Social environmental factors in Japan affecting the development of proper eating behaviors.

This article summarizes issues related to myofunctional disorders/dysphagia and focuses upon social and economic changes within Japanese culture affecting eating habits and behaviors in children. The authors suggest that unfavorable environmental factors negatively impact upon the acquisition of mastication and swallowing behaviors. The article includes discussion of prior research. Studies indicate that decreased observation of early childhood eating habits, dietary changes with regard to higher consumption of fast food and changes within the family, i.e. busy work schedules, decrease in family mealtimes, combine to incur negative change with regard to orofacial function.

The effectiveness of orofacial myofunctional therapy in improving dental occlusion.

The most significant findings of this study definitively establish the beneficial effects of orofacial myofunctional therapy on improving dental occlusion, decreasing dental open bite, and decreasing dental overjet. The results reported are actually quite conservative because of the method of measuring. Measuring and recording every tooth unquestionably dilutes the results which would have been achieved if only the anterior teeth had been used in the calculations. Some may question the small millimeter change as being significant. The change is reflective of the overall relative value change of incorporating all teeth within the dental arches and not limiting the analysis to only the anterior teeth. The secondary findings of the study confirm that age is not necessarily a factor in predicting success of a therapy program. Further, this study indicates that improvement of open bite and overjet can result from OMT without prior or concurrent orthodontic intervention. Orofacial myofunctional therapy, from a public health standpoint, is a classic form of primary prevention to improve the overall health and well-being of the individual. The end result of OMT therapeutic programs is the establishment of new neuromuscular patterns, correction of functional and resting postures, correction of chewing/swallowing/feeding patterns and elimination of deleterious behaviors. Stabilization and maintenance of therapeutic goals become part of the lifelong learning and change process. Orofacial myofunctional therapy utilizes knowledge and skills acquired through multidisciplinary education and training. Licensed professionals, from dental hygiene, dentistry, speech pathology, medicine, nursing, and other allied health professions with advanced education and training in orofacial myofunctional therapy have demonstrated expertise in providing collaborative, integrated, and interdisciplinary primary care. Reference to earlier research works and anecdotal reports of ineffectiveness unfortunately perpetuate and reinforce the dichotomous quandary of form and function. Instead, recognition of the interrelationship of form and function, as conjoint fundamental processes, would encourage more pro-active patient referrals for orofacial myofunctional therapy services. This would allow the specialty area of orofacial myology to further validate the effectiveness of OMT on tooth movement in a positive, collaborative, and beneficial manner. Acknowledging the small sample size in this study may encourage other clinicians to conduct future research in this area. Additional research is needed on the physiologic adaptive capacity of the orofacial environment. Developmental aspects of orofacial and jaw neurophysiology, especially in children, are scant in the literature. Treatment recommendations for specific dental malocclusions are based on many factors. Each malocclusion classification presents opportunity for OMT research. A major research dilemma for the practicing clinician is the moral and ethical responsibility of providing treatment when dysfunction is diagnosed. Designing a study and identifying a "control group" is difficult due to the unethical aspect of knowingly withholding therapy when the benefits are statistically proven and available. A study design using the sample as its own control can infer and demonstrate validity. The next logical test is replication of this study to determine the level of reliability. This issue of the I.J.O.M. addresses the effectiveness of orofacial myology treatment in improving speech articulation, eliminating digit sucking, and improving dental occlusion. It is time the professions of dental hygiene, dentistry, medicine, and speech pathology move forward and acknowledge current substantive research and literature that supports the philosophies of prevention, early interception (intervention), and corrective treatment. The dark ages of disbelief only remain dark as long as we forget to turn on the light. (ABSTRACT TRU

Analysis of adverse effects among patients with essential hypertension receiving an ACE inhibitor or a beta-blocker.

Evaluation of safety and efficacy of new drugs is based largely on data from clinical trials involving a limited number of patients. This approach does not necessarily detect the rare adverse events that may only be observed when very large numbers of patients are studied. Consequently, we designed a double-blind 12-week trial comparing the new angiotensin-converting enzyme (ACE) inhibitor, quinapril (n = 5,053), with a well-established beta-adrenergic receptor blocker, metoprolol (n = 506). Essentially hypertensive patients (diastolic blood pressure 95-114 mm Hg) received either 10 mg quinapril or 50 mg metoprolol once daily, and the doses were doubled at 4-week intervals to a maximum of 40 and 200 mg, respectively, in nonresponders. Responder rates were similar under both regimens. Adverse events were assessed by interview as well as by a standard questionnaire. The overall prevalence of adverse events reported by standard questionnaire was higher than that reported spontaneously during interviews. With respect to typical ACE inhibitor adverse reactions (e.g. cough and taste disturbances), there was no difference between quinapril and metoprolol independent of the mode of reporting. In summary, both drugs showed comparable overall tolerance and safety. The discrepancy between spontaneously reported and questionnaire-reported adverse events was noteworthy, and this finding prevailed in a volunteer group of 327 patients who were treated with quinapril for 52 weeks. Thus, a questionnaire is of great significance in addition to the patient history/interview in a large-scale, double-blind study designed to learn about details of drug safety.

[Gynecologic examination: perceptions, fears and expectations of polyclinic patients]. / Die gynäkologische Untersuchung: Empfindungen, Befürchtungen und Erwartungen von Poliklinikpatientiennen.

OBJECTIVE: What kind of expectations, desires and fears do patients have concerning the pelvic examination, and is it possible to improve the procedure? METHODS: We asked 1,061 women of our gynecological outpatient clinic using a questionnaire. RESULTS: 48% said that the pelvic examination caused no problem at all, while nearly every third patient felt tense and uncomfortable. 75% of the women wanted explanations during the examination, which had to be carried out in the absence of a third person in 46%. The same percentage said that it did not matter. 53% had no preference of gender concerning the examiner, 37% preferred a female doctor and 10% gave preference to a male one. CONCLUSIONS: The pelvic examination, which is mainly associated with reluctance and discomfort of the patient, does not seem to be experienced like this by almost half of our patients. It is easily possible to ameliorate the procedure, for example by explaining the findings during the examination and by complying with the gender preferences of the patients as much as possible.