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Objective: This study evaluated the effect of bromelain and propolis extract on the bond strength (BS) of a universal adhesive system to eroded dentin. Materials and Method s : Sixty human molars with exposed dentin were halved, with one half protected by composite resin and the other subjected to erosive treatment followed by remineralization. After the erosive treatment, the composite resin was removed, and the teeth were randomly assigned to three groups (n = 20): Adhesive‐Control System; Br‐10%; Pr‐16%. Following the treatments, composite resin blocks were built on the dentin surfaces and sticks of 0.9 mm2 were obtained and stored in distilled water at 37°C for 24 h and 6 months. After these periods, the sticks underwent bond strength testing and the data were analyzed using 2‐way ANOVA, Bonferroni test, p < 0.05. Fracture patterns were observed using light microscope and scanning electron microscopy. Results: Irrespective of the substrate and aging duration, propolis demonstrated higher BS (p < 0.05) compared to the other treatments. Eroded dentin exhibited greater removal of the smear layer and dentinal tubules with a larger diameter than sound dentin, especially when treated with bromelain, resulting in the formation of resin tags. Conclusions: Propolis consistently promoted the highest bond strength, irrespective of aging or substrate. Eroded dentin treated with propolis, or bromelain exhibited a higher prevalence of non‐adhesive fractures and resin tag formation. Clinical Significance: Propolis shows promise for enhancing the longevity of adhesive restorations in eroded dentin due to its ability to promote high bond strength. [ABSTRACT FROM AUTHOR]

Abstract: This qualitative study examined caregivers' experiences with SafeCare®, an evidence‐based programme that focuses on child neglect through modules on health, safety, and parenting. Shortly after completing SafeCare, 30 caregivers participated in a semi‐structured interview about their experiences with the programme. Overall, caregivers indicated that the programme helped with improvements in their parenting skills. Among the factors that contributed to a positive experience were the simplicity of language, the skills‐based approach, and the quality of the relationship with the SafeCare provider. Caregivers also noted several factors that made it difficult to fully benefit from the programme, including financial constraints, removal of their child from the home, and general distrust towards the child welfare system. Findings provide relevant information for SafeCare providers in terms of identifying areas that work well for caregivers completing the programme, as well as areas that might serve as impediments. Implications for contemporary child welfare practice are also considered. [ABSTRACT FROM AUTHOR]

Background: Little is known about community pharmacist–patient interaction within a consultation room, particularly in terms of patient activation and engagement. Objective: To explore pharmacists' communication and attitudes while providing advanced medication‐related services. Methods: A cross‐sectional descriptive study, using the Roter Interaction Analysis System (RIAS) framework, to analyse a sample of audio‐recorded pharmaceutical care consultations with elderly patients. Results: Around 15.0 per cent of pharmacists' utterances and 3.6 per cent of patients' were related to engagement with the latter during the exchange. To improve health outcomes, such as adherence to a therapeutic regime, pharmacists should augment patients' participation in the dialogue, facilitating concerns and disclosure of doubts, thus improving correct medication use behaviour. [ABSTRACT FROM AUTHOR]

Aims To characterize drug prevalence among fatally injured drivers, identify significant associations (i.e. day of week, time of day, age, gender), and compare findings with those for alcohol. Design Descriptive and logistic mixed-model regression analyses of Fatality Analysis Reporting System data. Setting US states with drug test results for >80% of fatally injured drivers, 1998-2010. Participants Drivers killed in single-vehicle crashes on public roads who died at the scene of the crash ( n = 16 942). Measurements Drug test results, blood alcohol concentration ( BAC), gender, age and day and time of crash. Findings Overall, 45.1% of fatally injured drivers tested positive for alcohol (39.9% BAC ≥ 0.08) and 25.9% for drugs. The most common drugs present were stimulants (7.2%) and cannabinols (7.1%), followed by 'other' drugs (4.1%), multiple drugs (4.1%), narcotics (2.1%) and depressants (1.5%). Drug-involved crashes occurred with relative uniformity throughout the day while alcohol-involved crashes were more common at night ( P < 0.01). The odds of testing positive for drugs varied depending upon drug class, driver characteristics, time of day and the presence of alcohol. Conclusions Fatal single-vehicle crashes involving drugs are less common than those involving alcohol and the characteristics of drug-involved crashes differ, depending upon drug class and whether alcohol is present. Concerns about drug-impaired driving should not detract from the current law enforcement focus on alcohol-impaired driving. [ABSTRACT FROM AUTHOR]

Although researchers now concede that one in six men experiences childhood sexual abuse (CSA), this population remains understudied in both the empirical and clinical literature. Little is known about the characteristics of males' CSA experiences (e.g. duration, child‐perpetrator relationship) and about resilient functioning. This study described young adult males' abuse experiences during childhood and their current adaptive functioning. Participants were recruited from across North America through websites geared specifically for males with CSA histories. The sample included 46 males aged 17–25 years who anonymously completed an online questionnaire. Findings indicated that males tended to experience severe CSA, including early age of onset, invasive sexual acts and the use of perpetrator force. Males also reported the co‐occurrence of other forms of childhood maltreatment and adversity, including parental conflict, neglect, physical abuse and emotional maltreatment. Finally, males reported lower rates of resilience on standardised measures, compared with adult community samples in North America. However, scores were consistent with clinical age‐based norms for adolescents with trauma histories. This study contributes to the growing awareness of male CSA, multiple victimisation and its diverse outcomes. Implications of these findings for future research and clinical practice are considered. Copyright © 2018 John Wiley & Sons, Ltd. ‘Contributes to the growing awareness of male CSA, multiple victimisation and its diverse outcomes’ Key Practitioner Messages: The experiences of CSA among males were found to be severe and to occur alongside other forms of victimisation and adversity. Males with CSA histories experienced difficulties in their adaptation, in terms of coping with stress and functioning across work, school and interpersonal spheres. It is important that practitioners consider the serious impact of male CSA across multiple areas of functioning and inquire about other forms of victimisation when working with this population. [ABSTRACT FROM AUTHOR]

Rationale, aims and objectives In 2012, health care spending in Italy reached €114.5 billion, accounting for 7.2% of the Gross Domestic Product (GDP) and 14.2% of total public spending. Therefore, reducing waste in health facilities could generate substantial cost savings. The objective of this study is to show that Lean Six Sigma represents an appropriate methodology for the development of a clinical pathway which allows to improve quality and to reduce costs in prosthetic hip replacement surgery. Methods The methodology used for the development of a new clinical pathway was Lean Six Sigma. Problem solving in Lean Six Sigma is the DMAIC ( Define, Measure, Analyse, Improve, Control) roadmap, characterized by five operational phases which make possible to reach fixed goals through a rigorous process of defining, measuring, analysing, improving and controlling business problems. Results The following project indicated several variables influencing the inappropriate prolongation of the length of stay for inpatient treatment and corrective actions were performed to improve the effectiveness and efficiency of the process of care. The average length of stay was reduced from 18.9 to 10.6 days (−44%). Conclusion This article shows there is no trade-off between quality and costs: Lean Six Sigma improves quality and, at the same time, reduces costs. [ABSTRACT FROM AUTHOR]

Aim No epidemiological data on halitosis are available from Italy. Thus, the aim of this population-based cross-sectional study was to estimate the prevalence of halitosis in an urban adult population from North Italy and to explore related oral risk indicators. Materials and Methods The survey used a two-stage probability sampling method to collect a representative sample of inhabitants, aged between 20 and 75 years, in the city of Turin. Seven hundred and forty-four adults were clinically examined (47% of sampled subjects) for oral malodor and periodontal conditions. Using a standardized questionnaire social, health and halitosis-related parameters were collected. Logistic models with interaction terms between tongue coating scores (TCS) and periodontal status were used to explore halitosis risk indicators. Results The prevalence estimate of halitosis according to the organoleptic assessment was 53.51% (95% CI: 48.55-58.50). A statistically significant correlation was found between organoleptic and gas chromatography measurements ( p < 0.0001). Stronger associations between halitosis and periodontitis were observed in people having higher TCS: adjusted odds ratio considering low and high TCS in individuals with severe periodontitis were 2.95 and 20.77 ( p ≤ 0.003). Conclusions Due to the high prevalence of halitosis in the Turin population, its diagnosis and management should be incorporated in comprehensive dental care. [ABSTRACT FROM AUTHOR]

Background Chronic pancreatitis, a known complication of alcohol abuse, is characterized histopathologically by prominent fibrosis. Pancreatic stellate cells ( PSCs) are responsible for producing this fibrous tissue in chronic pancreatitis and are activated by alcohol. Progression of alcoholic chronic pancreatitis (as assessed by calcification and fibrosis) is thought to be facilitated by concurrent smoking, but the mechanisms are unknown. This study aimed to (a) determine whether human PSCs (hPSCs) and rat PSCs express nicotinic acetylcholine receptors ( nAChRs), which are known to bind 2 important components of cigarette smoke, namely nicotine and nicotine-derived nitrosamine ketone ( NNK), and (b) examine the effects of cigarette smoke components in the presence and absence of alcohol on PSC activation in vitro. Methods Western blotting was used to detect the presence of nAChRs in primary cultures of PSCs. Clinically relevant concentrations of cigarette smoke components (either cigarette smoke extract [ CSE], NNK, or nicotine) ± ethanol (EtOH) were used to treat primary cultures of PSCs, and stellate cell activation was assessed by cell migration, proliferation, collagen production, and apoptosis. Results We demonstrate, for the first time, that PSCs express nAChRs (isoforms α3, α7, β, ε) and that the expression of the α7 isoform in hPSCs is induced by CSE + EtOH. We also provide novel findings that PSCs are activated by CSE and NNK (both alone and in combination with EtOH) as evidenced by an increase in cell migration and/or proliferation. Further, we demonstrate that activation of PSCs by CSE + EtOH and NNK + EtOH may be mediated via nAChRs on the cells. Conclusions PSCs are activated by clinically relevant concentrations of cigarette smoke components ( CSE and NNK), alone and in combination with EtOH. Thus, in alcoholics who smoke, progression of pancreatic fibrosis may be facilitated by the combined effects of alcohol and cigarette smoke components on hPSC behavior. [ABSTRACT FROM AUTHOR]

Aim There is a paucity of up-to-date data regarding prevalence and risk indicators of periodontitis in Italy. Therefore, the aim of this study was to evaluate the prevalence of periodontitis and its risk indicators among adults from an urban area in North Italy. Material and Methods This cross-sectional survey used a stratified two-stage probability sampling method to draw a representative sample of the adult population of the city of Turin. About 1600 individuals, 20-75 years old, were randomly selected and 736 subjects agreed to participate (47% of the sampled subjects). Clinical parameters were assessed using a full-mouth protocol. Logistic models were applied to assess associations between periodontitis and its putative risk indicators. Age was included as restricted cubic spline. Results Based on CDC/ AAP case definition, the prevalence estimates of severe and moderate periodontitis were 34.94% (95% CI: 31.23-38.74) and 40.78% (95% CI: 36.89-44.79). The probability of periodontitis increased in smokers (adjusted OR 2.06, 95% IC: 1.26-3.37, p = 0.004) and with age but leveled off in the 50+ year-old group ( p < 0.001). Conclusion Periodontitis was highly prevalent in the Turin population. The present data will enable development of appropriate public health programs and allocation of resources. [ABSTRACT FROM AUTHOR]

Multipoint LV Pacing Improves Mid-Term CRT Response Introduction Cardiac resynchronization therapy (CRT) with multipoint left ventricular (LV) pacing in a single coronary sinus branch improves acute LV function. We hypothesized that multipoint pacing (MPP) can improve midterm echocardiographic and clinical response compared with conventional CRT. Methods and Results Consecutive patients receiving a CRT implant (Unify Quadra MP™ or Quadra Assura MP™ CRT-D and Quartet™ LV lead, St. Jude Medical, Sylmar, CA, USA) were randomized to receive biventricular (BiV) pacing with either conventional LV pacing (CONV group) or MPP (MPP group). For each patient, an optimal pacing configuration for the assigned pacing mode was programmed based on intraoperative pressure-volume (PV) loop measurements. A clinical evaluation and transthoracic echocardiogram were performed before implant (BASELINE) and at 3 months postimplant and analyzed by a blinded observer. A reduction in end-systolic volume (ESV) of ≥15% relative to BASELINE was prospectively defined as response to CRT. Forty-four patients (NYHA Class III, EF 29 ± 6%, QRS duration 152 ± 17 milliseconds) were enrolled and randomized. One patient in the MPP group was lost to follow-up and excluded from further analysis. After 3 months, 11 of 22 (50%) CONV patients and 16 of 21 (76%) MPP patients were classified as responders. ESV reduction, EF increase, and NYHA class reduction relative to BASELINE were significantly greater in the MPP group than in the CONV group (ESV: −21.0 ± 13.9 vs. −12.6 ± 11.1%, P = 0.03; EF: +9.8 ± 5.1 vs. +2.0 ± 7.8 percentage points, P < 0.001; ΔNYHA: −1.05 ± 0.22 vs. −0.72 ± 0.46 functional classes, P = 0.006). Conclusion PV loop optimized BiV pacing with MPP resulted in an improved rate of response to CRT. [ABSTRACT FROM AUTHOR]