A CBCT comparison of anterior root resorption in SureSmile and conventional edgewise treatments.

AIM: To utilize cone beam computed tomography (CBCT) to analyze the amount of linear root resorption that occurs in maxillary and mandibular permanent incisors during orthodontic treatment when comparing the SureSmile technique with conventional edgewise treatment. In addition, patient and treatment factors that may be correlated with root resorption were studied. METHODS: The records of 28 patients (14 SureSmile and 14 edgewise) treated in an orthodontic office were used for this study. CBCTs were taken of all patients prior to (T1) and after completion of orthodontic treatment (T2). Total tooth length of the permanent incisors were measured on the CBCTs at T1 and T2. Root resorption was calculated for each tooth by subtracting T1 from T2. RESULTS: No statistically significant differences in mean root resorption (MRR) were found for the permanent incisors when comparing SureSmile patients with conventional edgewise patients. The MRR for each tooth was found to be less than 1 mm when using either treatment modality. Subjects with increased resorption included Class II malocclusion, severe overjet, and treatment time greater than or equal to 25 months. Sex and the use of Class II elastics showed no significant differences in mean root resorption. CONCLUSION: No differences were found in root resorption of the permanent incisors when comparing SureSmile and edgewise treatments.

Socio-environmental factors associated with pubertal development in female adolescents: the role of prepubertal tobacco and alcohol use.

PURPOSE: Alcohol administered to laboratory animals has been shown to suppress puberty-related hormones and delay puberty by interfering with ovarian development and function. The effects of early substance use on human pubertal development are relatively unexplored. METHODS: This cross-sectional study of 3,106 female adolescents, aged 11-21 years, evaluated the association between prepubertal alcohol and tobacco use and the onset of puberty. Ages at initial breast development, body hair growth, and menarche were self-reported. Prepubertal alcohol and tobacco use were defined as the age at first use before the age of pubertal development and accompanied by regular use. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated using Cox proportional hazard models. Logistic regression was used to estimate the association between substance use and delayed puberty, defined as lack of breast development by the age of 13 years. RESULTS: Unadjusted models indicated prepubertal tobacco use was associated with a longer time required for breast development (HR = 0.74; 95% CI, 0.65-0.85) and body hair growth (HR = 0.81; 95% CI, 0.71-0.93). Prepubertal alcohol use was associated with late breast development (HR = 0.71; 95% CI, 0.57-0.88). The direction of the observed associations remained consistent after adjusting for covariates, but the magnitude of effects were attenuated and the upper bound of the 95% CIs exceeded the null value. Girls who used alcohol before puberty had four times the odds of having delayed puberty (OR = 3.99; 95% CI, 1.94-8.21) as compared with nonusers. CONCLUSION: The results of this study suggest that the endocrine-disrupting effects of alcohol and tobacco use may alter the timing of pubertal development. These cross-sectional findings warrant further investigation.

Smokeless tobacco and prevalence of cardiovascular disease.

INTRODUCTION: Few studies have examined the possible increased risk of cardiovascular disease with smokeless tobacco. Existing studies have yielded inconsistent results and have been based on limited populations. The purpose of this study was to assess whether the use of smokeless tobacco increases the risk of cardiovascular disease and to identify higher risk groups. METHODS: Data from the Behavioral Risk Factor Surveillance System (BRFSS) from 1999 to 2001 for the state of Oklahoma were analyzed. We analyzed 10332 complete records to assess association of any use of smokeless tobacco (over the respondent's life time) with cardiovascular disease. Similarly, the association between cardiovascular disease and individual socio-demographic covariates such as age, gender, smoking, and BMI was checked. As a secondary analysis we explored associations among three categories for smokeless tobacco users, current, former, and never users, with cardiovascular disease. RESULTS: Logistic regression models, which controlled for age, sex, race-ethnicity, obesity, and smoking, estimated the odds of having cardiovascular disease were 1.18 (95% CI: 0.96, 1.45) times higher among smokeless tobacco users. This odds ratio was more than two fold in the Non-White/Hispanic group (O.R. 2.31, 95% CI: 1.42, 3.73). Similarly the odds of cardiovascular disease were higher among female ST users than among females who were non-users of ST (O.R. 1.72 95% CI: 1.12, 2.65). CONCLUSION: A modest increase in the odds of cardiovascular disease was associated with smokeless tobacco. Two risk groups were identified, females and Non-Whites/Hispanics, whose odds of cardiovascular disease increased with the use of smokeless tobacco.

The effect of digital cervical examination on group B streptococcal culture.

OBJECTIVE: We sought to evaluate whether group B streptococcus (GBS) detection is altered by the digital cervical examination. STUDY DESIGN: A total of 302 women undergoing the clinical GBS culture had a digital cervical examination and a repeated GBS culture. Statistical comparison of pre-post culture results were performed with kappa and McNemar tests. RESULTS: The clinical prevalence of GBS was 19.5%. Discordant results were seen in 30/302 (9.9%) paired cultures (kappa = 0.68; 95% confidence interval, 0.568-0.783). An initially negative GBS culture result was positive on repeated testing in 13/243 (5.3%) pairs. Initially positive cultures were negative on repeated testing in 17/59 (28.8%) pairs. Patients with discordant results had similar characteristics as the remainder of the study group. Given the observed proportion of discordant results (9.9%), the study had 80% power to detect a 5% difference between discordant pairs. CONCLUSION: Paired GBS cultures showed a good level of agreement. The 28.8% rate of positive cultures becoming negative is clinically concerning and warrants further study.

Effect of breastfeeding education and support on promoting breastfeeding: a literature review.

Despite the widely documented benefits of breastfeeding, initiation rates and duration of breastfeeding lag behind the goals set in Healthy People 2010. This paper evaluates the effectiveness of breastfeeding education and support, which aim to encourage women to initiate and continue breastfeeding according to The Healthy People 2010 objectives; articles published in the United States from January 2000 to July 2005 are included. Effects of these interventions on different demographic groups are reviewed to assess the importance of each intervention in particular focus group.

Gynecologic Oncology Group risk groups for vulvar carcinoma: improvement in survival in the modern era.

OBJECTIVE: Patients with vulvar cancer were stratified into risk groups for survival based on surgicopathologic findings from a prospective study conducted by the Gynecologic Oncology Group from 1977-1984. The purpose of this study is to reassess these risk groups in patients treated in an era of contemporary management. METHODS: Patients with vulvar carcinoma were identified from 1990-2005 for retrospective analysis. Charts were abstracted for clinical, histopathologic and surgical data, and patients stratified into four risk groups for survival based on the clinical size of tumor and extent of lymph node metastasis. Univariate and multivariate characteristics were evaluated and 5-year survival determined by Kaplan-Meier method. RESULTS: 175 patients were identified that underwent surgical management with a median age at diagnosis of 59.9 years. Stage distribution included: I (n=89, 51%), II (n=53, 30%), III (n=29, 17%), and IV (n=4, 2%). Stratification into risk groups included: minimal (n=89, 51%), low (n=69, 40%), intermediate (n=11, 6%), and high (n=6; 3%). The survival rate was 100%, 97%, 82% and 100%, respectively, at median follow-up of 54.5 months. Comparatively, the survival rates for historic groups were 97.9%, 87.4%, 74.8% and 29.0%. Using multivariate analysis, age (p=0.04) and lymph node metastasis (p=0.009) were predictive of survival. CONCLUSIONS: Survival among the minimal and low risk groups is preserved in spite of less radical surgery. 5-year survival rate for intermediate and high risk patients also appears to be improved. This is likely a result of advancement in adjuvant chemo-radiation and a younger patient population that presents with less advanced disease.

Disparities in the prevalence of medication therapy for hyperlipidemia in the elderly.

OBJECTIVE: To explore differences in the prevalence of therapy with antihyperlipidemic drugs in patients older than 75 years of age, as compared with patients between the ages of 55 to 74, and other variables. DESIGN: A cross-sectional study. SETTING: Two Oklahoma state-paid pharmacy drug-claims databases. PATIENTS, PARTICIPANTS: The first database contained 69,119 eligible patients 55 years of age and older. The second database contained 82,360 eligible patients 55 years of age and older. MAIN OUTCOME MEASURE(S): Comparison of the prevalence of therapy with antihyperlipidemic drugs in those 55 to 74 years of age with those older than 75 years of age in the data sets, and evaluation of the effect of gender, race, place of residence, and socioeconomic status. RESULTS: In the combined data sets, the group 55 to 74 years of age had a higher prevalence of therapy with antihyperlipidemics than those 75 years of age or older. Men had a higher prevalence of therapy than women, and those in higher socioeconomic status had a higher prevalence, but only in the group 75 years of age or older. Caucasians had a prevalence of therapy greater than African-Americans, but only in the group 55 to 74 years of age or older. CONCLUSIONS: We found that older people were prescribed therapy less frequently than younger people, that women were prescribed therapy less frequently than men, that Caucasians were prescribed therapy more frequently than African-Americans, and that those living in a nursing facility were prescribed therapy less frequently than those living in other settings. Regarding socioeconomic status, only in the younger age group was lower status associated with lower prevalence of prescribed therapy.

Does participation in a nurse visitation programme reduce the frequency of adverse perinatal outcomes in first-time mothers?

Children First (C1), a nurse home visitation programme for first-time mothers, was implemented statewide in Oklahoma in mid-1997. The objective of this study was to compare the risks of low (< 2500 g) and very low birthweight (< 1500 g), preterm (< 37 weeks) and very preterm (< 30 weeks) deliveries and infant mortality between mothers participating and not participating in C1. All 239,466 Oklahoma birth certificates were reviewed. The C1 and birth certificate databases were matched to identify C1 participants. Mother's age at delivery, education level, race, marital status, prior pregnancy loss or pregnancy risk factors, birthweight and gestational age at delivery were measured from the birth certificates. Death certificates were matched to the birth certificates to identify infant deaths. A Bayesian multivariable logistic regression was used to analyse the data. Among single mothers without pregnancy risk factors, the risks of all study outcomes were lower for participants in C1: adjusted odds ratio (aOR) 0.89, [95% Bayesian Credible Interval (BCI) 0.79, 1.00] for preterm delivery; aOR 0.71, [95% BCI 0.50, 0.98] for very preterm delivery; aOR 0.86, [95% BCI 0.75, 0.98] for low birthweight; aOR 0.77, [95% BCI 0.56, 1.02] for very low birthweight and aOR 0.36, [95% BCI 0.17, 0.63] for infant mortality. These risk reductions were not observed among married mothers. In both single and married mothers, the presence of pregnancy risk factors reduced the impact of C1 on lowering the risk of low birthweight and preterm deliveries. The C1 programme targets young, pregnant women of low socio-economic level. We found that among single mothers, the risks of perinatal adverse outcomes are reduced or similar to those found in non-participating mothers. A reduced effect of C1 in the presence of pregnancy risk factors may be because mothers with pregnancy risk factors who did not participate in C1 received better prenatal care, or that C1 interventions do not impact these particular factors. C1 shows promise in reducing infant mortality in single mothers. Lower incidence of preterm and very preterm deliveries is especially interesting and future analyses should focus on isolating programme components specifically associated with influencing these outcomes.

Lead sources, behaviors, and socioeconomic factors in relation to blood lead of native american and white children: a community-based assessment of a former mining area.

Lead poisoning prevention requires knowledge of lead sources and of appropriate residential lead standards. Data are severely lacking on lead sources for Native American children, many of whom live in rural areas. Further, the relation of mining waste to blood lead concentrations (BPbs) of rural children is controversial. In collaboration with the eight tribes of northeastern Oklahoma, we assessed lead sources and their effects on BPbs for rural Native American and White children living in a former mining region. Venous blood lead, residential environmental (soil, dust, paint, water), and caregiver interview (e.g., hand-to-mouth behaviors, socioeconomic conditions) data were obtained from a representative sample of 245 children 1-6 years of age. BPbs ranged from 1 to 24 microg/dL. There were no ethnic differences in BPbs (p= 0.48) nor any patterns of excess lead sources for Native American or White children. Multiple linear regression analyses indicated that mean soil lead, mean floor lead loading, mouthing behaviors, caregivers' education, and residence in former mining towns were all strongly associated with BPbs. Logistic regression results showed mean floor dust lead loading greater than or equal to 10.1 microg/ft(2) (odds ratio [OR], 11.4; 95% confidence interval [CI], 3.5-37.3), and yard soil lead >165.3 mg/kg (OR, 4.1; CI, 1.3-12.4) were independently associated with BPbs greater than or equal to 10 microg/dL. We also found strong interactions between soil lead and poverty (p= 0.005), and dust and soil sources (p= 0.02). Our findings indicate that soil and dust lead derived largely from mining waste pose a health hazard to Native American and White children, and that current residential dust lead standards are insufficient to adequately protect children. Moreover, our finding that poor children are especially vulnerable to lead exposures suggests that residential standards should consider interactions among socioeconomic conditions and lead sources if environmental justice is to be achieved.