Impact of orthognathic surgery on the body posture.

BACKGROUND: Postural control is classically described as being based on the visual, vestibular, and proprioceptive musculo-articular sensory systems. The influence of mandibular proprioception on postural stabilization remains controversial. Most previous studies analyzed how postural stability is influenced by partial changes in mandibular proprioception (dental occlusion and jaw position). RESEARCH QUESTION: In the present experiment, we asked whether drastic mandibular changes, resulting from orthognathic surgery (including dental, joint and muscular efferents), modify postural control. METHODS: The analyzes were performed in 22 patients tested before, and 2.5 months, after orthognathic surgery for treatment of dysmorphic jaws. Experiments were performed under 4 experimental conditions: 2 visual conditions: Eyes Open (EO) and Eyes Closed (EC), and 2 occlusal conditions: Occlusion (OC: mandible positioned by the contact of the teeth), and Rest Position (RP: mandible positioned by the muscles without tooth contact). The analyses focused on head orientation in the frontal plane and on postural stabilization in a static task, consisting of standing upright. RESULTS: The results show that, 2.5 months after orthognathic surgery, head orientation in the frontal plane was improved, since patient's external intercanthal lines became closer to the true horizontal line when they were tested EC and in OC condition. Postural responses, based on the wavelet transformation data, highlight an improvement in maintaining an upright stance for all the tested sensory conditions. However, such improvement was greater in the EC and RP conditions. SIGNIFICANCE: These results show, for the first time, that after drastic mandibular changes, the weight of proprioceptive cues linked to the mandibular system may be so enhanced that it may constitute a new reference frame to orient the head in space, in darkness, and improve static postural stabilization, even in the presence of visual cues.

Upper aerodigestive tract cancer and oral health status before radiotherapy: A cross-sectional study of 154 patients.

OBJECTIVES: We aimed to determine primarily the oral health status of patients with upper aerodigestive tract cancer before radiotherapy, and secondarily the prevalence of risk factors for poor oral status. METHODS: A cross-sectional study was conducted in Marseille University hospital. Assessment criteria were the Decay, Missing and Filled (DMF) Index and periodontal status. RESULTS: One hundred and fifty-four patients, mean age 60.9years, were included. The most common sites of primary tumors were the larynx (28.6%) and oral cavity (26.6%). Current or past smokers accounted for 80.5% of patients and 67% were alcohol abusers. Most patients (83.8%) did not have xerostomia. They ate three meals a day (61%), with sugar consumption in 40%. The median number of daily tooth brushings was 2, with a manual toothbrush (81.2%). Few patients used dental floss or interproximal brushes. Individual DMF index was 17.6 (D=2.3, M=9.3, F=6.0) and was higher in patients with xerostomia and alcohol abusers (P=0.01). Osseous level was 62.3% and 57.8% of patients had osseous infections, which were more common with poor hygiene (P=0.04). Most patients (85.7%) had periodontal disease, but incidence did not significantly differ according to risk factors. DISCUSSION: The DMF index was higher in presence of periodontal disease and osseous infections. Alcohol and xerostomia were associated with a high individual DMF index and osseous infections were more frequent in patients with poor hygiene. Patients with upper aerodigestive tract cancer are at high risk of osteoradionecrosis if they do not receive dental treatment before radiotherapy.

Dental implants and diabetes: conditions for success.

AIMS: To assess the success of dental-implant treatment in patients with diabetes. BACKGROUND: Dental-implant treatment is an efficient means of replacing lost teeth. However, diabetes can be considered a relative contraindication for this type of treatment because of the slightly higher failure rate compared with populations without diabetes. RECOMMENDATIONS: Prerequisite selection of suitable diabetic patients, eradication of co-morbidities (poor oral hygiene, cigarette-smoking, periodontitis), stabilization of glycaemic control (HbA(1c) at around 7%) and preventative measures against infection can increase the success of dental implantation in diabetic patients to a satisfactory rate of 85-95%. CONCLUSION: Implant surgery is never a matter of urgency; thus, diabetes patients with the best chances of success should be conjointly selected and prepared by both dental and diabetes clinicians.

Monitoring of the intra-dermal tuberculosis skin test performed by Belgian field practitioners.

The present study aimed to monitor skin test practices as performed by veterinarian field practitioners in Belgium. For this purpose, an anonymous postal questionnaire was elaborated and dispatched to veterinarians involved in bovine tuberculosis detection. The questionnaire included items focusing on the skin test performance. International experts in the field of bovine tuberculosis were asked to fill the questionnaire and a scoring scale was built as follows: 0 = 'ideal' answer, 1 = acceptable answer, whereas 2 = unacceptable answer. Furthermore, experts were asked to rank the questionnaire's items according to their possible impact on the risk of not detecting reactors. A global score was further calculated for each participant and a comparison of practices was carried out between the two regions of the country, i.e. Wallonia and Flanders. Significant differences were observed between both regions, a harmonization at the country level is thus essential. No veterinarian summed a null score, corresponding to the ideal skin test procedure, which suggests that skin-testing is far from being performed correctly. Field practitioners need to be sensitized to the importance of correctly performing the test. The authors recommend the questionnaire is suitable for application in other countries or regions.

Effect of dual cure composite as dentin substitute on the marginal integrity of Class II open-sandwich restorations.

This study compared the marginal adaptation of Class II open-sandwich restorations with an RMGIC versus a dual-cure composite as dentin substitute. Class II cavities were prepared on 50 extracted human third molars. The teeth were randomly assigned to two groups of 25 teeth to compare one dual cure composite (Multicore Flow) with one resin-modified glass-ionomer cement (Fuji II LC) in open-sandwich restorations covered with a light cure composite. The teeth were thermomechanically cycled (2000 cycles, 5 degrees C to 55 degrees C; 100,000 cycles, 50 N/cm2). The specimens were then sealed with a 1 mm window around the cervical margin interface. Samples were immersed in a 50% w/v ammoniacal silver nitrate solution for two hours and exposed to a photodeveloping solution for six hours. The specimens were sectioned longitudinally and silver penetration was directly measured using a light microscope. The results were expressed as a score ranging from 0 to 3. The data were analyzed with a non-parametric Kruskall and Wallis test. The degree of leakage significantly increased with Multicore Flow (median = 2) compared to Fuji II LC (median = 1). The resin-modified glassionomer cements remain the best intermediate materials when open-sandwich restorations are indicated. A comparison of the degradation of these materials over time remains a topic to be investigated by future studies.

Effect of dual cure composite as dentin substitute on marginal integrity of class II open-sandwich restorations.

The current study compared the marginal adaptation of Class II open-sandwich restorations with a RMGIC versus a dual-cure composite as dentin substitute. Class II cavities were prepared on 50 extracted human third molars. The teeth were randomly assigned to two groups of 25 teeth to compare one dual cure composite (MultiCore Flow) with one resin-modified glass-ionomer cement (Fuji II LC) in open-sandwich restorations recovered with a light cure composite. The teeth were thermomechanocycled (2000 cycles, 5 degrees C to 55 degrees C; 100,000 cycles, 50 N/cm2). The specimens were then sealed with a 1 mm window around the cervical margin interface. Samples were immersed in a 50% w/v ammoniacal silver nitrate solution for two hours and exposed to a photo-developing solution for six hours. The specimens were sectioned longitudinally and silver penetration was directly measured using a light microscope. The results were expressed as a score from 0 to 3. The data were analyzed with a non-parametric Kruskal and Wallis test. The degree of leakage significantly increased with MultiCore Flow (median 2) compared to Fuji II LC (median 1). Resin-modified glassionomer cements remain the best intermediate material when open-sandwich restorations are indicated. A comparison of the degradation of these materials over time remains a topic to be investigated by future studies.

Predictors of depression in geriatric medically ill inpatients.

OBJECTIVE: Depression in medically ill inpatients has been associated with increased morbidity and mortality. The purpose of this study was to identify variables that would successfully predict depression in this population. METHODS: The sample consisted of 314 male, medically ill veterans, age 60 and older, admitted to the acute medical service at Baltimore Veteran Administration Medical Center. Sixty of 314 patients met criteria for Major Depression and scored 11 or higher on the Geriatric Depression Scale. Variables assessing age, race, social support, severity of illness, degree of functional disability, life satisfaction, and hopelessness were included in a logistic regression analysis as predictors of depression. RESULTS: The variables that significantly predicted depression were derived from the Beck Hopelessness Scale, Life Satisfaction Score, and the Cumulative Illness Rating Score. CONCLUSIONS: The results indicated that medically ill inpatients who feel hopeless about the future, feel the best years of their lives are behind them, and have serious medical problems are likely to be clinically depressed.

Psychiatric assessment of a nursing home population using audiovisual telecommunication.

The purpose of this study was to demonstrate that psychiatric assessment of nursing home residents could be reliably carried out remotely via telecommunications. Twenty-seven nursing home residents each had two interviews consisting of the following three rating scales: the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and the Brief Psychiatric Rating Scale (BPRS). The interviews were conducted by three trained psychiatrists, each of whom interviewed two-thirds of the subjects. Subjects were sequentially assigned to have either two in-person interviews (in-person group) or one in-person and one remote interview via telecommunication (remote group). Inter-rater reliability was calculated separately for each condition (in-person vs remote group) for each of the three rating scales. Intraclass correlations on the MMSE were .95 for the remote group and .83 for the in-person group. On the GDS, they were .82 for the remote group and .86 for the in-person group. Finally, on the BPRS, they were .81 for the remote group and .49 for the in-person group. There were no statistically significant differences in intraclass correlation on any of the three scales for the remote group compared with the in-person group, indicating that nursing home residents can be reliably assessed remotely via telecommunication.

Religion and end of life treatment preferences among geriatric patients.

The purpose of this study was to determine if religious preference and religiosity influenced choosing end of life treatments in medically ill geriatric patients. The sample consisted of 374 males 60 years of age or older, hospitalized on the acute medical service at the Baltimore Veterans Affairs Medical Center. Choices for end of life treatment preferences were CPR, medical ventilation, tube feeding and IV fluids within six different illness scenarios. Patients indicated how often they attended religious services, how much strength and comfort they got from religion and how religious they would describe themselves. Analyses of variance were performed using as the dependent variables the summation scores across the six scenarios of a willingness to undergo each of the four life saving procedures. The religious preference, race and religiosity scores served as the independent variables. Only tube feeding showed a significant (p<0.05) relationship, with Catholics less willing to undergo this procedure than other Christians. The same trend was found for the other life saving procedures, but was not statistically significant.

Reliability of in vitro microleakage tests: a literature review.

PURPOSE: The literature contains conflicting data about in vitro microleakage evaluations and their usefulness and reliability. No standardization has yet been established. Here we consider features of published studies that might affect the results of the in vitro microleakage tests. MATERIALS AND METHODS: We reviewed 144 in vitro microleakage studies, published in 14 international reviews between 1992 and 1998, which comprised 917 sets or groups of experiments. The published studies were entered in a database and compared using selected literature criteria: sample, cavities, restoration procedures, thermocycling and mechanical cycling, evaluation method. RESULTS: The methods employed vary widely. The most frequent methodological choices (%) were (1) specimen storage after extraction: duration (unspecified, 59.2), medium (distilled or deionized water, 33.8), temperature (unspecified, 52.2), additives (none, 47.0); (2) aging method (79.1): duration before aging (< 24 h, 35.9); medium and temperature of storage before aging (distilled or deionized water, 26.8; 37 degrees C, 54.3); (3) medium of cycling (tap water, 50.5), number of cycles ([250-500], 34.6), number of baths (2, 84.0), bath temperature (5 degrees C to 55 degrees C, 60.6), immersion dwell time (30 s, 44.3); (4) tracer: type (basic fuchsin, 40.7), time of immersion (after thermocycling and/or mechanical cycles, 64.1), immersion duration (basic fuchsin: 24 h, 59.5); assessment of dye penetration of sections (91.7): direction (perpendicular, 88.5), number (1, 47.1). CONCLUSION: The great variability in the methods used in these 144 studies prevented meta-analysis and comparison of the results, thus reducing the value of these methods.

Racial differences in the prevalence of dementia among patients admitted to nursing homes.

OBJECTIVE: The purpose of this study was to determine the prevalence of dementia among black and white residents on admission to nursing homes and to determine whether demographic and health characteristics known to be associated with dementia were correlated with dementia in this population. METHODS: Data from medical records and structured interviews with family members, nursing staff, and nursing home residents were gathered for 2,285 persons newly admitted to nursing homes in Maryland from 1992 to 1995. A stratified sample of 59 nursing homes was used. An expert panel of five physicians classified each resident as demented, nondemented, or indeterminate. Associations between dementia status, race, and selected characteristics were examined. RESULTS: Black residents (77 percent) were significantly more likely than white residents (57 percent) to be classified as demented. Older age was associated with dementia in both races. Less education, male gender, and a history of a cerebrovascular accident were associated with an increased prevalence of dementia among white residents only. After demographic and health characteristics associated with dementia were controlled for, black race remained independently associated with a diagnosis of dementia. CONCLUSIONS: The rate of dementia on admission to nursing homes was higher among black residents than among white residents, a finding that has implications for the delivery of care. The higher rate may be due to psychosocial factors operating differently in blacks and whites that influence the timing of admission to a nursing home.

Influence of the isolation method on the 10-year clinical behaviour of posterior resin composite restorations.

The aims of this prospective randomised clinical study were to clinically evaluate a radiopaque, highly filled, hybrid, light-activated resin-based composite for posterior teeth (Occlusin, ICI Dental, Macclesfield, UK and GC Dental, Tokyo, Japan) and compare the performance of restorations placed using rubber dam or cotton roll isolation. One clinician placed 100 (42 Class I and 58 Class II) restorations of the material under investigation. The isolation mode for each restoration was determined randomly: 52 preparations were protected from contamination with cotton rolls and aspiration, and 48 preparations were isolated under rubber dam. At baseline and periodically thereafter (0.5, 1, 2, 3, 4, 5, 6, and 10 years), each composite was evaluated by two practitioners using a modified (USPHS) rating system. After 10 years, 37 restorations were reviewed. The results showed satisfactory clinical performance with and without rubber dam after 10 years. A concern was the number of failures at 10 years due to unsatisfactory proximal contact. The evaluations for the surviving restorations were acceptable but with a large reduction in the percentage with ideal occlusal and proximal anatomy. The 10-year comparison of isolation modes showed no statistically significant differences (Kruskal-Wallis test) for each of the evaluation criteria. Furthermore, survival analysis showed no significant difference between the groups (Mantel-Haenszel method). It was concluded that the 10-year clinical behaviour of the restorations of a posterior composite placed under well-controlled, effective isolation with cotton rolls and aspiration, was not significantly different from the behaviour of restorations placed using rubber dam isolation.

Prevalence of bovine herpesvirus-1 in the Belgian cattle population.

The national bovine herpesvirus 1 (BHV-1) seroprevalence (apparent prevalence) in the Belgian cattle population was determined by a serological survey that was conducted from December 1997 to March 1998. In a random sample of herds (N=556), all cattle (N=28478) were tested for the presence of antibodies to glycoprotein B of BHV-1. No differentiation could be made between vaccinated and infected animals, because the exclusive use of marker vaccines was imposed by law only in 1997 by the Belgian Veterinary Authorities. Twenty-one percent of the farmers vaccinated continuously against BHV-1. In the unvaccinated group, the overall herd, individual-animal and median within-herd seroprevalences were estimated to be 67% (95% confidence interval (CI)=62-72), 35.9% (95% CI=35.0-36.8) and 33% (quartiles=14-62), respectively. Assuming a test sensitivity and specificity of 99 and 99.7%, respectively, the true herd, individual-animal and median within-herd prevalence for the unvaccinated group of herds were estimated to be 65, 36 and 34%, respectively. The true herd prevalence for dairy, mixed and beef herds were respectively, 84, 89 and 53%; the true individual-animal prevalence for those types of herds were, respectively, 35, 43 and 31%; whereas, the true median within-herd prevalences were 36, 29 and 38%.

Prevalence of herds with young sows seropositive to pseudorabies (Aujeszky's disease) in northern Belgium.

In Belgium, pseudorabies in swine has been the subject of a mandatory eradication programme since 1993. From December 1995 to February 1996, a survey was conducted in the five provinces of northern Belgium to estimate the provincial pseudorabies virus (PRV) herd seroprevalence. Seven hundred and twenty randomly selected herds were included in this survey. To detect recently infected animals, only young sows were sampled. The results show that 44% of these herds had an important number of PRV-seropositive young sows. The highest herd seroprevalence was observed in West Flanders (68%), followed by Antwerp (60%), East Flanders (43%), Limburg (18%), and Flemish Brabant (8%). Assuming a diagnostic test sensitivity and specificity of 95% and 99%, respectively, and a true PRV within-herd prevalence of 43%, the overall true PRV herd prevalence was estimated to be 35%. A logistic multiple-regression revealed that the presence of finishing pigs was associated with a two-fold increase in odds of a herd being seropositive (odds ratio (OR)=2.07, 95% confidence interval (CI) = 1.31-3.26); a breeding herd size > or =70 sows was associated with a four-fold increase in odds of a herd being seropositive (OR = 4.09, 95% CI = 2.18-7.67); a pig density in the municipality of >455 pigs/km2 was associated with a 10-fold increase in odds of a herd being seropositive (OR = 9.68, 95% CI = 5.17-18.12). No association was detected between the PRV herd seroprevalence and purchase policy of breeding pigs (purchased gilts, or use of homebred gilts only).

The psychological effects of the war in Afghanistan on young Afghan refugees from different ethnic backgrounds.

This study examined the psychological effects of the war in Afghanistan on two groups of young Afghan refugees currently residing in the United States. One group, with Tajik parents showed significantly less evidence of post-traumatic stress disorder (PTSD) and depression than the second group with Pashtun parents. These two groups of young refugees came from very different socioeconomic and cultural backgrounds. Some of these differences persist to the present. The Tajik parents are wealthier, more likely to speak English at home and less religious than the Pashtun parents. Their wartime experiences were also different. The Pashtun parents and their children spent more time in Afghanistan during the war, and experienced or witnessed more traumatic events, such as torture or combat, than the Tajik parents and their children. The possible effects of these ethnic differences on current psychopathology are described and discussed.

A 24-week randomized trial of controlled-release physostigmine in patients with Alzheimer's disease.

OBJECTIVE: To evaluate the safety and efficacy of controlled-release physostigmine, an acetylcholinesterase inhibitor, in patients with probable AD of mild to moderate severity. METHODS: A prospective, 24-week, randomized, multicenter, double-blind, parallel group study of patients was conducted. The study enrolled 475 patients at 24 sites. Patients met criteria for probable AD and were randomized to one of three arms: placebo, controlled-release (CR) physostigmine 30 mg daily, or CR physostigmine 36 mg daily. Dosage was escalated by a forced upward titration during the first 6 to 9 weeks of the trial, then maintained at a constant dose to 24 weeks. Primary outcome measures were the Alzheimer's Disease Assessment Scale-Cognitive subscale (ADAS-Cog) and the Clinician's Interview-Based Impression of Change-Plus with caregiver input (CIBIC+). Secondary outcome measures included the Clinical Global Impression of Change (CGIC), the Geriatric Evaluation by Relatives Rating Instrument, and an Instrumental Activities of Daily Living Scale. RESULTS: In an intent-to-treat population, the last observation carried forward analysis revealed a 2.9-point ADAS-Cog (p = 0.002) difference between physostigmine and placebo-treated patients for both dosages, and a 0.26 to 0.31-point difference on the CIBIC+ (p = 0.048). There were no significant differences on the secondary outcome measures except for a difference on the CGIC when analyzed by use of the Cochran-Mantel-Haenszel statistic (p = 0.014). There were significant increases in gastrointestinal side effects including nausea, vomiting, diarrhea, anorexia, dyspepsia, and abdominal pain for patients on either dose of physostigmine, resulting in a high dropout rate. Agitation was decreased significantly. There was no evidence of cardiac rhythm disturbance or liver function abnormalities. CONCLUSION: CR physostigmine enhanced cognitive and global function. It is relatively safe for the treatment of cognitive dysfunction secondary to AD. However, in light of the gastrointestinal side effects, a lower starting dose and a flexible titration schedule might lead to a more favorable adverse event profile in the clinical arena.

Clinical evaluation of a posterior composite 10-year report.

OBJECTIVE: The 10-year findings of one of the studies which comprised the multicentre clinical evaluation of a light-cured posterior composite restorative are reported, with special emphasis on the reasons and timing of failure of restorations included in the study. Effects of the use of rubber dam or cotton rolls and aspiration for isolation at the time of placement are considered. METHOD: One hundred Class I and II restorations of the resin composite investigated were placed by a single operator in a group of selected, predominantly young-adult patients under highly controlled conditions, with the use of rubber dam or cotton rolls and aspiration for isolation being determined according to a scheme of randomisation. The restorations were reviewed clinically after 1 week and within 1 month of placement (baseline) and, thereafter, at 6 months, 1, 2, 3, 4, 5, 6 and 10 years using modified USPHS codes and criteria. Epoxy models and photographs were obtained for retrospective analysis. RESULTS: After 10 years, 37 restorations were reviewed and 32 restorations were known to have failed. Regarding the reasons for failure, loss of occlusal anatomic form during the first 5 years and loss of approximal contacts near the end of the study accounted for most of the failures. Only two failures were attributed to recurrent caries. Few of the restorations found to be clinically satisfactory at 10 years had retained ideal functional characteristics. Location, Class and size of restoration and the method of isolation were not found to significantly influence 10-year performance and survival. CONCLUSION: The actual 10-year failure rate, estimated to have been between 40 and 50% is considered to have been high, notably given the limited incidence of recurrent caries and bulk fracture. However, the findings indicate that certain restorations of the material investigated, despite the use of outdated operative techniques, may be found to perform satisfactorily over periods in excess of 10 years.

A psychoeducational program for caregivers of the chronic mentally ill residing in community residencies.

The objective of this study was to develop a psychoeducational program for caregivers of the chronically mentally ill residing in community residencies. An evaluative component was added to determine how well the program was received by caregivers and what impact the program had on the residents. A total of 20 caregivers and 63 residents participated in the program. In general, the psychoeducational program was well received by the caregivers. They especially liked the mental health component and opportunity to meet and interact with other caregivers. There was a significant drop in hospital admissions following the program. There was also improvement in a number of quality of life activities such as trips to the local coffee shop and mall.