Does optimal access to dental care counteract the oral health-related quality of life social gradient?

BACKGROUND: The aim of this study was to determine if an oral health-related quality of life (OHRQoL) social gradient existed when Australian Defence Force (ADF) members have universal and optimal access to dental care. METHODS: A nominal roll included 4089 individuals who were deployed to the Solomon Islands as part of Operation ANODE and a comparison group of 4092 ADF personnel frequency matched to the deployed group on gender, age group and service type, from which 500 deployed and 500 comparison individuals were randomly selected. The dependent variables were the OHIP-14 summary measures. Rank was used to determine socioeconomic status. The demographic variables selected were: gender and age. RESULTS: The response rate was 44%. Of the individual OHIP-14 items, being self-conscious, painful aching and having discomfort when eating were the most common problems. Mean OHIP-14 severity was 2.8. In bivariate analysis, there was not a significant difference in mean OHIP-14 severity (p = 0.52) or frequency of OHIP-14 impacts (p = 0.57) by military rank. There was a significant increasing OHIP-14 extent score from commissioned officer to non-commissioned officer to other ranks (0.07, 0.19, 0.40, p = 0.03). CONCLUSIONS: Even with optimal access to dental care, there was an OHRQoL social gradient between military ranks in the ADF.

Will improving access to dental care improve oral health-related quality of life?

BACKGROUND: The aim of this study was to determine if Australian Defence Force (ADF) members had better oral health-related quality of life (OHRQoL) than the general Australian population and whether the difference was due to better access to dental care. METHODS: The OHRQoL, as measured by OHIP-14 summary indicators, of participants from the Defence Deployed Solomon Islands (SI) Health Study and the National Survey of Adult Oral Health 2004-06 (NSAOH) were compared. The SI sample was age/gender status-adjusted to match that of the NSAOH sample which was age/gender/regional location weighted to that of the Australian population. RESULTS: NSAOH respondents with good access to dental care had lower OHIP-14 summary measures [frequency of impacts 8.5% (95% CI = 5.4, 11.6), extent mean = 0.16 (0.11, 0.22), severity mean = 5.0 (4.4, 5.6)] than the total NSAOH sample [frequency 18.6 (16.6, 20.7); extent 0.52 (0.44, 0.59); severity 7.6 (7.1, 8.1)]. The NSAOH respondents with both good access to dental care and self-reported good general health did not have as low OHIP-14 summary scores as in the SI sample [frequency 2.6 (1.2, 5.4), extent 0.05 (0.01, 0.10); severity 2.6 (1.9, 3.4)]. CONCLUSIONS: ADF members had better OHRQoL than the general Australian population, even those with good access to dental care and self-reported good general health.

Dental caries experience in young Australian Army recruits 2008.

BACKGROUND: Recent studies have shown a substantial decline in caries experience in Australian Army recruits between 1996 and 2002-2003, and in Australian adults between 1987-1988 and 2004-2006. However, studies in children have reported an increasing trend in caries experience between 1998 and 2002. The aim of this study was to investigate caries experience in Australian Army recruits in 2008. METHODS: A cross-sectional study involving 1084 Australian Army recruits was conducted from January to May 2008. Data were obtained from a clinical dental examination with bitewing radiographs, and a questionnaire elicited socio-demographic data and history on lifetime exposure to fluoridated drinking water. RESULTS: Mean DMFT scores were 3.16, 4.08, 5.16 and 7.11 for recruits aged 17-20, 21-25, 26-30 and 31-35 years, respectively. Recruits with a lifetime exposure to fluoridated drinking water had a mean DMFT of 3.02, while recruits with no exposure had a mean DMFT of 3.87. CONCLUSIONS: Caries experience in Australian Army recruits aged 17-25 years increased between 2002-2003 and 2008. Recruits with lifetime exposure to fluoridated drinking water had 25 per cent less caries experience compared with recruits who had no exposure to fluoridated drinking water after adjusting for the effects of age, gender, education and socio-economic status.

Training retention of Level C personal protective equipment use by emergency medical services personnel.

OBJECTIVES: To assess the six-month training retention for out-of-hospital providers donning and doffing Level C personal protective equipment (PPE). METHODS: In this prospective observational study, 36 out-of-hospital providers enrolled in a paramedic program were trained in Level C (chemical-resistant coverall, butyl gloves, and boots and an air-purifying respirator) PPE use. A standardized training module and checklist of critical actions developed by a hazardous materials (hazmat) technician were used to evaluate donning and doffing. Students were trained until they were able to correctly don and doff the Level C PPE. An investigator used the checklist accompanying the training module to assess proficiency and remediate mistakes. Six months after initial training, the subjects were reassessed using the same investigator and checklist. Errors were designated as either critical (resulted in major self-contamination of the airway, such as early removal of the respirator) or noncritical (potentially resulted in minor self-contamination not involving the airway). RESULTS: Only five subjects (14.3%) were able to don and doff PPE without committing a critical error. The most common critical errors were premature removal of the respirator (65.7%; n = 23) and actions allowing the contaminated suit to touch the body (54.3%; n = 19). The most common noncritical error was possible self-contamination due to the boots not being removed before exposing other body parts (37.1%; n = 13). Of the seven subjects (20%) with additional prior hazmat training, only two donned and doffed PPE without committing a critical error. CONCLUSIONS: Retention of proper donning and doffing techniques in paramedic students is poor at six months after initial training. Even in subjects with previous hazmat, firefighter, and emergency medical services training, critical errors were common, suggesting that current training may be inadequate to prevent harmful exposures in emergency medical services personnel working at a hazmat or weapons of mass destruction incident.

Big brother is watching you--the ethical implications of electronic surveillance measures in the elderly with dementia and in adults with learning difficulties.

Electronic surveillance has insidiously seeped into the fabric of society with little public debate about its moral implications. Perceived by some as a sinister Orwellian tool of repression and social control, the new technologies offer comfort and security to others; a benevolent parental watchful eye. Nervousness at being watched has been replaced increasingly by nervousness if we're not. These technologies are now becoming widely available to health care professionals who have had little opportunity to consider their ethical and moral ramifications. Electronic tagging and tracking devices may be seen as away of creating a more secure environment for vulnerable individuals such as the elderly with dementia or people with learning disabilities. However, the proponents of surveillance devices have met with considerable resistance and opposition,from those who perceive it as contrary to human dignity and freedom, with its connotations of criminal surveillance. In addition, they cite increased opportunity for abuse through, for example, the withdrawal of staff and financial resources from the care of people with complex needs. Implementing these technologies, therefore, has ethical implications for human rights and civil liberties. Optional alternatives to long-term and/or restrictive care, in the context of the practical difficulties involved in caring for those who represent a risk to themselves from wandering, demands rigorous exploration of pragmatic questions of morality, with reference to risk versus benefit strategies. Like reproductive cloning techniques, the mere existence of surveillance technologies is morally neutral. Rather it is the use (in this instance that of health and social care settings) to which it is put which has the potential for good or bad.

The effects of early motor intervention on children with Down syndrome or cerebral palsy: a field-based study.

This study reports the results of a field-based investigation of the effects of two motor intervention approaches--neurodevelopmental treatment and developmental skills--on children with two different diagnoses. The sample included 50 children, of whom 27 were diagnosed as having Down syndrome and 23 as having cerebral palsy. Children had a mean chronological age of 14 months at the beginning of the study. The severity of their motor impairment was assessed with the Gross Motor Function Classification System for Cerebral Palsy. Children's motor functioning was examined at entry into the study and after they received 1 year of motor intervention services. Dependent measures included children's general development, rate of motor development, and quality of movement. Pre-post comparisons indicated that children made significant changes in their motor development age and quality of movement over the course of intervention. However, there was no evidence that motor intervention accelerated development or improved quality of movement beyond what could be expected on the basis of maturation. Furthermore, no differential intervention effects were associated either with children's diagnosis or treatment model. Regression analyses indicated that the rate of motor development children attained after 1 year of intervention was highly related to their rate of development at the onset of intervention and, to a lesser degree, to the number of sessions of intervention children received. These results are discussed in terms of the need for the field of motor intervention to develop new treatment paradigms.

Measurement of nicotine in hair by reversed-phase high-performance liquid chromatography with electrochemical detection.

We have developed an assay for nicotine in hair based on reversed-phase HPLC with electrochemical detection. The method uses a low-metal, high-purity silica reversed-phase column. We have investigated the washing, digestion and extraction procedures and discuss the important points in the HPLC method development. The assay is presented as an application in a population of exposed and non-exposed children. Analytical parameters are satisfactory with linearity, recoveries, limit of quantitation and precision all suitable for epidemiological studies involving environmental tobacco smoke exposure assessment.

Co-administration of drugs and blood products.

The addition of a drug to a blood product intravenous line raises the question of physical and chemical compatibility of the drug with the blood and any preservatives or additives in the blood product. This clinical scenario is encountered frequently, however the practice has not been well studied. Protocols at most institutions prohibit the addition of drugs to blood products. We investigated the addition of analgesic drugs used for patient-controlled analgesia (morphine 1 mg/ml, pethidine 10 mg/ml and ketamine 1 mg/ml) to a standard red cell concentrate, resuspended red blood cells. The red cells were analysed by a Blood Transfusion Service Haematologist and subjected to standard quality control tests. The morphology of the red cells in resuspended red blood cell preparations was unchanged by the addition of these drugs at any stage during storage. The drug concentration in the resuspended red blood cell serum was measured at 0 and at 20 minutes and there was no decrease in concentration which showed that there was no loss of free drug in the resuspended red blood cell serum. This study demonstrates that the concern regarding injury to red cells in standard red cell concentrates by addition of these drugs is unjustified.

A literature review of dental casualty rates.

The ability to determine dental casualty rates for the Australian Defence Force in a given situation is vital for military planners. This article reviews the literature and the available Australian Defence Force data on the subject to give some guide to planners. The review found the studies to be fairly consistent in that a well-prepared dentally fit force can expect 150 to 200 dental casualties per 1,000 soldiers per year. If the force were less prepared, as in the case of a reserve call out, this figure would be likely to increase; in the extreme case of an ill-prepared force or a force assisting in humanitarian aid, the emergency rate could be five times that figure. The literature also indicates a change in the nature of dental casualties. Although maxillofacial cases have remained steady at 25%, dental disease has decreased and endodontic cases have had a corresponding increase.

Association of spatial distribution of childhood respiratory morbidity with environmental dust pollution.

The objective of this study was to investigate the spatial distribution of respiratory morbidity and asthma in children in relation to high levels of airborne dust pollution. A cross-sectional survey of 2035 children (aged 5-11 yr) by parent-completed questionnaire, with concurrent monitoring of dust deposition rates in the vicinity of children's homes, was performed in 15 primary schools (5 in each of 3 areas of Merseyside). The main outcome measures were (1) doctor-diagnosed asthma, (2) parent-reported respiratory symptoms of recent excess cough, wheeze, and breathlessness, and (3) school absenteeism due to respiratory ill health. Proximity to the source of dust pollution was associated with increased prevalence of excess cough, breathlessness, school absence due to respiratory ill health, and doctor-diagnosed asthma, after adjusting for a range of socioeconomic, environmental, and other confounding factors. The adjusted odds for excess cough and breathlessness for children living within 2 km of the source (dock area) are estimated to be almost twice those for children living more than 2 km away: excess cough 1.9 (95% CI 1.4-2.6); breathlessness 1.9 (1.3-2.7); school absence 1.5 (1.2-1.9); and doctor-diagnosed asthma 1.5 (1.1-2.0). Excess cough was significantly associated with the mean annual dust deposition recorded in the vicinity of the child's home. The adjusted odds ratio for excess cough corresponding to an increase in mean annual dust deposition of 50 mg/m2/d was 3.1 (95% CI 1.1-8.2). These results suggest that airborne dust was associated with respiratory morbidity in these children, which could relate to the high prevalence of childhood doctor-diagnosed asthma in this community.

Postpartum coronary artery dissection.

A 34-year-old woman presented to the emergency department 12 weeks postpartum with chest pain. An ECG indicated an acute myocardial infarction. The patient underwent cardiac catheterization with findings suggestive of coronary artery dissection later confirmed on intravascular ultrasonography. She underwent emergency coronary artery bypass grafting and has subsequently done well.

A method for the separation of delta bilirubin using Cibacron Blue affinity chromatography.

We developed and evaluated a method for the separation of delta bilirubin (B delta) by micro-column affinity chromatography based on Cibacron Blue 3G-A-Agarose. Untreated serum was applied to affinity columns and free non-protein bound bilirubins were eluted with phosphate buffer containing 20 g/l Triton X-100. Retained albumin was eluted using caffeine-benzoate reagent and bilirubin associated with this fraction (B delta) quantitated by the method of Jendrassik and Gróf modified by Doumas et al (Clin Chem 1985;31:1779-1789); results correlated well with the high performance liquid chromatography (HPLC) method (n = 35, y (affinity) = 1.009x (HPLC)-5.49; r = 0.959) described by Lauff et al. (J Chromatography 1981;226:391-402). Two controls analyzed with each batch gave between-batch imprecision less than 4.0% (n = 10; Control 1, mean = 20.05 mumol/l; Control 2, mean = 74.82 mumol/l). Within-batch imprecision was less than 3.3% for both levels. Specimens collected from 25 neonates less than 20 days of age showed a B delta concentration of 1.7 +/- 0.7 mumol/l (mean +/- 1 S.D.) and percent B delta of 2.2 +/- 1.9 (mean total bilirubin +/- 1 S.D. = 118 +/- 79 mumol/l). Although time consuming, this simple and precise method allows the measurement of B delta in laboratories without the need for specialized instruments.

The misuse of buprenorphine and a buprenorphine-naloxone combination in Wellington, New Zealand.

Two surveys of 12 months duration were undertaken on opioid users presenting to the Wellington Alcohol and Drug Centre before and after the introduction of a combination buprenorphine 0.2 mg-naloxone 0.17 mg tablet (Bu-Nx), which was launched in 1991 in the hope of reducing intravenous misuse. There was considerable intravenous (i.v.) misuse of buprenorphine 0.2 mg tablets (Bu) in 1990 with self-reports of misuse in 81% of the patients over the 4 weeks prior to presentation, and 65% of the patients had buprenorphine in their urine. In the repeat survey 57% reported misuse of the Bu-Nx combination over the previous 4 weeks, and 43% had buprenorphine +/- naloxone detected in their urine. There was a reduction in the street price of Bu-Nx. One-third of the patients who used Bu-Nx i.v. reported instances of withdrawal symptoms, and subjectively the drug was less attractive to misusers. The combination product may have less misuse potential than buprenorphine alone, but it remains a preparation, in the dosages employed, that is intravenously misused.

Perceptions of pediatricians' helpfulness: a national study of mothers of young disabled children.

A national sample of 503 mothers of young children (up to six years of age) with developmental disabilities was surveyed to determine the extent to which their family pediatricians are helpful in providing information and support. The respondents ranged from lower-middle to upper class, with the mean SES reflective of middle socio-economic status. Their children had a variety of disabilities that qualified them to receive early intervention services. The majority of the mothers found their pediatricians helpful about issues related directly to their child's medical condition. However, few found them helpful with issues relating to the effect of the disability on their child's development, or to their own personal or family needs.

No association between RFLPs at the porphobilinogen deaminase gene and schizophrenia.

An association study of restriction fragment length polymorphisms (RFLPs) in the porphobilinogen deaminase (PBGD) gene and schizophrenia was conducted. RFLPs detected by MspI, PstI, ApaLI and BstNI in intron 1 of the gene were studied in 49 patients and 79 controls. There were no significant differences between the groups in allele frequencies, genotype counts or haplotype distribution.

A comparison of the fibrinogen receptor distribution on adherent platelets using both soluble fibrinogen and fibrinogen immobilized on gold beads.

The distribution of fibrinogen receptors was determined on the surface of adherent platelets using both direct labeling with the ligand fibrinogen which was immobilized on gold particles (Fg-Au) and indirect immunogold (Ig-Au) labeling of bound soluble fibrinogen identified with a rabbit polyclonal anti-fibrinogen antibody. Two distinctly different patterns of labeling were obtained and appeared to depend on whether solid phase fibrinogen (Fg-Au) or soluble phase released fibrinogen were bound to the membrane receptor. The membrane-bound Fg-Au reorganized in patterns that closely mimicked the organization of the underlying cytoskeleton. In approximately 18% of the adherent platelets, Fg-Au was seen in channels or vesicle-like structures lying deep to the platelet surface suggesting internalization into the open canalicular system and/or endocytosis. The labeling pattern obtained when identifying the location of membrane-bound soluble released fibrinogen by Ig-Au was diffuse and lacked the organizational patterns characteristic of Fg-Au. Unlike the Fg-Au probe, early dendritic platelets were heavily labeled by the soluble phase fibrinogen using the Ig-Au technique. Although the label covered the entire exposed platelet membrane in fully spread platelets, labeling over the peripheral web was more dense than that over the intermediate or granulomere zone. The diffuse organization and heavier peripheral distributional pattern of the glycoprotein IIb-IIIa (GP IIb-IIIa) receptor in fixed, adherent platelets, was also seen with the GP IIb-IIIa receptor-specific antibody AP-2. The binding of both the Fg-Au and Ig-Au were inhibited using the tetrapeptide Arg-Gly-Asp-Ser (RGDS) (93% and 98% inhibition, respectively), AP-2 (98% and 97%, respectively) and platelets from patients with Glanzmann's thrombasthenia (GT) (99% and 98%, respectively). The data presented provides the first report that receptor reorganization, following binding of fibrinogen, appears to be related to the state of the ligand. Substrate bound fibrinogen (i.e., Fg-Au or fibrinogen bound to another platelet) induces receptor translocation toward the platelet granulomere in a capping-like phenomenon. On the other hand, the binding of soluble released fibrinogen results in formation of microclusters and short linear arrays in a diffuse distribution but does not induce central movement of receptors. Furthermore, double labeling studies clarify that Fg-Au does not identify all available fibrinogen receptors as many are occupied by soluble released fibrinogen. The data presented provides an interesting new perspective on what constitutes an appropriate ligand-receptor stimulus sufficient to induce receptor reorganization.

Early intervention practices with families of children with handicaps.

A survey to examine the degree to which early intervention activities currently focus on the family was distributed to service providers for birth to 6-year-old children with handicaps from six randomly selected states. Most goals selected by providers were child-focused clinical goals, although family intervention goals were cited frequently. Forty-percent of the sample reported spending no time with families during a typical week. Published programs or curricula were rarely used as a basis for working with families. Service providers reported that they successfully achieved goals set for many of their families, yet they also encountered several problems, including insufficient time for family services. Comparisons were made between providers working with 0- to 3-year-old children and those working with 3- to 6-year-old children. Suggestions concerning the implementation of the family-focused agenda of P.L. 99-457 were made.

Maternal directive behavior revisited.

A comparative analysis of the directives produced by mothers while interacting with young children with Down syndrome and normally developing children was conducted. The results not only replicated previous findings of increased rates of directives by mothers of children with down syndrome but also identified several qualitative differences in the types of directives produced. Mothers of mentally retarded children produced a high number of requests for their children to perform actions, requested actions that were relatively difficult, and asked their children to attend to information that was not directly related to children's current focus of attention. Results suggest that group differences in maternal directive behavior cannot be explained on the basis of children's behavior but appear to reflect differences in maternal interactive intentions.