Clinical Evaluation of the Retention of Four Different Pit and Fissure Sealants on the First Permanent Molars - An Original Research

Objective

In this study, the retention rates of four different pit and fissure sealant materials on the first permanent molars were clinically assessed and compared.

Materials and Methods

A total of 120 kids aged 7 to 10 participated in a randomized controlled experiment. On their first permanent teeth, the subjects each got one of the four sealant materials (A, B, C, or D). Over the course of 24 months, the retention rates were evaluated every 6 months. The Chi-square test and Kaplan-Meier survival analysis were used for statistical analysis.

Results

At 6, 12, 18, and 24 months, the following retention rates were observed overall: A (85%, 78%, 65%, 52%), B (90%, 82%, 70%, 60%), C (78%, 70%, 55%, 42%), and D (95%, 88%, 75%, 62%). At each time point, the sealant materials showed significant variations in retention rates (P 0.05). While sealants A and C showed lower retention rates, sealant D showed the best retention rates, followed by sealant B.

Conclusion

This study shows that different materials have different retention rates for pit and fissure sealants on first permanent molars. Higher retention rates for sealants D and B suggest that they may be superior than sealants A and C. These results highlight how crucial it is to choose the right sealant materials to guarantee long-term retention and effectiveness in avoiding dental cavities.

Assessing Breast Cancer Screening and Outcomes Among First Nations Women in Alberta

BACKGROUND

Breast cancer (BC) incidence rates for First Nations (FN) women in Canada have been steadily increasing and are often diagnosed at a later stage. Despite efforts to expand the reach of BC screening programs for FN populations in Alberta (AB), gaps in screening and outcomes exist.

METHODS

Existing population-based administrative databases including the AB BC Screening Program, the AB Cancer Registry, and an AB-specific FN registry data were linked to evaluate BC screening participation, detection, and timeliness of outcomes in this retrospective study. Tests of proportions and trends compared the findings between FN and non-FN women, aged 50-74 years, beginning in 2008. Incorporation of FN principles of ownership, control, access, and possession (OCAP®) managed respectful sharing and utilization of FN data and findings.

RESULTS

The average age-standardized participation (2013-8) and retention rates (2015-6) for FN women compared to non-FN women in AB were 23.8% (P < .0001) and 10.3% (P = .059) lower per year, respectively. FN women were diagnosed with an invasive cancer more often in Stage II (P-value = .02). Following 90% completion of diagnostic assessments, it took 2-4 weeks longer for FN women to receive their first diagnosis as well as definitive diagnoses than non-FN women.

CONCLUSION

Collectively, these findings suggest that access to and provision of screening services for FN women may not be equitable and may contribute to higher BC incidence and mortality rates. Collaborations between FN groups and screening programs are needed to eliminate these inequities to prevent more cancers in FN women.

Retention in care for type 2 diabetes management in Sub-Saharan Africa: A systematic review

OBJECTIVE

Diabetes prevalence has risen rapidly in Sub-Saharan Africa, but rates of retention in diabetes care are poorly understood. We conducted a systematic review and meta-analysis to determine rates of retention in care of persons with type 2 diabetes.

METHODS

We searched MEDLINE, Global Health and CINAHL online databases for cohort studies and randomised control trials (RCTs) published up to 12 October 2021, that reported retention in or attrition from care for patients with type 2 diabetes in Sub-Saharan Africa. Retention was defined as persons diagnosed with diabetes who were alive and in care or with a known outcome, while attrition was defined as loss from care.

RESULTS

From 6559 articles identified, after title and abstract screening, 209 articles underwent full text review. Forty six papers met the inclusion criteria, comprising 22,610 participants. Twenty one articles were of RCTs of which 8 trials had 1 year or more of follow-up and 25 articles were of non-randomised studies of which 19 had 12 months or more of follow-up. A total of 11 studies (5 RCTs and 6 non-randomised) were assessed to be of good quality. Sixteen RCTs were done in secondary or tertiary care settings. Their pooled retention rate (95% CI) was 80% (77%, 84%) in the control arm. Four RCTs had been done in primary care settings and their pooled retention rate (95% CI) was 53% (45%, 62%) in the control arm. The setting of one trial was unclear. For non-randomised studies, retention rates (95% CI) were 68% (62%, 75%) among 19 studies done in secondary and tertiary care settings, and 40% (33%, 49%) among the 6 studies done in primary care settings.

CONCLUSION

Rates of retention in care of people living with diabetes are poor in primary care research settings.

First-line levetiracetam versus enzyme-inducing antiseizure medication in glioma patients with epilepsy

OBJECTIVE

This study aimed to directly compare the effectiveness of first-line monotherapy levetiracetam (LEV) versus enzyme-inducing antiseizure medications (EIASMs) in glioma patients.

METHODS

In this nationwide retrospective observational cohort study, Grade 2-4 glioma patients were included, with a maximum duration of follow-up of 36 months. Primary outcome was antiseizure medication (ASM) treatment failure for any reason, and secondary outcomes were treatment failure due to uncontrolled seizures and due to adverse effects. For estimation of the association between ASM treatment and ASM treatment failure, multivariate cause-specific cox proportional hazard models were estimated, adjusting for potential confounders.

RESULTS

In the original cohort, a total of 808 brain tumor patients with epilepsy were included, of whom 109 glioma patients were prescribed first-line LEV and 183 glioma patients first-line EIASMs. The EIASM group had a significantly higher risk of treatment failure for any reason compared to LEV (adjusted hazard ratio [aHR] = 1.82, 95% confidence interval [CI] = 1.20-2.75, p = .005). Treatment failure due to uncontrolled seizures did not differ significantly between EIASMs and LEV (aHR = 1.32, 95% CI = .78-2.25, p = .300), but treatment failure due to adverse effects differed significantly (aHR = 4.87, 95% CI = 1.89-12.55, p = .001).

SIGNIFICANCE

In this study, it was demonstrated that LEV had a significantly better effectiveness (i.e., less ASM treatment failure for any reason or due to adverse effects) compared to EIASMs, supporting the current neuro-oncology guideline recommendations to avoid EIASMs in glioma patients.

Retention in treatment and therapeutic adherence: How are these associated with therapeutic success? An analysis using real-world data

INTRODUCTION

Treatment retention and adherence are used as outcomes in numerous randomized clinical trials and observational studies conducted in the addiction field. Although usual criteria are 3/6 months of treatment retention or number of sessions attended, there is not a methodological support for conclusions using these criteria. This study analyzed the usefulness of retention and adherence to predict therapeutic success.

METHODS

Retrospective observational study using real-world data from electronic health records of 11,907 patients in treatment diagnosed with cocaine, alcohol, cannabis and opiate use disorders or harmful use.

RESULTS

Moderate effect size relations were found between the different type of clinical discharge and months in retention (η²  = 0.12) and proportion of attendance (η²  = 0.10). No relationship was found with the number of sessions attended. Using cut-off points (i.e., 3 or 6 months in treatment or attending 6 therapy sessions) worsens the ability to predict the type of discharge.

DISCUSSIONS/CONCLUSION

Treatment retention and adherence are indicators moderately related to therapeutic success. Research using these indicators to assess the effectiveness of therapies should complement their results with other clinical indicators and quality of life measures.

The Effect of Selected Factors on the Content of Fat-Soluble Vitamins and Macro-Elements in Raw Milk from Holstein-Friesian and Simmental Cows and Acid Curd Cheese (Tvarog)

Simple Summary

Depending on the region, specific methods of cheese production are used. Acid coagulation is applied in the production of the traditional acid curd cheese highly valued in Poland, called ‘tvarog’. It is important to maintain the traditional nature of production that guarantees cheese with a high nutritional value and health-promoting properties. By conducting an analysis of tvarog, taking into account the quality of the raw milk and the type of starter cultures used, we found that the content of fat-soluble vitamins (A, D₃, and E) mainly depended on the quality of the raw milk from which it was produced. A higher content of fat-soluble vitamins was found in milk obtained from Simmental cows kept in a traditional system in the spring/summer season and in the tvarog produced from it. Vitamin retention rates from raw milk to cheese were above 90%. In contrast, we noticed that the mineral composition of the cheese was not linked to the quality of the milk used. More Ca and Mg were lost with the whey, as indicated by the very low retention rates of these minerals from milk to tvarog (below 20%).

Abstract

The study was conducted to determine the content and retention of selected fat-soluble vitamins and minerals in curd cheese–tvarog made by a traditional method, taking into account the effect of the quality of the raw milk and the type of starter cultures used. The raw milk used to make the tvarog was obtained in various conditions, i.e., with and without the use of pasture forage (in a traditional and an intensive system), in two production seasons (spring/summer and autumn/winter), from two breeds raised in Poland (the Black-and-White variety of Polish Holstein-Friesian and Simmental). Two variants of starter cultures were used to make tvarog: Freeze-dried DVS starters (Flora Danica) and pure cultures of mesophilic lactic acid bacteria. The acidity and content of protein, fat, selected fat-soluble vitamins (A, D₃, and E), and selected macro-elements (Ca and Mg) were determined in samples of bulk milk and cheese. Retention rates of individual nutrients from the milk to the cheese were calculated. A higher content of fat-soluble vitamins was found in milk obtained from Simmental cows kept in a traditional system in the spring/summer season, as well as in the tvarog produced from it. Vitamin retention rates from the raw material to the tvarog were above 90%. The mineral composition of the cheese was not associated with the quality of the milk used. Very low retention rates from milk to cheese were obtained for Ca and Mg (below 20%). Higher retention rates were obtained in the spring/summer season when culture variant 1 was used. However, the starter culture was not found to significantly influence the concentration or retention of vitamins in the experimental cheese.

Impact of milk and nutrient intake of piglets and sow milk composition on piglet growth and body composition at weaning

The main objective of this study was to evaluate the impact of milk intake, milk composition, and nutrient intake on piglet growth in lactation and body composition at weaning. To evaluate the body composition of piglets, data from one experiment (44 Danish Landrace × Yorkshire × Duroc piglets) were used to develop prediction equations for body pools of fat, protein, ash, and water based on live weight and deuterium dilution space (exp. 1). Furthermore, a total of 294 piglets (Danish Landrace × Yorkshire × Duroc) from 21 sows of second parity were included in a second experiment (exp. 2). In exp. 2, piglet live weight was recorded on days 3, 10, 17, and 25 of lactation. On the same days, the milk intake and body composition were measured, using the deuterium oxide (D2O) dilution technique. Piglet weight gain was highly positively correlated with the intake of milk and the intake of milk constituents each week and on an overall basis having r values ranging from 0.65 to 0.93 (P < 0.001). When evaluating regressions for piglet growth, the milk intake in combination with the milk protein concentration explained 85% and 87% of the total variation in piglet gain in the second and third week of lactation, respectively, whereas milk intake was the only predictor of piglet gain in the first week of lactation explaining 81% of the variation. Fat, protein, and energy retention rates were all highly positively correlated with the daily intake of milk and intake of milk nutrients with r values ranging from 0.76 to 0.94 (P < 0.001). Piglet gain and retention rates were rather weakly correlated with the milk composition with r values ranging from 0.01 to 0.50 (being either negative or positive). Curvilinear response curves were fitted for live weight gain and body fat content at weaning in response to milk protein concentration, showing that live weight gain was slightly greater and body fat content was slightly lower at 4.9% milk protein, but it should be emphasized that the quadratic effects did not reach significance. Body fat content at weaning was positively related with the intake of milk (R2 = 0.44, P < 0.001) and milk fat (R2 = 0.46, P < 0.01). In conclusion, milk intake had a major impact on the piglet growth rate, and milk fat intake greatly influenced the body fat percentage at weaning, whereas milk composition per se only played a minor role for these traits.

Favorable retention rates and safety of conventional anti-rheumatic drugs in older patients with rheumatoid arthritis

Physicians are challenged by the recognition and treatment of older patients with rheumatoid arthritis (RA). The aim of this case-control study was to evaluate the retention and safety of conventional disease-modifying anti-rheumatic drugs in older patients with RA.In this observational case-control study, we assessed older patients with RA (≥65 years) who were diagnosed in 3 different rheumatology centers from Turkey. Patients were divided as to those aged ≥65 years (elderly rheumatoid arthritis [ERA]) and those aged <65 years (young rheumatoid arthritis [YRA]) at the time of conventional DMARD treatment initiation. The Mann-Whitney U test was used for the comparison of 2 non-normally distributed groups. The Chi-square (χ) test was used for categorical variables. Survival analysis were performed using the Kaplan-Meier method.Four hundred eighteen patients with RA (296 females [71%]) were included from January 2010 to January 2018. The age of treatment onset of 190 (47%) patients was in the elderly period and they were included in the ERA group. In the analysis of drug retention rates, there was no significant difference between the ERA and YRA groups for each conventional DMARD (methotrexate 71.2% in ERA, 62.7% in YRA, P = .817; hydroxychloroquine 82.9% in ERA, 78.8% in YRA, P = .899; leflunomide 81.4% in ERA, 84.4% in YRA, P = .205; sulfasalazine 37.5% in ERA, 40.9% in YRA, P = .380). The adverse event data were also similar in both groups.The drug retention and adverse effect rates in older patients with RA using conventional DMARDS are similar to the rates in young patients with RA.

Persistence with golimumab in immune-mediated rheumatic diseases: a systematic review of real-world evidence in rheumatoid arthritis, axial spondyloarthritis, and psoriatic arthritis

PURPOSE

In immune-mediated rheumatic diseases (IMRDs), persistence to treatment may be used as a surrogate marker for long-term treatment success. In previous comparisons of persistence to tumor necrosis factor α inhibitors (TNFis), a paucity of data for subcutaneous (SC) golimumab was identified. The aim of this study was to conduct a systematic review of persistence to SC golimumab in clinical practice and contextualize these data with five-year persistence estimates from long-term open-label extension (OLE) trials of SC TNFis in IMRDs.

PATIENTS AND METHODS

PubMed, Embase, MEDLINE, and conference proceedings from European League Against Rheumatism (EULAR), American College of Rheumatology (ACR), and International Society for Pharmacoeconomics and Outcomes Research (ISPOR) were searched. All studies on patients treated with SC golimumab for IMRD were included if they reported data on the persistence to golimumab.

RESULTS

Of 376 available references identified through the searches, 12 studies with a total of 4,910 patients met the inclusion criteria. Furthermore, nine OLE trials were available. Among the included studies from clinical practice, at six months, one year, two years, and three years, the proportion of patients persistent to treatment ranged from 63% to 91%, 47% to 80%, 40% to 77%, and 32% to 67%, respectively. In the four studies that included comparisons to other biologics, golimumab was either statistically noninferior or statistically superior to other treatments, an observation that was supported by indirect comparisons of unadjusted point estimates of OLE trials.

CONCLUSION

The data reviewed in this study indicate that golimumab may have higher persistence than other TNFis, a notion that is supported by indirect comparisons of persistence data from OLEs of randomized controlled trials (RCTs). Furthermore, the study suggests that persistence may be lower in biologic-experienced compared with biologic-naive patients and higher in axial spondyloarthritis compared with rheumatoid arthritis and psoriatic arthritis.

Mystery behind the match: an undergraduate medical education-graduate medical education collaborative approach to understanding match goals and outcomes

BACKGROUND

There is a paucity of information regarding institutional targets for the number of undergraduate medical education (UME) graduates being matched to graduate medical education (GME) programs at their home institutions. At our institution, the Duke University, the number of UME graduates matched to GME programs declined dramatically in 2011. To better understand why this decline may have happened, we sought to identify perceived quality metrics for UME and GME learners, evaluate trends in match outcomes and educational program characteristics, and explore whether there is an ideal retention rate for UME graduates in their home institutions' GME programs.

METHODS

We analyzed the number of Duke University UME graduates remaining at Duke for GME training over the past 5 years. We collected data to assess for changing characteristics of UME and GME, and performed descriptive analysis of trends over time to investigate the potential impact on match outcomes.

RESULTS

A one-sample t-test analysis showed no statistically significant difference in the number of Duke UME graduates who stayed for GME training. For both UME and GME, no significant changes in the characteristics of either program were found.

DISCUSSION

We created a process for monitoring data related to the characteristics or perceived quality of UME and GME programs and developed a shared understanding of what may impact match lists for both UME graduates and GME programs, leaving the Match somewhat less mysterious. While we understand the trend of graduates remaining at their home institutions for GME training, we are uncertain whether setting a goal for retention is reasonable, and so some mystery remains. We believe there is an invaluable opportunity for collaboration between UME and GME stakeholders to facilitate discussion about setting shared institutional goals.