Put more "bite" into health promotion: a campaign to revitalize health promotion in the Army Dental Care System. Part I. The mouthguard, sealant, and nursing caries initiatives.

During the course of 1998, the Army Dental Care System launched "Put More 'Bite' into Health Promotion," a campaign to revitalize health promotion in the Army Dental Care System. In this paper, we discuss the content, rationale, and evidence base for three of five health promotion initiatives that are part of the campaign: mouthguard fabrication and counseling, sealant placement and education, and nursing caries education.

Dental health promotion and preventive dentistry practices of U.S. Army dentists.

In May 1997, all Army dentists assigned full-time to clinical duties (1,100) were sent a mail survey that queried how often they deliver dental health promotion and preventive dentistry services and the type and source of their patient educational materials. By August, 606 dentists had responded. Simple frequencies were generated using SPSS. Results show that tobacco, oral hygiene, and periodontal counseling and oral cancer and blood pressure screening are delivered frequently, whereas nursing caries, mouthguard, sealant, and nutrition services are delivered infrequently. Army dentists relied almost exclusively on oral presentations to deliver health promotion messages. Few used more than one source for health promotion materials. These results suggest that the delivery of dental health promotion and preventive dentistry services in the Army is suboptimal. A campaign to heighten provider awareness of the importance of delivering these services should be launched. The campaign should also teach providers how to make their health promotion efforts maximally effective through the application of proven health marketing techniques.

Estimated cost of dental treatment for active duty and recruit U.S. military personnel.

This paper estimates the cost of restoring U.S. military personnel to optimal oral health. The data come from a 30-site oral health survey of Army, Navy, Marine Corps, and Air Force personnel conducted from February 1994 to January 1995. A systematic random sample of 2,711 recruits was drawn. From a prestratified, random sample of 15,924 active duty personnel, 13,050 (82% response rate) participated in the survey. Applying their best clinical judgment, one dentist per site charted comprehensive dental treatment needs on each service member. Radiographs were used. After the samples were weighted to reflect the 1994 population of recruits (202,144) and active duty personnel (1,699,662), treatment costs were calculated applying median fees reported by U.S. general dentists in 1995. Results show total estimated costs of $1.9 billion for active duty personnel and $203 million for recruits. Periodontal disease accounts for the greatest proportion (47%) of active duty treatment costs, and oral surgery accounts for the greatest proportion (32%) of recruit treatment costs. The cost of restoring U.S. service members to optimal oral health is substantial.

Put More "Bite" into Health Promotion: a campaign to revitalize health promotion in the Army Dental Care System. II. The cancer initiatives.

During the course of 1998, the Army Dental Care System launched Put More "Bite" into Health Promotion, a campaign to revitalize health promotion in the Army Dental Care System. In this paper, we discuss the content, rationale, and evidence base for one of five health promotion initiatives that are part of the campaign: lip, oral, and skin cancer screening and counseling.

U.S. service members' satisfaction with family dental care.

This paper reports on U.S. service members' satisfaction with family dental care. The data come from a 26-site survey of active duty Army, Navy, Marine, and Air Force personnel conducted from April 1994 to January 1995. Of 12,050 respondents (81% response rate) to a prestratified, random sample, 4,412 had at least one child younger than age 21 or a nonmilitary spouse and answered 16 questions on satisfaction with family dental care. We derived simple distributions and an overall composite satisfaction score using factor analysis. Composite scores, transformed into a continuous variable with a mean of 100 and a standard deviation of 10, were regressed on respondent demographic and other factors to determine which factors influence overall satisfaction. Descriptive results show high satisfaction with family dental care. Regression results show that overall satisfaction varies with sex, branch of service, perceived barriers to dental care, and family dental insurance status. Because this survey was conducted before the change to the current dental insurance contractor, these findings may not reflect current service members' satisfaction with family dental care.

Impaired microvascular vasoconstrictive responses to vasopressin in septic rats.

OBJECTIVE: To evaluate mechanisms of vasodilation in sepsis by comparing responses of resistance arterioles to vasopressin in rat cremaster muscle of septic and control rats. DESIGN: Prospective, experimental study. SETTING: Experimental animal laboratory. SUBJECTS: Twenty male rats, anesthetized with ketamine and acepromazine. INTERVENTIONS: Topical superfusion of vasoactive compounds on skeletal muscle resistance arterioles. MEASUREMENTS AND MAIN RESULTS: The effect of sepsis on responses to local application of vasopressin was investigated using in vivo videomicroscopy. Vasopressin was superfused topically on the cremaster muscle resistance arterioles (15 to 25 microns) of rats made septic by cecal ligation and puncture, and the responses were compared with the responses of controls that underwent sham ligation. Responses to topically suffused vasopressin were also assessed in septic and control rats, before and after superfusion of the muscle with the nitric oxide synthase inhibitor NG-methyl-L-arginine (NMA). Sepsis produced a decrease in the vasoconstrictive effects of vasopressin; the maximal response was lower, and the concentration-response curve was shifted to the right in septic rats (p < .05). Contractions at vasopressin concentrations of 0.01, 1, and 10 nM were 39%, 36%, and 40%, respectively, of sham controls. Superfusion of the muscle with NMA partially restored arteriolar responsiveness in the septic rats, significantly increasing the arteriolar constriction of the septic rats in response to vasopressin. This effect was reversed with superfusion of excess L-arginine (1 mM). CONCLUSIONS: This study illustrates the reduced responsiveness of the resistance arterioles of septic rats in response to vasopressin in vivo, and the partial restoration of responsiveness by concurrent application of NMA. In previous studies using this model, we have shown similar results using norepinephrine and endothelin-1, as well as angiotensin II. These findings, and the findings of this study, suggest a generalized abnormality in responsiveness of resistance arterioles to endogenous vasoconstrictors in sepsis. Partial reversal of this abnormality with NMA supports an important role for nitric oxide in mediating abnormal vasopressor responsiveness in sepsis.

Nitric oxide synthase inhibition reverses arteriolar hyporesponsiveness to endothelin-1 in septic rats.

Persistent vasodilation refractory to vasopressor agents is the hemodynamic abnormality characteristic of septic shock. Induction of nitric oxide synthase (NOS) by sepsis-induced cytokines has been hypothesized to play a pathogenetic role in this refractory vasodilation. To evaluate the mechanism of vasodilation in sepsis, we used in vivo videomicroscopy to measure responses of resistance arterioles (15-20 microm) to topical suffusion of the potent vasoconstrictor, endothelin-1 (ET-1), in rat cremaster muscle. Rats made septic by cecal ligation and puncture were compared with controls that underwent sham ligation. Responses to topically suffused ET-1 were assessed in septic and control rats before and after superfusion of the muscle with the NOS inhibitor N(G)-monomethyl-L-arginine (L-NMMA). Sepsis produced a decrease in ET-1-induced vasoconstriction; the ET-1 concentration-response curve was shifted to the right in septic rats (P < 0.05). Contractions at ET-1 concentrations of 1, 10, and 100 nM were 20, 28, and 32%, respectively, of sham controls. Superfusion of the muscle with L-NMMA restored arteriolar responsiveness to ET-1 in the septic rats, significantly increasing arteriolar constriction at 1 and 10 nM. This effect was reversed with superfusion of excess L-arginine (1 mM). This study demonstrates that impaired vasoconstriction in response to ET-1 in resistance arterioles of septic rats in vivo is reversed by NOS inhibition. Taken together with previous studies showing sepsis-induced impairment of vasoconstriction with norepinephrine, a vasopressor with a mechanism of action different from ET-1, these findings suggest a generalized abnormality in the responsiveness of resistance arterioles in sepsis. Reversal of hyporesponsiveness to both of these vasopressor agents by NOS inhibition suggests an important role for nitric oxide as a mediator of refractory vasodilation in sepsis.

Cardiac endothelin release and infarct size, myocardial blood flow, and ventricular function in canine infarction and reperfusion.

BACKGROUND: The potent vasoconstrictor endothelin-1 (ET) may play an important pathophysiologic role in acute myocardial infarction, but its precise effects are incompletely understood. The purpose of this study was to evaluate the interrelationships between cardiac ET-1 release and infarct size, myocardial blood flow, and ventricular function. METHODS: Fifteen closed chest dogs underwent 3 hours of coronary artery occlusion followed by 3 hours of reperfusion. Coronary sinus and aortic ET-1 levels during occlusion and after reperfusion were determined by radioimmunoassay. Left ventricular function and regional myocardial blood flow were measured by echocardiography and colored microspheres, respectively. Myocardial infarct size was determined by postmortem staining with blue dye and triphenyl tetrazolium chloride. RESULTS: Coronary occlusion and reperfusion produced significant elevations of coronary sinus ET-1 (p < 0.05) and cardiac ET-1 release (p < 0.05), and a trend toward an increase in aortic ET-1 (p = 0.08). A trend toward more ET-1 release was observed in dogs with larger infarcts (p = 0.06), and in dogs with substantial no-reflow in the reperfused territory (p = 0.05). Endothelin-1 release also was associated with increased contractility in nonischemic myocardial segments (p = 0.002), and ET-1 correlated with increased global left ventricular function (p < 0.02). CONCLUSIONS: In this canine model of coronary occlusion and reperfusion, greater increases in cardiac ET-1 release were observed in dogs with larger infarcts, and increased ET-1 release was associated with the no-reflow phenomenon in the reperfused territory. These data suggest that ET-1 release may have adverse consequences in acute myocardial infarction, including a reduction of myocardial blood flow in the reperfused zone after reperfusion and increased contractility in nonischemic myocardium.

Workers' perceptions of discrepancies between chronological age and personal age: you're only as old as you feel.

A large manufacturing organization was surveyed to determine whether workers perceive discrepancies between their chronological ages and the ages they "feel" themselves to be. A substantial proportion (61.5%) of the sample did report such discrepancies. Feeling "younger than one's years" was reported significantly more frequently than feeling "older than one's years"; the mean magnitude of discrepancies was 5.6 years. However, age of respondent affected both the magnitude and the direction of perceived discrepancies. Younger respondents were more likely to perceive themselves as older than their chronological ages, and older respondents were more likely to report that they felt themselves to be younger than their chronological ages. The implications of these observations for the understanding and measurement of subjective age and other age-related variables is discussed.