AIM The aim of the study was to explore how nurse faculty prepare students to teach chronic disease self-management. BACKGROUND Self-management addresses patient activities in response to a change in baseline health. Evidence suggests nurses may not be educated on how to engage patients in chronic disease self-management. METHOD This qualitative study used semistructured interviews to explore experiences of 13 nurse faculty across three universities in preparing nursing students to address self-management concepts for adults living with chronic disease. RESULTS Three themes emerged from 104 identified significant statements: conceptualizing and valuing chronic disease self-management in nursing education, making chronic disease self-management fit, and sharing the impact of health care reform on chronic disease care. CONCLUSION Self-management is regarded as highly complex and evolving. As such, nursing education curricula must also evolve to emphasize successful approaches to preventing chronic disease and incorporating chronic disease self-management and behavior modification in the curriculum.

OBJECTIVES:Various risk factors for oral human papillomavirus (HPV) infections have been described, including tobacco smoking and sexual behavior. However, less is known about the influence of oral health on such infections. The present study aimed to determine a possible association between the quality of oral hygiene and the presence of oral HPV. METHODS:In a prospective analysis, the approximal plaque index (API), the gingival bleeding index (GBI), and the lifetime number of extracted teeth was determined in 187 patients. Additionally, the presence of oral low-risk and/or high-risk HPV was investigated by brush smear testing in all participants. RESULTS:Seventy-four patients had an API < 20%, 84 participants showed an API of 20-40%, and in 29 cases, an API > 40% was recorded. Ninety-six patients presented a GBI < 20%, 75 had a GBI of 20-40%, and 16 showed a GBI > 40%. One hundred four patients had experienced one to three extractions, and 36 had lost more than three teeth. Thirty-nine participants had a positive oral HPV testing (27 high-risk HPV, 26 low-risk HPV, 14 low- and high-risk HPV). A higher API respectively GBI and a greater number of extracted teeth were significantly correlated with the presence of high-risk HPV. The presence of low-risk HPV was significantly higher in patients with API > 40% and GBI > 40% (OR 7.89). Similar results were found regarding the number of extracted teeth. CONCLUSION:The present analysis confirms a relationship between the quality of oral hygiene, determined by objective markers. Thus, improvement of oral health may reduce the incidence of oral HPV infection. CLINICAL SIGNIFICANCE:The present article investigates the relationship between oral hygiene and the presence of oral HPV. As a significant correlation between these two factors could be recorded, improvement of oral hygiene may reduce actively the incidence of oral HPV. Thereby, good oral hygiene may contribute oral cancer prevention.

In the past, maxillomandibular advancement has resulted in considerable improvement in the volume of the posterior airway space. The objective of the present study was to find out how mandibular advancement without maxillary involvement would affect the posterior airway space in patients with mandibular retrognathism. Cone-beam computed tomographic (CT) scans were done for 20 patients before, and six months after, mandibular advancement. Cephalometric analysis at both time points included 2-dimensional and 3-dimensional assessment of the upper airway. Eight men and 12 women presented a preoperative mean (SD) Wits value of 7.4 (1.54) mm, with an airway area of 7.11 (1.88) cm2 and a volume of 14.92 (4.46) cm3. Six months postoperatively they showed a Wits value of 2.7 (0.41) mm, an airway area of 11.33 (3.49) cm2, and a volume of 25.7 (6.10) cm3. There was a mean (range) enlargement of 59 (22-82) % of the area and 73 (29-108) % of the volume. A preoperative Wits value of 8mm or more correlated significantly with a larger increase of the posterior airway space (p=0.002). At the same time, an improvement in the Wits value of 4.5mm or more correlated significantly with an increase in volume (p=0.016). The effect of mandibular advancement on the posterior airway space was significant, and the volumetric effect seems to be even more relevant than the two-dimensional changes.

Im Präzisionslevel 3 der AO-CMF-Trauma-Klassifikation werden Kiefergelenkfortsatzfrakturen in Frakturen des Gelenkkopfs (Walze, Capitulum), des Gelenkhalses und der Gelenkfortsatzbasis unterteilt. Kopffrakturen weisen 2 typische Bruchverläufe auf. Bei einer Fraktur im medialen Walzenbereich (Frakturtyp m) bleibt die Relation lateraler Kondylus zu Fossa und Diskus i.d.R. erhalten. Eine Fraktur im Bereich des lateralen Walzenpols (Frakturtyp p) ist üblicherweise mit einem Höhenverlust assoziiert; der Diskus mit dem kleinen (proximalen) Fragment wird nach anteromedial disloziert, was mit oder ohne Verletzung des lateralen Kapselansatzes einhergehen kann. Die Frakturmorphologie wird neben dem Höhenverlust durch die Attribute Fragmentation („minor“, „major“), vertikale Fragmentapposition sowie Dislokation, Luxation und Distorsion des proximalen Fragments in Bezug auf die Fossa näher definiert. Gelenkfortsatzbasis- und Gelenkhalsfrakturen werden gemäß einer neuen Ein-Drittel- zu Zwei-Drittel-Regel für den Frakturverlauf ober- bzw. unterhalb der sog. Loukota-Linie („sigmoid notch line“) differenziert. Attribute zur Definition der Morphologie sind auch hier das Vorliegen einer Luxation oder Dislokation und deren Richtung, die Angulation des gelenktragenden Fragments und Parameter wie Fragmentation, Höhenverlust und Dislokationen in der Kondylus-Fossa-Relation.

Different authors hypothesized an important impact of sexual behavior on the prevalence of oral human papillomavirus (HPV) infections. In order to investigate this relationship more in detail and in contrast to most other studies, the present work focused on the population group with the highest risk for sexually transmitted infections: young and sexual active adults.

Das Ziel dieser Studie war, den anabolen Effekt von strontiumbeschichteten Titanimplantaten (Ti-Sr-O), die ein exakt steuerbares Freisetzungsprofil von Strontium haben, auf die periimplantäre Knochenneubildung sowie den Knochen-Implantat-Kontakt nach einer 14-tägigen Einheilungsphase bei monokortikaler Insertion im Kaninchenfemur zu untersuchen.

Background: Studies have shown that incorporation of strontium (Sr) into surfaces may enhance osseointegration. Thus, a sustained Sr release from implant surfaces could improve bone healing and thereby accelerate osseointegration.

In this study we took advantage of known impact of strontium (Sr) on bone metabolism and evaluated the effect of sustained supply of Sr on local bone healing. Four distinct surface modifications prepared by a magnetron co-sputtering process with different Sr-release profiles were investigated in a rat model. Four weeks after surgery bone blocks with implants (1.1 mm diameter, 5 mm length), which were inserted bicortically in the femoral shaft, were harvested and subsequently evaluated via histomorphology. Eight implants of each group were analyzed. 8–9% Sr containing surfaces showed statistically significant increase in new bone formation in comparison to the 5.5% Sr containing groups and the reference. In detail data was 14.4% for pure titanium, 22.6% for SrTi 5.5% 1500 nm with 60 min washout, 40.4% for SrTi 5.5% 1500 nm, 47.4% for SrTi 8–9% 1500 nm with 60 min washout and 62.1% for SrTi 8–9% 1500 nm with 20 min washout. No inflammation was found in any of the animals. The development of a new bioactive surface with local supply of strontium is a promising approach for enhancement of bone healing and thereby accelerating osseointegration.

OBJECTIVETumours with neuroendocrine differentiation frequently express chromogranin A, synaptophysin and somatostatin receptors. The role of neuroendocrine differentiation in head and neck squamous cell carcinoma is not yet clear.METHODThe presence of chromogranin A, synaptophysin and somatostatin receptors was studied immunohistochemically in 78 head and neck squamous cell carcinoma specimens.RESULTSSparse chromogranin A expression was found in 41 per cent, associated with high chromogranin A messenger RNA expression and the presence of dense core granules. Low synaptophysin expression was found in 18 per cent. The highest staining scores were found for somatostatin receptor 5 (82 per cent), followed by somatostatin receptor 1 (69 per cent) and somatostatin receptor 2 (54 per cent), whereas somatostatin receptors 3 and 4 expression was low. Expression was not correlated with tumour stage or survival.CONCLUSIONCells with neuroendocrine differentiation are sparsely scattered in some head and neck squamous cell carcinomas. Their pathophysiological role is elusive. In contrast, somatostatin receptor and particularly somatostatin receptor 5 expression is frequent in head and neck squamous cell carcinoma. Somatostatin receptor expression is not considered to indicate neuroendocrine differentiation in head and neck squamous cell carcinoma.

Die Autoren postulieren die Differenzierung des Distraktionsprotokolls für die jeweilige Region des zu distrahierenden Alveolarfortsatzes, das heißt Oberkiefer-Frontzahn­bereich, Oberkiefer-Seitzahnbereich, Unterkiefer-Frontzahnbereich und Unterkiefer-Seitzahn­bereich. Diese Studie beschreibt eine Methodik der Alveolarfortsatzdistraktion ausschließlich für den Seitzahnbereich des Unterkiefers. Es wurden 40 Alveolarfortsatzdistraktionen des Unterkiefer-Seitzahnbereiches retrospektiv untersucht. Das durchschnittliche Distraktionsprotokoll hielt eine Latenzphase von 8 Tagen nach Einbringen des Distraktors ein, gefolgt von der Distraktionsphase mit einer Rate von 0,65 mm/Tag. Der Distraktor blieb für eine durchschnittliche sekundäre Latenzphase von 6,7 Monaten in situ und stabilisierte über diese Zeit den neu geschaffenen Knochen. Die komplette durchschnittliche Konsolidierungsphase betrug zum Zeitpunkt des Setzens dentaler Implantate und somit nach Ablauf der tertiären Latenzphase 10,5 Monate. Die untersuchten Fälle wurden klinisch und radiologisch retrospektiv untersucht. Die Komplikationen innerhalb der Distraktionsphasen wurden entsprechend in chirurgische, technische und klinische unterteilt. Morphometrische standardisierte Messungen zur Untersuchung der neu geschaffenen Knochenhöhe erfolgten an Panoramakontrollröntgenaufnahmen. Der durchschnittliche Gewinn an Knochenhöhe vor Implantation betrug 7,3 mm. Mit der Distraktion alleine wurde in allen untersuchten Fällen genügend vertikale Knochenhöhe erzeugt. Das horizontale Knochenvolumen jedoch war in 20% aller Fälle insuffizient und machte eine sekundäre Augmentation zum Zeitpunkt der dentalen Implantation erforderlich. Die Komplikationsrate bis zum Zeitpunkt der Insertion dentaler Implantate nach durchschnittlich 11,3 Monaten betrug 77% – chirurgische, technische und klinische Komplikationen beinhaltend. Über den gesamten Heilungsverlauf waren lokale Entzündungsreaktionen mit 50% hauptausschlaggebend. Umgekehrt könnte man hervorheben, dass 23% aller Patienten einen völlig komplikationslosen Verlauf zeigten. Die Statistik konnte keinerlei Korrelation zwischen einer abgelaufenen Entzündung und der Quantität neu geschaffenen Knochens zeigen. Die durchgeführte Morphometrie anhand Panoramakontrollröntgen errechnete keinen Knochenverlust in den mittleren Anteilen der transportierten Knochensegmente über die Dauer der sekundären Latenzphase. Lediglich die lateralen Anteile der transportierten Knochensegmente wiesen Resorp­tionszeichen aufgrund physiologischer Knochenremodellierung auf. Nach der sekundären Latenzphase von 6,7 Monaten zeigten alle Panoramakontrollröntgenaufnahmen noch immer unterschiedlich stark ausgeprägte transluzente Areale innerhalb der Distraktionsspalten. Die Ergebnisse der vorliegenden Studie schlagen für den Unterkiefer-Seitzahnbereich eine eher langsame Distraktionsrate von 0,6 mm/Tag oder geringer vor. Eine ausgedehnte sekundäre Latenzphase (mit dem Distraktor als Stütze in situ verbleibend) von mindestens 5 Monaten scheint mehr als günstig. Eine tertiäre Latenzphase von 1,5 Monaten wird vorgeschlagen, um die Weichgewebssituation aber auch die Knochenqualität zum Zeitpunkt der dentalen Implantation zu verbessern. Entzündungsreaktionen waren leicht zu behandeln und hatten keinen Einfluss auf die neu geschaffene Knochenhöhe. Ungeachtet aller Komplikationen konnte mit der alleinigen Distraktion bei beschriebenem Protokoll in 80% aller Fälle genügend Knochen für eine sichere primärstabile dentale Implantation geschaffen werden.

Purpose: Distraction protocols are recommended to be adapted to the various regions of the alveolar process, i.e. anterior maxilla, posterior maxilla, anterior mandible, and posterior mandible. This superior conformity would make comparisons and conclusions of clinical studies more relevant, resulting in a higher level of treatment care. The present study sets its focus on vertical alveolar distraction of the posterior mandible, exclusively.Patients and Methods: 40 cases of vertical alveolar distraction of the posterior mandible are presented. An extra-osseous distraction device was utilized in the present study. A mean primary latency period of 8 days was adhered to. Distraction was performed at a mean rate of 0.65 mm/day. Distractor devices were left in situ for 6.7 months (mean secondary latency period) to stabilize the regenerate chamber. The complete mean consolidation period was 10.5 months before dental implants were inserted. Evaluation was performed clinically and radiologically.Results: The average gain in bone height was 7.3 mm. In all cases sufficient vertical bone height was produced by distraction alone. 20 % of all cases showed insufficient transversal bone volume and secondary augmentation became necessary. The total amount of all complications (including surgical and post-surgical) was 77 % forthright. 50 % of all cases exhibited inflammatory conditions over the healing period of 10.5 months. Statistics revealed no correlation between inflammation and clinical outcome. Morphometry of panoramic radiographs detected no decrease in bone height of the middle portions of transported bone segments during the secondary latency period. After the secondary latency period of 6.7 months all panoramic radiographs still showed translucent areas within the distraction gap.Conclusion: Our results demand for distraction rates of 0.6 mm/d or preferably lower in the posterior mandible. A prolonged secondary latency period of at least 5 months without prior retrieval of the distractor device seems favourable. A second stage implant surgery further improves osseous and soft tissue conditions. Complications caused by surgery or failure of utilized extra-osseous distraction devices were negligible for the treatment outcome. Inflammatory conditions were easily manageable. The distraction process alone following our proposed protocol produced sufficient bone for insertion of dental implants in 80 %, regardless of the total amount of complications.

The treatment of midfacial fractures depends on the dislocation of the fracture and patient-related limitations. Surgical treatment risks iatrogenic complications. In 740 patients with midfacial fractures, the age, sex, fracture type, concomitant injuries, cause of accident and the decision to use operative or non-surgical treatment were recorded. Follow-up was performed 6 and 12 months after the injury. In 41% the fractures were isolated; they were multiple in 59%. Initially, hypaesthesia of the infraorbital nerve was present in 10% of the single and 16% of the multiple fracture patients. Surgical treatment was performed in 57% of the single and in 75% of the multiple fracture patients. Women underwent surgical treatment considerably less frequently than men. After 6 and 12 months, significantly more complications were present in the surgically treated cohort. Nerve disturbances and ‘meteorosensitivity’ were most prominent. These results, together with previous findings, indicate that there is a need for prospective clinical investigations that fulfil the criteria of evidence-based medicine to generate guidelines for decision making in trauma surgery. In the meantime, the decision to use surgical treatment for midfacial fractures has to be made carefully.

Die Kiefergelenksankylosen sind in der Literatur meist als posttraumatisch, seltener als entzündlich verursachte Erkrankung beschrieben. Die Prophylaxe umfasst bei konservativer Bruchbehandlung auch die Funktionsbehandlung mit kiefer­orthopädischen Geräten. Selbst bei konsequenter Therapie kann es jedoch zu bindegewebigen, ­später knöchernen Ankylosen kommen. Die chirurgische Therapie kann eine Wiederherstellung der Mundöffnung erzielen. Die dargestellte Methode mit Gelenkspaltrekonstruktion im physiologischen Niveau, Diskusreposition und Gelenkkapselrekonstruktion ermöglicht eine annähernd symmetrische Öffnung und erreicht auch geringe Laterotrusions- und Protrusionsbewegungen. Dies ist für die Kaufunktion und die Rezidivprophylaxe vorteilhaft.

Over the last few years there has been an increase in the number of fractures of the condylar region of the mandible which have been surgically treated and the indications for this seem to be supported by the literature. 1 Eckelt U. Schneider M. Erasmus F. Gerlach K.L. Kuhlisch E. Loukota R. et al. Open versus closed treatment of fractures of the mandibular condylar process-a prospective randomized multi-centre study. J Craniomaxillofac Surg. 2006; 34 ([Epub 2006 June 15]): 306-314 Abstract Full Text Full Text PDF PubMed Scopus (198) Google Scholar The potential benefit also appears to be present irrespective of the anatomical position of the condylar fracture, but is more dependent on the extent of the displacement of the proximal fragment. 2 Schneider M. Erasmus F. Gerlach K.L. Kuhlisch E. Loukota R.A. Rasse M. et al. Open reduction and internal fixation versus closed treatment and mandibulomaxillary fixation of fractures of the mandibular condylar process: a randomized, prospective, multicenter study with special evaluation of fracture level. J Oral Maxillofac Surg. 2008; 66: 2537-2544 Abstract Full Text Full Text PDF PubMed Scopus (115) Google Scholar The benefits of fixation of condylar head fractures have also been identified. 3 Hlawitschka M. Loukota R. Eckelt U. Functional and radiological results of open and closed treatment of intracapsular (diacapitular) condylar fractures of the mandible. Int J Oral Maxillofac Surg. 2005; 34: 597-604 Abstract Full Text Full Text PDF PubMed Scopus (111) Google Scholar

Ankylosis is reported to be favourably caused by trauma, less frequently by inflammation. If treated conservatively orthodontic appliances are in use. Unfortunately even in cases treated immediately and consequently, ankylosis may occur. The author's method can offer restoration of a physiologically situated hinge axis with good and almost symmetrical mouth opening. Moreover some laterotrusion and protrusion is possible due to preservation of caudal parts of the lateral pterygoid muscle and refixation of the disc. Movement and interposition of the disc seem to be favourable for prevention of recurrence.