local risk factors

  • 文章类型: Journal Article
    背景:政策制定者试图通过国家和地方非药物干预措施来减轻covid-19的传播。此外,证据表明,由于异质的局部特征,一些地区比其他地区更容易受到传染风险的影响。我们研究意大利的区域政策,于2020年11月4日推出,有效解决了由这种异质性引起的当地感染风险。方法:意大利由19个地区(和2个自治省)组成,又分为107个省。我们收集了35个与人口统计相关的特定省份的预测变量,地理,经济活动,和流动性。首先,我们测试了它们的区域内变化是否可以解释意大利第二波中covid-19的发病率。使用LASSO算法,我们隔离了具有高解释力的变量。然后,我们测试他们的解释力是否在区域层面的政策出台后消失。研究结果:七个前covid特征的区域内变异具有统计学意义(F检验p值<0·001),并解释了covid-19发病率的省一级变异的19%,除了特定地区的因素之外,在区域政策出台之前。在区域政策出台后,其解释力下降到7%,但仍然很重要(p值<0·001),即使在被置于更严格政策下的地区(p值=0.067)。解释:即使在同一地区,由于当地特点,意大利各省在接触covid-19感染风险方面存在差异。区域政策并没有消除这些差异,但可能会让他们受挫.我们的证据可能与需要设计非药物干预措施的决策者相关。它还为试图估计其因果影响的研究人员提供了方法论建议。资金:无。
    Background: Policy-makers have attempted to mitigate the spread of covid-19 with national and local non-pharmaceutical interventions. Moreover, evidence suggests that some areas are more exposed than others to contagion risk due to heterogeneous local characteristics. We study whether Italy\'s regional policies, introduced on 4th November 2020, have effectively tackled the local infection risk arising from such heterogeneity. Methods: Italy consists of 19 regions (and 2 autonomous provinces), further divided into 107 provinces. We collect 35 province-specific pre-covid variables related to demographics, geography, economic activity, and mobility. First, we test whether their within-region variation explains the covid-19 incidence during the Italian second wave. Using a LASSO algorithm, we isolate variables with high explanatory power. Then, we test if their explanatory power disappears after the introduction of the regional-level policies. Findings: The within-region variation of seven pre-covid characteristics is statistically significant (F-test p-value < 0 · 001 ) and explains 19% of the province-level variation of covid-19 incidence, on top of region-specific factors, before regional policies were introduced. Its explanatory power declines to 7% after the introduction of regional policies, but is still significant (p-value < 0 · 001 ), even in regions placed under stricter policies (p-value = 0 · 067 ). Interpretation: Even within the same region, Italy\'s provinces differ in exposure to covid-19 infection risk due to local characteristics. Regional policies did not eliminate these differences, but may have dampened them. Our evidence can be relevant for policy-makers who need to design non-pharmaceutical interventions. It also provides a methodological suggestion for researchers who attempt to estimate their causal effects. Funding: None.
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  • 文章类型: Journal Article
    BACKGROUND: The current retrospective case-control study examined the potential systemic and local risk factors in relationship to external cervical resorption (ECR). The study hypothesis stated that both local and systemic risks are associated with higher ECR rates.
    METHODS: The ECR group included data about 76 patients (98 teeth) diagnosed with ECR at the university graduate endodontics clinic from 2008-2018. An equivalent comparative control group without ECR was composed of the same pool of patients and matched with cases by sex and age. Information about dental and medical history, including potential local risk factors (bruxism, trauma, eruption disorders, extraction of an adjacent tooth, orthodontics, and restorations) and systemic risk factors (medical conditions, medication, and allergies), was collected for both groups. Data were analyzed at tooth and patient levels. The chi-square test or Fisher exact test compared proportions between the 2 study groups.
    RESULTS: The overall ECR prevalence among endodontic patients during the 10-year follow-up was 2.3%. ECR was most frequent in maxillary anterior teeth (31.6%), and the Heithersay class 2 was the most frequent (38.8%) ECR diagnosis. Diabetes was the only significant systemic risk factor (P < .05). Trauma, as a local risk factor, was significantly (P < .05) more frequently reported in cases than in controls.
    CONCLUSIONS: The study hypothesis stating that both systemic and local risk factors were associated with higher ECR rates was partly confirmed, as one systemic (diabetes) and one local (trauma) risk factor were associated with higher ECR rates.
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  • 文章类型: Journal Article
    OBJECTIVE: This retrospective study examined the mid- to long-term clinical and radiographic performance of a tapered implant in various treatment protocols in patients with local and systemic risk factors (RFs).
    METHODS: Two hundred seven NobelActive implants were inserted in 98 patients in the period from 10/2008 to 02/2015. The subdivision of the cohort was defined by local (n = 40), systemic (n = 6), local and systemic (n = 8), or without any RFs (n = 44) to analyze implant survival and marginal bone levels.
    RESULTS: Fifteen implants failed within the follow-up period. The mean follow-up period of the remaining implants was 34 months (range 12 to 77 months). The cumulative survival rate according to Kaplan-Meier was 91.5%. The survival rate for 93 implants in 45 patients with no RFs was 94.8% whereas it was 94% for 83 implants in 48 patients with local RFs (p = 0.618), 81.3% for 14 implants in 6 patients with systemic RFs (p = 0.173), and 76.5% for 17 implants in 6 patients with local and systemic risk factors (p = 0.006). The interproximal marginal bone level was - 0.49 ± 0.83 mm at the mesial aspect and - 0.51 ± 0.82 mm at the distal aspect in relation to implant shoulder level and showed no relevant difference in the various risk factor groups.
    CONCLUSIONS: It can be assumed that the negative effects of the local or/and systemic risk factors were partially compensated by the primary stability and grade of osseointegration of the NobelActive implant.
    CONCLUSIONS: The use of this system in patients with risk factors and immediate loading procedures.
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  • 文章类型: Journal Article
    牙周健康定义为不存在临床可检测的炎症。免疫监视的生物学水平与临床牙龈健康和体内平衡一致。临床牙龈健康可以在完整的牙周组织中发现,即没有临床附着丧失或骨丢失,以及非牙周炎患者(例如,患有某种形式的牙龈退缩或牙冠延长手术后的患者)或有牙周炎病史且目前牙周稳定的患者的牙周组织减少。在治疗牙龈炎和牙周炎后,可以恢复临床牙龈健康。然而,治疗和稳定的牙周炎患者与当前牙龈健康仍然在复发牙周炎的风险增加,因此,必须密切监测。牙龈疾病的两大类包括非牙菌斑生物膜诱导的牙龈疾病和牙菌斑诱导的牙龈炎。非牙菌斑生物膜诱导的牙龈疾病包括不是由牙菌斑引起的并且通常在牙菌斑去除后不解决的各种病症。这种病变可以是全身性病症的表现,或者可以局限于口腔。牙菌斑引起的牙龈炎有多种临床体征和症状,局部诱发因素和系统改变因素都会影响其程度,严重程度,和进步。在非牙周炎患者或目前稳定的“牙周炎患者”中,即成功治疗的牙菌斑诱发的牙龈炎可能出现在完整的牙周膜上或减少的牙周膜上,临床炎症已消除(或大大减少)。患有牙龈炎症的牙周炎患者仍然是牙周炎患者(图1),全面的风险评估和管理对于确保早期预防和/或治疗复发性/进行性牙周炎至关重要。精准牙科医学定义了以患者为中心的护理方法,因此,在临床实践中定义牙龈健康或牙龈炎的“病例”的方式与人口患病率调查中的流行病学方式不同。因此,同时提供了牙龈健康和牙龈炎的案例定义。虽然牙龈健康和牙龈炎有许多临床特征,病例定义主要基于探查时有无出血.在这里,我们对牙龈健康和牙龈疾病/状况进行分类,以及用于定义各种临床情况下的健康和牙龈炎的诊断特征汇总表。
    Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non-periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non-dental plaque biofilm-induced gingival diseases and dental plaque-induced gingivitis. Non-dental plaque biofilm-induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque-induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque-induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non-periodontitis patient or in a currently stable \"periodontitis patient\" i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient-centered approach to care, and therefore, creates differences in the way in which a \"case\" of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations.
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  • 文章类型: Journal Article
    牙周健康定义为不存在临床可检测的炎症。免疫监视的生物学水平与临床牙龈健康和体内平衡一致。临床牙龈健康可以在完整的牙周组织中发现,即没有临床附着丧失或骨丢失,以及非牙周炎患者(例如,患有某种形式的牙龈退缩或牙冠延长手术后的患者)或有牙周炎病史且目前牙周稳定的患者的牙周组织减少。在治疗牙龈炎和牙周炎后,可以恢复临床牙龈健康。然而,治疗和稳定的牙周炎患者与当前牙龈健康仍然在复发牙周炎的风险增加,因此,必须密切监测。牙龈疾病的两大类包括非牙菌斑生物膜诱导的牙龈疾病和牙菌斑诱导的牙龈炎。非牙菌斑生物膜诱导的牙龈疾病包括不是由牙菌斑引起的并且通常在牙菌斑去除后不解决的各种病症。这种病变可以是全身性病症的表现,或者可以局限于口腔。牙菌斑引起的牙龈炎有多种临床体征和症状,局部诱发因素和系统改变因素都会影响其程度,严重程度,和进步。在非牙周炎患者或目前稳定的“牙周炎患者”中,即成功治疗的牙菌斑诱发的牙龈炎可能出现在完整的牙周膜上或减少的牙周膜上,临床炎症已消除(或大大减少)。患有牙龈炎症的牙周炎患者仍然是牙周炎患者(图1),全面的风险评估和管理对于确保早期预防和/或治疗复发性/进行性牙周炎至关重要。精准牙科医学定义了以患者为中心的护理方法,因此,在临床实践中定义牙龈健康或牙龈炎的“病例”的方式与人口患病率调查中的流行病学方式不同。因此,同时提供了牙龈健康和牙龈炎的案例定义。虽然牙龈健康和牙龈炎有许多临床特征,病例定义主要基于探查时有无出血.在这里,我们对牙龈健康和牙龈疾病/状况进行分类,以及用于定义各种临床情况下的健康和牙龈炎的诊断特征汇总表。
    Periodontal health is defined by absence of clinically detectable inflammation. There is a biological level of immune surveillance that is consistent with clinical gingival health and homeostasis. Clinical gingival health may be found in a periodontium that is intact, i.e. without clinical attachment loss or bone loss, and on a reduced periodontium in either a non-periodontitis patient (e.g. in patients with some form of gingival recession or following crown lengthening surgery) or in a patient with a history of periodontitis who is currently periodontally stable. Clinical gingival health can be restored following treatment of gingivitis and periodontitis. However, the treated and stable periodontitis patient with current gingival health remains at increased risk of recurrent periodontitis, and accordingly, must be closely monitored. Two broad categories of gingival diseases include non-dental plaque biofilm-induced gingival diseases and dental plaque-induced gingivitis. Non-dental plaque biofilm-induced gingival diseases include a variety of conditions that are not caused by plaque and usually do not resolve following plaque removal. Such lesions may be manifestations of a systemic condition or may be localized to the oral cavity. Dental plaque-induced gingivitis has a variety of clinical signs and symptoms, and both local predisposing factors and systemic modifying factors can affect its extent, severity, and progression. Dental plaque-induced gingivitis may arise on an intact periodontium or on a reduced periodontium in either a non-periodontitis patient or in a currently stable \"periodontitis patient\" i.e. successfully treated, in whom clinical inflammation has been eliminated (or substantially reduced). A periodontitis patient with gingival inflammation remains a periodontitis patient (Figure 1), and comprehensive risk assessment and management are imperative to ensure early prevention and/or treatment of recurrent/progressive periodontitis. Precision dental medicine defines a patient-centered approach to care, and therefore, creates differences in the way in which a \"case\" of gingival health or gingivitis is defined for clinical practice as opposed to epidemiologically in population prevalence surveys. Thus, case definitions of gingival health and gingivitis are presented for both purposes. While gingival health and gingivitis have many clinical features, case definitions are primarily predicated on presence or absence of bleeding on probing. Here we classify gingival health and gingival diseases/conditions, along with a summary table of diagnostic features for defining health and gingivitis in various clinical situations.
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