Social Network Factors Affect Nutrition Risk in Middle-Aged and Older Adults: Results from the Canadian Longitudinal Study on Aging.

OBJECTIVES: To determine which social network, demographic, and health-indicator variables are associated with SCREEN-8 (nutrition risk) scores at two time points, three years apart, using data from the Canadian Longitudinal Study on Aging. DESIGN: A retrospective cross-sectional study. SETTING AND PARTICIPANTS: 17051 Canadians aged 45 years and older with data from baseline and first follow-up of the Canadian Longitudinal Study on Aging. MEASUREMENTS: Nutrition risk was measured using SCREEN-8. Social network factors included social network size, frequency of contact with social network members, social participation, social support, self-rated social standing, and household income. Demographic variables included age, sex assigned at birth, marital status, educational attainment, and living situation (alone or with others). Health-indicator variables included depression, disability, and self-rated general health, mental health, healthy aging, and oral health. Multivariable linear regression was used to analyze the relationship between the social network, demographic, and health-indicator variables and SCREEN-8 scores at two time points, three years apart. RESULTS: Among the social network variables, individuals with higher social participation, self-rated social standing, and social support had higher SCREEN-8 scores at baseline and follow-up. Among the demographic variables, individuals who were single or widowed, compared to married or partnered, had lower SCREEN-8 scores at both time points. For the health-indicator variables, individuals who screened negative for depression, and those with higher self-rated general health, healthy aging, and oral health had higher SCREEN-8 scores at both time points. At baseline, as age increased, SCREEN-8 scores also increased. CONCLUSION: Individuals with low social participation, low social standing, and low social support may be at increased nutrition risk and should be proactively screened by healthcare professionals. Interventions and community programs designed to increase levels of social participation and foster social support may help to reduce the prevalence of nutrition risk.

Masseter muscle thickness as a predictive variable in treatment outcome of the twin-block appliance and masseteric thickness changes during treatment.

OBJECTIVES: To estimate the association of initial masseter muscle thickness with treatment outcomes using functional appliances and the effect of treatment on masseter muscle thickness. MATERIAL AND METHODS: Twenty-two children, aged 8-12, with skeletal and dental class II relationships and increased overjet were treated with twin-block appliances for 9-17 months, until a class I molar relationship and decreased overjet was achieved. Dental casts, lateral cephalograms, and ultrasonographic measurements of the masseter muscle were performed before and after treatment. Twenty-two children, aged 8-12, without immediate need for orthodontic treatment, served as controls. They were observed for 11-17 months, and ultrasonographic masseter muscle measurements were taken before and after the observation period. RESULTS: Masseter muscles in treated children were thinner at the end of treatment, while untreated controls showed an increase in thickness. Treated children with thinner pre-treatment muscles showed greater mandibular incisor proclination, distalisation of maxillary molars, and posterior displacement of the cephalometric A point during treatment. CONCLUSION: Treatment of a dental class II relationship with functional appliances leads to mild atrophy of the masticatory muscles, possibly because of their decreased functional activity. The initial condition of the muscles may be associated with mandibular incisor proclination, and the position of maxillary first molars and A point.

Iatrogenic injury in childhood staphylococcal scalded skin syndrome.

Staphylococcal scalded skin syndrome (SSSS) may cause significant morbidity in children. It is common practice for adhesive occlusive dressings to be used to apply topical local anaesthetic prior to venepuncture. We report two cases in which removal of these dressings from children with SSSS caused injury and discomfort in areas previously free from blistering. We recommend that an alternative method of topical anaesthetic application is used to minimize skin trauma in these patients.

Posttreatment changes after successful correction of Class II malocclusions with the twin block appliance.

This investigation is a continuation of a previously published study assessing the treatment effects of the Twin Block appliance. All active treatment was carried out during the mixed dentition stage (mean starting age, 9 years 1 month) with final follow-up for the treatment group occurring in the permanent dentition (mean age, 13 years 1 month). Of the original group consisting of 28 consecutively treated severe skeletal Class II patients, 26 were available for follow-up. A comparison group of 28 untreated Class II subjects matched for age, sex, and vertical facial type was obtained from the Burlington Growth Centre according to the original study design. Of these 28 control subjects, 24 had 4-year follow-up cephalometric films available. The mean age of the controls was 12 years 11 months at the time of follow-up. During the active treatment phase, the Twin Block group experienced an average increase in mandibular unit length of 6.5 mm over a mean of 14 months (annualized rate of change of 5.6 mm per year). In comparison, the control group experienced a 2.3 mm increase in mandibular unit length during the 13-month observation period (annualized rate of 2.1 mm per year). In the posttreatment phase, the change in mandibular unit length for the Twin Block group was 6.0 mm over a 36-month period (annualized rate of change of 2.0 mm per year). The control group experienced an average increase in mandibular unit length of 6.7 mm over the posttreatment assessment period that was 34 months in duration (annualized rate of change of 2.4 mm per year). Although there was a slight reduction in mandibular growth rate after treatment, much of the significant increase in mandibular length achieved during the active phase of treatment with the Twin Block appliance was still present 3 years later when the subjects had matured into the permanent dentition stage.

Treatment of keratosis pilaris atrophicans with the pulsed tunable dye laser.

BACKGROUND: Few therapies are currently available to treat keratosis pilaris atrophicans (KPA), a spectrum of disorders which includes ulerythema ophryogenes and atrophoderma vermiculata. OBJECTIVE: To evaluate the response of KPA to treatment with the pulsed dye laser (PDL) with regard to improvements in erythema and skin roughness, treatment tolerability, and side effects. METHODS: Treatment of all facial areas involved with KPA with the PDL at 585 nm was evaluated in 12 patients. Prior to and after each treatment skin erythema was estimated using an erythema meter, and skin roughness was analysed using micrometer evaluation of a skin surface biopsy taken from the same mapped area and analysed by computer to calculate the roughness profile. RESULTS: Patients received 2 to 8 treatments with the PDL with energies ranging from 6.0 to 7.5 J/cm2. Clinical improvement was noted in all patients with significant reduction in erythema scores. Pre-treatment scores ranged from 4 to 13 (mean 8.3) and post-treatment 0 to 8 (mean 3.1) (P < 0.05). Improvements in skin roughness were clinically apparent in all but two patients, but these were not significant on evaluation of skin surface biopsies. Treatment was generally well tolerated, and side effects other than local pain during treatment were very few. CONCLUSION: PDL treatment appears to be a safe and effective treatment for the erythema associated with KPA but does not give significant improvement in associated skin roughness.

Treatment effects of the twin block appliance: a cephalometric study.

A clinical study was undertaken to investigate the treatment effects of a modified Twin Block appliance. Pretreatment and posttreatment cephalometric records of 28 consecutively treated patients with Class II malocclusions were evaluated and compared with an age- and sex-matched sample of untreated Class II control subjects. The treatment group was considered to have severe skeletal Class II malocclusions and was treated using only the Twin Block appliance. Results indicated that mandibular growth in the treatment group was on average 4.2 mm greater than in the control group over the 14-month treatment period. In addition, some dentoalveolar effects in both arches contributed to the overjet correction. No statistically significant increase in the SN-mandibular plane angle occurred during treatment and, in general, the magnitude and direction of the skeletal changes were found to be quite favorable.

A practical guide to topical therapy in children.

The parents of children with skin disease are often unsure how much topical therapy, particularly of corticosteroids, they should apply. The aims of this study were to devise simple guidelines on topical therapy for children, parents, doctors and nurses, and to check the accuracy of these guidelines in practice. The guidelines are based upon four principles: the adult fingertip unit (FTU); the 'rule of 9s'; standard height and weight charts for children; and standard nomograms for calculating body surface area. Twenty-four children (11 boys and 13 girls) aged 6 months to 9 years 4 months with atopic eczema were recruited and the number of FTUs required to treat different anatomical areas calculated in accordance with the proposed guidelines. Ointment was applied and the number of FTUs needed for each area was recorded. The amount used was then compared with that predicted. No child required a greater number of FTUs than that predicted, and the number of FTUs predicted for each anatomical region was accurate to within 1 FTU. The guidelines provide a useful indication of how much topical therapy is required for children, and advice sheets have been prepared for children of different ages.

Dens evaginatus: review of the literature and report of several clinical cases.

Dens evaginatus (DE) presents as an innocuous looking tubercle of enamel on the occlusal surface of a tooth, most commonly a bicuspid. Problems can arise when the tubercle is either worn, ground, or fractured off, resulting in pulpal exposure and possible loss of vitality of the tooth. Dentists who perform orthodontic treatment should be aware of this dental anomaly, which occurs in at least two per cent of the Asian and Native Indian populations. Bicuspid extraction cases should involve the extraction of the anomalous premolars rather than the normal ones. In addition, the dentist should be mindful of occlusal changes that may occur during treatment or occlusal equilibration, both of which can jeopardize the vitality of teeth with DE. Pulp capping or partial pulpotomy has been postulated to be one of the most reliable forms of vital tooth treatment when pulp exposure is encountered following the sterile removal of the tubercle. When pulp exposure is not encountered, preventive resin composite sealing of the dentin or class I amalgam cavity preparation seems to be the treatment of choice.

Transdermal nicotine suppresses cutaneous inflammation.

BACKGROUND: Cigarette smoking significantly alters the inflammatory response in the skin following application of irritants and rubefacients. The mechanism of this effect is unknown. There are thousands of components in cigarette smoke that may be pharmacologically important, but there is evidence to suggest that nicotine may play an important role in the observed effect on the inflammatory process. DESIGN: This was an interventional study to assess cutaneous responsiveness to different stimuli after transdermal nicotine administration in volunteer subjects. Cutaneous testing was performed at baseline and at weeks 2 and 4 (the end) of the study. SETTING: The department of Dermatology, University Hospital of Wales, Cardiff. PARTICIPANTS: Ten lifelong nonsmokers were recruited for the study. INTERVENTION: Nicotine patches were applied daily for 1 month. MAIN OUTCOME MEASURES: The following tests were performed: application of 2 times the minimal irritancy dose of sodium lauryl sulfate, irradiation with 2 times the minimal erythema dose of UV-B, measurement of cutaneous vasodilation following application of ethyl and hexyl nicotinate, and reactive hyperemia following arterial occlusion. RESULTS: There was a significant reduction in the cutaneous inflammatory response to sodium lauryl sulfate (P < .001) and irradiation with UV-B (P < .003) and a reduction in reactive hyperemia (P < .03) after 2 weeks of treatment, which returned values to normal at 4 weeks. There was no change in blood flow following application of topical nicotinates. CONCLUSIONS: Nicotine administration via a transdermal delivery system suppresses the cutaneous inflammatory response to sodium lauryl sulfate and UV-B, as well as triggers a transient suppression of reactive hyperemia following arterial occlusion. The apparent anti-inflammatory effects of smoking cigarettes can therefore only partially be explained as a long-term effect of nicotine.

Demographic study of port wine stain patients attending a laser clinic: family history, prevalence of naevus anaemicus and results of prior treatment.

All patients with port wine stains (PWS) attending a tunable dye laser clinic were examined by one author (SWL), forming a large group which has allowed study of the demographic data of such patients. Two hundred and eighty-three patients, 217 females (median age 24 years, range 0.5-73) and 66 males (median age 20 years, range 0.75-72), were examined. The PWS were on the face in 226, neck in 69, trunk in 36, upper limb in 35 and lower limb in 29. The commonest lesional colour was purple (63 patients), while 39 naevi were pink/red, 35 pink/ purple and 35 pink. The naevus was flat in 255 patients, cobblestoned in 28, associated with hypertrophy in 31 and with scarring in 22. Seventy-two patients (25.4%) had a positive family history of birthmarks, 20 strawberry haemangiomas and 22 PWS, the family history of PWS being higher than expected for the prevalence of this naevus in the population. One hundred and forty-six patients were also examined for naevus anaemicus which was noted in 12 (8.2%), confirming an association between these two naevi. Ninety-four patients had received previous treatment, most commonly with the argon laser (56 patients), of whom only five reported a good result, and 17 of 22 patients with treatment-related scarring had been treated with this laser. Cosmetic camouflage was used in 109 (38.5%) of patients, who usually had PWS on the face (94%), of whom only 46 (16%) had received advice of its use.