BMI in childhood and adolescence is associated with impaired reproductive function-a population-based cohort study from birth to age 50 years.

STUDY QUESTION: What is the association between childhood and adolescent BMI and reproductive capacity in women? SUMMARY ANSWER: Adolescent girls with obesity had an increased risk of infertility and childlessness in adulthood independently of their marital status or the presence of polycystic ovary syndrome (PCOS). WHAT IS KNOWN ALREADY: Girls with obesity (BMI (kg/m2)>95th percentile) more often exhibit menstrual irregularities and infertility problems as compared to those with normal weight, and premenarcheal girls with obesity have an increased risk of childlessness and infertility in adulthood. Follow-up studies on the relation between childhood and adolescence growth patterns and fertility or parity throughout the reproductive life span are limited. STUDY DESIGN, SIZE, DURATION: A prospective, population-based cohort study (the Northern Finland birth cohort 1966) was performed with 5889 women born in 1966 and followed from birth to age 50 years. Postal questionnaires at ages 31 and 46 years addressed questions on reproductive capacity evaluated by decreased fecundability, need for infertility assessment and treatment by 46 years of age. Childlessness and number of children by age 50 years were recovered from registers. Women who did not report ever having attempted to achieve pregnancy (n = 1507) were excluded. The final study population included 4382 women who attempted to achieve pregnancy before age 46 years. PARTICIPANTS/MATERIALS, SETTING, METHODS: Data on BMI were collected by trained personnel at all stages. We assessed association with both prospectively measured BMI at various time points and with early adiposity phenotypes derived from linear mixed models including the timing and the BMI at adiposity peak (AP) and adiposity rebound (AR). Self-reported infertility assessments and treatments were assessed at ages 31 and 46 years. Data on deliveries were collected from the national birth register. Decreased fecundability was defined at age 31 years as time to achieve pregnancy over 12 months. Logistic regression analyses were conducted with adjustments for marital status, education level and smoking at age 31 years. Women with PCOS were excluded from stratification-based sensitivity analyses. Obesity at a specific age group was defined by having at least one BMI value above the 95th percentile during the related period. MAIN RESULTS AND THE ROLE OF CHANCE: BMI at the age of AR (5-7 years) was not associated with fertility outcomes after adjustments, but girls with AR <5.1 years had a higher risk of remaining childless compared to girls with AR over 5.1 years (adjusted odds ratio (OR): 1.45 (1.10-1.92)). At ages 7-10 and 11-15 years, obesity was associated with decreased fecundability (adjusted OR 2.05 (1.26-3.35) and 2.04 (1.21-3.44), respectively) and a lower number of children. At age 11-15 years, both overweight and obesity were associated with a higher risk of childlessness (adjusted OR 1.56 (1.06-2.27), 1.77 (1.02-3.07), respectively), even after excluding women with PCOS. Underweight at age 11-15 years was associated with an increased risk for infertility treatment (adjusted OR 1.55 (1.02-2.36)) and a tendency for an increased risk for infertility assessment (adjusted OR 1.43 (0.97-2.10)) after excluding women with PCOS. LIMITATIONS, REASON FOR CAUTION: Despite a high participation rate throughout the follow-up, some growth data for children over the different age groups were missing. Infertility outcomes were self-reported. A potential over-diagnosis of obesity may have reduced the significance of the association between childhood obesity and fertility outcomes, and the diagnosis of PCOS was self-reported. WIDER IMPLICATIONS OF THE FINDINGS: This study supports previous results showing that girls with obesity in late childhood and in adolescence displayed reduced fertility and an increased risk of remaining childless in adulthood, independently of marital history and PCOS in adulthood. These findings corroborate the body of evidence for a causal relation between early adiposity and the reproductive functions in women. We recommend reinforcing the prevention of obesity in school-age girls to reduce the risk of impaired reproductive functions. STUDY FUNDING/COMPETING INTEREST(S): NFBC1966 received financial support from University of Oulu Grant no. 65354, Oulu University Hospital Grant no. 2/97, 8/97, Ministry of Health and Social Affairs Grant no. 23/251/97, 160/97, 190/97, National Institute for Health and Welfare, Helsinki Grant no. 54121, Regional Institute of Occupational Health, Oulu, Finland Grant no. 50621, 54231. The Finnish Medical Foundation, the North Ostrobothnia Regional Fund, the Academy of Finland (project grants 315921, 104781, 120315, 129269, 1114194, 24300796), Center of Excellence in Complex Disease Genetics and SALVE, the Sigrid Juselius Foundation, Biocenter Oulu, University Hospital Oulu and University of Oulu (75617), Jalmari ja Rauha Ahokkaan säätiö, The Finnish Medical Foundation, Medical Research Center Oulu, National Institute for Health Research (UK). M. R. J., S. S. and R. N. received funding by the Academy of Finland (#268336) and the European Union's Horizon 2020 research and innovation program (under Grant agreement no. 633595 for the DynaHEALTH action and GA 733206 for LifeCycle). The funders had no role in study design, in the collection, analysis and interpretation of the data, in the writing of the article and in the decision to submit it for publication. The authors have no conflict of interest to disclose. TRIAL REGISTRATION NUMBER: N/A.

Concurrent heavy use of general and oral health services among Finnish adults.

OBJECTIVE: The aim was to identify heavy users of public health (PHS) and public oral health (POHS) services and combined and concurrent users of these services. MATERIAL AND METHODS: Numbers of 18+ year-old patients and their visits to POHS (12,124 patients) and PHS (28,479 patients) were collected from two patient registers in a Finnish town in 2013. The combined dataset consists of 32,481 patients. Using a highest decile criterion for both for POHS and PHS, those patients who had made 8 or more visits were categorised as heavy users. Patients who had made total of 10 or more visits to the POHS and/or PHS were categorised as combined heavy users. Patients who had made 8 or more visits to both the POHS and PHS were categorised as concurrent heavy users (195 patients). RESULTS: Heavy users of POHS were more often men and those of PHS more often women. Combined heavy users were likely to be women and to be older. The combined heavy users accounted for 40% of all visits of POHS and/or PHS. Among them 30% did not have any POHS visits and 4% did not have any PHS visits. Concurrent heavy use was rare, involving 0.06% of all patients, but made 3.4% of all visits. CONCLUSIONS: Of the patients making 10 or more POHS and/or PHS visits, only five percent were concurrent heavy users of both services. As many non-communicable diseases share common risk factors the combined heavy users of PHS should be directed to use POHS and vice versa.

Tobacco use and dental fear among 15-16 year-old adolescents in Finland.

OBJECTIVE: The aim of this cross-sectional study was to evaluate the association between tobacco use and dental fear when adjusting for gender, parent's level of education and oral health habits. MATERIAL AND METHODS: This secondary analysis used questionnaire data from 15- and 16-year-old adolescents and their parents (n=2486). Ninety-four percent of the adolescents and 73% of the parents responded. For logistic regression analysis, variables were categorized as follows: dental fear (dependent) 0=not at all to somewhat afraid, 1=quite or very afraid; tobacco use (independent) 0=never, 1=occasionally or more often; and for confounders: tooth-brushing 0=at least twice a day, 1=once a day or less often; xylitol products 0=at least three times a day, 1=two times a day or less often; and parents' occupation: 0=both low, 1=high+low, and 2=both high. RESULTS: 2223 adolescents were included in the final analyses resulting in a 89% response rate. Those using tobacco at least occasionally were more likely to have dental fear than those who reported they had never used tobacco, also when adjusting for oral health habits, gender and parents' occupation (OR=1.74, 95% CI=1.31-2.33). CONCLUSIONS: Adolescent tobacco users were more likely to have dental fear than non-users. Dental teams should consider this when meeting adolescents who have dental fear and/or are using tobacco. The possible common vulnerability factors for dental fear and tobacco use needs further study.

Outcome of Chair-Side Dental Fear Treatment: Long-Term Follow-Up in Public Health Setting.

AIM: Purpose of this practice and data-based study was to evaluate the outcome of dental fear treatment of patients referred to the Clinic for Fearful Dental Patients (CFDP) in the primary oral health care, City of Oulu, Finland, during period 2000-2005. METHODS: A psychological approach including behavioral interventions and cognitive behavioral therapy (BT/CBT) was used for all participants combined with conscious sedation or dental general anesthesia (DGA), if needed. The outcome was considered successful if later dental visits were carried out without any notifications in the patient records of behavioral problems or sedation. Data collection was made in 2006; the average length of the observation period from the last visit in the CFPD to data collection was 2 y 3 m (SD 1 y 5 m). All information was available for 163 patients (mean age 8.9 y at referral). Study population was dominated by males (58.0%). Cause for referrals was mostly dental fear (81.0%) or lack of cooperation. RESULTS: The success rate was 69.6% among females and 68.1% among males. Success seemed to be (p=0.053) higher for those treated in ≤12 years compared with the older ones. The participants, without need for dental general anesthesia (DGA) in the CFDP, had significantly a higher success rate (81.4%) compared with those who did (54.8%, p < 0.001). Use of conscious oral sedation (p=0.300) or N2O (p=0.585) was not associated with the future success. CONCLUSIONS: A chair-side approach seems successful in a primary health care setting for treating dental fear, especially in early childhood. Use of sedation seems not to improve the success rate.

Social gradient in intermediary determinants of oral health at school level in Finland.

OBJECTIVE: An adapted framework for oral health inequalities suggests that structural determinants cause oral health inequalities through socio-economic position (SEP) and intermediary determinants. We applied this framework to examine whether there is a social gradient in the intermediary determinants at the school level, even when adjusted for school size, geographical location and teaching language. BASIC RESEARCH DESIGN: Cross-sectional survey. METHODS: This study combined data from two independent studies focusing on Finnish upper comprehensive schools (N=970): the School Health Promotion study (SHPS) and the School Sweet Selling survey (SSSS). All schools that took part in the SSSS and whose pupils answered the SHPS were included in the analysis (n=360, response rate=37%). From the questions of the SHPS and the SSSS suitable for the theoretical framework, attitudes and access to intoxicants, school health services, school environment, home environment, the school's oral health-related actions and the pupil's own behaviour were selected as the intermediary determinants and as the factors determining the school-level SEP. The social gradient in the intermediary determinants of oral health was investigated with Pearson's and Spearman's correlation coefficients between those and the school-level SEP. In the multivariable analysis, the General Linear Model with manual backward elimination was used. RESULTS: A social gradient was observed in the intermediary determinants 'home environment' and 'the pupils' tooth brushing frequency' and an inverse social gradient in 'attitudes and access to intoxicants' and 'school health services'. CONCLUSIONS: Social gradient between schools could increase Finnish adolescents' oral health inequalities.

Effect of Lactobacillus rhamnosus and Bifidobacterium lactis on gingival health, dental plaque, and periodontopathogens in adolescents: a randomised placebo-controlled clinical trial.

To determine the effect of a probiotic combination of Lactobacillus rhamnosus GG (LGG) and Bifidobacterium lactis BB-12 on the gingival health, dental plaque accumulation, and the oral carriage of four putative periodontal pathogens in healthy adolescents. 108 schoolboys, aged 13-15 years, participated in this study. They were divided into two groups: probiotics (n=54) and placebo (n=54). Both groups received two probiotic-laced or placebo lozenges twice a day during a four-week period. Plaque Index (PI) and Gingival Index (GI) were recorded at baseline and after four weeks. Salivary and plaque carriage of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum were also monitored likewise. 101 subjects completed the study. A statistically significant reduction in GI was seen in the probiotic group as compared to the placebo group (P=0.012). A reduction in PI was found for both groups, with no difference observed between the groups after intervention (P=0.819). Probiotic lozenges significantly reduced levels of A. actinomycetemcomitans and F. nucleatum in saliva and plaque (P<0.05) and levels of P. gingivalis in plaque (P<0.05), while no significant changes were found in the control group. A significant reduction (P<0.001) was also noted in the total salivary bacterial counts of the test group. The short-term daily consumption of LGG and BB-12 probiotic lozenges improved the gingival health in adolescents and decreased the microbial counts of A. actinomycetemcomitans, and P. gingivalis. Hence probiotic supplements may serve as a simple adjunct to standard oral care for promoting the oral health in adolescents.

Efficacy of stabilisation splint treatment on the oral health-related quality of life-A randomised controlled one-year follow-up trial.

The aim of this randomised controlled trial was to assess the efficacy of stabilisation splint treatment on the oral health-related quality of life OHRQoL during a 1-year follow-up. Originally, the sample consisted of 80 patients (18 men, 62 women) with temporomandibular disorders (TMD) who had been referred to the Oral and Maxillofacial Department, Oulu University Hospital, Finland, for treatment. Patients were randomly designated into splint (n = 39) and control group (n = 41). Patients in the splint group were treated with a stabilisation splint. Additionally, patients in both groups received counselling and instructions on masticatory muscle exercises. The patients filled in the Oral Health Impact Profile-14 (OHIP-14) questionnaire before treatment and at 3 months, 6 months and 1 year. At total, 67 patients (35 in the splint group vs. 32 in the control group) completed the questionnaire at baseline. The outcome variables were OHIP prevalence, OHIP severity and OHIP extent. Linear mixed-effect regression model was used to analyse factors associated with change in OHIP severity during the 1-year follow-up, taking into account treatment time, age, gender and group status. OHIP prevalence, severity and extent decreased in both groups during the follow-up. According to linear mixed-effect regression, decrease in OHIP severity did not associate significantly with group status. Compared to masticatory muscle exercises and counselling alone, stabilisation splint treatment was not more beneficial on self-perceived OHRQoL among TMD patients over a 1-year follow-up.

A longitudinal study of changes in psychosocial well-being during orthognathic treatment.

The aim was to evaluate changes in the psychosocial well-being of orthognathic surgery patients (n=22) during treatment and to compare results with those of adults not requiring orthognathic treatment (n=22). Patient data were collected before treatment (T0), after the first orthodontic examination (T1), three times during treatment (T2-T4), and 1 year after surgery (T5). In this article, only data corresponding to patient stage T5 are reported for the control subjects. Participants filled in a structured diary and the modified version of the Secord and Jourard body image questionnaire, the Orthognathic Quality of Life Questionnaire, the Rosenberg Self-Esteem Scale, and the Acceptance and Action Questionnaire II. Moreover, patients filled in the Symptom Checklist-90. After the placement of orthodontic appliances (T2), orthognathic quality of life, self-esteem, and psychological flexibility were lower and psychiatric symptoms increased. Improvements were observed from T2 to T5 in orthognathic quality of life, body image, self-esteem, psychological flexibility, and psychiatric symptoms. Treatment resulted in improvements from T0 to T5 in orthognathic quality of life, body image, and psychiatric symptoms. At T5, patient psychosocial well-being was comparable to or even better than that of control subjects. Orthognathic treatment seems to support psychological well-being, but the range of individual variation is wide.

Pregnancy-related anxiety and depressive symptoms are associated with visuospatial working memory errors during pregnancy.

BACKGROUND: Cognitive deficits, especially in memory and concentration, are often reported during pregnancy. Similar cognitive dysfunctions can also occur in depression and anxiety. To date, few studies have investigated the associations between cognitive deficits and psychiatric symptoms during pregnancy. This field is of interest because maternal cognitive functioning, and particularly its higher-order aspects are related to maternal well-being and caregiving behavior, as well as later child development. METHODS: Pregnant women (N =230), reporting low (n =87), moderate (n =97), or high (n =46) levels of depressive, general anxiety and/or pregnancy-related anxiety symptoms (assessed repeatedly with EPDS, SCL-90/anxiety subscale, PRAQ-R2, respectively) were tested in mid-pregnancy for their cognitive functions. A computerized neuropsychological test battery was used. RESULTS: Pregnant women with high or moderate level of psychiatric symptoms had significantly more errors in visuospatial working memory/executive functioning task than mothers with low symptom level. Depressive symptoms throughout pregnancy and concurrent pregnancy-related anxiety symptoms were significant predictors of the performance in the task. General anxiety symptoms were not related to visuospatial working memory. LIMITATIONS: Cognitive functions were evaluated only at one time-point during pregnancy precluding causal conclusions. CONCLUSIONS: Maternal depressive symptoms and pregnancy-related anxiety symptoms were both associated with decrements in visuospatial working memory/executive functioning. Depressive symptoms seem to present more stable relationship with cognitive deficits, while pregnancy-related anxiety was associated only concurrently. Future studies could investigate, how stable these cognitive differences are, and whether they affect maternal ability to deal with demands of pregnancy and later parenting.

Diagnostic criteria for temporomandibular disorders (DC/TMD): interexaminer reliability of the Finnish version of Axis I clinical diagnoses.

Recently, updated diagnostic criteria for temporomandibular disorders (DC/TMD) were published to assess TMD in a standardised way in clinical and research settings. The DC/TMD protocol has been translated into Finnish using specific cultural equivalency procedures. To assess the interexaminer reliability using the Finnish translations of the DC/TMD-FIN Axis I clinical diagnostic assessment instruments. Reliability assessment data were collected during a 1-day DC/TMD Examiner Training Course at the University of Turku, Finland, in collaboration with the International DC/TMD Training and Calibration Center in Malmö University. Clinical TMD examinations according to the Finnish pre-final version of the DC/TMD Axis I assessment protocol were performed by four experienced TMD specialists on altogether 16 models. Kappa coefficient, overall percentage agreement (%A) as well as positive (PA) and negative (NA) agreements were used to define the reliability. Myofascial pain with referral, headache attributed to TMD and disc displacement (DD) without reduction without limited opening showed excellent kappa values (range 0·87-1·00). Fair-to-good reliability was observed for diagnoses of myalgia (k = 0·67), arthralgia (k = 0·71) and DD with reduction (k = 0·64). The PA was high for all pain-related diagnoses and DD without reduction without limited opening (medians ≥83%), and acceptable for DD with reduction (median 67%). The NA was high (medians ≥87%) for all DC/TMD diagnoses, except for myalgia which showed acceptable NA (median 75%). The %A was high for all assessed diagnoses (medians >85%). The findings of this study showed DC/TMD-FIN Axis I to demonstrate sufficiently high reliability for pain-related TMD diagnoses.

Effect of Removal of Enamel on Rebonding Strength of Resin Composite to Enamel.

Objective. To examine the effect of removing the surface layer of enamel on the rebonding strength of resin composite. Methods. Teeth in four groups (n = 10) were etched, a small amount of resin composite was bonded and debonded, then specimens in three groups were ground for different lengths of time (10 s, 20 s, 30 s) to remove an increasing amount of enamel, one group was left untouched. The teeth were bonded again and the bond strengths of 1st and 2nd bonding were compared and analysed against the amount of enamel loss in different groups (7 µm (±2); 12 µm (±1); 16 µm (±3)). Specimens were examined with SEM and by noncontacting optical profilometer. Results. Although results indicated higher rebonding strength with increasing enamel removal ANOVA showed low statistical differences between the groups (p > 0.05). However, values between first bonding and rebonding strengths differed significantly (p < 0.05) in the group that was not ground. SEM revealed that enamel-surfaces that were ground after debonding etched well, compared to the surfaces that still contained adhesive remnants. Conclusions. Removal of small amount of enamel refreshed the surface for rebonding. Rebonding strengths without grinding the surface before bonding were lower than bond strength to intact enamel.

Adaption of pregnancy anxiety questionnaire-revised for all pregnant women regardless of parity: PRAQ-R2.

The 10-item Pregnancy-Related Anxiety Questionnaire-Revised (PRAQ-R) is a widely used instrument to assess and identify pregnancy-specific anxiety in nulliparous women. It has good psychometric values and predictive validity for birth and childhood outcomes. Nonetheless, the PRAQ-R is not designed for use in parous women, as particularly one item of the questionnaire is not relevant for women who gave birth before. We tested the factorial and scalar invariance of a modified PRAQ-R2 across nulliparous and parous women with an adapted item to fit both groups of pregnant women. A longitudinal study among 1144 pregnant women (n = 608 nulliparous and n = 536 parous) with two repeated measures of the PRAQ-R2 was used to test for measurement invariance of the instrument. Results show metric and scalar invariance, indicating that the PRAQ-R2 measures similar constructs on the same scale for all pregnant women at two different times during pregnancy. We conclude that the PRAQ-R2 can be used, compared, or combined in a sample of nulliparous and parous women.

Maternal alexithymic traits, prenatal stress, and infant temperament.

We aimed at investigating, whether maternal alexithymia or prenatal anxiety influences infant temperament (Infant Temperament Questionnaire, IBQ) at six months. Maternal alexithymic trait of "Difficulty in Identifying Feelings" predicted higher infant "Duration of Orienting". "Fear of Bearing a Handicapped Child" predicted lower infant "Activity Level".

The effect of dietary intervention on paraffin-stimulated saliva and dental health of children participating in a randomized controlled trial.

OBJECTIVES: The aim was to study the impact of dietary intervention on the properties of paraffin-stimulated saliva, and on dental caries. STUDY DESIGN: At 7 months of age 1062 infants (540 intervention; 522 controls) started in the prospective, randomized Special Turku Intervention Project (STRIP) aimed at restricting the child's saturated fat and cholesterol intake to prevent atherosclerosis of adult age (www.clinicaltrials.gov NCT 00223600). At 3 years of age, every fifth child was invited to an oral sub-study, and 148 (78 boys) children attended. At 6, 9, 12 and 16 years of age 135, 127, 114 and 88 children were restudied, respectively. Dietary intakes of carbohydrates, protein, saturated fat, calcium, phosphate, and fibre were regularly recorded using 4-day food records. Height and weight were regularly monitored. Paraffin-stimulated saliva samples were collected at 6, 9, 12 and 16 years of age, and analyzed for flow rate, buffer capacity, calcium, phosphate and proteins. Dental health was recorded and expressed as d3mft/D3MFT, and as time of caries onset. RESULTS: Dietary intakes of calcium, phosphate and fibre, and salivary flow rate increased with time in both groups (p<0.001, GLM for repeated measures). Fibre intake and salivary flow rate were higher in the intervention than in the control group (p=0.042 and p=0.0394, respectively, GLM for repeated measures). There were no correlations between dietary intakes and salivary concentrations of calcium or phosphate. Children who did not have caries experience (d3mft/D3MFT=0) during the entire follow-up had higher salivary calcium than those who had caries already at 3 years of age. The association between salivary calcium and caries onset was significant up to 12 years of age. Toothbrushing frequency was statistically significantly associated with caries-onset at ages 6 (gamma statistic 0.457, p=0.046) and 12 years (gamma statistic 0.473, p=0.019). CONCLUSIONS: The current long-term dietary intervention increased children's paraffin-stimulated salivary flow rate. The concentration of salivary calcium was directly correlated to dental health. Higher salivary flow rate in the intervention group is believed to be due to higher fibre intake in the intervention group.

Associations between schools' guidelines and pupils' smoking and sweet consumption.

OBJECTIVE: The aims were to find out if schools' sweet-selling was associated with pupils' sweet consumption, and whether the school's guideline about leaving the school area was associated with pupils' tobacco and sweet consumption. METHODS: Two independently collected datasets from all Finnish upper secondary schools (N = 988) were linked together. The first dataset on schools' sweet-selling (yes/no) and guideline about leaving school area (yes/no) was collected via school principals in 2007 using an Internet questionnaire with a response rate of 49%, n = 480. The second dataset on pupils' self-reported: weekly school-time (0, never; 1, less than once; 2, 1-2 times; 3, 3-5 times), overall sweet consumption frequencies (1, never; 2, 1-2 times; 3, 3-5 times; 4, 6-7 times) and smoking and snuff-using frequencies (1, never; 2, every now and then; 3 = every day) was collected in 2006-2007 in the School Health Promotion Study from pupils. An average was calculated for the school-level with a response rate 80%, n = 790. The total response rate of the linked final data was 42%, n = 414. Mean values of self-reported sweet and tobacco consumption frequencies between sweet-selling and non-sweet-selling schools and between schools with different guidelines were compared using Mann-Whitney test. RESULTS: Pupils in sweet-selling schools and in schools without a guideline about leaving the school area, more frequently used sweet products and tobacco products than their peers in other schools. CONCLUSIONS: Schools may need help in building permanent guidelines to stop sweet-selling in school and to prevent leaving the school area to decrease pupils' sweet consumption and smoking.

Evaluating the provision of oral health education material in Schools in Finland.

INTERVENTIONS: The Finnish Dental Association donated new oral health education material (OHEM) to all upper comprehensive schools in 2008. OBJECTIVE: The aim of this study was to determine whether that OHEM was noticed, received and used in schools, and whether oral health teaching and teachers' attitudes towards oral health changed after distribution of the OHEM. METHODS: Surveys were conducted using online questionnaires for all health education teachers in upper comprehensive schools in Finland. Schools response rates were 39% in 2008, and 40% in 2009. Statistical significances between the teachers and between the schools according to background variables were analysed using a Pearson's Chi-square test for nominal data and Mantel-Haenszel Chi-square test for ordinal data. Changes between 2008 and 2009 were evaluated using percentage change and confidence intervals. RESULTS: Of the responding teachers, 46% reported that they had received the OHEM and 33% had used it in their teaching. The number of teachers teaching oral health did not change after the OHEM, but teachers who taught oral health reported teaching all oral-health-related topics more frequently than they did before. Female teachers more often reported having received the OHEM (48% vs 32%, p=0.011) and having used it (36% vs 22%, p=0.017) than did male teachers. CONCLUSIONS: The OHEM may not lead more teachers to teach oral health, but it provides them with the resources to teach the subject more comprehensively. The OHEM must be planned in close co-operation between schools and local dental health care professionals, to make it better known and accepted among teachers, especially male teachers.

Xylitol carryover effects on salivary mutans streptococci after 13 months of chewing xylitol gum.

To assess mutans streptococci (MS) during xylitol gum chewing (mean 3.8 g/day, 2.9 times/day) for 13 months and then for 15 months after the intervention, Japanese mothers with high salivary MS were randomized into two groups: xylitol gum (n = 56) and no gum (n = 51). The proportion of low MS levels was highest at 3 months of consumption (48.8%), but was significantly lower compared to baseline at the end of the intervention (p < 0.001). MS levels did not change during the postintervention period. The data suggest that in the xylitol group 23.3% showed persistent carryover effects by xylitol gum chewing in the postintervention period.

Transgenic bioreactors.

Since the generation of the first transgenic mice in 1980, transgene technology has also been successfully applied to large farm animals. Although this technology can be employed to improve certain production traits of livestock, this approach has not been very successful so far owing to unwanted effects encountered in the production animals. However, by using tissue-specific targeting of the transgene expression, it is possible to produce heterologous proteins in the extracellular space of large transgenic farm animals. Even though some recombinant proteins, such as human hemoglobin, have been produced in the blood of transgenic pigs, in the majority of the cases mammary gland targeted expression of the transgene has been employed. Using production genes driven by regulatory sequences of milk protein genes a number of valuable therapeutic proteins have been produced in the milk of transgenic bioreactors, ranging from rabbits to dairy cattle. Unlike bacterial fermentors, the mammary gland of transgenic bioreactors appear to carry out proper postsynthetic modifications of human proteins required for full biological activity. In comparison with mammalian cell bioreactors, transgenic livestock with mammary gland targeted expression seems to be able to produce valuable human therapeutic proteins at very low cost. Although not one transgenically produced therapeutic protein is yet on the market, the first such proteins have recently entered or even completed clinical trials required for their approval.

Leukocyte adhesion--structure and function of human leukocyte beta2-integrins and their cellular ligands.

Leukocyte adhesion is of pivotal functional importance and this has resulted in extensive research and rapid development in the field. Leukocyte adhesion involves members of three molecular families: integrins, members of the immunoglobulin superfamily and carbohydrate binding selectins and sialoadhesins. Recently, considerable structural information on leukocyte integrins and members of the immunoglobulin superfamily of adhesion molecules has been obtained. This fact, combined with the identification of several novel adhesion molecules, has increased our understanding of how they function at the molecular level. Furthermore, the important issue of how integrins are activated to become adhesive is rapidly advancing. It is clearly evident that the knowledge accumulated from basic research will increasingly be applied in clinical medicine. In this review we focus on two important families of adhesion molecules, the leukocyte-specific beta2-integrins and their ligands, the intercellular adhesion molecules. Emphasis is put on their structural/functional relationships, their mode of regulation and on novel adhesion molecules recently discovered.

Expression of bovine beta-lactoglobulin/human erythropoietin fusion protein in the milk of transgenic mice and rabbits.

We have generated several transgenic mouse lines and rabbits expressing efficiently (up to 0.3 mg/ml in mice and up to 0.5 mg/ml in rabbits) human erythropoietin in their milk as bovine beta-lactoglobulin fusion protein. Human erythropoietin cDNA was inserted in frame into exon 5 of the bovine beta-lactoglobulin gene with a linker oligonucleotide encoding the cleavage site for bacterial IgA protease. RNA analysis performed on one lactating transgenic mouse and one transgenic rabbit revealed that the fusion gene was expressed almost exlusively in the mammary gland, although low amounts of transgene-derived RNA were detectable in salivary glands and uterus or in the kidney. The fusion protein was specifically cleaved with IgA protease. The erythropoietin part obtained upon digestion had a lower molecular mass than recombinant erythropoietin produced in Chinese hamster ovary cells. By deglycosylation analysis it was shown that the difference in size was due to a different type of glycosylation. Biological activity of the fusion protein, as determined by growth stimulation of TF-1 erythroleukemia cells, was less than 15% of that of human recombinant erythropoietin. Upon digestion of the fusion protein with IgA protease, biological activity comparable to that of the recombinant erythropoietin was recovered. Transgenic males and virgin females did not show signs of enhanced erythropoiesis, but lactating females expressing the transgene displayed transient increases in their hematocrit values.