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Conscious Sedation Procedures Using Intravenous Midazolam for Dental Care in Patients with Different Cognitive Profiles: A Prospective Study of Effectiveness and Safety
Valérie Collado, Denise Faulks, Emmanuel Nicolas, Martine Hennequin
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0071240
Abstract: The use of midazolam for dental care in patients with intellectual disability is poorly documented. This study aimed to evaluate the effectiveness and safety of conscious sedation procedures using intravenous midazolam in adults and children with intellectual disability (ID) compared to dentally anxious patients (DA). Ninety-eight patients with ID and 44 patients with DA programmed for intravenous midazolam participated in the study over 187 and 133 sessions, respectively. Evaluation criteria were success of dental treatment, cooperation level (modified Venham scale), and occurrence of adverse effects. The mean intravenous dose administered was 8.8±4.9 mg and 9.8±4.1 mg in ID and DA sessions respectively (t-test, NS). 50% N2O/O2 was administered during cannulation in 51% of ID sessions and 61% of DA sessions (NS, Fisher exact test). Oral or rectal midazolam premedication was administered for cannulation in 31% of ID sessions and 3% of DA sessions (p<0,001, Fisher exact test). Dental treatment was successful in 9 out of 10 sessions for both groups. Minor adverse effects occurred in 16.6% and 6.8% of ID and DA sessions respectively (p = 0.01, Fisher exact test). Patients with ID were more often very disturbed during cannulation (25.4% ID vs. 3.9% DA sessions) and were less often relaxed after induction (58.9% ID vs. 90.3% DA) and during dental treatment (39.5% ID vs. 59.7% DA) (p<0.001, Fisher exact test) than patients with DA. When midazolam sedation was repeated, cooperation improved for both groups. Conscious sedation procedures using intravenous midazolam, with or without premedication and/or inhalation sedation (50% N2O/O2), were shown to be safe and effective in patients with intellectual disability when administered by dentists.
Inequalities in Oral Health for Children with Disabilities: A French National Survey in Special Schools
Martine Hennequin, Véronique Moysan, Didier Jourdan, Martine Dorin, Emmanuel Nicolas
PLOS ONE , 2008, DOI: 10.1371/journal.pone.0002564
Abstract: Background Despite wide recognition that children with disability often have poor oral health, few high quality, controlled results are available. Method Twenty-four objective and subjective criteria covering feeding, autonomy, access to dental care, oral hygiene, oral disease, general health and behavior were evaluated in a observational cross-sectional study of 2,487 children with disability (DC group), 4,772 adolescents with disability (DA group) and 1,641 children without disability (NDC group). Five algorithms ranked the subjects according to clinical criteria in three original oral health indices: the Clinical Oral Health Index (COHI), indicating the level of oral health problems, the Clinical Oral Care Needs Index (COCNI) giving dental care need levels, and the Clinical Oral Prevention Index (COPI) determining possible needs in terms of dental education initiatives. Results DC-group children presented poorer oral health and had greater needs in both treatment and preventive oral health actions than NDC-group children (OR = 3.97, 95% CI = 3.25–4.86 for COHI; OR = 2.01, 95% CI = 1.77–2.28 for COCNI; OR = 5.25, 95% CI = 4.55–6.02 for COPI). These conditions were worse again in the DA group comparing to the DC group (OR = 3.52, 95% CI = 2.7–4.6 for COHI; OR = 1.52, 95% CI = 1.38–1.69 for COCNI; OR = 1.53, 95% CI = 1.39–1.69 for COPI). Conclusion Clinical indices generated by algorithmic association of various clinical indicators allow sensitive clinical measurement, and in this study demonstrated inequalities in oral health for children with disabilities schooling in institutions. Questions need now to be addressed as to the measures that could be taken to compensate for this situation.
A national cross-sectional survey of dental anxiety in the French adult population
Emmanuel Nicolas, Valérie Collado, Denise Faulks, Brigitte Bullier, Martine Hennequin
BMC Oral Health , 2007, DOI: 10.1186/1472-6831-7-12
Abstract: A convenience sample of 2725 adults (mean age = 47 years, SD16, minimum = 16, maximum = 101 years), representative of the French population with regard to age and urban distribution, completed a French version of the Corah Dental Anxiety scale (DAS) and a questionnaire relating to their dental appointments.Moderate dental anxiety (14≥DAS≥13) was revealed for 172 persons (6.2%), while 195 (7.3%) had severe dental anxiety (DAS≥15), giving an overall prevalence of dental anxiety of 13.5%. Prevalence was lower proportionally with age (P < 0.001) and was higher in French overseas territories and in the countryside (P < 0.01). Farmers and low skilled workers were significantly more anxious than executives and shopkeepers (P < 0.001). Anxiety was associated with avoidance of care (p < 0.001) and lack of regular dental appointments (p < 0.001).Dental anxiety in France appears to concern a similar proportion of the population as in other industrialised European, Australasian or North American countries. Recommendations for prevention and management of dental anxiety are made with reference to dental education and health care services in France.Dental anxiety partially limits, or completely prevents, utilisation of oral health care services [1,2]. It increases the prevalence of dental disease [2,3]. Anxious persons present more damaged or missing teeth and less restored teeth [4]. Regular and conventional care is bypassed by dentally anxious persons, who rely on self-care, use of emergency services, and occasionally use of traditional or parallel remedies to relieve pain. The oral health and quality of life of this population are affected [5]. When professional care is provided, it is often given under general anaesthesia without consideration for the aetiological factors behind dental fear. Ideally, the management of patients with dental anxiety requires psycho-behavioural and sedation procedures [6,7] as alternatives to general anaesthesia. Such techniques have been shown t
Comparison of the OHIP-14 and GOHAI as measures of oral health among elderly in Lebanon
El Osta Nada,Tubert-Jeannin Stephanie,Hennequin Martine,Bou Abboud Naaman Nada
Health and Quality of Life Outcomes , 2012, DOI: 10.1186/1477-7525-10-131
Abstract: Background The respective abilities of the GOHAI and OHIP-14 to discriminate between aged patients with different levels of oral diseases have rarely been studied in developing countries. The aim of this study was to compare the discriminative abilities of the OHIP-14 and the GOHAI in an elderly Lebanese population, and particularly to identify persons with different masticatory function. Methods A sample of elderly, aged 65 years or more, living independently was recruited in two primary care offices in Beirut, Lebanon. Data were collected by means of personal interview and clinical examination. The Arabic OHIP-14 and GOHAI questionnaires were used after cultural adaptation for use in Lebanon. The internal consistency, reproducibility and concurrent validity were verified. To test their discriminative abilities, the ADD (GOHAI and OHIP) and SC (GOHAI and OHIP) scores were dichotomized according to the 25th and 75th percentile respectively and logistic regressions were conducted using socio-demographic, clinical and subjective explanatory variables. Results Two hundred and six participants were included; mean age was 72 years and 60% were women. Good psychometric properties were observed for both questionnaires for internal consistency (Cronbach’s alpha>0.88), reproducibility (ICC>0.86) and concurrent validity. Strong correlations were found between GOHAI and OHIP-14 scores but a high prevalence of subjects with no impact was observed using the OHIP-14. Both questionnaires were able to discriminate between participants according to age, perception of temporomandibular joint (TMJ) pain or functional status as represented by the number of dental Functional Units (FU). GOHAI was more discriminant since it identified participants with high dental care needs: high numbers of decayed teeth, low numbers of teeth and socially deprived status. Conclusions Lebanese elderly with high dental care needs and impaired oral health were identified more easily with the GOHAI. These results may guide the choice of dental indicators to use in a national geriatric survey.
Using the International Classification of Functioning, Disability and Health (ICF) to Describe Children Referred to Special Care or Paediatric Dental Services
Denise Faulks, Johanna Norderyd, Gustavo Molina, Caoimhin Macgiolla Phadraig, Gabriela Scagnet, Caroline Eschevins, Martine Hennequin
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0061993
Abstract: Children in dentistry are traditionally described in terms of medical diagnosis and prevalence of oral disease. This approach gives little information regarding a child’s capacity to maintain oral health or regarding the social determinants of oral health. The biopsychosocial approach, embodied in the International Classification of Functioning, Disability and Health - Child and Youth version (ICF-CY) (WHO), provides a wider picture of a child’s real-life experience, but practical tools for the application of this model are lacking. This article describes the preliminary empirical study necessary for development of such a tool - an ICF-CY Core Set for Oral Health. An ICF-CY questionnaire was used to identify the medical, functional, social and environmental context of 218 children and adolescents referred to special care or paediatric dental services in France, Sweden, Argentina and Ireland (mean age 8 years ±3.6yrs). International Classification of Disease (ICD-10) diagnoses included disorders of the nervous system (26.1%), Down syndrome (22.0%), mental retardation (17.0%), autistic disorders (16.1%), and dental anxiety alone (11.0%). The most frequently impaired items in the ICF Body functions domain were ‘Intellectual functions’, ‘High-level cognitive functions’, and ‘Attention functions’. In the Activities and Participation domain, participation restriction was frequently reported for 25 items including ‘Handling stress’, ‘Caring for body parts’, ‘Looking after one’s health’ and ‘Speaking’. In the Environment domain, facilitating items included ‘Support of friends’, ‘Attitude of friends’ and ‘Support of immediate family’. One item was reported as an environmental barrier – ‘Societal attitudes’. The ICF-CY can be used to highlight common profiles of functioning, activities, participation and environment shared by children in relation to oral health, despite widely differing medical, social and geographical contexts. The results of this empirical study might be used to develop an ICF-CY Core Set for Oral Health - a holistic but practical tool for clinical and epidemiological use.
Stochastic dynamics of the magneto-optical trap
Daniel Hennequin
Physics , 2003, DOI: 10.1140/epjd/e2003-00293-3
Abstract: The cloud of cold atoms obtained from a magneto-optical trap is known to exhibit two types of instabilities in the regime of high atomic densities: stochastic instabilities and deterministic instabilities. In the present paper, the experimentally observed stochastic dynamics is described extensively. It is shown that it exists a variety of dynamical behaviors, which differ by the frequency components appearing in the dynamics. Indeed, some instabilities exhibit only low frequency components, while in other cases, a second time scale, corresponding to a higher frequency, appears in the motion of the center of mass of the cloud. A one-dimensional stochastic model taking into account the shadow effect is shown to be able to reproduce the experimental behavior, linking the existence of instabilities to folded stationary solutions where noise response is enhanced. The different types of regimes are explained by the existence of a relaxation frequency, which in some conditions is excited by noise.
Effect of Dental Status on Changes in Mastication in Patients with Obesity following Bariatric Surgery
Anne Espérance Godlewski, Jean Luc Veyrune, Emmanuel Nicolas, Cécile A. Ciangura, Catherine C. Chaussain, Sébastien Czernichow, Arnaud Basdevant, Martine Hennequin
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0022324
Abstract: Background Patients scheduled for bariatric surgery (BS) are encouraged to chew slowly in order to optimise the digestion process. The influence of dental status on patients' ability to comply with advice on chewing behaviour is poorly documented. This study aims to compare modifications of chewing function before and after BS in three groups of obese patients differing in dental status. Method and Findings A cohort of 46 obese women provided three groups: FD group: fully dentate (7–10 functional dental units [FU]); PD group: partially dentate (4–6 FU) without partial dentures; DW group: partial and complete denture wearers. Chewing time (CT), number of chewing cycles (CC), and chewing frequency (CF) were measured before and after surgery during mastication of standardised samples of raw carrot, peanuts, banana, apple and jelly. The median particle-size distribution (D50) of the pre-swallowed bolus was also evaluated for peanut and carrot. Before surgery, the PD and DW groups exhibited greater mean CCs and CTs than the FD group (SNK p<0.05) and produced a bolus with higher granulometry (SNK, p<0.05) than the FD group. After surgery, CT and CC increased for all groups and for all foods, but not statistically significant for jelly. The resulting changes in bolus granulometry observed depended on both food and dental status. The granulometry of carrot bolus remained as fine or as coarse in FD and DW groups respectively as it was before surgery while it was significantly decreased in the PD group (Student's test, p<0.001). Conclusions After bariatric surgery, all the obese patients, regardless of dental status modified their chewing kinematics. The effects of this chewing behaviour on bolus granulometry depended on dental status and type of food. Further studies are needed to understand better the impact of dental status on feeding behaviour and nutrition in patients with obesity.
Evaluation of safe and effective administration of nitrous oxide after a postgraduate training course
Valérie Collado, Emmanuel Nicolas, Denise Faulks, Corinne Tardieu, Marie-Cécile Manière, Dominique Droz, Peter Onody, Martine Hennequin
BMC Pharmacology and Toxicology , 2008, DOI: 10.1186/1472-6904-8-3
Abstract: 45 practitioners were trained between 2002 and 2004. They carried out 826 sessions of inhalation sedation in 662 patients. The clinical competency of this group was compared with an expert group.There was no difference between trainees and experts in ability to complete the planned dental treatment under sedation (89.6% vs 93.2%). Trainees were less successful than experts for patients with intellectual disability (87.4% vs 94.2%, p < 0.01). For both groups, the degree of cooperation improved between initial induction and each perioperative step (Wilcoxon test, p < 0.01). However, for trainees, Venham behaviour scores varied with the type of patient (Kruskal Wallis test, p < 0.001). No major adverse effects were recorded. Trainees reported more minor adverse effects than experts (13% vs. 5.3% respectively, Fisher exact test, p < 0.001)The trainee practitioners provided effective and safe inhalation sedation. This challenges the current French restriction of the 50% nitrous oxide in oxygen premix to the hospital setting. Further emphasis is required on the teaching of behaviour management skills for patients with intellectual disability.In September 2002, four French dental faculties (Clermont-Ferrand, Marseille, Nancy and Strasbourg) set up the first one-year collaborative training course in conscious sedation for dental care. The course objectives were the acquisition of the knowledge, skills and attitudes necessary for the practice of all techniques of conscious sedation relevant to dentistry. This course was evaluated over the first two years in order to validate a minimum training requirement for dentists to ensure safe and effective conscious sedation. Reservations expressed by non-dental professionals, including anaesthetists, could then be addressed [1]. Harmonisation of practices and dental training between European countries could also be improved, as conscious sedation techniques (in particular inhalation and intravenous sedation) have been declared to be
GIS and Multi-Criteria Decision Analysis for Land Use Resource Planning  [PDF]
Martine Nyeko
Journal of Geographic Information System (JGIS) , 2012, DOI: 10.4236/jgis.2012.44039
Abstract: Natural resources management is indispensable in ensuring environmental sustainability and reducing the risk associated with climate change and increasing demand for ecological goods and services. Natural resources planners need to have at their disposal tools that can objectively help in prioritizing land use allocation. Traditional application of land use change model based on economic model, trend analysis, and or scenario analysis present some challenges of data availability and reliability necessary for implementation of the models. However, with the advent of information technology, GIS and remote sensing, biophysical data known for having influence on land use allocation can easily be accessed. The current study explores the application of GIS-Multi-criteria analysis in modeling future land use scenarios for resources planning and management using easy to construct biophysical parameters known for influencing future land use allocation. The decision problems in this study are to find the best spatial allocation of land to future agriculture and forest development, which are considered to present critical land use change in the study area. The afforestation scenarios are meant to offset the pressure on the native forest resources due to the increased demand for fuel and timber and also to contribute to the environmental protection and the agricultural land use scenarios are meant to increase productivity and ensure environmental protection. The land use scenarios did not consider “when” in the future the land use pattern may develop. The analyses of scenarios indicate that afforestation extent in the basin can be increased from 4.6% to 42.9% of the total basin area. However, the afforestation extent of 42.9% may be considered unrealistic, since in practice, it may not be possible to realize up to 42.9% afforestation, nevertheless, the spatial pattern of the afforestation may provide crucial insight into spatial afforestation policies and it future consequences. The agricultural land use can increase from 6.2% to 53.7% of the basin area. The agricultural land use expansion can be realised since the expansion of farm land is primarily the main option to achieve food production increase in the near future. The findings indicate potential use of the methodology in land use planning.
Synchronization in non dissipative optical lattices
Daniel Hennequin,Philippe Verkerk
Physics , 2009, DOI: 10.1140/epjd/e2009-00324-1
Abstract: The dynamics of cold atoms in conservative optical lattices obviously depends on the geometry of the lattice. But very similar lattices may lead to deeply different dynamics. For example, in a 2D optical lattice with a square mesh, the sign of the detuning plays a crucial role: in the blue detuned case, trajectories of an atom inside a well are chaotic for high enough energies. On the contrary, in the red detuned case, chaos is completely inhibited inside the wells. Here, we study in details the dynamical regimes of atoms inside a well of a red detuned lattice, with the aim to understand the dynamical mechanisms leading to the disappearance of chaos. We show that the motions in the two directions of space are frequency locked in most of the phase space, for most of the parameters of the lattice and atoms. This synchronization, not as strict as that of a dissipative system, is nevertheless a mechanism powerful enough to explain that chaos cannot appear in red detuned lattices.
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