Effects of orthognathic surgery on quality of life compared with nonsurgical controls in an American population.

INTRODUCTION: To determine the psychosocial effects of a facial skeletal mal-relationship with its subsequent surgical correction in a group of patients treated using surgical orthodontics compared with a matched group of nontreated controls. METHODS: This study was approved by The Ohio State University Institutional Review Board. Subjects were patients presenting with facial skeletal mal-relationships whose proposed treatment plans included orthognathic surgery. This study used valid and reliable questionnaires: Orthognathic Quality of Life Questionnaire (OQLQ), Beck Depression Inventory II (Children's Depression Inventory - 2), Satisfaction with Life Scale, and State Trait Anxiety Inventory (State Trait Anxiety Inventory for Children), administered at 3 different stages of treatment (time 1 = initial pretreatment, time 2 = before oral surgery, and time 3 = at completion of treatment). Matched controls recruited at each time point completed the same questionnaires. RESULTS: A total of 267 subjects were recruited to participate in this study. There were no significant differences between treatment and control groups in age, sex, education level, or employment status at any of the 3 time points. The randomization test was used to compare values for all outcome variables between groups at the 3 stages of treatment. For the pretreatment period, T1, there were significant differences between patients and controls in domains 1 (P = 0.0126), 2 (P = 0.0000), and 3 (P = 0.0000) of the OQLQ (social aspects, facial esthetics, and oral function, respectively) as well as total OQLQ (P = 0.0000). For the presurgery period, T2, there were significant differences between patients and controls in domains 2 (P = 0.0136) and 3 (P = 0.0001) of the OQLQ (facial esthetics and oral function) as well as total OQLQ (P = 0.0291). Finally, for the posttreatment period, T3, there was a significant difference between patients and controls only in domain 3 (P = 0.0196) of the OQLQ (oral function). CONCLUSIONS: The psychosocial profile of patients with a facial skeletal mal-relationship does not differ from the general population in depression, anxiety, and overall satisfaction with life. However, these patients do report a reduced quality of life based on condition-specific measures in social aspects, facial esthetics, and oral function. Concerns about oral function remain even up to 2 years after treatment is completed.

Diagnostic testing of cervical vertebral maturation staging: An independent assessment.

INTRODUCTION: The reliability of the cervical vertebral maturation (CVM) method has been questioned. The objective of this research was to evaluate the diagnostic reliability of the CVM method to diagnose the mandibular growth spurt using longitudinal records from an alternative database (Iowa Facial Growth Study [IFGS]) using established diagnostic testing methods. METHODS: Cephalometric films from 43 subjects (males = 20, females = 23) with Class I or Class II skeletal pattern from the IFGS were scanned, digitized, and adjusted for magnification. At least 5 consecutive, annual films were digitized. For each subject, mandibular length (Co-Gn) was measured for each film, and the growth increment between films was calculated. The largest growth increment was the growth spurt. For each subject, the film displaying CVM stage 3 was identified by a blinded examiner viewing the films in random order. Interrater and intrarater repeatability for Co-Gn (intraclass correlation) and CVM staging (weighted kappa) were calculated. Diagnostic tests, including sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were carried out. The present data were compared with data previously derived from samples of the University of Michigan, Oregon, and Burlington Growth studies (UMGS, OGS, and BGS, respectively). A multilevel logistic regression analysis was also run with the mandibular growth peak as the response variable. RESULTS: Interrater repeatability for mandibular measurements (intraclass correlation coefficient [ICC] = 0.91) and CVM staging (k = 0.88) were excellent. Intrarater repeatability for mandibular measurements (ICC = 0.98) and CVM staging (kw = 0.55) were excellent to moderate. The UMGS data demonstrated higher sensitivity with comparable specificity. Accuracy was largely similar. Their PPV and NPV had larger ranges. The OGS and BGS data, compared with the IFGS data, showed that our sensitivity and PPVs were higher, that their specificity was higher, and that the NPV and accuracy were very similar. The regression analysis was applied to age groups 10-11 years through 13-14 years. Only chronological age was significant (P = 0.04). CONCLUSIONS: Agreement between CVM stage 3 and the maximum mandibular growth spurt is inconsistent. The diagnostic capability of CVM for the mandibular growth spurt is questionable.

The effect of dental and background facial attractiveness on facial attractiveness and perceived integrity and social and intellectual qualities.

INTRODUCTION: The purposes of this study were to assess the role of dental attractiveness in background facial attractiveness and to evaluate how facial and dental attractiveness influenced raters' opinions of the integrity, social attractiveness, and intellectual attractiveness of the models. METHODS: Photographs of male and female individuals rated by peers as unattractive, average, and attractive were combined with oral images of 4 different levels of dental attractiveness (Index of Orthodontic Treatment Need [IOTN] 1, 5, 7, and 10). Sixty-seven participants meeting the inclusion criteria were recruited as raters. Raters viewed closed-lip smile and open-lip, posed smile of 24 models and rated them for facial attractiveness and integrity and multiple social/intellectual attractiveness dimensions using a Visual Analog Scale. RESULTS: Intrarater reliability was fair to excellent. Analysis of variance showed significant 3-way interactions (P < 0.0001=aim 1; P < 0.005=aim 2) for model sex, facial attractiveness, and dental attractiveness. The contribution of dental attractiveness to facial attractiveness was not fixed or linear, but dependent on dental attractiveness level, background facial attractiveness, and model sex. For both sexes, dental impact on facial attractiveness was neutral or negative when teeth were less than ideal, beginning at IOTN 5 for all background facial attractiveness levels. The impact of dental attractiveness on integrity and social and intellectual attractiveness was also dependent on dental attractiveness level, background facial attractiveness, and model sex. Dental attractiveness can make dramatic differences in Average and Attractive male individuals. CONCLUSIONS: The impact of dental attractiveness on facial attractiveness and integrity and social and intellectual attractiveness was dependent on dental attractiveness level, background facial attractiveness, and model sex. The effect of dental esthetics on facial attractiveness was neutral or negative for both male and female individuals when there was a need for treatment (IOTN 5 or higher) for all levels of facial attractiveness. For both male and female models, lower dental esthetics had a greater effect on more attractive faces. Judgments about integrity and social and intellectual attractiveness were strongly affected by dental esthetics, and these effects were more dramatic and consistent for male faces.

Comparison of digital intraoral scanners and alginate impressions: Time and patient satisfaction.

INTRODUCTION: Recent technological advances have made intraoral scans and digital models a possibility and a promising alternative to conventional alginate impressions. Several factors should be examined when considering an intraoral scanner, including patient acceptance and efficiency. The objectives of this study were to assess and compare patient satisfaction and time required between 2 intraoral scanners and conventional alginate impressions. METHODS: An initial pilot study was completed to create a valid and reliable survey instrument that would measure 3 areas of patient satisfaction with the impression experience. A visual analog scale survey was developed and administered to 180 orthodontic patients receiving 1 of 3 types of impressions: (1) iTero Element intraoral scan (Align Technologies, San Jose, Calif), n = 60; (2) TRIOS Color intraoral scan (3Shape, Copenhagen, Denmark), n = 60; and (3) conventional alginate impression (imprEssix Color Change; Dentsply Sirona, York, Pa), n = 60, and the time required to obtain the impressions was recorded. RESULTS: Reliability was evaluated with intraclass correlation coefficient values for 17 paired questionnaires, and all questions were found to be reliable (intraclass correlation coefficient, ≥0.65). For the main study, 180 subjects completed timed impressions and surveys. Data indicated that subjects receiving intraoral scans preferred the digital impressions, and subjects receiving alginate impressions were neutral regarding impression preference, and that efficiency varied based on the impression method. CONCLUSIONS: Intraoral scanners are accepted by orthodontic patients, and they have comparable efficiency with conventional impression methods depending on the type of scanner.

Objective assessment of the contribution of dental esthetics and facial attractiveness in men via eye tracking.

INTRODUCTION: Recently, greater emphasis has been placed on smile esthetics in dentistry. Eye tracking has been used to objectively evaluate attention to the dentition (mouth) in female models with different levels of dental esthetics quantified by the aesthetic component of the Index of Orthodontic Treatment Need (IOTN). This has not been accomplished in men. Our objective was to determine the visual attention to the mouth in men with different levels of dental esthetics (IOTN levels) and background facial attractiveness, for both male and female raters, using eye tracking. METHODS: Facial images of men rated as unattractive, average, and attractive were digitally manipulated and paired with validated oral images, IOTN levels 1 (no treatment need), 7 (borderline treatment need), and 10 (definite treatment need). Sixty-four raters meeting the inclusion criteria were included in the data analysis. Each rater was calibrated in the eye tracker and randomly viewed the composite images for 3 seconds, twice for reliability. RESULTS: Reliability was good or excellent (intraclass correlation coefficients, 0.6-0.9). Significant interactions were observed with factorial repeated-measures analysis of variance and the Tukey-Kramer method for density and duration of fixations in the interactions of model facial attractiveness by area of the face (P <0.0001, P <0.0001, respectively), dental esthetics (IOTN) by area of the face (P <0.0001, P <0.0001, respectively), and rater sex by area of the face (P = 0.0166, P = 0.0290, respectively). For area by facial attractiveness, the hierarchy of visual attention in unattractive and attractive models was eye, mouth, and nose, but for men of average attractiveness, it was mouth, eye, and nose. For dental esthetics by area, at IOTN 7, the mouth had significantly more visual attention than it did at IOTN 1 and significantly more than the nose. At IOTN 10, the mouth received significantly more attention than at IOTN 7 and surpassed the nose and eye. These findings were irrespective of facial attractiveness levels. For rater sex by area in visual density, women showed significantly more attention to the eyes than did men, and only men showed significantly more attention to the mouth over the nose. CONCLUSIONS: Visual attention to the mouth was the greatest in men of average facial attractiveness, irrespective of dental esthetics. In borderline dental esthetics (IOTN 7), the eye and mouth were statistically indistinguishable, but in the most unesthetic dental attractiveness level (IOTN 10), the mouth exceeded the eye. The most unesthetic malocclusion significantly attracted visual attention in men. Male and female raters showed differences in their visual attention to male faces. Laypersons gave significant visual attention to poor dental esthetics in men, irrespective of background attractiveness; this was counter to what was seen in women.

Gambling Type, Substance Abuse, Health and Psychosocial Correlates of Male and Female Problem Gamblers in a Nationally Representative French Sample.

Many studies carried out on treatment-seeking problem gamblers (PG) have reported high levels of comorbid substance use disorders, and mental and physical health problems. Nevertheless, general population studies are still sparse, most of them have been carried out in the United States or Canada, and gender differences have not always been considered. Thus, the aim of this study was to describe the type of games, and psychological and physical correlates in male and female PG in a nationally representative French sample. The total sample studied involved 25,647 subjects aged 15-85 years, including 333 PG and 25,314 non-problem gamblers (NPG). Data were extracted from a large survey of a representative sample of the French general population. They were evaluated for sociodemographic variables, gambling behavior, type of gambling activity, substance use, psychological distress, body mass index, chronic disease, and lack of sleep. Overall, there were significant differences between PG and NPG in gender, age, education, employment and marital status, substance use disorders (alcohol, tobacco, cannabis, cocaine and heroin), psychological distress, obesity, lack of sleep and type of gambling activity. Although male and female PG had different profiles, the gambling type, especially strategic games, appeared as an important variable in the relationship between gender and problem gambling. This research underlines the importance of considering gender differences and gambling type in the study of gambling disorders. Identifying specific factors in the relationship between gender, gambling type and gambling problems may help improve clinical interventions and health promotion strategies.

[Suicide, mental health and substance uses among French adolescents in 2014]. / Suicide, santé mentale et usages de substances psychoactives chez les adolescents français en 2014.

BACKGROUND: The aim of this study was to describe potential associations between suicidal behaviors and psychoactive substance uses among adolescents. METHODS: A cross-sectional, national survey representative of adolescents aged 17, living in continental France, was conducted in 2014. A total of 22,023 adolescents answered an anonymous, self-administered questionnaire about their health and their use of psychoactive substances. Suicidal risk was assessed by means of a 4-level indicator [1. No depression, as stipulated by the Adolescent Depression Rating Scale (ADRS); 2. Depression, no suicidal ideation, no suicidal attempts; 3. Depression with suicidal ideation; 4. Depression with suicidal attempts]. Multivariate logistic regressions were conducted to identify the factors significantly related to frequent substance uses. RESULTS: Three percent of adolescents (1.8% of boys vs. 3.7% of girls) were labeled as suffering from severe depression, 10% stated they had suicidal thoughts during the last year and 3% attempted to commit suicide at least once in their lifetime. The results support the view of a gradient between suicidal risk severity and regular use of tobacco and cannabis. The association with regular alcohol use appears somewhat weaker. CONCLUSION: Suicidal behaviors and regular substance uses are significantly related but also mediated by adolescents' mental health.

Role of facial attractiveness in patients with slight-to-borderline treatment need according to the Aesthetic Component of the Index of Orthodontic Treatment Need as judged by eye tracking.

INTRODUCTION: Previous eye-tracking research has demonstrated that laypersons view the range of dental attractiveness levels differently depending on facial attractiveness levels. How the borderline levels of dental attractiveness are viewed has not been evaluated in the context of facial attractiveness and compared with those with near-ideal esthetics or those in definite need of orthodontic treatment according to the Aesthetic Component of the Index of Orthodontic Treatment Need scale. Our objective was to determine the level of viewers' visual attention in its treatment need categories levels 3 to 7 for persons considered "attractive," "average," or "unattractive." METHODS: Facial images of persons at 3 facial attractiveness levels were combined with 5 levels of dental attractiveness (dentitions representing Aesthetic Component of the Index of Orthodontic Treatment Need levels 3-7) using imaging software to form 15 composite images. Each image was viewed twice by 66 lay participants using eye tracking. Both the fixation density (number of fixations per facial area) and the fixation duration (length of time for each facial area) were quantified for each image viewed. Repeated-measures analysis of variance was used to determine how fixation density and duration varied among the 6 facial interest areas (chin, ear, eye, mouth, nose, and other). RESULTS: Viewers demonstrated excellent to good reliability among the 6 interest areas (intraviewer reliability, 0.70-0.96; interviewer reliability, 0.56-0.93). Between Aesthetic Component of the Index of Orthodontic Treatment Need levels 3 and 7, viewers of all facial attractiveness levels showed an increase in attention to the mouth. However, only with the attractive models were significant differences in fixation density and duration found between borderline levels with female viewers. Female viewers paid attention to different areas of the face than did male viewers. CONCLUSIONS: The importance of dental attractiveness is amplified in facially attractive female models compared with average and unattractive female models between near-ideal and borderline-severe dentally unattractive levels.

Evaluation of Invisalign treatment effectiveness and efficiency compared with conventional fixed appliances using the Peer Assessment Rating index.

INTRODUCTION: The purpose of this retrospective case-control study was to compare the treatment effectiveness and efficiency of the Invisalign system with conventional fixed appliances in treating orthodontic patients with mild to moderate malocclusion in a graduate orthodontic clinic. METHODS: Using the peer assessment rating (PAR) index, we evaluated pretreatment and posttreatment records of 48 Invisalign patients and 48 fixed appliances patients. The 2 groups of patients were controlled for general characteristics and initial severity of malocclusion. We analyzed treatment outcome, duration, and improvement between the Invisalign and fixed appliances groups. RESULTS: The average pretreatment PAR scores (United Kingdom weighting) were 20.81 for Invisalign and 22.79 for fixed appliances (P = 1.0000). Posttreatment weighted PAR scores between Invisalign and fixed appliances were not statistically different (P = 0.7420). On average, the Invisalign patients finished 5.7 months faster than did those with fixed appliances (P = 0.0040). The weighted PAR score reduction with treatment was not statistically different between the Invisalign and fixed appliances groups (P = 0.4573). All patients in both groups had more than a 30% reduction in the PAR scores. Logistic regression analysis indicated that the odds of achieving "great improvement" in the Invisalign group were 0.329 times the odds of achieving "great improvement" in the fixed appliances group after controlling for age (P = 0.0150). CONCLUSIONS: Our data showed that both Invisalign and fixed appliances were able to improve the malocclusion. Invisalign patients finished treatment faster than did those with fixed appliances. However, it appears that Invisalign may not be as effective as fixed appliances in achieving "great improvement" in a malocclusion. This study might help clinicians to determine appropriate patients for Invisalign treatment.

[How do we catch flu? Beliefs in France in 2010]. / Comment attrape-t-on la grippe ? Les croyances des Français en 2010.

AIMS: Our goals were to describe beliefs held by French people concerning the contagiosity of influenza and analyze the relationship of these beliefs with vaccination against seasonal flu. METHODS: A subsample (4749 people aged 15-79) of the Health Barometer 2010 responded to questions dealing with influenza. Responses were analyzed using clustering analysis and logistic regression. RESULTS: Overall, observed beliefs were quite good, but also socially differentiated. 'False' beliefs were more frequent among people with a lower socioeconomic status. Those who overestimated the contagiosity of influenza were less likely to have been vaccinated against seasonal influenza in 2008. CONCLUSIONS: The beliefs analyzed here were associated with vaccination behaviors. 'False' beliefs may be difficult to change as they are nevertheless coherent. These beliefs also exhibit social inequalities that should be taken into account when determining preventive measures.

Orthodontic informed consent considering information load and serial position effect.

INTRODUCTION: Previous research has demonstrated that current methods of informed consent are relatively ineffective as shown by poor recall and comprehension by adolescent patients and their parents. The purpose of this study was to determine whether adding a short videotape presentation reiterating the issues related to informed consent to a modified informed consent document that emphasizes a limited number of core and patient-specific custom "chunks" at the beginning of an informed consent presentation improved the recall and comprehension of the risks, benefits, and alternatives of orthodontic treatment. A second objective was to evaluate the current related data for recommendable practices. METHODS: Seventy patient-parent pairs were randomly divided into 2 groups. The intervention group (group A) patients and parents together reviewed a customized slide show and a short videotape presentation describing the key risks of orthodontic treatment. Group B followed the same protocol without viewing the videotape. All patients and parents were interviewed independently by research assistants using an established measurement tool with open-ended questions. Interviews were transcribed and scored for the appropriateness of responses using a previously established codebook. Lastly, the patients and parents were given 2 reading literacy tests, 1 related to health and 1 with general content followed by the self-administered demographic and psychological state questionnaires. RESULTS: There were no significant differences between the groups for sociodemographic variables. There were no significant differences between the groups for overall recall and comprehension; recall and comprehension for the domains of treatment, risk, and responsibility; and recall and comprehension for core, general, and custom items. The positional effects were limited in impact. When compared with previous studies, these data further demonstrate the benefit of improved readability and audiovisual supplementation with the addition of "chunking." CONCLUSIONS: There is no benefit to adding a short video to the previously established improved readability and audiovisual supplementation. There is a significant benefit of improved readability and audiovisual slide supplementation with the addition of "chunking" over traditional informed consent methods in terms of patient improvement in overall comprehension, treatment recall, and treatment comprehension. The treatment domain is the most affected.

Contribution of malocclusion and female facial attractiveness to smile esthetics evaluated by eye tracking.

INTRODUCTION: There is disagreement in the literature concerning the importance of the mouth in overall facial attractiveness. Eye tracking provides an objective method to evaluate what people see. The objective of this study was to determine whether dental and facial attractiveness alters viewers' visual attention in terms of which area of the face (eyes, nose, mouth, chin, ears, or other) is viewed first, viewed the greatest number of times, and viewed for the greatest total time (duration) using eye tracking. METHODS: Seventy-six viewers underwent 1 eye tracking session. Of these, 53 were white (49% female, 51% male). Their ages ranged from 18 to 29 years, with a mean of 19.8 years, and none were dental professionals. After being positioned and calibrated, they were shown 24 unique female composite images, each image shown twice for reliability. These images reflected a repaired unilateral cleft lip or 3 grades of dental attractiveness similar to those of grades 1 (near ideal), 7 (borderline treatment need), and 10 (definite treatment need) as assessed in the aesthetic component of the Index of Orthodontic Treatment Need (AC-IOTN). The images were then embedded in faces of 3 levels of attractiveness: attractive, average, and unattractive. During viewing, data were collected for the first location, frequency, and duration of each viewer's gaze. RESULTS: Observer reliability ranged from 0.58 to 0.92 (intraclass correlation coefficients) but was less than 0.07 (interrater) for the chin, which was eliminated from the study. Likewise, reliability for the area of first fixation was kappa less than 0.10 for both intrarater and interrater reliabilities; the area of first fixation was also removed from the data analysis. Repeated-measures analysis of variance showed a significant effect (P <0.001) for level of attractiveness by malocclusion by area of the face. For both number of fixations and duration of fixations, the eyes overwhelmingly were most salient, with the mouth receiving the second most visual attention. At times, the mouth and the eyes were statistically indistinguishable in viewers' gazes of fixation and duration. As the dental attractiveness decreased, the visual attention increased on the mouth, approaching that of the eyes. AC-IOTN grade 10 gained the most attention, followed by both AC-IOTN grade 7 and the cleft. AC-IOTN grade 1 received the least amount of visual attention. Also, lower dental attractiveness (AC-IOTN 7 and AC-IOTN 10) received more visual attention as facial attractiveness increased. CONCLUSIONS: Eye tracking indicates that dental attractiveness can alter the level of visual attention depending on the female models' facial attractiveness when viewed by laypersons.

Minimal-invasive pain procedures are effective in different degenerative pain generators in CLBP: A prospective cohort study.

BACKGROUND: It is estimated that a significant number of spinal surgeries are performed, but many patients do not often benefit. OBJECTIVE: Our aim was to determine how effective minimally invasive pain procedures (MIP) are in chronic low back pain (CLBP) patients with proven degenerative causes (specific low back pain). METHODS: 386 eligible patients with CLBP/sciatica resistant to conservative therapy and scheduled for open surgery were screened, and 167 could be enrolled in this study. Indications for MIP in the remaining 150 individuals were made by one experienced spinal surgeon. Before and 6 months after the intervention, the numeric rating scale (NRS) and Oswestry Disability Index (ODI) were recorded. MIP was performed, such as radiofrequency of the facet and SI-joint, intradiscal electrothermal therapy in case of discogenic pain, as well as epidural neuroplasty in patients with disc herniation/epidural fibrosis. RESULTS: There was a statistically significant decrease in NRS (p< 0.05), as well as a significant increase in ODI (p< 0.001) 6 months after the procedures. This was also true for the results of all different pain generators and subsequent performed procedures alone. CONCLUSIONS: The indication of MIP should be routinely reviewed in patients with CLBP to avoid potentially open surgery and a burden on healthcare costs.

Dramatic change in public attitudes towards vaccination during the 2009 influenza A(H1N1) pandemic in France.

We investigated the potential impact of the 2009 influenza A(H1N1) pandemic on attitudes towards vaccination among people aged 18 to 75 years and living in metropolitan France. We used data from three national telephone surveys conducted on representative samples in 2000, 2005 and 2010 (n=12,256, n=23,931, n=8,573 respectively). In France, unfavourable attitudes towards vaccination in general dramatically increased from 8.5% in 2000 and 9.6% in 2005 to 38.2% in 2010. In 2010, among respondents who held unfavourable attitudes towards vaccination, 50% mentioned specifically their opposition to the influenza A(H1N1) vaccine. The sociodemographic profile associated with these attitudes also changed greatly. In particular, unfavourable attitudes towards vaccination in general became significantly more frequent among less educated people in 2010. These attitudes were also correlated with vaccination behaviours. For example, parents who were unfavourable towards vaccination in general were more likely to report that they had at least one child who did not get the measlesmumps- rubella vaccine. As this shift in attitude may have a significant impact on future vaccination coverage, health authorities should urgently address the vaccine confidence gap.

[Connection between the knowledge of the recommendations of the National Nutrition and Health Program and patterns of eating behaviour and physical activity]. / Associations entre la connaissance des recommandations du Programme National Nutrition Santé et les comportements en matière d'alimentation et d'activité physique.

BACKGROUND: Nutrition education is one of the main lines of the French nutrition policy that has been undertaken for several years. The underlying hypothesis of this approach is that knowledge improvement is one of the ways likely to contribute to health-enhancing diet and physical activity. The objective of this paper, based on the 2008 Health and nutrition Barometer, is to examine the associations observed between knowledge and behavior with regard to diet and physical activity. METHODS: The 2008 Health and nutrition Barometer is a nationally representative telephone survey conducted on 4714 individuals aged 12-75 years. For six recommendations of the National Nutrition and Health Program (Programme national nutrition santé [PNNS]), multiple logistic models were used to identify associations between knowledge of these recommendations and behavior, among adults aged 18-75 years. For food consumed on the day before the interview, odds ratios were adjusted for sex, age, education level, agglomeration size and region. As bivariate analysis showed that income level was significant for recommended consumption of fish, this variable was introduced among adjustment variables. Similarly, the variable occupation was introduced for physical activity. RESULTS: A positive association between knowledge of recommendations and nutritional behavior on the day before interview was observed for fruit and vegetables (OR=1.7), dairy products (OR=1.6), and starchy food (OR=1.6). The same was observed for consumption of fish during the 15 days before the interview (OR=5.0) and for physical activity during a usual week (OR=1.5) but not for the "meat, seafood and eggs" food group. CONCLUSION: Eating habits and physical activity are positively associated with knowledge of nutritional recommendations, mainly acquired via nutritional information and educational actions. Nevertheless, the important differences observed for certain dietary groups between knowledge of recommendations and dietary intake emphasizes the need to further support individual-focused initiatives with health-enhancing environmental strategies.

Efficient interventions on suicide prevention: a literature review.

AIM: This review focuses on interventions to prevent suicide. It excludes psychotherapy evaluations and pharmaceutical clinical trials. The aim of this article is to provide useful input to the reflection on and the development of actions for professionals who may be concerned by suicide prevention. METHOD: This research is based on 41 published evaluation studies presenting results on at least one of the three following outcomes: completed suicides, suicide attempts, and suicidal ideations. These studies have been classified into seven categories of preventive action. RESULTS: According to data from the literature selected for our analysis, the three most efficient categories of intervention seem to be the limitation of access to lethal means, the preservation of contact with the patients hospitalized for a suicide attempt after hospitalization, and the implementation of emergency call centers. The four other categories of intervention examined in this study - the training of general practitioners, the reorganization of care, programs in schools, and information campaigns - have not yet shown sufficient proof of their efficacy. Nevertheless, these interventions, under certain conditions, can also contribute significantly to the prevention of suicide. CONCLUSION: The majority of effective interventions minister to people already suffering from psychological disorders, but health promotion initiatives prior to situations of psychological disorders also deserve to be considered, in particular the implementation of services for the isolated elderly.

[Injuries in France: trends and risk factors]. / Les accidents en France : évolution et facteurs associés.

BACKGROUND: Whatever the type of injury considered, prevention requires an improvement in health services' awareness of risk factors. The Health Barometer is a general population survey conducted in France since 1992 to contribute to surveillance in this field. The survey's statistical power and the numerous health topics included in the questionnaire provide accurate information for healthcare professionals and decision-makers. METHODS: The Health Barometer 2010 was a nationwide telephone survey of 9110 persons representative of the 15-85-year-old population. One part of the questionnaire detailed injuries which had occurred during the past year. The numerous variables recorded enabled application of logistic regression models to explore risk factors related to different types of injury by age group. The findings were compared with the Health Barometer 2005 data to search for temporal trends of injury prevalence. RESULTS: The data analysis showed that 10.3% of the 15-85-year-olds reported an injury during the past year. This rate was higher than recorded in 2005; the increase was mainly due to domestic accidents and injuries occurring during recreational activities. Both type of injury and risk factors exhibited age-related variability. Domestic accidents and injuries occurring during recreational activities predominated in the older population and were associated with physical or mental health problems (chronic disease, diability, sleep disorders). For younger people, injuries were related to cannabis use, drunkedness, and insufficient sleep. Risk factors were also depended on type of injury: occupational accident-related injuries were linked with social disadvantage (manual worker population) whereas sports injuries were more common in the socially advantaged population. CONCLUSION: This survey confirms established knowledge and highlights, at different stages of life, new risk factors that contribute to injuries in France. These findings should be helpful for the development of adapted injury prevention programs, by providing a better understanding of the characteristic features of this major public health issue.

[Insomnia and total sleep time in France: prevalence and associated socio-demographic factors in a general population survey]. / Prévalence et facteurs sociodémographiques associés à l'insomnie et au temps de sommeil en France (15-85ans).

INTRODUCTION: Sleep is considered as a major protective factor for good health and quality of life. The epidemiology of chronic insomnia and other sleep disorders has recently been developed in France. The aim of this study was to evaluate total sleep time and the prevalence of chronic insomnia in the general population aged 15 to 85 years. It was also to investigate factors associated with sleep disorders. METHODS: Within the framework of the Health Barometer 2010, a French general population survey, 27,653 15 to 85-year-old individuals were questioned about their health behaviors and attitudes, in particular about their sleeping time and habits. RESULTS: The average sleeping time of the 15 to 85-year-old was 7 hours 13 minutes. It was higher for women than for men (7 hours 18 minutes vs 7 hours 07 minutes; P<0.001), whereas 15.8 % of the population presented criteria for chronic insomnia, 19.3 % of women and 11.9 % of men (P<0.001). The prevalence of chronic insomnia was stable with age among women, around 19 %, whereas it increased for men from 3 % in the 15-19-year age range to 18 % in the 45-54-year age range, before decreasing to 8 % beyond 65 years. Chronic insomnia was also found to be related to precarious situations and to several difficult events of life such as violence or chronic alcohol abuse, whereas the relationship observed with tobacco smoking was no longer found after logistic regression adjustment for socio-demographic characteristics. Since the beginning of 1990s, a single-question inquiry on "sleeping problems present during the last 8 days" has been asked in the Health Barometer. The rate of subjects concerned increased from 1995, with a prevalence stabilized at a high level since 2000. CONCLUSIONS: Based on these data, we think that the surveillance of sleep disorders is an important public health issue and that prevention and health educational initiatives should be launched in the general population to promote a better quality of sleep.

Fetal reduction of triplet pregnancy: one or two?

OBJECTIVE: To review outcomes following reductions in trichorionic triplet pregnancies at our institution. METHOD: Retrospective analysis of the outcome of trichorionic triamniotic triplets reduced to singletons (group I, n = 44) or twins (group II, n = 136) at 10 and 12 weeks of gestation. RESULTS: Reduction to one or two was based on parent's preference, hence unrelated to any specific obstetrical or maternal issue. Early fetal loss rate (e.g. <24 weeks) was 9.1% in group I versus 5.1% in group II (p = 0.83). In group I, the take-home baby rate was 86.4% versus 91.9% in group II (p = 0.8). In group I, 17.5% of the women gave birth between 33 and 36(+6) weeks of gestation versus 40.6% in group II (p = 0.026). Delivery beyond 37 weeks was 72.5% in group I and 46.9% in group II (p = 0.01). Intrauterine growth restriction rate was 27.0% in group I versus 45.0% in group II (p = 0.049). CONCLUSION: Reduction to one rather than two fetuses led to significantly higher term delivery rate without significant differences in fetal loss rate or take-home baby rate.

Smile characterization by U.S. white, U.S. Asian Indian, and Indian populations.

STATEMENT OF PROBLEM: With growing demand for high esthetic standards, dentists must understand patient perception and incorporate their preferences into treatment. However, little is known about how cultural and ethnic differences influence esthetic perception. PURPOSE: The purpose of this study was to determine whether differences in ethnic background, including the possibility of assimilation, affected a layperson's perception of esthetic and smile characteristics. MATERIAL AND METHODS: A survey was developed containing images that were digitally manipulated into a series of barely perceptible steps, changing 1 smile parameter to form a strip of images that displayed that parameter over a wide range. Data were collected with a customized program which randomly displayed a single image and allowed the subject to use the mouse to adjust an on-screen slider according to displayed instructions, that is, "Please move the slider to select the image you find to be most ideal"; or "Please move the slider to select the first image that you find unattractive." A convenience sample (n=288) comprised of U.S. whites, U.S. Asian Indians, and Indians living in India was surveyed. This sample provided a power of .86 to detect a difference of ±1.5 mm. Subjects evaluated images showing the smile arc, buccal corridor, gingival display, vertical overlap, lateral incisal step, maxillary midline to midface, and maxillary to mandibular midline. Rater reliability was assessed with the Fleiss-Cohen weighted Kappa (Kw) statistic and corresponding 95% confidence interval after each question was repeated in a random sequence. Choice differences due to ethnicity were assessed with a multiple randomization test and the adjusted P value with the step-down Bonferrroni method of Holm (α=.05). RESULTS: The Kw for the 17 variables in all 3 groups ranged from 0.11 for ideal vertical overlap to 0.64 for ideal buccal corridor space. Overall reliability was fair to moderate. Differences attributed to ethnicity were demonstrated between the Asian Indians and U.S. whites. Differences attributed to assimilation were demonstrated between U.S. Asian Indians and Asian Indians. Differences between U.S. Asian Indians and U.S. whites can be instructive and demonstrate the relative power of ethnicity and assimilation. A difference between these groups shows the power of ethnicity and no difference between these groups shows the power of assimilation. The ratings of the Asian Indians and the U.S. whites showed a clinically significant difference for Ideal Buccal Corridor and Maximum Smile Arc. There were no significant differences between the U.S. Asian Indians and Asian Indians. There were clinically significant differences between the U.S. Asian Indians and U.S. whites only for Ideal Buccal Corridor. CONCLUSIONS: Ethnicity had a significant effect on the esthetic choices for Buccal Corridor and Smile Arc. There is no conclusive evidence for assimilation.