Kerstin Petersson

Treatment of deep caries lesions in adults: randomized clinical trials comparing stepwise vs. direct complete excavation, and direct pulp capping vs. partial pulpotomy

Less invasive excavation methods have been suggested for deep caries lesions. We tested the effects of stepwise vs. direct complete excavation, 1 yr after the procedure had been carried out, in 314 adults (from six centres) who had received treatment of a tooth with deep caries. The teeth had caries lesions involving 75% or more of the dentin and were centrally randomized to stepwise or direct complete excavation. Stepwise excavation resulted in fewer pulp exposures compared with direct complete excavation [difference: 11.4%, 95% confidence interval (CI) (1.2; 21.3)]. At 1 yr of follow-up, there was a statistically significantly higher success rate with stepwise excavation, with success being defined as an unexposed pulp with sustained pulp vitality without apical radiolucency [difference: 11.7%, 95% CI (0.5; 22.5)]. In a subsequent nested trial, 58 patients with exposed pulps were randomized to direct capping or partial pulpotomy. We found no significant difference in pulp vitality without apical radiolucency between the two capping procedures after more than 1 yr [31.8% and 34.5%; difference: 2.7%, 95% CI (-22.7; 26.6)]. In conclusion, stepwise excavation decreases the risk of pulp exposure compared with direct complete excavation. In view of the poor prognosis of vital pulp treatment, a stepwise excavation approach for managing deep caries lesions is recommended.

Leisure time physical activity is associated with a reduced risk of preterm delivery

OBJECTIVE This study was undertaken to study the association between the times spent on sports activities and leisure time physical activity in the first and early second trimester of pregnancy and the risk of preterm delivery. STUDY DESIGN Population-based follow-up study of 5749 healthy pregnant women who delivered in Aarhus University Hospital, Denmark. RESULTS Women who practiced more than 1 type of sports had a significantly reduced adjusted risk (odds ratio = 0.09 95% CI, 0.01-0.66) of preterm delivery compared with women with no sports activity. Compared with sedentary pregnant women, women engaged in light leisure time physical activity had a 24% nonsignificantly reduced adjusted risk (odds ratio = 0.76, 95% CI, 0.60-1.02) of preterm delivery and those engaged in moderate-to-heavy leisure time activity had a 66% reduced adjusted risk (odds ratio = 0.34, 95% CI, 0.14-0.85). CONCLUSION Moderate-to-heavy leisure time physical activity during pregnancy is associated with a significantly reduced risk of preterm delivery.

Balancing: A Basic Process in End-of-Life Cancer Care

In this grounded theory study, the authors interviewed caregivers andpatients in end-of-life cancer care and found Balancing to be a fundamentalprocess explaining the problem-solving strategies of most participants and offering a comprehensive perspective on both health care in general and end-of-life cancer care in particular. Balancing stages wereWeighing— sensing needs and wishes signaled by patients, gauging them against caregiverresources in diagnosing and care planning; Shifting—breaking bad news, changing care places, and treatments; and Compensating—controlling symptoms, educating and team-working, prioritizing and “stretching” time, innovating care methods, improvising, and maintaining the homeostasis of hope. The Balancing outcome is characterized by Compromising, or “Walking a fine line,” at best an optimized situation, at worst a deceit.

Sports and leisure‐time physical activity in pregnancy and birth weight: a population‐based study

We examined the association between sports and other leisure‐time physical activities during pregnancy and birth weight of babies born after 37 completed weeks of gestation. All Danish‐speaking pregnant women attending routine antenatal care at the Department of Obstetrics, Aarhus University Hospital, Denmark, from August 1989 to September 1991 were invited to participate in the study. A total of 4458 healthy women who delivered after 37 completed gestational weeks participated in this study. The associations between sports (0, 1–2, 3+ h/week) or leisure‐time physical activity (sedentary, light, and moderate to heavy) and birth weight were examined by linear and logistic regression and adjusted for potential confounding factors such as smoking, parity, schooling, pre‐pregnancy body mass index and gestational age. The results showed that pregnant women who practiced sports or were moderate to heavy leisure‐time physical active during the early second or the early third trimester gave birth to infants with a similar birth weight as inactive women. The proportion of newborns with a low (<2500 g) or a high birth weight (≥4500 g) was also unchanged. In conclusion, in this large population‐based study, we found no association between sports and leisure‐time physical activity and low‐birth weight, high‐birth weight, or average‐birth weight.

Experiences of physical activity during pregnancy in Danish nulliparous women with a physically active life before pregnancy. A qualitative study

BackgroundNational guidelines recommend that healthy pregnant women take 30 minutes or more of moderate exercise a day. Most women reduce the level of physical activity during pregnancy but only a few studies of womens experiences of physical activity during pregnancy exist. The aim of the present study was to elucidate experiences and views of leisure time physical activity during pregnancy in nulliparous women who were physically active prior to their pregnancy.MethodsA qualitative study was conducted by means of personal interviews. Nineteen women, all with a moderate pre-pregnancy level of physical activity but with different levels of physical activity during pregnancy, participated in the study. Content analysis was applied.ResultsIn the analyses of experiences and views of physical activities during pregnancy, four categories and nine sub-categories were developed: Physical activity as a lifestyle (Habit and Desire to continue), Body awareness (Pregnancy-related discomfort, Having a complicated pregnancy and A growing body), Carefulness (Feelings of worry and Balancing worry and sense of security) and Sense of benefit (Feelings of happiness and Physical well-being).ConclusionAs other studies have also shown, women find that the discomfort and complications associated with pregnancy, the growing body, and a sense of insecurity with physical activity are barriers to maintaining former levels of physical activity. This study adds a new perspective by describing womens perceptions of these barriers and of overcoming them - thus, when pregnant, the majority of the women do not cease to be physically active but continue to be so. Barriers are overcome by applying ones own experience, looking to role models, mirroring the activities of other pregnant women and following the advice of experts (midwives/physiotherapists). Women then continue to be physically active during pregnancy, most often to a lesser extent or in alternative activities, and derive considerable enjoyment and physical well-being from this.

Diagnostic yield of conventional radiographic and cone-beem computed tomographic images in patients with atypical odontalgia

AIM To investigate whether the additional diagnostic yield of a cone-beam computed tomography (CBCT) examination over conventional radiographs in patients primarily suspected of having atypical odontalgia (AO) improves differentiation between AO and symptomatic apical periodontitis (SAP) in patients with severe chronic intraoral pain. METHODOLOGY In this clinical study, 25 patients (mean age 54 ± 11 years, range 34-72) participated; 20 were diagnosed with AO and 5 with SAP. All patients were recruited from the clinics of the Faculty of Odontology, Malmö University. AO inclusion criteria were chronic pain (>6 months) in a region where a tooth had been endodontically or surgically treated, with no pathological cause detectable in clinical or radiologic examinations. SAP inclusion criteria were recurrent pain from a tooth diagnosed with apical periodontitis in clinical and radiographic examinations. Assessments comprised a self-report questionnaire on pain characteristics, a comprehensive clinical examination and a radiographic examination including panoramic and intraoral radiographs and CBCT images. The main outcome measure was periapical bone destruction. RESULTS Sixty per cent of patients with AO had no periapical bone destructions detectable with any radiographic method. Overall, CBCT rendered 17% more periapical bone destructions than conventional radiography. Average pain intensity in patients with AO was 5.6 (± 1.8) on a 0-10 numerical rating scale, and average pain duration was 4.3 (± 5.2) years. CONCLUSION Cone-beam computed tomography improves identification of patients without periapical bone destruction, which may facilitate differentiation between AO and SAP.

General parental education in Sweden: participants and non-participants

Scand J Prim Health Care 2002;20:xxx-xx. ISSN 0281-3432 Objective - To study factors of importance for participation in parental education within routine child health care. Design - All parents of children born during 1 year were invited by the district nurse to participate in parental education; their participation during the infant year was registered. Setting - Catchment area of two health centres in Växjö, Sweden. Subjects - 221 infants and their parents. Main outcome measures - Number of educational sessions for mothers and fathers. Results - 63% of mothers and 20% of fathers attended at least one session. These mothers attended a mean of 5.7 (SD 2.2) sessions and these fathers a mean of 2.8 (SD 2.3) sessions. Logistic regression analyses showed that the only variable of significance for participation was being a first-time parent (odds ratio 3.9 for the mothers and 3.7 for the fathers). Odds ratios above 2.0 (non-significant) were found for married mothers and Swedish mothers, as well as for Swedish fathers. Conclusion - It is still a considerable problem to get certain groups involved in routine parental education in Swedish child healthcare programmes.

Learner-centred education in end-of-life care improved well being in home care staff: a prospective controlled study

The aim of this controlled study was to evaluate a 1-year learner-centred educational project in end-of-life care for home care staff in a rural district of Sweden. Another rural district in the same region served as a control area. A 20-item questionnaire measuring attitudes towards end-of-life care was designed, and the Hospital Anxiety and Depression (HAD) scale was used to measure mental well being. Increased agreement to 18 of 20 attitude statements was seen in the education group, while 2 of 20 items showed a decreased agreement in the control group. Test retest reliability of the 20-item questionnaire was good (r =0.92). The total HAD score decreased from 8.3 pretest to 5.3 post-test in the education group (95% CI=2.1– 3.7; P<0.001), and was 6.8 for both years in the control group. Our study shows that a comprehensive educational programme not only improved attitudes towards end-of-life care, but also the mental well being of the home care staff.

Effect of education intervention on the quality and long-term outcomes of root canal treatment in general practice

AIM To compare the technical quality and long-term outcomes of root canal treatment by general practitioners of a Swedish Public Dental Service, before and after an endodontic education including Ni-Ti rotary technique (NiTiR). METHODOLOGY A random sample was compiled, comprising one root filled tooth from each of 830 patients, treated by 69 general practitioners participating in the education: 414 teeth root filled in 2002, pre-education, using primarily stainless steel instrumentation and filling by lateral compaction, and 416 teeth root filled post-education (2005), using mainly NiTiR and single-cone obturation. Follow-up radiographs taken in 2009 were evaluated alongside immediate post-filling radiographs from 2002 to 2005. The density and length of the root fillings were registered. Periapical status was assessed by the Periapical Index (PAI), using two definitions of disease: apical periodontitis (AP) (PAI 3 + 4 + 5) and definite AP (PAI 4 + 5). Tooth survival was registered. Root fillings pre- and post-education were compared using chi-square and Fishers exact tests. Crude extraction rates per 100 years were calculated for comparison of tooth survival. Explanatory variables (type of tooth, root filling quality, periapical status, marginal bone loss, type and quality of coronal restoration) in relation to the dependent variable (AP at follow-up) were analysed by multivariable logistic regression. RESULTS Follow-up data were available for 229 (55%) of teeth treated pre- and 288 (69%) treated post-education: both tooth survival (P < 0.001) and root filling quality were significantly higher (P < 0.001) in the latter. However, there was no corresponding improvement in periapical status. Both pre- and post-education, root fillings with definite AP on completion of treatment had significantly higher odds of AP or definite AP at follow-up. For teeth treated post-education, inadequate root filling quality was significantly associated with AP at follow-up. CONCLUSIONS Despite a higher tooth survival rate and a significant improvement in technical quality of root fillings after the education, there was no corresponding improvement in periapical status.

The association between leisure time physical activity in the year before pregnancy and pre-eclampsia

In order to investigate the association between leisure time physical activity in the year before pregnancy and pre-eclampsia, stratifying for maternal BMI, a prospective study was carried out from 1996 to 1998. Pregnant women attending their first antenatal care visit, were invited to participate in the study. Inclusion criteria: Danish-speaking, ≥18 years of age, gestational age <22 weeks, no psychiatric disease, or abuse. The participants (n = 2,793) self-filled a questionnaire at 12–18 gestational weeks. Leisure time physical activity was categorised as sedentary, light and moderate-to-heavy. The results showed that pre-eclampsia occurred in 4.2%, 4.2% and 3.1% of women with sedentary, light and moderate-to-heavy leisure time physical activity, respectively. Although we found a tendency towards a lower risk of pre-eclampsia in women with the highest degree of physical activity during leisure time, especially in overweight women, no significant associations were found. It was concluded that leisure time physical activity the year before pregnancy does not protect against pre-eclampsia.