Journal articles: 'Vermont. University. Department of Preventive Medicine' – Grafiati (2024)

Abstract:

Testing during the COVID-19 pandemic has been crucial to public health surveillance and clinical care. Supply chain constraints—spanning limitations in testing kits, reagents, pipet tips, and swabs availability—have challenged the ability to scale COVID-19 testing. During the early months, sample collection kits shortages constrained planned testing expansions. In response, the University of Vermont Medical Center, University of Vermont College of Medicine, Vermont Department of Health Laboratory, Aspenti Health, and providers across Vermont including 16 area hospitals partnered to surmount these barriers. The primary objectives were to increase supply availability and manage utilization. Within the first month of Vermont’s stay-at-home order, the University of Vermont Medical Center laboratory partnered with College of Medicine to create in-house collection kits, producing 5000 per week. University of Vermont Medical Center reassigned 4 phlebotomists, laboratory educators, and other laboratory staff, who had reduced workloads, to participate (requiring a total of 5.3-7.6 full-time equivalent (FTE) during the period of study). By August, automation at a local commercial laboratory produced 22,000 vials of media in one week (reducing the required personnel by 1.2 FTE). A multisite, cross-institutional approach was used to manage specimen collection kit utilization across Vermont. Hospital laboratory directors, managers, and providers agreed to order only as needed to avoid supply stockpiles and supported operational constraints through ongoing validations and kit assembly. Throughout this pandemic, Vermont has ranked highly in number of tests per million people, demonstrating the value of local collaboration to surmount obstacles during disease outbreaks and the importance of creative allocation of resources to address statewide needs.

Abstract:

Objectives: The study was aimed to audit autopsies in the year 2018 and promoting statistical approach in Forensic Medicine. Also to study the gender based distribution of cases and study shifting trends in weapon of offence. Study Design: Retrospective Study. Setting: Post Mortem Unit of the Department of Forensic Medicine & Toxicology, Faisalabad Medical University, Faisalabad. Period: From 1st January, 2018 to 31st December, 2018. Material & Methods: Autopsy was performed on 248 cases reported to Post Mortem Unit. Study Material was collected from the Post Mortem Unit of Allied Hospital and DHQ Hospital Faisalabad which are referral tertiary care teaching hospitals affiliated with Faisalabad Medical University, Faisalabad. Results: Out of a total 248 autopsies conducted 178 (71.77%) were males and 70 (28.23%) were females. The male to female ratio was 2.54:1. Most used weapon of offence was Firearm. Followed by firearm the second major cause of death was road traffic accidents which were followed by Asphyxia (12.9% of total autopsies). Conclusion: Ban on illegal possession of Firearms - educational lectures to Public and steps to raise the literacy rate along with the improvement of socioeconomic status of the society. Preventive-strategy to create an awareness of safe traveling practices especially among the groups at high risk.

Abstract:

Abstract: Introduction: Examination of the burnout syndrome in various healthcare fields has paramount importance for a better understanding of the disorder as well as for the establishment of a suitable preventive and intervention program. The surgical departments’ employees are at risk among healthcare workers, so it is our objective to further expand the knowledge on the characteristics of the burnout syndrome among the Hungarian surgical staff. Additionally, we compare the results obtained from the Department of Surgery at the University of Szeged with the results of the Department of Emergency Medicine. Aim: Aim of this study is to examine the burnout syndrome and its associations with different variables among the workers of the Department of Surgery at the University of Szeged, and to compare the data with a previous study conducted at the Department of Emergency Medicine at the University of Szeged. Method: Cross-sectional design utilizing a self-administrated questionnaire was used to collect data from the staff. Burnout was measured using the Maslach Burnout Inventory, while psychological immune competence was measured using the Psychological Immune Competence Questionnaire. Results: Based on statistical analysis, the number of weekly working hours and the number of somatic symptoms have a negative impact on burnout, while the greater number of high-quality social relationships and the stronger psychological immune competence have proven to be protective factors. Comparing the Department of Surgery and Department of Emergency Medicine at the University of Szeged, we found a difference in the age of the workers, the number of years spent in the healthcare as well as the scores on the burnout depersonalization scale. Conclusions: The results obtained show further correlations and reveal protective and risk factors in burnout which can be a key to establishing preventive and intervention strategies. Orv Hetil. 2019; 160(20): 784–791.

Abstract:

The article “Factors Influencing the Implementation of Screening and Brief Interventions for Alcohol Use in Primary Care Practices: A Systematic Review Protocol”, published on our edition January 2018 [Acta Med Port 2018 Jan;31(1):45-50] exhibited an error on the authorship line.On page 45, where it currently reads:Frederico ROSÁRIO[AC,1,2], Maria Inês SANTOS[3], Kathryn ANGUS[4], Leo PAS[5], Niamh FITZGERALD[4]It should read:Frederico ROSÁRIO[AC,1,2], Maria Inês SANTOS[3], Kathryn ANGUS[4], Leo PAS[5], Cristina RIBEIRO[1,6], Niamh FITZGERALD[4]Also, on the affiliation informations on the footer in the same page 45, where it reads:1. Institute of Preventive Medicine and Public Health. Faculty of Medicine. Lisbon University. Lisbon. Portugal.2. Tomaz Ribeiro Primary Health Care Center. Dão Lafões Primary Health Care Centers Grouping. Viseu. Portugal.3. Department of Pediatrics. Tondela-Viseu Hospital Center. Viseu. Portugal.4. Institute for Social Marketing (ISM). UK Centre for Tobacco & Alcohol Studies. Faculty of Health Sciences & Sport. University of Stirling. Stirling. United Kingdom.5. Academic Centre for General Practice. KU Leuven. Leuven. Belgium.It should read:1. Institute of Preventive Medicine and Public Health. Faculty of Medicine. Lisbon University. Lisbon. Portugal.2. Tomaz Ribeiro Primary Health Care Center. Dão Lafões Primary Health Care Centers Grouping. Viseu. Portugal.3. Department of Pediatrics. Tondela-Viseu Hospital Center. Viseu. Portugal.4. Institute for Social Marketing (ISM). UK Centre for Tobacco & Alcohol Studies. Faculty of Health Sciences & Sport. University of Stirling. Stirling. United Kingdom.5. Academic Centre for General Practice. KU Leuven. Leuven. Belgium.6. Quality Department. Directorate-General of Health. Lisbon. Portugal.Link for the full published article.

Abstract:

Background. Peripheral arterial disease (PAD) indicates generalized atherosclerosis but is still underdiagnosed and undertreated. Methods. Data were collected from patients with PAD from the Department of Cardiology and Angiology, University of Heidelberg, Germany. The prevalence of cardiovascular risk factors and medication were documented. Results. Atherogenic risk factors, cardiovascular disease, and cerebrovascular disease were highly prevalent. By continuous care at the university clinic, in addition to family medicine treatment, the use of platelet inhibitors, antihypertensives, and lipid-lowering therapy was increased. Ankle—brachial index and walking distance improved. Conclusion. Long-term treatment at the university clinic had positive effects on atherogenic risk factors. The regular use of secondary preventive medication was improved. Still, this patient population remained undertreated and showed a high incidence of vascular event rates and a need for vascular interventions. This study implies the importance of both specialists and general practitioners in the care of these individuals.

Abstract:

Introduction. The Department of Hygiene, Faculty of Medicine, University of Novi Sad, is responsible for undergraduate and graduate courses in the field of preventive medicine. The principal task of physicians in the 21st century is to provide health promotion and disease prevention. In the future, evaluation of physician knowledge and competence will be predominantly based on patients' health conditions. Health and Environment. Human health is a result of long-term interaction between human genome and the environment. Good human health requires permanent control of health conditions as well as control of environmental health hazards. Various environmental factors, such as physical, chemical, biological, social and economic, affect the population health. Air, drinking water and food are fundamental to the existence of life of all living beings on Earth, and therefore they have enormous influence on the health of individuals and populations. Conclusion. The significance of the above mentioned requirements, essential for human health, is the reason why the Department of Hygiene conducted an investigation on the quality of air, food and water (water is a foodstuff as well) in Vojvodina.

Abstract:

Objective: The aim of this study was to evaluate the attitude of parents towards the oral health of their children before oral rehabilitation under general anesthesia (GA).Study design: Children receiving dental treatment under GA between November 2013 and July 2014 in the Pediatric Dentistry Department (University Hospital Center, Toulouse, France) were enrolled in an oral health preventive program. An anonymous questionnaire was self-administered by the parents during the pre-operative session. Results: The sample comprised 67 children with a mean age of 4.8 years. 48 % of the parents had difficulties in maintaining the oral hygiene of their child. Two thirds of them reported a lack of cooperation. An adult cleaned the child's teeth in 43% of the cases. 14% of the study population brushed their teeth twice a day or more. In addition, half of the parents reported that they modified food consumption or teeth cleaning habits of their children since the initial consultation. Conclusions: This study suggests a low compliance of parents and children with the recommendations on oral hygiene and food consumption given at the initial visit and demonstrates the feasibility of a preventive program in this population.

Abstract:

The new chemical threats, existing and constantly emerging to public health require the improvement of the system of training specialists in the field of preventive toxicology. Preventive toxicology is an independent discipline. However, medical and preventive doctors carrying out hygienic regulation, assessment of toxicity and hazard of chemicals and dealing with prevention and risk assessment of the effects of xenobiotics on human health, have only basic toxicology training. Currently, in the nomenclature of the professional standard in the specialty “Medical and Preventive Business”, the specialty “Preventive Toxicology” is absent, and the number of hours allocated for studying this section is very limited.Diploma education in the field of preventive toxicology is carried out on the basis of the Federal State Educational Standard of Higher Education in the specialty “Medical and Preventive care”, within the framework of which specialized hygienic disciplines with components of preventive toxicology are taught. At the postgraduate education stage, issues of chemical safety and preventive toxicology are addressed only in selected educational institutions, for example, on certification cycles in hygienic specialties, as well as on short-term specialized advanced training cycles.At the Department of Human Ecology and Environmental Hygiene of the I.M. Sechenov First Moscow State Medical University, a separate training module on preventive toxicology was developed and introduced into the educational process. One of the main objectives of the development of this curriculum was the formation of the students’ algorithms for conducting toxicological research and approaches to the evaluation of the results. At this stage of the training, students study in-depth laboratory toxicological methods, the adaptation mechanisms of the organism, and questions of extrapolation of human data obtained in animal experiments, the pathogenesis of intoxication and long-term effects of exposure to harmful substances. The analysis of the system of training specialists in the field of preventive toxicology suggests the need to improve the forms and methods of teaching students, primarily through the development of skills to work with data registries and toxicological laboratories, using the capabilities of research institutes and institutions of the of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare

Abstract:

The purpose of this study is to evaluate the usefulness of rapid palatal expansion in growing patients to eliminate the nasal pyramid stenosis as a cause of primary headache. Patients were invited to participate in the clinical study at the University of Milan, Department of Orthodontics. Forty-one growing patients of both genders suffering from primary neurovascular headaches and having transverse maxillary deficiency were studied before and after rapid palatal expansion. A clinical examination, postero-anterior radiography and rhinomanometry were performed. After rapid palatal expansion (RPE) therapy all patients showed a constant and important increase in the values relating to both skeletal and dental structures, a significant reduction in the mean nasal resistance, and a significant decrease or elimination of headache symptoms. This therapy provides a preventive alternative for surgical procedures, such as the neurovascular decompressive septo-ethmoidosphenoidectomy performed in adult patients.

Abstract:

Since 1983, a broad research and development programme has been carried out with the support of Sweden through the Swedish Agency for Research Cooperation in Developing Countries (SAREC). One of the medical research and development projects deals with the environment and state of health of the population of an entire village, and is referred to as the Abdon Vega project. It is pursued by the Department of Social and Preventive Medicine of the University of León, Nicaragua, with the support of the Department of Social Medicine at the Karolinska Institute in Stockholm. The project comprises two stages. The first one centres on the state of health of the workers and the mining environment. This article reports on the objectives of the project and the study area. It presents experience from the development work up to now and the difficulties encountered.

Abstract:

Cystic duct leakage with metal clips persists after laparoscopic cholecystectomy (LC). The aim of the study is to evaluate the preventive effect of locking clips on leaks from the cystic duct stump after LC as an alternative to metal clips. Locking clips were routinely used to close the cystic duct in LC. A total of 1101 patients who underwent LC were retrospectively assessed from a database of the surgical department at our university hospital. A main outcome measurement is bile leakage after LC. From January 2006 to April 2011, 1053 LCs were performed. Of these, the cystic duct was closed with locking clips in 1017 cases, and no bile leaks from the cystic duct were observed in any of these 1017 cases. Locking clips should be routinely used to close the cystic duct in preference to metallic clips to reduce postoperative bile leaks after LC.

Abstract:

The paper describes an interdisciplinary experience of teaching one of the modules of medical informatics in English. The interdisciplinary approach was introduced in the Ural State Medical University (USMU). During 2015–2017 academic years, the interdisciplinary team including teachers of the biomedical physics, informatics and mathematics department and foreign languages department of USMU were developing and introducing integrative classes on medical informatics in English. In total, 287 students of general medicine, pediatrics, dentistry and preventive medicine faculties participated in the survey concerning integrative training in medical informatics in English. Evaluation of both foreign language communication skills and abilities to search medical information in international databases was performed during practical studies. 76% of medical students responded positively to the opportunity to improve foreign language communication skills for professional purposes. We find it possible to develop some modules of professional disciplines in English to teach medical students.

Abstract:

The training of ultrasound-guided fine needle aspiration in pathology residency and fellowship programs can be a challenging task with variable outcomes, particularly when there is a lack of a standardized approach. In 2014, the Department of Pathology and Laboratory Medicine in collaboration with the Endocrine Division of the Department of Medicine at the University of Vermont Medical Center implemented simulation training for the incoming cytopathology and endocrinology fellows prior to fellows interacting with patients at the clinic in order to provide a structured approach to learning the technical components of ultrasound-guided fine needle aspiration. In 2018, a second simulation session was added to focus on communication, providing fellows an opportunity to further develop the communication skills that enhance patient connection, empathy, and trust. The combined simulation experience has provided the fellows an ideal learning environment to enhance their understanding of the technical aspects of ultrasound-guided fine needle aspiration as well as the necessary components of communication prior to having to perform the procedure on actual patients. This results in a biopsy clinic that runs more efficiently with improved patient satisfaction and trainee confidence when addressing patient concerns. This collaborative training experience also addresses many of the important aspects surrounding the Accreditation Council for Graduate Medical Education competencies in patient safety, procedure, communication, professionalism, and team-based systems. We report the details of these simulation sessions, how they are structured, key stakeholders involved, and means for communicating feedback to our learners with an emphasis on the importance and value of utilizing standardized patients.

Abstract:

Background. The magnitude of the problem of chronic kidney disease (CKD) is enormous, and the prevalence keeps rising. To highlight the burden of CKD in developing countries, the authors looked at end-stage renal disease (ESRD) patients seen at the University of Nigeria Teaching Hospital (UNTH), Enugu, South-East Nigeria.Method. ESRD patients seen from 01/05/1990 to 31/12/2003 were recruited. Records from A&E Department, medical-out-patients, wards and dialysis unit were used.Results. A total of 1001 male versus 537 female patients were reviewed. About 593 male versus 315 female patients had haemodialysis. The mean age was years and 86.5% were <60 years. Primary renal disease could not be determined in 51.6% while hypertension and glomerulonephritis accounted for −17.2% and 14.6%, respectively. Death from renal causes constituted 22.03% of medical deaths.Conclusion. The prognosis for CKD patients in Nigeria is abysmal. Only few patients had renal-replacement-therapy (RRT). The prohibitive cost precludes many patients. This underscores the need for preventive measures to reduce the impact of CKD in the society.

Abstract:

Background and Objectives: Among the oldest in the nation, the University of Utah Physician Assistant Program (UPAP) serves the state of Utah and surrounding areas and is a division of the Department of Family and Preventive Medicine. Recognizing the need to produce health care providers from diverse racial and ethnic backgrounds, UPAP instituted structural changes to improve student compositional diversity. This paper is a presentation and evaluation of the changes made to determine their relationship with compositional diversity, ultimate practice setting, and national rankings. Methods: UPAP changed diversity messaging, curriculum, efforts in admissions, recruitment, and retention to improve the representation of Black, Latinx, American Indian/Alaska Native, and Native Hawaiian/Other Pacific Islander students, as well as those from educationally and economically disadvantaged backgrounds. Results: UPAP tripled the number of underrepresented minority matriculated students over the course of five admitted classes, while simultaneously increasing the proportion of students from educationally or economically disadvantaged backgrounds. UPAP maintains both high boards pass rate and top national rankings, (number two ranking in public physician assistant program and number four overall program in the United States). Conclusions: The UPAP experience demonstrates that intentional diversity efforts are associated with improvement in racial/ethnic diversity and national rankings. Other medical school graduate programs, specifically the medical doctor (MD), public health, and basic science programs can use this model to improve their compositional diversity.

Abstract:

1 Department of Microbiology, The Royal Women's Hospital, Victoria, 2 Menzies School of Health Research, Rocklands Drive, Tiwi, 3 Department of Epidemiology and Preventive Medicine, Alfred Hospital, Monash University, Prahran, Victoria and 4 AIDS/STD Unit, Centre for Disease Control, Territory Health Services, Darwin, Australia Summary: Self-administered sampling techniques for the detection of sexually transmitted diseases (STDs) are particularly useful due to their ease of collection and better patient compliance. Urine specimens, and recently tampons, have been described as methods of specimen collection for the detection of some STDs in women. In this study, 660 women had both first-void urine (FVU) and tampon specimens analysed by polymerase chain reaction (PCR) for the detection of Chlamydia trachomatis , Neisseria gonorrhoeae and Trichom*onas vagin*lis . Overall 6.5%, 10.1% and 17.9% of urine samples were positive whereas 7%, 21.2% and 22% of tampon specimens were positive for C. trachomatis , N. gonorrhoeae and T. vagin*lis respectively. Tampon-collected specimens tested by PCR were more sensitive than urine specimens for the detection of N. gonorrhoeae and T. vagin*lis ( P 0.001) and equally sensitive for the detection of C. trachomatis ( P =0.45). <

Abstract:

Waldemar Haffkine is an outstanding bacteriologist, immunologist and epidemiologist who was born in Ukraine. He studied at the Department of Natural Sciences at the Imperial Novorossiisk University (now Odessa I.I. Mechnikov National University), and his scientific career as a zoologist began under the guidance of the Nobel Prize for Physiology or Medicine Ilia Mechnikov. Working at the Pasteur Institute, Paris, he developed a vaccine against cholera, tested its effectiveness on himself and for the first time vaccinated people against bacterial diseases. During the cholera epidemic in India, he established a vaccine production, organized preventive vaccinations and inoculated tens of thousands of people, as a result of which morbidity and mortality decreased tenfold. When the plague epidemic struck Bombay, W. Haffkine soon developed a plague vaccine and re-tested its safety. He founded a bacteriological laboratory in Bombay for the production of vaccines and organized large-scale vaccination schemes. The Haffkine Institute still makes millions of doses of vaccines and serums, saving people from cholera, plague, typhus, rabies, tetanus and other diseases. Keywords: anticholera vaccine, antiplague vaccination, inoculation schemes, the Haffkine Institute.

Abstract:

In the article, the analysis of the introduction of innovative technologies which are applied in profiling disciplines within the framework of the training experts on “medical-preventive business” is given. There are presented areas of subject-specific competencies, which are introduced and summarized in clusters. The effectiveness of pedagogical technologies promoting the educational and cognitive activity of students in the field of sanitary and hygienic monitoring is shown. For the creative use of subject knowledge and skills, there are widely used non-imitative active research methods allowing students not only realizing personally themselves in the performance of research work but also studying in detail scientific research problems in the field of hygiene. There is presented the experience of the use of applied computer technologies, allowing students developing virtually practical skills and skills of conducting hygienic monitoring on the simulators. Applied modules enable students to develop the necessary practical skills of sanitary supervision, demonstrate the search, analytical and practical stages of work, taking into account all indices and environmental factors, with following generalization and systematization of the conclusions of their own research. Training is accompanied by the active participation of students in the scientific activities of the department, with the preparation of scientific reports and theses, and work in a scientific student group. Practical skills of working with hygienic equipment are acquired by students according to algorithms and standards, specifically for each device and allow to unify their actions when measuring environmental factors and production environment. The applied pedagogical technologies in the training of future hygienists are directed more towards the development of independent thinking, have a reasoned position on how to solve the problem, work in a team and find the most rational solution to the hygienic task

Abstract:

The present study was carried out to determine the prevalence of Glanders in horses of Iraq. For this reason, a serological surveillance was conducted during the period extended between November 2015 and March 2016. Four hundred and four samples of serum were collected from horses lived in eight different Iraqi provinces that were Al-Muthanna, Baghdad, Al-Najaf, Babylon, Al-Qadsyia, Diyala, Karbala and Wasit. Sera transported to the lab of clinical pathology/ department of internal and preventive veterinary medicine at Baghdad University, where they were analyzed by cELISA technique to determine the seropositivity against Burkholderia mallei. The results of sera analysis showed that 2.97 % (12 horses) were positive toward the applied test. The positive cases were recorded in Baghdad and Muthanna governorate (11 and 1, respectively). Statistical analysis revealed no significant variations (P<0.05) in the seropositivity against Glanders between different genders or ages.

Abstract:

Abstract Aims An integral part of the World Health Organization (WHO) plan to reduce suicide by 10% by 2020 is to identify areas and demographic groups, which should be priority target groups for preventive activities. This study aimed to present the demographic differences between victims of suicide by hanging in the Warsaw metropolitan area, in Poland, by examining the sobriety of victims. Methods Data for analysis were obtained from the documentation of the Department of Forensic Medicine (DFM) at the Medical University of Warsaw (MUW). The retrospective analysis included 358 out of 466 victims of suicides by hanging in the Warsaw metropolitan area, in Poland, recorded in the DFM documentation covering 2011–2013. The data gathered included age, gender, the cause of death, a post-mortem examination as well as the level of ethanol in the blood and muscles of victims. Results In both groups, men accounted for a larger percentage of victims than women, P = 0.068. In the no-alcohol group, the victims were older than in the alcohol group (47.52 ± 19.21 vs. 40.88 ± 12.77) (P &lt; 0.001). The majority of the studied population were victims aged 25–34 (22.90%), mainly men (20.95%). Young men were also the largest group among victims in the alcohol group (28.33%). The most numerous age group among no-alcohol group were older victims aged 55–64 (19.10%), especially men (16.29%). Conclusion Regardless of sobriety, men were the largest group of suicide victims in the study population, which means that men die suicide more often than women. Differences in gender proportions are related to age. In the studied population, it was primarily young victims, mainly men. These are the groups that should be priority target groups for preventive activities aimed at reducing the number of suicides. The presence of ethanol in more than half of the victims of suicide in the study population indicates that alcohol is an important suicidal risk factor.

Abstract:

Cardiovascular medications (CVMs) are frequently prescribed for cardiovascular diseases. The unconscious use of cardiovascular drugs may lead to severe clinical manifestations, even to death, especially when in overdose. The objective of this study is to clarify the profile of CVM exposures admitted to Department of Emergency Medicine in Dokuz Eylul University Hospital (EMDEU) between 1993 and 2006. Case demographics, type of the medication, route and reason for exposure, clinical effects and outcome were recorded. Related to the CVM exposures, 105 poisoning cases were admitted. Mean age of children and adults were 12.8 ± 1.0 and 30.1 ± 1.8, respectively. Females were dominating (77.1%). Poisoning by accident occurred mainly among children in the 0—6 age group (64.3%) and suicide attempt was predominant in the 19—29 age group (47.8%). The most common ingested CVMs admitted to EMDEU were calcium channel blockers (19.7%), beta-blockers (17.3%), angiotensin converting enzyme inhibitors and diuretics (11.8%). Most of the patients were asymptomatic (59.1%). Frequently observed symptom was altered consciousness (18.6%). Antihypertensive drugs are responsible for the most of the CVM exposures. Prospectively designed multi-centered studies are needed to reflect the epidemiological properties of cardiovascular drug exposures throughout our country and would be very valuable for the determination of preventive measures.

Abstract:

Background and Objectives: There has been a growth in the demand for convenient, walk-in access in health care across the United States, resulting in primary care practices seeing a shift in services to urgent care centers (UCCs). In order to incorporate the flexibility of a UCC and improve primary care access and preventive care for our regular patients, the University of North Carolina (UNC) Family Medicine Center (FMC) established a UCC within the practice. This report describes that process and the impact of the new UCC on our academic practice. Methods: With the support of the UNC health care system, our primary objectives were to provide enhanced access for patients with acute problems, decrease emergency department (ED) utilization, and increase enrollment of new patients for ongoing primary care. As part of our intervention, we asked providers to respond to a series of questions at the end of each visit. These questions, along with data regarding number of visits and revenue, were tracked longitudinally. Results: By the end of our first year, we were treating about 900 patients per month, of which approximately one-third would have otherwise visited the ED. We averaged 115 new patients establishing care per quarter. In addition to the success of this new service line, our primary practice maintained provider continuity and grew at a higher rate than prior to opening the UCC. Conclusions: The opening of urgent care at the UNC FMC provided improved access for our patients, increased the number of patients empaneled in our primary care practice, and provided a new revenue stream.

Abstract:

Objective: During the interwar period, the healthcare system in Europe experienced a dramatic transformation. It was perceived that preventive medicine was no less important than curative medicine. Moreover, without proper prevention of the so-called social diseases, all later therapeutic measures were expensive and ineffective. The former battle against the consequences was replaced by measures targeting the causes. The fight against social diseases involved a state-owned strategy and a broad arsenal of measures. The University’s scholars also took part in this process. Our study revealed that the significance of the disease prevention in the Faculty of Medicine at the University of Stephen Bathory was well understood. Moreover, the treatment was not segregated from hygiene as strictly as it is today. Many hygienists as well as clinicians contributed to the development of preventive mechanisms. The broad specialization of doctors enabled them to see not only biomedical, but also social and economic aspects of a disease. Hygienists and doctors encouraged cooperation and coordination of their activities with the central and local authorities as well as education of the local population. The progress of medical science in Europe and the World, as well as the Soviet ideology in Eastern Europe distracted doctors from the search for the etiology of social illness. Biomedical treatment had become much more effective, and the development of social hygiene research in Eastern Europe had experienced stagnation. For ideological reasons the disease etiology in the Soviet bloc could not be associated with social factors. Social hygiene in the Soviet Union was highly politicized; it could only be interpreted in a frame of Soviet models. The healthcare system that had been created in the Soviet Union was named as the best in the world. The actual medical statistics were concealed from the public, since their logical interpretation could reveal the social causes of illnesses and the disadvantages of the soviet system. Sometimes we must return to basic ideas to improve current public health mechanisms. It is worth reconsidering fundamental questions, i.e. what public health is and how to achieve it. The breadth of the approach of the interwar Vilnius hygienists and doctors, the sensitivity to the social origins of diseases and persistence in combating them by all possible means could serve as an example for today’s doctors. At that time, hygienists approached the idea that the highest goal of prevention was to create a healthy environment, healthy living and working conditions. Although today we live in a much safer environment than those individuals did, new threats are emerging because of changing technology and lifestyle. The broad approach of physicians remains equally important in order not only to combat individual precedents, but also to overcome the preconditions for emerging precedents. Therefore, the purpose of this paper is to reveal the theoretical patterns of hygiene and public health established by the hygienists of the Vilnius Hygiene Department as well as the attempts to apply them in practice. Methods: The study was conducted by analyzing the primary and secondary historical sources using the comparative method. A lot of data from the Lietuvos Centrinis Valstybės Archyvas (Lithuanian Central State Archives) that had been used in this research were published for the first time. According to the original archival data, an analysis of the scientific publications of the Faculty of Medicine of the University of Stephen Bathory was made to find out the priorities of the research carried out at that time. Conclusions: The complicated economic conditions, the lack of support from the local and central government as well as the imperfections in health legislation of that time hindered the full implementation of the hygienist strategies of the University of Stephen Bathory. However, the activities of the Department of Hygiene of Stephen Bathory University had a significant impact on the development of hygiene science as well as medical practice in the Vilnius region during the Interwar period (1919–1939).

Abstract:

IntroductionEmerging evidence suggests community health workers (CHWs) delivering preventive maternal and child health (MCH) interventions through home visiting improve several important health outcomes, including initiation of prenatal care, healthy birth weight and uptake of childhood immunisations.Methods and analysisThe Arizona Health Start Program is a behavioral-based home visiting intervention, which uses CHWs to improve MCH outcomes through health education, referral support, and advocacy services for at-risk pregnant and postpartum women with children up to 2 years of age. We aim to test our central hypothesis that mothers and children exposed to this intervention will experience positive health outcomes in the areas of (1) newborn health; (2) maternal health and healthcare utilisation; and (3) child health and development. This paper outlines our protocol to retrospectively evaluate Health Start Program administrative data from 2006 to 2015, equaling 15 576 enrollees. We will use propensity score matching to generate a statistically similar control group. Our analytic sample size is sufficient to detect meaningful programme effects from low-frequency events, including preterm births, low and very low birth weights, maternal morbidity, and differences in immunisation and hospitalisation rates.Ethics and disseminationThis work is supported through an inter-agency contract from the Arizona Department of Health Services and is approved by the University of Arizona Research Institutional Review Board (Protocol 1701128802, approved 25 January 2017). Evaluation of the three proposed outcome areas will be completed by June 2020.

Abstract:

Improvement of patients` knowledge about their disease is an important part of management of chronic diseases. One of the effective methods to increase the level of medical education of the population is to hold regular meetings with patients within the framework of «schools for patients». Urolithiasis is one of the most common urological diseases (3.5‒9.6% of the population). In addition to its high prevalence, Urolithiasis has a high recurrence rate (50‒75% over 5‒10 years). The most common prostate diseases are prostatitis, benign hyperplasia, and cancer. These diseases have a chronic course and require а long-term observation. Treatment of urolithiasis and prostatic diseases is one of the priority fields for the urology department of the Pavlov First St. Petersburg State Medical University. In addition to surgical treatment, the specialists of urology department take measures aimed at prevention of recurrence and complications of these diseases. Schools for patients with urolithiasis and prostate diseases are held every 3 months. The topics for discussion are chosen by the patients themselves. In addition to reports, patients undergo ultrasound of the kidneys, bladder and prostate, as well as consultations. Participation in schools of patients creates a conscious attitude to their disease, increases adherence to treatment and improves the prognosis of the disease. The distribution of such programs corresponds to the modern concept of preventive medicine and increases the efficiency of providing medical care to the population.

Abstract:

Objective To evaluate the effect of intraperitoneal (IP) administration of heparin on clearance of advanced glycation end-products (AGEs) and peritoneal dialysis efficiency. Design Sequential self-controlled intervention study. Setting University hospital, Department of Nephrology. Patients and Methods Pyrraline, urea, and creatinine levels in plasma and dialysate, along with AGE-derived fluorescence intensity (excitation, 370 nm; emission, 440 nm) in dialysate were measured 0, 30, and 60 days after IP administration of heparin in 11 patients on continuous ambulatory peritoneal dialysis (CAPD). Pyrraline levels were determined by ELISA. Results Heparin induced a significant decrease in plasma pyrraline levels; the values on days 0, 30, and 60 were 162.0 ± 89.8 μmol/L, 101.1 ± 32.1 mmol/L ( p < 0.01), and 94.0 ± 19.8 μmol/L ( p < 0.001), respectively. Heparin also induced a tendency of increased dialysate pyrraline levels and a significant increase in AGE-derived fluorescence intensity in the dialysate. The values for the latter on days 0, 30, and 60 were 51.0 ± 9.3 AU (arbitrary units/ mg of collagen), 73.5 ± 16.0 AU ( p < 0.001), and 65.6 ± 15.5 AU ( p < 0.01), respectively. Furthermore, heparin administration resulted in a significant ( p < 0.01) increase in the dialysate/plasma ratio of urea (means 0.80, 0.90, and 0.94 on days 0, 30, and 60, respectively). Conclusion These results suggest that a beneficial effect of IP administration of heparin is in part due to its action on AGE kinetics, supporting a potential preventive strategy for peritoneal membrane distortion in CAPD.

Abstract:

We are considering the main aspects of the professional activity of an outstanding naval hygienist, alumnus of the Faculty of residency training for the Naval Service of Military Medical Academy named after S.M. Kirov (1964), Candidate of Medical Sciences (1971), Higher Senior Officer (graduate education hygiene) of the Scientific Research Center of the Academy (1975), Associate Professor at the Department of Naval and Radiation Hygiene (2004), retired Colonel of the Medical Service Zun Andrey Vadimovich. Having gained a unique experience in medical practice as the Head of the medical service of a diesel-electric submarine of the Baltic Fleet and having completed his postgraduate studies at the Department of Naval and Radiation Hygiene (Military Medical Academy named after S.M. Kirov), Andrey Vadimovich successfully defended his thesis for the degree of Candidate of Medical Sciences (graduate education hygiene) on the topic "Hygienic characteristics of the working conditions of specialists working on the fleet shore installations of the Naval Service, working with components of rocket fuel". After this more than 45 years of his professional activity were devoted specifically to the preventive medicine trend hygiene. The main professional achievements of Andrey Vadimovich undoubtedly include the study of the physiological effect of negative air ions in closed premises with conditions of oxygen deficiency, the study of the workplace hygiene of coastal missile systems specialists, as well as the hygienic characteristics of military clothing. Andrey Vadimovich has been also teaching such academic disciplines as naval and radiation hygiene, as well as medical ecology for all categories of Academy students. He is a veteran of the Armed Forces and Military Medical Academy named after S.M. Kirov. Andrey Vadimovich considers the success of his son and grandson as the main achievement of his life. His son Sergey followed the path taken by his father and graduated from the Faculty of Residency Training for the Naval Service of Military Medical Academy named after S.M. Kirov, also he deployed downrange on submarines, and then became an Associate Professor of the Psychiatry Department at the Academy. The grandson of Andrey Vadimovich, Pavel, graduated from the University of Information Technologies, Mechanics and Optics. After he completed his postgraduate studies at the same University, his area of expertise is computer modeling of the circulatory system.

Abstract:

AbstractFor 2 decades, the Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, has served the Occupational Medicine Residency training program in Thailand. Graduates of this program undertake to work in occupational medicine to promote health and prevent morbidity and mortality in the workplace and provide occupational medical services for the working population in Thailand. Qualifying for a Postgraduate Diploma in Occupational Medicine in Thailand can be achieved in 2 ways: through a 3-year residency training or 5 years of working experience in the field of occupational medicine combined with an elective 2-month short course. There are currently 159 Thai board-certified occupational medicine physicians. Occupational medicine physicians in Thailand work in both public and private healthcare facilities. A number of certified occupational physicians occupy leading national health positions in various government and academic organizations. Knowledge of occupational medicine is currently essential for undergraduate medical students as specified in the medical competency assessment criteria of the Thai Medical Council. Updating content and incorporating needs of employers are keys to success for Thailand, as a country with an occupational medicine training program in its initial stages. In Thailand, the supply of occupational medicine physicians is still less than the increasing demand. Advancement of health research schemes would contribute to the curriculum. Occupational medicine development in Thailand needs to address challenges in local issues including work in the informal sector, particularly in agriculture, and incorporate standardization and international consistency into the training curriculum and qualifying management.

Abstract:

This essay has the objective of revisiting the intellectual output of Ricardo Bruno Mendes-Gonçalves (1946-1996), Professor of the Department of Preventive Medicine of the Faculty of Medicine of the University of São Paulo and one of the theoreticians who participated in the construction of the field of Brazilian Collective Health during the years 1970-1990. On the basis of brief biographical and bibliographical information, as well as relevant aspects regarding the historical context in which his output is located, I examine the principal works of the author, their effects on the lines of investigation of investigation of his students and his legacy of contributions and challenges for Collective Health. I highlight the genesis and development of his Theory of the Health Work Process and its impact on the understanding and empirical investigation of the socio-historical dimensions of health practices and on the reconstruction of knowledge and technologies in the context of the Brazilian Health Sector Reform. In particular, I highlight his concern with the ethical perspective of academic praxis and in this sense, with hope as a human value which is historically objectified and intersubjectively constructed.

Abstract:

Summary Objective: To characterize the use of alcohol and tobacco and correlate both to the diseases of outpatients in a general practice outpatient clinic. Method: The ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) questionnaire was answered by 300 randomly chosen subjects assigned to different groups according to the diseases being treated at the Outpatient General and Teaching Clinic of the Department of Internal Medicine, Hospital das Clínicas of the University of São Paulo's School of Medicine (HC-FMUSP, in the Portuguese acronym), São Paulo, Brazil. The consumption of tobacco and alcohol was characterized and its correlation with the groups of diseases being treated was calculated using Chi-square and Pearson test statistics. Results: Compared to alcohol, tobacco use was more prevalent, more intense and showed more health-, social-, legal- and financial-related damage. Tobacco smoking presented a positive significant (p<0.0001) correlation with respiratory diseases. According to the questionnaire's criteria, few alcohol users would be referred to clinical interventions in comparison to smokers. Conclusion: Respiratory diseases and tobacco use were well correlated based on the ASSIST questionnaire. The preventive value of the questionnaire was more evident in relation to tobacco than alcohol consumption.

Abstract:

The study presented in the article was performed at the Department of Family Medicine of North-Western State Medical University named after I.I. Mechnikov. The aim of study was to assess the attitude of general practitioners, residents, and students towards vaccination. Materials and methods. The study involved 22 students, 14 residents and 21 general practitioners. Participants completed a questionnaire that included questions about self-assessment of the level of knowledge in the field of vaccination, attitude towards vaccination, opinion about its effectiveness, etc. Statistical analysis was performed using the software SPSS 20.0 (SPSS Inc., Chicago, IL, USA) and MedCalc 11.5.00 (Medcalc Software, Oostende). The Chi-square test was used to assess intergroup differences. Results and discussion. 61% of the participants rated their own level of knowledge in the field of vaccine prevention as good, 21% as satisfactory and 5% as excellent. The most confident in their level of knowledge were students, in the second place residents and in the third place doctors (p 0.05). 90% of respondents identified their attitude to vaccination as positive. 95.5% of students, 85.7% of residents and 76.2% of doctors noted that vaccination is necessary (mandatory). The effectiveness of vaccination is considered high by 86% of participants. When asked whether the respondents do preventive vaccinations for themselves and their children, the majority chose the options Yes, within the national calendar plus additional and all within the national calendar (51% and 39%, respectively). Conclusion. The attitude of the surveyed doctors, residents and students to vaccination is mostly positive, the majority of respondents assess the effectiveness of vaccination as high. Most respondents are vaccinated in accordance with the national vaccination schedule, a large proportion of respondents also do vaccinations that are not included in the national schedule. Almost all respondents recommend preventive vaccinations to patients.

Abstract:

IntroductionPostnatal mental health problems, which are an international public health priority, are a suitable target for preventive approaches. The financial burden of these disorders is borne across sectors in society, including health, early childhood, education, justice and the workforce. This paper describes the planned economic evaluation of What Were We Thinking, a psychoeducational intervention for the prevention of postnatal mental health problems in first-time mothers.Methods and analysisThe evaluation will be conducted alongside a cluster-randomised controlled trial of its clinical effectiveness. Cost-effectiveness and costs-utility analyses will be conducted, resulting in estimates of cost per percentage point reduction in combined 30-day prevalence of depression, anxiety and adjustment disorders and cost per quality-adjusted life year gained. Uncertainty surrounding these estimates will be addressed using non-parametric bootstrapping and represented using cost-effectiveness acceptability curves. Additional cost analyses relevant for implementation will also be conducted. Modelling will be employed to estimate longer term cost-effectiveness if the intervention is found to be clinically effective during the period of the trial.Ethics and disseminationApproval to conduct the study was granted by the Southern Health (now Monash Health) Human Research Ethics Committee (24 April 2013; 11388B). The study was registered with the Monash University Human Research Ethics Committee (30 April 2013; CF12/1022-2012000474). The Education and Policy Research Committee, Victorian Government Department of Education and Early Childhood Development approved the study (22 March 2012; 2012_001472). Use of the EuroQol was registered with the EuroQol Group; 16 August 2012.Trial registration numberThe trial was registered with the Australian New Zealand Clinical Trials Registry on 7 May 2012 (registration number ACTRN12613000506796).

Abstract:

The pattern of coronary artery atherosclerosis is valuable in informing mitigation strategies for coronary heart disease. Histomorphological data on this disease among Africans living in Sub Saharan Africa are, however, scarce. The left anterior descending is one of the most commonly afflicted arteries. This study, therefore, examined the left anterior descending artery of 213 black Kenyans [Mean age 36.8 years, range 5 – 82 years] who had died of non cardiovascular causes for features of atherosclerosis. The individuals were divided into male and female, then into 10-yr age groups. Specimens were obtained from the proximal segment of the artery during autopsy at the Department of Human Anatomy University of Nairobi, Kenya. They were processed routinely for paraffin embedding andsectioning. Five micron sections were stained with Haematoxylin/Eosin and Mason’s trichrome and examined with light microscope. Micrographs of representative features were taken using a high resolution digital camera. At least one feature of atherosclerosis was present in 54 (25.4%) of the individuals. The features observed included severe intimal hyperplasia (34; 63%), disintegration of the internal elastic lamina [30; 55.6%]; atherosclerotic plaque (20; 37%), adventitial thicknening (14; 26%) and mural neovascularization (10; 18.5%). The mean age of those with features of atherosclerosis was 38.4 years, range 6 – 62 years with 25 (46.3%) being aged 40 years and below. Of these, the male: female ratio was 1.7:1. In conclusion, features of atherosclerosis are present in over 25% of the population studied. The disease affects young people, including women. Proactive preventive measures including follow – up should commence early, and involve both men and womenKeywords: Atherosclerosis, coronary, young, men, women, Kenya

Abstract:

Objective: To determine the frequency of various clinical presentations of snakebitten admitted patients. Study design: Descriptive case series study. Place and duration ofstudy: This study was carried out in General Medicine ward, at Medical department of PeoplesMedical University & Hospital Nawabshah, from September 2011 to March 2012. Methodology:This study consisted of 55 patients admitted through the outpatient department, as well as fromcasualty department of Peoples Medical University & Hospital Nawabshah. Detailed History wastaken from all the patients with special regard to type of snake, age , sex , site , time of bite, timelapsed between bite and reaching to hospital. Detailed clinical examination of local features werefang marks, swelling, bleeding from wound, pain and systemic features like nausea, vomiting,echymosis, drowsiness, discharge from wound, hematuria, ptosis, respiratory failure ofenvenomation. Systemic review was also done to see any co-morbidity. All patients underwentfor base line and specific investigations especially clotting time (CT). Inclusion criteria were thatall diagnosed patients of snake bite, aged > 12 year of either sex admitted with the history ofsnake bite with irrespective of toxicity were included. Patients with history of thorn prick, insectbite were excluded criteria. Results were prepared with help of tables and graphs. Data wasanalyzed through SPSS software. Results: Out of 55 patients included in this study, 39 were men(70.9%) and 16 patients were female (29%); with male to female ratio of 2.4:1. There was widevariation of age ranging from a minimum of >12 year to 60 year. The mean age was 39±5.8 years.In our study mostly patients 35(63.63%) reached hospital within 60 minutes followed by12(21.88%) patients within 30 minutes. 5(9%) patients reached within 90 minutes and onepatients reported more than 120 minutes. Symptoms of patients were pain at the bite side in55(100 %), ecchymosis in 18(32.72%), discharge from wound in 9(16.36%), bleeding from gum in8(4.4%) Nausea and vomiting in 7(12.72 %), hematuria in 11(20%), ptosis in 8(14.54%),drowsiness in 5(9%) and respiratory failure in 5(9%). Conclusions: We conclude that males arecommonly affected than females and the farmers and labourers are the most vulnerable sectionof the population for snake bites. In this study age, presence signs and treatment by faith healersis independent predictors of death in case of snake bite. This may provide important evidence toformulate preventive strategies especially health education.

Abstract:

Although most victims of disasters recover on their own, a minority of survivors, uniformed services, and relatives develop long-term disaster related psychic disorders such as Posttraumatic Stress Disorder (PTSD). Especially this subgroup should receive timely and appropriate psychosocial help. In many EU countries is offered post-disaster psychosocial care by a variety of caregivers (i.e. professionals and volunteers, NGOs, church or commercial organizations). Therefore, European standardization of providing post-disaster psychosocial support is currently required. The presentation describes the project supported by the European Commission and named European Guideline for Target Group Oriented Psychosocial Aftercare – Implementation (EUTOPA-IP), supported by the European Commission. EUTOPA-IP has integrated two materials: German “Target Group Intervention Programme” and Dutch “Multidisciplinary guideline”, also with the experiences of experts in the area of psychosocial support from the EU countries. Main target is to develop a guideline for the uniformed services on the basis of the Multidisciplinary guideline for early psychosocial interventions, the adaptation of the Target group Oriented Intervention Program (TGIP) to the International Classification of Functioning, Disability and Health (ICF) and preparation and implementation of training program for various professional groups. The project aims at standardization of psychosocial aftercare in case of disasters as well as at the development of European network based on current findings in psychotraumatology. Early screening, supportive context, early preventive and curative psychosocial interventions, management of interventions, implications for the clinical field and future research are topics discussed in the project. Project consortium: – City of Cologne (Germany)– Centre of Psychotraumatology (Germany)– Impact (The Netherlands)– Spanish Society for Psychotraumatology and Traumatic Stress (Spain)– Charles University in Prague (Czech Republic)– Capital City of Dusseldorf, Department of Public Health (Germany).

Abstract:

Background and aim Most patients who present with a fourth ventricle tumor have concurrent hydrocephalus, and some demonstrate persistent hydrocephalus after tumor resection. There is still no consensus on the management of hydrocephalus in patients with fourth ventricle tumor after surgery. The purpose of this study was to identify the factors that predispose to postoperative hydrocephalus and the need for a postoperative cerebrospinal fluid (CSF) diversion procedure. Materials and methods We performed a retrospective analysis of patients who underwent surgery of the fourth ventricle tumor between January 2013 and December 2018 at the Department of Neurosurgery in West China Hospital of Sichuan University. The characteristics of patients and the tumor location, tumor size, tumor histology, and preventive external ventricular drainage (EVD) that were potentially correlated with CSF circulation were evaluated in univariate and multivariate analysis. Results A total of 121 patients were enrolled in our study; 16 (12.9%) patients underwent postoperative CSF drainage. Univariate analysis revealed that superior extension (p = 0.004), preoperative hydrocephalus (p<0.001), and subtotal resection (p<0.001) were significantly associated with postoperative hydrocephalus. Multivariate analysis revealed that superior extension (p = 0.013; OR = 44.761; 95% CI 2.235–896.310) and subtotal resection (p = 0.005; OR = 0.087; 95% CI 0.016–0.473) were independent risk factors for postoperative hydrocephalus after resection of fourth ventricle tumor. Conclusion Superior tumor extension (into the aqueduct) and failed total resection of tumor were identified as independent risk factors for postoperative hydrocephalus in patients with fourth ventricle tumor.

Abstract:

According to the curriculum of Bachelor of Medicine and Bachelor of Surgery (MBBS) program of the Tribhuvan University (TU), Institute of Medicine (IOM), the Department of Community Medicine of Gandaki Medical College (GMC) has been conducting the District Health System Management (DHSM) study for the students of MBBS, third phase (4th year). This program provides us an opportunity for clinical and community orientation to develop skills to become a competent medical professional to work at different levels of hospitals and district health system. This course enables us to assess resource potentials and constraints, prioritize the health problems and set strategies for solving them. It also enables us to be able to work in promotive, preventive, curative and rehabilitative health services as part of district health team. The program begins with theory classes on management and orientation classes at the college and placement of the students in three different places with rotation along with field supervisions in between. Here we are presenting our investigations on epidemiology of chronic obstructive pulmonary disease made at Western Regional Hospital during our District Health System Management (DHSM) study in third phase (Fourth year).Journal of Gandaki Medical College Volume, 09, Number 2, July December 2016, Page: 65-69

Abstract:

Background and Objectives: Antiresorptive or anti-angiogenic agents may induce medication-related osteonecrosis of the jaws (MRONJ), which represents a challenge for clinicians. The aim of this study is to design and apply a composed and stage-approach therapy combining antibiotherapy, surgical treatment, and photo-biomodulation (PBM) for the prevention or treatment of MRONJ lesions. Materials and Methods: The proposed treatment protocol was carried out in the Department of Oral & Maxillofacial Surgery of the “Victor Babes” University of Medicine and Farmacy of Timisoara, in 2018–2020. A total of 241 patients who were previously exposed to antiresorptive or anti-angiogenic therapy, as well as patients already diagnosed with MRONJ at different stages of the disease were treated. A preventive protocol was applied for patients in an “at risk” stage. Patients in more advanced stages received a complex treatment. Results: The healing proved to be complete, with spontaneous bone coverage in all the n = 84 cases placed in an “at risk” stage. For the n = 49 patients belonging to stage 0, pain reductions and decreases of mucosal inflammations were also obtained in all cases. For the n = 108 patients proposed for surgery (i.e., in stages 1, 2, or 3 of MRONJ), a total healing rate of 91.66% was obtained after the first surgery, while considering the downscaling to stage 1 as a treatment “success”, only one “failure” was reported. This brings the overall “success” rate to 96.68% for a complete healing, and to 99.59% when downscaling to stage 1 is included in the healing rate. Conclusions: Therefore, the clinical outcome of the present study indicates that patients with MRONJ in almost all stages of the disease can benefit from such a proposed association of methods, with superior clinical results compared to classical therapies.

Abstract:

Introduction. Oral health is an important part of general health. Knowledge, beliefs and attitudes that students acquire during dental school can influence their behavior towards not just their own health, but also towards health in their immediate environment. The aim of the study was to assess the level of oral health among dental students of the second and fifth year at the University of East Sarajevo. Material and Methods. Sixty-six students from the Dental Department of the Faculty of Medicine, the University of East Sarajevo were assessed. The study was conducted in 2012. The parameters used to assess oral health were: DMFT (decayed, missing, filled teeth) index and its components, index for the assessment of periodontal tissues (CPITN), and Green?s Vermillion oral hygiene debris index (DI). According to the methodology and criteria of the World Health Organization (WHO) all patients were examined using standard dental diagnostic tools under artificial light on dental chair. Results. Average number of decayed teeth of the second year students was 9.93 while it was 11.44 in the fifth year students. The mean dental caries index was 38.23% and person caries index was 100%. The average value of the debris index was 0.42. Healthy periodontium had 18.2% of students, while in 34.8% of students shallow periodontal pockets were observed. Conclusion. Oral hygiene and periodontal health was satisfactory in dental students. However, high average values of decayed teeth indicated that for better results caries preventive services should be activated earlier, even in school or preschool period.

Abstract:

Comparative Analysis for Effectiveness of Azacitidine versus Decitabine in Acute Myeloid Leukemia and Myelodysplastic Syndromes with Marrow Fibrosis: A Single Institution Experience Ala Ebaid, MD1, Shashank Cingam, MD1, Quiying Liu, MD2, Khine Z Win3, MD, Daniel Babu, MD4, Tawny Boyce, MS, MPH4, Cecilia Arana-Yi, MD1 Department of Internal Medicine, Hematology/Oncology, University of New Mexico, Albuquerque, NM. Department of Internal Medicine, University of New Mexico, Albuquerque, NM. University of California San Francisco. University of New Mexico and Tricore Reference Laboratories Department of Internal Medicine, Division of Epidemiology, Biostatistics and Preventive Medicine, University of New Mexico, Albuquerque, NM. Introduction The hypomethylating agents (HMA) azacitidine (AZA) and decitabine (DEC) are used clinically for the management of myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML); however, treatment responses and survival outcomes are very limited. Bone marrow fibrosis (MF) is present in 10-20% of MDS/AML and is predictor of poor responses to azacitidine and dismal survival outcomes. Genetic abnormalities including TP53 accumulation, WT1 gene expression, increased CXCL9 and CXCL10 among others contribute to the etiology of MF. The impact of MF in therapeutic responses and survival to AZA versus DEC has not been previously assessed. Methods Retrospective chart review of cases from 2000-2019 at UNM Cancer Center to identify clinical characteristics, cytogenetic, molecular status, treatment and overall survival. AML patients were risk stratified according to ELN risk category, and MDS patients based on their IPSS-R scoring system. 142 bone marrow samples were analyzed for marrow fibrosis with hematoxylin and eosin-stained slides and confirmed with trichrome staining at Tricore Reference lab. 92 AML patients had a complete cytogenetics analysis. The goal of this study is to evaluate the clinical, pathologic characteristics and survival outcomes of AML and MDS patients with and without MF treated with AZA compared to DEC at the University of New Mexico Comprehensive Cancer Center. Results 142 patients with MDS (n=45, 31.7%) and AML (n=97, 68.3%) treated with AZA (n=85) 59.9%, and DEC (n=57) 40.1%. 45 patients have MF (31.7%) vs. 97 patients without MF (68.3%). 39.4% (n=56) were females, 31.7% had MDS (n=45), 68.3% had AML (n=97) and 31.7% (n=45) had MF. The median age at diagnosis was 69.5 years for the AZA group and 68 years for the DEC group. In AML group there was 20 (20.8%) patients with high-risk cytogenetics and 38 (39.6%) with diploid cytogenetics. There was no statistical difference between the MF degree and the cytogenetics of the patients. In the MDS group 9 patients (20%) with very low risk IPSS, 16 (35.6%) low risk, 13 (28.9%) intermediate and 13 (15.5%) patients with high and very high risk IPSS. In the fibrosis group 21 patients (46.7%) had low grade and 24 patients (53.3%) had high grade (MF2 and MF3). There were no significant differences in MF degree and IPSS or ELN categories. Median duration of treatment was 3.2 months and median number of treatment cycles was 4 for AZA and 3 for DEC. There was no significant difference in median overall survival between two groups (AZA 18 months vs DEC 17 months, p=0.3355). Median overall survival was not significant in AZA group with de novo AML patients (AZA 19 months versus DEC 15 months, p=0.3013). There were no OS differences in AML and MDS patients with MF. (Figure 1) Patients with MF on AZA had a trend toward better OS compared to DEC. (Figure 2) In MDS and AML, younger than 65 years old had better OS compared to older than 65 years. (p=0.011) In AML, TP53 mutation was associated with worsening survival outcomes. (median OS 2m vs 18m, p=0.0238) Conclusions The frequency of MF was 46.7% in MDS and 24.7 % of AML cases, higher than reported in other studies. However, MF did not affect survival outcomes of MDS/AML treated with AZA or DEC. Although non-statistically significant, MF cases had a trend towards better survival on AZA compared to DEC. The presence of TP53 was associated with decreased survival in AML patients with fibrosis. Our study confirms that MF is a common feature in MDS/AML in New Mexico, but does not influence survival outcomes in patients treated with AZA or DEC. Disclosures Arana Yi: Jazz Pharmaceuticals: Other: Advisory Board.