The role of insulin therapy and glucose normalisation in patients with acute coronary syndrome.

Patients with acute myocardial infarction (AMI) and diabetes mellitus, as well as patients admitted with elevated blood glucose without known diabetes, have impaired outcome. Therefore intensive glucose-lowering therapy with insulin (IGL) has been proposed in diabetic or hyperglycaemic patients and has been shown to improve survival and reduce incidence of adverse events. The current manuscript provides an overview of randomised controlled trials investigating the effect of IGL. Furthermore, systematic glucose-insulin-potassium infusion (GIK) has been studied to improve outcome after AMI. In spite of positive findings in some early studies, GIK did not show any beneficial effects in recent clinical trials and thus this concept has been abandoned. While IGL targeted to achieve normoglycaemia improves outcome in patients with AMI, achievement of glucose regulation is difficult and carries the risk of hypoglycaemia. More research is needed to determine the optimal glucose target levels in AMI and to investigate whether computerised glucose protocols and continuous glucose sensors can improve safety and efficacy of IGL.

Prevalence and distribution of selected occlusal characteristics in the US population, 1988-1991.

The inclusion of occusal traits as part of the oral health component of the Third National Health and Nutrition Examination Survey, Phase 1, 1988-91, provided an opportunity to assess several occlusal characteristics in the US population: diastema > or = 2 mm, alignment of lower and upper anterior teeth, posterior crossbite, overbite, and overjet. Household questionnaires asked whether the individual had ever received orthodontic treatment. Prevalence of clinical measures of occlusal characteristics and orthodontic treatment was estimated for over 7,000 sample persons from 8 to 50 years of age, representing approximately 150 million non-institutionalized people in the United States. These findings present the first estimates of occlusal status of the US non-institutionalized population in more than 25 years. Eight percent of the population had severe overbite of 6 mm or more. The average overbite was 2.9 mm. Maxillary diastemas > or = 2 mm were observed in 19% of 8-11-year-olds, 6% of 12-17-year-olds, and 5% of adults 18-50 years old. Twenty-five percent and 22% of persons had zero mm of malalignment in maxillary and mandibular incisors, respectively. Conversely, 11% and 15% of persons had 6 mm or more displacement of maxillary and mandibular molars, respectively. Posterior crossbite affects less than 10% of this population, and less than 10% had overjet of 6 mm or more. Non-Hispanic black adults had the least amount of malalignment in mandibular incisors. Three times as many non-Hispanic blacks compared with non-Hispanic whites and Mexican-Americans had diastemas > or = 2 mm. Comparisons with published data from the National Health Examination Survey (1966-70) indicated a 20% increase of 12-17-year-olds with overbite in the normal range (0-3 mm). Almost 20% of adults ages 18-50, as well as 18% of children, have had orthodontic treatment.

Ethnicity and the pain experience.

The first objective of this investigation was to examine interethnic differences and similarities in the reported pain experience of Black, Irish, Italian, Jewish and Puerto Rican facial pain patients. Responses, attitudes and descriptions were found to be relatively similar after controlling for most variables shown by previous studies to influence reported pain experience. These variables include symptom history, signs elicited on physical, radiographic and laboratory examination, as well as social, cultural and psychological data. A thirty-five item scale was employed to measure patients' pain experience. Using analysis of variance and covariance, no significant interethnic differences were found for twenty-three (65.7%) of the items. The majority of the twelve items for which interethnic differences were found concerned the patients' emotionality (stoicism vs expressiveness) in response to pain, and interference in daily functioning attributed to pain. The pain experiences reported by the Black, Italian and Jewish patients were found most similar as measured by the twelve items. Irish and Puerto Rican patients appeared relatively distinct from the other groups as well as from each other. The second objective of this study was to identify particular variables that influence intraethnic variation in the pain experience. These were determined by multiple regression analysis of two summary indices previously derived by factor analysis of the thirty-five items. The specific variables which were most influential differed according to ethnicity, as follows: degree of medical acculturation for Black patients; degree of social assimilation for Irish patients; duration of pain for Italian patients; and level of psychological distress for Jewish and Puerto Rican patients. Thus, it appears that, in our study population, interethnic homogeneity is present for most aspects of the pain experience, while intraethnic heterogeneity exists for factors that may influence that experience. That is, the five ethnic groups were generally found to be similar in their reported responses to pain. Yet, each group was quite different with regard to factors which influence the responses.

International distribution of dental materials publications and patents.

International patterns of research and development in the field of restorative dental materials were examined with data on publications (1981-85) and patents (1979-88). It was found that United States-based authors produced approximately one-half of all dental materials journal articles published worldwide, while US inventors had nearly the same share of the US dental materials patents. During the periods studied, the share of US patents in dental materials awarded to US inventors declined, while the share of US patents awarded to Japanese inventors rose. The role of the United States in research (as measured by journal articles) remained stable. Nations differed in the degree to which their researchers specialized in particular research areas. US-based authors and inventors were relatively over-represented in prosthetic materials and under-represented in dental cements, an area in which the British and the Japanese concentrated more of their activity. There was some, but not complete, agreement in the patterns of national specialization as indexed by patent and publication data. When dental materials data were compared with data for broader fields of science and technology, important differences were found. For publications, US-based authors displayed greater dominance in dental materials than in the fields of dentistry, chemistry, and materials science. US-based inventors' share of US dental materials patents was smaller than their share of all US patents. These analyses demonstrated that it was possible to use indicators derived from publication and patent data files to conduct insightful studies of a discrete specialty of science and technology.

Aspects of illness behavior in patients with facial pain.

Results of recent studies have suggested that factors other than clinical signs and symptoms have a significant role in determining whether people seek treatment for perceived facial pain and mandibular dysfunction. The concept of "illness behavior" can be used to investigate this problem. Knowledge of a patient's illness behavior patterns helps enable the dentist to understand who seeks care for symptoms of facial pain and mandibular dysfunction; why the care is sought; the meaning of the symptoms to the patient; and the patient's response to treatment.

Burning mouth syndrome: an update.

Though it has been the subject of much research, burning mouth syndrome--a chronic oral-facial pain condition that affects many U.S. adults--remains poorly understood. It has been associated with numerous oral and systemic conditions. Treatment options frequently include various medications. While patients with symptoms of BMS are more likely to seek care from physicians, dentists should be involved in the evaluation and management of these patients.

Biopsychosocial factors of the temporomandibular pain dysfunction syndrome. Relevance to restorative dentistry.

The biomedical and psychological models have failed to provide reliable diagnostic or treatment methods for TMPDS. A social dimension that combines salient physical and psychological data is an improvement over previous approaches to the problem. This article shows how biopsychosocial data can be applied to patients with TMPDS.

Contribution of women dentists to dental research.

Since the mid-1960s, the number of women in dentistry in the USA has increased dramatically, including women in dental research. Their attraction to the dental profession is motivated by the following factors: the desire to be a part of the delivery of health care in the community; independence and the opportunity to develop individual expression of career goals; and a career that is compatible with the demands of a family. There is every indication that the proportion of women in dental research will continue to increase in the next decade.

Hyperglycemia at admission and during hospital stay are independent risk factors for mortality in high risk cardiac patients admitted to an intensive cardiac care unit.

AIMS: Hyperglycemia is associated with increased mortality in cardiac patients. However, the predictive value of admission- and average glucose levels in patients admitted to an intensive cardiac care unit (ICCU) has not been described. METHODS: Observational study of patients admitted to the ICCU of a tertiary medical center in whom glucose levels were measured at and during admission. Over a 19-month period, 1713 patients were included. Mean age was 63±14 years, 1228 (72%) were male, 228 (17%) had known diabetes. Median (interquartile) glucose levels at admission were 7.9 (6.5-10.1) mmol/l; median glucose levels during ICCU admission (873 patients with three or more measurements) were 7.3 (6.7-8.3) mmol/l. Cox regression analysis was performed including the variables age, gender, admission diagnosis, length of stay, prior (cardio)vascular disease and diabetes. RESULTS: A 1 mmol/l increase in admission glucose level (above 9 mmol/l) was associated with a 10% (95% confidence interval (CI): 7 -13%) increased risk for all-cause mortality. A 1 mmol/l higher average glucose level (above 8 mmol/l) was an additional independent predictor of mortality (HR 1.11, 95% CI: 1.03 - 1.20). At 30 days, 16.8% (97/579) of the patients with an admission glucose level in the highest tertile (>9.8 mmol/L) had died vs 5.2% (59/1134) of those with a lower admission glucose level. CONCLUSION: In a high risk ICCU population, both high admission glucose levels as well as high average glucose levels during hospitalization were independently associated with increased mortality, even when accounting for other risk factors and parameters of disease severity.

Total NIH support to US dental schools, 2005-2009.

This study compared total NIH research funding across US dental institutions from 2005 to 2009. Utilizing the online NIH RePORT, we obtained comprehensive award data for US dental schools by funding NIH Institutes/Centers (ICs). Fifty dental schools were awarded a total of $974.393 million, 69.3% from NIDCR and 30.7% from 21 other ICs. These provided the majority of support to 12 schools. Greater than 50% of non-NIDCR support came from 4 ICs. The median dental school NIH portfolio was $14.572 million, with a minimum of $0.241 million and a maximum of $88.609 million. Forty-six schools received $544.899 million for R01 awards. Thirty-five schools were awarded $100 million in research training and career development grants. Several dramatic differences are found for dental schools' rankings based on total NIH dollars compared with NIDCR-only support. Dollars from ICs other than NIDCR increased 34.6% between 2005 and 2009. Grants to US dental institutions comprised 50% or less of total NIDCR awards globally from 2005 through 2009. Funds received from all NIH ICs are an objective metric for evaluation of the research performance of dental schools. NIDCR has played a diminishing role in funding research at US dental schools between 2005 and 2009.

The Dentist Scientist Award program and prosthodontics.

The Dentist Scientist Award (DSA) program was started by the National Institute of Dental Research (NIDR) in 1984 to prepare dentists for careers as clinical research scientists who would be highly skilled investigators and potential leaders in the full scope of oral health research. The DSA program provides support for dentists to undertake 5 years of intensive preparation in a course of study that includes basic and clinical science components integrated with a supervised research experience. From 1984 to 1994, the NIDR has invested +66.1 million dollars in the individual and institutional Dentist Scientist Award programs. Almost 250 people have been or are involved now in the DSA career development activity. Men comprise 72% of the recipients and women 28%.

Research evaluation and policy in dental public health.

Decision and policy makers in dental public health are confronted increasingly with the problem of which programs make the best use of limited resources and are the most worthwhile investments. One way that the research and public health community can assist the decision process and thereby facilitate policy development is through rigorous, objective, quantitative, policy-oriented research evaluations that synthesize findings from relevant epidemiologic studies of particular oral conditions and clinical trials of preventive and treatment technologies. Issues covered in the most recent research evaluations of oral health topics include the assessment of cost-effectiveness analyses for various procedures and techniques used in caries prevention and oral cancer screening. Several papers in the dental public health literature also have critically discussed basic methodologic issues involved in performing cost-effectiveness analyses and implications of research evaluations for the development and assessment of oral health policy.

Predictors of treatment outcome in patients with myofascial pain-dysfunction syndrome and organic temporomandibular joint disorders.

A total of 46 variables were initially examined for their usefulness as predictors of treatment outcome in patients with facial pain diagnosed as either MPDS or an organic disorder, such as disease of the TMJ (for example, degenerative joint disease or inflammatory arthritis) or typical facial neuralgia. The information about each variable was collected from the patients prior to beginning of treatment. Data included sociocultural background, social group attitudes, sociomedical orientation, level of psychologic distress, symptoms and treatment history, behavioral and attitudinal responses to pain, and clinical findings. Two discriminant analyses were performed to determine the most important variables for predicting whether a patient would respond successfully (with either elimination of or significant decrease in pain) or unsuccessfully (no change or increase in pain) to conservative reversible treatment. The first analysis was used to reduce the original group of 46 variables to 18 variables, which were labelled "potential" predictors. In the first analysis it was noted that clinical factors, such as oral status and physical examination findings, were irrelevant for predicting treatment outcome. Of the 16 clinical variables initially included for analysis, only the presence of clenching was included as a potential predictor. Patients' psychologic status, as measured by their level of psychologic distress, was also not relevant. The greatest number of potential predictors was related to patients' sociocultural background, sociomedical orientation, symptom and treatment history, and behavior in response to and attitudes toward pain. These factors, then, appear to be more useful than clinical and physical data as indicators of the potential response of facial pain patients with either MPDS or organic TMJ deficits to treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of patients with temporomandibular joint and other facial pain by otolaryngologists.

By virtue of referral patterns, the otolaryngologist is in a position to be of considerable influence in the treatment of numerous patients with facial pain. In a facial pain clinic, the 525 consecutive patients seen could be classified into groups: myofascial pain dysfunction syndrome (52.9%); degenerative arthritis of the temporomandibular joints (16.6%); trigeminal neuralgia (15.3%); and a variety of other pain syndromes (15.2%). The most frequent types of health professionals contacted were, in decreasing order, dentists, general medical practitioners, otolaryngologists, and neurologists. The greatest number of consultations with all physicians resulted in either no treatment or referral. This was most common among otolaryngologists, and least among dentists and neurologists. Specific treatment, when provided, varied by specialty.

Illness behavior, depression and anhedonia in myofascial face and back pain patients.

Levels of depression, anhedonia, and illness behavior, as well as clinical and demographic variables, were measured in two groups of patients with chronic pain, one with facial, the other with back pain. For the total sample, significant correlations (p less than 0.01) were found between illness behavior and pain estimate (r = 0.30), anhedonia and depression (r = 0.33), and pain estimate and pain duration (r = 0.31). Facial pain patients showed illness behavior most strongly related to estimate of pain severity (r = 0.62); back pain patients showed illness behavior significantly related to depression (r = 0.59). Results also show that the physical site of pain relates to illness behavior but not mood of chronic pain patients.

Facial pains and anxiety levels: considerations for treatment.

The data presented in this article question the traditional beliefs in the dental literature about the relationship between facial pain and anxiety. The findings have important implications for treating individuals with any of the IFP syndromes.