Young adults' views on the relevance of three measures for oral health-related quality of life.

OBJECTIVE: The aim of this study was to explore the views of young adults on the relevance of three measures of oral health-related quality of life (OHRQoL). METHODS: Sixteen young adults aged 21-29 years were interviewed. The selection was strategic with reference to age (21-25 years.; 26-30 years), sex and education (university degree; upper secondary school). The interview guide covered areas on the content and construction of the measures: The Oral Health Impact Profile (OHIP), the Oral Impacts on Daily Performances (OIDP) and the Oral Health-Related Quality of Life UK (OHRQoL-UK). The data were analysed using qualitative content analysis. RESULTS: A theme expressing the latent content was formulated during the data analysis: 'young adults' own experiences were reflected in their views on the OHRQoL measures'; that is, the experiences of young adults of own oral problems and aspects that were found to be especially important for their age group influenced their view on the measures. The self-reported ability to understand and answer the questions varied and the perceived advantages and disadvantages were almost equally distributed among the three measures. CONCLUSIONS: The OHIP, OIDP and OHRQoL-UK were evaluated as being equal by the young adults in this study, with regard both to their pros and cons. The clarity of the measures was regarded as the most important factor, while the length and assessment period were less significant.

Caries increment in primary teeth from 3 to 6 years of age: a longitudinal study in Swedish children.

AIM: To longitudinally follow and analyse caries prevalence and development in primary dentition in Swedish preschool children from 3 to 6 years of age. STUDY DESIGN: A longitudinal clinical study. METHODS: Three hundred 3-year-old children in the Public Dental Service were consecutively included. The children underwent annual clinical examinations at 3, 4, 5 and 6 years of age, performed by four calibrated dentists in clinical settings. Initial (d1-2) and manifest (d3-5) lesions were registered at surface and tooth level. Radiographs were taken when indicated and possible. STATISTICS: Chi-squared test was used for group comparisons. Friedman's test, Wilcoxon non-parametric test and logistic regression analyses explored caries development over the years. RESULTS: The parents of 271 children agreed to their children participating in the study (total dropout rate at 6 years, 10.3%). At baseline, 27.3% of the children had carious lesions (d1-5 mean 0.98, SD ± 2.44), and only 50.6% of the children were totally caries-free at 6 years (d1-5 mean 1.88, SD ± 2.81). Initial carious lesions made up the greater share at all ages. The greater part of the caries increment occurred between 3 and 4 years of age (p < 0.001). Having initial and/or manifest carious lesions at 3 years of age was a significant explanatory factor for new lesions at 6 years of age (OR 2.29; 95% CI 1.58-3.31). CONCLUSION: Children with an early caries experience had a high risk of further disease progression. Oral health promotion and prevention programmes should target small children and their carers.

Cholinergic dysfunction after traumatic brain injury: preliminary findings from a PET study.

OBJECTIVE: There is evidence that the cholinergic system is frequently involved in the cognitive consequences of traumatic brain injury (TBI). We studied whether the brain cholinergic function is altered after TBI in vivo using PET. METHODS: Cholinergic function was assessed with [methyl-(11)C]N-methylpiperidyl-4-acetate, which reflects the acetylcholinesterase (AChE) activity, in 17 subjects more than 1 year after a TBI and in 12 healthy controls. All subjects had been without any centrally acting drugs for at least 4 weeks. RESULTS: The AChE activity was significantly lower in subjects with TBI compared to controls in several areas of the neocortex (-5.9% to -10.8%, p=0.053 to 0.004). CONCLUSIONS: Patients with chronic cognitive symptoms after TBI show widely lowered AChE activity across the neocortex.

Group treatment of obesity in primary care practice: a qualitative study of patients' perspectives.

AIMS: To explore patients' experiences of very low calorie diet (VLCD) and subsequent corset treatment of obesity in a primary care setting, and to explore their perceptions of factors influencing weight control. METHODS: In western Sweden, five focus group sessions were carried out. The main themes for the discussions were the informants' perceptions of the treatment they had received and their experiences of living with obesity. The analysis was based on the Grounded Theory methodology. RESULTS: The outcomes reflect obese individuals' struggle to handle the demands of their life situation and to recognize their own resources. The core category generated was labelled ''Achieving a balance in life and adjusting one's identity''. Three categories related to the process of weight reduction were identified: living with obesity, reducing weight and developing self-management. The group treatment with VLCD was positively perceived by the participants, but the corset treatment was considered to be of less value. CONCLUSIONS: Maintenance after weight reduction was demanding and the findings indicate a need for extended support. For some individuals the corset treatment could be a psychological support. Follow-up after weight reduction programmes should focus on long-term self-help strategies.

Clinical correlates of oral impacts on daily performances.

OBJECTIVES: The aim of this study was to investigate the associations between oral health measures and oral health-related quality of life as captured by OIDP (oral impacts on daily performances). METHODS: The study was performed in three dental clinics in Sweden and included 204 patients, 43.8% men and 56.2% women (aged 20-86 years), consecutively recruited in connection with their routine dental examination. The patients were interviewed using the OIDP followed by a clinical examination. Four bite-wing radiographs were taken in two of the clinics (n = 154). A self-administered questionnaire provided information about socio-economic data. RESULTS: Subjects >or=60 years had significantly more missing teeth, lesser maximal jaw opening, higher number of sites with alveolar bone loss and proportionally more filled teeth than younger individuals. Impacts related to the oral health that affected their daily life were reported in 39.7%. Multivariate logistic regressions analysis showed that missing teeth (>or=10) and a limited jaw opening (<40 mm) were significantly associated with having one or more impact as measured with the OIDP [odds ratio (OR) 6.50, 95% CI 1.48-28.43 and OR 2.87, 95% CI 1.03-7.96, respectively]. CONCLUSIONS: Individuals with diminished functional oral health status (missing teeth and limited jaw opening) had significantly more often one or more oral impacts on daily life than those with fewer than 10 missing teeth and a jaw opening >or=40 mm. The OIDP instrument may be valuable for use in routine dental check-ups in patients with related problems to determine possible oral impacts on daily life.

Similar inhibition of platelet adhesion, P-selectin expression and plasma coagulation by ioversol, iodixanol and ioxaglate.

Contrast media (CM) are reported to possess both prothrombotic and anticoagulant properties. The mechanisms are not clearly understood, and early reports are contradictory. To study the effects of CM on haemostasis, we analysed the ex vivo effects of ioversol and iodixanol on platelet adhesion and P-selectin expression, and the in vitro effects of ioversol, iodixanol and ioxaglate on platelet adhesion, P-selectin expression and plasma coagulation. A novel enzymatic assay was used to measure platelet adhesion to protein surfaces, and an enzyme-linked immunosorbent assay was used to measure platelet P-selectin surface expression. Prothrombin time (PT) and activated partial thromboplastin time (APTT) were used to measure plasma coagulation. The ex vivo study consisted of blood from 27 outpatients administered ioversol and 9 patients administered iodixanol intravenously. Samples were collected before and 5 min after CM administration. Healthy donors were used for the in vitro studies on the effects of CM. The ex vivo study showed significantly (p<0.05) decreased platelet adhesion and P-selectin expression after administration of ioversol and iodixanol. Adhesion was more affected than P-selectin expression. The in vitro study showed that ioversol, iodixanol and ioxaglate significantly (p<0.05) and dose-dependently (beginning at 3 mg ml(-1)) decreased platelet adhesion and P-selectin expression. APTT and PT were significantly (p<0.01) prolonged at concentrations of 10 mg ml(-1) and 30 mg ml(-1), respectively. In conclusion, ioversol, iodixanol and ioxaglate inhibit platelet adhesion and P-selectin expression, as well as plasma coagulation. Platelets are more sensitive in relation to the inhibiting effect on plasma coagulation.

Use of low-dose mitozantrone to treat aggressive multiple sclerosis: a single-centre open-label study using patient self-assessment and clinical measures of multiple sclerosis status.

BACKGROUND: There is significant evidence supporting the use of mitozantrone in the treatment of multiple sclerosis (MS) but few data on the subtypes of MS that respond or which measures of disease status are most useful. AIMS: To assess the efficacy of low-dose (5 mg/m2 3 monthly) mitozantrone using patient self-assessment questionnaire (SAQ), expanded disability status score (EDSS), multiple sclerosis functional composite score (MSFC), and the fatigue severity scale (FSS). Then, to compare the responses of a subgroup of relapsing remitting MS (RRMS) and secondary progressive MS (SPMS) patients to treatment, and to assess which measures of MS disease status are the most useful in a study of this type. METHOD: Thirty-one patients with definite (McDonald criteria) active MS were commenced on mitozantrone 5 mg/m2 every 3 months. EDSS, MSFC and FSS data collected before treatment and after 12 months were analysed. The SAQ was administered after at least 12 months of therapy. RESULTS: RRMS patients showed significantly more response to mitozantrone than SPMS patients in terms of MSFC (P = 0.02) and SAQ (P = 0.01). CONCLUSIONS: Low-dose mitozantrone was well tolerated and useful in active RRMS in the short term; however, mitozantrone did not display any useful activity in SPMS patients over this time interval or at the mitozantrone dose used. Patient perception of treatment is a worthwhile outcome measure and the MSFC is the most useful objective measure of MS status change in this type of study.

Self-perceived oral health in adolescents associated with family characteristics and parental employment status.

OBJECTIVE: To investigate self-perceived oral health and its associations with family characteristics and parental employment status in an adolescent population from a gender perspective. DESIGN: A cross-sectional study using self-reported questionnaires answered anonymously in classrooms. SETTING: All senior (13-15 years) and upper secondary (16-18 years) level schools in Skaraborg County, Sweden. SUBJECTS: 17,035 students, participation rate 88.5%. OUTCOME MEASURES: A single-item rating of self-perceived oral health; satisfaction with the appearance of the teeth; self-assessed gingival bleeding; a perceived oral health index. RESULTS: Independent of family characteristics and parental employment status, girls, more often than boys, perceived their oral health to be good and had less self-assessed gingival bleeding but were less satisfied with the appearance of their teeth. Adolescents living with a single mother (senior level odds ratios OR 0.71 [Confidence Interval CI 0.59,0.84], upper secondary level OR 0.76 [CI 0.62,0.92]) or with neither parent were less likely to perceive their oral health as good when single-item rated and reported more gingival bleeding (living with a single mother: senior level OR 1.37 [CI 1.20.1.57], upper secondary level OR 1.51 [CI 1.28,1.77]) than those who lived with both parents, while adolescents who lived with a single father did not. Associations between parental employment status and self-perceived oral health were weak and inconsistent. CONCLUSIONS: Family characteristics were important for adolescents' self-perceived oral health while parental employment status was not. Children living in single-parent households should be supported and recognised in strategies for oral health promotion and prevention. Gender differences should also be taken into consideration.

Posterior capsule opacification with AcrySof and poly(methyl methacrylate) intraocular lenses. Comparative study with a 3-year follow-up.

PURPOSE: To evaluate whether reports of reduced posterior capsule opacification (PCO) rates with AcrySof intraocular lenses (IOLs) are applicable to a mixed group of cataract patients in everyday surgical practice. SETTING: Department of Ophthalmology, Kärnsjukhuset, Skövde, Sweden. METHODS: A retrospective study comparing a study group receiving an AcrySof IOL (n = 145) and a group receiving a poly(methyl methacrylate) (PMMA) IOL (n = 153) was performed. The follow-up was 3 years in both groups. The performance of a neodymium:YAG laser capsulotomy was used as the end point for clinically significant PCO. RESULTS: Nine capsulotomies (6.2%) were performed in the AcrySof group and 34 (22.2%) in the PMMA group. The difference in the capsulotomy rate between the 2 groups was highly significant (P <.001). The relative risk was 3.6 times higher in the PMMA group. CONCLUSIONS: There was a significant difference in the frequency of capsulotomy between AcrySof and PMMA IOLs in a mixed group of cataract patients in everyday clinical practice. This finding indicates the importance of the IOL type in PCO formation.

A gender perspective of self-perceived oral health in adolescents: associations with attitudes and behaviours.

OBJECTIVE: To investigate the associations between dental attitudes and behaviours, and self-perceived oral health from a gender perspective in an adolescent population. DESIGN: A census survey. Self-reported questionnaires were answered anonymously in a standardised manner in classrooms. Attitudes studied included the importance of sound teeth and feelings towards visits to the dentist. Behaviours were represented by floss usage and sweets consumption. SETTING: All senior and upper secondary level schools in Skaraborg County, Sweden. SUBJECTS: 17,280 students, aged 13-18 years. OUTCOME MEASURES: Self-perceived oral health, represented by a single-item rating; satisfaction with the appearance of the teeth; self-assessed gum bleeding; and a perceived oral health (POH) index. RESULTS: Recognising sound teeth as important was a predominating attitude among the respondents (boys 94%, girls 97%) and was significantly associated with a good perceived oral health overall. Individuals who experienced visits to dentist as unpleasant (boys 36%, girls 43%) were less likely to perceive good oral health as single-item rated (OR for boys 0.55[0.49, 0.63], girls 0.40[0.34, 0.47]). Regular use of floss had a small protective effect on bleeding gums. Daily sweets consumption showed a significant and inverse association with self-perceived oral health as single-item rated (OR for boys 0.53[0.44, 0.66], girls 0.49[0.40, 0.60]). Girls, more often than boys, perceived their oral health to be good, except in the perception of the appearance of their teeth. CONCLUSIONS: It is concluded that the strong associations between attitudes and self-perceived oral health should be recognised in strategies for oral health promotion and that gender differences must be considered.

Gender differences in knowledge, attitude, behavior and perceived oral health among adolescents.

A cross-sectional dental questionnaire census survey was conducted in classrooms of 17,280 students aged 13-18 years in Skaraborg County, Sweden. The overall response rate, based on school attendance on the test day, was 91% with no gender differences at the senior level, and 86% (boys 87%, girls 85%) at the upper secondary level. The aim was to examine gender differences in knowledge, attitude, behavior and perceived oral health. A retest study showed good agreement. Thirty-one percent of the girls and 21% of the boys flossed regularly. Eleven percent reported daily candy consumption, with no significant gender difference. Girls, however, more often than boys considered their own consumption to be too high. This gender difference in attitude was most pronounced among older daily consumers (odds ratio (OR) = 5.8 [3.7-9.2]). Oral health was regarded as important by a majority of the students (95%). Girls considered sound teeth to be more important than did boys, both among the younger (OR = 1.7 [1.4-2.1]) and the older (OR = 2.4 [1.9-3.1]) adolescents. It is concluded that most adolescents had a positive dental attitude and perceived their own oral health to be good. Poorer knowledge and behaviors concerning oral health were demonstrated. Gender differences existed in most issues. Girls scored more favorably on behavioral measures, showed more interest in oral health, and perceived their own oral health to be good to a higher degree than did boys.

Management of detachment of Descemet's membrane caused by injection of hyaluronic acid.

We report a case in which, in an attempt to reform a flat anterior chamber, hyaluronic acid inadvertently was injected between Descemet's membrane and the corneal stroma. The surgical repair is described and a way to prevent this complication is recommended.

Reinnervation of fast and slow mammalian muscles by a superfluous number of motor axons.

In this study peripheral nerves from flexor digitorum longus, (alien nerve) as well as the deep branch of the muscle's own lateral popliteal nerve were cut and connected to the distal stump of the lateral popliteal nerve. Extensor digitorum longus and tibialis anterior muscles then became reinnervated to a similar extent by either nerve, showing no preference for its own nerve. A significant proportion of the endplates in these muscles remained permanently supplied by more than one axon, and a proportion of the muscle fibres was supplied by both nerves. No ectopic endplates were formed on fast muscle fibres. The same two nerves were also connected to the slow soleus muscle and this muscle became preferentially reinnervated by the nerve to flexor digitorum longus. In contrast to fast muscles, endplates of soleus muscle fibres were only rarely contacted by more than one axon, and ectopic endplates were often found in this muscle. In both types of muscles that had an excess of motor nerves, extensive sprouting persisted for many months. Thus, identical motor nerves induce different patterns of innervation in slow and fast muscles, and muscle fibres do not show a preference for their own nerve.

Protease inhibitors reduce the loss of nerve terminals induced by activity and calcium in developing rat soleus muscles in vitro.

The end-plate of a mammalian skeletal muscle fibre is innervated by several axons at the time of birth but by only one axon in the adult. In the rat soleus muscle the transition from polyneuronal to single innervation occurs during the first 2-3 weeks after birth. While it is evident that the loss of the excess nerve terminals depends to some extent on neuromuscular activity, the mechanism involved is not known. In the present experiments neonatal rat soleus muscles were stimulated in vitro in the presence of a variety of combinations of calcium, the cholinesterase inhibitor edrophonium and the proteolytic enzyme inhibitors leupeptin, pepstatin and Ep-475. Electron microscopical examination revealed that stimulation alone had little effect on the morphology of the end-plate region but stimulation in the presence of raised levels of calcium caused severe disruption of the nerve terminals and a marked reduction in the number of intact nerve terminal profiles contacting each end-plate. Contraction measurements showed that, in spite of this, the muscles were not functionally denervated to any large extent. The addition of edrophonium potentiated the morphological alterations but caused no further reduction in the number of profiles. Conversely, the protease inhibitors wholly or partially (in the case of Ep-475) prevented the effects of stimulation and calcium on the nerve terminals. These results are consistent with the idea that neuromuscular activity induces the secretion of proteolytic enzymes into the end-plate region, where they digest the immature nerve terminals. The importance of calcium suggests that the calcium-dependent neutral protease may be involved, and is also consistent with a secretory mechanism. The possibility that the nerve terminals are digested by their own proteases is also discussed.

Competitive reinnervation of the rat superior cervical ganglion by foreign nerves.

The efficacy of foreign nerves to form synapses was studied morphologically and physiologically in the superior cervical ganglion of the rat. The denervated ganglion was anastomosed to the central stump of either the vagus, the hypoglossal or both nerves together. The degree of reinnervation was assessed two to ten months later. We measured the strength of contraction of the nictitating membrane after each type of operation and compared this to the number, type and distribution of synapses in the same ganglion. Both the vagus and hypoglossal nerves preferentially reinnervated a population of neurones that are situated in the cranial pole of the superior cervical ganglion and supply the nictitating membrane. When both nerves were connected to the ganglion only the vagus nerve could be shown to reinnervate it, and no reinnervation by the hypoglossal nerve was detected. However, in this experiment neither foreign nerve did as well in competition as each did alone and the overall result was reduced functional efficiency. We conclude that not all sympathetic neurones are equivalent and that, just like sympathetic afferents, the foreign nerves are capable of selectively reinnervating preferred target cells.

Timolol versus pilocarpine separately or combined with acetazolamide-effects on intraocular pressure.

Fifty-eight patients with intraocular hypertension or primary open angle glaucoma participated in a double masked randomized study. Timolol in concentrations 0.25% and 0.5% was compared with 1, 2, or 4% pilocarpine Acetazolamide (250 mg x 3) was added if intraocular pressure (IOP) was uncontrolled with the highest concentrations tested. No statistical difference was found in hypotensive effect between pilocarpine and timolol neither on ocular hypertensions nor glaucomas. The additive hypotensive effect of acetazolamide was the same for both substances. Once a day by administration of timolol was sufficient in 17 of 20 cases controlled merely by topical administration.