The effect of lifetime fluoridation exposure on dental caries experience of younger rural adults.

BACKGROUND: The aim of this study was to confirm whether the level of lifetime fluoridation exposure is associated with lower dental caries experience in younger adults (15-46 years). METHODS: Data of the cohort born between 1960 and 1990 residing outside Australia's capital cities from the 2004-2006 Australian National Survey of Adult Oral Health were analysed. Residential history questionnaires were used to determine the percentage of each person's lifetime exposure to fluoridated water (<50%/50+%). Examiners recorded decayed, missing and filled permanent teeth (DMFT). Socio-demographic variables, periodontal risk factors, and access to dental care were included in multivariable least-squares regression models. RESULTS: In bivariate analysis, the higher level of fluoridation category had significantly lower DMFT (mean 6.01 [SE=0.62]) than the lower level of fluoridation group (9.14 [SE=0.73] p<0.01) and lower numbers of filled teeth (4.08 [SE=0.43], 7.06 [SE=0.62], p<0.01). In multivariate analysis, the higher number of full-time equivalent dentists per 100,000 people was associated with a lower mean number of missing teeth (regression coefficient estimate=-1.75, p=0.03), and the higher level of water fluoridation with a lower mean DMFT (-2.45, p<0.01) and mean number of filled teeth (-2.52, p<0.01). CONCLUSIONS: The higher level of lifetime fluoridation exposure was associated with substantially lower caries experience in younger rural adults, largely due to a lower number of filled teeth.

Is poor access to dental care why people outside capital cities have poor oral health?

BACKGROUND: Why oral health status outside capital cities is poorer than that in capital cities has not been satisfactorily explained. The aim of this study was to determine if the reason was poorer access to dental care. METHODS: Data were obtained from the Australian National Survey of Adult Oral Health (2004-06). Oral health status was measured by DMFT Index, and numbers of decayed, missing and filled teeth. A two-step analysis was undertaken: comparing the dependent variables by location, socio-demographic confounders and preventive dental behaviours, and then including six access to dental care variables. RESULTS: Of the 14 123 people interviewed, 5505 were examined, and 4170 completed the questionnaire. With socio-economic parameters in the first regression model, non-capital city people had higher DMFT (regression coefficient = 1.15, p < 0.01), more decayed (0.42, p < 0.01) and missing teeth (0.85, p < 0.01), but not filled teeth (-0.11, p = 0.71), than capital city based people. In the second step analysis, non-capital city people still had a greater DMFT (1.01, p < 0.01), more decayed (0.27, p = 0.03) and missing teeth (0.74, p < 0.01), but not filled teeth (0.00, p = 0.99) than capital city based people. CONCLUSIONS: Access to dental care was not the only reason why people outside capital cities have poorer oral health than people living in capital cities.

Costs of illness due to endemic cholera.

Economic analyses of cholera immunization programmes require estimates of the costs of cholera. The Diseases of the Most Impoverished programme measured the public, provider, and patient costs of culture-confirmed cholera in four study sites with endemic cholera using a combination of hospital- and community-based studies. Families with culture-proven cases were surveyed at home 7 and 14 days after confirmation of illness. Public costs were measured at local health facilities using a micro-costing methodology. Hospital-based studies found that the costs of severe cholera were US$32 and US$47 in Matlab and Beira. Community-based studies in North Jakarta and Kolkata found that cholera cases cost between US$28 and US$206, depending on hospitalization. Patients' cost of illness as a percentage of average monthly income were 21% and 65% for hospitalized cases in Kolkata and North Jakarta, respectively. This burden on families is not captured by studies that adopt a provider perspective.

Phase III trial of gemcitabine plus docetaxel versus capecitabine plus docetaxel with planned crossover to the alternate single agent in metastatic breast cancer.

BACKGROUND: Safety and efficacy of gemcitabine plus docetaxel (GD) and capecitabine plus docetaxel (CD) were compared in patients with metastatic breast cancer, where the alternate crossover monotherapy (GD→C or CD→G) was predetermined. PATIENTS AND METHODS: Patients were randomly assigned to 3-week cycles of either gemcitabine 1000 mg/m(2) on days 1 and 8 plus docetaxel 75 mg/m(2) on day 1 or capecitabine 1000 mg/m(2) twice daily on days 1-14 plus docetaxel 75 mg/m(2) day 1. Upon progression, patients received crossover monotherapy. Primary end point was time to progression (TtP). Secondary end points evaluated overall response rate (ORR), overall survival (OS), and adverse events (AEs). RESULTS: Despite over-accrual of 475 patients, the trial matured with only 324 of 385 planned TtP events due to patient discontinuations. Human epidermal growth factor receptor 2 status was not captured in this study. More CD patients (28%) discontinued due to AEs than GD patients (18.0%, P = 0.009). TtP [hazard ratio (HR) = 1.101, 95% confidence interval (CI) 0.885-1.370, P = 0.387] and OS (HR = 1.031, 95% CI 0.830-1.280, P = 0.785) were not significantly different comparing GD and CD. ORR was not statistically different (P = 0.239) comparing GD (72 of 207, 34.8%) and CD (78 of 191, 40.8%). TtP, OS, and ORR were not significantly different comparing crossover groups. GD caused greater fatigue, hepatotoxicity, neutropenia, and thrombocytopenia but not febrile neutropenia; CD caused more hand-foot syndrome, gastrointestinal toxicity, and mucositis. CONCLUSIONS: GD and CD produced similar efficacy and toxicity profiles consistent with prior clinical experience.

Relative oral health outcome trends between people inside and outside capital city areas of Australia.

BACKGROUND: The aim of this study was to evaluate relative change over 17 years in clinical oral health outcomes inside and outside capital city areas of Australia. METHODS: Using data from the National Oral Health Survey of Australia 1987-88 and the National Survey of Adult Oral Health 2004-06, relative trends in clinical oral health outcomes inside and outside capital city areas were measured by age and gender standardized changes in the percentage of edentate people and dentate adults with less than 21 teeth, in mean numbers of decayed, missing and filled teeth, and mean DMFT index. RESULTS: There were similar reductions inside and outside capital city areas in the percentage of edentate people (capital city 63.7%, outside capital city 60.7%) and dentate people with less than 21 teeth (52.5%, 50.1%), in the mean number of missing teeth (34.3%, 34.5%), filled teeth (0.0%, increase of 5.5%), and mean DMFT index (21.2%, 19.2%). The reduction in mean number of decayed teeth was greater in capital city areas (78.0%) than outside capital city areas (50.0%). CONCLUSIONS: Trends in four of the five clinical oral health outcomes demonstrated improvements in oral health that were of a similar magnitude inside and outside capital city areas of Australia.

Risk indicators of caries experience among young adults.

BACKGROUND: Significant gains have been documented on the oral health of Australian children. However, the question remains as to whether improvements have extended to the oral health of young adults. This study aimed to determine the risk indicators associated with oral health status in young adults aged 20-25 years. METHODS: A random sample of young adults was selected from the South Australian electoral roll. Telephone interviews were conducted for 1261 young adults. These provided socio-demographic, health behaviour and dental visiting data. Dental examinations were carried out on 644 subjects by three calibrated examiners in clinical settings. RESULTS: The mean number of tooth surfaces affected by dental caries (DMFS) was 6.05 with the presence of untreated cavitated decayed surfaces (DS) evident in 28.6 per cent. In regression models the risk indicators associated with DS were being on government benefits, unemployed, usually visiting for a problem rather than a check, visiting a public clinic, drinking 5+ acidic drinks per day and being a current smoker. Risk indicators for higher DMFS scores were usually visiting for a problem, visiting a public clinic, being on government benefits and having made a dental visit in the previous 2 years. CONCLUSIONS: Socio-demographic factors, dental visiting patterns and general health behaviours are risk indicators for caries in young adults.

Dental fear in Australia: who's afraid of the dentist?

BACKGROUND: This study aimed to describe both the prevalence of dental fear in Australia and to explore the relationship between dental fear and a number of demographic, socio-economic, oral health, insurance and service usage variables. METHODS: A telephone interview survey of a random sample of 7312 Australian residents, aged five years and over, from all states and territories. RESULTS: The prevalence of high dental fear in the entire sample was 16.1 per cent. A higher percentage of females than males reported high fear (HF). Adults aged 40-64 years old had the highest prevalence of high dental fear with those adults aged 80+ years old having the least. There were also differences between low fear (LF) and HF groups in relation to socioeconomic status (SES), with people from higher SES groups generally having less fear. People with HF were more likely to be dentate, have more missing teeth, be covered by dental insurance and have a longer time since their last visit to a dentist. CONCLUSIONS: This study found a high prevalence of dental fear within a contemporary Australian population with numerous differences between individuals with HF and LF in terms of socioeconomic, socio-demographic and self-reported oral health status characteristics.

Access to dental care by young South Australian adults.

BACKGROUND: Despite reported concern over the dental care of young adults little research has been done on their use of dental services in Australia. The aim of this study was to investigate the patterns of dental utilization of young South Australian adults aged 20-24 years. METHODS: A random sample of 2300 young adults was selected from the electoral roll. Partial or complete addresses and possible phone numbers were obtained for 1921 persons. Telephone interviews were conducted for 1261 subjects to obtain information on socio-demographics, health behaviour and dental visiting (response rate 65.6 per cent). RESULTS: One third of young adults (34 per cent) had not made a dental visit in the previous two years and 38 per cent usually visited for a problem rather than a check-up. Making a dental visit in the last two years was significantly associated with a number of socio-demographic variables including age and gender, with holders of private dental insurance and those who have not avoided care because of cost having higher odds of making a visit and males and government concession card holders having lower odds of visiting. Usual reason for visiting a dentist for a problem was significantly associated with no private dental insurance, holding a government concession card, no tertiary education and avoiding care because of cost. CONCLUSIONS: This study suggests that demographic and economic factors influenced use of dental services and reason for visiting of young South Australian adults.

Neural tube defects and the 13q deletion syndrome: evidence for a critical region in 13q33-34.

Neural tube defects (NTD) are common findings in the 13q deletion syndrome, but the relationship between the 13q- syndrome and NTDs is poorly understood. We present a child with a 13q deletion and lumbosacral myelomeningocele. This was a boy with microcephaly, telecanthus, minor facial anomalies, and ambiguous genitalia. Cytogenetic and fluorescence in situ hybridization analysis showed a de novo 46,XY,del(13)(q33.2-->qter) with no visible translocation. By using microsatellite markers, the deletion breakpoint was mapped to a 350-kb region between D13S274 and D13S1311 and was paternal in origin. An analysis of 13q deletions with NTDs, including the present case, suggests that a deletion in 13q33-34 is sufficient to cause an NTD. The deletions associated with NTDs are distal to and nonoverlapping with the previously defined critical region in 13q32 for the major malformation syndrome [Brown et al., 1999: Am J Hum Genet 57: 859-866]. Our analysis also suggests that one or more genes in 13q33-34 produces NTDs by haploinsufficiency.

Pamidronate reduces skeletal morbidity in women with advanced breast cancer and lytic bone lesions: a randomized, placebo-controlled trial. Protocol 18 Aredia Breast Cancer Study Group.

PURPOSE: To assess whether pamidronate can reduce the frequency of skeletal morbidity in women with lytic bone metastases from breast cancer treated with hormone therapy. PATIENTS AND METHODS: Three hundred seventy-two women with breast cancer who had at least one lytic bone lesion and who were receiving hormonal therapy were randomized to receive 90 mg of pamidronate or placebo as a 2-hour intravenous infusion given in double-blind fashion every 4 weeks for 24 cycles. Patients were evaluated for skeletal complications: pathologic fractures, spinal cord compression, irradiation of or surgery on bone, or hypercalcemia. The skeletal morbidity rate (the ratio of the number of skeletal complications to the time on trial) was the primary efficacy variable. Bone pain, use of analgesics, quality of life, performance status, bone tumor response, and biochemical parameters were also evaluated. RESULTS: One hundred eighty-two patients who received pamidronate and 189 who received placebo were assessable. The skeletal morbidity rate was significantly reduced at 12, 18, and 24 cycles in patients treated with 90 mg of pamidronate (P = .028, .023, and .008, respectively). At 24 cycles, the proportion of patients having had any skeletal complication was 56% in the pamidronate group and 67% in the placebo group (P = .027). The time to the first skeletal complication was longer for patients receiving pamidronate than for those given placebo (P = .049). There was no statistical difference in survival or in objective bone response rate. Pamidronate was well tolerated. CONCLUSION: Treatment with 90 mg of pamidronate as a 2-hour intravenous infusion every 4 weeks in addition to hormonal therapy significantly reduces skeletal morbidity from osteolytic metastases.

Mitotic effect of autologous blood injection and diode laser bleb revision on rabbit filtration blebs.

OBJECTIVE: To investigate the effect of intrableb autologous blood injection and diode laser bleb revision on cellular proliferation in filtration blebs of rabbits. METHODS: Bilateral filtration surgery with mitomycin was performed on 19 white 2.5- to 3-kg New Zealand rabbits. Autologous blood injection (n = 9) or diode laser bleb revision (n = 10) was performed on blebs of right eyes (intervention eyes) on day 14 after filtration surgery. The blebs of the left eyes served as controls. Cellular proliferation was assessed by in vivo incorporation of 5-bromo-2'-deoxyuridine (BrdU), after BrdU, 10 mg/kg, was injected via the ear vein on days 15, 16, and 18. The rabbits were euthanized on day 21. Conjunctival sections were stained with hematoxylin-eosin for total cell counts and with anti-BrdU antibody for counts of proliferating cells. The BrdU labeling index was calculated by dividing the mean proliferating cell count by the mean total cell count. RESULTS: The BrdU labeling index was significantly increased in the blood-injected eyes as compared with the control eyes (P = .03). The BrdU labeling index was increased in the diode laser-revised eyes as compared with the control eyes, approaching significance (P = .06). Intraocular pressure increased significantly in the eyes that underwent bleb interventions in both groups from baseline and compared with the control eyes. CONCLUSIONS: Intrableb autologous blood injection and diode laser bleb revision stimulate cellular proliferation in the rabbit filtration bleb, which may contribute to the rise in intraocular pressure observed clinically after these interventions.

Use of human recombinant erythropoietin and prednisone for treatment of myelodysplastic syndrome with erythroid predominance in a dog.

A 7-year-old German Shepherd dog was referred for evaluation of severe nonregenerative anemia (PCV, 10%; reticulocyte fraction, 0.2%). Cytologic examination of a bone marrow aspirate indicated erythroid predominance and dyserythropoiesis, and a diagnosis of myelodysplastic syndrome (MDS) with erythroid predominance was made. The dog was given a single blood transfusion and was treated with prednisone and recombinant human erythropoietin (EPO). Eight weeks later, anemia had resolved. The dog remained clinically normal 30 months after treatment, with a PCV of 45%. Results suggest that EPO may be useful in the treatment of dogs with MDS with erythroid predominance or erythroleukemia. Additional studies are required to confirm the benefit of EPO to manage MDS-associated anemia in dogs.

Public perception of cross-infection control in dentistry.

Since the advent of HIV/AIDS at the beginning of the 1980s, concern has generated considerable impetus for change in cross-infection control procedures in dentistry. This process has been hastened partly by media coverage which, in tending to favour sensation over rational discourse, has played a not inconsiderable role in shaping public understanding and expectations. This study aimed to investigate public perceptions of cross-infection control in dentistry in Australia using a postal follow-up to the 1995 National Dental Telephone Interview Survey. The postal survey response rate was 85.2 per cent. Concerns about the procedures used by their dentist to sterilize instruments were reported by 13.3 per cent of respondents overall, and this was greater among non-health-card-holders, individuals who mainly spoke a language other than English in the home, and those who reported a non-routine dental visiting pattern. Avoidance or delaying of dental visits due to the perceived cross-infection risk was reported by an overall 3.6 per cent of people, and this was higher among females and those who expressed concern about cross-infection control. The profession has a responsibility to ensure that information on the measures which have been taken to reduce the risk of cross-infection in dentistry is disseminated as widely and as clearly as possible so that undue public concern and avoidance of dental care are minimized.

Low-risk febrile neutropenia in a medical oncology unit.

BACKGROUND: Febrile neutropenia occurring in patients receiving chemotherapy for solid tumours or lymphoma is usually of short duration, and therefore may have a better outcome compared to patients with acute leukaemia or patients receiving myeloablative chemotherapy. AIMS: To review retrospectively the outcomes for febrile neutropenia occurring in patients of the Medical Oncology Unit at our institution, and to identify factors associated with worse outcome, particularly prolonged admission or death. METHODS: We reviewed 102 episodes of febrile neutropenia occurring in 85 patients treated between 1992 and 1994. Demographic factors, tumour-related factors and clinical aspects of the episodes were correlated with outcome. RESULTS: The median age was 60 years (range, 18-87), with 56 (55%) episodes occurring in females. Twenty-eight (27%) episodes occurred in patients with lymphoma, with the remaining 74 (73%) occurring in patients with solid tumours. At presentation, the median absolute neutrophil count (ANC) was 0.14 x 10(9)/L with a median duration of significant neutropenia (ANC < 0.5 x 10(9)/L) of three days. The median duration of fever was two days. Twenty-nine (28%) episodes had positive cultures; of these 11 had bacteraemia. Forty-four (43%) episodes were classified as unexplained fevers. The remaining 29 episodes were associated with clinically documented infection but negative cultures. There was a high treatment success rate (81%) with first-line empirical antibiotics. Of 19 treatment failures, 13 were due to the necessity for antibiotic modification; the other six patients died from infection. Factors associated with a worse outcome (including prolonged admission and death) include: diagnosis of lymphoma; increasing number of chemotherapy courses; early onset of neutropenia; pneumonia; severe hypotension; and multiple co-morbidities. CONCLUSIONS: Febrile neutropenia in adult patients with solid tumours or lymphoma is associated with a relatively good outcome, possibly due to the short duration of neutropenia. A future prospective study to validate the risk factors identified in this study would be useful for defining patients at low risk for the adverse outcomes examined, in whom less intensive management for this condition may be possible.

The effect of a brief education program on glaucoma patients.

PURPOSE: To assess our patients' knowledge of glaucoma and to measure the effect of a brief education program on their understanding of glaucoma. METHODS: Patients attending glaucoma clinics at a university and a Veterans' Affairs hospital were randomized into two groups: "exposed" and "unexposed" to a simple education program of a video and brochures. Glaucoma knowledge was assessed twice by an oral questionnaire, at 2 weeks and 6 months after randomization plus or minus education. RESULTS: Younger patients and those with more years of formal schooling knew more about glaucoma. Two weeks after the education program, the exposed group performed significantly better than did the unexposed group. Analysis of the results showed benefit from both brochures and video. This effect of education was not seen at retesting 6 months later. CONCLUSION: Older patients and those with less formal education know less about glaucoma. A brief, simple education program can significantly improve levels of knowledge about glaucoma, even in a relatively well-informed population. However, patient education must be repeated to maintain a useful effect.

The Australian public's perception of mercury risk from dental restorations.

The debate about mercury and dental amalgam has been one of the longest running in dentistry, and shows no signs of abating. This study aimed to investigate perceptions about mercury in dental fillings among a representative sample of the Australian public. A random sub-sample of participants in a national dental telephone interview survey completed a follow-up postal questionnaire which included four items on dental mercury. The postal survey response rate was 85.2%. Concern about mercury in dental fillings was expressed by 37.5%, while 16.2% reported having requested fillings that do not contain mercury. Avoidance of dental care because of concern about mercury in fillings was reported by 5.8%, but only 4.7% reported having had fillings replaced because they contained mercury. The data indicate that there is a substantial degree of concern about mercury and dental amalgam among the Australian public, but that the dental behavioural and treatment-pattern consequences of that concern are infrequent.

Caries experience among children in fluoridated Townsville and unfluoridated Brisbane.

Fluoridation of community water supplies constitutes the main public health strategy for prevention of dental caries in Australia. In recent years questions have been raised about the effectiveness of water fluoridation. The aim of this paper was to examine differences in caries experience of children aged 5 to 12 years who were lifetime residents either of Brisbane (the unfluoridated Queensland capital) or Townsville (fluoridated since 1965). Children from each city were sampled from patients of the school dental service. Dental therapists and dentists from the school dental service recorded data describing dental caries experience and parents were asked to complete a questionnaire about their children's residential history and exposure to other fluorides. Of the 18,348 children sampled, 10,195 (55.6 per cent) provided completed questionnaires, and 4588 were lifetime residents of their respective cities. Caries rates were significantly lower (P < 0.01) among children in Townsville than in Brisbane, both in the deciduous dentition (according to age 32 to 55 per cent fewer tooth surfaces affected) and permanent dentition (20 to 65 per cent fewer tooth surfaces affected). Significantly lower rates in Townsville persisted (P < 0.01) in multivariate analyses that controlled for oral hygiene practices, exposure to fluoride supplements and household income. Water fluoridation appears to provide a substantial public health benefit for children in Townsville.

Radical prostatectomy with preservation of urinary continence.

PURPOSE: In an effort to improve postoperative urinary continence after radical retropubic prostatectomy, a new operation to preserve the bladder neck and a significant portion of the prostatic urethra has been developed. MATERIALS AND METHODS: The prostatic urethra is dissected in continuity with the bladder away from the lumen of the prostate, which allows for a true urethra-to-urethra anastomosis. RESULTS: A total of 24 patients who underwent the new continence sparing radical retropubic prostatectomy was compared retrospectively to 80 who previously underwent a nerve sparing procedure. Total continence was noted immediately in 11 patients, within 9 days in 15 and within 7 weeks in 21 of 24 who underwent the new operation, compared to 1, 5 and 33, respectively, of 80 who underwent the standard operation. Microscopic positive margins were noted in 2 of 24 patients with the new continence sparing operation. Early results of cancer control were good. CONCLUSIONS: Early followup of this new technique of radical retropubic prostatectomy suggest that preservation of the continence mechanism at the level of the bladder neck and prostatic urethra results in significantly improved postoperative urinary continence without adversely affecting cancer control.

Dental anxiety among Australians.

This study aimed to estimate the prevalence of dental anxiety and examine its associations among a representative sample of Australians aged 18 and over. A random sub-sample of participants in a national dental telephone interview survey completed a follow-up postal questionnaire (response rate 85.2 per cent) which included Corah's Dental Anxiety Scale (DAS). The prevalence of dental anxiety (defined by a DAS score of 13 or more) in the sample was 14.9 per cent, with overall severity represented by the mean score of 9.04 (sd, 3.45). The prevalence and severity of dental anxiety were greater among women than men, and in the 35-44 age group. High-anxiety individuals reported more deferring of dental care, and more frequently reported an episodic dental visiting pattern. Although there were no differences in dental anxiety by self-reported dental status, individuals who reported impact from their oral conditions had higher dental anxiety. These associations with social impacts and deferment of care indicate that dental anxiety may be an important dental public health problem in Australia.

Patient mobility in Australian dentistry.

Data on the mobility of dental patients are scarce. The aim of this study was to investigate movement among dentists of a representative sample of the Australian public. A postal questionnaire was completed by a random subsample of 1,010 participants in the 1995 National Dental Telephone Interview Survey. The response rate was 85.2 per cent. Approximately one-third of the 885 dentate respondents reported attending a different dentist to that attended two years previously; this was substantially higher (over half) among those whose last visit was not in the private sector. Most (81.8 per cent) of those who had changed dentist had done so for reasons which were beyond the immediate control of the dental profession, but 15.2 per cent had changed because they were unhappy with the care provided by the previous dentist, and 3.0 per cent had changed because the previous dentist was too expensive. Perceived freedom to change dentist was greater among individuals who used the private sector, spoke English in the home, and who were not holders of health cards. The findings of this study indicate that the Australian public manifests a moderate degree of movement among dental providers, and that such movement is greater among users of public-sector dental services.