Genetic variation in the promoter region of the beta2 bradykinin receptor gene is associated with essential hypertension in a Chinese Han population.
The present study examined whether a genetic variant (-58T/C) in the promoter region of the human beta2 bradykinin receptor gene was genetically involved in essential hypertension. Chinese hypertensive subjects (n = 120) and normotensive controls (n = 98; sex- and age-matched with hypertensives) were recruited from the outpatients of Fu Wai hospital. Distribution of the -58T/C polymorphism was determined in patients and controls by means of PCR, SSCP, cloning and sequencing. The allelic frequencies were 0.56 for the C allele and 0.44 for the T allele in hypertensive subjects, and 0.46 for the C allele and 0.54 for the T allele in normotensive subjects. The allelic frequencies were in Hardy-Weinberg equilibrium. Significant differences between hypertensive and normotensive subjects were seen in the genotypes distribution (p = 0.045) and allelic frequencies (p = 0.033). These results suggested that -58C allele of the human beta2 bradykinin receptor gene may be an independent risk factor for essential hypertension in the Chinese Han population.


Effects of the Chinese medicine Jiang-Tang-Ke-Li on insulin resistance in fructose-fed rats.
The aim of this study was to determine the effect of Jiang-Tang-Ke-Li (JTKL), a Chinese medicine used to treat diabetes mellitus, on insulin resistance and hypertension in fructose-fed rats (FFR). Six-week-old male Sprague-Dawley rats were fed either normal rat chow (control) or a fructose-rich chow (FFR) for 6 weeks. For the last 2 weeks of the 6-week period of either diet, the rats were treated by gavage with gum arabic solution as a vehicle (control or FFR) or JTKL (3.24 g/kg/day; FFR+JT), and then an euglycemic hyperinsulinemic glucose clamp technique was performed to estimate insulin sensitivity. Systolic blood pressure was measured each week of the 6-week period. At the end of the glucose clamp, the soleus and extensor digitorum longus (EDL) muscles were dissected out for determination of the role of tumor necrosis factor (TNF)-alpha by an ELISA assay. Systolic blood pressures in the FFR groups were significantly higher than that in the control group, although there was no effect on systolic blood pressure for the last 2 weeks of treatment with JTKL. The average rate of glucose infusion during the glucose clamp, as an index of insulin sensitivity (M value), was significantly lower in the FFR than in the control rats, and treatment with JTKL for 2 weeks significantly increased the M value to that of control. TNF-alpha levels were significantly higher in the soleus and EDL muscles of the FFR (480+/-46 and 570+/-45 pg/g wet tissue in the soleus and EDL muscles, respectively) than in those of the control rats (177+/-34 and 206+/-33 pg/g wet tissue in the soleus and EDL muscles, respectively; p<0.01). Treatment with JTKL for 2 weeks significantly lowered TNF-alpha levels to the control levels (189+/-22 and 239+/-92 pg/g wet tissue in the soleus and EDL muscles, respectively). The results suggest that the Chinese medicine JTKL improves insulin resistance and modulates TNF-alpha in the soleus and EDL muscles in hypertensive and insulin-resistant fructose-fed rats.


Effect of long-acting isosorbide-5-mononitrate administration on large artery distensibility in patients with essential hypertension.
To evaluate the clinical efficacy of long-acting nitrates, isosorbide-5-mononitrate (IS-5-MN), on large artery distensibility in patients with essential hypertension. Large arterial distensibility was assessed by automatic noninvasive measurement of the carotid-femoral pulse wave velocity (PWV). Seventeen patients aged 62.53+/-7.94 years (mean+/-SD) with essential hypertension undering long-term antihypertensive therapy were studied in this trial. PWV was measured 2 weeks and 4 weeks after oral administration of IS-5-MN (30 mg once daily) with previous therapy. There was no significant difference in systolic blood pressure, diastolic blood pressure, pulse pressure or heart rate at 2 weeks and 4 weeks after treatment compared with baseline. The carotid-femoral PWV decreased significantly at 2 and 4 weeks after treatment (p<0.05, p< 0.05, respectively). Long-acting nitrates have potential value in improving large arterial distensibility in patients with essential hypertension independent of blood pressure alteration. It might be used as an effectively additive drug in hypertension control.


Ethnic and environmental differences in various markers of dietary intake and blood pressure among Chinese Han and three other minority peoples of China: results from the WHO Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study.
Our aim was to examine differences in dietary intake and blood pressure (BP) and their associations in four different ethnic Chinese populations, the Han, the Uygur, the Kazak and Tibetan subjects. This study used a sub-database of the Chinese sample of the WHO-Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study. The WHO-CARDIAC Study was a multicenter cross-sectional study. In each center, 100 men and 100 women aged 48-56 years were selected at random from the local population. Various markers of dietary intake and their relation with BP were studied. The results of the present study indicated the following. 1) There were significant differences in mean BP and prevalence rates of hypertension, with both being higher in the Kazak and Tibetan subjects than in Han and Uygur subjects. 2) The highest mean body mass index (BMI) was observed in the Kazak subjects, while the highest 24-h urinary sodium (Na) and sodium to potassium (Na/K) ratio excretion were observed in the Tibetan subjects. There were also significant differences in other factors, such as magnesium, 3-methylhistidine (3MH) (a biological marker of animal protein intake) and taurine (a biological marker of seafood intake) excretion levels among the four ethnic peoples. 3) In general, BMI, Na and/or Na/K ratios were positively, and 3MH/creatinine and taurine/creatinine ratios were negatively associated with BP. 4) After adjustment for age, sex and potassium, subjects with obesity (BMI > or =26 kg/m2) had significantly higher relative risk of being hypertensive (HT) than those with BMI<26 kg/m2 in the Han, Uygur and Kazak populations; and subjects with elevated sodium excretion (Na > or =244 mmol/day) had significantly higher relative risk of being HT than those with Na<244 mmol/day in the Han, Uygur and Tibetan populations. In conclusion, mean BP and prevalence rates of hypertension were significantly different among the four ethnic groups. These differences are likely to be due, at least in part, to the differences in several diet-related factors, which in turn are associated with culture and environmental differences. Different health promotion strategies might thus be emphasized in different populations.


An angiotensin II type 1 receptor blocker, candesartan, increases myocardial apoptosis in rats with acute ischemia-reperfusion.
Angiotensin II (Ang II) and apoptosis contribute significantly to myocardial ischemia-reperfusion (I-R) injury. Evidence indicates that Ang II may activate apoptosis in myocytes. The present study was undertaken to investigate the effects of angiotensin receptor blockers (ARBs), candesartan, on the apoptosis of cardiac myocytes in rats after I-R. Rats were divided into a control group, a candesartan group I (0.015 mg/kg), and a candesartan group II (0.03 mg/kg). Candesartan was intravenously administered 30 min before ischemia. All rats were subjected to 30 min of coronary occlusion followed by 3 h of reperfusion. The data showed that left ventricular (LV) systolic pressure and LV +dp/dt was decreased after administration of candesartan, but increased after reperfusion in the candesartan group II, compared with those in the candesartan group I and control group. LV -dp/dt was decreased after candesartan administration in candesartan group II. The number of apoptotic cells in the candesartan groups (497+/-204 and 543+/-254, respectively) was higher than that in the control group (287+/-166; p<0.05). There was no significant difference in infarct size among the three groups. However, plasma CPK was lower in the candesartan groups than in the control group. Northern blot analysis showed that p53 mRNA was upregulated in the candesartan groups, in association with increased expression of bax mRNA. Immunohistochemical analysis showed that p53 and bax immunoreactivity were increased in both of the candesartan groups. In conclusion, candesartan increased apoptosis in the rat hearts after acute I-R, and this increase was possibly mediated by upregulation of p53 and bax gene expressions. In addition, candesartan was shown to improve LV function, in association with reduction of CPK release.


Identification of case complexity and increased health care utilization in patients with rheumatoid arthritis.
To document biopsychosocial profiles of patients with rheumatoid arthritis (RA) by means of the INTERMED and to correlate the results with conventional methods of disease assessment and health care utilization. Patients with RA (n = 75) were evaluated with the INTERMED, an instrument for assessing case complexity and care needs. Based on their INTERMED scores, patients were compared with regard to severity of illness, functional status, and health care utilization. In cluster analysis, a 2-cluster solution emerged, with about half of the patients characterized as complex. Complex patients scoring especially high in the psychosocial domain of the INTERMED were disabled significantly more often and took more psychotropic drugs. Although the 2 patient groups did not differ in severity of illness and functional status, complex patients rated their illness as more severe on subjective measures and on most items of the Medical Outcomes Study Short Form 36. Complex patients showed increased health care utilization despite a similar biologic profile. The INTERMED identified complex patients with increased health care utilization, provided meaningful and comprehensive patient information, and proved to be easy to implement and advantageous compared with conventional methods of disease assessment. Intervention studies will have to demonstrate whether management strategies based on INTERMED profiles can improve treatment response and outcome of complex patients.


Use of alternative therapies by older adults with osteoarthritis.
To examine the rates of use and expenditures on alternative therapies by adults with osteoarthritis (OA). Adults with OA recruited from the community to participate in a randomized clinical trial recorded alternative and traditional health care use on postcard diaries. General and arthritis-specific quality of life was assessed by questionnaires. More than 47% of participants reported using at least one type of alternative care during the 20-week intervention period. Among alternative care consumers, the most commonly used treatments were massage therapy (57%), chiropractic services (20.7%), and nonprescribed alternative medications (17.2%). Four percent of subjects reported using only alternative care during the study period. Expenditures for alternative therapy averaged $1,127 per year, compared with $1,148 for traditional therapies. Use of and expenditures for alternative care were high among this cohort of older adults with OA. Clinicians may want to inquire about use of these therapies before recommending treatments for this condition.


Primary care-based physical activity programs: effectiveness in sedentary older patients with osteoarthritis symptoms.
This study examined, in a group of older patients, (a) the effectiveness of an invitation to participate in a program providing individualized physical activity advice in a primary care setting and (b) the changes in self-reported physical activity and symptoms in patients with osteoarthritis (OA). Healthy, sedentary community-dwelling men and women aged 60 years or more were invited to participate. Following random allocation, the intervention group received individualized physical activity advice at baseline and at 3, 6, and 12 months followup. Of the 299 people who satisfied the study's inclusion criteria, a subgroup of 69 people reported pain and stiffness of the hip or knee at baseline. These patients reported increases in frequency and time of walking and vigorous exercise (all P < 0.001), with no change to OA symptom scores (pain and stiffness), and a small decline in physical functioning was reported at 12 months followup in the control group only (P = 0.027). At the 12-month followup more intervention participants than control participants (P = 0.013) reported a greater intention to exercise. An offer of primary care-based physical activity advice, with an emphasis on the benefits for general health (rather than "treatment" for OA), will attract individuals with OA symptoms. Although the present study was unable to demonstrate intervention-control group differences for the majority of outcomes, intention to exercise did appear to be positively influenced.


Tendon disorders attributed to fluoroquinolones: a study on 42 spontaneous reports in the period 1988 to 1998.
Fluoroquinolone antibiotics have been associated with tendinitis and tendon rupture. In this paper we report on the followup of 42 spontaneous reports of fluoroquinolone-associated tendon disorders. This study is based on cases of fluoroquinolone-associated tendon disorders reported to the Netherlands Pharmacovigilance Foundation Lareb and the Drug Safety Unit of the Inspectorate for Health Care between January 1, 1988, and January 1, 1998. By means of a mailed questionnaire, we collected information on the site of injury, onset of symptoms, treatment, and course of the tendon disorder as well as information on possible risk factors and concomitant medication. Of 50 mailed questionnaires, 42 (84%) were returned. The data concerned 32 patients (76%) with tendinitis and 10 patients (24%) with a tendon rupture. Sixteen cases (38%) were attributed to ofloxacin, 13 (31%) to ciprofloxacin, 8 (19%) to norfloxacin, and 5 (12%) to pefloxacin. There was a male predominance, and the median age of the patients was 68 years. Most of the reports concerned the Achilles tendon, and 24 patients (57%) had bilateral tendinitis. The latency period between the start of treatment and the appearance of the first symptoms ranged from 1 to 510 days with a median of 6 days. Most patients recovered within 2 months after cessation of therapy, but 26% had not yet recovered at followup. These reports suggest that fluoroquinolone-associated tendon disorders are more common in patients over 60 years of age. Ofloxacin was implicated most frequently relative to the number of filled prescriptions in the Netherlands.


The effectiveness and toxicity of cyclosporin A in rheumatoid arthritis: longitudinal analysis of a population-based registry.
To determine factors associated with response or toxicity to cyclosporin A (CSA) in a population-based inception cohort with rheumatoid arthritis (RA). Prospectively collected longitudinal measures including tender joint count (JC), duration of morning stiffness (MS), systolic and diastolic blood pressure (SBP, DBP), and serum creatinine (SCr) were modeled using generalized estimating equations. Survival methods were used to estimate CSA continuation time and its determinants. Of 133 patients (75% female, median RA duration 13 years), 37 discontinued CSA because of ineffectiveness (19) or because of toxicity (18) including increased SCr in 10, hypertension in 4, infections in 3, and gingival hyperplasia in 1. Patients remained on CSA a median of 75 months (95% confidence interval [CI] 38-112). Those receiving concomitant methotrexate (MTX) were more than 4 times as likely to continue on CSA therapy (hazard ratio 0.22, 95% CI 0.10-0.94). A lower final JC was predicted by a longer CSA treatment duration (relative risk [RR] 0.99 per month, 95% CI 0.98-0.99) and concomitant MTX therapy (RR 0.79, 95% CI 0.63-0.99); decreased MS was predicted only by longer CSA treatment duration (reduction of 2.0 minutes per month, 95% CI 1.1-3.0). Each previous disease-modifying antirheumatic drug (DMARD) exposure predicted a rise in SCr (35 micromole/liter, 95% CI 22-48), SBP (7.2 mm Hg, 95% CI 2.7-11.7), and DBP (3.8 mm Hg, 95% CI 3.0-6.4). Combination CSA/MTX prolongs therapy and reduces JC. Long-term CSA treatment was fairly well tolerated. Previous DMARD use appears to be a determinant for the development of toxicity.


Testing the effectiveness of an osteoporosis educational program for nursing students in Thailand.
Osteoporosis, a health problem that is on the rise, has received considerable attention among the health care community and the public. The majority of primary prevention programs for osteoporosis have been focused on women in mid-life. A concern is that young women may not be aware of osteoporosis risk factors and therefore may not be engaging in preventive behaviors. The purpose of this study was to test the effectiveness of an osteoporosis educational program for young women. A sample of 100 female undergraduate students who were enrolled in the first year of a nursing program in Thailand were randomly assigned to a control group or an experimental group. Participants in the experimental group participated in a 3-hour osteoporosis educational program (OEP). At entry to and exit from the study, all participants completed the Osteoporosis Knowledge Test, the Osteoporosis Health Belief Scale, and the Osteoporosis Self-Efficacy Scale. The experimental group had higher change scores for knowledge, health belief, and self-efficacy than the control group. The OEP increased knowledge of osteoporosis in these young women. These findings indicate the need for further health education concerning the importance of dietary calcium and exercise on osteoporosis prevention in young women.


Differential efficacy of tumor necrosis factor inhibition in the management of inflammatory eye disease and associated rheumatic disease.
To evaluate the clinical usefulness of tumor necrosis factor (TNF) inhibitors in patients with inflammatory eye disease that is resistant to conventional immunosuppressive therapies. Sixteen patients (4 males and 12 females aged 7 to 78 years) who received etanercept (n = 14) or infliximab (n = 2) for either inflammatory eye disease or associated joint disease were studied retrospectively to determine the effect of these medications on their ocular inflammation. Nine cases of uveitis and 7 cases of scleritis were treated. Systemic diagnoses included rheumatoid arthritis (n = 8), juvenile rheumatoid arthritis (n = 3), ankylosing spondylitis (n = 1), and psoriatic spondylarthropathy (n = 1). Three patients had uveitis without associated systemic disease. Although 12 of 12 patients with active articular inflammation (100%) experienced improvement in joint disease, only 6 of 16 with ocular inflammation (38%) experienced improvement in eye disease. Five patients developed inflammatory eye disease for the first time while taking a TNF inhibitor. No patient discontinued treatment because of adverse drug effects. TNF inhibitors are well tolerated immunosuppressive medications that may benefit certain subgroups of patients with inflammatory eye disease, but they appear to be more effective in controlling associated inflammatory arthritis.


Comparative responsiveness of measures of pain and function after total hip replacement.
To compare the responsiveness of the Functional Assessment System (FAS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Medical Outcomes Study 36-item Short Form (SF-36) in patients with osteoarthritis (OA) scheduled for total hip replacement. Twenty patients with a mean age at surgery of 72.6 years, with primary OA of the hip, were investigated preoperatively and at 3, 6, and 12 months postoperatively with the FAS, WOMAC, and SF-36. The responsiveness was calculated as standardized response mean, effect size, and relative efficiency. The pain and function scores of WOMAC and SF-36 showed greater responsiveness than FAS at 3 months. These differences remained at 6 and 12 months postoperatively. The differences between these 3 outcome measures were found to be similar using several methods for calculating responsiveness. Self-administered questionnaires like WOMAC and SF-36 are more responsive measures of pain and function than range of motion, performance tests, and observer-administered questions (FAS) following total hip replacement.


Does satisfaction with abilities mediate the relationship between the impact of rheumatoid arthritis on valued activities and depressive symptoms?
Both impact of rheumatoid arthritis (RA) on valued life activities and dissatisfaction with abilities have been linked to depression among individuals with RA. We integrated these concepts by examining the hypothesis that satisfaction with one's abilities may explain the mechanism by which the impact of RA on valued activities leads to depression. Data were collected over 2 years (1997 and 1998) through interviews with the University of California, San Francisco, RA panel. Analyses examined whether activity impairment in 1997 predicted later (1998) dissatisfaction with abilities and depression. Greater impact on activities predicted dissatisfaction with abilities, which in turn was associated with higher depression scores. There was no direct relationship between activity impact and depression when satisfaction with abilities was considered. Satisfaction with abilities mediated the relationship between the impact of RA on valued activities and an increase in depressive symptoms, suggesting a need to assess not only physical decline but also individuals' interpretation of the decline.


"Are you better?" A qualitative study of the meaning of recovery.
Research into the meaning of illness has often focused on an individual's transition into a state of being ill, for example the adoption of a sick role. The question "Are you better?" addresses the transition out of this state and is fundamental to the patient-clinician relationship, guiding decisions about treatment. However, the question assumes that all patients have the same meaning for "being better." The purpose of this study was to explore the meaning of the concept of recovery (getting better) in a group of people with upper limb musculoskeletal disorders. Qualitative (grounded theory) methods were used. Individual interviews were conducted with 24 workers with work-related musculoskeletal disorders of the upper limb. The audiotaped interviews were transcribed and coded for content. Categories were linked, comparisons made, and a theory built about how people respond to the question "Are you better?" The perception of "being better" is highly contextualized in the experience of the individual. Being better is not only reflected in changes in the state of the disorder (resolution) but could be an adjustment of life to work around the disorder (readjustment) or an adaptation to living with the disorder (redefinition). The experience of the disorder can be influenced by factors such as the perceived legitimacy of the disorder, the comparators used to define health and illness, and coping styles, which in turn can influence being better. Two patients could mean very different things when saying that they are better. Some may not actually have a change in disease state as measured by symptoms, impairments, or function.


Rheumatology outpatient nurse clinics: a valuable addition?
"Transmural rheumatology nurse clinics," where nursing care is provided under the joint responsibility of a home care organization and a hospital, were recently introduced into Dutch health care. This article gives insight into outcomes of the transmural rheumatology nurse clinics. Patients with rheumatologic conditions who attended a transmural nurse clinic, in addition to receiving regular care, were compared with patients with rheumatologic conditions who received regular care only. The main outcome measures were the need for rheumatology-related information, the use of aids and adaptations, the use of health care services, and daily functioning. Attending a transmural nurse clinic does not influence patients' need for information, the application of practical aids and adaptations, or daily functioning. However, attending a transmural nurse clinic does result in more contacts with rheumatologists and occupational therapists. Attending transmural nurse clinics does not result in major differences in outcomes compared with regular care. Further studies are needed to appreciate the long-term effects of transmural nurse clinics.


Walking velocity in aged persons: its association with lower extremity joint range of motion.
To measure the association between walking velocity and hip and knee flexion range, ethnic background, anthropometrics, comorbid pathologies, and coimpairments, in a sample of community-dwelling aged persons. To reach our objective, we used data from the San Antonio Longitudinal Study of Aging (SALSA), a population-based cohort of Mexican American and European American persons aged 64 to 79. By fitting hierarchical regression models, we measured the variance in the walking velocity over 50 feet explained by hip and knee flexion range, adjusting for the combined influence of demographic and anthropometric variables, coexistent pathologic conditions, impairments, and the examiners who conducted the assessments. The average walking velocity among the 702 subjects for whom data were available was 73.6 meters per minute (range 20 to 121). Bivariate analyses revealed significant associations between walking velocity and age, sex, ethnic background, height, weight, presence of arthritis, diabetes mellitus, stroke, upper leg pain, peripheral vascular disease, left ventricular hypertrophy, and forced expiratory volume at 1 second. The correlation (r) between walking velocity and flexion range of the hip and knee were 0.40 and 0.35, respectively (P < or = 0.001 for each). Multivariate hierarchical models adjusting for demographic and anthropometric characteristics of the subjects, and examiner variation, revealed that hip and knee flexion range explained 6% of the variance in walking velocity. Adjusting for the presence of comorbid conditions and coimpairments reduced the variance attributable to hip and knee flexion range only slightly, to 5%. Hip and knee flexion range contribute significantly to walking velocity in the SALSA cohort of community-dwelling aged persons.


Pre-appointment management of new patient referrals in rheumatology: a key strategy for improving health care delivery.
To analyze the impact of a rheumatologist reviewing each newly referred patient's medical records prior to scheduling an appointment (pre-appointment management). All 279 new patients who were referred in the 6 months after initiating pre-appointment management were studied. The authors reviewed systemwide patient records, appointment intake information, visit schedules, physician comments, and patient complaint data. Only 59% of referred patients required a rheumatology consultation for appropriate care. Some problems were rapidly resolved without consultation. In some cases, other specialty consultation or continuing prior care was considered to be more appropriate. The latter alternative did not compromise these patients' outcomes. Practice access and efficiency were improved. Profitability was maintained. Referring physicians and patients were generally accepting and cooperative. New patient pre-appointment management should be a key strategy for reducing health care costs, addressing personnel shortage, and improving access to and coordination of rheumatic disease care.


Living with osteoarthritis: patient expenditures, health status, and social impact.
To determine "out-of-pocket" expenditures related to osteoarthritis (OA) and to explore whether demographic details, health status scores (Medical Outcomes Study 36-item Short Form [SF-36] and Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC]), or perception of social effect were expenditure determinants. A prospective cohort study of community-dwelling subjects with OA completed 4 consecutive 3-month cost diaries. In addition, subjects completed the SF-36 and WOMAC at baseline and at 12 months. Social impact at baseline was collected. Four groups categorized by age and sex were compared. Patients undergoing joint replacement were excluded. Differences in health status were defined more by age than by sex, especially for physical function. The costs to the patients were high, particularly for women, who spent more on medications and special equipment. Women also reported receiving more assistance from family and friends. Higher disease-related expenditures were associated with greater pain levels, poorer social function and mental health, and longer duration of disease. Significant independent predictors of total patient expenditures related to OA were being female and having joint stiffness. Despite having heavily subsidized health care and access to the Pharmaceutical Benefits Scheme, out-of-pocket costs for patients with OA in Australia are considerable. Higher expenditures for patients with OA are related to more advanced disease, especially for women.


Oral health promotion evaluation--time for development.
Increasing emphasis is now being placed upon the evaluation of health service interventions to demonstrate their effects. A series of effectiveness reviews of the oral health education and promotion literature has demonstrated that many of these interventions are poorly and inadequately evaluated. It is therefore difficult to determine the effectiveness of many interventions. Based upon developments from the field of health promotion research this paper explores options for improving the quality of oral health promotion evaluation. It is essential that the methods and measures used in the evaluation of oral health promotion are appropriate to the intervention. For many oral health promotion interventions clinical measures and methods of evaluation may not be appropriate. This paper outlines an evaluation framework which can be used to assess the range of effects of oral health promotion programmes. Improving the quality of oral health promotion evaluation is a shared responsibility between researchers and those involved in the provision of programmes. The provision of adequate resources and training are essential requirements for this to be successfully achieved.


Social inequality in oral health and use of dental care in Sweden.
To describe oral health and use of dental care in relation to socio-economic determinants over time in Sweden. Cross-sectional study based on interview data on two randomly sampled sequential populations consisting of 7,610 Swedish adult (25-64 years) residents and 4,315 children (3-15 years) in their households from the Survey of Living Conditions 1996-97, and 7,649 adult Swedish residents (25-64 years) from the survey of 1988-89. Low educational level, having no cash margin and being born outside of Sweden was associated with higher odds of problems with chewing, wearing a prosthesis and not having been treated by a dentist during the 24 months preceding the interview, in a logistic regression analysis of data from the 1996-97 survey in the adult study population (adjusted odds ratios 1.6-2.9). The same socio-economic determinants were associated with caries in children (adjusted odds ratios 1.2-1.5). The socio-economic differences in dental treatment and problems with chewing were greater in the age group 45-64 years compared to 25-44-year-olds. The prevalence of problems with chewing increased from 7.1% (95% CI 6.5-8.1) in the 1988-89 survey to 9.1% (8.4-9.8) in the 1996-97 survey. A similar increase, from 2.4% (2.2-2.6) to 4.4% (3.9-4.9) was observed for individuals not having been in dental treatment during the last 24 months. The socio-economic distribution of oral health and use of dental care in the adult population was similar in the two surveys. This study demonstrates that socio-economic differences in oral health and use of dental care are most marked in older (45-64 years) adults in Sweden, but are significant in young adults and, in terms of oral health, in children as well. A steep increase in user charges during the 1990s has been paralleled by a moderate increase in problems with chewing and the proportion of the population that has no regular dental care, which suggests a link that needs to be evaluated in further studies.


An assessment of sensitivity to change of the Oral Health Impact Profile in a clinical trial.
Patient-based assessment of oral health outcomes is of growing interest. Measurement of change following clinical intervention is a key property of a health status measure. To date, most of the research on oral health status measurement has focused on construct and discriminant validity of health status measures. The objective of this study was to assess sensitivity to change of an oral-specific health status measure, the Oral Health Impact Profile (OHIP). Study subjects were in three groups, namely, edentulous/edentate subjects who requested and received complete implant stabilised oral prostheses (IG, n=26), edentulous/edentate subjects who requested implants but received conventional dentures (CDG1, n=22), and edentulous subjects who had new conventional complete dentures (CDG2, n=35). Data were collected pre- and post-operatively using the OHIP and a validated denture satisfaction questionnaire. All subjects reported similar low levels of denture satisfaction pre-operatively. Denture problems had a more significant impact on oral health-related quality of life (OHRQL) for implant seekers (IG and CDG1 subjects) than subjects seeking conventional dentures (CDG2). Following treatment, significant improvement in satisfaction with oral prostheses and OHRQL was reported by IG and CDG2 subjects; the level of improvement was more moderate for CDG1 subjects. OHIP change scores were correlated with denture satisfaction change scores. It was concluded that sensitivity to change of the OHIP was good. This property was not improved by using statement weights.


Type 1 diabetes mellitus and oral health: assessment of coronal and root caries.
The oral health of a large cohort of adult insulin-dependent diabetic patients (Type 1), diagnosed 24 years previously with juvenile onset, was comprehensively assessed. This paper describes the prevalence of coronal and root caries in this adult Type 1 diabetic population and evaluates demographic, dietary, behavioral, physiologic, salivary and medical variables associated with decayed and filled surfaces in the crown (DFS) or root (RDFS). Type 1 diabetes mellitus subjects participating in this oral health evaluation had been monitored for 6-8 years as participants in the University of Pittsburgh, Department of Epidemiology, longitudinal study of medical complications associated with diabetes. Four hundred and six diabetic subjects received a comprehensive oral health examination during one of their regularly scheduled medical visits. Oral assessments included coronal and root caries, missing teeth, edentulism, periodontal status, soft tissue pathologies, salivary function and health behaviors. Sixteen diabetic subjects and one control subject were edentulous. Coronal and root caries data from the remaining 390 dentate diabetic subjects were compared with 202 dentate nondiabetic control subjects. The adult Type 1 diabetic subjects were not found to have significantly higher DFS rates as compared with our control subjects or published age-adjusted NHANES III findings. Both control and diabetic subjects had low decayed to filled tooth surface ratios. A linear regression model evaluated possible associations with coronal decayed and filled tooth surfaces (DFS) within the diabetic population. Significant factors included older age, women, fewer missing teeth, more frequent use of dental floss, more frequent visits to the dentist during the last 12 months, and diabetic nephropathy. The prevalence of RDFS was higher in the diabetic subjects as compared to recruited control subjects. Neither dietary behaviors nor glycemic control were found to contribute to coronal or root caries. Factors associated with presence of coronal and root caries and fillings are discussed. Possible causes and implications for the association between DFS and diabetic nephropathy are provided.


Prevalence of impacts of dental and oral disorders and their effects on eating among older people; a national survey in Great Britain.
The objective was to assess the prevalence, in a British population aged 65 years and older, of oral health related impacts and the effects they had on the quality of daily life and in particular on eating. 753 free living and 202 institutionalised subjects aged 65 years and over, participating in the oral health survey of the British National Diet and Nutrition Survey (NDNS), had a dental examination and interview. Data on the impact of dental and oral disorders on the activities of daily living based upon the modified Oral Impacts on Daily Performance (OIDP) indicator were collected. 17% of the free living edentate participants reported that their mouth affected their pattern of daily living on a regular basis. Oral impacts levels were lowest in dentate subjects with the greatest number of teeth. For the dentate, the most common oral impacts were on eating and speaking. Impacts relating to emotional stability, sleeping, relaxing, carrying out physical activity and social contact were very infrequent, but were severe when they did occur. Among those with an impact on eating, 25% said it was severe and 42% had the impact nearly every day or in a spell of 3 or more months. Oral impacts were more prevalent among the institution sample, particularly the dentate. The impacts were associated with the inability or difficulty to eat a range of 16 common foods. This survey has shown that the oral status of older people fairly frequently affects the quality of life of older people, and in particular, the ability to eat several common types of foods.


Adolescents' sense of coherence, oral health status, and oral health-related behaviours.
To investigate the relationship between sense of coherence (SOC) and oral health. It was hypothesised that subjects with better oral health status and better oral health-related behaviours have higher levels of SOC. A cross-sectional study was conducted in Goiânia-GO, Middle-West Brazil, on a sample of 664 15-year-olds randomly selected from schools. Data were collected through questionnaires, the short version of Antonovsky's SOC Scale (13-item) and clinical dental examinations. Multiple logistic regression and polytomous ordered regression were used in the data analysis. Two sets of outcome variables were selected for the analyses: oral health status (dental caries, oral cleanliness, and periodontal disease), and oral health-related behaviours (frequency of sugar intake, toothbrushing frequency, and pattern of dental attendance). Adolescents' SOC was associated with their caries experience in anterior teeth (OR=0.81 for 10 units increase in SOC scale; 95% CI=0.66-0.98), but the relationship did not remain significant after controlling for other factors. Adolescents with higher SOC were less likely to visit the dentist mainly when in trouble, compared with those with lower SOC (OR=0.83, 95% CI=0.71-0.98), or equivalently more likely to visit for mainly check-ups. Other measures of oral health status and behaviours were not significantly associated with SOC. SOC was identified as a psychosocial determinant of adolescents' oral health-related behaviour, particularly affecting their pattern of dental attendance.


Evaluation of oral health promotion in the workplace: the effects on dental care costs and frequency of dental visits.
An oral health promotion program has been conducted since 1989 at a shipyard in Japan. The purpose of the present study was to assess the impact of oral health promotion in the workplace in terms of dental care costs and frequency of dental visits. This program consisted of orientation, an initial regimen, and group counseling. The initial regimen included an evaluation of each participant's oral health status, and instruction concerning oral hygiene, and prevention of oral disease. The participants were selected with each unit being a preexisting peer group. Eighty-seven participants were compared with 216 control subjects in terms of annual dental care costs and frequency of dental visits in four periods: the 1-year period before the program, the 1st year after the program, the 2nd year after, and the 3rd year after. The annual mean dental care cost in the participant group for the year prior to the program was higher than that in the control group (21,317 vs. 17,116 yen). In the 1st year after the program, the difference increased (26,642 vs. 19,481 yen). In the 2nd and 3rd years after the program, dental care costs in the participant group were lower than those in the control group (2nd year: 18,305 vs. 22,841 yen, 3rd year: 16,911 vs. 21,920 yen). It can be concluded that this oral health promotion program in the workplace contributed to saving of costs associated with dental care. The workplace can be regarded as a key area for implementation of an oral health care system to make good use of limited resources.


Modified IOTN: an orthodontic treatment need index for use in oral health surveys.
This paper reports the results of a study of the reliability of a modified version of the Index of Orthodontic Treatment Need (IOTN) for use in oral health surveys. Twelve non-specialist dental examiners were trained in the use of the Modified IOTN using a standardised teaching protocol lasting approximately 1.5 hours. Following a school-based calibration exercise it was found that nearly all the examiners achieved either good or excellent agreement (mean Kappa=0.74). The average sensitivity and specificity scores were 0.90 and 0.84, respectively. The Modified IOTN appears to overcome the training and reliability problems that often accompany the use of orthodontic indices by non-specialists in oral health surveys.


Socioeconomic factors that affect international caries levels.
Health policy makers have examined the impact of economic policies and a nation's social development on the health of its population. The purpose of this research was to investigate the association between health care expenditures, socioeconomic factors, and caries levels in 109 countries representing an array of social and economic conditions, and to determine how such factors are related to caries experience at different levels of economic development. Countries were divided into established market economies and three groups of developing nations, based on their GNP (high, medium, low income). Total health expenditures as percent GDP and as US dollars per capita, public expenditures and aid flow as percent of total health expenditures, dentists per 100,000 population, per capita sugar consumption, and urbanization of the population were compared among these countries. Correlations between these variables, and decayed, missing and filled teeth (DMFT) of 12-year-olds in these countries were assessed. The highest correlations were found between DMFT and public expenditures, sugar consumption, and urbanization. Highly significant differences emerged across nation groups by stages of development on several variables. The findings suggest that it is important to consider the stage of development of a given country when planning caries prevention policies and programs. Such a contextual approach is more likely to be successful in reducing caries levels.


Rugby players' satisfaction with custom-fitted mouthguards made with different materials.
This study compared the comfort of two bimaxillary custom-fitted mouthguards. One type was made with silicone rubber and the other with methyl-methacrylate (acrylic). The study was a within-subject crossover clinical trial with 52 high-school rugby players who were randomly allocated to one of two groups. The first group wore a silicone mouthguard for 4 months and an acrylic one for the following 4-month period. The second group wore an acrylic mouthguard followed by a silicone one for similar periods. Comfort, bulkiness, stability, hardness, ability to talk and to breathe, oral dryness, nausea and inclination to chew were evaluated for each period using a Visual Analogue Scale questionnaire. There was no significant difference concerning comfort, bulkiness, ability to talk and to breathe, oral dryness and nausea between silicone and acrylic mouthguards by group and time of examination (Three-way ANOVA P>0.05). Acrylic mouthguards were more stable and harder than silicone ones (Wilcoxon's test P<0.01). Tendency to chew was greater for silicone appliances (P<0.01). For stability, hardness and inclination to chew, there was no significant difference in the response of the players based on the sequence of use of the two types of mouthguard during the survey (Mann-Whitney test P>0.05). At the end of the study, 56% of the players preferred to keep the acrylic mouthguard and 44% chose the silicone one. This choice did not vary between the groups (chi2, P>0.05). Silicone rubber mouthguards were well accepted by the players but technical improvements in silicone materials are needed to improve hardness and stability of silicone mouthguards for sport.


Impairment of antigen-specific cellular immune responses under simulated microgravity conditions.
Microgravity has been implicated to play a role in the observed immune dysfunction of astronauts and cosmonauts after either short-term or long-term space travel. These reports, together with studies describing increased levels of microorganisms in the space cabin environment suggest potential risk for in-flight incidences of infectious diseases. In order to understand the mechanism underlying these immune defects, it is important to have a ground-based model that would reliably mimic the effects of microgravity on antigen-specific immune function. We tested the utility of the rotating wall vessel (RWV) technology developed at NASA as a model system because in the RWV the culture medium and the cells rotate synchronously with the vessel, thereby creating simulated microgravity conditions. We compared the RWV to the conventional tissue culture flask (T-flask), for culturing immune precursor cells with cytotoxic T lymphocyte (CTL) activity against synthetic viral peptides. We observed a significant loss of antigen-specific CTL activity in RWV cultures, but not in those from the T-flask, irrespective of the peptide immunogen used for inducing the primary immune response in different mouse strains. Loss of CTL activity in RWV cultures coincided with a significant reduction in CD8+ cells as well as CD4+ cells and DEC205+ dendritic cells, suggesting adverse effects of RWV culturing on both the effector and accessory cells for the loss of antigen-specific CTL function. These results provide a strong parallel to the reported defects in cell-mediated immunity during space travel and strongly support the utility of the RWV technology as an effective ground-based model for identifying key steps in immune cell dysfunction related to microgravity.