Psychosocial impact of anterior dental esthetics on periodontal health, dental caries, and oral hygiene practices in young adults.

This study sought to determine whether the self-perceived image of a young adult's anterior dental esthetics is linked with periodontal health, dental caries, and oral hygiene practices. Two hundred subjects were assessed via a clinical examination, including intraoral photographs. The subjects were questioned about their demographics and oral hygiene practices and given the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) to measure their self-perceived variables related to dental esthetics. A high PIDAQ score indicates a negative image of one's own dental esthetics, while a low PIDAQ score indicates a positive outlook. A self-perceived negative psychosocial impact of anterior dental esthetics was detected in subjects with higher levels of dental caries and visible gingival inflammation in the anterior region of the mouth.

Pain control in orthodontics using a micropulse vibration device: A randomized clinical trial.

OBJECTIVE: To investigate the relationship between a micropulse vibration device and pain perception during orthodontic treatment. MATERIALS AND METHODS: This study was a parallel group, randomized clinical trial. A total of 58 patients meeting eligibility criteria were assigned using block allocation to one of two groups: an experimental group using the vibration device or a control group (n  =  29 for each group). Patients used the device for 20 minutes daily. Patients rated pain intensity on a visual analog scale at appropriate intervals during the weeks after the separator or archwire appointment. Data were analyzed using repeated measures analysis of variance at α  =  .05. RESULTS: During the 4-month test period, significant differences between the micropulse vibration device group and the control group for overall pain (P  =  .002) and biting pain (P  =  .003) were identified. The authors observed that perceived pain was highest at the beginning of the month, following archwire adjustment. CONCLUSION: The micropulse vibration device significantly lowered the pain scores for overall pain and biting pain during the 4-month study period.

Recurrent headache in military-dependent children and the impact of parent deployment.

Our objective is to determine the prevalence of recurrent headaches in military-dependent children and to study the changes in headache frequency, severity, and duration during a parental deployment. Recurrent headaches are common in children and are often intensified by stressful life events. Military-dependent children are subjected to unique stressors, most significantly parental wartime deployment. No studies have evaluated the effect of deployment on somatic complaints, to include headaches. We conducted a parental, cross-sectional questionnaire-based study in patients aged 5 to 17 years who were seen in the pediatric or adolescent clinics at a regional military medical center. The overall prevalence of recurrent headaches in the preceding 12 months was 30%. Almost half reported headache worsening in frequency, severity, or duration over the previous 12 months, whether a parent was deployed or not. For children who had experienced parental deployment, younger children and females were affected more often. Younger females had the highest rates of headache worsening. This trend may indicate a more detrimental effect of parental deployment on childhood headache in certain populations.

IMOUTA: a proposal for patient care handoffs.

OBJECTIVES/HYPOTHESIS: An increased frequency of patient handoffs has occurred as a result of the new resident work-hour restrictions that have recently been instituted. Inadequate handoff of patient care has been associated with adverse patient events due to residents being unprepared for events that happen during cross cover periods. The objective of our study was to develop and test the effectiveness of a patient handoff method in an otolaryngology residency program. STUDY DESIGN: Single-blinded controlled clinical trial. METHODS: A standardized, anonymous questionnaire was developed that scored on-call residents' understanding of their patients' diagnoses, hospital courses, active concerns, and treatment plans. For the first 45 days, residents used their traditional handoff. This handoff was prepared by the residents, relaying relevant patient information without any structured format. For the next 45 days, the residents followed the acronym of IMOUTA for handoffs. This mnemonic was developed to help residents identify data (I), medical course (M), outcomes possible tonight (OU), responsibilities to do tonight (T), and opportunity to ask questions and give morning feedback in the AM (A). The questionnaires were then compared at the end of the study. RESULTS: The residents who used the IMOUTA acronym scored significantly higher on their perceived knowledge of patients diagnoses (P = 0.001), hospital courses (P <0.001), active concerns (P <0.001), and treatment plans (P <0.001). CONCLUSION: Residents felt significantly better prepared for call duties when using the IMOUTA acronym. This standardized system of patient handoff may also be valuable to other residency programs.

Documented combat-related mental health problems in military noncombatants.

Although combat-related posttraumatic stress disorder (PTSD) has been documented for military combatants, little is known about PTSD in noncombatants. Active-duty U.S. Air Force noncombatants (N = 5,367) completed a Post-Deployment Health Assessment upon return from combat zones in Iraq (n = 4,408) or a noncombat zone in Qatar (n = 959). Those deployed to Iraq were significantly more likely to report exposure to someone who was wounded or killed (20.8% vs. 6.3%), feeling in great danger of being killed at some point during deployment (18.9% vs. 3.5%), symptoms of PTSD (4.1% vs. 0.7%), and symptoms of major depression (9.9% vs. 5.4%). These findings suggest that deployment to a war zone is associated with increased mental health problems, even for noncombatants.

Predicting irreparable renal ischemic injury using a real-time marker in the porcine model.

PURPOSE: We determined the maximal renal tolerance of warm ischemia using renal cortical interstitial metabolic changes to identify a potential real-time marker of irreparable renal function. MATERIALS AND METHODS: Using a single kidney model 3 groups of 5 pigs each underwent 120, 150 and 180 minutes of warm ischemia, respectively. Microdialysis samples were collected before, during and after ischemia. Renal function assessments consisting of serum creatinine and GFR measurements were performed before ischemia and on post-ischemia days 1, 5, 9, 14 and 28. Kidneys exposed and not exposed to ischemia were collected for histological study. RESULTS: Interstitial glucose and pyruvate concentrations decreased, while lactate concentrations increased to stable levels during ischemia. Glutamate spiked at 30 minutes of ischemia and subsequently tapered, while glycerol increased throughout warm ischemia time. At post-ischemia day 28 renal function returned to pre-ischemia baseline levels in the group with 120 minutes of ischemia but did not recover to baseline in the 150 and 180-minute ischemic groups. Functional data correlated with histological findings. The 120-minute maximal renal tolerance of warm ischemia correlated with a mean +/- SD glycerol concentration of 167 +/- 24 micromol/l. CONCLUSIONS: Interstitial glycerol is a real-time, renal unit specific, minimally invasive marker of renal function deterioration. Exposure of porcine kidneys to ischemic insults resulting in renal cortical interstitial glycerol concentrations higher than 167 micromol/l is associated with irreparable functional damage in this model.

Real-time analysis of renal interstitial metabolites during induced renal ischemia*.

PURPOSE: Microdialysis is an innovative technique used to monitor the chemistry of the interstitial fluid in living tissue. We documented changes in concentration of interstitial fluid metabolites before, during, and after induced renal ischemia. MATERIALS AND METHODS: Under general anesthesia, a microdialysis probe was laparoscopically positioned into the renal cortex of six pigs. Isotonic sterile perfusion fluid was pumped through the probe at 2 microL/min. After collecting a baseline sample, the renal artery was occluded with a Satinsky clamp for 90 (n = 3) or 120 (n = 3) minutes. A dialysate sample was collected every 30 minutes during the ischemic and 3-hour postischemic period. The samples were analyzed for glucose, lactate, pyruvate, glutamate, urea, and glycerol concentrations with the CMA/600 Microdialysis Analyzer. Serum metabolic panels from peripheral venous samples drawn before ischemia, after ischemia, and 3 hours after ischemia were analyzed. RESULTS: Glucose and pyruvate concentrations significantly declined (P = 0.01, P = 0.05, respectively) while lactate and glycerol concentrations significantly increased during ischemia (P = <0.01, P < 0.01, respectively). Glutamate increased to 2.5 times the baseline concentration (P < 0.01) at 1 hour of ischemia and subsequently declined during ischemia. The lactate/pyruvate ratio increased sharply during ischemia and returned to baseline within 1 hour postischemia. There were no changes noted in serum creatinine levels before and after ischemia. CONCLUSIONS: Microdialysis can accurately measure minute real-time changes in the renal interstitial environment caused by ischemia not detected with serum studies. These local changes may be correlated with ischemic times to predict tissue preservation in future studies.

Lapra-Ty holding strength and slippage with various suture types and sizes.

OBJECTIVES: To investigate the holding strength and slippage of Lapra-Ty clips on various suture types and sizes. METHODS: Using an automated materials testing system with the Lapra-Ty in a fixed position, Lapra-Ty holding strength and displacement were determined with 0, 2-0, 3-0, and 4-0 Vicryl, Monocryl, and polydioxanone suture (PDS). To simulate clinical application, Lapra-Tys were also tested by applying a load to these sutures after being passed through a full-thickness layer of tautly suspended fresh porcine bladder tissue. Three trials were performed with each suture type and size. RESULTS: The Lapra-Ty holding strength with Vicryl suture was significantly higher than with Monocryl or PDS of the same suture size in bladder tissue trials. Monocryl suture had a significantly higher displacement than Vicryl or PDS of the same suture size in bladder tissue trials (except for 4-0 Monocryl and PDS having insignificantly different displacements). Lapra-Tys slipped off Vicryl, Monocryl, and PDS in 25%, 67%, and 67% of their respective trials. Lapra-Tys did not slip during any of the trials with 2-0 suture of any type or 3-0 Vicryl. Lapra-Tys with holding strengths on suture less than approximately 8 Newtons (N) slipped and greater than 8 N pulled through the bladder tissue without slipping. CONCLUSIONS: The optimal suture type and size to maximize Lapra-Ty holding strength and minimize slippage was determined to be 2-0 and 3-0 Vicryl, 2-0 Monocryl, and 2-0 PDS. Monocryl suture stretches more than Vicryl and PDS at higher loads.

The effects of ureteral mobilization and transection on ureteral oxygenation.

OBJECTIVES: To determine the impact of ureteral transection with and without prior ureteral mobilization on ureteral oxygen partial pressure (p(u)O(2)). METHODS: Sixteen pigs underwent general anesthesia with laparoscopic transperitoneal access to the right ureter. With no dissection and minimal manipulation, a tissue oxygen probe (Licox, Kiel, Germany) was introduced via a trocar and inserted into the ureter. The probes were placed at the ureteropelvic junction (UPJ, n = 8) and ureterovesical junction (UVJ, n = 8). Baseline p(u)O(2) was measured. Subsequently, half of the animals at each level (n = 4) underwent complete ureteral transection proximal to UPJ probes and distal to UVJ probes with or without prior mobilization. p(u)O(2) levels were measured after ureteral mobilization and transection. RESULTS: Of the ureters transected at the UPJ without mobilization, the mean p(u)O(2) level declined by 13 mm Hg relative to baseline (P = 0.07). The baseline UPJ p(u)O(2) level declined by 5 mm Hg after ureteral mobilization alone and subsequently by 31 mm Hg after transection (P <0.01). Of the ureters transected at the UVJ without mobilization, the p(u)O(2) level decreased by 4 mm Hg relative to baseline (P = 0.08). The baseline UVJ p(u)O(2) level decreased by 15 mm Hg after ureteral mobilization alone and subsequently by 39 mm Hg after transection (P <0.01). At both the UPJ and UVJ, the transected-only p(u)O(2) level was statistically higher than the mobilized and transected level (P = 0.03, respectively). CONCLUSIONS: During ureteral surgery, mobilization alone exposes the distal ureter to more ischemia than the proximal ureter, and efforts to minimize ureteral mobilization when transection is necessary are crucial in maintaining tissue oxygenation.

Shock wave lithotripsy success for renal stones based on patient and stone computed tomography characteristics.

OBJECTIVES: To determine the patient and noncontrast computed tomography (NCCT) stone characteristics that predict either of 2 extracorporeal shock wave lithotripsy (ESWL) outcomes: stone-free (SF) status or ESWL success. METHODS: The records of 200 consecutive patients with nephrolithiasis treated with ESWL were reviewed. Patient age, sex, stone laterality, body surface area, body mass index, maximal stone dimension, mean stone Hounsfield units (HU), stone Hounsfield density, skin-to-stone distance (SSD), and intrarenal stone location were studied as potential predictors. Patients with no calcifications on postoperative kidneys, ureters, and bladder (KUB) at 6 weeks were defined as SF. ESWL success was defined as SF or remaining stone fragments less than 4 mm. RESULTS: Intrarenal stone location was found to be the only predictor of SF status. Renal pelvic/ureteropelvic junction (UPJ) stones cleared better than calyceal stones, and upper/middle calyceal stones cleared better than lower calyceal stones. Stone size, mean HU, and location predicted ESWL fragmentation success. Smaller stones and stones with lower mean HU levels were more successfully fragmented. Higher SF and ESWL success rates were found with a shorter SSD among calyceal stones when renal pelvic/UPJ stones were excluded from analysis. CONCLUSIONS: Stone location is the most important factor in achieving SF status after ESWL. NCCT stone characteristics such as stone size, mean HU, and intrarenal location are important predictors of ESWL success.

The significance of high-risk human papillomavirus detection in women aged > or = 50 years with atypical squamous cells of undetermined significance cytologic preparations.

BACKGROUND: The use of high-risk human papillomavirus (HRHPV) testing in the triage of women with a cytologic diagnosis of atypical squamous cells of undetermined significance (ASC-US) has gained widespread acceptance. To date, very little has been reported on the significance of the detection of HRHPV in elderly women. METHODS: Results of HRHPV testing performed on women aged > or =50 years were examined for a 20-month period. Reflex testing for HRHPV was performed on residual liquid-based cytology specimens from women who were diagnosed with ASC-US by using the Digene Hybrid Capture method. Follow-up information on women who had HRHPV detected was obtained from subsequent pathology reports (cytology and surgical). RESULTS: HRHPV testing was performed on 762 specimens from women aged > or =50 years; virus was detected in 105 specimens (13.8%), and follow-up was available in 63 of those women (60%). Follow-up results included negative tests in 32 women (50.8% of those with follow-up available), low-grade squamous intraepithelial lesion in 26 women (41.3%), and high-grade squamous intraepithelial lesion (HSIL) in 5 women (7.9%). No glandular neoplasia or invasive carcinoma was identified. Relative light units/cutoff (RLU/CO) values ranged from 1 RLU/CO to 1705 RLU/CO; no significant associations were identified between RLU/CO values and follow-up results. CONCLUSIONS: Although HRHPV was detected in a minority of samples, HSIL was present in 7.9% of those with HRHPV. This confirms that the presence of HRHPV in women aged > or =50 years with ASC-US specimens needs clinical follow-up. There were no significant differences in RLU/CO values between women with positive versus negative follow-up to allow for further discrimination for follow-up.

Exhaled nitric oxide levels in military recruits with new onset asthma.

Approximately 800 United States Air Force basic military trainees (BMTs) are diagnosed with asthma, annually, resulting in separation from the military. With training costs of approximately 10,000 dollars/person, around 8 million dollarsis lost per year. Improved methods in diagnosing asthma would be beneficial. The aim of this study was to determine the fraction of exhaled nitric oxide (FENO), a marker of airway inflammation, in a military recruit population referred for an asthma evaluation. In BMTs referred for respiratory complaints during basic training, FENO levels were determined before an asthma evaluation consisting of a history, physical, baseline spirometry, and histamine bronchoprovocation. Of 172 BMTs who had symptoms suggestive of asthma and underwent histamine bronchoprovocation, 80% were diagnosed with asthma. FENO levels were significantly higher in asthmatic patients than nonasthmatic patients (mean, 30 parts per billion [ppb] versus 19 ppb, p < 0.001; median, 21 ppb versus 17 ppb, p < 0.02). Various FENO cutoff points provided a range of sensitivity and specificity for the diagnosis of asthma. However, an optimal FENO cutoff level for asthma was not obtained. An FENO value of 10.5 ppb provided a sensitivity of 86% for the diagnosis of asthma, but specificity was only 21%. In contrast, an FENO value of 46 ppb provided 100% specificity but only 17% sensitivity. FENO levels were significantly elevated in BMTs diagnosed with asthma but the lack of an optimal cutoff level limits the test as a diagnostic tool for asthma. Additional studies are necessary to determine the value of FENO for asthma screening in a military population.

A national survey of terrorism preparedness training among pediatric, family practice, and emergency medicine programs.

OBJECTIVES: Domestic terrorism is a real threat focusing on a need to engage in effective emergency preparedness planning and training. Front-line physicians are an important component of any emergency preparedness plan. Potential victims of an attack include children who have unique physiologic and psychological vulnerabilities in disasters. Front-line providers need to have adequate training to effectively participate in local planning initiatives and to recognize and treat casualties including children. The goal of the survey was to assess the current state of terrorism preparedness training, including child victims, by emergency medicine, family practice, and pediatric residency programs in the United States and to assess methods of training and barriers to establishing effective training. METHODS: A survey was e-mailed to a comprehensive list of all US pediatric, family practice, and emergency medicine residency programs 3 times between September 2003 and January 2004. The survey measured the perceived risk of terrorist attack, level of training by type of attack, level of training regarding children, method of training, and barriers to training. RESULTS: Overall, 21% of programs responded (46 of 182 pediatric, 75 of 400 family practice, and 29 of 125 emergency medicine programs). Across all of the event types, emergency medicine programs were more likely to report adequate/comprehensive training. However, < 50% of emergency medicine programs report adequate training for children. Didactic classroom-based lectures were the most commonly used method of training. Emergency medicine programs were more likely to use scenario-based exercises. Among programs that use scenario exercises, 93% report that they never (40%) or only sometimes (53%) incorporate child victims into the scenarios. Time, funding, access to subject matter experts, and availability of training material are the most important barriers to effective training. CONCLUSIONS: Children are a precious national resource and a vulnerable population in disasters. Despite the availability of terrorism preparedness funding, these data suggest that we are failing to provide adequate training to front-line providers who may care for children in a catastrophic domestic terrorist event.

Shear bond strength and SEM evaluation of composite bonded to Er:YAG laser-prepared dentin and enamel.

OBJECTIVES: The purpose of this study was to evaluate dentin and enamel bond strength to resin composite following high-speed rotary or Er:YAG laser preparation using a total etch adhesive system. The microstructure of resin-tooth interfaces was also investigated. METHODS: Human dentin and enamel specimens were prepared with a high-speed handpiece (KaVo) or Er:YAG laser (DELight) at manufacturer's recommended settings and etched with either 37% H(3)PO(4), laser etched, or not etched. Composite rods (Z-250, 3M/ESPE) were bonded to specimens with an adhesive (Adper Scotchbond Multi-Purpose, 3M/ESPE). After thermocycling, specimens were tested in shear to failure. RESULTS: Two-factor ANOVA detected significant differences in the main effects of preparation and etch type, and interaction (p<0.001). Post hoc analyses showed that in both dentin and enamel, only the acid-etched specimens had significantly higher mean bond strengths, with rotary-prepared specimens having significantly higher mean bond strengths versus laser prepared specimens. Within each preparation type, in both dentin and enamel, acid etch was better than laser etch, and laser etch was better than no etch. Scanning electron microscopy of laser-ablated specimens demonstrated significant surface scaling and subsurface fissuring beyond normal resin penetration depth. SIGNIFICANCE: Adhesion to laser-ablated or laser-etched dentin and enamel was inferior to that of conventional rotary preparation and acid etching.

Reflex high-risk human papillomavirus testing for women with atypical squamous cells of undetermined significance in cytologic smears: effects since implementation in a large clinical practice.

Reflex high-risk human papillomavirus (HPV) testing often is used in the management of women with atypical squamous cells of undetermined significance identified in cervicovaginal screening. Following implementation of reflex testing, our laboratory processed 8,022 specimens during a 20-month period; sufficient material was available for testing in 7,334 specimens. High-risk HPV was detected in 34.10% of these specimens. Detection rates varied with age, with positive rates as high as 58.46% in women 20 years old or younger, decreasing to 14.58% in women older than 35 years. The detection rate, categorized in 5-year age increments, showed a significant decrease until after 35 years, when the rate remained fairly constant (P < .0001). The detection rate decreased over the time of the study. These results demonstrate that high-risk HPV detection might vary according to the age mix of the population tested and the interval after implementation of testing.

Improving recruitment and funding in psychiatry by teaching college undergraduates.

OBJECTIVE: To explore attitudes among leaders in psychiatric training about the usefulness of teaching college undergraduates about psychiatry and to assess benefits in recruitment and funding. METHOD: A survey of current practices and beliefs was sent to most adult and child psychiatry residency training directors (RTDs) and Chairs of academic departments of psychiatry in the U.S.). A follow-up survey was then sent to RTDs at responding programs that teach undergraduates. Interviews were also conducted with education experts to learn about the potential financial benefits of teaching undergraduates. RESULTS: Of the 289 (64%) respondents to the first survey, 237 (82%) expressed that teaching undergraduates might or would lead to increased recruitment. All RTDs at responding programs that offered courses answered the second survey, and four reported that undergraduate teaching brings in revenue. Experts confirmed the financial feasibility of these courses. CONCLUSION: Undergraduate psychiatry courses may increase overall recruitment and provide financial benefits for the departments that offer such courses.

Allogeneic hematopoietic stem cell transplantation in the active duty military population: 1987-2001.

Wilford Hall Medical Center at Lackland Air Force Base is the only military medical center in the United States at which allogeneic hematopoietic stem cell transplants (HSCT) are performed. Through May 2001, 367 patients, including 163 active duty service members, have received allogeneic HSCT from related donors. We performed a retrospective review of the outcomes of allogeneic HSCT in active duty members to determine what proportion was returned to full-time military service after HSCT and to delineate the factors associated with successful return to military service. Twenty-one percent of service members who received allogeneic HSCT were returned to active duty at some point after treatment. Age, sex, branch of service, and rank had no significant influence on return to duty status. When adjusted for age and rank, the only significant predictor of successful return to active duty was a diagnosis of chronic myelogenous leukemia. Although individuals with good risk diseases such as aplastic anemia, myelodysplastic syndrome, paroxymal nocturnal hemoglobinuria, and acute myelogenous leukemia in first complete remission have also been returned active duty after HSCT, these diagnoses were not statistically predictive of a return to active duty. We conclude that it may be possible to predict which service members will return to active duty after allogeneic HSCT based on the disease for which HSCT is being performed. Most importantly, active duty service members need not be a priori medically retired after HSCT, and each return to duty decision must be individualized.

A comparison of polymerization by light-emitting diode and halogen-based light-curing units.

BACKGROUND: Light-emitting diode, or LED, technology provides certain advantages over halogen-based light polymerization of resin-based composites. The authors investigated the adequacy of cure of LED light-curing units, or LCUs. METHODS: The authors used two halogen-based light-curing units (Optilux 400 and 501, Demetron Research Corp., Danbury, Conn.) and two commercially available LED LCUs (LumaCure, LumaLite, Spring Valley, Calif., and VersaLux, Centrix, Shelton, Conn.) to polymerize top surfaces of hybrid (Filtek Z-250, 3M, St. Paul, Minn.) and microfilled (Renamel, Cosmedent, Chicago) resin-based composite specimens. Specimens were indented on their top and bottom surfaces with a Knoop hardness tester and measured for hardness. Bottom:top hardness ratios determined the percentage of cure. The authors separated the data into eight groups (two composites cured with four different lights) with 15 observations per group, for a total sample size of 120. RESULTS: The authors compared composites and curing lights by a two-way analysis of variance, and results indicated significant main effects. The main effect of composite was statistically significant (P < .0001) when microfilled composite was compared with hybrid composite, regardless of curing light, for all top and bottom hardness measurements, with the hybrid producing much higher hardness measurements overall. The main effect of light was significant as well (P < .0001), regardless of composite type, with the two halogen-based lights producing harder top and bottom composite surfaces than the two LED LCUs. CONCLUSIONS: The light output of commercially available diodes for resin-based composite polymerization still requires improvement to rival the adequacy of cure of halogen-based LCUs. Additional studies are necessary. CLINICAL IMPLICATIONS: Commercially available LED LCUs were introduced just in the past year. However, they may not adequately polymerize resin-based composites, which can lead to restoration failures and adverse pulpal responses to unpolymerized monomers.