Magister Chirurgiae Dentium (MChD) / Occupational hazards are common among many professions and dentistry is no exception. Occupational hazards include percutaneous injuries, inhalation of noxious chemicals, noise and musculoskeletal disorders (MSD). Despite the fact that MSD have been documented to be very prevalent among dentists in various countries, there is a paucity of literature from South Africa. Aim The aim of the present study was to determine the prevalence of musculoskeletal disorders among the dentists in KwaZulu-Natal (KZN), South Africa and to identify risk factors associated with it. The study was a cross-sectional, descriptive one and questionnaires were used to elicit information regarding socio-demographic details, medical history, work history and work-related posture information from dentists based in KwaZulu-Natal. A convenience sample of all qualified dentists in this region who were registered members of the South African Dental Association (SADA) was used. Results One hundred and nine dentists responded to the questionnaire. The response rate was 31%. The majority were male; a third aged between 30 - 39 years and the ratio of females to males was 1:3. Almost all the dentists reported pain in the neck, lower back and shoulder. Less than a quarter of the dentists in KZN reported hand pain, numbness in the hands and a tingling sensation in the hands. More than three quarters reported that they had no negative effects when performing restorative work and scaling and polishing, but 3.1% reported having extreme levels of pain. The most common working position reported was the 2 0' clock position. Nearly three quarters rotated their necks while performing clinical dentistry and a third tilted their shoulders towards their dominant hand. There was no relationship between Body Mass Index (BMI) and whether respondents treated patients while seated or standing and neither was there a relationship between pain in the lower back and BMI. There was a strong association between pain in the neck while performing clinical work and the number of years in practice confounded by age. When compared to other countries the prevalence of MSD is very high. The highest occurrence was for neck, back and shoulder pain. Avoiding these injuries is critical and self-recognition is important in either preventing further injuries or in increasing severity of the condition. The findings of this study suggests that it may be valuable to include ergonomic work practice in the training of dentists and dentists should be involved in a proper exercise routine which should include stretching and weight training to prevent injuries. Regular breaks should be taken to perform stretching exercises in-between the management of patients in order to reduce the risk of MSD.

No description available.

Purpose. To evaluate the effect of Fit Kids for Life (FKFL), a multi-disciplinary exercise and nutrition intervention, on body composition, fitness levels, cardiovascular risk factors and quality of life among overweight and obese children. Subjects. Forty-eight overweight or obese children (BMI ≥ 85th percentile), ages 8-17, were matched by age and BMI and then randomized into an exercise or wait list control group. The groups were similar at baseline for age, gender and ethnicity (p>.05). Method. The exercise group trained for 60 minutes, two times per week for 10 weeks, then performed a 10 week home program. After 10 weeks of waiting to start, the control group began the 10 week exercise program followed by a 10 week home program. Body composition (dual energy X-ray absorptiometry), fitness measures, quality of life, and cardiovascular risk factors were assessed at baseline, at completion of the 10 week intervention and following the 10 week home program. Results. Body composition improved over time in both groups with significant changes in % body fat and % lean tissue noted between baseline and twenty weeks (p<.05). Fitness measures improved and changes were maintained or increased during the home program phase. Cardiovascular risk factors remained unchanged between groups and across time, with the exception of systolic blood pressure which increased at 10 weeks. The physical domain of the Impact of Quality of Life scale significantly improved following completion of the program (p<.05). Conclusions.Overweight and obese children who completed the 10 week FKFL program improved their body composition and fitness levels. The beneficial changes were sustained or improved following an additional 10 week home program. Recommendations. Overweight and obese children can benefit from a 10 week multidisciplinary exercise and nutrition program. The use of body composition methods and fitness measures may be better indicators of program effectiveness.

Objetivo: Evaluar la asociación entre el estado nutricional de jóvenes peruanos que pertenezcan a una familia biparental y su estado nutricional luego de siete años de análisis. Métodos: Análisis de datos secundarios de la base de datos Niños del Milenio. Se incluyeron participantes peruanos que tenían ocho años en el año 2002 y fueron seguidos hasta el 2009. Los datos se trabajaron como una cohorte prospectiva. La variable de resultado es el índice de masa corporal (IMC) kg/m2 de los jóvenes y la variable de exposición fue pertenecer a una familia biparental Resultados: La muestra final fue de 625 jóvenes, de los cuales el 53,0% eran varones. La mediana de edad al inicio del estudio fue de 8 años (DE 0,05). Aquellos que pertenecían a familias biparentales representaron al 79,5%. El promedio de IMC de los varones fue 20,5 kg/m2,lo cual fue significativamente menor al de las mujeres (21,7 kg/m2) (p< 0,001). En las familias no biparentales el promedio de IMC fue 21,2 kg/m2 en comparación al 21,0 kg/m2 de las familias biparentales, la diferencia no fue estadísticamente significativa (p=0,447). Conclusión: No se encontró asociación entre el estado nutricional de jóvenes peruanos que pertenecen a una familia biparental a los 8 años y su estado nutricional siete años después. / Objective: Evaluate the association between the nutritional status of peruvian youth that belong to a twoparent family and their nutritional status after seven years of analysis. Methods: Analysis of secondary data from the Young Lives database. It included peruvian participants that were eight years old in 2002 and were followed up until 2009. This is a prospective longitudinal study. The outcome variable is the Body Mass Index (BMI) in young people and the exposure variable was having two-parent and non-two parent families. Results: A total of 625 adolescents were analyzed. From that total, 53,0% were male. The median of age was 8 years old (SD 0,05). The ones that belonged to a two parent families were 79,5%. The BMI average in men was 20.5 kg/m2 and was significantly lower average than women (21.7 kg/m2) (p<0.001). In non-two parent families the average BMI was 21,2 kg/m2 against 21,0 kg/m2 for two-parent families, the difference was not significant (p=0,447) Conclusion: No association was found between the nutritional status of young Peruvians belonging to a biparental family at 8 years of age and their nutritional status seven years later. / Tesis

No description available.

Les expériences de maltraitance vécues à l’enfance ont été associées à une morbidité physique et psychologique, dont un plus grand risque de développer des maladies cardiovasculaires (MCV). Ceci pourrait être expliqué par les effets de la maltraitance sur la régulation émotionnelle et l’indice de masse corporelle (IMC). Objectifs : Évaluer si (1) la maltraitance est associée à un IMC plus élevé au départ et à une augmentation plus importante de l'IMC 5 ans plus tard chez les adultes plus âgés souffrants de maladie coronarienne (MAC) ou d'autres maladies chroniques; (2) le sexe et/ou le statut coronarien influencent ces résultats; et (3) les symptômes d'anxiété, de dépression et de stress perçu (comme indices de dérégulation émotionnelle) expliquent l'association entre la maltraitance et l’IMC au suivi. Participants et méthodes : 1232 hommes et femmes (âgés de 60,86 ± 6,95 ans) ont rempli des questionnaires validés sur la maltraitance et les symptômes de détresse psychologique. Le poids en kilogrammes et la taille du participant ont été recueillis. L'IMC du participant a été calculé en utilisant le rapport poids (kg)/taille (m2). Résultats : La maltraitance n'était pas associée à l'IMC au départ ni lors du suivi. Cette relation n'était pas modérée par le sexe ou le statut de MAC. La maltraitance dans l'enfance était associée à une détresse psychologique significativement plus importante au départ (tous les p < ,001), mais ces derniers n'expliquaient pas cette relation au suivi. Conclusion : La maltraitance n'était pas associée à l'IMC au départ ni à l'IMC cinq ans plus tard. La dysrégulation émotionnelle résultant de la détresse psychologique a été associée à un risque accru de morbidité et de mortalité et peut représenter une cible importante pour la prévention et l'intervention, y compris en ce qui concerne la promotion d'habitudes de vie plus saines chez des personnes ayant vécu de la maltraitance. / Objectives: Childhood trauma has been associated with greater psychological and physical morbidity, including a greater risk of developing coronary artery disease (CAD). Mechanisms leading to increased risk of illness may involve emotional dysregulation and increased body mass index (BMI). This study evaluated whether (1) childhood maltreatment is associated with higher BMI at baseline and with greater increases in BMI 5 years later among older adults with CAD or other chronic illnesses; (2) sex and/or CAD status influence these results; and (3) symptoms of anxiety, depression, and perceived stress (as indicators of emotional dysregulation) mediate the association between childhood maltreatment and BMI at 5-year follow-up. Participants and Methods: A total of 1232 men and women (aged 60.86 [6.95] years) completed validated questionnaires on childhood maltreatment and symptoms of psychological distress. Weight in kilograms and height were collected for each participant, and their BMI was calculated using the ratio of weight (kg)/height (m2).Findings: Childhood maltreatment was not associated with BMI at baseline nor at follow-up. This relation was not moderated by sex nor CAD status. Childhood maltreatment was associated with significantly greater psychological distress at baseline (all ps<.001), though the latter was not found to mediate this relation at follow-up. Conclusion: Childhood maltreatment was not associated with BMI at baseline nor with BMI five years later. Emotional dysregulation resulting from psychological distress has been associated with increased risk for morbidity and mortality and may represent an important target for prevention and intervention, including as concerns promoting healthier lifestyle habits. However, further studies are needed.

No description available.

Obesity is related to poor academic achievement, reduced quality of life, discrimination, lower educational attainment, lower earnings, and a number of socio-emotional problems (Dockray et al., 209; Erickson et al., 2008; Gerberding, 2008; Roth et al., 2008; Salvy et al., 2008; Barlow, 2007; Marsh et al, 2007; Storch et al., 2007; Davison & Birch, 2002; Braet et al., 1996). The present study investigates the significance of English, math, and physical self-concept as moderators of the relationship between Body Mass Index (BMI), academic achievement, and psycho-social outcomes of depression and anxiety. The study includes 15-year-old female and male participants from the database of the Study of Early Child Care (SECC) by the National Institute of Child Health and Human Development (NICHD). The research controls for prior self-concept measured in 6 th grade, academic achievement measured in 5 th grade, psycho-social factors measured in 6 th grade, and attendance measured in 8 th grade. Other controls measured at the same time as the independent and dependent variables include the amount of TV watched and SES. Overall findings suggest that among females BMI was significantly related to each of the outcome variables with the exception of English achievement. There was a negative relationship between BMI and achievement in math and positive relationships between BMI and depression and anxiety among females. For males, there was only one significant relationship between BMI and an outcome variable, achievement in English (a negative relationship). Overall, BMI does not appear to be correlated with negative socio-emotional outcomes of depression and anxiety nor does it appear to be related to achievement in math among males. However, among females BMI does appear to be related to negative socio-emotional and achievement outcomes. Self-concept in math interacts with BMI in its effects on achievement in math however self-concept does not appear to be a protective factor. For males, physical self-concept interacts with BMI in its effects on depression however; it again does not appear to be a protective factor against these negative outcomes.

Objectives. Evaluate C-reactive protein (CRP) levels according to weight and physical activity. The study explored how changes in CRP were associated with baseline CRP, weight, and physical activity and changes in these variables. Methods. A randomized controlled study design assigned 348 individuals to the intervention or control group with measurements taken at baseline, 6 weeks, and 6 months of body weight, physical activity, and serum CRP levels. Participants attended an intensive 40-hour educational course delivered over a four-week period. Results. At baseline, CRP was negatively associated with total steps/week, and positively associated with weight, BMI, percent fat, and saturated fat at baseline. CRP significantly decreased through 6 weeks and also through 6 months for only those with high CRP at baseline. For those with high CRP at baseline, the decrease was significant for normal, overweight, and obese groups of people. Changes in weight or physical activity were not significantly associated with changes in CRP. Conclusions. Over 6 week and 6 month follow-up periods, the intervention failed to discriminate changes in CRP. Changes in CRP were only associated with baseline levels of CRP and BMI and were not associated with changes in any of the selected variables considered.

Die Implantation eines linksventrikulären Herzunterstützungssystems (LVADs) hat sich in den letzten Jahren als eine vielversprechende Therapieoption für die terminale Herzinsuffizienz etabliert. Obwohl Infektionen nach LVAD-Implantation eine der häufigsten Komplikationen darstellen, sind die Veränderungen immunologischer Parameter vor und nach LVAD-Implantation unzureichend untersucht. Ein Großteil der Patienten mit LVAD-Implantation leidet unter Adipositas und weist damit zusätzliche Risikofaktoren in Bezug auf die Ausbildung von Komplikationen, insbesondere Infektionen auf. Deshalb wurde in der vorliegenden Studie untersucht, welche Veränderungen sich in Bezug auf ausgewählte immunologische Zellparameter in Abhängigkeit vom Body-Mass-Index (BMI) im ersten Jahr nach LVAD-Implantation ergeben. Die Patienten wurden anhand ihres BMI zum Zeitpunkt der LVAD-Implantation einer von drei Gruppen (Gruppe A, Normalgewicht: BMI von 18,5-24,9 kg/m2; n = 17; Gruppe B, Präadipositas: 25,0-29,9 kg/m2; n = 24; Gruppe C, Adipositas: ≥ 30,0 kg/m2; n = 27) zugeordnet. Die Gruppen wurden anhand der Erhebung demografischer Daten, vor Implantation bestehender Komorbiditäten, im postoperativen Verlauf auftretender Komplikationen sowie klinischer Laborparameter verglichen. An vier Messzeitpunkten (vor Implantation, 3 Monate, 6 Monate und 12 Monate nach LVAD-Implantation) wurden Vollblut- und Serumproben entnommen. Diese wurden mittels Durchflusszytometrie auf zelluläre Immunzellpopulationen, wie T- und B-Zellen, regulatorische T-Zellen (Tregs), dendritische Zellen (DCs) sowie Natürliche Killerzellen (NK-Zellen) untersucht. Mittels Multiplex-Analyse wurde das Zytokinprofil analysiert. In der vorliegenden Studie waren die Gruppen in Bezug auf ihre demografischen Daten, vor Implantation bestehender Komorbiditäten und nicht-infektiöser Komplikationen im Verlauf nach LVAD-Implantation vergleichbar. Die Analyse der T-Zellen und ausgewählter T-Zell-Subpopulationen zeigte zum einen eine stärkere Erhöhung der T-Zellen bei präadipösen Patienten, geringere Anteile der CD8+ T-Zellen bei adipösen Patienten ein Jahr nach LVAD-Implantation sowie geringere Anteile von Tregs bei präadipösen Patienten ab sechs Monaten nach LVAD-Implantation. Ein Jahr nach LVAD-Implantation wiesen adipöse Patienten einen höheren Anteil an DCs auf als normalgewichtige und präadipöse Patienten. Eine vertiefende Analyse der Subpopulationen von mDCs und pDCs anhand der BDCA-Oberflächenmoleküle ergab, dass normalgewichtige und präadipöse Patienten im Verlauf des ersten Jahres nach LVAD-Implantation eine Erhöhung der Anteile BDCA1+ und BDCA3+ mDCs aufwiesen. Die Anteile der BDCA4+ pDCs waren bei den präadipösen und adipösen Patienten im Vergleich zu den normalgewichtigen Patienten drei Monate nach LVAD-Implantation reduziert. Es konnten keine Unterschiede der Anteile von NK-Zellen zwischen normalgewichtigen, präadipösen und adipösen Patienten detektiert werden, jedoch zeigte sich bei adipösen LVAD-Patienten im Vergleich zu den Normalgewichtigen zum ersten Messzeitpunkt nach LVAD-Implantation ein erhöhter Anteil der CD56bright NK-Zellen und ein reduzierter Anteil der CD56dim NK-Zellen. Zusammenfassend lässt sich mit dieser Studie ein deutlicher Einfluss des BMI auf immunologische Veränderungen nach LVAD-Implantation nachweisen. Neben den adipösen LVAD-Patienten zeigten auch präadipöse LVAD-Patienten weitreichende Änderungen immunologischer Zellparameter, die NK-Zellen, Tregs, DCs sowie CD4+ und CD8+ T-Zellen betrafen. Die Betrachtung aller nachgewiesenen immunologischen Veränderungen präadipöser und adipöser Patienten deutet auf eine eingeschränkte antivirale und antibakterielle Immunreaktivität und damit auf ein erhöhtes Risikoprofil für Infektionen nach LVAD-Implantation hin.:1. Inhaltsverzeichnis II 2. Abbildungsverzeichnis IV 3. Tabellenverzeichnis VII 4. Abkürzungsverzeichnis IX 5. Einführung 1 5.1 Herzinsuffizienz und linksventrikuläre Herzunterstützungssysteme 1 5.2 Infektionen als Komplikation nach LVAD-Implantation 4 5.3 Immunologische Parameter bei Herzinsuffizienz und nach LVAD-Implantation 6 5.3.1 T-Zellen 6 5.3.2 B-Zellen 8 5.3.3 Dendritische Zellen 9 5.3.4 Natürliche Killerzellen 10 5.3.5 Zytokine 10 5.4 Einfluss einer Adipositas auf das Outcome nach LVAD-Implantation und auf immunologische Parameter 12 6. Aufgabenstellung 14 7. Materialien und Methoden 15 7.1 Studiendesign und Probenentnahme 15 7.2 Probenaufarbeitung 17 7.3 Durchflusszytometrie 17 7.3.1 Messung der Immunzellpopulationen 19 7.3.2 Auswertung der durchflusszytometrischen Daten 22 7.4 Multiplexanalyse 26 7.5 Demografische Datenerhebung 28 7.6 Statistik 28 8 Ergebnisse 29 8.1 Demografische Daten und Komorbiditäten 29 8.2 Medikation im Zeitraum von sechs Wochen vor LVAD-Implantation 31 8.3 Gesundheitlicher Verlauf im Zeitraum von einem Jahr nach LVAD-Implantation 33 8.3.1 Gesundheitlicher Verlauf ohne Betrachtung eines Infektionsgeschehens 33 8.3.2 Infektionsgeschehen im Zeitraum von einem Jahr nach LVAD-Implantation 33 8.4 Flussraten des LVADs im Zeitraum von einem Jahr nach LVAD-Implantation 36 8.5 Vergleich ausgewählter Laborparameter 36 8.5.1 Hämatokrit, Erythrozyten- und Hämoglobinkonzentration 36 8.5.2 Thrombozytenkonzentration 39 8.5.3 Leukozytenkonzentration 40 8.5.4 CRP-Konzentration 40 8.5.5 Quick-Wert und die INR 41 8.6 Durchflusszytometrische Analyse 43 8.6.1 CD3+ T-Zellen 43 8.6.2 CD3+ CD8+ T-Zellen 44 8.6.3 CD3+ CD4+ T-Zellen 46 8.6.4 Regulatorische T-Zellen 49 8.6.5 B-Zellen 50 8.6.6 Zirkulierende DCs 50 8.6.7 Plasmazytoide DCs 51 8.6.8 Myeloide DCs 53 8.6.9 NK-Zellen 55 8.6.10 CD56bright und CD56dim/- NK-Zellen 56 8.7 Analyse der Immunbalance 58 9 Diskussion 60 10 Zusammenfassung der Arbeit 69 11 Literaturverzeichnis 71 12 Anhang 83 13 Selbstständigkeitserklärung 97 15 Danksagung 98