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Background: Disabling hearing loss is a prevalent public health issue, with significant impact on patients’ communication. The disability associated with hearing loss depends on the severity of the hearing loss. There are limited rehabilitative measures in resource challenged environment. This study assesses the incidence, the factors for hearing impairment and the management outcome. Methods: A descriptive three-year chart review of patients managed for hearing loss in a tertiary health center in a developing country. The data collected include demographic data, clinical presentation and risk factors for hearing loss, audiometric reports, rehabilitative measures and management outcome. Results: The patients with ear symptoms managed within the study period were 1350, of whom 498 (36.8%) had hearing loss of varying degrees. These included 145 (29.1%) males and 353 (70.9%) females with male to female ratio of 1:2.4. The age ranged from 8 to 80 years (median age of 35.7). Disabling hearing loss in the better-hearing ear occurred in 216 (43.4%) of cases. Increasing age and chronic supportive otitis media were associated with disabling hearing loss. The hearing thresholds improved with hearing aids and ear surgical procedures; nonetheless the patients’ rehabilitation was impaired by limited resources. Conclusion: There is poor rehabilitation of people with hearing loss, though management outcome is commendable in a few of them. Health education will reduce the risk factors for disabling hearing loss and improved rehabilitative measures are needed for these individuals.

Background: Tongue swelling often presents as an acute upper airway obstruction. Aim: To present a case series of patients presenting with an acute tongue swelling sharing our experience in managing these patients. Subjects and methods: A retrospective analysis of consecutive patients presenting acutely to the emergency department (ED) at two institutions in Scotland. All patients were evaluated by an otolaryngologist for probable causes of tongue swelling. Data were collected on demographics, co-morbidities, clinical history, examination findings, acute airway management and subsequent care the patients needed. Results: A total of 32 patients (mean age ± STD, 61.6 ± 18.8; 65% male) were included in the study from two teaching hospitals. The most common presenting symptoms were difficulty in speaking (30/32, 94%) and dysphagia (27/32, 84%). Breathing difficulty was only observed in 8 of 32 patients (25%). Angiotensin converting enzyme (ACE) inhibitor’s induced angioedema was the most common cause (45%) for acute tongue swelling. Three (9.4%) patients required intubation; 2 (6.3%) on initial presentation. Two patients had emergency tracheostomy for breathing difficulties due to supraglottic swelling on flexible pharyngolaryngoscopy. Conclusion: Acute tongue swelling is a life-threatening condition. The patients on ACE inhibitors would appear to be at higher risk of developing acute tongue swelling. Such patients with potentially compromised airway need to be treated in a facility where emergency intubation and tracheostomy can be performed at a short notice.

Introduction: Obesity (BMI ≥ 30 kg m-2) is epidemic globally and is associated with increased risk for a wide range of physical and mental health comorbidities. This is a particular concern for rural residents who have a greater rate of obesity than urban residents, but are disadvantaged in obtaining care because of a shortage of health care professionals. Community health fairs provide an opportunity for rural residents to receive health care services and education at reduced or no cost. Therefore, this study explored the role of community health fairs for providing health services and improving the health of residents in a rural community where obesity is a serious health concern. Methods: This study involved a retrospective longitudinal analysis of data collected during community health fairs conducted in a rural western Nebraska, USA community during 2014, 2015, and 2016 (n = 83). The Planned Approach to Community Health (PATCH) framework was used to target health education in this rural community. This approach involved 1. Mobilizing the community (via health fairs), 2. Collecting and organizing data (from consented attendees), 3. Selecting health priorities (obesity), 4. Developing a comprehensive intervention (nutrition and physical activity education), and 5. Evaluating the effectiveness of the framework (declines in measures of obesity over time). Analyses characterized BMI, percent body fat, visceral fat, and BP and explored differences between genders. The sample was recruited by advertising with flyers for health fairs at the College of Nursing. Most booths provided printouts of results for participants in order for them to keep and track their health information. Once potential participants arrived at the health fair site, there were asked if they would like to participate in the study via an invitation letter. They could then decline or sign the consent. Results: Percent body fat and visceral fat level differed between genders (p = < .001 and .001, respectively). Mean body fat levels (women 39.4%, men 28.8%) were unhealthy. Mean visceral fat level was unhealthy in men (16), but healthy in women (10). BMI and systolic and diastolic blood pressure did not differ between genders. Mean BMI was 31 kg m-2; 33% of participants were overweight, 44% were obese. Mean systolic and diastolic BP were 134 and 78 mg Hg, respectively. Most participants were hypertensive (systolic: men 57%, women 32%; diastolic: men 24%, women 7%) or prehypertensive (systolic: men 21%, women 39%; diastolic: men and women 36%). Conclusion: Obesity and high BP were common in this rural population, supporting the need for effective education and intervention efforts to address these health issues. Health fairs provide a manner in which to reach community persons needing referrals to local clinics, mental health providers and physicians. Education provided at such events is valuable as well and may in fact be the only health care contact they receive. Though community health fairs provide an economical way for individuals to receive screenings and health information, few men participated and few individuals attended in multiple years. The lack of repeat attendees prevented assessment of the efficacy of the education intervention. Means of enhancing participation, particularly by men and previous attendees, need to be explored. Repeatedly attending health fairs enables participants to monitor their progress, seek physical and mental health screenings and discuss any health concerns and helps researchers assess the efficacy of interventions. 

Background: Corneal injuries are significant contributors to blindness. Cornea being the most anterior structure of eye is exposed to various hazards like airborne debris and blunt trauma. By understanding different types of injuries to which cornea is exposed, the practitioner maybe more capable in managing injuries to minimise structural and visual sequelae. Objectives: To study various patterns of corneal injuries and its visual outcome among patients of ocular trauma in a tertiary care hospital. Methods: Study of 100 cases of corneal injuries wherein patients were treated according to injury type and followed up for 4 months. Results: Majority of patients belonged to working population between age groups 21-65 years. Most patients suffered from corneal abrasions while the least common were perforating and lacerating injuries. Alkali injuries were more common than acid injuries. Most patient presented within 24 hours and had only epithelial defects. Therefore, the number of patients receiving conservative management was higher than those receiving surgical intervention. Conclusion: Most common causes of blindness and low vision in our study was full thickness corneal laceration and corneal abrasions, foreign body injuries affecting the pupillary area and involving anterior or mid stroma causing nebular or macular grade opacities hampering vision.

Introduction: Rural populations often experience disparities in health and access to and quality of healthcare. Such disparities may differ among subpopulations. Community outreach events provide an opportunity for rural residents to receive health services and education at reduced or no cost. This project builds on our previous experience with community health fairs by providing health events that target specific underserved subpopulations (rural youth, Latinas, and men). Methods: Our first event provided free sports physicals to area students. The second provided free health screenings to men during an annual agricultural event (Bean Day). The third was a cardiovascular health event for Latinas that featured free or reduced cost health screenings and other health-related and culturally appropriate activities. Results: Thirty-five students received sports physicals, enabling them to participate in sports. Twenty-two Bean Day participants, primarily men, received health screenings; four were hypertensive, three were overweight, and 12 were obese. Over 100 women attended Latina Red Dress and received health services and education. For many in these subpopulations, events such as this provide the only healthcare they receive. During all three events, participants received education regarding any health issues of concern and referrals to local health clinics when appropriate (e.g. hypertension, high glucose levels). Conclusion: Community health events such as these provide culturally appropriate and economical means to deliver health services and education, enabling participants to identify and address any health concerns. Targeting events for underserved subpopulations helped engage them in their healthcare. These findings support the need for effective education and intervention efforts to address physical and mental health concerns in this rural area. This was our first contact with these particular populations whom we know need intervention to receive health care. Moving forward through 2020 and beyond we will have future health fairs in the same groups in order to assess if the health fairs are indeed impacting health of these children, men and minority women. 

WHO declared the coronavirus disease 2019 (COVID-19) outbreak, caused by SARS-CoV-2, to be a pandemic on March 12, 2020. In Morocco, the first case was reported in March 2nd 2020. The mental health of general population, medical and nursing staff especially has been greatly challenged. The aim of the present article is to explore the stress status of medical and nursing staff associated with exposure to the COVID-19. The medical staff was asked to complete a self-reported questionnaire anonymously. In University Hospital Mohamed VI, in Marrakesh, Morocco. During May 2020. In total, 120 valid questionnaires were collected. Among them, there were 57 residents (47,5%), 30 internes (25%), 22 nurses (19%) and others: medicine students and technical staff. The age was between 23 and 60 years. 15% of professional lived alone, 85% with their family, 74% lived with an old person or with a person having a chronic disease. In our study: the severity of symptoms in 36% of the asked professional, deaths among health professionals in 15%, death of a family member in 14%, the rapid spread of pandemic in 90%, the lack of knowledge in 83%, and finally contamination risk especially if comorbidity associated in 2%. Further risk factors: feelings of being inadequately supported by the hospital in 42%, fear of taking home infection to family members or others in 80%, being isolated, feelings of uncertainty and social stigmatization in 43%. The psychological presentation was the nightmare 19 in %, the insomnia in 48%, the somatization in 18%, the irritability in 22%, the aggressiveness in 14%, the nervousness in 70% and the drowsiness in 5%. During the vulnerability of the individual’s conditions during and after the COVID-19, psychological intervention should be done and a mental health support for the health professional.

Background/Aim: In spite of global initiatives to provide sight for all by the year 2020, many middle-aged to elderly people in the Niger Delta still have significant visual impairment due to uncorrected refractive errors. The aim of this study is to assess the types of refractive anomalies that occur among presbyopic patients in Port Harcourt and determine the demographic pattern of these anomalies based on age and gender characteristics. Methodology: This is a hospital-based descriptive cross-sectional study in which sixty consecutive adult patients for refraction were seen. Every adult patient that came to get glasses during the study period was included in the study except where ocular or systemic contraindications were present. In addition to visual acuity, all patients had a detailed ocular examination and then refraction. The collected data was subsequently analysed using SPSS version 20. Results: The mean age of the patients was 54.4 ± 9.4 years with a range of 35 to 80 years. A total of 60 patients were seen, comprising 30 males and 30 females. The commonest refractive error was presbyopia with hyperopic astigmatism and this accounted for 80% of all cases. Hyperopic presbyopia and presbyopia alone were the least common. Conclusion: There is a high level of cylindrical and spherical errors in Port Harcourt. The full optical correction should always be prescribed to presbyopic patients to fully correct the associated visual impairment and improve the patients’ well-being.

Background: Alcohol and chat use during adolescence is associated with academic and health problems, including abuse or dependence in adulthood. The aim of the present study was to investigate associations between adverse childhood experiences (ACEs) and early initiation of alcohol and chat use among school-going adolescents. Methods: A cross-sectional study was performed with 546 school-going adolescents. The ACE International Questionnaire (ACE-IQ) was used to assess ACEs, Alcohol and chat use was assessed by questions prepared by the authors. Multiple logistic regression models were used to examine the associations between overall ACE score and alcohol use and the potential moderating effects of confounders. Results: prevalence of chat chewing behavior was 26.6% followed by alcohol use 20%. A total of 66.2% of participants reported at least one ACE, and 5.93% reported four or more ACEs. High/Multiple ACEs (ACEs=1-3 and above 3) were significantly associated with increased alcohol use behaviors (AOR=1.491(1.072-3.078) and (AOR=3.171(1.330-7.560) respectively and increased chat use behaviors by 4.92 times (AOR=4.92, 95%CI=2.640-8.432) and 11.022 times (AOR=11.022, 95%CI=1.230-25.560) respectively controlling other factors. Conclusion: ACEs were significantly associated with risk behaviors, alcohol and chat use may lead to poor health, and educational outcomes among adolescent students and numbers of ACEs have graded association. Social support, sex, residence, parent educational status, and current level of depressive symptoms were significant modulating factors, which parents, school teachers, psychologists, and adolescent health care providers should give the concern to decrease the effect on school-going adolescents. 

The present study was designed to measure the relationship between the consumption of Information Technology (IT) and anxiety among Pakistani youth. The inquiry included 200 conveniently selected Pakistani youth aged 16 to 24 years from 4 cities. The anxiety subscale of Depression Anxiety and Stress Scale was administered along with a demographic information questionnaire. It was hypothesized that higher use of IT would be positively correlated with higher levels of anxiety among Pakistani youth. The results significantly supported the hypothesis, and it was established that the excessive use of IT is positively and significantly correlated with anxiety. The results are consistent with similar studies carried out in countries other than Pakistan.

Visual impairment is a global health problem. Cataract is responsible for 50% of blindness worldwide [1]. Posterior capsular opacification is the most common late complication of cataract surgery as a result of proliferation of residual lens epithelial cells overall 25% of patients undergoing extra-capsular cataract surgery develops visually significant PCO within 5 years of the operation [2]. Nd: YAG laser provides the advantage of cutting the posterior lens capsule, thereby avoiding and minimizing infection, wound leaks, and other complication of intraocular surgery. Thus Nd:YAG laser capsulotomy is noninvasive, effective and relatively safe technique [3]. However, this procedure is associated with complications such as- postoperative increased intraocular pressure (IOP), cystoid macular edema (CME), disruption of the anterior vitreous surface, uveitis, lens subluxation, increased incidence of retinal detachment and pitting of the IOL [4]. Laser shots can be applied in several patterns such as “Cruciate or Cross pattern”, “Can opener”, inverted “U-Method” and in a “Circular pattern”. Many authors promote the use of a cruciate pattern in the Centre of the visual axis, with the clinician starting off on both axes away from the Centre to avoid pitting the lens centrally [5]. This study mainly aims to analyze the effect of various forms of PCO capsulotomy openings on visual function after Nd: YAG capsulotomy.

The use of Information Technology (IT) has made our live comfortable at present however, it has also generated certain health concerns. The disproportionate exercise of IT, with indication to accessible literature, has been consistently interrelated with psychopathological indications counting the problems of aggression as well. Although this issue was not much focused in Pakistan, this study was planned to determine the connection among the expenditure of IT and aggression in Pakistani youth. The query incorporated 200 conveniently chosen Pakistani youth between 16 to 24 years of age from 4 cities. The Aggression Scale of Buss & Perry was used along with a demographic information questionnaire. The study was hypothesized that among Pakistani youth elevated utilization of IT would be positively correlated with higher levels of aggression. It was significantly proved by the results that elevated utilization of IT is positively and significantly correlated with aggression. The findings of this study may be helpful to psychologists, counsellors, parents and teachers in diagnosing problems of the Facebook generation.

Background: The present study was conducted to study the donor profile and to assess the trends of cornea donation. Methodology: This was conducted as a hospital based cross sectional study at a tertiary care centre in Central India for a period of 5 years. Data was retrieved from 70 patients from eye bank who filled form of eye donation at Eye bank of our institution. Sociodemographic profile of donors, cause of death and time since death was recorded. Source of information regarding corneal donation and reason for not willing to donate the cornea for research purpose was recorded from the filled form. Further cornea enucleated were subjected to serology and their utilization for various purposes were recorded in questionnaire. Results: The present study retrieved data from a total of 70 donor forms with mean age of 65.84 ± 18.4 years. Cornea obtained from younger patients were mainly utilized for corneal transplantation whereas that from elderly age group > 60 years were mainly utilized for research/training purpose and the observed difference was statistically significant (p < 0.01). The corneas retrieved and utilized immediately after death were significantly used for optical or therapeutic purposes (p < 0.05). Conclusion: The present highlights the donor profile and trends of corneal donation at the tertiary care facility of Central India. It was observed that though the younger population and older population both are aware regarding corneal donation but still they are less aware on purpose for which cornea can be utilized. Quality of donor cornea is better when death to enucleation time interval was less.

Background: A cracked tooth may be challenging for dentists because it may present with varied intensities, may be asymptomatic, and may still not be clinically visible. The transilumination method can facilitate diagnosis and ensure appropriate treatment in such cases. The aim of the present article was to report a clinical case of an anterior cracked tooth with a nonesthetic class IV restoration. Clinical considerations: A 22-year-old male patient with chief complaint of esthetics of upper front tooth reported a history of dental trauma. Transilumination with a dental curing light unit was used to examine the region. The tooth 11 was diagnosed with several cracks and a nonesthetic class IV restoration. For repair, the universal adhesive system Scotchbond Universal was applied without previous acid etching, followed by the application of Filtek Z350 of color type B2 (for body) above the old restoration, taking care to slightly overlap the fracture line with the composite and to not extend the composite until the incisal margin. Subsequently, a thin layer of Filtek Z350 of color type B2 (for enamel) was applied over the bevel until the incisal margin, and the tooth shape was carved. Conclusion: This case report demonstrates simplified diagnosis of an anterior cracked tooth with transilumination; following repair, the esthetic quality of the restoration was considered satisfactory and approved by the patient.

The neuromuscular disorders may be hereditary, autoimmune, and in some cases with unknown etiology. These diseases are characterized by progressive course, muscle weakness, and in an advanced stage with binding the patient to a wheelchair. This group includes a number of diseases, but from the dental perspective, the most interesting are muscular dystrophy, multiple sclerosis and myasthenia gravis. Neuromuscular disorders affect the oral cavity and the impact on oral hygiene procedures should be monitored with great attention.

Background: Mechanical chronic neck pain is very common musculoskeletal dysfunction among people, manifesting one or more pain-induced movements and disability impairments. Clinical guidelines suggest passive cervical mobilization and thoracic manipulation as manual therapy interventions. Mulligan concept has positive effect in patients with lumbar and thoracic spine mechanical chronic pain. Study objective was to investigate possible clinical effects of Mulligan techniques in patients with cervical pain according to pain and disability status. Methods: forty participants diagnosed with mechanical chronic cervical pain, randomly assigned into experimental and control group. NAG, SNAG and self-SNAG joint mobilization in a nine-sessions protocol implemented to the study group, while SHAM-Mulligan techniques applied to control group. Self-reported questionnaires Numeric Pain Rating scale (NPRT) and Neck Disability Index (NDI) were used for the measurement of pain and disability levels respectively. Possible Interactions among Factors (TIME X GROUP) and simple effects in three-time measurements of pre, post and one-month follow-up concerning NDI and NPRS variables, were detected with Mixed-ANOVA test. Results: Baseline scores of pain and disability resulted in no differences between groups. A significant Group and Time factors interaction founded and simple main effects analysis showed that Mulligan concept-group had significant improvement in post-intervention NPRT and NDI scores (p<.001), compared to baseline scores. Follow-up also differed compared to post-treatment score (p<.001). SHAM-Mulligan control group had no significant differences in dependent variables at any level of TIME factor (p>.001). Significant differences were found between groups according to second and third measurement phase (p<.001). Conclusion: Our findings suggest that Mulligan concept techniques improve symptoms of pain and disability in chronic mechanical neck pain patients in short and mid-term effect level. Summary: Mobilization techniques of SNAGs, NAGS and self-SNAGs reduces pain and improve function in patients with mechanical neck pain. Taken into consideration the safety and simplicity of application, future studies are encourage to examine the underline mechanism of action.

Radiation of different wavelengths can kill living organisms, although, the mechanism of interactions differs depending on their energies. Understanding the interaction of radiation with living cells is important to assess their harmful effects and also to identify their therapeutic potential. Temporally, this interaction can be broadly divided in three stages – physical, chemical and biological. While radiation can affect all the important macromolecules of the cells, particularly important is the damage to its genetic material, the DNA. The consequences of irradiation include- DNA damage, mutation, cross-linkages with other molecules, chromosomal aberrations and DNA repair leading to altered gene expression and/or cell death. Mutations in DNA can lead to heritable changes and is important for the induction of cancer. While some of these effects are through direct interaction of radiation with the target, radiation can interact with the surrounding environment to result in its indirect actions. The effects of radiation depend not only on the total dose but also on the dose rate, LET etc. and also on the cell types. However, action of radiation on organisms is not restricted to interactions with irradiated cells, i.e. target cells alone; it also exerts non-targeted effects on neighboring unexposed cells to produce productive responses; this is known as bystander effect. The bystander effects of ionizing radiations are well documented and contribute largely to the relapse of cancer and secondary tumors after radiotherapy. Irradiation of cells with non-ionizing Ultra-Violet light also exhibits bystander responses, but such responses are very distinct from that produced by ionizing radiations.

Background: In line with the so-called “embodiment concept”, human bodily experience is characterized by the immediate feeling that our body is localized in a certain position in space and that the self is localized within these body limits. Aim: To verify in a cohort of patients affected by unilateral spatial neglect (NSU) secondary to cerebrovascular damage the possible correlation between a comprehensive neuromotor/neuropsychological rehabilitative treatment and the modification of body representation. Setting: A rehabilitation institute for the treatment of neurological gait disorders and neuropsychological failures. Methods: 12 patients (7 males, 5 females; mean age 60 ± 2yy) affected by NSU secondary to cerebral stroke and recovered in the Neurological Rehabilitation Section of the Clinical Institute Città di Brescia were recruited for the aim of this study. In accordance with our inclusion criteria we recruited 4 patients affected by ischemic stroke and 8 patients affected by haemorragic stroke; 9 patients of our study group arrived from a coma state period. Recruited patients underwent at time T0 (hospitalization day) to a functional impairment evaluation (Motricity Index = MI; Trunk Control Test = TCT; Functional Ambulation Category = FAC) and to a neuropsychological evaluation (Behavioural Inattention Test = BIT; Representional drawing; Personal Neglect evaluation scale); each evaluation was repeated in the same way at time T1 (intertime between 2 and 4 months after hospitalization) and time T2 (inter time between 5 and 6 months after hospitalization). At time T0 each patient began an individualized integrated (motor and neuropsychological) rehabilitative treatment course. Results: In all patients recruited a statistical significant modification was observed for the MI LL left, the TCT and the FAC; no significant statistical modification was observed for the MI UL left, the MI UL and the MI LL right. The t-test showed a significant statistical modification of the personal neglect evaluation scale while no significant statistical modification was defined for the spontaneous human figure drawing test proceeding from time T0 to time T1. The spontaneous drawing of the human figure showed an individual different trend and modification in all patients recruited. A correlation analysis was made comparing the mean value of all motor scales (G1) with the mean value of all neuropsychological scales (G2) and no statistical significant correlation was observed between G1 (T0) and G1 (T1), G1 (T0) and G2 (T0), G1 (T0) and G2 (T1), G2 (T0) and G1 (T1), G2 (T0) and G2 (T1), G1 (T1) and G2 (T1). A second correlation analysis was made comparing all single motor scales with the neuropsychological scales, for the group made by 12 patients and the group made by 5 patients. For the group made by 12 patients, we observed the subsequently significant correlations: MI UL left (T0) correlates with MI LL left (T0); MI LL left (T0) correlates with MI LL left (T1); MI UL left (T1) correlates with MI LL left (T1); MI LL left (T1) correlates with FAC (T1); TCT (T1) correlates with FAC (T1). For the group made by 5 patients, we observed the subsequently significant correlation: TCT (T2) correlates with FAC (T2). In the group made by 12 patients, the mean amelioration of the time related normalized (T0-T1) motor scales is equal to 49% while to 63% was observed for the neuropsychological scales. The mean amelioration of the neuropsychological scale proceeding from time T0 to T1 is equal to 26% with an increase equal to 57% proceeding from time T1 to T2. The neurocognitive amelioration can be observed especially between the 5th and 6th month from the ischemic cerebral damage with a mean increase from 26% to 57%. Conclusions: It would certainly make sense to treat patients with NSU from the neuropsychological point of view in the long term and from the neuro-motor point of view in the first 3-4 months after stroke; in all this, we cannot exclude that an improvement of the visuo-spatial exploration, emphasized by the neuropsychological treatment, can positively influence also patient’s motor outcome.

Objective: The purpose of the study was to evaluate if there is a link between salivary pepsin levels and tooth erosion. Also, to determine if gastroesophageal reflux disease (GERD) is responsible for much of the tooth erosion seen by dentists. Background: Pepsin is only produced within the stomach. If found within other parts of the body [for example within saliva or sputum samples], the only mechanism by which that would be possible is via the reflux of gastric contents. One of the causes of dental erosion is thought to be due to direct contact between tooth surfaces and acidic substances and digestive enzymes present in gastric refluxate. GERD is a common condition, with its prevalence seemingly trending higher in recent decades. It is reportedly a known cause of tooth erosions. From the hypothesis, there was an expectation to see patients with dental erosions to have pepsin detected [and perhaps at high levels] and to see patients without dental erosions to have no or low levels of pepsin. Method: Three saliva samples were collected [on waking and 2 post-prandial] from 50 anonymous participating patients (26 females, 24 males) from a single dental practice. Extra information was collected related to lifestyle, Reflux Symptom Index (RSI – reflux questionnaire) and tooth erosions. These samples were analyzed for the stomach enzyme pepsin using the validated medical device Peptest. Results: There was no correlation between positive pepsin levels and the presence of tooth erosion during this study. There was a statistical difference between the on waking pH vs. positive pepsin levels and post prandial pH vs. positive pepsin levels. The average pH was lower for on waking and post-prandial samples with positive pepsin, suggesting that the saliva was acidic and gastric reflux had occurred. Conversely, the average pH was higher for on waking and post-prandial samples with negative pepsin. There was no statistical difference between pH vs. tooth erosion in the on waking and post- prandial. Conclusion: Patients identified as having tooth erosion did not have higher levels of pepsin detected, suggesting that pepsin was not associated with dental erosion in these patients.

Behavioral dentistry is an interdisciplinary science, which needs to be learned, practiced and reinforced in the context of clinical care and within the community oral health care system. The objective of this science is to develop in a dental practitioner an understanding of the interpersonal, intrapersonal, social forces that influence the patients’ behavior. The clinician must acquire knowledge to develop appropriate behavioral skills with an improved quality of communication and management of patients. Behavior dentistry also teaches to develop a recognition and understanding that the body and mind are not separate entities and focuses on patients’ social, emotional and physiological dental experiences. Behavior is an observable act. It is defined as any change observed in the functioning of an organism. Learning as related to behavior is a process in which experience or practice results in relatively permanent changes in an individual’s behavior. Self-perceptions of dental-facial appearance begin with aesthetic values shared within families and based generally on social norms, but that they may be strongly influenced by peer values and specific experiences of individual children, particularly those involving social responses. Theories incorporating concepts of social comparison and self-efficacy suggest that individuals evaluate themselves in comparison with others in their social environment. Children who perceive themselves to be attractive will reflect those perceptions in their behaviors and generally will receive confirming social responses. The comparison group may express an attractiveness norm that reflects negatively on the individual’s behavior. This, in turn, can affect the individual perceived sense of self-efficacy or adequacy within that group and lead to behaviors that reflect more negative beliefs about the self, thereby inviting still more negative social responses. Patient cooperation is the single most important factor every dentist must contend with. Major considerations are • Regularity in keeping appointments • Compliance in wearing removable appliances • Refraining from chewing hard and tenacious substances that are likely to distort or damage the teeth or crowns • Maintenance of oral hygiene. Laxity in following these instructions may lead not only to compromised treatment but also to slow progress of treatment, loss of chair time and frustration. What may be more interesting to the Dentist than the shaping of self-perceptions in the shaping of behavior that will ensure a successful result of treatment, that is, the patient’s adherence to prescribed routines for self-care and other regimens during Dental treatment. It is helpful in this regard to know that most patients expect improved dental-facial appearance as an outcome of treatment, but there is much more to know about factors influencing cooperation. Poor motivation can also contribute to non-compliance. The regulatory loop requires a motivational system to adjust behavior to coincide with the recommended regimen. A patient may recognize that the regimen is not being followed and yet simply not be motivated to correct the discrepancy. Poor motivation can also result from a lack of concern over the long-term health consequences of one’s behavior and/or a lack of belief in the treatment. Cognitive approaches that emphasize the personal relevance of the regimen or address misconceptions about the treatment may enhance motivation. Several approaches may be useful in treating poor compliance. Providing incentives or rewards for compliant behavior might be a useful strategy to enhance motivation. The cause of noncompliance is multifactorial and strategies to improve compliance must be tailored to fit each situation. Current Dental research focuses on a critical aspect of the feedback; specifically, the input received by the comparator that quantifies the actual amount of adherent behavior. Likewise, Patients, parents, and clinicians need a way to ascertain this information.

Background: The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Aim: To clarify and figure out food habits and different lifestyle pattern among a sample of Palestinian women attending the nutrition center in the Gaza Strip. Methods: A cross-sectional study involved 116 women were randomly chosen by purposive census sampling. They aged 25 to 60 years with a diagnosis of obesity. The data collected by interview questionnaire that included social factors, lifestyle habits, and health/disease history. Results: Age group variable has distributed significantly (p=0.024), (31.0%) of morbid obese were ≥35 years group compared to (13.5%) of morbid obese amongst the younger group. The higher intakes of legumes (OR: 2.134, P=0.003), nuts (OR: 3.917, P=0.019), eggs (OR: 6.840, P=0.009), fast foods (OR: 4.461, P=0.005), and soda drinks (OR: 2.230, P=0.004) were the risk factors linked to the increased risk of morbid obesity. Moreover, the higher intakes of legumes (OR: 8.439, P=0.011), eggs (OR: 6.900, P=0.041), chips (OR: 5.049, P=0.012), sugar (OR: 2.068, P=0.011), and fast foods (OR: 3.029, P=0.025) are risk factors of chronic diseases. Conclusion: The study identified several lifestyle factors and improper dietary habits associated with obesity among women in Gaza city. There is a great need to change these habits to avoid the increased risk of obesity. Gene-environment interaction can explain the high incidence of obesity. A national plan of action to overcome obesity is urgently needed to reduce its economic and health burden