The effects of systemic proteolytic enzyme therapy on pain and swelling in third molar surgery equal to diclofenac therapy: a prospective randomized double blinded clinical trial.

OBJECTIVE: The aim of this study was to determine if the timing of administration of systemic enzyme therapy [SET] has any effect on its efficacy in controlling postoperative sequelae of third molar surgery. STUDY DESIGN: A double blinded prospective randomized control trial was planned. The sample included patients requiring impacted mandibular third molar surgical extraction. Patients were randomly allocated to four groups (50 patients per group). Group A included administration of SET 48 h prior to surgery; Group B, started on the day of surgery; Group C started immediately after surgery and control group D included NSAIDS started 3 h after surgery. The predictor variable was timing of administration of SET. The primary outcome variables were pain and swelling measured on 1st day, 5th day, and 7th day after surgery. FINDINGS: Groups A and D reported lower mean and median VAS scores and lesser swelling than groups C and D on postop day 1. On days 5 and 7, all four groups were comparable. On overall analysis, no statistically significant difference (p > 0.05) was evident. INTERPRETATION: The results of the study showed that the differences in swelling and pain with starting the SET 2 days before, on the day of surgery, or immediately after when compared with diclofenac was not statistically significant. TRIAL REGISTRATION: CTRI Registration Number CTRI/2018/03/012502.

Is dermis fat arthroplasty better than plain gap arthroplasty? A prospective randomised controlled trial.

The aim of the study was to compare interpositional arthroplasty using a dermis fat graft with gap arthroplasty in the management of ankylosis of the temporomandibular joint (TMJ). We organised a prospective randomised study of 22 patients who presented with ankylosis of the TMJ. They were randomised to be treated with either plain gap arthroplasty or dermis fat arthroplasty, and the predictor variable was the method of treatment. The primary outcome variables were mouth opening and pain on jaw exercises. Pain and interincisal opening were measured on day 5, day 14, at the end of one month, and at six months, one year, two years, and three years. There was a significant difference between the two groups on two occasions: postoperative day 5 (p=0.013) and at one year (p=0.018). The mean (SD) scores for mouth-opening were higher in the dermis fat group at all times (41.20 (4.69) mm compared with 39.50 (2.46) mm in gap arthroplasty at two years, and 41.40 (3.60) mm compared with 38.9 (2.02) mm at three years). The visual analogue pain scores were also lower in the dermis fat graft group. The groups showed similar results at the end of three years follow up, with no significant difference in mouth opening. We conclude therefore that the two techniques have similar outcomes in the management of ankylosis of the TMJ.

New protocol to prevent TMJ reankylosis and potentially life threatening complications in triad patients.

The management of patients with the triad of temporomandibular joint (TMJ) ankylosis, micrognathia and obstructive sleep apnea syndrome is challenging for the oral and maxillofacial surgeon because it involves achieving the desired oral opening, correction of micrognathia, and correction of the obstructed airway. Seven of the authors' triad patients, in whom only the release of ankylosis was performed, developed bradycardia and respiratory distress during postoperative jaw physiotherapy, leading to their non-compliance for active jaw physiotherapy and subsequent reankylosis. This paper suggests a new surgical protocol for the management of patients with the triad, to achieve correction of the obstructed airway, relief of the respiratory distress symptoms, correction of micrognathia and restricted mouth opening. It also provides a logical reason for the occurrence of bradycardia following ankylosis release and its potential role in TMJ reankylosis. It emphasizes that the occurrence of bradycardia in triad patients during jaw exercises is dictated by the severity of their apnea-hypopnea index and the degree of narrowing of their posterior airway space. The recognition and prevention of this by the new protocol is discussed in 7 patients.

Medpor in maxillofacial deformities: report of three cases.

OBJECTIVE: This paper deals with the usefulness and versatility of the porous high-density polyethylene implants for correction of various facial deformities as an augmentation and an onlay graft material with its advantages. MATERIALS AND METHODS: Prefabricated porous high-density polyethylene implants were used in three patients (post-trauma facial deformity, Goldenhar syndrome, nasal deformity in cleft patient) for secondary reconstruction of orbital floor, depressed nose and supra-orbital ridge, augmentation of hypoplastic mandible and depressed nasal dorsum under general anaesthesia. RESULTS: Good esthetic results were achieved in all the three patients treated with porous high-density polyethylene implants with no complications. CONCLUSION: Porous high-density polyethylene alloplastic implant is an excellent biomaterial for reconstruction of various facial deformities with many advantages over autogenous and other alloplastic materials.

Equivalencies regarding the measurement and constructs of self-esteem and major life events in an Asian/Pacific islander sample.

Construct, scalar, and functional measurement equivalencies of the Rosenberg Self-Esteem Scale (RSES) and Major Life Events checklist (MLE) and the constructs assessed were investigated across groups differentiated on Hawaiian/part-Hawaiian and non-Hawaiian (e.g., Caucasian, Filipino, Hispanic, Japanese, and mixed/2 or more) ethnicity and gender. Initial results from maximum likelihood factoring with promax rotation showed that RSES negatively worded Item 5 loaded with the positively worded Items 1, 2, 4, 6, and 7 on 1 of 2 factors for Hawaiian/part-Hawaiian female participants. Similarly, negatively worded Item 8 and the same positively worded items comprised 1 of 2 factors for non-Hawaiian male participants. For the other 2 Ethnicity x Gender groups, factors were respectively comprised of the 5 positively and 5 negatively worded RSES items. Construct equivalence or simple (2-factor) structure underlying the RSES was indicated across the 4 groups after Items 5 and 8 were excluded from a subsequent factoring procedure. Simple structure showed that Factor 1 comprised the positively worded Items 1, 2, 4, 6, and 7, and the remaining negatively worded Items 3, 9, and 10 loaded on Factor 2. Scalar equivalence of the self-esteem and major life events measures was supported by the statistical nonsignificance of the Major Life Events x Ethnicity x Gender interaction effect in multiple regression models. The consistency in the absolute size and direction of the intercorrelations between overall self-esteem, self-esteem Factors 1 and 2, and major life events variables indicated the functional equivalence of respective measures and constructs assessed. Measurement equivalency findings concerning the RSES and MLE, the constructs measured, and their utility versus caution against their use in multiethnic studies were discussed.

Risk and protective factors related to native Hawaiian adolescent alcohol use.

The present study examined protective and risk factors in the prediction of alcohol use for Hawaiian and non-Hawaiian (i.e. Caucasian, Japanese, Filipino, 'other') adolescents. Comparable rates of approximately 25% were found for both the Hawaiian and non-Hawaiian samples regarding sometimes drinking too much alcohol. However, Hawaiians reported a statistically significantly higher rate (3.7%) of taking 'a drink in the morning to steady my nerves or to get rid of a hangover' than non-Hawaiians (1.3%). The reason for this is unknown but might indicate a higher rate of dependent alcohol use. The overall results supported the traditional model of protective and risk factors predicting alcohol use (R(2) > 15.0%), with relatively few differences found between the two ethnic groups. Further research is needed in assessing possibly unique cultural variables such as Hawaiian acculturation.

Sociocultural and community factors influencing the use of Native Hawaiian healers and healing practices among adolescents in Hawai'i.

Recently, there has been much emphasis placed on both alternative approaches to health care and the provision of culturally competent care. Despite these trends, few studies have examined the use of alternative therapies on the part of adolescents. Even fewer studies have been done focusing on traditional Hawaiian approaches to health care. This is essential, especially in Hawai'i, where Hawaiians have not attained health parity with other majority ethnic populations, despite significant efforts and funding to achieve this end. This study examines the sociocultural and community factors influencing the use of traditional Native Hawaiian healers and healing practices by adolescents in Hawai'i. The Hawaiian High Schools Health Survey was administered at five high schools on three islands in Hawai'i during the 1993-1994 school year. The sample included 1,321 high school students who preferred either an allopathic or alternative practitioner. Ethnicity, gender, community access, healer preference, health status, level of education, and health insurance status were used to predict healer use and participation in healing practices. Community access and healer preference predicted both healer use and participation in native healing practices. Mental health predicted healer use (i.e., seeing a Native Hawaiian healer in the past six months), but did not predict taking part in native healing practices, such as ho'oponopono and lomilomi. Hawaiian ethnicity, female gender, and a measure of health insurance predicted participation in native healing practices, but not healer use. These results suggest that native healing practices and traditional healers are being used in Native Hawaiian communities and this is perhaps not due to a lack of health insurance. Given the general separation between Western and Native Hawaiian health services, traditional healing practices should be made available in Native Hawaiian communities to see whether a collaboration between Western practitioners and traditional healers can have a greater positive impact on the health of Native Hawaiians, particularly for adolescents.

Prediction of anxiety disorders using the state-trait anxiety inventory for multiethnic adolescents.

The purpose of this study was to determine the validity of the State-Trait Anxiety Inventory (STAI) in predicting DSM-III-R anxiety disorders based on the Diagnostic Interview Schedule for Children (DISC, Version 2.3) and using Asian/Pacific Islander adolescents. An overall prevalence rate of 9.19% for generalized anxiety disorder, overanxious disorder, or social phobia was consistent with past studies. As hypothesized, STAI negatively worded (i.e., Factor 2) items were better predictors than positively stated (i.e., Factor 1) items. The STAI State mean was a better predictor of concurrent DISC anxiety disorders as compared to STAI State Factors I or 2. In contrast, the STAI Trait Factor 2 (negatively worded) composite was the best predictor for nonconcurrent DISC anxiety disorders as compared to STAI Trait Factor 1 or the overall STAI Trait subscale. Satisfactory predictive-validity values were obtained when using the STAI State mean and Trait Factor 2 composite. Implications of these findings are discussed, including using the STAI as a screening measure for ethnically diverse adolescents.

Prediction of DISC substance abuse and dependency for ethnically diverse adolescents.

PURPOSE: This study examines the validity of selected items from the Substance Abuse Subtle Screening Inventory-Adolescent (SASSI-A) version in predicting Diagnostic Interview Schedule for Children (DISC version 2.3) Substance abuse and dependency (SA/D) for Native Hawaiian (i.e., indigenous people of the Hawaiian Islands) and non-Hawaiian adolescents (youth without any Native Hawaiian indigenous ancestry). METHODS: 542 students were randomly selected from the larger sample to participate in the DISC administration. Demographic information, SASSI-A scores, and DISC diagnoses were obtained for each student. Univariate and multiple logistic regressions were performed in the prediction of DISC SA/D. RESULTS: SASSI-A Factor 1, consisting of three items measuring substance use, was found to have the best utility, accounting for 18.1% of the variance, in predicting DISC SA/D. IMPLICATIONS: These results support selected SASSI-A items in screening for SA/D for Native Hawaiian and non-Hawaiian adolescents in Hawaii as compared to other community-based screening instruments for other populations.

Sociocultural factors influencing adolescent preference and use of native Hawaiian healers.

OBJECTIVE: Few studies have examined the use of alternative therapies among adolescents. This study examines the predictors of Native Hawaiian healer preference in the treatment of physical or emotional problems as well as the predictors of healer use. DESIGN: This study is a longitudinal cross-sectional design. SETTING: The survey was conducted in five high schools in Hawai'i. PARTICIPANTS: 1,322 high school students selected preference for and/or use of allopathic or alternative practitioners. MAIN OUTCOME MEASURES: Grade level, gender, ethnicity and cultural identity were used to predict healer preference. Healer preference, socioeconomic status and health status were used to predict healer use. RESULTS: Identification with the Hawaiian culture was the strongest predictor of healer preference for both Hawaiian and non-Hawaiian adolescents. Mental health was also predictive of healer preference for non-Hawaiians. Healer use by Native Hawaiian adolescents was also predicted by Hawaiian cultural identity. Gender, grade level, and socioeconomic variables were not predictive of healer preference or use. CONCLUSION: Cultural identity plays a significant role in the preference and use of alternative practitioners, especially for minority adolescent populations.

Psychometric properties of the Hawaiian Culture Scale--Adolescent Version.

This article reports on the psychometric properties of a newly constructed Hawaiian Culture Scale--Adolescent Version. A total of 2,272 Native Hawaiian and 1,170 non-Hawaiian adolescents were administered this 50-item inventory that measures the source of learning the Hawaiian way of life, how much Hawaiian beliefs are valued and important to maintain, how much non-Hawaiian beliefs are valued, Hawaiian blood quantum, and specific cultural traditions (seven subscales = Lifestyles, Customs. Activities, Folklore, Causes-Locations, Causes-Access, and Language Proficiency). The results strongly supported the internal consistency and validity of the measures for both the Hawaiian and non-Hawaiian groups. On the basis of the demographic data, partial support was offered for cross-cultural theories of ethnic identity. More consistent support was found for multiculturalism in Hawai'i's adolescents. Further research is needed to link these measures with indicators of psychological adjustment (e.g., depression, anxiety, substance use).

Cumulative effect of family environment on psychiatric symptomatology among multiethnic adolescents.

PURPOSE: To examine the influence of family adversity and support on levels of psychiatric symptomatology in Hawaiian and non-Hawaiian adolescents. METHOD: More than 4000 students from five high schools in Hawaii completed a survey during the 1992-1993 school year about their family environment and mental health. The response rate was approximately 60%. Logistic regression analyses were performed and responses for Hawaiians and non-Hawaiians were compared. RESULTS: Hawaiian adolescents experienced significantly more adversity than their non-Hawaiian counterparts. The cumulative effect of family adversity had a greater effect on psychiatric symptomatology than any single indicator. Family support reduced the risk for internalizing symptoms, particularly for Hawaiian adolescents. The influence of family support was less clear for externalizing symptoms, increasing the risk for some adolescents and decreasing the risk for others. CONCLUSION: We identified strong associations between family adversity and levels of psychiatric symptomatology. We found that Hawaiian adolescents are at increased risk for psychiatric symptomatology, given the presence of family adversity and the effect of reduced family support. However, risk was also substantial for non-Hawaiians. Clinicians need to assess the family environment routinely and implement family-oriented interventions.

Psychometric properties of the state-trait anxiety inventory for Asian/Pacific-islander adolescents.

Anxiety disorders are said to be universal across all cultures and recent reviews have found relatively high prevalence rates across different countries. However, the experience and interpretation of anxiety are strongly influenced by cultural factors. Demonstrating cross-cultural equivalence of measures of anxiety is essential to assure that comparisons between cultures will result in meaningful interpretations. Despite the State-Trait Anxiety Inventory being the most researched of anxiety measures from a cross-cultural basis, there is a lack of empirical studies on the psychometric properties of the STAI with adolescent Asian/Pacific Islanders. The present study examined the STAI using a large sample of ethnically diverse high school students in Hawaii. In general, a four-factor model (State-Anxiety Absent, State-Anxiety Present, Trait-Anxiety Absent, and Trait-Anxiety Present) provided the best fit based on a series of confirmatory factor analyses. Indicators of internal consistency supported the reliability of the factors and subscales, and the inter-factor correlations reflected positively on the concurrent validity of the different STAI factor and subscale measures. This study suggested cautious use and interpretation of one particular item (Trait Item 14 = I try to avoid facing a crisis or difficulty ), and cautious application of the STAI to Filipino adolescents (particularly Filipino males). Domains for further research are discussed.

Prediction of major depression and dysthymia from CES-D scores among ethnic minority adolescents.

OBJECTIVE: The Native Hawaiian Mental Health Research Development Program is an epidemiological longitudinal study of adolescents residing in Hawaii. This article examines the utility of the Center for Epidemiologic Studies-Depression Scale (CES-D) for predicting DSM-III-R diagnoses of major depression (MD) and dysthymic disorder (DD) and investigates whether prediction differs by gender and ethnicity. METHOD: Diagnostic Interview Schedule for Children interviews were conducted with 556 adolescents randomly selected from among more than 7,000 students who had completed the CES-D. RESULTS: Six-month prevalence rates were as follows: MD = 8.5%, DD = 4.7%, either (MDDD) = 9.9%. Prevalence rates were significantly higher among females, but after CES-D scores were accounted for, gender no longer predicted depression in most analyses. When a cutoff score of 16 was used, classification accuracy was lower for Native Hawaiians than non-Hawaiians. However, after group differences in gender and grade level were accounted for, the predictive validity of the CES-D did not differ by ethnicity. CES-D factor 1 scores identified MD, DD, and MDDD about as well as the total score or all three factors together. CONCLUSIONS: These results support the validity of the CES-D for screening for depression among adolescents of Native Hawaiian and other minority backgrounds.

Depressive symptoms among Filipino American adolescents.

Minority ethnic status has been found to be related to higher levels of depressive symptoms among adolescents and adults. The present study examined the rates of depressive symptoms (as measured by the Center for Epidemiologic Studies Depression Scale: CES-D Scale) of 270 Filipino American adolescents residing in rural and small-town areas of Hawaii. CES-D scores were compared with scores of a White group, and no ethnic differences were found. Compared with Filipino males, Filipino females were found to have higher CES-D scores, with higher mean scores on the majority of the CES-D items. The few Filipino students who reported attempting suicide had moderately high to very high levels of reported depressive symptoms. Lack of ethnic differences may be due to Hawaii's unique cultural mix, where there is no single "majority group" and a high rate of cultural interaction.

Intergroup similarities in judgements of psychiatric symptom severity.

Researchers have stated that racial/ethnic groups, even if residing in the same locale, differ substantially in their judgments of the severity of psychiatric symptoms. Severity was defined as the degree to which a symptom would lead to the belief that the person manifesting the symptom had some form of mental disturbance or psychological problem needing treatment. Research participants residing in Hawaii's, varying in sex, age, educational level, and ethnicity, rated the severity of 49 psychiatric symptoms. All groups were in close agreement with one another in their severity ratings, suggesting that group differences in beliefs may be far less than had been claimed.

Psychiatric symptoms in offspring of within vs. across racial/ethnic marriages.

A large number of adolescents of interracial ancestry (parents comprising various combinations of African-American, American Indian/Alaska Native, European-American, Chinese, Filipino, Hispanic, Japanese, Korean, Puerto Rican, Samoan, and Tongan ancestry) were contrasted with a monoracial European-American sample in the degree to which they reported symptoms of depression, anxiety, conduct disorder/aggression, and substance abuse. The adolescents of interracial ancestry were subdivided into three groups in terms of parental ancestry: both parents of interracial ancestry, one parent of interracial and the other of monoracial ancestry, and both parents of monoracial but different ancestries. The interracial ancestry groups did not differ significantly from one another or from the European American sample in terms of symptom scores.

Psychosocial risk and protective influences in Hawaiian adolescent psychopathology.

A large community sample of adolescents of a Native Hawaiian (Asian/ Pacific Islander) minority group was studied along with a small comparison group of non-Hawaiians, for the relationship between psychopathology (as measured by standard symptom scales) and (a) perceived support from family and friends, and (b) discussing problems with others. Expected gender patterns for friend support but not for family support were found. The Hawaiian boys appeared atypical, reporting nearly equal family support as Hawaiian girls. Discussing problems with another person was correlated with lower anxiety and depression scores but not aggression and substance abuse scores. It is concluded that gender and cultural factors influence symptom prevalence and severity as well as the impact of psychosocial risk factors.

Psychiatric symptoms of Hawaiian adolescents.

The purpose of this study was to examine the interrelationship of depressive symptoms with symptoms of anxiety, aggression, and substance abuse in Native Hawaiian adolescents. A total of 1,819 Native Hawaiian students were recruited from three high schools as part of the initial phase of an ongoing, 4-year, longitudinal, cross-sequential study. Psychiatric symptoms were measured with the Center for Epidemiological Studies-Depression Scale (CES-D), Spielberger's State Anxiety Inventory (SAI), Braver Aggression Dimension Scale (BADS), and Substance Abuse Subtle Screening Inventory-Abbreviated (SASSI-A). Scales were standardized for this minority population. Depressive symptoms were strongly associated with symptoms of anxiety and aggression but only weakly associated with self-reported substance abuse. Girls had substantially higher scores than boys on all scales. Ninth graders reported more aggressive symptoms than did 12th graders. The educational level of the adolescent's main caregiver was not associated with symptoms reported in any of the scales. Native Hawaiian adolescents report similar symptoms and symptom clusters as do adolescents on the mainland U.S. However, Native Hawaiian adolescent girls report a greater number of symptoms in all categories when compared to boys. This distinguishes them from most mainland adolescent populations.

Oral submucous fibrosis: a new concept in surgical management. Report of 100 cases.

Oral submucous fibrosis (OSF) is a collagen disorder commonly seen in the Indian subcontinent. A series of 100 patients is presented. All lesions were biopsied. The condition was staged into four categories. Very early and early cases were treated by local injection of triamicinolone acetonide, while advanced cases were treated by surgical intervention. A new surgical technique of a palatal island flap based on the greater palatine artery in combination with temporalis myotomoy and bilateral coronoidectomy was used in 35 cases. A follow-up ranging from 6 months to 31/2 year showed good results.