Colorado dental practitioners' attitudes and practices regarding tobacco-use prevention activities for 8- through 12-year-old patients.

BACKGROUND: Tobacco use is a leading risk factor for oral morbidities and mortalities such as oral cancers and periodontitis. This study characterizes the factors related to dentists and hygienists conducting tobacco-use prevention counseling with 8- through 12-year-old patients. METHODS: The study used a mailed survey of dentists (n = 434), orthodontists (n = 91) and hygienists (n = 160) practicing in Colorado to collect data on the practitioners' tobacco-use prevention counseling activity, demographic characteristics, barriers to counseling and attitudes toward tobacco use. The authors used multiple logistic regression to determine which variables were associated independently with a dental practitioner's counseling children. RESULTS: The response rate was 25.6 percent. Prevalence of tobacco-use prevention counseling for children was low (38 percent for dentists and 44 percent for hygienists). Among dentists, the perception of tobacco use in children as a problem, perceived effectiveness of counseling and perceived role of a dental practitioner in counseling children were associated positively with counseling. Lack of skills was associated negatively with counseling. Among hygienists, perceived role in counseling children was associated positively and lack of time was associated negatively with counseling. CONCLUSIONS: Few dental practitioners counsel 8- through 12-year-old patients about tobacco use. Factors related to counseling appear to be amenable to education of dentists, in particular, regarding the importance of the problem, the effectiveness of counseling and skill development. CLINICAL IMPLICATIONS: Preventing tobacco use among children is integral to promoting patients' oral health. Training dentists through continuing education should increase the frequency of tobacco-use prevention counseling with children by both dentists and hygienists.

Recombinant human activated protein C reduces human endotoxin-induced pulmonary inflammation via inhibition of neutrophil chemotaxis.

Recombinant human activated protein C (rhAPC) is a natural anticoagulant with potentially important anti-inflammatory properties. In humans with severe sepsis, rhAPC treatment reduces mortality, but mechanisms responsible have not been well characterized. Accumulation of activated neutrophils in the lungs and other organs during severe infection contributes to sepsis-induced organ dysfunction, including acute inflammatory lung injury. Because neutrophils express an APC receptor, we hypothesized that immunomodulatory effects of rhAPC occur, in part, via modulation of neutrophil responses. To examine this issue, we performed a double-blinded, placebo-controlled study of rhAPC in a human model of endotoxin-induced pulmonary inflammation. Administration of rhAPC significantly reduced leukocyte accumulation to the airspaces, independent of pulmonary cytokine or chemokine release. Neutrophils recovered from bronchoalveolar lavage fluid of volunteers receiving rhAPC demonstrated decreased chemotaxis ex vivo. Decreased neutrophil chemotaxis following exposure to rhAPC was confirmed in vitro. No differences were detected in gene expression, kinase activation, cytokine release, cell survival, or apoptosis of neutrophils recovered in the presence or absence of rhAPC. These studies demonstrate that rhAPC reduces both endotoxin-induced accumulation of leukocytes in the airspaces and neutrophil chemotaxis. These rhAPC-induced effects on neutrophil function may represent a mechanism by which rhAPC improves survival in patients with sepsis.