Danish dentists' knowledge, attitudes and management of procedural dental pain in children: association with demographic characteristics, structural factors, perceived stress during the administration of local analgesia and their tolerance towards pain.

OBJECTIVE: The aim of the present study was to describe Danish dentists' knowledge of, attitudes towards and management of procedural pain during paediatric dental care, and to assess the importance of demographic characteristics, structural factors, perceived stress during administration of local analgesia and the dentists' own tolerance towards procedural dental pain. DESIGN: A cross-sectional questionnaire study was conducted in Denmark in May 2001. SUBJECTS AND METHODS: The subjects were a random sample of 30% of Danish dentists treating children. Usable information was obtained from 327 (80.3%) of the dentists in the sample. RESULTS: One-quarter of the respondents answered that a 3-5-year-old child could report pain only with uncertainty. More than 80% of the dentists stated that they never compromised on painlessness. Very few agreed to the statement that children forget pain faster than adults. One-third agreed to, or were neutral to, the statement that all restorative care in primary teeth could be performed painlessly using N2O-O2 sedation alone. The majority of the respondents reported using three or more methods to assess the effect of their pain control methods. Almost 90% reported using local analgesia for restorative work 'always' or 'often'. A similar proportion reported using topical analgesia before injection 'always' or 'often'. Administering a mandibular block to preschool children was the procedure perceived as the most stressful (33.6%) pain control method. Demographic factors (gender), structural factors (always working alone and treating 3-5-year-old children daily), perceived stress during the administration of a mandibular block in preschool children and the dentists' own willingness to accept potentially painful dental treatment without local analgesia were associated with knowledge of, attitudes towards and management of procedural dental pain in children. CONCLUSIONS: Danish dentists treating children demonstrate concern about procedural dental pain in children. Factors amenable to change via training and reorganization into larger clinical units seem to determine their knowledge of, attitudes towards and management of procedural dental pain in children.

Intimate violence in a southwestern American Indian tribal community.

Much has been written about intimate violence and American Indians, but little empirical data are available. This study investigated the prevalence and characteristics of intimate violence among 104 members of a Southwestern American Indian tribe. A semistructured psychiatric interview and a measure of intimate violence were administered to 104 tribal community members from an overall study sample of 582. Both men and women reported high rates of lifetime (91%) and recent (31%) intimate violence; much of this behavior was interactive. However, female victims were more likely to require medical attention because of sustained injuries and to have their children involved with the violence than were male victims. For women in this study, forced sex was the only incident significantly associated with lifetime affective disorders and lifetime posttraumatic stress disorder. In this Southwestern American Indian community, intimate violence appears to be another variable in an environmental context that includes alcoholism, other psychiatric disorders, and traumatic events.

Relationship of binge drinking to alcohol dependence, other psychiatric disorders, and behavioral problems in an American Indian tribe.

The hypothesis that binge drinking is a benign behavior not associated with alcohol dependence, other psychiatric disorders, or problem areas, in American Indians, was tested in a sample of 582 adult Southwestern American Indian males and females in large multigenerational pedigrees. All information was obtained from semistructured psychiatric interviews that were independently blind-rated for DSM-III-R diagnoses. Three main outcome measures were used: the relationship between binge drinking and (1) alcohol dependence and other psychiatric disorders, (2) substance abuse treatment, and (3) four behavioral problem categories-violence/lawlessness, physical, social, and work. Binge drinking and alcohol dependence were strongly associated. Most binge drinkers were diagnosed as alcohol dependent. However, when controlling for alcohol dependence and other covariates, binge drinking was independently associated with an increase in odds for positive diagnoses for multiple psychiatric disorders, and for social, work, physical, and violence/lawlessness behavioral problems. In sum, binge drinking was found to be a common and severe problem with deleterious consequences in multiple domains of functioning. Assessment instruments should be designed to elicit information on binge patterns of drinking and strategies devised to provide appropriate treatment.

Prevalence and characteristics of trauma and posttraumatic stress disorder in a southwestern American Indian community.

OBJECTIVE: High rates of violence and trauma in many American Indian communities have been reported. The authors investigated the relationship between both the frequency and type of traumatic events and the prevalence of posttraumatic stress disorder (PTSD) in a Southwestern American Indian tribe. METHOD: A structured psychiatric interview and the Traumatic Events Booklet were administered to a subset of 247 tribal members from an overall study population of 582. Subjects were recruited from the community on the basis of membership in pedigrees, and not by convenience. DSM-III-R diagnoses were assigned by consensus after the interviews were evaluated blindly by independent raters. RESULTS: The prevalence of lifetime PTSD was 21.9% (N = 54), and 81.4% of the subjects (N = 201) had experienced at least one traumatic event apiece. The most predictive factor for lifetime PTSD among women was the experience of physical assault, and for men the most predictive factors were a history of combat and having experienced more than 10 traumatic events. CONCLUSIONS: In this Southwestern American Indian community, the prevalences of lifetime PTSD and of exposure to a traumatic event were higher than in the general U.S. population. However, the nearly 4:1 ratio of subjects who reported at least one traumatic event to those with PTSD diagnoses is similar to findings from studies of non-Indians. Individuals with a history of multiple traumatic events (66.0%, N = 163) had a significantly higher risk of developing PTSD. Chronic and multiple trauma did not preclude the identification of acute and discrete traumatic events that resulted in PTSD.

Prevalence, characteristics, and impact of childhood sexual abuse in a Southwestern American Indian tribe.

OBJECTIVE: There were two objectives; first, to investigate the prevalence and characteristics of child sexual abuse in an American Indian community, and second, to determine whether persons with histories of child sexual abuse are at greater risk to develop psychiatric disorders and behavioral problems than persons who report no such history. METHOD: A sample of 582 Southwestern American Indian tribal members was collected for a genetic and linkage study on alcoholism and psychiatric disorders in three large and interrelated pedigrees. Subjects were recruited from the community without knowledge of their clinical histories or those of their relatives. Child sexual abuse and psychiatric disorders were assessed using a semi-structured psychiatric interview. RESULTS: Females were more likely to be sexually abused as children (49%) than were males (14%). Intrafamilial members accounted for 78% of the reported child sexual abuse. Sexually abused males and females were more likely to report childhood and adult behavioral problems than were nonabused subjects. There was a strong relationship between multiple psychiatric disorders and child sexual abuse, with sexually abused males and females more likely to be diagnosed with > or = 3 psychiatric disorders, both including and excluding alcohol dependence or abuse, than were nonabused subjects. CONCLUSION: Child sexual abuse in this population is both an index of family dysfunction and community disorganization as well as a predictor of later behavioral patterns and psychopathology.

Factors influencing utilization of mental health and substance abuse services by American Indian men and women.

OBJECTIVE: This study investigated the effects of gender, number of lifetime psychiatric diagnoses, and childhood victimization on utilization of mental health and substance abuse treatment services in a Southwestern American Indian tribe. METHODS: A total of 582 individuals were recruited based on tribal enrollment and membership in large multigenerational pedigrees. Subjects were interviewed using a modified version of the Schedule for Affective Disorders and Schizophrenia-Lifetime Version, a semistructured psychiatric interview. For this study the definition of childhood victimization was limited to childhood sexual abuse. RESULTS: Fifty-six percent of the subjects had received mental health treatment, substance abuse treatment, or both. Patterns of service utilization differed by gender with the odds of inpatient and substance abuse treatment higher for men than for women. Women were more likely than men to receive mental health treatment. Subjects who had been sexually abused as children were more likely to have three or more psychiatric diagnoses and to have received extensive treatment, compared with subjects who reported no childhood sexual abuse history. Logistic regression demonstrated strong relationships between number of psychiatric diagnoses and the likelihood of treatment among both men and women. CONCLUSIONS: Gender, number of psychiatric diagnoses, and childhood sexual abuse are strong predictors of utilization of mental health and substance abuse treatment services. These factors should be considered in designing treatment interventions.

Immobilization of manganese peroxidase from Lentinula edodes on alkylaminated Emphaze AB 1 polymer for generation of Mn3+ as an oxidizing agent.

Manganese peroxidase (MnP) is secreted by white-rot fungi and participates in the degradation of lignin by these organisms. MnP uses H2O2 as an oxidant to oxidize MnII to MnIII as the manganic ion Mn3+. The Mn3+ stabilized by chelation, is a highly reactive nonspecific oxidant capable of oxidizing a variety of toxic organic compounds. Previous attempts at immobilization of MnP, purified from Lentinula edodes through reactive amino groups, have been hindered by the protein's low lysing content of only 1% and its instability above pH 6.0. As an alternative to amine coupling, the enzyme has now been covalently immobilized through its carboxyl groups, using an azlactone-functional copolymer derivatized with ethylenediamine and 2-ethoxy-1-ethoxycarbonyl-1,2-dihydroquinoline (EEDQ) as a coupling reagent. The immobilization reaction was performed under acidic (pH 5.25) conditions, and 90% coupling efficiency was achieved within 2h. Net immobilization efficiencies, expressed as the product of protein coupling efficiency and enzyme activity, have been measured at > 95% within 4h. The MnP-NH-polymer and the free soluble protein were characterized and compared for their pH, temperature, and storage stabilities, as well as their H2O2 dependence and kinetics. The tethered MnP, employed in an immobilized enzyme bioreactor for generation of chelated Mn3+ may have industrial applications as a nonspecific oxidant of organopollutants.

Tissue plasminogen activator release and plasminogen activator inhibitor levels in coronary artery disease.

Unstable angina and Q wave myocardial infarction are associated with intraluminal coronary thrombosis, a process to which impaired fibrinolysis may contribute. The authors examined the extrinsic fibrinolytic system, including tissue plasminogen activator antigen, plasminogen activator inhibitor activity and antigen, and euglobulin clot lysis time before and after venous occlusion in 56 patients undergoing coronary angiography for chest pain syndromes and in 16 healthy controls. Fibrinolysis variables were similar (with greater than 95% confidence) in the patients with thrombus-associated coronary syndromes as compared with those with chest pain syndromes not due to coronary thrombosis. These fibrinolytic variables were also similar to those in patients without coronary artery disease and in healthy controls. Their data suggest that defective fibrinolysis is not involved, at least systemically, in the pathogenesis of thrombus-associated coronary artery syndromes.

Antigenic identification of chemotactic factor inactivator in normal human serum and bronchoalveolar lavage fluid.

Several proteins have been described that can modulate the activity of the complement component C5a, a potent chemoattractant for neutrophils. One of these inhibitors has been termed chemotactic factor inactivator (CFI). We hypothesized that CFI was antigenically present in normal human serum and that antigenic levels would correlate with the ability of serum to inhibit C5a. To test this hypothesis, CFI was purified from normal human serum, antibodies to CFI were developed in rabbits, and these reagents were used to develop an enzyme-linked immunoadsorbent assay to measure CFI. Sera from 32 normal volunteers were assayed for CFI and found to contain 77 +/- 29 micrograms/ml (range 17 to 137 micrograms/ml). Partially purified CFI from normal human sera was found to inhibit 61% +/- 9% (range 45% to 75%) of the ability of C5a to attract human neutrophils. Importantly, the ability of CFI to inhibit C5a-induced neutrophil chemotaxis correlated with the antigenic amounts of CFI (r = 0.68, P less than 0.05), suggesting that CFI is a major inhibitor of C5a. This was confirmed by the finding that (1) all C5a inhibitory activity coprecipitated with CFI by ammonium sulfate precipitation (45% to 65% saturation), and (2) depletion of this ammonium sulfate fraction of CFI resulted in a major loss in its ability to inhibit the chemotactic activity of C5a (57% vs. 8% inhibition, P less than 0.01). To determine whether CFI could play a role in the modulation of inflammation at tissue sites, normal bronchoalveolar lavage fluid was evaluated for the presence of CFI. CFI was identified in all fluids (mean 0.50 +/- 0.09 micrograms/mg albumin, range 0.14 to 1.43 micrograms/mg albumin.(ABSTRACT TRUNCATED AT 250 WORDS)

Activation of the complement system in the adult respiratory distress syndrome.

The adult respiratory distress syndrome (ARDS) is an acute pulmonary disorder characterized by the accumulation of neutrophils within the lower respiratory tract. Because activation of the complement system can generate C5a, a potent neutrophil chemoattractant, complement activation was assessed in both serum and bronchoalveolar lavage fluid obtained from 10 patients with ARDS and compared with that from normal control subjects. Crossed immunoelectrophoresis was used to determine activation of the complement components C3 and properdin factor B (PFB), and radioimmunoassay was used to determine the presence of C5a. Complement activation was not detected either in the plasma or in the lung epithelial lining fluid of the control subjects. In contrast, evidence of C3 activation was found in the plasma of 50% of the patients with ARDS when initially studied; likewise, C3 activation, PFB activation, and C5a could all be detected in the epithelial lining fluid of all patients with ARDS with a single exception. Follow-up bronchoalveolar lavages revealed decreased amounts of C3 activation and C5a 2 to 7 days after the onset of ARDS, and the complement activation had resolved when the patients with ARDS had completely recovered. To determine if the C5a in bronchoalveolar lavage fluid could be responsible for the influx of neutrophils observed in ARDS, epithelial lining fluids obtained from both normal control subjects and from patients with ARDS were fractionated by molecular sieve chromatography. Two distinct fractions of chemotactic activity were found in the ARDS bronchoalveolar lavage fluid.(ABSTRACT TRUNCATED AT 250 WORDS)

Complement component C5 is required for release of alveolar macrophage-derived neutrophil chemotactic activity.

The influx of neutrophils into the alveolar structures can be induced by stimulation of the resident lung phagocyte, the alveolar macrophage, to release a potent neutrophil chemoattractant(s). We hypothesized that the fifth component of complement (C5) on the cell surface may be required for activation of the alveolar macrophage to release neutrophil chemotactic activity. C5 was identified on guinea pig alveolar macrophages by epifluorescent microscopy, flow cytometry, and enzyme-linked immunoabsorbent assay of eluted macrophages. When cultured for 4 h with stimuli that induce the release of chemotactic activity or for 24 h without added stimuli, purified Fab' fragments of a goat anti-C5 antibody significantly inhibited the ability of macrophages to release chemotactic activity as determined by a blindwell chamber method (p less than 0.001, all comparisons). This inhibition of chemotactic activity was not detected when anti-C5 antibody was added after the culture period. In contrast, anti-C3 antibody had no inhibitory effect at 4 h or at 24 h (p greater than 0.2, all comparisons). Partial characterization of released chemotactic activity revealed it was of low molecular weight, partially lipid soluble, and not inhibited by C5a chemotactic factor inactivator. These studies suggest that C5 may have a regulatory role in the release of chemotactic activity by alveolar macrophages.

Role of chemotactic factor inactivator in modulating alveolar macrophage-derived neutrophil chemotactic activity.

The stimulated alveolar macrophage is a potent source of neutrophil chemotactic activity. The release of this chemotactic activity can be inhibited by pretreating alveolar macrophages with anti-C5 antibody. We hypothesized that C5a, a fragment cleaved from C5 when C5 is activated, might activate the alveolar macrophage to release neutrophil chemotactic activity and that chemotactic factor inactivator, a serum inhibitor of C5a, could decrease this release. Activated complement components including C5a were found to stimulate guinea pig macrophages to release chemotactic activity into their culture supernatants at levels that were significantly higher than the chemotactic activity of C5a alone (P less than 0.001). Chemotactic factor inactivator was found to cause a marked reduction in the chemotactic activity released by macrophages stimulated with phagocytic and nonphagocytic stimuli (P less than 0.001, all comparisons). These data indicate that C5a can stimulate alveolar macrophages to release chemotactic activity in vitro, and that chemotactic factor inactivator may play a role in modulating this process.

Osteoporosis: a bone morphogenetic protein auto-immune disorder.

Simultaneous reduction in the bone formation phase, and a normal or accelerated bone resorption phase of the bone remodelling process occurs in patients with severe osteoporosis having normal calcium or mineral intake, endocrine function, and exercise patterns. A large body of research suggests that the resorption phase is under the control of the immune system, cell mediated, and involves interaction of macrophages and T-lymphocytes. Much less is known about the bone formation phase. The present hypothesis is based upon speculation on the immunosuppressive effects of B-cell-synthesized humoral antibody (anti-BMP) against bone morphogenetic protein, subsequently reducing osteoprogenitor cell differentiation and causing either gradual or precipitous decline in bone mass. The hypothesis assumes that approximately 74% of white Caucasian women of postmenopausal age, and nearly all of the black population in the USA who do not develop osteoporosis, maintain a low anti-BMP titre. The hypothesis emphasizes a recorded (albeit low) incidence of osteoporosis in children, postpartum women, young men, exogenous adrenal hypercorticoidism, various endocrinopathies who warrant investigation for auto-immune disease. Based upon a high anti-BMP titre, and a low BMP anti-BMP ratio in 10 patients with severe osteoporosis, the hypothesis proposes investigation of an auto-immune disorder in the 26% of the female population who become disabled by severe osteoporosis.