Evaluation of zirconia surface roughness after aluminum oxide airborne-particle abrasion and the erbium-YAG, neodymium-doped YAG, or CO2 lasers: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Veneer chipping and crown decementation are the most frequent failures in restorations using zirconia as an infrastructure. Increasing the roughness of the zirconia surface has been suggested to address this problem. PURPOSE: The purpose of this systematic review and meta-analysis was to evaluate yttria-stabilized tetragonal zirconia polycrystal surface roughness, produced with aluminum oxide airborne-particle abrasion and the erbium yttrium aluminum garnet (YAG), neodymium-doped YAG, or CO2 lasers. MATERIAL AND METHODS: This study was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The review identified relevant studies through December 2017 with no limit on the publication year in the search databases: Web of Science, Scopus, and MEDLINE via PubMed. The selected studies were submitted to a risk of bias assessment. The means and standard deviations of roughness were evaluated for the meta-analysis using Review Manager software. RESULTS: The 17 studies that met all inclusion criteria presented a medium risk of bias. All the treatment methods tested were able to create a roughness on the yttria-stabilized tetragonal zirconia polycrystal surface. The I2 test values presented a high heterogeneity among the studies. CONCLUSIONS: The presintered specimens submitted to airborne-particle abrasion had higher surface roughness compared with abrasion after the sintering process. Irradiation with the neodymium-doped YAG and CO2 lasers was destructive to the zirconia surfaces. The erbium laser used with lower energy intensity appears to be a promising method for surface treatment.

Gender differences in rural adolescent drinking patterns.

PURPOSE: The purpose of this study was to examine differences in rural adolescent male and female drinking patterns, problem drinking behavior, and the factors associated with problem drinking behavior. METHODS: An anonymous written survey was administered to 2,297 adolescents, aged 12 to 18 years, in a rural Mississippi River Delta county. Potential risk factors for problem drinking behavior examined included demographic, behavioral, peer, and parental characteristics. Drinking patterns were examined separately for male and female adolescent drinkers. RESULTS: Individual factors associated with problem drinking behavior for these rural adolescents were consistent with previous research. However, these factors were gender specific in prevalence. Males were more likely than females to report all of the behavioral and peer risk factors associated with problem drinking, except depressive symptoms, which were more frequently reported by females than males. The interactions of gender with race and gender with peer approval of drinking were significantly associated with problem drinking. The ratio of male to female problem drinkers among African-American adolescents was twice as high as the ratio among Caucasian adolescents. Females were much more strongly influenced by peer disapproval of drinking than were males. CONCLUSIONS: Prevention and intervention programs may be more effective for rural females if they target depression and focus on support systems, whereas intensive programs for adolescents with multiple high risk behaviors may be more effective for rural males.

Classifying patients with burns for hospital reimbursement: diagnosis-related groups and modifications for severity.

This study was designed to evaluate the relative severity and resource consumption of hospitalized patients with burns in a national cross section of hospitals, both with and without burn centers. We investigated to determine whether clinical variables or severity of illness measures not recorded in the Uniform Hospital Discharge Data Set are significant in explaining variation in length of stay, total cost, and mortality for patients with burns. The ability of the six burn diagnosis-related groups (DRGs) to explain variation in patients' length of stay was 20% and their ability to predict total costs was 24%. For the same patient population, the explanatory power of the DRGs improved to 54% for length of stay and 44% for costs when these variables were adjusted by the Severity of Illness Index. We also investigated whether hospitals with burn centers treated a more severely ill population of patients with burns than did hospitals without such centers. Significantly higher levels of severely ill patients with burns (p less than or equal to 0.0001) were found at burn center hospitals. Other patients or treatment variables, combined with a case-mix severity measure, were evaluated for their ability to further increase the explanatory power of DRGs. We also discuss here the use of the study results for reevaluating reimbursement policy.

Vital statistics data as a measurement of perinatal regionalization in Alabama, 1970 and 1980.

Although regionalization of perinatal health care services has received credit for much of the recent improvement in neonatal mortality, until now no measurement of regionalization has been proposed. The measurement presented in this paper--the average of the percentage of infants of very low birthweight and neonatal deaths occurring among residents of a geographic area at a perinatal center--provides a means of comparing the extent of perinatal regionalization in various geographic areas and time periods. Despite continued disparities in the degree of regionalization from one perinatal district to another, Alabama's perinatal system became substantially regionalized from 1970 to 1980. The lower mortality for infants of very low birthweight born at a perinatal center suggests that if Alabama were more completely regionalized, its neonatal mortality would be improved.

Gestational age and the management of preterm labor in obstetric programs.

The gestational age at which obstetric training programs aggressively manage and attempt to salvage preterm vertex fetuses in distress was determined by survey. More than half the programs initiate fetal monitoring and perform cesarean section for certain cases of fetal distress by 26 weeks gestational age. By 28 weeks gestational age, most programs consistently perform a cesarean delivery for a vertex fetus in distress. Management practices in university training programs appear to be more aggressive than those in nonuniversity programs. Not all programs--either within or outside the university--try aggressively to salvage fetuses in distress at 28 weeks gestational age or more, however, despite the excellent chance for survival and normal development.

Neonatal deaths in Alabama. III. Out-of-hospital births, 1940-1980.

Out-of-hospital births in Alabama are characterized with special emphasis on the period from 1970 to 1980. Women having an out-of-hospital birth were more likely to be nonwhite, aged greater than or equal to 35, and multiparous and to have little or no prenatal care. However, within the group of women having out-of-hospital delivery, characteristics which predicted neonatal death included being white, aged less than 20, primiparous, and unmarried and having little or no prenatal care. Both the risk factors for and outcomes of out-of-hospital birth differed markedly by race. In all, out-of-hospital births, which declined from 25% to 0.5% of all births from 1940 to 1980, were associated with a twofold increase in neonatal mortality. The major care provider for out-of-hospital births, the "granny" midwife, was found to have little knowledge about, or ability to provide, modern obstetric care. High-risk status of the patients, limited capability of the care-givers, and lack of appropriate medical resources are suggested as the likely reasons for the excess neonatal mortality in out-of-hospital births.

Lethal congenital anomalies as a cause of birth-weight-specific neonatal mortality.

The percentage of neonatal mortality caused by lethal congenital anomalies and the distribution of specific anomalies in various birth-weight groups are presented. State vital statistics data and autopsy-confirmed data from a single hospital are compared. Of neonates who died, less than 5% who were born weighing between 500 and 999 g died of a congenital anomaly, and nearly 45% who were born weighing more than 2,500 g died of a congenital anomaly. Most deaths associated with congenital anomalies in infants born weighing more than 2,500 g are cardiac in origin. Twenty-three percent of all neonatal deaths in Alabama are attributed to a lethal congenital anomaly. Use of these data to define limits to future improvements in neonatal mortality by standard medical care is discussed.

Neonatal deaths in Alabama. II. Policy and research implications derived from a comparison of birth weight-specific state and medical center neonatal mortality rates.

An analysis of Alabama's recent neonatal mortality rate was performed to answer questions pertaining to projected changes in the neonatal mortality rate in the next decade. With current technology these questions include: (1) Can the current decline in the neonatal mortality rate continue? (2) Which infants not now surviving are potentially able to be saved? (3) What types of new programs may further reduce the neonatal mortality rate? (4) For which infants may research provide technology leading to further reductions in the neonatal mortality rate? In this analysis, birth weight-specific neonatal mortality rates for Alabama were compared with the lowest birth rate-specific neonatal mortality rates achieved in perinatal centers. Specific causes of neonatal death for each birth weight group were determined. Data suggest that 20% of current neonatal deaths would be preventable with available technology through expanded regionalization of perinatal care for infants born weighing less than 2,500 gm. Since lethal congenital anomalies cause the majority of neonatal deaths in infants born weighing greater than 2,499 gm, there is apparently little room for an improved neonatal mortality rate in this group. Without successful research leading to a reduction in preterm delivery rates, a reduction in lethal congenital anomalies or better survival of low-birth weight infants. Alabama's neonatal mortality rate is likely to level off at five to six per 1,000.

Neonatal deaths in Alabama, 1970-1980: an analysis of birth weight- and race-specific neonatal mortality rates.

Alabama birth and death certificate tapes for the years 1970-1980 were linked and analyzed to determine race-specific birth weight and neonatal mortality rate distributions. Changes which occurred over time were evaluated. Our analyses demonstrated that there were no substantial changes in birth weight distributions which could account for the nearly 50% reduction in the neonatal mortality rate in Alabama during this period. Birth weight changes did result in a 12% decrease in the white neonatal mortality rate but resulted in no decrease in the nonwhite neonatal mortality rate. All other improvement in the neonatal mortality rate is attributed to better survival within birth weight groups. Eighty percent of the reduction in the neonatal mortality rate during this period of time occurred in low-birth weight infants with most of the reduction found in infants weighing between 1,000 and 2,000 gm. Improvements in the quality of medical care and better access to medical care through regionalization of perinatal services, especially for low-birth weight infants, are suggested as the major reasons for this improvement.

Costs and benefits associated with treatment for coronary artery disease.

Direct and indirect costs of medical and of surgical treatment are presented for patients entered into the Birmingham portion of the Coronary Artery Surgery Study. For comparison, similar results are shown for the Birmingham portion of the national Cooperative Unstable Angina Study. In the Unstable Angina Study, mean inpatient costs at the end of 1 year in the study were $6867 for medical therapy, $10,574 for surgical therapy and $23,045 for those who failed medical therapy and required late surgery. A stepwise multiple regression analysis shows that the single best predictor of cost was the number of myocardial infarctions that the patient had while in the study. A discriminant-function analysis identified 85% of the medical patients who required late surgery. A significantly lower proportion of surgical than medical patients returned to work. Total inpatient costs for patients in the Coronary Artery Surgery Study (i.e, patients with stable angina) were $3432, $11,100 and $13,554 for medical, surgical and late surgical patients, respectively, for the first year in the study. There was no significant difference in the percentage of medical and surgical patients who were working at the end of 1 year. According to their own perceptions, the surgical group was in the best and the late surgical group in the worst health.

Employment status after coronary artery bypass surgery.

With a few exceptions, prevailing data on return to work after coronary artery bypass surgery indicate no net gain in employment status for at least several years after the operation. Despite the improved surgical experience and advances in the medical management of postoperative patients, only limited employment benefits occur after surgery, and no gains in work rehabilitation over the past decade have been noted. Several characteristics--preoperative work status, nonwork income, occupation, relief of symptoms, age, perception of health, education and severity of disease--appear to be important for estimating the likelihood of employment after surgery. Other influences, such as attitudes of the family, employers and physicians, undoubtedly alter the probability of return to the work force, but are less well documented. Unless constructive approaches toward work rehabilitation are made, the possibility of return to gainful employment should not be considered an indication for or a necessary consequence of coronary artery bypass surgery.

A survey of the graduates of the University of Alabama School of Optometry. Screening for hypertension.

Systemic hypertension is a major health problem in the United States. Almost 16 million people with this disease are estimated to be untreated or inadequately treated. Optometry graduates of the University of Alabama in Birmingham School of Optometry have always received clinical and didactic training in the routine assessment of blood pressure. This study reports the results of a survey of these graduates to determine the number who screened for high blood pressure following graduation, their criteria for referral, their management of hypertensive patients, and their patient characteristics. Over 90% of the optometrists surveyed screened for high blood pressure, and they screened 57% of their patients. Twenty percent of these patients were found to have high blood pressure. These results indicate that optometrists are an important and significant resource in the detection of hypertension in many high risk groups.

Unstable angina pectoris: an examination of modes and costs of therapy.

Debate exists over the most appropriate form of treatment for patients with unstable angina pectoris. This study examined 106 patients randomized at the University of Alabama in Birmingham as part of the National Cooperative Study Group and focuses on the phenomenon of patients who fail medical therapy and thus require late surgery, and the costs of therapy. Discriminant function analysis revealed that the significant predictors (p less than 0.01) of patients who would later require surgery were: total number of vessels diseased, angina severly, presence of congestive heart failure, hypertension, and number of years that the patient had had angina. By means of this analysis, 85% of the late surgery patients were correctly predicted. Late surgery patients averaged 2.4 diseased vessels vs 1.5 for persistent medical patients (p less than 0.01). Mean charges for the first 2 years in the study were $6,226 (SD $2,967) for persistent medical patients, $10,416 (SD $2,146) for surgery patients, and $20,059 (SD $10,748) for late surgery patients (p less than 0.001). These data indicate that surgery is clearly an expensive procedure; but that it is more expensive for late surgery patients, who have total costs that are twice as high as surgical costs and 3.5 times as high as persistent medical costs.

Unstable angina pectoris: a comparison of the costs of medical and surgical treatment.

This study compares the inpatient costs of therapy of patients with unstable angina pectoris randomized to surgical or medical therapy at the University of Alabama in Birmingham as part of the National Cooperative Study Group. For 74 patients followed up for 2 years, the mean inpatient charges were $4,728 for 22 medically treated patients, $9,528 for 34 surgically treated patients and $20,215 for 18 patients who crossed over from medical to surgical therapy. Differences among the three groups were statistically significant (P less than 0.001). Stepwise multiple regression analysis of total inpatient charges with medical and procedural factors as explanatory variables showed that a history of congestive heart failure, the number of infarctions during the period of the study, the duration of the longest anginal attack, the type of unstable angina and the type of treatment were significant predictors of total inpatient cost, with an R2 value of 0.829 (P less than 0.001). These variables explain the cost of treatment. One should not infer that they will also predict the appropriate type of treatment for patients with unstable angina. Although the cost of surgical therapy was double the cost of therapy for patients treated only medically, those medically treated patients whose therapy failed and who subsequently required surgery incurred mean costs twice those of the surgically treated patients and four times of patients who received only medical therapy. Reassessment of previous criticism of the high cost of surgical therapy is indicated.