An exploratory study on cultural variations in oral health attitudes, behaviour and values of freshman (first-year) dental students.

OBJECTIVE: To identify similarities and differences in oral health attitudes, behaviour and values among freshman dental students. DESIGN: Cross-cultural survey of dental students. SETTING: 18 cultural areas. PARTICIPANTS AND METHODS: 904 first-year dental students completed the Hiroshima University-Dental Behavioural Inventory (HU-DBI) translated into their own languages. Individual areas were clustered by similarity in responses to the questions. RESULTS: The first group displayed an 'occidental-culture orientation' with the exception of Brazil (Cluster 1 comprised: Australia, United Kingdom, Ireland, Belgium and Brazil, Cluster 2: Germany, Italy, Finland and France). The second group displayed an 'oriental-cultural orientation' with the exception of Greece and Israel (Cluster 3 comprised: China and Indonesia, and Cluster 4: Japan, Korea, Israel, Hong Kong, Malaysia, Thailand and Greece). Australia and United Kingdom were the countries that were most alike. Ireland was the 'neighbour' to these countries. Greece and Malaysia had similar patterns of oral health behaviour although geographic conditions are very different. Although it was considered that in Hong Kong, occidental nations have affected the development of education, it remained in the oriental-culture group. Comparison with the data from the occidentals indicates that a higher percentage of the orientals put off going to the dentist until they have toothache (p < 0.001). Only a small proportion of the occidentals (8%) reported a perception of inevitability in having false teeth, whereas 33% of the orientals held this fatalistic belief (p = 0.001). CONCLUSIONS: Grouping the countries into key cultural orientations and international clusters yielded plausible results, using the HU-DBI.

Relationship between mesial temporal seizure focus and elevated serum prolactin in temporal lobe epilepsy.

We evaluated the relationship between mesial temporal seizure focus and serum prolactin (PRL) in patients before and after they underwent anterior temporal lobectomy (ATL) for medically intractable temporal lobe epilepsy (TLE). These patients had a confirmed unilateral epileptogenic focus in mesial temporal structures, a postictal rise in serum PRL 15 to 20 minutes after onset of complex partial seizures, and were refractory for more than 2 years to antiepileptic drugs. Presurgical interictal serum PRL levels were significantly elevated (16.47 +/- 0.85 ng/mL, n = 62) and declined after ATL to normal values (patients, 9.63 +/- 0.55 ng/mL, n = 54; normal subjects, 8.99 +/- 0.57 ng/mL, n = 52). Serial evaluations indicated that normalization was seen 3 months after surgery (9.42 +/- 1.22 ng/mL, n = 9). The postsurgical reduction in serum PRL was similar in men and women, in patients with epileptogenic focus on either side of mesial temporal structures, and was unaffected by antiepileptic medication. We conclude that PRL is elevated following seizures and that a seizure focus in mesial temporal structures may exert a sustained excitatory influence on PRL release in patients with medically intractable TLE.

Combination of ofloxacin and amikacin in the treatment of sternotomy wound infection.

Mycobacterium fortuitum infection of soft tissue and wound (postoperative or otherwise) has been well reported in medical literature. In 1987, ten patients in our hospital with various cardiac diagnoses requiring open-heart surgery developed M fortuitum infection at the sternotomy site. As successful chemotherapy, in addition to surgical debridement, relies on in vitro susceptibility testing, ofloxacin and amikacin were thus assessed and found to have very satisfactory MIC. For the former: 1.25 mg/L for eight isolates, 2.5 mg/L for one isolate, and greater than 20 mg/L for one isolate were found. For the latter: 1 mg/L for six isolates, 2 mg/L for two isolates, and 4 mg/L and 8 mg/L for the remaining two isolates were found, respectively. These patients were given ofloxacin (300 mg once daily to 1,200 mg daily in divided doses) for three to six months and 500 mg amikacin daily (in two divided doses intravenously or intramuscularly) for three to eight weeks. The clinical outcome was favorable except for one patient who died of bacteremia due to M fortuitum coupled with many medical complications. Encouraged by these preliminary results, a future prospective study with ofloxacin as single agent for soft tissue, particularly postoperative sepsis due to M fortuitum, will be planned.

Single daily-dose ofloxacin monotherapy for Mycobacterium fortuitum sternotomy infection.

Infection of sternotomy wounds due to Mycobacterium fortuitum-chelonei complex postoperatively was noted in ten patients in 1987 and six patients in 1988 in our hospital. The first ten patients were treated with a combination of ofloxacin and amikacin, successfully in nine. In the six later patients, five had M fortuitum infection and one had M chelonei infection. In those five we used single daily-dose ofloxacin, 600 mg, in three with rapid clinical response and bacteriologic cure. The MIC of ofloxacin for these three isolates ranged from 0.32 mg/L to 1.25 mg/L, and peak serum level of ofloxacin assessed by high-performance liquid chromatography ranged from 4.1 mg/L to 8.0 mg/L. Monotherapy with ofloxacin is recommended for M fortuitum infection of wound and soft tissue, with in vitro susceptibility studies as a guide, pending further reinforcing clinical evidence.

Diagnosis of tuberculous pleural effusion by the detection of tuberculostearic acid in pleural aspirates.

Detection of TBSA was attempted in pleural aspirates of 74 patients with tuberculous and 44 patients with nontuberculous pleural effusion by gas chromatography/mass spectrometry with selected ion monitoring. The results were disappointing with a test sensitivity of 67.6 percent and a specificity of 52.3 percent. In contrast, histologic examination of pleural biopsies gave a diagnostic sensitivity of 71.0 percent. Pleural biopsy remains a better investigational procedure for the diagnosis of tuberculous pleural effusion.

Clinical and socioeconomic features of subjects with red cedar asthma. A follow-up study.

A follow-up study of 128 subjects with red cedar asthma was conducted to evaluate the clinical and socioeconomic impact of the disease in determining the working status of the subjects after the diagnosis was made. The results suggest that the severity of asthma is not the main determinant of working status. Comparing the data at diagnosis and at follow-up examination, we found that the persistence of exposure resulted in a deterioration in the asthma despite the use of more medications. Subjects who were working were younger and had a larger number of dependents than the subjects who were not working at the time of the follow-up examination. We conclude that the socioeconomic factors are important in determining the working status of subjects with red cedar asthma. To prevent severe impairment and disability, there should be more economic incentives for these subjects to choose other jobs.

Identification and characterization of Podophyllum emodi by API-LC/MS/MS.

An API-LC/MS/MS method was developed for the identification of the medicinal herb Podophyllum emodi based on the profile of its aryltetrahydronapthalene and related lignan marker compounds. This was done by matching the structural information from the tandem mass spectrometric data with those lignan marker compounds already reported for the herb. The method could be employed in the absence of reference standards for the markers and was particularly useful in view of the scarcity of supply of these chemical standards. It has been used successfully to differentiate Podophyllum emodi from two commonly used medicinal herbs of a different genus but having similar appearance, Radix clematidis and Radix gentiana, as well as a closely related herb, Podophyllum peltatum.

Antimicrobial activity of ofloxacin and other agents against mycobacterial isolates from postoperative sternotomy wounds.

In 1987 and 1988, 16 patients in a cardiothoracic hospital developed median sternotomy wound infections from Mycobacterium fortuitum or Mycobacterium chelonei (M fortuitum, 14 patients; M chelonei, two patients). For M fortuitum isolates, the minimum inhibitory concentration (MIC) (by agar dilution) of ofloxacin was 0.32 to 1.25 mg/L; of amikacin, 0.5 to 1 mg/L; of sulfadiazine, 16 to 256 mg/L; of imipenem, less than or equal to 2 to 4 mg/L; of cefoxitin, 4 to 16 mg/L; of ampicillin, 64 to greater than 256 mg/L; of cephapirin, 64 to 128 mg/L; of cefoperazone, greater than 256 mg/L; and of ceftazidime, greater than 256 mg/L. Addition of sulbactam to ampicillin and cefoperazone resulted in at least a four- to eight-fold reduction of their respective MICs. For M chelonei isolates, the MIC of ofloxacin was greater than 20 mg/L; of amikacin, 8 mg/L; of sulfadiazine, 64 mg/L; of imipenem, 8 mg/L; of cefoxitin, 16 mg/L; of ampicillin, 128 mg/L; of cephapirin, 128 mg/L; of cefoperazone, greater than 256 mg/L; and of ceftazidime, greater than 256 mg/L. Addition of sulbactam resulted in much smaller reductions of the MICs of ampicillin and cefoperazone. Synergism was noticed between ofloxacin and amikacin against M chelonei but not against M fortuitum. The results indicate that ofloxacin alone is as effective as the combination of ofloxacin and amikacin in treating M fortuitum, but not M chelonei, infection.

Two cases of Nocardia asteroides sternotomy infection treated with ofloxacin and a review of other active antimicrobial agents.

Two patients who developed post-operative sternotomy infections due to Nocardia asteroides were treated successfully with ofloxacin, in vitro susceptibility of the organisms being used as a guide to dosage. The place of this drug in the treatment of infection due to Nocardia asteroides merits further investigation.

Tongue dyskinesia as an early manifestation of Wilson disease.

A 15-year-old boy was diagnosed as having Wilson disease. He perceived involuntary tongue movement and speech disorder since March 1990. The tongue movements presented in the resting state and during action. It contracted transversely and bilaterally with an irregular frequency about 1 Hz. As a result, the sides of the tongue moved to form a narrow central groove. This was quite different from the tongue protrusion of tardive dyskinesia. His speech had imprecise consonants, monopitch, low pitch, low volume, harsh voice, and hyponasality. These suggested that tongue dyskinesia could be an early sign of Wilson disease and was not the main cause of his dysarthria.

Coexistence of Parkinson's disease and myasthenia gravis: a case report.

This is a report on a 62-year-old Chinese woman with Parkinson's disease (PD) for 8 years who developed myasthenia gravis (MG) in the last year. In this case, there was no adverse effect of trihexyphenidyl on MG, whereas pyridostigmine worsened the PD.

Lateralizing value of early head turning and ictal dystonia in temporal lobe seizures: a video-EEG study.

To investigate early head turning, we retrospectively studied videotapes of 262 seizures from 82 patients who were seizure free after temporal lobectomy. Early head movements were arbitrarily classified into non-tonic turning, tonic turning, and absence of turning. Among the 222 seizures which showed early head turning, 168 (75.7%) had non-tonic turning and 54 (24.3%) had tonic turning. The direction of the first head turning was ipsilateral to the epileptogenic foci in 132 (78.6%) seizures with non-tonic turning and in 35 (64.8%) seizures showing tonic head turning. The proportion of seizures with turning towards the ipsilateral side in the presence of tonic and non-tonic head turning were significantly different (P= 0.04). Seventy-four seizures (28.2%) evolved to secondary generalization, more frequently found in seizures with early head turning (P= 0.0015) and especially those showing tonic turning (P< 0.0001). The direction of head turning immediately preceding secondary generalization was contralateral to the lesion side in 53 seizures (82.8%). Dystonic upper limb posturing occurred in 86 seizures (32.8%), exclusively contralateral to the seizure focus, whereas 65 (75.6%) were associated with initial head turning ipsilateral to the focus. In summary, temporal lobe seizures with tonic head turning tends to secondarily generalize and the direction of head turning before secondarily generalized was contralateral to the seizure foci. Earlier in the seizures the direction of non-tonic head turning tends to be towards the epileptogenic hemisphere. In addition, dystonic posturing of the extremities is a significant lateralizing sign to the contralateral hemisphere in temporal lobe seizures.

Magnetoencephalographic study of rhythmic mid-temporal discharges in non-epileptic and epileptic patients.

To evaluate the source location and clinical significance of rhythmic mid-temporal theta discharges (RMTD) by MEG in non-epileptic and epileptic patients, we conducted simultaneous MEG and EEG recordings with a whole-scalp 306-channel neuromagnetometer in three patients: one with right temporal lobe epilepsy (TLE), one with right frontal lobe epilepsy (FLE), and one with tension headache. We visually detected the RMTD activity and interictal spikes, and then localised their generators by MEG source modelling. We repeated MEG measurement 3 months after right anterior temporal lobectomy (ATL) in the TLE patient; 3 months after anticonvulsant medication in the FLE patient. In epileptic patients, RMTD activities were found during drowsiness over the left temporal channels of both MEG and EEG recordings, and their generators were localised to the left posterior inferior temporal region. In the patient with tension headache, RMTD was localised in the right inferior temporal area. When the epileptic patients became seizure free with disappearance of epileptic spikes, RMTD was still found over the left temporal channels. Besides, some bursts of RMTD appeared also in the right temporal channels in our TLE patient after ATL. Our results indicate that the source of RMTD activity is located in the fissural cortex of the posterior inferior temporal region. As a physiologic rhythm related to dampened vigilance, RMTD has no direct relation to epileptogenic activity.

The use of clinical dental auxiliaries as examiners in caries prevalence surveys in the United Kingdom: a feasibility study.

OBJECTIVE: This study investigated the use of clinical dental auxiliaries as examiners in caries prevalence surveys of 5- and 12-year-old children in the United Kingdom. METHODS: A random sample of four therapists and four hygienists was drawn from 23 clinical dental auxiliaries employed in the Community Dental Service in Yorkshire, United Kingdom. Training and calibration were carried out according to national guidelines for caries prevalence surveys. Sixteen 5-year-old and sixteen 12-year-old children were examined in the calibration exercise. Agreement was assessed using 95% confidence intervals of mean dmft/DMFT of the group, sensitivity and specificity values, and kappa statistics on dft/DFT. RESULTS: For 5-year-old children, a good level of agreement with the standard examiner was achieved with sensitivity scores ranging from 0.84-0.98, specificity scores from 0.93-0.97, and kappa scores from 0.80-0.89. For 12-year-old children, sensitivity scores ranged from 0.56-0.95; specificity scores from 0.93-0.99; and kappa scores from 0.66-0.83. Four examiners failed to achieve the minimum scores on all measurements. CONCLUSION: It was concluded that clinical dental auxiliaries could be used as examiners in caries prevalence surveys of 5-year-old children. However, in order to attempt to meet the national standard for agreement in surveys of 12-year-old children, four of the eight examiners in the present study would require further training. Possible reasons for this difference are discussed.

The reliability of interview data for age at which infants' toothcleaning begins.

A number of studies have reported on the age at which toothbrushing started and drawn important conclusions. Such studies often relied on parental recall of a particular event that occurred some years previously, assuming the quality of retrospectively reported data. The present study aimed to investigate consistency of reporting the age at which toothcleaning began. Mothers from two different cultural backgrounds, 100 Caucasian and 150 Asian living in a deprived inner city area, were interviewed in their homes on two separate occasions, when the sample child was 6-24 months old and again at 3-4 years. Of the 39 Caucasian and 31 Asian mothers who specified an age at which toothbrushing commenced at both interviews, complete agreement occurred among 4 (10%) Caucasian and 2 (6%) Asian mothers, with a variation of +/- 2 months among 12 (31%) and 5 (16%) respectively. Intraclass correlation coefficients were -0.01 for Caucasian and -0.46 for Asian mothers. Kappa values were 0 and -0.09 respectively. Of the 139 mothers who stated that their children's teeth were not cleaned at the time of the first interview, 17 claimed an earlier age than this at the second interview. It was concluded that there was little agreement between the two interviews, although the extent of the variation differed between the two cultural groups. Although these findings represent relatively deprived population groups, caution is recommended in unquestioningly accepting the accuracy of retrospective reporting of oral hygiene practices in dental surveys until evidence of better reliability is available.

Tolerance of ofloxacin in the treatment of pulmonary tuberculosis in presence of hepatic dysfunction.

Twenty-nine patients with extensive pulmonary tuberculosis and drug-induced hepatitis were treated with ofloxacin along with other relatively non-hepatotoxic drugs, either during the interim phase to await recovery of liver function in some, or as definitive therapy as required by the compromised hepatic status of others. No adverse drug reactions were noted and no treatment failures were observed. This preliminary experience indicates the exceedingly good tolerance of ofloxacin when utilized in treatment of extensive pulmonary tuberculosis in the face of deranged liver function tests. Due to the small number of patients and numerous variables, no definite conclusion can be drawn on the specific efficacy of ofloxacin against Mycobacterium tuberculosis. However, it is concluded that acquisition of further clinical experience is warranted for similar patients.

Nosocomial tuberculosis in hospital staff. The size of the problem in a Hong Kong chest hospital.

In the past three decades, among 831 staff (over 6,862 staff-years) under regular chest radiographic survey in the Grantham Hospital, Hong Kong, the cumulative incidence of active pulmonary tuberculosis requiring treatment was 27 (belonging to 23 staff). Number of cases detected per year ranged from 0 to 3. The mean duration from the beginning of employment to the first evidence of disease was 6.43 years. Although this incidence is low, yet the hospital caters for quite a large number of patients with bacteriologically confirmed tuberculosis, we feel that the active screening program for hospital staff should be maintained, and that review of the situation is also recommended.

Dental beliefs, knowledge and behaviour of Chinese people in the United Kingdom.

OBJECTIVE: This study explored oral health beliefs, knowledge and behaviour among a sample of United Kingdom Chinese. DESIGN: A quota sample of Chinese people, stratified by age and gender, were interviewed by trained and standardised Chinese interviewers using a piloted, validated semi-structured questionnaire. SUBJECTS: One hundred and fifty-six Chinese people--with similar number of teenagers, younger adults and older people--resident in the North East of England. SETTING: Chinese communities. OUTCOME MEASURE: Reported dental knowledge, beliefs and behaviours. RESULTS: Regardless of gender and age, the majority of respondents believed that it was natural for people to lose all their teeth in old age. Less than half were convinced that they would be able to keep their own teeth for life. The majority of the sample considered that they were susceptible to dental diseases, the consequences of which were thought to be serious. Approximately half presumed that dental diseases were preventable, although the aetiology of dental caries, periodontal disease and tooth loss was poorly understood. While 94% claimed to brush their teeth as part of routine dental care, dental visiting and dietary restriction of sugar intake were reported only in 61% and 30% of the sample respectively. Inter-generational differences were marked; older people tended to have a fatalistic attitude and were least likely to attend the dentist. CONCLUSIONS: A low level of dental awareness was found among the UK Chinese. In order to facilitate effective health promotion and treatment services, the extent of Chinese people's traditional oral health beliefs and behaviour must be taken into account.

The diagnostic reliability of clinical dental auxiliaries in caries prevalence surveys--a pilot study.

The Nuffield Report recommended the development of further education and training for dental auxiliary personnel. The extent to which clinical dental auxiliaries might carry out oral assessments is under consideration currently. While other countries have employed clinical dental auxiliaries as examiners in national surveys, there is no evidence to suggest that they are able to perform oral assessments effectively in the United Kingdom. This study aimed to investigate the possibility of using dental hygienists or therapists as examiners in epidemiological surveys. Five dentists and three clinical dental auxiliaries were trained and calibrated together using standardised BASCD training procedures. Forty 5-year-old children in Leeds were recruited to the training and calibration exercise. Data were analysed according to BASCD recommendations. There were no differences in performance between dentists and auxiliaries. All examiners fell within 95 percent confidence limits of the group mean dt, mt, ft and dmft. Mean grouped dmft scores for the benchmark examiner, dentists and auxiliaries were 1.92, 1.84 and 1.92 respectively. Sensitivity values for dentists and auxiliaries ranged from 0.54 to 1.00 and 0.80 to 0.94 respectively. Kappa scores were 0.70 to 0.90 for dentists; and 0.82 to 0.87 for the auxiliaries. It was concluded that the dental hygienists and therapist recruited to this study could be used in epidemiological surveys of caries in 5-year-old children.

Attitudes of Chinese people toward obtaining dental care in the UK.

OBJECTIVE: To explore the attitudes of Chinese people regarding dentists and toward obtaining dental care in the UK. INTRODUCTION: Injudicious use of general health services has been reported among Chinese people in the UK. In relation to oral healthcare, the extent to which cultural beliefs and values affect use remains uncertain. SETTING: Chinese communities in the north east of England. SUBJECTS AND METHODS: A quota sample of 156 Chinese people was recruited in 1996. 50 elderly people, 56 adults, 50 teenagers were interviewed by 5 trained and standardised multilingual Chinese interviewers using a validated structured questionnaire. RESULTS: Access varied substantially according to age, with the younger generations more likely to obtain dental care without difficulty. Overall, the sample perceived that dentists possessed adequate technical competence, but their patient management skills lacked sensitivity. Older Chinese people placed less trust in dentists. Many elderly people reported problems in finding a UK dentist and would have preferred one of Chinese origin. Potential problems in follow-up prosthetic dental care were also apparent among this age group. Cost, communication problems, anxiety and cultural beliefs were identified as major barriers to dental care. CONCLUSIONS: There is a clear need to raise cultural awareness among dental professionals as well as to help Chinese people's positive attitudes toward dentists and dental care.