bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Social Support and Job Stress on Public Health Nurses' Organizational Citizenship Behaviors in Rural Taiwan
Authors: Chu Cheng‐I , Lee Ming‐Shinn , Hsu Hsiang‐Ming
Published: November 2006

ABSTRACT
Objective: To examine the relationship between job stress, social support, and organizational citizenship behaviors, by using job satisfaction and organizational commitment as intervening variables among public health nurses (PHNs) in rural areas of Taiwan.

Design: A cross‐sectional design was used to sample all 265 PHNs in two rural counties of Taiwan. Of those, 231 (87.2%) PHNs responded.

Method: A mailed survey questionnaire was sent to subjects for completion in early 2004. Responses were analyzed using descriptive statistics, exploratory factor analyses, and multiple regression analyses. With six multiple regression models, intervening effects were explored by the approach of Baron and Kenny (1986).

Results: Supervisor support indirectly influenced organizational citizenship behaviors through the intervening effect of organizational commitment, whereas, kinship support, role ambiguity, and workload demonstrated direct impacts on organizational citizenship behaviors.

Conclusions: This study provides insights into how social support and job stress impacted PHNs' organizational citizenship behaviors. Those PHNs who experienced more supervisor support exhibited higher levels of organizational citizenship behaviors via the intervening effect of organizational commitment.
The Evaluation of Behavioral Disturbances in Epilepsy
Authors: Krishnamoorthy Ennapadam S.
Published: November 2006

Summary:  The evaluation of behavioral disturbances in epilepsy is an area fraught with complexity. On the one hand, there are no instruments that have been developed specifically for the assessment of behavioral disturbances in epilepsy. On the other hand, the phenomenology and pathophysiology of behavioral disturbances in epilepsy are unique and defy conventional descriptions in the psychiatric literature. The vast majority of studies have used instruments that have not been validated for this purpose. Studies with a psychiatric orientation generally tend to employ unvalidated semistructured or structured tools except for the Structured Clinical Interview for DSM, which has been validated for epilepsy. Studies with a neurological orientation generally use screening questionnaires and interpret the results of these as diagnostic. Neither approach is valid and both generally fail to measure potential confounders, such as seizure frequency, seizure severity, temporality of seizure occurrence in relation to time of assessment, life events, disablement, quality of life, and other socioeconomic indicators. Furthermore, instruments are generally employed using cutoff scores that may not be valid for epilepsy populations; the emphasis is often on symptom severity rather than symptom multiplicity (or load), which may also have an impact on the patient's outcome. In addition, instruments that have a basis in psychiatric criteria as opposed to symptomatology have inherent pitfalls at the interface between epilepsy and behavior. These and other issues in evaluating behavioral disturbances in people with epilepsy are reviewed and some solutions for the future are proposed.
Neuropsychology: Traditional and New Methods of Investigation
Authors: Lassonde Maryse , Sauerwein Hannelore C. , Gallagher Anne , Thériault Martin , Lepore Franco
Published: November 2006

Summary:  The neuropsychological assessment is an integral part of the clinical investigation of patients suffering from epilepsy. The aim of the evaluation is to determine disease‐related and treatment‐related effects on cognition and behavior in order to orient therapeutic interventions, by taking into account the compensatory mechanisms that are available to the patient. Examples of the tests best illustrating the classical neuropsychological protocol are presented. Neuropsychology also plays an important role in the assessment of language lateralization in patients slated for epilepsy surgery. Traditionally, this has been achieved by means of the rather invasive Wada procedure. However, with the advent of new neuroimaging techniques, this procedure is gradually being replaced by minimally invasive or noninvasive methods, such as functional magnetic resonance imaging, positron emission tomography, and optical imaging. In the present paper, we discuss some of the newer techniques that are available to the neuropsychologist for the study of the impact of epilepsy on cerebral functioning.
Learning Disorders in Epilepsy
Authors: Beghi Massimiliano , Cornaggia Cesare Maria , Frigeni Barbara , Beghi Ettore
Published: November 2006

Summary: Learning disorders (LD) are disorders interfering with academic performance or with daily living activities requiring reading, writing, or mathematical abilities in subjects with a normal intelligence quotient. The prevalence of LD in the general population has been found to be 2–10% and reading disorders are the most frequent subtype. Epilepsy is one of the commonest neurological disorders in childhood with an estimated prevalence in 4–5/1,000. Epilepsy is considered to be idiopathic or cryptogenic in approximately two‐thirds of cases. LD are more common in people with epilepsy than in the general population: about 25% of patients with epilepsy are said to have LD. Various psychosocial, medication‐related, and epilepsy‐related factors may be associated with LD in epilepsy. LD can be either permanent or state‐dependent. Permanent LD are caused by a brain lesion and/or a stable brain dysfunction. In contrast, state‐dependent LD are potentially reversible and treatable; they are caused by epilepsy‐related factors. If allowed to persist for a long period, a state‐dependent LD may become permanent.
Severe Myoclonic Epilepsy of Infants (Dravet Syndrome): Natural History and Neuropsychological Findings
Authors: Wolff Markus , Cassé‐Perrot Catherine , Dravet Charlotte
Published: November 2006

Summary:  Severe Myoclonic Epilepsy in infancy (SMEI, or Dravet syndrome) is a drug‐resistant epilepsy that occurs in the first year of life of previously healthy children. The main clinical features are prolonged and repeated febrile and afebrile generalized or unilateral convulsive seizures. In the course of the epilepsy, cognitive deterioration becomes evident, and interictal myoclonus, clumsiness and ataxia appear. One third of the children with SMEI show de novo mutations of the SCN1A gene, and additional familial genes probably contribute to the phenotype. While the clinical picture of SMEI has been well studied, neuropsychological data remain scarce. Global mental retardation, attention deficit and psychotic behavior have been reported but the long‐term outcome has not been evaluated. We conducted a longitudinal neuropsychological study of children with SMEI. Twenty children, aged 11 months to 16 years, were prospectively examined using standardized neuropsychological tests. Correlation analysis with other clinical features was performed in 12 cases. Marked slowing or stagnation of psychomotor development, accompanied by psychotic or autistic traits and hyperactivity, was observed between the ages of one and four years. In the later stages (at ages 5 to 16 years), cognitive function stabilized but remained below normal. In children with a more favorable course, language capacities were better preserved than visuospatial functions, and behavior improved. The cognitive and behavioral impairment tended to correlate with the frequency of convulsive seizures (>5 per month). The data suggest that SMEI can be considered as a prototype of an epileptic encephalopathy.
Circadian Rhythm and Personality Profile in Juvenile Myoclonic Epilepsy
Authors: Pung Tamara , Schmitz Bettina
Published: November 2006

Summary:  Juvenile Myoclonic Epilepsy (JME) is a prototype of idiopathic generalized epilepsy and is characterized by a strong genetic predisposition. According to clinical observations by Janz and Christian (1), the syndrome is associated with a characteristic sleep/wake rhythm and a typical personality profile. These features have subsequently been interpreted as a mild frontal lobe behavior syndrome. Recent neuropsychological and imaging studies confirmed mesiofrontal and prefrontal dysfunction in JME.

We studied 20 patients with JME and a matched comparison group with temporal lobe epilepsy (TLE) using standardized questionnaires with respect to the sleep‐wake rhythm and with respect to personality profiles. We confirmed the characteristic circadian rhythm in JME with the tendency to go to bed later at night, to get up later in the morning, and to feel fit at a later time during the day compared to patients with TLE. With the exception of some subanalyses we did not find evidence for a specific personality profile in JME.
Fixed Rehabilitation of an ACP PDI Class IV Dentate Patient
Authors: Potiket Narong
Published: November 2006

This clinical report describes the prosthodontic rehabilitation of a Class IV dentate patient. Maxillary and mandibular fixed restorations were constructed for the therapy. Canine‐protected occlusion was developed in the definitive restorations to decrease lateral forces on the posterior dentition. Protrusive guidance was developed to distribute protrusive forces to the maxillary and mandibular incisors.
Increased Ventricular Ectopic Activity in Relation to C‐Reactive Protein, and NT‐Pro‐Brain Natriuretic Peptide in Subjects With No Apparent Heart Disease
Authors: SAJADIEH AHMAD , NIELSEN OLAV WENDELBOE , RASMUSSEN VERNER , OLE HEIN HANS , HANSEN JØRGEN FISCHER
Published: November 2006

Background: Subjects with frequent ventricular premature complexes (VPC) and no apparent heart disease make a heterogenic group with regard to prognosis. Some biomarkers have recently proved useful in risk stratification in different heart diseases. We examined prognostic impact of NT‐Pro‐brain natriuretic peptide (NT‐Pro BNP), and C‐reactive protein (CRP) in relation to frequent VPC in subjects with no apparent heart disease.

Methods: Six hundred seventy‐eight healthy subjects between 55 and 75 years of age with no history of cardiovascular disease were included in the study. All were tested with fasting laboratory testing and 48‐hour ambulatory ECG monitoring. Frequent VPC was defined as VPC ≥30/hour.

Results: In 56 subjects (8%) with frequent VPC the prognosis was much poorer compared to those without frequent VPC (Hazard ratio and 95% CI: 2.3;1.2–4.4, P = 0.01), after adjustment for conventional risk factors. In subjects with frequent VPC increased levels of CRP (above 2.5 μg/mL) was the only factor among the tested biomarkers, which was associated with a poor prognosis. Taking subjects without frequent VPC as reference, the hazard ratio and 95% CI for subjects with frequent VPC and increased CRP was 3.6;1.8–7.1, P = 0.0004, and for those with frequent VPC and normal CRP 0.8;0.2–3.5, P = 0.83, after correction for conventional risk factors.

Conclusions: Among middle‐aged and elderly subjects with no apparent heart disease and frequent VPCs, a CRP value ≥2.5 μg/mL is associated with a significantly higher risk of death and acute myocardial infarction. These subjects deserve primary prevention measures and further work up for structural heart disease.
Psychological Distress in Patients with ICD Recall
Authors: CUCULI FLORIM , HERZIG WERNER , KOBZA RICHARD , ERNE PAUL
Published: November 2006

Background: Multiple clinical trials have shown that a properly functioning implantable cardioverter‐defibrillator (ICD) is capable of interrupting sudden death caused by ventricular tachyarrhythmias. However, ICDs are complex medical devices, and they do not always perform as expected or they may fail completely. Exposure of ICD recipients to professional or media reports that their specific device type is potentially malfunctioning could negatively influence their psychological status.

Methods: This study aimed to evaluate and quantify psychological distress in patients implanted with an ICD‐recall device. Thirty patients implanted with ICD‐recall devices (ICD‐recall group) and 25 patients with unaffected ICD devices (ICD‐control group) were interviewed using the Brief Symptom Inventory (a psychological self‐report symptom scale).

Results: Mean values of all primary psychiatric distress symptom dimensions and global indices were within the normal range for both the ICD‐recall and the ICD‐control group. New York Heart Association (NYHA)
class was a predictor of higher distress symptoms in all categories, independently of the ICD group. NYHA II group patients tended toward higher stress levels than the NYHA I group, but only somatization was significantly different. An upward, but not significant, trend in 7 of the 12 scales was associated with symptomatic shock experience.

Conclusion: This study demonstrates that psychological distress was not significantly increased in patients recently informed about a potential malfunction of their device.
Evaluating Fluctuations in Human Atrial Fibrillatory Cycle Length Using Monophasic Action Potentials
Authors: NARAYAN SANJIV M. , KRUMMEN DAVID E. , KAHN ANDREW M. , KARASIK PAMELA L. , FRANZ MICHAEL R.
Published: November 2006

Objective: To study fluctuations in intracardiac atrial fibrillation (AF) cycle length (CL).

Background: Sites of short AF CL may be good ablation targets, and cycle lengthening predicts ablation success. However, the optimum method for measuring AF CL, and its stability, are unclear. We hypothesized that autocorrelation better estimates AF CL than spectral dominant frequency (DF), which is susceptible to double counting, using monophasic action potentials (MAPs) to separate atrial activation from artifact.

Methods: In 28 patients with paroxysmal or persistent AF, we analyzed 49 AF epochs using MAPs at the high (HRA) and low (LRA) right atrium. We estimated AF CL over 2 seconds, 10 seconds, and 2 minutes using spectral DF and autocorrelation in MAPs and filtered bipoles.

Results: In the HRA, manually measured CL was 167 ± 25 ms. Spectral DF poorly estimated AF CL in bipolar signals (R = 0.31; P = NS), due to double counting, but accurately estimated MAP CL (R = 0.73, P < 0.001). Autocorrelation estimated MAP (R = 0.92; P < 0.001) and bipolar (R = 0.83; P < 0.001) CL, with lower errors than spectral DF (P < 0.0001). Over time, changes in DF consistently preceded reciprocal changes in organization (P < 0.001). Finally, excluding inaccurate spectra, DF and AF organization differed between HRA and LRA over 2 seconds, but correlated over 10 seconds and 2 minutes (P < 0.05).

Conclusions: AF CL is better estimated by autocorrelation than spectral DF, particularly for bipoles, and stable when measured for >10 seconds. Notably, changes in AF CL preceded reciprocal changes in organization, yet changes in organization did not precede changes in AF CL. These results may help to interpret AF CL fluctuations.
Atriofascicular Pathways: Where to Ablate?
Authors: KOTHARI SNEHAL , GUPTA ANOOP K. , LOKHANDWALA YASH Y. , VORA AMIT M. , KERKAR PRAFULLA G. , THAKUR RANJAN K.
Published: November 2006

Background: Atriofascicular accessory pathway (AP), often referred to as Mahaim pathway, is an uncommon form of preexcitation. The usual target for ablation is at the site of a high‐frequency potential along the tricuspid annulus (TA). We present our observations in mapping and ablation of 29 patients with atriofascicular APs.

Methods and Results: Twenty‐nine consecutive patients who underwent radiofrequency ablation (RFA) for atriofascicular pathways comprised the series. Demographic factors, clinical features of the tachycardia, ablation site, and results were analyzed. The mean age was 19 ± 8 years; 15 were men. Three patients had Ebstein's anomaly of the tricuspid valve. Four patients had an additional AP and two patients had concomitant typical atrioventricular nodal reentrant tachycardia. RFA was successful in 28 patients (97%); repeat ablation was required in two patients. The site of successful ablation was on the TA at the site of a sharp, high frequency potential in 15 patients (52%). In the remaining 14 patients, a potential was not found along the TA, and ablation was targeted at the ventricular insertion of the AP into the distal right bundle. At the successful ventricular ablation site, local ventricular activation preceded the surface electrocardiogram by 20 ± 6 ms. Eight of the 14 patients (57%) undergoing ablation in the ventricle, developed right bundle branch block (RBBB). One patient who underwent successful ablation along the TA also manifested RBBB after ablation; however, this patient had Ebstein's anomaly and preexcitation had completely masked the RBBB. The mean procedure and fluoroscopy time was 150 ± 32 and 35 ± 12 minutes, respectively.

Conclusions: In atriofascicular pathways, an AP potential was found along the TA in only 52% of patients. Ablation at the ventricular insertion site often resulted in RBBB (57%), but the AP was also successfully ablated.
Slow Pathway Ablation Decreases Vulnerability to Pacing‐Induced Atrial Fibrillation: Possible Role of Vagal Denervation
Authors: RAZAVI MEHDI , CHENG JIE , RASEKH ABDI , YANG DONGHUI , DELAPASSE SCOTT , AI TOMOHIKO , MEADE THOMAS , DONSKY ALAN , GOODMAN MARY J. , MASSUMI ALI
Published: November 2006

Background: Studies indicate that success of radiofrequency (RF) ablation of atrial fibrillation (AF) may be in part due to vagal denervation. RFA
of supraventricular tachycardia (SVT) has been associated with vagal denervation. The effects of slow pathway (SP) ablation on AF inducibility have not been studied.

Objective: To test the hypothesis that SP ablation renders AF less inducible.

Methods: Consecutive patients referred for SVT were studied. After atrioventricular nodal reentrant tachycardia (AVNRT) was confirmed they underwent induction of AF. After SP ablation AF induction was reattempted. Vulnerability to AF was reassessed.

Results: Twenty‐four patients were enrolled; eight were not inducible for AF in the preablative state. Mean CL
of the AVNRT was 340 ± 16 ms. The average RF ablation time was 131 ± 42 seconds. Presence of junctional rhythm was required. Of the 16 with inducible AF two patients had AF induced during routine invasive electrophysiology study. None of these had inducible AF after SP ablation. Fourteen of 16 patients required specific AF induction. Ten of these were noninducible after SP ablation; two were inducible after SP ablation but with a more aggressive pacing protocol (P < 0.03 compared to preablation) and two had no change in AF vulnerability. Seven of the eight noninducible patients remained noninducible for AF post SP ablation. In the 12 patients who were inducible prior but noninducible after ablation the mean atrial effective refractory period (AERP) increased for both BCL at 400 and 600 ms (400/216 ± 8 ms preablation vs 400/248 ± 12 ms postablation, P < 0.03; 600/228 ± 8 ms preablation vs 600/259 ± 6 ms postablation, P < 0.04). There were no significant changes in AERP of patients who remained inducible or who were noninducible before ablation. The average ablation time for patients who became noninducible after ablation was significantly higher than those who had no change in inducibility or remained inducible but at a more aggressive pacing threshold (157 ± 24 seconds vs 35 ± 5 seconds; P < 0.005).

Conclusion: SP ablation acutely decreases vulnerability to pacing‐induced AF in patients with AVNRT. This may reflect the effect of ablation on atrial vagal tone.
Diagnostic Patterns in the Evaluation of Patients Hospitalized with Syncope
Authors: SUZUKI TAKEKI , MATSUNAGA NAOHISA , KOHSAKA SHUN
Published: November 2006

Background: Syncope accounts for 5% of all hospital admissions. The etiology of syncope varies broadly, and nonselective, inpatient diagnostic evaluations to determine the cause of syncope are often inconclusive. We analyzed the yield of inpatient diagnostic tests for syncope, comparing patients with and without an initial suspected diagnosis of vasovagal syncope.

Methods: We retrospectively reviewed the medical records of consecutive adult patients with a principal diagnosis of syncope (ICD‐9 Code 780.2) who were admitted through the emergency department of an 800‐bed teaching hospital from January 1, 2000, to May 31, 2001.

Results: A total of 267 patients (150 women, 117 men; mean age, 72.4 ± 15.3 years) were identified. On admission, a diagnosis of vasovagal syncope was suspected in 47% of patients. Inpatient tests, including telemetry monitoring, echocardiography, and stress testing, were significantly lower yielding in patients with suspected vasovagal syncope when compared to patients with other suspected etiologies (P < 0.05).

Conclusions: Despite the significant length of hospital stay (median 4 days), we found that inpatient diagnostic workups for patients with suspected vasovagal syncope were low yielding, especially with regard to cardiac testing. Furthermore, abnormal test results did not change the discharge diagnosis.
Atrial Fibrillation Associated with Hypokalemia Due to Primary Hyperaldosteronism (Conn's Syndrome)
Authors: ALOUL BASEL AL. , LI JIAN‐MING , BENDITT DAVID , THOLAKANAHALLI VENKATAKRISHNA
Published: November 2006

Aldosterone is a major regulator of the body potassium stores through its role in potassium excretion by the kidney. However, it is unclear whether aldosterone affects transcellular distribution of potassium in atrial myocytes, and whether hypokalemia associated with primary hyperaldosteronism increases susceptibility to atrial fibrillation (AF). We report a case of a 58‐year‐old male with Conn's syndrome in whom symptomatic AF was related to hypokalemia.
May‐Thurner Syndrome: A Vascular Abnormality Encountered During Electrophysiologic Study
Authors: BILLAKANTY SREEDHAR , BURKET MARK W. , GRUBB BLAIR P.
Published: November 2006

In the course of clinical practice the electrophysiologist may encounter a variety of vascular abnormalities which are important to recognize, as they may impact upon the health and welfare of the patient. We describe a case of iliac vein compression (May‐Thurner) syndrome and review its etiology, diagnosis, significance, and treatment.
Selection of TiN as the Interconnect Material for Measuring the Electrical Conductivity of Polymer‐Derived SiCN at High Temperatures
Authors: Ryu Hee‐Yeon , Raj Rishi
Published: November 2006

Three transition metals, Ni, Mo, and Ti, were reacted with SiCN at high temperatures, and the reaction products characterized by X‐ray diffraction. It was concluded that TiN is the most suitable interconnect material for the measurement of the electrical conductivity of SiCN at temperatures up to 1400°C. The TiN interconnects were produced by an in situ process on H‐shape specimens of SiCN, with an appropriate correction factor (which was obtained by finite‐element analysis) for the four‐point measurement of the electrical resistance. The process consisted of placing a small drop of a slurry constituted from liquid Ceraset™ (the precursor for SiCN) and Ti metal powder (50 wt%) on the contact point. The droplet was photo‐cured and pyrolyzed. The TiN interconnect was generated during the pyrolysis. Finally, as an example, the measurement of the conductivity of a SiCNO sample up to 1300°C is reported. A more complete study of the relationship between the conductivity and the composition of SiCNO will be reported separately.
Creep and Microstructural Evolution at High Temperature of Liquid‐Phase‐Sintered Silicon Carbide
Authors: Meléndez‐Martínez Juan J. , Castillo‐Rodríguez Miguel , Domínguez‐Rodríguez Arturo , Ortiz Angel L. , Guiberteau Fernando
Published: November 2006

The compressive creep characteristics at 1625°C of liquid‐phase‐sintered silicon carbide ceramics containing 5 and 15 wt% of crystalline Y3Al5O12 (YAG) as the secondary phase were studied. In the two cases, strains between 10% and 15% were reached without failure. The creep behavior was characterized by a stress exponent n≈2, and the proportion of secondary phase was related to the creep resistance of the materials. The microstructural evolution during creep consisted firstly in the re‐distribution of the secondary phase, probably as a consequence of its viscous flow at the creep conditions, and secondly an extensive nucleation and growth of cavities, which was more important for the highest YAG content. The latter reflects the carbothermal reduction that the secondary phase undergoes during creep.
Production of Aluminum–Zirconium Oxide Hybridized Nanopowder and Its Nanocomposite
Authors: Kong Young‐Min , Kim Hyoun‐Ee , Kim Hae‐Won
Published: November 2006

The alumina–zirconia (Al2O3–ZrO2) system is considered as one of the most useful nanocomposites, finding widespread applications in structural field. To provide optimal performance, the scale reduction of the initial powder or of the final grain morphology is of particular importance. To accomplish this, we developed a novel Al–Zr‐oxide hybridized nanopowder using the Pechini‐type sol–gel method. Within this process, we maintained a uniform distribution of the Al and Zr metallic ions, and kept these ions stable at the molecular distance level with the help of polymeric additives. The transmission electron spectroscopyanalysis of the nanopowder revealed that the individual particles were ultrastructured, with both Al‐oxide and Zr‐oxide regions being interspaced within 10 nanometers. The Al2O3–ZrO2 nanocomposite made from the hybridized nanopowder by a hot‐pressing technique showed ultrafine grain morphology. Moreover, the mechanical strength of the nanocomposite measured by a four‐point flexural test was as high as 1.5 GPa. The Al–Zr‐oxide hybridized nanopowder and its nanocomposite developed herein are considered to find potential uses in engineering applications.
A framework for evidence‐based mental health care and policy
Authors: Salvador‐Carulla L. , Haro J. M. , Ayuso‐Mateos J. L.
Published: November 2006

Objective:  Care planning integrates a growing number of disciplines, research fields and analysis techniques. A framework of the main areas of interest with regard to evidence‐based health care in mental health is provided here.

Method:  The framework is based on the experience of working with data analysts and health and social decision makers at the PSICOST/RIRAG network, a Spanish research association which includes psychiatrists, health economists and health policy experts, as well as on a review of the literature.

Results:  Three main areas have been identified and described here: outcomes management, knowledge discovery from data, and decision support systems. Their use in mental health care is reviewed.

Conclusion:  It is important to promote bridging strategies among these new fields in order to enhance communication and information transfer between the different parts involved in mental health decision making: i) clinicians and epidemiologists, ii) data analysts, iii) care policy makers and other end‐users.
Assessment of service use patterns in out‐patients with schizophrenia: a Spanish study
Authors: Pezzimenti M. , Haro J. M. , Ochoa S. , González J. L. , Almenara J. , Alonso J. , Moreno B. , Muñoz P. E. , Jáuregui V. M. , Salvador‐Carulla L. ,   the PSICOST Group
Published: November 2006

Objective:  The objective is to describe and characterize patterns of service use by out‐patients with schizophrenia in Spain.

Method:  A representative treated prevalence sample of cases with schizophrenia was selected from four Spanish health areas. The evaluation included health service use, clinical severity, functioning and disability. Statistical analysis was based on hierarchical clustering methods.

Results:  A total of 356 patients were included in the analysis. Five patterns of health service use were defined: heavy out‐patient mental health users; mental health and general health service users; heavy hospital service users; nursing service users; low users of mental health services. Patients in each group showed differences in clinical and disability status. Patterns of health service use showed consistency, but also variability, among the geographical areas.

Conclusion:  Development and organization of mental health services should take into account the combinations of services patients most frequently use.
Changes of mineralization of free autogenous bone grafts used for sinus floor elevation
Authors: Schlegel Karl Andreas , Schultze‐Mosgau Stefan , Wiltfang Jörg , Neukam Friedrich Wilhelm , Rupprecht Stephan , Thorwarth Michael
Published: November 2006

Abstract: For augmentations before implant placement in areas of minor bone quantity, autogenous bone is considered the reference to all bone substitutes used alternatively. Autogenous bone transplants originate from various donor areas and can be prepared in different ways before augmentation. They may either be used as block grafts or may be milled to granules that can be used solitarily or in combination with a bone substitute. In a prospective study, 61 patients of the Maxillofacial Surgery Department of our University receiving two‐stage sinus floor elevation because of insufficient bone supply were randomly selected. At first‐stage surgery, the local augmentation procedure, monocortical probes were obtained on the site of bone harvesting. At second‐stage surgery, the implant insertion 6 months after the elevation procedure, bone cores were harvested in the areas of implant placement. Donor regions were the following three areas: the posterior (N=28) and anterior pelvic region (N=15) and the chin region (N=18). The implanted bone in all three groups was particulated to granules of 2–3 mm2 using a bone mill. All biopsies were analyzed by means of microradiography. The anterior pelvic bone grafts showed a mineralized tissue grade of 35.1±7.6% before milling and augmentation. The posterior pelvic bone grafts exhibited a mineralization of 30.7±9.5% and the chin bone grafts 74.6±8.6%.

At second‐stage surgery after 6 months, the mineralization was 36.1±7.59% in the areas where bone grafts from the anterior pelvic crest were used. Probes harvested from sites with posterior pelvic bone augmentations showed a mineralization rate of 34.5±6.5%, and sites were chin bone grafts were applied expressed a mineralization of 54±8.6% (P=0.003 compared with the pre‐operative value). The comparison of the microradiographical results demonstrated significant differences in the mineralization grades depending on the origin of the graft. The origin of the grafts and their remodeling influenced the mineralization rates found at 6 months. How these data may influence the long‐term clinical outcome considering implant survival and bone resorption has to be examined in further long‐term studies.
Expression of bone matrix proteins during the osseus healing of topical conditioned implants: an experimental study
Authors: Schlegel Karl Andreas , Thorwarth Michael , Plesinac Alexandra , Wiltfang Joerg , Rupprecht Stephan
Published: November 2006

Objectives: Osseointegration of implants depends on time and local bone conditions regarding quality and quantity. This led to the bone classification by Lekholm et al. The aim of the present study was to follow the expression of bone matrix proteins during the phase of osseointegration after conditioning of the bone bed by means of immunohistochemistry.

Methods: In the porcine frontal skull, implant beds of identical size were created. Before placement of the implants (Ankylos® 4 × 3.5 mm), the implant beds were conditioned using bone condensation (cond), an osteoinductive collagen (Co) and platelet‐rich plasma (PRP). These conditioning methods were compared with standard procedure. The animals were sacrificed after 2, 4 and 8 weeks. The specimens were then analyzed by light microcopy and immunohistochemistry for expression of bone morphogenic proteins (BMP)2, procollagen I and osteocalcin (OC).

Results: Light microscopy revealed an initial effect of condensation and the bovine collagen at 2 weeks in comparison with the standard group. The PRP did not achieve a significant effect. At 8 weeks, the results of the standard, bone condensation and the bovine collagen group had aligned. The PRP group showed a significantly lower bone–implant contact (BIC) (P=0.003) compared with the standard group. BMP2 expression was significantly higher in all evaluated test groups at 4 and 8 weeks, as well as at 2 weeks in the condensation group. The procollagen I expression at 2 weeks was significantly increased for PRP and lower in the collagen and condensation group compared with standard procedure. Values for 4 and 8 weeks were slightly higher than in the standard group. No significant differences were obvious in the OC group at any time.

Conclusions: During the initial healing phase, an effect of the evaluated methods of topical bone conditioning can be demonstrated by differences in the expression of BMP2 and procollagen I. These findings had leveled at 8 weeks and were, in contrast, not detectable in the expression of OC or by means of light microscopy.
Load‐related bone modelling at the interface of orthodontic micro‐implants
Authors: Büchter André , Wiechmann Dirk , Gaertner Christoph , Hendrik Marc , Vogeler Martin , Wiesmann Hans Peter , Piffko Josef , Meyer Ulrich
Published: November 2006

Abstract: The purpose of this study was to determine the interface reaction of two different titanium micro‐implant systems activated with different load regimens. A total of 200 micro‐implants (100 Abso Anchor® and 100 Dual Top®) were placed in the mandible of eight Göttinger minipigs. Two implants each were immediately loaded in the opposite direction by various forces (100, 300 or 500 cN) through tension coils. Three different distances between the neck of the implant and the bone rim (1, 2, 3 mm) were used. The loads provided by superelastic tension coils (which are known to develop a virtually constant force) led to a range of tip moments 0–900 cN mm at the neck of implants. Non‐loaded implants were used as a reference. Bone tissue responses were evaluated by histology, histomorphometry and scanning electron microscopy after 22 and 70 days of loading. Implant loosening was present in the groups where the load reached 900 cN mm. No movement of implants through the bone was found in the experimental groups, for any of the applied loads. A direct bone‐to‐implant contact to various extents was observed at differently loaded implants. Ultrastructural analysis confirmed the clinical and histological finding that implants (except when loaded at 900 cN mm) were well osseointegrated after 22 days. An increase in the bone‐to‐implant contact ratio was observed during the experimental period in the coronal part of the implants in most experimental groups. The difference reached a level of statistical significance at 500 cN mm (Abso Anchor®) and 600 cN mm (Dual Top®). We conclude that micro‐implants can not only be loaded immediately without impairment of implant stability but many enhance bone formation at the interface when the load‐related biomechanics do not exceed an upper limit of tip moment at the bone rim.
Tissue modeling following implant placement in fresh extraction sockets
Authors: Araújo Mauricio G. , Sukekava Flavia , Wennström Jan L. , Lindhe Jan
Published: November 2006

Objective: To study whether osseointegration once established following implant placement in a fresh extraction socket may be lost as a result of tissue modeling.

Material and methods: Seven beagle dogs were used. The third and fourth premolars in both quadrants of the mandible were used as experimental teeth. Buccal and lingual full‐thickness flaps were elevated and distal roots were removed. Implants were installed in the fresh extraction socket. Semi‐submerged healing of the implant sites was allowed. In five dogs, the experimental procedure was first performed in the right side of the mandible and 2 months later in the left mandible. These five animals were sacrificed 1 month after the final implant installation. In two dogs, the premolar sites on both sides of the mandible were treated in one surgical session and biopsies were obtained immediately after implant placement. All biopsies were processed for ground sectioning and stained.

Results: The void that existed between the implant and the socket walls at surgery was filled at 4 weeks with woven bone that made contact with the SLA surface. In this interval, (i) the buccal and lingual bone walls underwent marked surface resorption and (ii) the height of the thin buccal hard tissue wall was reduced. The process of healing continued, and the buccal bone crest shifted further in the apical direction. After 12 weeks, the buccal crest was located>2 mm apical of the marginal border of the SLA surface.

Conclusion: The bone‐to‐implant contact that was established during the early phase of socket healing following implant installation was in part lost when the buccal bone wall underwent continued resorption.
A longitudinal study of early childhood caries in 9‐ to 18‐month‐old Thai infants
Authors: Thitasomakul Songchai , Thearmontree Angkana , Piwat Supatcharin , Chankanka Oitip , Pithpornchaiyakul Wattana , Teanpaisan Rawee , Madyusoh Sorae
Published: November 2006

Abstract –  Objective:  To examine the rate and pattern of early childhood caries (ECC) development and to investigate the transitional changes of the carious lesions during a follow‐up period of 3–9 months.

Methods:  A longitudinal observational community‐based survey of 599 children, 9–18 months old. The children's dental examinations were first carried out at the age of 9 months with re‐examination at 12 and 18 months by five dentists using standardized methods. The affected rates of dental caries were determined for prevalence, incidence density for risk of caries per person (IDp) and risk by surface (IDs). Changes in dental status over time were explored from unerupted (U) to sound (S), including enamel caries (D1), dentine caries (D2) and caries involving pulp (D3) by computing transitional probabilities.

Results:  The prevalence of caries was 2.0%, 22.8% and 68.1% among 9‐, 12‐ and 18‐month olds, respectively. The IDp observed for newly affected children 9–12 and 12–18 months old was 10.32 and 15.70 persons/100 person‐months, respectively. The IDs for children 9–12 months old was 2.17 newly affected surfaces/100 surface‐months whereas it was 2.22 surfaces/100 surface‐months for children 12–18 months old. The buccal surface of maxillary incisors was the most affected (44.9%) followed by lingual, mesial and distal surfaces, respectively. The transitional probability of caries progression ranged between 1.79% and 15.38% during the follow‐up period from 9 to 12 months old. It was 3.43–39.60% from 12 to 18 months old.

Conclusions:  An extremely high caries‐affected rate was found among the study children even before the age of 18 months. The buccal surface of the maxillary incisors was the most affected. The teeth acquired caries at 3–6 months after initial eruption and carious lesions developed continuously over time.
Factors associated with quitting areca (betel) quid chewing
Authors: Lai Ching‐Shiun , Shieh Tien‐Yu , Yang Yi‐Hsin Connie , Chong Mian‐Yoon , Hung Hsin‐Chia , Tsai Chi‐Cheng
Published: November 2006

Abstract –  Objectives:  The purpose of this study was to provide useful data for a future abstinence project by identifying the factors related to quitting areca (betel) quid chewing.

Methods:  The study was cross‐sectional. Data on demographic variables, psychological factors and substance‐use behaviors were collected via questionnaires from 326 participants.

Results:  Multiple logistic regression analysis indicated that the areca/betel quid chewers who were less educated (OR = 0.58, 95% CI = 0.34–0.98) were least likely to try to give up. Among the chewers who tried to quit, those employed as full‐time drivers (OR = 2.24, 95% CI = 1.14–4.39), who had drinking habits (OR = 2.41, 95% CI = 1.24–4.66), and who preferred to chew only betel quid wrapped with leaf (OR = 4.44, 95% CI = 1.99–9.90) were more likely to fail. Chewers who successfully quit had a higher internal health locus of control compared with those who failed to quit (one‐point increments, OR = 0.94, 95% CI = 0.90–0.98).

Conclusions:  The results suggest that health educators and researchers can better influence people's chewing behavior if the importance of chewers’ education level, job type, substance use (i.e. drinking habits, type of betel quid), and level of health locus of control are all taken into consideration when devising interventions.
Caries‐preventive effect of resin‐based and glass ionomer sealants over time: a systematic review
Authors: Beiruti N. , Frencken J. E. , Van‘t Hof M. A. , Van Palenstein Helderman W. H.
Published: November 2006

Abstract –  Introduction:  The difference in preventing dentine lesion development between resin‐based and glass ionomer sealant materials is unclear. Two recently published reviews were unable to conclude on the difference because the comparison was an exclusion criterion in one review and there were statistical shortcomings in the relevant papers in the other (Cochrane) review.

Objectives:  The aim of the present investigation was to carry out a systematic review on the caries‐preventive effect of these two types of sealant materials under more liberal exclusion criteria concerning the statistical presentations in the publications.

Methods:  Based on five exclusion criteria, the literature search in the electronic libraries PubMed and MEDLINE and the publications retrieved in the Cochrane review, revealed 12 eligible publications for analyses. A variety of glass ionomers and resin‐based sealant materials had been applied in the included studies. Attributable risk (AR) was chosen rather than relative risk (RR), as used in the Cochrane review, because RR is very instable in a low caries population.

Results:  There was no consistent pattern observed with respect to the caries‐preventive effect of either resin‐based or glass ionomer sealants. Therefore, it was impossible to calculate an overall AR.

Conclusions:  There is no evidence that either resin‐based or glass ionomer sealant material is superior to the other in preventing dentine lesion development in pits and fissures over time.
The role of regulatory T cells in the control of natural killer cells: relevance during tumor progression
Authors: Ghiringhelli Francois , Ménard Cédric , Martin Francois , Zitvogel Laurence
Published: November 2006

Summary:  Tumor immunosurveillance relies on cognate immune effectors [lymphocytes and interferon‐γ (IFN‐γ)] and innate immunity [natural killer (NK) cells, natural killer group 2, member D (NKG2D) ligands, perforin/granzyme, and tumor necrosis factor‐related apoptosis‐inducing ligand]. In parallel, tumor cells promote the expansion of CD4+CD25+ regulatory T cells (Tregs) that counteract T‐cell‐based anti‐tumor immunity. Moreover, accumulating evidence points to a critical role for Tregs in dampening NK cell immune responses. This review summarizes the findings showing that Tregs suppress NK cell effector functions in vitro and in vivo, i.e. homeostatic proliferation, cytotoxicity, and interleukin‐12‐mediated IFN‐γ production. The molecular mechanism involve selective expression of membrane‐bound transforming growth factor‐β on Tregs, which downregulate NKG2D expression on NK cells in vitro and in vivo. The regulatory events dictating NK cell suppression by Tregs have been studied and are discussed. The pathological relevance of the Treg–NK cell interaction has been brought up in tumor models and in patients with cancer. Consequently, inhibition of Tregs through pharmacological interventions should be considered during NK‐cell‐based immunotherapy of cancer.
Uterine natural killer cells: a specialized differentiation regulated by ovarian hormones
Authors: Anne Croy B. , Van Den Heuvel Marianne J. , Borzychowski Angela M. , Tayade Chandrakant
Published: November 2006

Summary:  In adult females of many species, a transient population of natural killer (NK) cells appears in cycles within the uterine endometrium (lining). Appearance of these lymphocytes coincides with specific phases of the ovarian hormone cycle and/or early pregnancy. Studies in rodents, women, and pigs dominate the literature and suggest the uterine (u)NK cells are an activated subset sharing many but not all features with circulating or lymphoid organ‐residing NK cells. During successful murine pregnancy, uNK cells appear to regulate initiation of structural changes in the feed arterial systems that support maternal endometrial tissue at sites of implantation and subsequent placental development. These changes, which reverse after pregnancy, create a higher volume arterial bed with flaccid vessels unresponsive to vasoactive compounds. These unique pregnancy‐associated arterial changes elevate the volume of low‐pressure, nutrient‐rich, maternal arterial blood available to conceptuses. Regulation of the differentiation, activation, and functions of uNK cells is only partially known, and there is lively debate regarding whether and how uNK cells participate in infertility or spontaneous abortion. This review highlights the biology of uNK cells during successful pregnancy.
Activation, coactivation, and costimulation of resting human natural killer cells
Authors: Bryceson Yenan T. , March Michael E. , Ljunggren Hans‐Gustaf , Long Eric O.
Published: November 2006

Summary:  Natural killer (NK) cells possess potent perforin‐ and interferon‐γ‐dependent effector functions that are tightly regulated. Inhibitory receptors for major histocompatibility complex class I display variegated expression among NK cells, which confers specificity to individual NK cells. Specificity is also provided by engagement of an array of NK cell activation receptors. Target cells may express ligands for a multitude of activation receptors, many of which signal through different pathways. How inhibitory receptors intersect different signaling cascades is not fully understood. This review focuses on advances in understanding how activation receptors cooperate to induce cytotoxicity in resting NK cells. The role of activating receptors in determining specificity and providing redundancy of target cell recognition is discussed. Using Drosophila insect cells as targets, we have examined the contribution of individual receptors. Interestingly, the strength of activation is not determined simply by additive effects of parallel activation pathways. Combinations of signals from different receptors can have different outcomes: synergy, no enhancement over individual signals, or additive effects. Cytotoxicity requires combined signals for granule polarization and degranulation. The integrin leukocyte function‐associated antigen‐1 contributes a signal for polarization but not for degranulation. Conversely, CD16 alone or in synergistic combinations, such as NKG2D and 2B4, signals for phospholipase‐C‐γ‐ and phosphatidylinositol‐3‐kinase‐dependent degranulation.
Activation and self‐tolerance of natural killer cells
Authors: Gasser Stephan , Raulet David H.
Published: November 2006

Summary:  Natural killer (NK) cells are regulated by numerous stimulatory and inhibitory receptors that recognize various classes of cell surface ligands, some of which are expressed by normal healthy cells. We review two key issues in NK cell biology. How do NK cells achieve tolerance to healthy self‐cells, despite great potential variability in inhibitory and stimulatory receptor engagement? How is the disease status of unhealthy cells translated into changes in ligand expression and consequent sensitivity to NK cell lysis? Concerning the second question, we review evidence that ligands for one key NK receptor, NKG2D, are induced by the DNA damage response, which is activated in cells exposed to genotoxic stress. Because cancer cells and some infected cells are subject to genotoxic stress, these findings suggest a new concept for how diseased cells are discriminated by the immune system. Second, we review studies that have overturned the prevalent notion that NK cells achieve self‐tolerance by expressing inhibitory receptors specific for self‐major histocompatibility complex class I molecules. A subset of NK cells lacks such receptors. These NK cells are hyporesponsive when stimulatory receptors are engaged, suggesting that alterations in signaling pathways that dampen stimulatory receptor signals contribute to self‐tolerance of NK cells.