Reversible cognitive decline during high-dose alpha-interferon treatment.

The cognitive effects of high-dose human leukocyte alpha-interferon (IFN-alpha) treatment were evaluated among 15 patients with the newly diagnosed spinal form of amyotrophic lateral sclerosis (ALS). To confirm the earlier findings showing reversible effects on cognitive performance and to exclude confounding effects, a randomized blinded placebo controlled study was conducted. Twelve patients with continuous intravenous IFN-alpha-infusion treatment over five days and 3 placebo control patients were neuropsychologically evaluated. The neuropsychological examination included tests of intelligence, memory, complex mental processing, visuoconstructional skills, writing, and calculation. A clear difference in the performance profiles of the placebo and the IFN-alpha-treated patient groups was detected: The IFN-alpha group showed significant deterioration during treatment in the digit span backwards task, logical verbal memory task, calculation ability, and writing time, while improvement was seen after treatment. Concomitant fever did not explain the findings. In the placebo group an improvement indicating a learning effect in the three consecutive measurements was found. The reversible cognitive deterioration indicates a clear CNS effect during the IFN-alpha treatment.

Quality of life 4 years after stroke.

The quality of life for 46 stroke survivors under the age of 65 years in a stroke register was studied 4 years after their first stroke. A questionnaire covering four domains of life (working conditions, activities at home, family relationships, and leisure time activities) was used for investigation of the quality of life. The results showed that in spite of a good recovery in terms of discharge from the hospital, activities of daily living, and return to work, the quality of life of most patients (83%) had not been restored to the prestroke level. Deterioration among the several domains of life ranged from 39% to 80%, the lowest being in the domain of activities at home and the highest in the domain of leisure time activities. Hemispheral localization of the lesion, paresis, coordination disturbances, and especially subjective tendency to depression were highly correlated with a deterioration in the quality of life. Dependence in activities of daily living and an inability to return to work were also associated with the lack of restoration. Our results suggest that much more attention should be paid to the quality of life of stroke patients.

[Gingival abrasion and plaque removal with manual vs. electric toothbrushes]. / Gingivale Abrasion und Plaqueentfernung mit manuellen gegenüber elektrischen Zahnbürsten.

In a clinical study, the relative incidence of gingival injuries after standardized tooth brushing was tested by 22 volunteer dental assistants whose teeth were brushed with a soft multi-tufted toothbrush, a manual V-form toothbrush, and an electric toothbrush. At the beginning of the study, a dental hygienist cleaned the right or left side of the jaw of each subject with a manual V-form toothbrush or an electric toothbrush; the other side was manually cleaned with a multi-tufted toothbrush. At the second cleansing one week later, the same dental hygienist cleaned the side contralateral to that brushed in the first test week with the multi-tufted brush; the manual V-form brush was used instead of the electric toothbrush and vice versa. The number of new gingival lesions was recorded after each brushing. The cleansing effect was established by determining the amount of residual plaque. The subjects did not know which type of toothbrush was used to cleanse the evaluated side of the jaw. The results showed that the manual V-form toothbrush abraded the gingiva more than the electric toothbrush (p less than 0.005). A similar difference was found between the manual multi-tufted and the electric toothbrush (p less than 0.05). No significant differences could be established with respect to the plaque-removing properties of the three types of toothbrush tested.

Gingival abrasion and plaque removal after toothbrushing with an electric and a manual toothbrush.

The aim of the study was to evaluate the cleanliness achieved with and the number of gingival lesions caused by brushing with a manual, multitufted toothbrush and an electric toothbrush that oscillated horizontally and vertically. Fifteen female dental assistant students participated in the crossover clinical trial. Eight students brushed their teeth for the first 2 weeks with the multitufted manual brush and seven with the electric brush. For the next 2 weeks the brush assignment was reversed. After the two brushing periods the number of gingival lesions and the amount of stained plaque were recorded. The manual toothbrush caused more gingival lesions than the electric brush (P less than 0.05). With regard to plaque scores, no difference was found between manual and electric brushing.

The effect of toothbrush grip on gingival abrasion and plaque removal during toothbrushing.

The aim of the present study was to determine whether the type of toothbrush grip affects gingival injury during brushing. The cleanness of the teeth achieved by use of 2 different brush grips was also evaluated. The teeth of 13 dental nurse students were brushed by a dental hygienist. Using the split mouth technique, one side of the mouth was brushed for 2 min holding the toothbrush with a pen grip and the other side for another 2 min using the palm grip. The procedure was repeated 11 days later with reversed brush grips on the 2 sides of the jaws. More gingival injuries were found when the toothbrush was held with the palm grip than with the pen grip. This difference was statistically significant (P less than 0.01). No statistically significant difference were observed between corresponding plaque scores as measured according to the PLQ-index, irrespective of whether the plaque scores were presented as plaque remaining after experimental brushing or as the difference between the PLQ scores before and after brushing.

Gingival abrasion and plaque removal with manual versus electric toothbrushing.

A clinical trial was designed to test the relative numbers of gingival lesions caused during standardized brushing of the teeth of 22 volunteer dental nurse students with a manual soft multitufted, a manual soft V-shaped, and an electric toothbrush. First, the left or the right side of the jaws of each subject was brushed by a dental hygienist using the manual V-shaped or the electric brush, and the other side using the manual multitufted brush. At the 2nd brushing 1 week later, the same hygienist used the multitufted brush for brushing the side contralateral to the one in which it was used the 1st week and the V-shaped manual brush instead of the electric and vice versa. After each brushing, the number of new gingival lesions was recorded and the cleansing effect evaluated by assessment of the amount of remaining plaque. This examiner was unaware of the type of brush used. The V-shaped manual toothbrush was found to have caused more gingival abrasion than the electric toothbrush (P less than 0.005) and a similar difference was found between the multitufted manual and the electric toothbrush (P less than 0.05). There was no clinically significant difference between the plaque removing effects of the 3 brushes tested.

Four-year prognosis of stroke patients with visuospatial inattention.

The four-year prognosis of patients with visuospatial inattention in a stroke register (altogether 255 patients) was studied. Sixty-six surviving patients under the age of 65 were examined neurologically and neuropsychologically after 3 months and 1 year from stroke. Fifty-two of these 66 patients were still reexamined after 4 years from onset. Twelve patients with ischaemic brain infarction had visuospatial inattention: 7 had a clear-cut and contralateral neglect and 5 had milder and less lateralized inattention. The recovery of these 12 patients was poorer in ADL than the other 54 patients. Even when hemiparesis was taken into account, the difference still existed in ADL. The recovery of the 7 neglect patients was poorer than that of the 5 inattention patients. During the follow-up the visuospatial neglect persisted in all 7 cases and the visuospatial inattention disappeared in only one case.

Dementia after stroke.

The aim of this 4-year follow-up study was to find out how often dementia appears after stroke in unselected material. All patients younger than 65 years (52) still alive 4 years after stroke in a stroke register (total 255 patients) were studied neurologically and neuropsychologically. Three patients with brain infarction filled the criteria for mild dementia. This is more than was to be expected. All 3 demented patients could be classified as multi-infarct dementia. The findings concerning dementia are discussed.

The occurrence of gingival brushing lesions during 3 phases of the menstrual cycle.

Since hormonal changes during the menstrual cycle may alter the vulnerability of the female gingiva, the present study was undertaken to investigate whether there are any differences in the number of toothbrushing lesions occurring during different phases of the menstrual cycle. 45 women of 20-35 years of age and with healthy gingiva were examined for overt signs of gingival laceration or ulceration. Such signs were recorded as a brushing injury. Dental plaque was assessed using the visible plaque index (VPI) and gingival inflammation using the gingival bleeding index (GBI). The examinations were made on the 1st day of menstruation (MD), on the estimated ovulation day (OD), and on the day with the predominance of progesterone secretion (PD). The examinations were made during 1-3 menstrual cycles for each individual; the study includes 78 cycles. No statistically significant differences were found between the numbers of brushing injuries on the 3 days of examination (MD, OD, & PD). During PD, a significantly positive correlation (p less than 0.01) was observed between VPI and GBI scores, but on OD and MD, the correlations were highly significant (p less than 0.001). A weak significant positive correlation (p less than 0.05) was found between GBI scores and the number of brushing injuries on the 1st day of menstruation, while during other phases of the menstrual cycle, no such correlation was found. The present study gave little evidence that the hormonal status of women could be of clinical significance in the development of soft tissue trauma from habitual toothbrushing.

Memory and psychomotor impairment following high-dose interferon treatment in amyotrophic lateral sclerosis.

Patients with amyotrophic lateral sclerosis were treated with high-dose intravenous infusion of human leukocyte interferon for six days. Neuropsychological examinations were carried out before, during and after the treatment. Marked reversible dysfunction was detected in immediate memory functions, coordination of hand movements, and drawing. Motor perseveration, micrographia, and slowing of behaviour were also observed. Changes appeared four to 12 days after start of treatment, with the peak on days six to eight. Recovery was almost complete by day 15. Intellectual ability, as measured by three WAIS subtests, praxis of hand movements, visuognostic functions, speech, reading, writing, and calculation remained essentially unaffected. The profile of the neuropsychological deficits observed, the absence of defects typical of focal posterior cortical lesions, the simultaneously slowed electroencephalographic activity with frontal accentuation, and the increased central conduction times of brain stem auditory evoked potentials suggest frontobasal involvement.

The profile of recovery from stroke and factors influencing outcome.

The recovery from stroke of 154 survivors out of 255 stroke patients was analyzed. The outcomes documented were: discharge from hospital, activities of daily living (ADL) and return to work. A clear improvement in neurological and neuropsychological deficits was seen from the acute stage to three months, and this continued to twelve months, but to a lesser degree. 69% and 78% respectively, of the patients were at home three and twelve months after stroke. Independence in ADL increased from 32% acutely to 62% and 68% by three and twelve months, respectively. Of those gainfully employed prior to stroke, 55% had returned to work after twelve months. As a group, SAH patients seemed to recover better, but, for those that could be age-matched with infarction patients, there was no difference in outcome. Old age, acute stage hemiparesis, impairment of intelligence and memory, visuoperceptual deficits, nonadequate emotional reactions, and living alone all had a major negative influence on outcome. This study suggests that neurological and neuropsychological deficits, as well as emotional reactions, influence the outcomes after stroke, and all should be taken into consideration in prognosis.

Neurotoxic and other side effects of high-dose interferon in amyotrophic lateral sclerosis.

6 patients with amyotrophic lateral sclerosis were treated with intravenous infusion of 100-200 million IU per day of human leukocyte interferon. Side effects of treatment included fever, chills, malaise, nausea, marked leukopenia, mild anemia, and thrombocytopenia. Tiredness, confusion, papilledema, and overall signs of acute encephalitis were observed. Tendon reflexes and muscle force decreased. EEG activity was slowed, and evoked potentials showed significant slowing of conduction times. Neuropsychological tests revealed congitive dysfunction. The syndrome of inappropriate antidiuretic hormone secretion developed in all patients. All side effects were reversible with cessation of interferon treatment.

Frequency of gingival lesions after standardized brushing as related to stiffness of toothbrush and abrasiveness of dentifrice.

The clinical trial was primarily designed to determine to what extent the stiffness of toothbrush bristles and the abrasiveness of dentifrices influence the degree of gingival erosion. Further, the plaque removing effectiveness of the toothbrushes and dentifrices tested was evaluated. 24 dental hygienist students with clinically healthy gingivae volunteered for the study. A "soft" toothbrush with a bristle thickness of 0.15 mm, a "hard" toothbrush with a bristle thickness of 0.23 mm and 2 dentifrices of different abrasiveness were used for the experiment. The 2 brushes were also used without a dentifrice. Prior to each examination the teeth of the test subjects were brushed by the same dental hygienist. Evident signs of laceration or.ulceration at any 1 of 4 gingival aspects of each tooth were recorded as brushing injuries. The teeth were then stained with basic fuchsin and the amount of remaining plaque was assessed according to the PLQ Index (Bay & Ainamo 1974). The use of the hard brush resulted in lower plaque scores and, at the same time, more gingival erosions than the use of the soft brush. With both brushes a significantly greater number of lesions was recorded after use of an abrasive powder than when no dentifrice was employed. The difference in the amount of erosions occurring when utilizing either brush, without a dentifrice or with a moderately abrasive toothpaste, was not, however, found to be statistically significant. When assessed separately for the 2 brushes, the slight tendency towards lower PLQ scores with increasing abrasiveness of the dentifrice was not considered statistically significant. The study showed that the modes decrease observed in mean PLQ scores with increasing stiffness of the toothbrush bristles and with increasing abrasiveness of the dentifrice is accompanied by increased damage caused to the soft gingival tissues.

Assessment of methods and results of reproductive occupational epidemiology: spontaneous abortions and malformations in the offspring of working women.

Epidemiological studies relating occupational exposures of working women to spontaneous abortions and malformation are reviewed and some methodological considerations are presented. The reproductive epidemiology is less developed than epidemiology in general and seems to involve some specific problems. The ascertainment of exposure and of outcome may be problematic. The exposures may be reported differently by the women depending on the outcome of the pregnancy; thus confirmation of exposure from an independent data source would be an asset. The recognition of spontaneous abortions by women is variable and this should be considered in the study design. An access to medical records could provide objective data on the outcome, but it may introduce other types of asymmetries. The types of occupational exposures of the women, suggested to carry a risk of spontaneous abortions, include anesthetic agents, laboratory work, copper smelting, soldering, and chemical sterilization using ethylene oxide and glutaraldehyde. Maternal employment in laboratories and exposure to solvents has been linked to a risk of congenital malformations in the offspring in five studies. Data on the teratogenic effects of anesthetic gases has been conflicting. In one study, employment in copper smelting was associated with malformations in the offspring.

Spontaneous abortions in an industrialized community in Finland.

Spontaneous abortions were analyzed in an industrialized Finnish community according to the occupation and workplace of both the women and their husbands. Information about spontaneous abortions and births was obtained from the hospital discharge register, and data about the women and their families were collected from census files. When compared with all women employed outside the home, women who worked at a textile plant (factory A, a clothing manufacturer) had an increased rate of spontaneous abortion (16.7 per cent vs 11.4 per cent). The rate of spontaneous abortions among women employed at factory A differed according to the husband's workplace. The odds ratio for women employed at factor A whose husbands worked at a large metallurgical factory was 3.8, whereas the odds ratio for women whose husbands worked elsewhere was 1.2. Between 1973 and 1976, the rate of spontaneous abortions in this town was consistently lower for the summer period. (May-August) than for the other periods of the year.

PIP: The effects of occupational and other environmental factors of the frequency of spontaneous abortions was studied in a single Finnish community, Kokkola, a town with over 30,000 inhabitants. The frequency of hospitalized spontaneous abortion in Kokkola and in the surrounding area exceeds that of other parts of Finland. The metallurgical industry of Kokkola emits cadmium and other heavy metals and a sulfur factor discharged sulfur dioxide into the air until shut down in 1977. From the computerized hospital discharge registry maintained by the Finnish National Board of Health, information was obtained on all women for Kokkola who had been treated for spontaneous abortion (diagnoses numbers 643 and 645), for induced abortion (diagnoses numbers 640-642), or who gave birth (diagnoses 650-662) between 1974-77. A patient was only included once if she had been discharged from hospital twice within 4 months with any diagnosis used. The data comprised 3216 pregnancies, 2377 of which were births. Because of underreporting, the births covered 94% of all the officially recorded births in Kokkola between 1974-77. Increasing parity increased the risk of spontaneous abortion only among those under age 25 (with relatively few pregnancies for the 2 and 3+ parity data points). There were seasonal changes in the rates of spontaneous abortion. The rates were calculated per pregnancies that had started 3 months earlier. The rates were 3-7 percentage units above average in March and April and dropped in June and July by 3-4 percentage units below average. These changes were constant for the 3 years studied. The rates and ratios of spontaneous abortion were investigated according to the occupation of both the women and their husbands. The rate for all the women of Kokkola was 9.5% and the ratio was 12.9% Industrial workers had the highest rate (12.2%), but their rate failed to differ significantly from the rate for all economically active (working) women. The rate and ratio of spontaneous abortion for working women were significantly higher than the respective rate and ratio of economically active women. Women working in industry were hospitalized because of spontaneous abortion more often than other women in the community. No such clear occupational correlations were found for the paternal occupation if it was analyzed without consideration of the maternal occupation. When compared with all women employed outside the home, women who worked at a textile plant (factory A, a clothing manufacturer) had an increased rate of spontaneous abortion (16.7% vs 11.4%). The odds ratio for women who worked at factory A whose husbands worked at a large metallurgical factory was 3.8; the odds ratio for husbands who worked elsewhere was 1.2.

Spontaneous abortions in hospital staff engaged in sterilising instruments with chemical agents.

Spontaneous abortions in hospital sterilising staff were analysed using data from a postal questionnaire and a hospital discharge register. The study included all the sterilising staff employed in Finnish hospitals in 1980; the controls were nursing auxiliaries. Data from the questionnaire showed that the frequency of spontaneous abortions was 11.3% for the sterilising staff and 10.6% for the nursing auxiliaries. When the staff were concerned in sterilising procedures during their pregnancy the frequency was 16.7% compared with 5.6% for the non-exposed pregnancies. Adjustment for age, parity, decade of pregnancy, smoking habits, and intake of coffee and alcohol did not affect the differences. The increased frequency of spontaneous abortion correlated with exposure to ethylene oxide but not with exposure to glutaraldehyde or to formaldehyde. Analysis of spontaneous abortions from the hospital discharge register confirmed the findings. Thus the results from the two independent analyses suggest that exposure to ethylene oxide in hospitals may carry a risk of spontaneous abortion among sterilising staff.