No abstract

We quantified the effectiveness of an oral health intervention among home care recipients. Seven German insurance funds invited home care recipients to participate in a two-arm randomized controlled trial. At t0, the treatment group (TG) received an intervention comprising an oral health assessment, dental treatment recommendations and oral health education. The control group (CG) received usual care. At t1, blinded observers assessed objective (Oral Health Assessment Tool (OHAT)) and subjective (Oral Health Impact Profile (OHIP)) oral health and the objective periodontal situation (Periodontal Screening Index (PSI)). Of 9656 invited individuals, 527 (5.5%) participated. In the TG, 164 of 259 (63.3%) participants received the intervention and 112 (43.2%) received an outcome assessment. In the CG, 137 of 268 (51.1%) participants received an outcome assessment. The OHAT mean score (2.83 vs. 3.31, p = 0.0665) and the OHIP mean score (8.92 vs. 7.99, p = 0.1884) did not differ significantly. The prevalence of any periodontal problems (77.1% vs. 92.0%, p = 0.0027) was significantly lower in the TG than in the CG, but the prevalence of periodontitis was not (35.4% vs. 44.6%, p = 0.1764). Future studies should investigate whether other recruitment strategies and a more comprehensive intervention might be more successful in improving oral health among home care recipients.

Trotz vieler gesetzlicher Maßnahmen erscheint die Mundgesundheit Pflegebedürftiger in häuslicher Pflege immer noch unbefriedigend. In dem vom Innovationsfonds geförderten Projekt „Mundgesundheit bei Pflegebedürftigen“ wird untersucht, inwieweit eine Verbesserung der Mundgesundheit erreicht werden kann, wenn Krankenkassen proaktiv einen Zahnarztbesuch initiieren. Der Beitrag skizziert das Projekt und stellt Ergebnisse der Prozessevaluation dar. Wie sich zeigt, ist das größte Problem dieses zugehenden und aufsuchenden Ansatzes, dass es nicht gelingt, die Zielgruppe zielgenau und umfassend anzusprechen.

In this study, we attempted to determine the proportion of type V neurons relative to the putative whole neuron population in the two submucosal plexuses of pigs identified by their neurofilament immunoreactivity. The total neuron number was estimated in cuprolinic blue (CB)/anti-Hu protein (HU) costained wholemounts as the sum of the number of CB+/HU+, CB+/HU– and CB–/HU+ neurons. In the external submucosal plexus (ESP), HU labelled 98.6% and CB 97.3% of neurons. In the internal submucosal plexus, HU labelled 98.3%, whereas CB only marked 92.5% of neurons. Furthermore, we investigated the chemical coding of submucosal type V neurons and searched for submucosal, non-type V neurons displaying the same chemical coding as the myenteric type V neurons described earlier, i.e. the colocalization of calcitonin gene-related peptide (CGRP) and somatostatin (SOM). In order to facilitate immunohistochemical detection of neuroactive peptides, ileal segments were pretreated with colchicine prior to fixation. Type V neurons in the ESP occurred either as single cells displaying one or few prominent dendrite(s) or within aggregates displaying a dendritic tangle. In this plexus, type V neurons amounted to between 0.9 and 1.6% of all CB-stained neurons. ESP type V neurons displayed immunoreactivities for choline acetyl transferase (95.8%) and leucine-enkephalin (73.9%). All type V neurons were negative for neuronal nitric oxide synthase. Fifty-eight percent of ESP CGRP/SOM co-immunoreactive neurons displayed type V morphology, whereas 42% were non-type V neurons. Thus, the chemical coding of ESP type V neurons is in principal similar to that of the myenteric type V neurons described earlier. In the internal submucosal plexus, we found no type V neurons. In this plexus, 0.2% of all neurons counterstained with HU displayed CGRP/SOM coreactivity. As had been observed earlier concerning the myenteric type V neurons, ESP type V neurons were also closely apposed by conspicuous accumulations of boutons reactive for the same markers as the neurons themselves. Although we cannot exclude that axons of CGRP/SOM-reactive enteric, non-type V or extrinsic neurons end synaptically on type V neurons, we suggest that the main synaptic input to type V neurons originates from other type V neurons. This presents an argument for an interneuronal role of type V neurons.