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The aim of this study was to identify factors in the working environment associated with regular dental attendance. Thirty-three general practitioners provided data on 488 patients who underwent dental maintenance between 2003 and 2015. The age of the patients ranged from 40 to 65 years. Appointment adherence, employment format, overtime work, night work, and subjective evaluation of work were investigated. Multiple logistic regression analysis was performed to identify factors associated with regular dental attendance. Among all participants, 296 (60.7%) were female, 320 (65.6%) worked full-time, 193 (39.5%) worked overtime, and 34 (7.0%) worked nights. The results of the analysis revealed that only night work was a significant factor after adjusting for sex, age, and employment format (odds ratio, 0.220; 95% confidence interval, 0.088-0.550). The results of this study suggest that night work disturbs regular dental attendance.

Type D personality-the tendency toward combined negative affectivity and social inhibition-is a risk factor for coronary heart disease. Although Type D personality has been linked to low adherence to diabetic care, it is unclear whether it is related to adherence to dental therapy. Thus, study examined the relationship between Type D personality and withdrawal from dental therapy. A web-based questionnaire was used to compare a treatment dropout group (n = 225) and maintenance group(n = 236). The questionnaire was designed to assess Type D personality traits, reasons for dropout, and respondent sociodemographic characteristics and attitudes. There were no significant differences in the sociodemographic characteristics of the two groups. However, the proportion of respondents with a Type D personality was significantly larger in the dropout group than in the maintenance group (P = 0.04). The most common reasons for dental therapy dropout were "improvement of symptoms" (46.2%) and "busy with business or study" (30.7%). The most frequent attitude reported in the dropout group was negative feelings toward dental practice. In conclusion, Type D personality might be related to dropout from dental therapy.

The purpose of this study was to investigate whether number of non-vital teeth was an indicator of tooth loss during maintenance. Thirty-three general practitioners provided data on 321 patients undergoing maintenance over 10 years. The number of present teeth (PT), smoking status, level of bone loss, number of non-vital teeth, and reason for tooth loss during that period were investigated. Multiple logistic regression was performed to identify whether the number of non-vital teeth was associated with tooth loss. The average number of lost teeth was 1.07±1.82; that of PT at baseline was 24.4±3.9; and that of non-vital teeth at baseline was 5.4±4.5. Multiple logistic regression revealed a significant association between >8 non-vital teeth and tooth loss during maintenance (odds ratio [OR]: 2.40; 95% confidence interval [CI]: 1.18-4.87). It also demonstrated relationships between >8 non-vital teeth and root fracture or caries (OR: 3.90; 95%CI: 1.68-9.03 or OR: 2.85, 95%CI: 1.14-7.10, respectively). The number of non-vital teeth was associated with tooth loss during maintenance. The results suggest that patients with many non-vital teeth before commencement of maintenance are particularly at risk of tooth loss due to root fracture or caries. Therefore, the number of non-vital teeth offers a useful indicator of potential tooth loss.

The presence of any age-related differences in gingival pigmentation associated with smoking, particularly in a young population, remains to be fully investigated. The purpose of this study was to determine the age-related differences in smoking gingival pigmentation. Gingival pigmentation was analyzed using the gingival melanosis record (GMR) and Hedin’s classification with frontal oral photographs taken at 16 dental offices in Japan. Participants were categorized into 10-year age groups, and their baseline photographs were compared. In addition, to evaluate the effect of smoking cessation on gingival pigmentation, subjects were divided into a former smoker group (stopped smoking) and current smoker group. A total of 259 patients 19 to 79 years of age were analyzed. People in their 30s showed the most widespread gingival pigmentation. In addition, subjects in their 20s showed a weak effect of smoking cessation on gingival pigmentation. These findings suggested that the gingival pigmentation induced by smoking was more remarkable in young people than in middle-aged people. This information may be useful for anti-smoking education, especially among young populations with a high affinity for smoking.

Dental caries is an important public health problem worldwide. This study aims to prove how preventive therapies reduce the onset of caries in adult patients and to identify patients with high or low risk of caries by using Classification and Regression Trees based survival analysis (survival CART). A clinical data set of 732 patients aged 20 to 64 years in nine Japanese general practices was analyzed with the following parameters: age, DMFT, number of mutans streptococci (SM) and Lactobacilli (LB), secretion rate and buffer capacity of saliva and compliance with a preventive program. Results showed the incidence of primary carious lesion was affected by SM, LB and compliance with a preventive program; secondary carious lesion was affected by DMFT, SM and LB. Survival CART identified high-risk patients for primary carious lesion according to their poor compliance with a preventive program and SM (≥106 CFU/ml) with a hazard ratio of 3.66 (p = 0.0002). In the case of secondary caries, patients with LB (≥105 CFU/ml) and DMFT (>15) were identified as high risk with a hazard ratio of 3.50 (p

Background: Due to moisture and the anatomical complexity of the oral mucosa, it is difficult to measure the extent of gingival melanosis in an optical manner. Therefore, we developed a new quantitative method using clinical oral photographs and compared the extent of gingival melanosis before and after smoking cessation. Methods: A new analysis method, which we named the gingival melanosis record (GMR), is a quantitative analysis method using clinical oral photographs. We obtained 659 clinical photographs from 263 patients from 16 general dental offices in Japan. Standardized measuring sites were automatically spotted on the screen, and the presence of gingival melanosis was determined at the measuring sites. We assessed the validity of the GMR with the previously reported Hedin’s classification using Spearman’s rank correlation and intraclass correlation coefficients. Results: The GMR showed a significant association with Hedin’s classification (p < 0.01, correlation coefficient = 0.94). The GMR also showed excellent reproducibility of the substantial repeated agreement intraclass correlation coefficients (ICC) (1,1) and ICC (2,1), p > 0.61). The longitudinal loss of gingival melanosis was confirmed by a change in the GMR among patients who successfully achieved smoking cessation for a mean of 4.5 years. Conclusion: The GMR is an effective method to assess gingival melanosis. The loss of gingival melanosis after smoking cessation can be objectively confirmed with the use of the GMR.

Background Continued periodontal maintenance after active therapy is highly important for maintaining a healthy oral function. In Japan, the rate of consultation for periodontal maintenance is remarkably low compared to other developed countries. This study analyzed the relationship between long-term maintenance and patient background characteristics in an effort to identify ways to increase the rate of consultation for periodontal maintenance in Japan. Methods Thirty-three long-term maintenance patients were interviewed. The interviews were recorded on video. The conversation between the patient and the interviewer was converted to text, and the data were qualitatively analyzed using the Steps for Coding and Theorization (SCAT) method. Results The mean age of the patients was 61.4 years and the average duration of maintenance was 10.7 years. The majority (90.9 %) of patients cared about their dietary habits, and 72.7 % of the patients understood the importance of physical activity. All of the patients wished to continue the maintenance, and 72.7 % of patients had good feelings about the staff of the dental clinic. However, their recognition of the description of primary prevention was low, with a response rate of only 21.2 %. Conclusions The long-term maintenance patients had a high level of consciousness regarding their health and good feelings about the staff of the dental clinic. Oral hygienists, who are the main staff involved in periodontal maintenance were suggested to be important for increasing the maintenance consultation rate.

Although cervical anterior osteophytes accompanying diffuse idiopathic skeletal hyperostosis (DISH) are generally asymptomatic, large osteophytes sometimes cause swallowing disorders. Surgical resection of the osteophyte has been reported to be an effective treatment; however, little study has been given to the recurrences of osteophytes. A prospective study was performed for seven patients who underwent surgical resection of cervical anterior osteophytes for the treatment of recalcitrant dysphagia caused by osteophytes that accompanied DISH. The seven patients were six men and one woman ranging in age from 55 to 78 years (mean age = 65 years). After a mean postoperative follow-up period of 9 years (range: 6–13 years), surgical outcomes were evaluated by symptom severity and plain radiographs of the cervical spine. On all operated intervertebral segments, the effect of postoperative intervertebral mobility (range of movement >1 degree) on the incidence of recurrent osteophytic formation (width >2 mm) was analyzed by Fisher’s exact test. Complete relief of the dysphagia was obtained within one month postoperatively in five patients, while it was delayed for 3 months in two patients. All of the patients developed recurrent cervical osteophytic formation, with an average increase rate of approximately 1 mm/year following surgical resection. Of the 20 operated intervertebral segments, the incidence of recurrent osteophytes was significantly higher (P = 0.0013) in the 16 segments with mobility than in the four segments without mobility. Five of the seven patients remained asymptomatic, although radiological recurrence of osteophytes was seen at the final follow-up. The two remaining patients complained of moderate dysphagia 10 and 11 years after surgery, respectively; one of these two required re-operation due to progressive dysphagia 11 years postoperatively. In patients with cervical DISH and dysphagia, surgical resection of osteophytes resulted in a high likelihood of the recurrence of osteophytes. Therefore, attending surgeons should continue to follow these patients postoperatively for more than 10 years in order to assess the regrowth of osteophytes that may contribute to recurrent symptoms.

OSCE (Objective Structured Clinical Examination;客観的臨床能力試験) は, 1975年Hardenらによって開発, 提案された方法で, 臨床能力を適正に評価する方法として世界に広く導入されている。わが国では94年に川崎医科大学で初めて実施され, 現在ではほとんどの医学部・医科大学で行われているだけでなく, 看護などコメディカルの教育にも導入されつつある。鍼灸教育においては, 97年丹澤らの実験的報告によって紹介されたものの, 当初教育現場の反響はさほど大きなものでなく関心も薄かったが, その後次第に関心が高まっていった。2000年, 鍼灸教育におけるepoch makingともいえる「鍼灸等臨床教育におけるOSCE導入に関する研究」 (文部科学省委託研究) が始まり, 以後3ヵ年にわたり東洋療法学校協会加盟校, 盲学校, 大学, 短大の教員が参加のもとに調査・研究が行われ, 多くの意義ある成果を得た。こうした調査・研究活動がOSCE啓蒙の機会を広げ, その進展に伴い, いくつかの専門学校, 盲学校, そして大学においてOSCEが試行されるようになった。今や鍼灸教育におけるOSCEは, 「啓蒙の段階」から「実施と成果検証の段階」へと移りつつあるといえよう。このような現状を踏まえて, 今回のパネルでは既にOSCEを実施している養成校5校の教員 (OSCEを担当された) から, 1) OSCE導入の目的, 2) 実施状況, 3) 実施の上での問題点, 4) 今後にむけた実施方針などについて報告を頂き, 引き続き「OSCEを実施して学生や教員がどう変わったか?」, 「今後の課題は何か?」などの課題を提示して討論を行った。OSCE導入の背景は各校それぞれであるが, 目的は5校のうち3校が卒業や進級判定のための総括評価として実施, 2校が形成的評価として実施しており, 実施の時期や評価の対象者に相違がみられた。設置ステ作ションについては, カリキュラムの移行期にあたる1校を除く全ての養成校で「医療面接」ステーションが設けられ, 鍼灸教育におけるコミュニケーション能力習得に向けた取り組みが徐々に広がりつつあることが伺われたが, 評価の上で重要な役割を担うSP (Standardized Patient;標準模擬患者) の確保や育成に苦慮している様子が報告された。OSCEの長所としては, 情意領域と精神運動領域の評価法として優れているだけでなく, OSCEを実施することによる学生の積極的学習に向けた態度の形成や, 教員にとっては学生の出来ている点と出来ない点とが明確になり, 指導上有益なフィードバックが得られることなどが挙げられた。作方, 短所としては, 各校とも労力・場所・時間などの問題点が大きく, これらのことによりOSCE実施に躊躇している養成校も多いと考えられた。今後の課題としては, 評価としての信頼作生について検証していくことや, 人材の共同利用と外部評価の導入という観点から, 単独での実施ではなく学校間で協力し合いながら, 共通の評価基準のもとに相互に評価しあうというシステムづくりの検討, さらには卒前教育のみならず, 卒後臨床教育におけるOSCEのあり方についての検討も必要と思われる。今回のパネルが, 今後OSCEを実施する養成校にとって参考となれば幸いである。

越婢加朮湯の変形性膝関節症 (膝OA) に対する効果と作用機序を検討する目的で, 膝関節に水腫, 熱感, 圧痛が認められるいわゆる越婢加朮湯の証と考えられる膝OA30例 (男性9例, 女性21例) を対象として, 8週間, 越婢加朮湯エキス顆粒を1日あたり7.5-15.0g投与した。臨床症状を日本整形外科学会の治療成績判定基準を一部改変したもので評価すると, 疼痛歩行能, 腫脹の項目で有意な改善が認められた。関節液検査では, 白血球数 (特に多核球数) 及びカタラーゼ活性が有意な減少を示した。以上から, 越婢加朮湯には, 滑膜炎を鎮静化させ関節水腫を軽減させる作用があり, このことが主に症状の改善に関与しているものと推測された。

Restraining the initial combustion and promoting the diffused combustion are of utmost importance to improving the fuel economy, exhaust gas emissions, and noise of the indirect injection (IDI)diesel engine. The authors closely studied a new combustion system which features a refined jet passage and a refined prechamber. The new combustion system offers the optimum discharge coefficient of the jet passage and improved diffusion and penetration of jet in the main chamber. Installed in a Mitsubishi S4S diesel engine (swirl-chamber system and four cylinders of 94 mm bore and 120 mm stroke each) and tested, the new combustion system was proven to reduce the engine fuel consumption, smoke emission, particulates, and noise.

Quantification of argyrophilic nucleolar organizer regions (AgNORs) stained by the silver colloid method in urinary exfoliative cells from 36 benign urological diseases and 33 transitional cell carcinomas (TCC) of the urinary bladder was carried out. Also, AgNORs of these cells were measured by means of the computer-assisted image analysis system. There was a significant correlation between AgNORs numbers of cells from voided or wash-out smears and those from touch smears (p less than 0.01). The mean AgNOR numbers per nucleus showed a stepwise increase from non-infected benign urological diseases (mean +/- SD: 3.33 +/- 0.60) through infected urological diseases (3.88 +/- 0.58), grade 1 of TCC (5.23 +/- 1.39) and grade 2 of TCC (6.34 +/- 0.86), to grade 3 of TCC (8.09 +/- 1.19). The maximum number of AgNORs in each group indicated almost the same results. The estimation of the distribution of the maximum AgNOR number might be of great value for rapid and reliable detection of bladder cancers. Moreover, the computer-assisted image analysis of AgNORs could offer an objective index for the cytological assessment of urinary bladder diseases including TCC.

Purpose To evaluate the clinical outcomes of cantilever transforaminal lumbar interbody fusion (c-TLIF) for upper lumbar diseases. Materials and Methods Seventeen patients (11 males, 6 females; mean ± SD age: 62 ± 14 years) who underwent c-TLIF using kidney type spacers between 2002 and 2008 were retrospectively evaluated, at a mean follow-up of 44.1 ± 12.3 months (2 year minimum). The primary diseases studied were disc herniation, ossification of posterior longitudinal ligament (OPLL), degenerative scoliosis, lumbar spinal canal stenosis, spondylolisthesis, and degeneration of adjacent disc after operation. Fusion areas were L1-L2 (5 patients), L2-L3 (9 patients), L1-L3 (1 patient), and L2-L4 (2 patients). Operation time, blood loss, complications, Japanese Orthopaedic Association (JOA) score for back pain, bone union, sagittal alignment change of fusion level, and degeneration of adjacent disc were evaluated. Results JOA score improved significantly after surgery, from 12 ± 2 to 23 ± 3 points (p < 0.01). We also observed significant improvement in sagittal alignment of the fusion levels, from - 1.0 ± 7.4 to 5.2 ± 6.1 degrees (p < 0.01). Bony fusion was obtained in all cases. One patient experienced a subcutaneous infection, which was cured by irrigation. At the final follow-up, three patients showed degenerative changes in adjacent discs, and one showed corrective loss of fusion level. Conclusion c-TLIF is a safe procedure, providing satisfactory results for patients with upper lumbar degenerative diseases.