Fluoridation in Anglesey 1993: a clinical study of dental caries in 5-year-old children who had experienced sub-optimal fluoridation.

Several studies since the commencement of fluoridation in 1955 have demonstrated over 50% reduction in mean dmft for 5-year-old Anglesey children in comparison with local control groups. From 1987 fluoridation became intermittent and in 1991 it was terminated. In the present study, carried out in 1993, the total number of children examined was 725 (88.4% of the entire population of 5-year-old school children), of whom 498 had continually resided in specific water distribution zones. The mean dmft for the entire number examined was 2.01 (SD = 3.27). For those who had experienced fluoridation during approximately 35% of their lives (n = 230) it was 1.81 (SD = 2.86) and for those who had experienced fluoridation for less than 10% of their lives (n = 268) it was 2.28 (SD = 3.48). In 1987/88, the last year of optimal fluoridation, the mean dmft of Anglesey 5-year-old children was 0.80 (SD = 1.43) and for those resident on the non-fluoridated Gwynedd mainland it was 2.26 (SD = 3.17). The study demonstrates the serious consequences for dental health when fluoridation is withdrawn and how difficult it will be to reach dental health targets in North Wales without fluoridation.

Non-completion of active orthodontic treatment.

Over a 1-year period, all patients attending a consultant orthodontist's new patient clinics in North Derbyshire and whose treatment plans involved active appliance treatment, were accepted into a prospective longitudinal study. In all 294 patients were included in the study. Subsequent to the consultant's new patient clinic the patients' active treatments were undertaken in the Hospital, General, or Community Dental Services. Four years after the commencement of the study, 207 patients had completed active treatment and 50 had non-completed during active treatment. This gave an overall non-completion rate (NCR) of 19.5 per cent for the study. Of the 50 patients who did not complete treatment during active treatment 23 (46 per cent) non-completed during the first 6 months of active treatment. A predictive model of non-completion of active orthodontic treatment (NCT) over time is suggested.

Bimodality in age of onset of psoriasis, in both patients and their relatives.

The ages at onset of 245 female and 211 male psoriasis (Ps) patients were recorded. The distribution of age of onset in both sexes is bimodal, with separation at the age of 40 years into an early-onset group and a late-onset group. These distributions were normal (Gaussian) with equal variances. These data are compatible with the hypothesis that there are two genotypes for Ps. Further evidence for this hypothesis is provided by the relationship between age of onset and number of affected relatives. The latter, corrected for age at time of study, demonstrates a mixture of two negative binomial distributions, also with likely separation at the age of 40 years. The age distribution of Ps patients reflects the bimodality of age of onset, but with larger means and variances.

Fluoridation in Anglesey: a clinical study of dental caries in mothers at term.

A study of dental caries was carried out involving 1537 mothers who attended St David's Hospital, Gwynedd, between July 1986 and July 1987 for their confinement. The study was 'blind' in respect of residence. The mean DMFT value for mothers with continuous residence in the non-fluoridated Gwynedd mainland was 13.6 and the mean DMFT value for mothers living in the Anglesey Health Unit who had consumed fluoridated mains water from birth was 30% lower at 9.5 (P less than 0.0001). The confidence interval for the difference between means was 3.4-4.9. The samples from the two areas showed no significant differences in social class and age group structures. The percentage of Anglesey mothers with DMFT exceeding 15 was less than one-sixth of that for mainland mothers and the percentage of those with DMFT less than 6 was three times greater. The mean DMFS value for occlusal sites in premolars was 3.9 for mainland Gwynedd and for Anglesey 52% less at 1.9 (P less than 0.0001) with a confidence interval of 1.6-2.4. For smooth surface sites in posterior teeth, the difference was not as pronounced, with a mean DMFS value for mainland of 20.3 and for Anglesey 42% less at 11.8 (P less than 0.0001) with a confidence interval of 7.5-9.6. The results showed that child-bearing women continued to enjoy important benefits from water fluoridation into their early thirties.

Concomitance of psoriasis and atopic dermatitis.

There is a widespread belief that psoriasis (Ps) and atopic dermatitis (AD) are clinically mutually exclusive. A prospective study was undertaken to record the concurrent and/or consecutive coincidence of the two conditions and any shared clinical features. Patients attending a dermatology clinic were systematically examined for the presence of Ps and/or AD. Nine hundred and eighty-three patients were studied--428 with Ps, 224 with AD, 45 with both Ps and AD, and 286 controls. Of AD patients 16.7% had Ps, and 9.5% of Ps patients had AD. In consecutive occurrences, Ps generally followed AD. The ratio of concurrent to consecutive incidences was 3:1. The two diseases are shown not to be mutually exclusive and may coexist in the same individual.

Topical glyceryl trinitrate and eutectic mixture of local anaesthetics in children. A randomised controlled trial on choice of site and ease of venous cannulation.

One hundred and four children aged between 1 and 11 years were studied in a double-blind randomised controlled trial of glyceryl trinitrate ointment versus placebo, when used in addition to standard eutectic mixture of local anaesthetics cream. Each child received glyceryl trinitrate ointment on one hand and placebo on the other, and thus acted as his/her own control. A group of 30 children who received only the eutectic mixture on both hands (60 measurements) was also studied. The choice of site and ease of cannulation was scored. Skin colour and venous dilatation under the eutectic mixture were scored on a visual analogue scale. The addition of topical glyceryl trinitrate ointment to the standard eutectic mixture positively affected venous dilatation (p less than 0.01), choice of cannulation site (p less than 0.001), and ease of cannulation (p less than 0.001) of topical anaesthetic-treated skin.

Gastric cancer in Gwynedd. Possible links with bracken.

One hundred and one histologically confirmed gastric cancer patients in Gwynedd, North Wales, were matched by sex, age and social class to two hospital inpatients without cancer. Seventy-seven of the gastric cancer cases were also matched, using the same criteria, to a patient with a confirmed cancer of a different site (excluding oesophagus). A questionnaire was used to determine bracken exposure and source of water in childhood. Residential and occupational histories were obtained and the consumption of buttermilk, a potential vector of the bracken carcinogens, was quantified. Comparison of the gastric cancer patients with the non-cancer controls indicated that exposure to bracken in childhood had an increased risk (RR = 2.34, P less than 0.001) compared to no exposure and that length of residence in Gwynedd was associated with increased risk (RR = 2.46 for durations of 61 years and over, P less than 0.01). Consumption of buttermilk in childhood and adulthood was attended by increased risk (RR = 1.61 and 1.86 respectively, the latter being statistically significant, P less than 0.05). Neither the residence effect nor consumption of buttermilk in adulthood remained significant when considered in a multivariate analysis with bracken exposure.

Nasal response of rhinitic and non-rhinitic subjects to histamine and methacholine: a comparative study.

The nasal responses to provocation with histamine and methacholine were compared in 20 subjects with and 20 without rhinitis. Two variables were measured: nasal airways resistance and the development of rhinorrhoea. Histamine had a greater effect than methacholine in increasing nasal airways resistance while the converse was true for rhinorrhoea. Rhinitic subjects had a significantly greater response to histamine induced changes in nasal airways resistance (p less than 0.05), rhinorrhoea (p less than 0.05) and methacholine induced rhinorrhoea (p less than 0.01) than those without rhinitis. No significant differences were found between the two groups in methacholine induced changes in nasal airways resistance. The findings show that, like the lower airways of patients with asthma, the nasal mucosa of rhinitic subjects shows a greater responsiveness to non-specific agonists than that of non-rhinitic subjects.

An investigation into private sector nursing and residential home care for the elderly in north Wales.

In January 1984 two questionnaires were sent to private homes for the elderly in an area of north Wales with a high concentration of private beds. The first questionnaire was completed by eight nursing homes and 13 residential homes for the elderly and the second questionnaire for each of 321 residents - 154 in the former and 167 in the latter.The two types of homes were compared for staffing levels, facilities available and the degree of dependency of residents. As expected the degree of dependency of the residents in nursing homes was higher than in residential homes but even so the degree of dependency in residential homes was found to be high. The isolation of many residents was evident. Twenty three per cent of residents had come directly to the homes on moving into the area. The problems arising for general practitioners visiting a number of different homes and for homes having many different doctors visiting are highlighted.The need for adequate consultation and assessment prior to admission and periodic reassessment is demonstrated in the light of the recent changes to the supplementary benefit regulations. It was found that at least 20% of the residents had their fees supplemented by the Department of Health and Social Security. The need for greater collaboration between the two different registration authorities under the new legislation (Registration of Homes Act 1984) and with the general practitioners providing general medical services is demonstrated.

A comparison of mercury and digital clinical thermometers.

A primarily clinical trial has been undertaken to investigate and compare the use of mercury and digital thermometers in a ward situation. Both laboratory and clinical studies show that there is no significant difference in the average accuracy of the two types of thermometers, however there is a greater fluctuation of readings of temperature when using electronic thermometers. In clinical studies between 9 and 23% of repeated measurements using an electronic thermometer differ by 0.5 degrees C or more whilst the corresponding range for mercury thermometers is 0.6%. It is also shown that when making clinical measurements with mercury thermometers there is no clinical advantage in using a measurement time longer than 3 minutes.

Trochanteric fractures of the femur. A randomised prospective trial comparing the Jewett nail-plate with the dynamic hip screw.

In a randomised prospective trial 98 elderly women with trochanteric fractures of the femur were treated with either a 135 degrees Jewett nail-plate or a 135 degrees Dynamic hip screw. The results at six weeks, three months and six months were statistically analysed. There were no significant differences in the two groups with regard to pain, length of hospital stay, morbidity or mortality. Although operative difficulties and open reduction were more common with the Dynamic hip screw, at the end of six months more patients in this group were mobile and there was significant radiological evidence of better compression without loss of fixation.

Management of gallstones in a district general hospital.

This survey reviews 815 consecutive patients undergoing surgery for benign biliary disease. There were no deaths following elective operations and the overall mortality was 0.7 per cent. One-third of patients had one or more complications. The mortality in patients having common bile duct exploration (n = 160) by one or more methods was 2.5 per cent (4 patients) with 46 per cent of these patients having complications. Of 95 patients undergoing duct exploration and postoperative T-tube cholangiography, 7 had unexpected residual calculi after initial cholecystectomy. Five have had further surgery to clear the duct. All patients having duct surgery alone for retained stones (n = 24) had previously had cholecystectomy with or without supraduodenal duct exploration. Of all patients undergoing choledochoduodenostomy or transduodenal sphincter exploration only one has returned with evidence of retained calculi. Patients with choledocholithiasis were examined in an attempt to identify a high risk group. These were found to be elderly patients, having emergency surgery for sepsis and on whom more than one duct procedure was performed (mortality 10 per cent).

Early elective cholecystectomy--an alternative to early cholecystectomy in acute cholecystitis?

Currently there are two forms of management for patients with acute cholecystitis. Conservative treatment during the acute episode and readmission after 6-8 weeks for elective surgery and early cholecystectomy during the emergency admission. An alternative treatment would be elective surgery before the acute episode which should reduce morbidity and mortality. This study has identified those patients who are likely to present with acute biliary disease so that they can be selected for elective surgery shortly after their attendance in outpatients.