Mental health and social support among public safety personnel.

BACKGROUND: Social support may be a protective factor for the mental health of public safety personnel (PSP), who are frequently exposed to potentially psychologically traumatic events and report substantial post-traumatic stress disorder (PTSD) and major depressive disorder (MDD) symptoms. Research examining perceived social support and its association with PTSD and MDD in different PSP categories (e.g. firefighters, paramedics) is limited. AIMS: To examine differences in perceived social support across PSP and determine whether perceived social support is associated with differences in rates of MDD and PTSD. METHODS: We asked Canadian PSP, including correctional workers and officers, public safety communications officials, firefighters, paramedics, municipal and provincial police officers, and Royal Canadian Mounted Police (RCMP) officers, to complete an online anonymous survey that assessed socio-demographic information (e.g. occupation, sex, marital status, service years), social supports and symptoms of mental disorders, including PTSD and MDD. Analyses included ANOVA and logistic regression models. RESULTS: Perceived social support differed by PSP occupation. RCMP officers reported lower social support than all other PSP except paramedics. For most PSP categories, PSP who reported greater social support were less likely to screen positive for PTSD (adjusted odds ratios [AORs]: 0.90-0.93). Across all PSP categories, greater perceived social support was associated with a decreased likelihood of screening positive for MDD (AORs: 0.85-0.91). CONCLUSIONS: Perceived social support differs across some PSP categories and predicts PTSD and MDD diagnostic status. Studies involving diagnostic clinical interviews, longitudinal designs and social support interventions are needed to replicate and extend our results.

Consistency of orthodontic extraction decisions.

Ten orthodontists having completed specialist training, examined on two occasions 1 month apart, the complete pre-treatment records of 60 Class II division 1 patients representing the full range of dental malocclusion severity. At each session the orthodontist recorded whether their proposed treatment involved extractions. The level of agreement both between and within the orthodontists was evaluated with the Kappa statistic. Data analysis revealed that the level of agreement within the examiners was good, however the between examiner agreement was poor. It appeared that the orthodontists were applying different criteria in terms of the extraction decision and this has implications for orthodontic patients.

Decision analysis to optimize the outcomes for Class II Division 1 orthodontic treatment.

Selection of the treatment method of choice in orthodontics is usually a question of the clinician's personal preference and is generally based on subjective criteria. Orthodontic treatment of malocclusions is unlike treatment of a disease and hence terms such as success and failure are relative and undefined. Ideally, both patients and providers should be able to arrive at treatment decisions that have the greatest potential for optimum outcomes at minimal cost and risks. This article applies the method of decision analysis to demonstrate how policy choices between "one-stage" or "two-stage" treatment of Class II Division 1 malocclusions for children between 11 and 14 years old can be based on objective criteria. A decision tree was designed to yield the value of payoffs, or outcomes, at each of the possible terminal nodes, and the probability of each payoff. Both positive (ie, improvement in malocclusion) and negative (ie, extraction of teeth and long treatment duration) attributes of outcomes were considered, and numerical values, or "utilities," were assigned to each outcome. For this model, one-stage nonextraction treatment yields the highest probability of maximum benefit. Further applications of decision analysis to resolve clinical uncertainties in orthodontics are discussed.

Attitude variables of dentofacial deformity patients: demographic characteristics and associations.

For patients to obtain satisfaction from surgical orthodontic treatment, a concordance needs to exist between the patients' concerns and expectations and the clinician's outcome measures of success. In this study, 231 patients 16 years or older were analyzed to define attributes of treatment that relate to patient satisfaction with outcome. The most prevalent patient concerns were related to facial and dental esthetics, and the effect of the dentofacial deformity on the quality of life was associated with a significantly higher motivation for surgical treatment.

The effects of maxillary surgery on nasal respiration.

Le Fort I osteotomies frequently involve impaction of the maxilla into the nasal cavity, potentially affecting nasal form. It has been speculated that a concomitant change in nasal function may occur. The purpose of this study was to determine if there is an association between maxillary position and nasal function and to evaluate the influence of Le Fort I surgery on nasal function. Presurgical and postsurgical nasal resistance and percent nasal respiration were compared in 36 patients. Results indicated a mean change in nasal resistance 1 year after surgery, but mean percent nasal respiration did not change significantly. No prediction could be made for any patient relative to the effect of maxillary surgery on the nasal function parameters. No consistent association could be found between the amount or direction of maxillary surgical movement or the position of the maxilla and nasal respiration.

Diagnosis and treatment planning for the surgical-orthodontic patient.

Contemporary orthognathic surgery has made it possible to reposition either or both jaws in one piece or as segmental osteotomies. This has provided the patient, who has a severe dentofacial problem, with the option of having all components of their malocclusion and facial aesthetic concerns addressed. The close collaboration between the orthodontist and the surgeon provides a comprehensive diagnosis and treatment plan to be generated. The goal of the presurgical phase of orthodontics is to remove the dental compensations and allow optimum surgical correction of the jaw discrepancy. A short phase of orthodontic treatment postoperatively is usually necessary to detail the final occlusion. A systematic approach to diagnosis and treatment planning is discussed in the context of the problem-oriented approach. The application of this approach is illustrated in a case report of the combined orthodontic-surgical treatment of a patient who benefited from a two-jaw surgical procedure with pre- and postoperative orthodontic treatment. The principles of presurgical orthodontic treatment are discussed and should avoid any counterproductive tooth movements that can be part of the surgical correction. Tooth movements done as part of the postoperative treatment should avoid compromising the surgical outcome. Illustrations of the cephalometric prediction tracing and its application to the diagnosis and treatment plan of the patient discussed in the case report is an important aspect in providing the dentofacial patient with a representation of the expected treatment outcome.

Diagnosis and treatment planning for the surgical-orthodontic patient.

Contemporary orthognathic surgery has made it possible to reposition either or both jaws in one piece or as segmental osteotomies. This has provided the patient, who has a severe dentofacial problem, with the option of having all components of their malocclusion and facial aesthetic concerns addressed. The close collaboration between the orthodontist and the surgeon provides a comprehensive diagnosis and treatment plan to be generated. The goal of the presurgical phase of orthodontics is to remove the dental compensations and allow optimum surgical correction of the jaw discrepancy. A short phase of orthodontic treatment postoperatively is usually necessary to detail the final occlusion. A systematic approach to diagnosis and treatment planning is discussed in the context of the problem-oriented approach. The application of this approach is illustrated in a case report of the combined orthodontic-surgical treatment of a patient who benefited from a two-jaw surgical procedure with pre- and postoperative orthodontic treatment. The principles of presurgical orthodontic treatment are discussed and should avoid any counterproductive tooth movements that can be part of the surgical correction. Tooth movements done as part of the postoperative treatment should avoid compromising the surgical outcome. Illustrations of the cephalometric prediction tracing and its application to the diagnosis and treatment plan of the patient discussed in the case report is an important aspect in providing the dentofacial patient with a representation of the expected treatment outcome.