Paraoxonase-1 activity evaluation as a diagnostic and prognostic marker in horses and foals

Background

In several species, paraoxonase‐1 (PON‐1) decreases during inflammation, because of the presence of oxidative stress; its measurement recently has been validated in horses, but its role as a clinical biomarker is unknown.

Objectives

To evaluate sensitivity, specificity and likelihood ratio of PON‐1 activity to identify systemic inflammatory response syndrome (SIRS)‐positive horses or horses with a poor prognosis.

Animals

One hundred seventy‐two blood samples from 58 sick horses from 3 different veterinary hospitals.

Methods

In a cross‐sectional study, PON‐1 activity was measured upon admission and at 24‐hour intervals until discharge or death, and results were analyzed based on SIRS status and outcome.

Results

No statistically significant difference was found in median PON‐1 activity between SIRS and non‐SIRS cases or between survivors and non‐survivors except for mares, in which PON‐1 activity was significantly lower in SIRS‐positive horses (P = .05). The sensitivity of PON‐1 activity in identifying horses with SIRS or negative outcome was low (0.0%‐46.2% depending on the examined group) but its specificity was high (87.0%‐100.0%). However, when PON‐1 is low, the likelihood of death is 2.40‐3.89 times higher than the likelihood of survival. Repeated measurement of PON‐1 after treatment does not predict outcome.

Conclusions and Clinical Importance

Evaluation of PON‐1 activity in horses with inflammation might be advisable in the future, but only low activity at admission may be relevant in predicting SIRS or negative outcome.

Dental services for adults with a learning disability: care managers' experiences and opinions

OBJECTIVE

To investigate care managers' experiences in obtaining dental services for their clients.

BASIC RESEARCH DESIGN

Descriptive survey collecting qualitative and quantitative data by semi-structured interviews.

SETTING

Inner London boroughs of Lambeth, Southwark and Lewisham.

PARTICIPANTS

Care managers or their delegated representatives in all homes listed in June 1996 by the registration and inspection units of the boroughs' social services departments, under the Registered Homes Acts (1984; 1991).

MAIN OUTCOME MEASURES

Managers' experiences in obtaining dental services for their residents and their perception of their residents' current need for dental treatment. Perceived barriers to care.

RESULTS

Managers perceived a current need for dental treatment in 14% of the residents. In 4 out of 80 homes (5%) none of the clients had seen a dentist during the preceding 12 months, but not because homes had been unable to obtain services. The most common reason given by managers was that clients were unwilling to accept care. Continuity of care and partnership between carers and dentists were seen as facilitating co-operation. Eighty five per cent of homes made some use of the Community Dental Services.

CONCLUSIONS

Managers perceived that sufficient services were available in the area; the chief barrier to care was residents' reluctance to accept treatment. The Community Dental Service played an important role in the provision of dental services. Managers felt that the treatment of severely disabled patients required special skills and experience.

Parental perceptions and attitudes on orthodontic care

The objective of this paper is to determine whether an association existed between parents' attitudes to orthodontic issues affecting themselves and their attitudes to possible orthodontic treatment for their child. It consisted of an analytical survey using a self-administered questionnaire, taken in South East England of six-hundred parents of children aged 9 years. The questionnaires were delivered to the parent with the help of their child's school. Four-hundred-and-thirty-seven questionnaires were returned (73 per cent). Significant associations were found between desire by the parents for orthodontic treatment for themselves and perception of need in their child, parental satisfaction with own dental appearance and perception of need in their child, a parental history of orthodontic treatment and a determination to insist on their child's co-operation with orthodontic treatment. Logistic regression models show the odds of parents who desire orthodontic treatment themselves, perceiving need in their children are three times greater than for other parents. 1. There is some evidence that parents who desire orthodontic treatment for themselves, or who are former orthodontic patients are more likely to approve of orthodontic care in principle and to perceive a need for it in their child. 2. Further research is required to establish to what extent genetic factors are involved.

Lack of knowledge among parents, of the implications of receiving orthodontic treatment

In a survey of parental knowledge of the complications of orthodontic treatment it was surprising to find how few 'experienced' parents knew that dental decay could occur beneath an appliance or that, after treatment ceased, there might be some relapse. Experienced parents were defined as those who had children who had received or were receiving treatment, or who had been patients themselves. Self-administered questionnaires were delivered to 600 parents of 9-year-old children randomly selected from school rolls in two areas of South East England. Among the 430 replies received, 123 were from parents with experience of orthodontic treatment. Only 41 per cent of them knew that decay could occur beneath a fixed appliance and less than a third that relapse could occur after treatment ceased.