Predictors of Unmet Dental Health Needs in US Adults in 2018: A Cross-Sectional Analysis.

OBJECTIVE: To identify predictors of unmet dental needs for adults 18 y of age or older in the United States. METHOD: Using the Aday and Andersen framework and data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), we ran logistic regression to estimate predictors for adults of not having a dental visit within 5 y and having lost any teeth using a national sample of 155,060 survey respondents. RESULTS: Results showed that predisposing factors (age, race/ethnicity, gender, and educational attainment) and enabling factors (income and health insurance status) are important predictors for losing teeth due to decay or gum disease. Men, the elderly, and less educated and low-income residents were less likely to have seen a dentist within the past 5 y and more likely to have lost their permanent teeth. Compared to non-Hispanic White adults, Hispanics adults were more likely to have had a dental visit within the past 5 y. Unmet dental needs varied across states. People living in states with extensive Medicaid dental care benefit coverage were less likely to lose their teeth and more likely to have had a dental visit within the past 5 y. CONCLUSION: Efforts to improve oral health should address unmet dental needs of men and adults with low socioeconomic status. Studying the variation between state oral health care programs could further our understanding of how public policy can improve population oral health. KNOWLEDGE TRANSFER STATEMENT: Men, non-Hispanic Blacks, mixed and other race minorities, and low socioeconomic status adults are most at risk of unmet dental needs. States can address these needs by expanding Medicaid coverage for adults.

Region-specific age at onset of beta-amyloid in dogs.

Cortical patterns of beta-amyloid (Abeta) deposition were evaluated in 40 beagle dogs ranging in age from 2 to 18 years. Abeta deposition in the prefrontal, occipital, parietal and entorhinal cortices was visualized by using an antibody against Abeta1-42. A logistic regression was used to estimate differences in age-at-onset and rate of deposition of Abeta as a function of brain region. The earliest and most consistent site of Abeta deposition with age was in the prefrontal cortex. Entorhinal Abeta deposition was not consistently observed until the age of 14 years, but was present in a subset of dogs under the age of 14 years. These regional vulnerabilities to Abeta accumulation are similar to those seen in the aging human. By using parameters derived from regression analyses, it may be possible to predict the presence of Abeta within specific brain regions in individual dogs. We propose that these models will be a useful tool to evaluate interventions that delay the age of onset or slow the rate of accumulation of Abeta in the dog.

Gender comparisons of cognitive performances among vascular dementia, Alzheimer disease, and older adults without dementia.

BACKGROUND: We hypothesized that women with Alzheimer disease (AD) would perform worse on a test of semantic memory but not on tests of other cognitive domains. We did not expect that women without dementia would perform more poorly than men without dementia on the same task. OBJECTIVE: To explore the specificity of a semantic memory deficit among women with AD by exploring gender differences among a group of subjects with vascular dementia (VD). DESIGN: A case-control study in which differences between men and women were explored using regression models to control for the potentially confounding effects of age, education, duration of dementia, and severity of dementia. SETTING: Alzheimer's Disease Research Center Consortium of Los Angeles and Orange Counties, California. SUBJECTS: Volunteers, recruited from the community or clinic referrals, who met clinical criteria for AD (n = 159) or VD (n = 117) or met criteria for control status without dementia (n = 134). MAIN OUTCOME MEASURES: Five neuropsychological measures, commonly used in the diagnosis and assessment of dementia. RESULTS: Women with VD scored lower than men with VD on 3 tests. However, when controlling for potential confounds, the gender difference was maintained only for the semantic memory task. Women with AD showed a strong trend to perform worse than men with AD on the test of semantic memory only. No gender differences were found among subjects without dementia. CONCLUSIONS: Findings support the existence of a semantic memory deficit for women with AD and suggest that a similar deficit may exist among women with VD.

Initiation and propagation stages of beta-amyloid are associated with distinctive apolipoprotein E, age, and gender profiles.

Several recent studies have defined a relationship between apo-lipoprotein E (apoE) genotype and the risk of various neurodegenerative disorders. However, few studies have examined the influence of apoE on quantitative measures of beta-amyloid (Abeta) accumulation in a large population of autopsy cases. Using a multi-level analysis model, the interrelationships among apoE genotype, gender, age, and Abeta accumulation were investigated. In the population of these cases, there was a strong relationship between the presence of an epsilon4 allele and extent of Abeta in the frontal and entorhinal cortex. That is, when evaluating the presence or absence of significant Abeta (>1% Abeta load), subjects with one and two epsilon4 alleles were 1.9 and 3.5 times more likely to have significant Abeta accumulation than those with no epsilon4 alleles. These risks increased by a multiplicative factor of 1.014 for each year of age (at the time of death). In the subset of cases with significant Abeta (>1% Abeta load), the degree of Abeta load was best predicted by the presence of an epsilon2 allele and gender; females with no epsilon2 alleles had the highest Abeta loads (mean=12.3%), while males with one epsilon2 allele had the lowest amount of Abeta accumulation (mean=8.6%). Our results suggest that the presence of an epsilon4 allele predicts an earlier onset of Abeta deposition that is independent of gender. In contrast, once Abeta deposition has been initiated, the presence of an epsilon2 allele is associated with slower rates of accumulation, with males benefiting from the protective effect more than females.

Ishihara test performance and dementia.

Ishihara trail-tracing (TT) and number-naming (NN) tests were administered to a clinical sample of 378 demented patients. Error counts on TT and NN tests were best fit by a negative binomial (overdispersed Poisson) distribution. TT, NN, and combined (TT + NN) error counts were regressed on patient characteristics (sex, age, and education), severity of cognitive impairment (Mini-Mental State Exam: MMSE), dementia stage (Clinical Dementia Rating: CDR), etiology, onset age, and symptom duration in a negative binomial generalized linear model. Patient characteristics, onset age, and symptom duration had no significant effects on any error count. The effects of MMSE, CDR, and etiology, on the other hand, were highly significant and appear to help discriminate vascular dementia from Alzheimer's disease. MMSE (which taps cognitive skills) correlated with both TT and NN errors. CDR (which taps both cognitive and functional skills) correlated only with TT errors and dementia etiology correlated only with NN errors. These distinct correlational patterns reflect differences between the TT and NN tasks (i.e., trail-tracing vs. number-naming) related to specific brain loci and associated functions. This aspect of the phenomenon suggests that Ishihara tests have useful clinical applications in dementia.

The spring peak in suicides: a cross-national analysis.

This study evaluates the relative influence of social vs bioclimatic factors on cross-national variation in the magnitude of spring suicide peaks. Time series and cross-sectional data for 28 countries are analyzed using bivariate plots and simple correlation. Suicide seasonality (both overall and specifically as manifest by the presence of a sizeable spring peak) is positively correlated with seasonality in other kinds of social activity (measured in this study by the proportion of national work forces engaged in agriculture). However, only populations in the temperature zone exhibit suicide seasonality, suggesting some contextual influence from geographical latitude.

A life course theory of suicide risk.

The three distinct suicide cycles reported since the late 19th century have been explained using sociological and biological theories. Despite their obvious differences, both theories operate through motivation. Like other aspects of suicide, however, such cycles can also be explained by opportunity. Analysis of recent findings on age- and sex-specific suicide cycles illustrates a fundamental confound of motivation and opportunity, and underscores the need for a theory of suicide that is based on risk (risk = motivation x opportunity), and that is situated in a framework of age- and sex-specific life course contingencies.

Test-retest reliability of reciprocal isokinetic knee extension and flexion peak torque measurements.

Our purpose in conducting this study was to estimate the reliability of reciprocal concentric knee extension and flexion peak torque obtained in uninjured male athletes using the Biodex isokinetic dynamometer. Twenty-six male intercollegiate athletes (age=19.5+/-4.1 yr; ht=70.3+/-14.9 in; wt=212.9+/-48.5 lb) participated in this study. We used the Biodex to measure peak torque occurring during right knee extension and flexion over 3 consecutive days. Means and standard deviations were calculated for both extension and flexion on each of the 3 days. We observed a significant main effect for days for both extension and flexion. Mean peak torque for the first day was significantly higher (Turkey, p<.05) than the means for the other 2 days, which were not significantly different from each other (Turkey, p>0.05). Intraclass correlation coefficients (ICCs) were estimated for each of the six trials on each of the 3 days. Intraclass correlation coefficients (ICCs) ranged from .88 on trial 1, day 1 for both extension and flexion peak torque to .97 for extension peak torque and .98 for flexion peak torque on day 3, trial 6. The standard error of measurement for extension peak torque was 7.0 ft-lbs and for flexion peak torque was 3.0 ft-lbs. These results indicate that reliable measurements of reciprocal right knee extension and flexion peak torque can be obtained from uninjured male athletes with the Biodex isokinetic dynamometer.

Higher trait- and state-anxiety in female law students than male law students.

To assess sex differences in anxiety, law students completed the State-Trait Anxiety Inventory prior to rating one-panel printed comics for humor level or copying text. Subjects completed the State-Anxiety subscale following the task. Although the humor-rating task was not more effective in reducing state anxiety than the copying task, scores on the anxiety subscales indicated that women law students scored consistently and significantly higher than men on both pretask measures and on the posttask measure. This finding is consistent with results from other studies in which other instruments were given. Analyses showed elevated anxiety and stress among preprofessional women; this supports the need for stress-management programs for law students.

Fornix damage enhances successive, but not simultaneous, object-discrimination learning in cats.

The purpose of this study was to compare the effects of fornix lesions with the deficits known to follow septum lesions in cats learning visual object discriminations. In Experiment 1 when eight cats with aspiration lesions of the fornix performed successive discrimination problems, acquisition was greatly facilitated, but first- and second-reversal scores were normal by comparison with eight normal cats and two operated corpus callosum-control cats without fornix damage. Four corpus callosum-damaged cats with secondary degeneration in the medial fornix also learned the initial problem faster than normals. In Experiment 2 in a simultaneous paradigm, eight cats with fornix lesions scored like five normal controls, although they perseverated in early stages of reversal problems. The authors hypothesize that medial fornix damage, in contrast with septum lesions, enhances both initiation and maintenance of response inhibition.

How a regression artifact makes ICFs/MR look ineffective.

Based on a simple matched-control group quasi-experiment, Conroy (1996) concluded that small ICFs for persons with mental retardation have negative quality-of-life impacts. Our analysis of Conroy's design suggests, in contrast, that the reported effect is a pure regression artifact. The flaw in Conroy's design is selecting a control group on the basis of pretest matching. Although selecting a subsample of controls by matching on static characteristics such as age or gender can reduce the confounding influence of these variables, selection on the basis of pretest scores leads invariably to a large, spurious effect. The literature on this issue dates back a century, with warnings against pretest matching by Galton, Thorndike, McNemar, Stanley, Campbell, Cronbach, and Cook. We reviewed this historical literature and then used a Monte Carlo experiment to estimate the spurious effect that Conroy would observe from pretest matching alone. The magnitude of the artifact is as large as the quality-of-life reduction that Conroy attributed to the effects of living in an ICF. We discussed the methodological logic involved in matching and the broader policy issues raised by this evaluation.

Age- and sex-specific cycles in United States suicides, 1973 to 1985.

Total US suicides peak on the first day of each week, in the first week of each month, and in the late spring of each year. Although these cycles are assumed to characterize all US suicides, analyses by age and sex show that the cycles occur only in a few subpopulations. Day-of-the-week effects are found almost exclusively in middle-aged suicides; day-of-the-month effects are found almost exclusively in elderly male suicides; and month-of-the-year effects asre found almost exclusively in teenaged and elderly suicides.

Full-information models for multiple psychometric tests: annualized rates of change in normal aging and dementia.

The rates of change for five widely used psychometric tests were analyzed to compare how much more variance reduction can be achieved using full-information methods relative to the single-equation methods previously used in dementia research. Nondemented controls and subjects with Alzheimer disease (AD), probable/ possible vascular dementia (VD), or mixed dementia (MD) were evaluated. A cohort design was followed, with follow-up of three demented groups and one normal control group; data were analyzed in a multiple-equation regression model estimated with full-information methods. The study was conducted at Alzheimer's Disease Research Center sites at the University of California, Irvine, and at the University of Southern California. In all, 226 patients and controls who had completed initial assessment and at least one annual reassessment were included in the study. Dependent variables were annualized rates of change in the Mini-Mental State Examination (MMSE), the Short-Blessed Dementia Rating Scale (DRS), the Consortium to Establish a Registry for Alzheimer's Disease drawings test (CD), the WAIS-R Block Design test (WRB), and the Boston Naming Test (BNT). Independent variables were dementia severity, diagnosis (AD, VD, MD, or control), sex, age, marital status, education, and age at onset. Full-information methods reduced the variance in the change scores by > or = 25% compared with previous studies. The model's prediction of a test's rate of change was almost entirely due to dementia stage and diagnosis. The effects of other explanatory variables (sex, marital status, age, and education) were weak and statistically insignificant. When the effects of other independent variables were controlled, AD and MD patients were found to decline at significantly faster rates than VD patients. Full-information methods, relative to single-equation methods, substantially reduce the variance of rates of change for multiple psychometric tests. They do so by simultaneously considering the correlated error terms in the regression for each dependent psychometric change score variable. The robustness of these results to minor variations in follow-up time suggests that annualization is a reasonably valid procedure for making change scores comparable. This study's results suggest that change scores in psychometric tests provide information that can be used to aid differential diagnosis. However, the large variances of change scores preclude many other uses. Finally, since standardization of psychometric change scores translates all tests to the same scale (0-100%), standardized change scores are easier to interpret. The analysis of standardized change scores deserves further investigation.