Abrasiveness of an air-powder polishing system on root surfaces in vitro.

OBJECTIVE: The purpose of this study was to evaluate the abrasiveness of a new air polisher on root surfaces. METHOD AND MATERIALS: Fifty extracted human teeth were air polished for 5 seconds. RESULTS: All root surfaces showed a circular defect visible with the naked eye. Scanning electron microscope examination showed smooth crater walls and a few open dentin tubules, but most seemed to be obliterated. Laser profilometry of the exposed areas revealed defects with an average depth of 484 microns, whereas the unexposed root surfaces showed irregularities with an average depth of 323 microns. The depths of the abraded areas were evaluated in relation to the values for the unexposed surfaces, and an average depth of 161 microns was found. The difference between the exposed and unexposed surfaces was statistically significant. CONCLUSION: The present study indicates that the air polisher has a strong abrading effect on exposed root surfaces and should therefore be used with caution on patients with gingival retractions.

Access to physicians, obstetric care use, and adequacy of prenatal care for Medicaid patients in Maine: 1985-1989.

OBJECTIVE: To document trends in prenatal care utilization and provider participation in the Maine Medicaid program for the period 1985-1989, and to examine the effect of physician availability on adequacy of care. METHODS: Five years of Medicaid claims data and 3 years of claims data linked to birth certificates were analyzed. RESULTS: Large decreases in overall physician participation in the Medicaid program were due to reductions in the number of family physicians and general practitioners, whereas the number of obstetricians increased during this time. Large increases in provider caseloads resulted from an increase in recipient enrollment. The number of prenatal visits per patient, a measure of access, increased during this time. Adequacy of care was not associated with physician availability after controlling for maternal age, maternal education, out-migration for care, and type of location (rural versus urban). Important differences by type of location that emerged included less physician availability in rural areas but a higher likelihood of receiving adequate care. Women from low-availability areas were more likely to seek care outside of their primary care area of residence. Women living in rural areas who out-migrated for care were not more likely to receive inadequate prenatal care. CONCLUSION: Access to prenatal care for Medicaid recipients may have increased from 1985 to 1989 despite decreased overall physician participation in the program, perhaps because of more participating obstetricians. In addition, adequacy of care was not associated with physician availability in this population. Women residing in rural areas experienced lower physician availability and greater out-migration for care with no adverse effect on adequacy of prenatal care.

Access of rural AFDC Medicaid beneficiaries to mental health services.

This article examines geographic differences in the use of mental health services among Aid to Families with Dependent Children (AFDC)-eligible Medicaid beneficiaries in Maine. Findings indicate that rural AFDC beneficiaries have significantly lower utilization of mental health services than urban beneficiaries. Specialty mental health providers account for the majority of ambulatory visits for both rural and urban beneficiaries. However, rural beneficiaries rely more on primary-care providers than do urban beneficiaries. Differences in use are largely explained by variations in the supply of specialty mental health providers. This finding supports the long-held assumption that lower supply is a barrier to access to mental health services in rural areas.

Wilson's disease in Israel: a genetic and epidemiological study.

Clinical and family history data on persons affected with Wilson disease (WD) living in Israel between 1958 and 1984 were ascertained from the literature, hospital records and neurological and gastroenterological clinics. From this population of 51 families, representing a diversity of Middle Eastern. North African and European backgrounds, blood samples were collected from affected individuals in 21 families, their parents, sibs and other relatives for quantitative determinations of plasma copper and ceruloplasmin, liver tests and DNA analysis. Although the majority of patients have the hepatic form of the disease, hepatic and neurological cases were found among all ethnic groups. In fact, affected sibs in several inbred families who most likely inherited two copies of the same mutant allele had different symptoms. Gene frequencies were calculated for each of the populations taking into account inbreeding, probability of ascertainment, and estimated incidence. Although many of these communities have gene frequencies which are comparable to worldwide estimates, high prevalence of disease is maintained by consanguineous mating patterns. Probabilities of WND genotypes were calculated for 129 unaffected relatives who had an a priori risk of inheriting at least one WND allele using information from 10 DNA markers closely linked to the WND locus. There was no evidence that multiple loci are responsible for the observed clinical variability in this sample of families. Furthermore, studies of serum copper and ceruloplasmin levels in unaffected relatives suggest that phenotypic variability in WD may be due in part to an interaction of the WND locus with other genetic or non-genetic modifiers such as age.