antioxidants, including vitamin C, carotenoids, alpha-tocopherol, urate, albumin, and bilirubin. In conclusion, we have shown a biological effect of potential medical importance that appears to be associated with the absorption of dietary flavonols.

Effects of flavonoids and vitamin C on oxidative DNA damage to human lymphocytes

This study assessed the antioxidant potencies of several widespread dietary flavonoids across a range of concentrations and compared with vitamin C as a positive control. The antioxidant effects of pretreatment with flavonoids and vitamin C, at standardized concentrations (7.6, 23.2, 93, and 279.4 micromol/L), on oxygen radical-generated DNA damage from hydrogen peroxide (100 micromol/L) in human lymphocytes were examined by using the single-cell gel electrophoresis assay (comet assay). Pretreatment with all flavonoids and vitamin C produced dose-dependent reductions in oxidative DNA damage. At a concentration of 279 micromol/L, they were ranked in decreasing order of potency as follows: luteolin (9% of damage from unopposed hydrogen peroxide), myricetin (10%), quercetin (22%), kaempferol (32%), quercitrin (quercetin-3-L-rhamnoside) (45%), apigenin (59%), quercetin-3-glucoside (62%), rutin (quercetin-3-beta-D-rutinoside) (82%), and vitamin C (78%). The protective effect of vitamin C against DNA damage at this concentration was significantly less than that of all the flavonoids except apigenin, quercetin-3-glucoside, and rutin. The ranking was similar with estimated ED50 (concentration to produce 50% protection) values. The protective effect of quercetin and vitamin C at a concentration of 23.2 micromol/L was found to be additive (quercetin: 71% of maximal DNA damage from unopposed hydrogen peroxide; vitamin C: 83%; both in combination: 62%). These data suggest that the free flavonoids are more protective than the conjugated flavonoids (eg, quercetin compared with its conjugate quercetin-3-glucoside, P < 0.001). Data are also consistent with the hypothesis that antioxidant activity of free flavonoids is related to the number and position of hydroxyl groups.