Attitudes to dental care, Sweden 2003-2013, and clinical correlates of oral health-related quality of life in 2013.

OBJECTIVE: To investigate attitudes to dental care, and to assess possible associations with socio-economic and clinical variables over a period of ten years, and to investigate the association between OHRQoL assessed by oral impact on daily performance (OIDP), and socio-economic, dental care habits, smoking and oral status. MATERIALS AND METHODS: Cross-sectional studies performed in the county of Dalarna, Sweden, in 2003, 2008 and 2013. Random samples of 1,107-1,115 dentate individuals, aged 30-85 years, who answered a questionnaire and who were radiographically and clinically examined were included. RESULTS: The importance of preventive treatment, regular recalls and meeting the same caregiver as on previous visits became less important. In individuals with alveolar bone loss, meeting the same caregiver as on previous visits was important (P<.05). In individuals with manifest caries, information on treatment cost was important, while prevention became less important (P<.05). OIDP was reported by 31% of the individuals in the study, and frequent impact was reported by 10%. Individuals with manifest caries lesions, less than 20 remaining teeth, and temporomandibular disorders (TMD) reported OIDP to a significantly higher degree, compared to orally healthy individuals. CONCLUSION: Attitudes important in maintaining and improving good oral health, such as preventive care and regular recalls to dentistry, became less important during this period of 10 years. Oral impact was found to be associated with irregular dental visits and limited economy for dental care, individuals with less than 20 remaining teeth, TMD and manifest caries.

Trends over 30 years in the prevalence and severity of alveolar bone loss and the influence of smoking and socio-economic factors--based on epidemiological surveys in Sweden 1983-2013.

OBJECTIVE: Epidemiological studies of the prevalence of periodontitis over an extended time using the same methodology to investigate and classify periodontitis are sparse in the literature. Smoking and socio-economic factors have been proven to increase the risk for periodontal disease. The objective of this study was to investigate 30-year time trends, using the same methodology to classify the prevalence and severity in alveolar bone loss (ABL) and to investigate the influence of tobacco and socio-economic factors. METHODS: Four cross-sectional epidemiological studies in an adult population were performed in the county of Dalarna, Sweden, in 1983, 2003, 2008 and 2013. Random samples of 787-1133 individuals aged 35-85 who answered a questionnaire about tobacco use and socio-economic factors were radiographically and clinically examined. A number of teeth, ABL and calculus visible on radiographs were registered. The severity of ABL as detected on radiographs was classified into no bone loss, moderate or severe. RESULTS: The prevalence of moderate ABL decreased from 45% in 1983 to 16% in 2008, but increased to 33% in 2013 (P < 0.05). The prevalence of severe ABL remained the same from 1983 (7%) to 2013 (6%). Calculus visible on radiographs increased from 22% in 2008 to 32% in 2013 (P < 0.05). Socio-economic factors had limited impact on the severity of ABL. CONCLUSION: Moderate ABL and calculus visible on radiographs significantly increased between 2008 and 2013. Smoking was the strongest factor associated with ABL overall.

Returning to a changed ordinary life--families' lived experience after completing a child's cancer treatment.

The aim of the study was to illuminate the families' lived experience after completing a child's cancer treatment. The study took place at a University Hospital in southern Sweden. Interviews were carried out with 10 mothers, eight fathers, four patients and two siblings from a total of 10 families. The interviews were analysed with a hermeneutical phenomenological approach. One essential theme emerged from their stories, 'returning to a changed ordinary life--incorporating a trying and contradictory experience'. The families felt relieved that the treatment was over yet they experienced strains in their daily life. Family members felt changed and especially the parents needed to focus on themselves in order to recover. Closeness with other people, especially their own family, was important. The previously sick children felt a loss of concern from their parents when treatment had ended, in contrast to siblings who experienced increased attention from their parents. Parents experienced being in uncharted territory and sometimes missed the security of hospital. For professionals it is important to offer the family a structured follow-up to help them in their daily life after the child's treatment is completed.

Time in care for older people living in nursing homes.

In order to measure actual care needs in relation to resources required to fulfill these needs, an instrument (Time in Care) with which to evaluate care needs and determine the time needed for various care activities has been developed with the aim of assessing nursing intensity in municipal care for older people. Interreliability (ICC = 0.854) of time measurements (n = 10'546) of 32 nursing activities in relation to evaluated care levels in two nursing homes (staff n = 81) has been determined. Nursing intensity for both periods at the two nursing homes comprised on average a direct care time of 75 (45%) and 101 (42%) minutes, respectively. Work time was measured according to actual schedule (462 hours per nursing home during two weeks). Given that the need for care was high, one must further investigate if the quality of care the recipients received was sufficiently addressed.

Gain of chromosome 3q is an early and consistent genetic aberration in carcinomas of the vulva.

The aim was to determine whether specific gains of chromosome 3q and laminin-5gamma2-chain expression can improve early detection of invasive capacity in precancerous and squamous cell carcinoma of the vulva (VSCC). Six VSCC and three precancerous lesions were studied. Multicolor fluorescence in situ hybridization (FISH) probe sets were applied to nuclei suspensions prepared from archival material using the Hedley method. The probe panel consists of the centromers of chromosome 7, chromosome 3, and the TERC gene residing on the long arm of chromosome 3. Laminin-5gamma2-chain immunohistochemical analysis was performed on corresponding specimens and was expressed only in the VSCC. The genome-specific FISH analysis revealed 3q amplification in 43% of the nuclei analyzed for the VSCC and 22% of the nuclei for the precancerous lesions. Low-level 3q amplifications were found in precancerous lesions with an average fold increase of 1.15 for 3q. The invasive lesions showed higher average fold increases for 3q, averaging 1.32. Laminin-5gamma2-chain protein was expressed only in VSCC, whereas 3q gains were observed both in precancerous lesions and in VSCC, indicating that gain of chromosome 3q is an early and consistent event during carcinogenesis of VSCC.

Laminin-5 gamma2-chain expression and DNA ploidy as predictors of prognosis in endometrial carcinoma.

Expression of the laminin-5 gamma2-chain in carcinoma cells has been implicated in tumor invasion. The aim was to investigate the expression and prognostic significance of the ln-5 gamma2-chain compared with clinicopathological factors and tumor cell DNA ploidy in endometrial carcinoma. Histological specimens from 80 endometrial carcinomas were examined with respect to immunohistochemical ln-5 gamma2-chain expression and correlated to the clinicopathological characteristics, DNA ploidy, and survival. Sixty-eight of 80 investigated cases were judged to be positive for the ln-5 gamma2-chain. Ln-5 gamma2-chain did not show any correlation to stage, histopathological subtype, grade, and DNA ploidy. In univariate analyses, advanced stage (p < 0.001), nonendometrioid carcinoma (p = 0.030), low grade (p < 0.001), aneuploid tumors (p < 0.001), and ln-5 gamma2-chain expression (p = 0.017) were highly associated with poor survival. Aneuploid tumors in combination with strong ln-5 gamma2-chain expression were significant predictors (p < 0.001) of poor prognosis. In multivariate analyses including stage, histopathological subgroup, grade, DNA ploidy, and ln-5 gamma2-chain expression, all lost their significant prognostic information except for stage (p < 0.001) and grade (p < 0.05). Ln-5 gamma2-chain expression and DNA ploidy both as a single parameter and in combination were demonstrated to be signifi- cant prognostic factors in univariate analysis. However, stage and grade provided more useful clinical information beyond histopathological subgroup, DNA ploidy, and ln-5 gamma2-chain expression. The results also indicate that ln-5 gamma2-chain expression is upregulated during the progression of endometrial carcinoma.

Nuclear DNA content, proliferative activity, and p53 expression related to clinical and histopathologic features in endometrial carcinoma.

The purpose of this study was to evaluate the prognostic impact of image cytometry DNA ploidy, MIB-1, and p53 in relation to clinicopathologic variables in 376 consecutive patients with endometrial carcinoma stages I-IV. Following primary treatment 358 patients were considered tumor-free. Relapses and tumor-specific deaths of these patients were noted. Image cytometry DNA ploidy (n = 340) and expression of MIB-1 (n = 318) and p53 (n = 323) were studied. In univariate analysis, stage (P < 0.001), histopathologic subtype (P < 0.001), degree of differentiation (P < 0.001), HRT (P = 0.034), DNA ploidy (P < 0.001), and p53 (P < 0.001) were significant predictors of relapse. Patient age showed that the estimated mean risk of relapse increases with nearly 64% per decade in life (P 0.003), and the MIB-1 expression with 21% per 10-unit increment (P 0.004). In multivariate analysis, degree of differentiation, MIB-1, and p53 lost their prognostic capability. However, after stage and histopathologic subtype, image cytometry DNA ploidy was the strongest predictor of outcome and was of value in predicting the risk for relapse. The combination of DNA ploidy, MIB-1, and p53 expression was an even stronger predictor of relapse-free survival than the individual prognostic factors.

Is the hypnotized subject complying.

To examine the role of compliance in responses to hypnotic suggestions, the authors administered a number of suggestions in the standard hypnotic manner and, also, with urging to comply. Participants' overt behavioral responses were noted, and they were questioned about their subjective experience of the suggestions, with electrodermal skin conductance responses providing a measure of the truthfulness of their reports. Results indicated that, although behavioral and verbal responses were consistent with the hypnotic suggestions under both instructional sets, responses in the standard hypnotic setting appeared to be experienced as genuine. That is, reports of subjective experiences met the criterion for truthfulness, whereas reports of suggested experiences administered with urging to comply did not meet the criterion for truthfulness.

Measurement of stellar age from uranium decay.

The ages of the oldest stars in the Galaxy indicate when star formation began, and provide a minimum age for the Universe. Radioactive dating of meteoritic material and stars relies on comparing the present abundance ratios of radioactive and stable nuclear species to the theoretically predicted ratios of their production. The radioisotope 232Th (half-life 14 Gyr) has been used to date Galactic stars, but it decays by only a factor of two over the lifetime of the Universe. 238U (half-life 4.5 Gyr) is in principle a more precise age indicator, but even its strongest spectral line, from singly ionized uranium at a wavelength of 385.957 nm, has previously not been detected in stars. Here we report a measurement of this line in the very metal-poor star CS31082-001, a star which is strongly overabundant in its heavy elements. The derived uranium abundance, log(U/H) = -13.7 +/- 0.14 +/- 0.12 yields an age of 12.5 +/- 3 Gyr, though this is still model dependent. The observation of this cosmochronometer gives the most direct age determination of the Galaxy. Also, with improved theoretical and laboratory data, it will provide a highly precise lower limit to the age of the Universe.

Effects of nicotine gum dose by level of nicotine dependence.

We used the Heaviness of Smoking Index, a subset of the Fagerstrom Test for Nicotine Dependence, to classify 608 cigarette smokers planning a cessation attempt as low or high in nicotine dependence. Subjects within each level of dependence were then randomly assigned to placebo, 2-mg, or 4-mg nicotine gum treatment. Subjects were also provided brief (5-10 min per visit) behavioral counseling during a 1-year period of follow-up. At 1 year post-cessation, quit rates were 11.2, 19.5, and 18.4% for low-dependence smokers receiving placebo, 2-mg, and 4-mg gum, respectively (plinear trend = 0.20). For high-dependence smokers, quit rates at 1 year were 6.1, 15.7, and 20.7% for the placebo, 2-mg, and 4-mg gum conditions, respectively (plinear trend = 0.002). The interaction of nicotine-gum dose and dependence group was not significant (p = 0.42), nor did the 2-mg and 4-mg doses differ significantly in effectiveness, though both 2-mg and 4-mg gum were significantly more effective than placebo gum. We also found a significant dose-related effect for nicotine gum to moderate post-cessation heart-rate decline. Other variables related to abstinence at 1 year post-cessation were a longer period of abstinence on a prior quit attempt, being married, higher education level, and having a non-smoking spouse or significant other. Results indicate that nicotine gum is a significant aid to smoking cessation, more than doubling the odds of successful cessation compared to the odds for placebo-gum users. The 4-mg dose provided a non-significant increase in cessation rates for high-dependence smokers. Smoking history and demographic variables also have a significant impact on the outcome of a quit-smoking attempt.

Predictors of continued smoking over 25 years of follow-up in the normative aging study.

OBJECTIVES: This study tested the hypothesis that high daily cigarette consumption and addiction to smoking are risk factors for the long-term continuation of smoking. METHODS: Using longitudinal data from 986 male smokers, we entered cigarettes per day, psychological addiction, age, and education into a survival analysis as predictors of continued smoking over a 25-year period. RESULTS: Younger men and those who smoked more cigarettes per day were more likely to remain smokers in the long term. Addiction and education level were not significant predictors of continued smoking. CONCLUSIONS: Heavier smokers are more at risk than lighter smokers for long-term smoking. It is therefore very important to provide smoking cessation treatments for heavy smokers as early as possible after the initiation of smoking.

Sound exposure as a measure against driver drowsiness.

Twelve lorry drivers participated in a field study, including in total 110 tests of a waking sound system. The system was based on a time and frequency varied sound, generated at intervals between 1 and 15 min for periods of 3-7 s. The waking effect of the sound was analysed through subjective ratings. Exposure to the sounds was correlated to improvements of the immediate as well as the long-term self-reported changes in wakefulness. The results of the study show consistently positive assessments concerning the applied waking system, both regarding the system as a measure for raised wakefulness, increased road safety and the interest in having the system installed in the vehicle. The waking sounds were in no case felt to be annoying. Analyses of the wakefulness and other factors and the interaction related to fatigue and driving are included in the investigation.

Laboratory studies on the effects of temperature variations on drowsiness.

20 subjects were analysed in a laboratory study investigating the inhibition of drowsiness by altering air temperature. The EEGs of the subjects were used to measure the effect of sequences of temperature lowerings of 10 degrees for 2- and 4-min. periods. The effect upon wakefulness was analysed through EEG recordings and subjective ratings. Results indicated that reductions of the air temperature of 10 degrees during repeated 2- and 4-min. periods significantly increased wakefulness.

Long-term effects of nicotine gum on weight gain after smoking cessation.

Smoking cessation usually results in weight gain. Nicotine gum therapy has been found to reduce weight gain in the first months after cessation, but its long-term effects are not fully known. The present study randomly assigned 608 smokers to receive placebo, 2 or 4 mg nicotine gum. In a follow-up analysis to the short-term weight change results reported in a previous paper [Doherty, Militello, Kinnunen, & Garvey (1996), Journal of Consulting and Clinical Psychology 64:799-807], we examined the effects of the nicotine gum on weight change for 1 year after cessation among the 92 1-year abstainers. We found that weight change showed some variation with gum dose (active vs. placebo), but that weight change appeared to depend more strongly on the percentage of pre-cessation cotinine levels replaced by the nicotine gum. Participants who replaced higher proportions of their pre-cessation cotinine during the gum therapy period gained less weight during the first year post-cessation than those who replaced less cotinine, with those who replaced greater than 90% of their cotinine gaining only 1.7 kg by 1 year post-cessation. These findings suggest that future research is warranted to determine whether sufficiently high levels of nicotine replacement can help to permanently reduce cessation-related weight gain.

Prognostic index models in stage I and II endometrial carcinoma.

BACKGROUND: In most studies, authors recommend the use of independent variables in clinical decision-making, but no guidelines are given about how to use all the extracted information. MATERIALS AND METHODS: By combining two or three prognostically independent variables and using their relative prognostic impact (results from Cox analyses), a novel way of identifying high- and low-risk groups was developed. A total of 336 women with stage I-II endometrial carcinoma of medium or high risk were included. Twenty-one clinico- pathological variables, were initially studied in univariate analyses and significant variables were used for the construction of prognostic indices. Six prognostic indices were constructed, which then were used to calculate individual index values for each patient. RESULTS: The index values were highly prognostic and used for the identification of a limited high-risk group (10% of the patients) and a large low-risk group (90% of the patients). Indices 1-3 were constructed for pre-treatment situations and included age, degree of differentiation, nuclear grade and S-phase fraction in various combinations. They identified a high- and a low-risk group with a 5-year disease-specific survival of 31-37% and 74.79%, respectively. Indices 4 and 5 were constructed using variables available after treatment and index 6 for patients with no evidence of disease (NED) after treatment completion. The 5-year survival for the latter indices were 30-52% and 75-85%, respectively. CONCLUSION: The use of prognostic indices in different clinical situations was generally superior to the use of single variables for the identification of well-defined high- and low-risk groups.

Effectiveness of interventions to improve patient compliance: a meta-analysis.

OBJECTIVES: This article summarizes the results of 153 studies published between 1977 and 1994 that evaluated the effectiveness of interventions to improve patient compliance with medical regimens. METHODS: The compliance interventions were classified by theoretical focus into educational, behavioral, and affective categories within which specific intervention strategies were further distinguished. The compliance indicators broadly represent five classes of compliance-related assessments: (1) health outcomes (eg, blood pressure and hospitalization), (2) direct indicators (eg, urine and blood tracers and weight change), (3) indirect indicators (eg, pill count and refill records), (4) subjective report (eg, patients' or others' reports), and (5) utilization (appointment making and keeping and use of preventive services). An effect size (ES) r, defined as Fisher's Z transformation of the Pearson correlation coefficient, representing the association between each intervention (intervention versus control) and compliance measure was calculated. Both an unweighted and weighted r were calculated because of large sample size variation, and a combined probability across studies was calculated. RESULTS: The interventions produced significant effects for all the compliance indicators (combined Z values more than 5 and less than 32), with the magnitude of effects ranging from small to large. The largest effects (unweighted) were evident for refill records and pill counts and in blood/urine and weight change studies. Although smaller in magnitude, compliance effects were evident for improved health outcomes and utilization. Chronic disease patients, including those with diabetes and hypertension, as well as cancer patients and those with mental health problems especially benefited from interventions. CONCLUSIONS: No single strategy or programmatic focus showed any clear advantage compared with another. Comprehensive interventions combining cognitive, behavioral, and affective components were more effective than single-focus interventions.

Laboratory studies of a sound system that maintains wakefulness.

Two studies investigated the effects of a waking sound that enhances wakefulness. Study I investigated the effect of the sound level and Study 2 the effect of time and frequency variability of the sound. The recordings of EEG and subjective ratings were analysed to study the effect upon wakefulness. The waking effect increased when sound varied in duration and frequency. A number of specific conditions necessary for the waking effect are described. The exposure should be based on high frequency sounds and several tones chosen to produce disharmony. The exposure should be loud enough to be heard over the masking background noise. The duration and tonal quality should be variable from one presentation to another.

A comparison of proliferation markers and their prognostic value for women with endometrial carcinoma. Ki-67, proliferating cell nuclear antigen, and flow cytometric S-phase fraction.

BACKGROUND: The understanding of proliferation is a central issue in oncology. Several methods exist for the assessment of the growth fraction and cell-cycle time, but comparative studies that give the clinician advice about the most reliable use of new markers are few. The aim of the current study was to perform methodologic, descriptive, comparative, and prognostic studies of Ki-67, proliferating cell nuclear antigen (PCNA), and flow cytometric S-phase fraction (SPF) in endometrial carcinoma. METHODS: The expression of Ki 67 (n = 175) and PCNA (n = 146) were studied immunohistochemically; and the SPF (n = 297) by flow cytometry. The median follow-up time was 78 months. RESULTS: Neither Ki-67 nor PCNA had any correlation to either the stage or the histopathologic subtype of the tumors, but they were covariant with the histopathologic grade (P < 0.05). There was an interrelationship between Ki-67 and PCNA (P < 0.001), and both were associated with the size of the SPF (P < 0.0001 and P < 0.05, respectively). Mean SPF was high in advanced stages and strongly associated with histopathologic subtype (P < 0.0001) and ploidy (P < 0.0001). Tumors with strong Ki-67 expression were more often aneuploid (P < 0.01). In initial analyses, Ki-67 and SPF were predictors of poor survival (P < 0.05 and P < 0.001, respectively), whereas PCNA was not. When SPF was added to a comprehensive multivariate model, Ki-67 provided no further prognostic information, whereas SPF remained a powerful predictor of survival. CONCLUSIONS: Ki-67 and, to a lesser extent, PCNA, give approximate estimates of the growth fraction, whereas SPF only reflects the proportion of cells in S-phase. However, SPF is by far the strongest predictor of survival.

Carcinoma of the endometrium: do the nuclear grade and DNA ploidy provide more prognostic information than do the FIGO and WHO classifications?

The aim of this study was to compare the World Health Organization (WHO), the International Federation of Gynecology (FIGO), and nuclear grading systems and to evaluate their reproducibility, as well as their prognostic impact, in relation to clinical variables and DNA ploidy. The study comprised 266 women with endometrial carcinoma in clinical stages I-IV. Low-risk patients, i.e., patients with grade 1-2 tumors in clinical stage I, were generally not included. In univariate Cox analyses, WHO, FIGO, and especially nuclear grading (p < 0.001), as well as age, stage, and ploidy, were prognostic regarding survival. In the multivariate Cox analyses, WHO and FIGO grades yielded little further independent information beyond nuclear grade. When DNA ploidy was added to the analyses, nuclear grade lost most of its impact because aneuploidy was a powerful factor (p < 0.001) that covaried with nuclear grade. The WHO, FIGO, and nuclear grading systems were found to be subjective, with correlation coefficients of approximately 0.60 between different pathologists. Age, stage, and aneuploidy were the most important predictors of outcome in the multivariate analyses. Nuclear grade was a strong prognostic factor in the univariate analyses and a more important indicator than the commonly used histopathological grading systems.

Endometrial carcinoma: the prognostic impact of papillary serous carcinoma (UPSC) in relation to nuclear grade, DNA ploidy and p53 expression.

In a histopathological review of 266 women with stage I-IV endometrial carcinoma, the prognostic significance of uterine papillary serous carcinoma (UPSC) and clear cell carcinoma (CCC) of the endometrium was compared with that of ordinary adenocarcinoma and adenoacanthoma. UPSC and CCC were diagnosed in 31/266 (12%) and 6/266 (2%) of the patients respectively. The median follow-up time was 79 months (range 3 to 133 months). 49% of the patients with UPSC or CCC died of their cancer compared with 31% in the adenocarcinoma + adenoacanthoma group (RH=2.25; p=0.0022). Strong expression of the mutated p53 gene product was significantly more common in the UPSC + CCC group than in the reference group (64% vs. 19%), (p<0.0001). In a Cox multivariate analysis including histopathological and clinical variables, UPSC and CCC were still significant predictors of survival (p<0.05). When nuclear grade was added to the analysis, UPSC + CCC as well as the degree of differentiation lost most of their prognostic impact. In a final multivariate analysis, DNA ploidy was found to be the strongest predictor of outcome besides age and clinical stage.