bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical course of chronic periodontitis
Authors: Schätzle Marc , Löe Harald , Bürgin Walter , Ånerud Åge , Boysen Hans , Lang Niklaus P. 
Published: September 2003

AbstractObjectives:  The purpose of this study was to determine the influence of long‐standing gingival inflammation on periodontal attachment loss. On the basis of repeated examinations, the present report describes the influence of gingival inflammation on the initiation of periodontitis from 16 to 59 years of age.Material and Methods:  The data originated from a 26‐year longitudinal study of Norwegian males, who practiced daily oral home care and received state‐of‐the‐art dental care. The initial examination included 565 individuals. Subsequent examinations took place in 1971, 1973, 1975, 1981, 1988 and 1995. Thus, the study covers the age range of 16–59 years. All tooth sites were divided into four categories according to their history of gingival inflammation over the entire observation period: sites always scoring GI=0, GI=1 and GI=2 sites (GI=gingival index). Sites disclosing various GI scores at different observation periods were not considered.Results:  The mean cumulative attachment loss for non‐inflamed (GI=0) sites in individuals approaching 60 years of age was 1.94 mm. Sites always scoring GI=1 yielded 2.42 mm, and sites that always scored GI=2 exhibited 3.31 mm of periodontal attachment loss. At interproximal sites of all three groups where gingival trauma was assumed to be minimal or non‐existent, only very few sites expressed attachment loss due to gingival recession (2–4%). At interproximal sites always scoring GI=0, 20% loss of attachment was in the form of pocket formation by 59 years of age. The GI=1 and the GI=2 cohorts exhibited attachment loss with pocket formation in 28% and 54%, respectively.Conclusion:  This study has shown that, as men approach 60 years of age, gingival sites that throughout the 26 years of observation bled on probing had approximately 70% more attachment loss than sites that were consistently non‐inflamed (GI=0). Before 40 years of age, there was a slight increase in periodontal attachment loss due to pocket formation, but after this, the frequency increased significantly. Loss of attachment due to gingival recession was very small in all three groups.The fact that sites with non‐inflamed gingiva also exhibited some loss of attachment and pocket formation may be explained by fluctuation in the variations of tissue status during long observation intervals combined with the presence of subclinical inflammation.
Effect of various chlorhexidine regimens on salivary bacteria and de novo plaque formation
Authors: Sekino Satoshi , Ramberg Per , Uzel Naciye Guzin , Socransky Sigmund , Lindhe Jan 
Published: September 2003

AbstractAim: The aim of the present experiment was to study the effect of different chlorhexidine regimens on the number of bacteria in saliva, and on de novo plaque formation.Material and Methods: Ten subjects with gingivitis, but no signs of destructive periodontitis, were recruited. Following a screening examination, the volunteers were given oral hygiene instruction, meticulous scaling and professional mechanical tooth cleaning (PTC). The PTC was repeated once every 3 days during a 2‐week period to establish healthy gingival conditions. The study was designed as a double‐blind cross‐over clinical trial including three phases. Each experimental phase comprised one preparatory period of 7 days and one plaque accumulation period (no oral hygiene measures) of 4 days. During all preparatory periods, the volunteers (i) performed mechanical tooth cleaning using a toothbrush and dentifrice and (ii) were, in addition, given two sessions of PTC. The final PTC was delivered after bacterial sampling had been made on Day 0. Preparatory period A: the participants continued the self‐performed plaque control regimen that employed only mechanical means. Preparatory period B: the participants were in addition instructed to rinse and gargle, twice daily, with a 0.2% chlorhexidine mouthrinse. Preparatory period C: in addition to the above, the participants were instructed to brush the dorsum of the tongue for 60 s, twice daily, with a 1.0% chlorhexidine gel. Following each plaque accumulation period, there was a 10‐day washout interval. The presence and amount of dental plaque (QHI) was scored after 1, 2 and 4 days of no oral hygiene. Samples of saliva were obtained on Day 0 and after 1 and 2 days. The samples were placed on Brucella agar plates and incubated (anaerobically) for 5 days. The total number of colony‐forming units was determined and used to estimate the density of bacteria in saliva.Results: In period A, the mean QHI increased from 1.0 (Day 1) to 1.4 (Day 2) and 2.1 (Day 4). The corresponding scores for periods B and C were 0.5, 0.8, 1.6 and 0.3, 0.8, 1.2, respectively. At all re‐examination intervals more plaque formed during period A than during periods B and C. Further, during period C, less plaque formed than that during period B. Saliva samples from Day 0 in period A contained a larger number of TVC than the baseline samples in periods B and C. There was no significant difference in TVC among the groups on Day 2.Conclusion: The daily use of chlorhexidine as an adjunct to mechanical tooth cleaning markedly reduced the number of microorganisms that could be detected in saliva. The number of salivary bacteria may have influenced the amount of plaque that formed during an early phase of no oral hygiene.
Trauma, Dissociation, and Posttraumatic Stress Disorder in Female Borderline Patients With and Without Substance Abuse Problems
Authors: Van Den Bosch Louisa M. C. , Verheul Roel , Langeland Willie , Van Den Brink Wim 
Published: September 2003

Objective: To examine the associations of childhood traumatic experiences and childhood neglect with dissociative experiences and posttraumatic stress disorder (PTSD) in a population of female borderline personality disorder (BPD) patients with and without substance abuse. Method: The sample included 64 female patients with BPD. Childhood traumatic experiences and childhood neglect were measured using the Structured Trauma Interview, dissociative experiences with the Dissociative Experiences Scale, and PTSD with the Structured Clinical Interview for DSM-IV. Results: In general, dissociation scores were higher among those with a history of childhood trauma and neglect, in particular among those who reported both sexual and physical abuse before age 16, more than one perpetrator and severe maternal dysfunction. The prevalence of PTSD was clearly associated with the severity of childhood sexual abuse (CSA) in terms of the occurrence of penetration during CSA, intrafamilial CSA, a duration of CSA longer than 1 year and more than one perpetrator. Comorbid substance abuse problems modified the observed associations such that the associations mentioned above were also present or even more pronounced among those without substance abuse, whereas no associations were found in those with substance abuse. Conclusions: The results suggest a moderately strong association between childhood trauma and neglect with dissociation and PTSD. However, trauma-dissociation and trauma-PTSD links were only observed among BPD patients without addictive problems. The findings are largely consistent with the literature. Potential explanations for the lack of a trauma-dissociation and trauma-PTSD link in the addicted subgroup are discussed.
Which Anxiety Disorders May Differentiate Attention Deficit Hyperactivity Disorder, Combined Type with Dysthymic Disorder from Attention Deficit Hyperactivity Disorder, Combined Type Alone?
Authors: Vance Alasdair , Harris Katrina , Boots Marilyn , Talbot Jessica , Karamitsios Mary 
Published: September 2003

Objective: Attention deficit hyperactivity disorder, combined type (ADHD-CT), dysthymic disorder, and anxiety disorders frequently co-occur in primary school age children, although there have been no published data describing their association. We investigated the association of anxiety, defined from a parent or child perspective, with primary school-age children with ADHD-CT with and without dysthymic disorder. Method: One hundred and forty-six medication naïve children with ADHD-CT were studied. Two groups with and without dysthymic disorder were formed to compare parent and child reports of anxiety, using categorical and continuous measures of anxiety, using logistic regression. Results: Separation anxiety disorder and social phobia were associated with primary school-age children with ADHD-CT and dysthymic disorder, compared to children with ADHD-CT without dysthymic disorder. Conclusions: The recognition of dysthymic disorder and anxiety disorders and their management in primary school-age children with ADHD-CT is generally poorly understood. The identification and elucidation of composite anxiety and depressive phenomena that may be systematically investigated through longitudinal studies of epidemiologically derived samples is needed in this particular group of children.
A Population-Based Study of Help-Seeking for Self-Harm in Young Adults
Authors: Nada-Raja Shyamala , Morrison Dianne , Skegg Keren 
Published: September 2003

Objective: To examine help-seeking for self-harm in a population-based sample of young adults. Method: Nine hundred and sixty-five participants aged 26 years were interviewed about help-seeking and barriers to help-seeking for a range of self-harmful behaviours. Self-harm included the traditional methods of suicide (ICD-9 self-harm) and other self-harmful behaviours such as self-battery and self-biting. Results: Just over half of the 25 in the ICD-self-harm group (based on ICD-9 self-harm criteria) and one-fifth of the 119 in the other self-harmful behaviour group had sought professional help. Counsellors, psychologists, and general practitioners were the commonest sources of help. Most participants rated help received from health services favourably, however, emergency services were rated less favourably than other health services. Among 77 self-harm participants who did not seek help, just over one-third reported attitudinal barriers. Conclusions: To encourage help-seeking by young adults who self-harm, especially young men who are at high risk for self-harm and suicide, it may be necessary to identify ways to reduce attitudinal barriers.
Clinical and Parenting Skills Outcomes Following Joint Mother–Baby Psychiatric Admission
Authors: Salmon Margaret , Abel Kathryn , Cordingley Lis , Friedman Trevor , Appleby Louis 
Published: September 2003

Objective: To examine maternal clinical and parenting outcomes as a function of diagnosis following joint mother–baby admission; to identify the associations of poor outcome. Method: Demographic and clinical information was collected on 1081 joint mother–baby admissions, including 224 women with schizophrenia, 155 with bipolar disorder and 409 with non-psychotic depression. Information was based on clinical judgements of senior staff in participating units using the Marcé checklist. Predictors of poor maternal clinical outcome, practical problems in baby care, poor emotional responsiveness to infant and perceived risk of harm to baby were identified by logistic regression. Results: Good clinical outcome was reported in 848 (78%) cases. On each parenting outcome, good outcome was reported in at least 80%. The predictors of poor outcome were similar for all four outcomes. These were a diagnosis of schizophrenia, behavioural disturbance, low social class and either psychiatric illness in the woman's partner or a poor relationship with the partner. Of those with poor outcome on all four variables, 66% suffered with schizophrenia. Women with schizophrenia showed more behavioural disturbance, were more likely to experience hallucinations and delusions, and were more likely to be of low social class. They were also less likely to have a partner and more likely to have a partner with a psychiatric illness. Conclusions: Clinical and parenting outcomes, as reported by clinical staff, are usually good following joint mother–baby admission. Women with schizophrenia may need particular measures to improve their parenting. A marital approach to treatment, directed at the woman's relationship with her partner or the latter's own mental health may improve outcome.
An audit of antiretroviral treatment use in HIV‐infected patients in a London clinic: the limitations of observational databases when auditing antiretroviral treatment use
Authors: Sabin CA , Lampe FC , Chaloner C , Madge SJ , Lipman MCI , Youle M , Phillips AN , Johnson MA 
Published: September 2003

ObjectiveTo audit the use of antiretroviral (ARV) treatment in a large treatment clinic in the UK against the British HIV Association (BHIVA) ARV treatment guidelines.MethodsAll patients under follow‐up between 1st January 2000 and 1st January 2001 were included. The most recent CD4 count and HIV RNA level prior to 1st January 2001, and the nadir CD4 count and peak HIV RNA level over follow‐up, were used to identify which patients should be receiving HAART according to the guidelines.ResultsOne thousand two hundred and sixty‐four patients were included in the analysis (63.8% homosexual, 29.0% heterosexual risk; 72.9% white; 79.2% male). Almost half of patients had ever had a CD4 count below 200 cells/µL and over 80% had previously had a viral load above 4 log10 HIV‐1 RNA copies/mL. Under 2000 BHIVA guidelines, treatment would be recommended in 77.4% patients. Overall, 819 patients were receiving ARV therapy. Two hundred and eighty‐five patients were not receiving treatment when guidelines suggest they should (including 33 patients who were receiving regimens not recommended in the guidelines). These patients were younger, less likely to be homosexual and had higher CD4 nadirs than those who were receiving ARV treatment. Almost half of these patients had previously received ARV therapy but were not currently receiving it.ConclusionOnly a small proportion of patients at our centre were not receiving ARV treatment in line with national guidelines. While genuine reasons may exist for these departures from optimal care, this may simply reflect the limitations of using observational databases when auditing treatment use in a clinic setting.
Determinants of adherence to highly active antiretroviral therapy (HAART) in Chinese HIV/AIDS patients
Authors: Fong OW , Ho CF , Fung LY , Lee FK , Tse WH , Yuen CY , Sin KP , Wong KH 
Published: September 2003

ObjectiveDrug adherence is crucial to the success of highly active antiretroviral therapy (HAART) in the treatment of HIV disease. Adherence to HAART and its determinants may, however, differ across HIV/AIDS populations.MethodsWe retrospectively studied drug adherence by self‐report in HIV‐1 infected Chinese patients who have been on HAART for at least 1 year as at the end of year 2000. HAART is defined as three or more antiretrovirals with at least one protease inhibitor or non‐nucleoside analogue reverse transcriptase inhibitor.ResultsThe last drug adherence level assessed by self‐report in 161 Chinese patients were: grade A (100%) – 130, 80.7%; grade B (95–99%) – 25, 15.5%; grade C (90–94%) – three, 1.9% and grade D (< 90%) – three, 1.9%. Patients with full adherence were more likely to have undetectable (< 500 copies/mL) plasma virus level (adjusted OR, 4.22; 95% CI, 1.75–12.33). Patients' demographics, HIV disease status and antiretroviral regimen did not affect adherence. Partial drug adherence was, however, independently associated with the psychosocial factors of missing clinic appointments (adjusted OR, 3.13; 95% CI, 1.23–8.33), forgetfulness (adjusted OR, 4.55; 95% CI, 1.64–12.5) and a busy work life (adjusted OR, 6.67; 95% CI, 1.75–25).ConclusionThere were similarities and differences in determinants affecting HAART adherence in Chinese compared with other patients. Psychosocial factors rather than HIV disease or treatment were more important factors in our Chinese patients. The relevance of patient populations and care setting for adherence to HAART shall be further studied.
Prevalence and Correlates of Recognized Depression in U.S. Nursing Homes
Authors: Jones Richard N. , Marcantonio Edward R. , Rabinowitz Terry 
Published: September 2003

Objectives: To provide descriptive epidemiological information on identified depression in nursing home residents.Design: Survey of the 1996 Medical Expenditure Panel Survey—Nursing Home Component (MEPS‐NHC).Setting: Nine hundred fifty‐one nursing facilities.Participants: Three thousand seven hundred ten noncomatose residents.Measurements: Demographic characteristics and health care and functional data were collected using key informant interview and medical‐record review. Depression diagnoses were derived from Minimum Data Set (MDS) diagnoses and are nonspecific with regard to formal diagnostic criteria.Results: The prevalence of identified depression was 20.3 cases per 100 residents (95% confidence interval=18.9–21.7). Younger age, female sex, marital status other than never married, white non‐Hispanic ethnicity, better cognitive functioning, heart disease, Parkinson's disease, and length of stay between 1 and 2 years were significantly and independently associated with a greater prevalence of identified depression.Conclusion: The prevalence of identified depression in the MEPS‐NHC is lower than that previously estimated using formal diagnostic assessment techniques for threshold and subthreshold depressive states combined. Therefore, MDS‐identified depression may underestimate the burden of depression. Underrecognition may be particularly acute in black or African‐American residents, the oldest old, and the cognitively impaired. Further research on the relationship of MDS‐identified depression and depression identified through structured diagnostic interviews in broadly representative samples of nursing home residents is needed to expand the availability of descriptive epidemiological data, to help clarify the results of research making use of MDS data, and to suggest methods for optimizing clinical and administrative data systems.
The Effect of Evercare on Hospital Use
Authors: Kane Robert L. , Keckhafer Gail , Flood Shannon , Bershadsky Boris , Siadaty Mir Said 
Published: September 2003

Objectives: To examine the use of hospital and related medical care services of a novel managed care program using nurse practitioners (NPs) and directed specifically at long‐stay nursing home residents.Design: Quasi‐experimental posttest design with two control groups to minimize selection bias.Setting: Nursing homes.Participants: Evercare enrollees in five sites were compared with two sets of controls: nursing home residents in the same nursing homes who did not enroll in Evercare (control‐in) and residents of nursing homes that did not participate in Evercare (control‐out).Measurements: Utilization data from Medicare and United Healthcare (the parent corporation for Evercare) were obtained for slightly more than 2 years. Patterns of use were assessed by calculating the monthly use rate for each group and aggregating to form annual rates. Usages addressed included hospital admissions and days, emergency room visits, therapy services, mental health services, and podiatry. Adjustments were made to correct for age, race, and sex. Because the groups differed in terms of the rate of cognitive impairment, the analysis was stratified on this variable.Results: The incidence of hospitalizations was twice as high in control residents as in Evercare residents (4.63 and 4.67 per 100 enrollees per month vs 2.43 in the 15 months after census, P<.001). This difference corresponded to Evercare's use of intensive service days. The same pattern held for preventable hospitalizations (0.80 and 0.86 vs 0.28, P<.001). The pattern held when residents were stratified by cognitive status. On average, using a NP is estimated to save about $103,000 a year in hospital costs per NP.Conclusion: The use of active primary care provided by NPs may have prevented the occurrence of some hospitalizable events, but its major effect was allowing cases to be managed more cost‐effectively.
The Mini‐Cog as a Screen for Dementia: Validation in a Population‐Based Sample
Authors: Borson Soo , Scanlan James M. , Chen Peijun , Ganguli Mary 
Published: September 2003

Objectives: To test the Mini‐Cog, a brief cognitive screening test, in an epidemiological study of dementia in older Americans.Design: A population‐based post hoc examination of the sensitivity and specificity of the Mini‐Cog for detecting dementia in an existing data set.Setting: The Monongahela Valley in Western Pennsylvania.Participants: A random sample of 1,119 older adults enrolled in the Monongahela Valley Independent Elders Survey (MoVIES).Measurements: The effectiveness of the Mini‐Cog in detecting independently diagnosed dementia was compared with that of the Mini‐Mental State Examination (MMSE) and a standardized neuropsychological battery.Results: The Mini‐Cog, scored by an algorithm as “possibly impaired” or “probably normal,” and the MMSE, at a cutpoint of 25, had similar sensitivity (76% vs 79%) and specificity (89% vs 88%) for dementia, comparable with that achieved using a conventional neuropsychological battery (75% sensitivity, 90% specificity).Conclusion: When applied post hoc to an existing population, the Mini‐Cog was as effective in detecting dementia as longer screening and assessment instruments. Its brevity is a distinct advantage when the goal is to improve identification of older adults in a population who may be cognitively impaired. Prior evidence of good performance in a multiethnic community‐based sample further supports its validity in the ethnolinguistically diverse populations of the United States in which widely used cognitive screens often fail.
Mutation Rate and Evolution of Fluoroquinolone Resistance in
Escherichia coli
Isolates from Patients with Urinary Tract Infections
Authors: Komp Lindgren Patricia , Karlsson Åsa , Hughes Diarmaid 
Published: September 2003

ABSTRACT

Escherichia coli
strains from patients with uncomplicated urinary tract infections were examined by DNA sequencing for fluoroquinolone resistance-associated mutations in six genes:
gyrA
,
gyrB
,
parC
,
parE
,
marOR
, and
acrR
. The 54 strains analyzed had a susceptibility range distributed across 15 dilutions of the fluoroquinolone MICs. There was a correlation between the fluoroquinolone MIC and the number of resistance mutations that a strain carried, with resistant strains having mutations in two to five of these genes. Most resistant strains carried two mutations in
gyrA
and one mutation in
parC
. In addition, many resistant strains had mutations in
parE
,
marOR
, and/or
acrR
. No (resistance) mutation was found in
gyrB
. Thus, the evolution of fluoroquinolone resistance involves the accumulation of multiple mutations in several genes. The spontaneous mutation rate in these clinical strains varied by 2 orders of magnitude. A high mutation rate correlated strongly with a clinical resistance phenotype. This correlation suggests that an increased general mutation rate may play a significant role in the development of high-level resistance to fluoroquinolones by increasing the rate of accumulation of rare new mutations.