Introduction: Periodontal disease (PD) and dental caries are oral infections leading to tooth loss that are associated with atherosclerosis and cerebrovascular disease. We assessed the hypothesis that PD and caries are associated with asymptomatic intracranial atherosclerosis (ICAS) in the Atherosclerosis Risk in Communities (ARIC) study. Methods: Full-mouth clinical periodontal measurements (7-indices) collected at 6 sites per tooth from 6155 subjects from the Dental Atherosclerosis Risk in Communities Study (DARIC) without prior stroke were used to differentiate seven periodontal disease stages (PPC-I to VII) and dental caries on coronal dental surface (DS) and dental root surface (DRS). All participants who had a previous brain MRI were eligible for imaging. A stratified subset underwent 3D time-of-flight MR angiogram and 3D high isotropic resolution black blood MRI. ICAS was graded according to the criteria established by the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. We evaluated the relationship between PD stage and dental caries with asymptomatic ICAS, graded as no ICAS, <50% ICAS, and ≥50% ICAS. Results: Among dentate subjects who underwent vascular imaging, 801 (70%) had no ICAS, 232 (20%) had <50% ICAS, and 112 (10%) had ≥50% ICAS. Compared to participants without gum disease (PPC-I), participants with mild-moderate tooth loss (PPC-VI), severe tooth loss (PPC-VII), and severe PD (PPC-IV) had higher odds of having <50% ICAS. Participants with extensive gingivitis (PPC- V) had significantly higher odds of having ≥50% ICAS. The association remained significant after adjusting for confounding variables: age, gender, race, hypertension, diabetes, dyslipidemia, 3-level education, and smoking status. There was no association between dental caries (DS and DRS) and ICAS <50% and ≥50%. Conclusion: We report significant associations between mild-moderate tooth loss, severe tooth loss and severe PD with <50% ICAS as well as an association between gingivitis and ≥50% ICAS. We did not find an association between dental caries and ICAS.
Introduction: Few studies have systematically investigated the association between periodontal disease (PD) and small vessel disease (SVD) in stroke/TIA patients. White matter hyperintensity (WMH) is a manifestation of SVD in the brain and is a surrogate for vascular cognitive impairment. Methods: Consecutive stroke/TIA patients admitted to our tertiary stroke center were assessed for PD as a part of a stroke study. PD was defined as moderate/severe periodontitis by Center for Disease Control/American Academy of Periodontology Working Group. Periventricular (PVWMH) and deep white matter (DWMH) were rated visually on axial FLAIR imaging using the 4-point Fazeka scale and were categorized into none/mild (grades 0-1) or moderate/severe (grades 2-3). Total WMHs were dichotomized into none/mild (grades 0-2) or moderate/severe (grades 3-6). Student t-tests were performed to test continuous variables, and X 2 test was used to compare categorical variables. Multivariable analysis was conducted using multiple logistic regression to test the association between PD and WMH. Results: A total of 861 consecutive patients, 404 with PD and 457 without PD, were compared for moderate/severe PVWMH and DWMH. Patients with PD were more likely to be African American (AA) compared to whites (55% vs. 36%, p<0.001). They were also more likely to be smokers (62% vs. 42%, p<0.001). Patients with PD were similar in age (63.7±12.0 vs. 63.4 ± 12.8), gender, hypertension, diabetes, hyperlipidemia, and atrial fibrillation status. PD was associated with total WMH (OR 1.51, 95% 1.14-2.00) and DWMH (OR 1.46, 95% 1.08-1.97). PD was not significantly associated with PVWMH (OR 1.30, 95% 0.98-1.73). These associations remained significant after adjusting for age, gender, race, hypertension, diabetes, and smoking for total WMH (Adj. OR 1.38, 95% 1.01-1.88) and DWMH (Adj. OR 1.37, 95% 1.00-1.90) and remained nonsignificant for PVWMH (Adj. OR 1.24, 95% 0.91-1.70). Conclusion: Stroke/TIA patients with PD were more likely to be AA and smokers. We report significant independent associations of PD with total WMH and DWMH manifestations of SVD. This suggests that stroke risk in AA and smokers may be partly mediated by SVD.
Purpose Mechanisms leading to burnout, associated with high turnover in nursing, may start as early as in nursing school. Given health habits (e.g., diet, physical activity, and sleep) can exacerbate or lessen the impact of burnout, this study examined current barriers and facilitators to healthy diet, physical activity levels, and sleep among nursing undergraduates (UGs) and early-career nurses (ECNs). Research Design Qualitative descriptive study. Sample 25 nursing UGs and 25 ECNs (within 3 years of graduation) from a Southeastern college of nursing. Data Collection and Analysis After development of theory-informed interview guides, participants conducted interviews either in-person or by phone, which were audio-recorded and transcribed. Braun and Clarke’s six-step thematic analysis was used to analyze the transcripts. Results All but one (aged 54) UG was in their early 20s and ECNs were in their early to mid-20s. Most participants were white, females. Time and stress were the strongest barriers among UGs and ECNs for adherence to healthy diet, physical activity, although stress did act as a facilitator for physical activity in a subset of both UGs and ECNs. Shiftwork was a common barrier to healthy behaviors among ECNs. Conclusion The fact that the more common and stronger barriers to healthier behaviors among UGs and ECNs were the same give credence to the idea that processes associated with burnout begin during or before nursing education and are persistent.
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