Rumination, gender, and depressive symptoms associated with caregiving strain in bipolar disorder.

OBJECTIVE: To evaluate the associations between indices of caregiving strain, ruminative style, depressive symptoms, and gender among family members of patients with bipolar disorder. METHOD: One hundred and fifty primary caregivers of patients enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) participated in a cross-sectional study to evaluate the role of ruminative style in maintaining depressive symptoms associated with caregiving strain. Patient lifetime diagnosis and current episode status were evaluated by the Affective Disorder Evaluation and the Clinical Monitoring Form. Caregivers were evaluated within 30 days of the patient on measures of family strain, depressive symptoms, and ruminative style. RESULTS: Men and women did not differ on depression, caregiver strain, or ruminative style scores. Scores suggest an overall mild level of depression and moderate caregiver strain for the sample. Greater caregiver strain was significantly associated (P<0.05) with rumination and level of depressive symptoms, controlling for patient clinical status and demographic variables. Rumination reduced the apparent association between strain and depression by nearly half. Gender was not significantly associated with depression or rumination. CONCLUSION: Rumination helps explain depressive symptoms experienced by both male and female caregivers of patients with bipolar disorder. Interventions for caregivers targeted at decreasing rumination should be considered.

Correlates of subjective and objective burden among caregivers of patients with bipolar disorder.

OBJECTIVE: We examined the relationship between mood symptoms and episodes in patients with bipolar disorder and burden reported by their primary caregivers. METHOD: Data on subjective and objective burden reported by 500 primary caregivers for 500 patients with bipolar disorder participating in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) were collected using semistructured interviews. Patient data were collected prospectively over 1 year. The relationship between patient course and subsequent caregiver burden was examined. RESULTS: Episodes of patient depression, but not mood elevation, were associated with greater objective and subjective caregiver burden. Burden was associated with fewer patient days well over the previous year. Patient depression was associated with caregiver burden even after controlling for days well. CONCLUSION: Patient depression, after accounting for chronicity of symptoms, independently predicts caregiver burden. This study underscores the important impact of bipolar depression on those most closely involved with those whom it affects.

Stability of skeletal Class II correction with 2 surgical techniques: the sagittal split ramus osteotomy and the total mandibular subapical alveolar osteotomy.

Combined orthodontic and surgical treatment of severe Class II dentoskeletal deformities with the use of the bilateral sagittal split ramus osteotomy is a routine procedure in orthodontic practices. However, an alternative surgical technique, the total mandibular subapical alveolar osteotomy, could be used for the same purpose. The aim of this investigation was to compare the stability of the sagittal split ramus osteotomy with the total mandibular subapical alveolar osteotomy in the correction of dentoskeletal Class II malocclusions. Forty patients that exhibited Class II dentoskeletal relationships were included in the study. Twenty of these patients had mandibular advancement with the sagittal split ramus osteotomy; the remaining 20 patients had advancement of the whole lower alveolar segment with the total mandibular subapical alveolar osteotomy. The cephalograms studied were taken before the surgical procedure (T1 = 4 weeks before operation), immediately after the procedure (T2 = 10 days after surgery), and 1 year later (T3). The statistical analysis used to assess the results between and within the groups over the different time periods was the analysis of variance. The regression analysis was used to test the interdependence of soft tissue response to hard tissue movement. The results of this study show that both procedures are equally stable when correcting Class II malocclusions. This was proved by the stability of the correction of overjet, B point, and incisor-mandibular plane angle. There were no statistically significant differences between or within the groups in the position of these landmarks over time. There was a statistically significant change in the position of pogonion from T1 to T2 (P <.0028) between the groups, although at T3 this difference was not significant (P <.05). There were no significant changes in face height either within or between the groups over time. The hard/soft tissue interactions for the total mandibular subapical alveolar osteotomy were as follows: The lower lip advanced 60% to the incisor movement; soft tissue B' point responded with a 130% advancement in relation to the change in its hard tissue counterpart. Soft tissue pogonion advanced 90% in relation to the hard tissue landmark. The data suggest that the total mandibular alveolar osteotomy is the treatment of choice for the correction of severe dentoalveolar retrusive Class II malocclusion for which alteration of the mentolabial sulcus is desirable.

Stability of bilateral sagittal split ramus osteotomy: rigid fixation versus transosseous wiring.

Although many improvements have been made in orthodontic surgical procedures for mandibular retrognathism, relapse continues to occur. This study was designed to compare the stability of rigid and nonrigid fixation between 2 groups of patients who had undergone mandibular advancement surgery via sagittal split ramus osteotomy. Retrospective cephalometric measurements were made on 54 randomly selected orthognathic surgical patients. The patients, 7 males and 47 females, were divided into 2 groups: 28 patients stabilized by means of rigid fixation and 26 patients fixated with interosseous wires. The age of the patients ranged from 15.3 to 49.7 years. Lateral cephalograms were used to evaluate each patient at 3 distinct intervals: 7.0 +/- 2.0 days before surgery (T1), 34.4 +/- 15.0 days postsurgery (T2), and 458 +/- 202 days after sagittal split osteotomy (T3). Eighteen linear and angular measurements were recorded and differences between the 3 time periods were evaluated. Statistical analyses were performed to assess the differences in the 2 fixation types between and within each group at different time intervals. The following measurements showed statistically significant skeletal relapse over time, for the P value.0028: Co-Go, ANS-Xi-Pm, IMPA, overbite, and overjet. The remaining variables showed no statistically significant relapse. The only measurement that showed a statistically significant group difference between T1 and T2 was DC-Xi-Pm. Results of the study led to the following conclusions: there was statistically significant relapse in mandibular length, lower anterior face height, mandibular arc, lower incisor inclination, overbite, and overjet in each group, regardless of the type of fixation. The potential was greater for relapse in patients stabilized with transosseous wiring. Although multifactorial, relapse in overbite and overjet may be a combination of skeletal and dental changes. (Am J Orthod Dentofacial Orthop 2000;118:397-403).

Photographic analysis of facial changes associated with maxillary expansion.

Previous studies on the effects of surgical and rapid palatal expansion have been largely based on general skeletal and dental findings ascertained from radiographs and casts. The aim of this study was to measure and compare the soft tissue changes of the face during the expansion process and to determine the stability of any changes 1 year later. The sample consisted of 44 patients with unilateral or bilateral posterior crossbites. Twenty-four of the patients required a surgically assisted expansion procedure, and a second group of 20 patients were treated with orthopedic expansion. Ten measurements were made from standardized frontal facial photographic slides at 5 intervals of treatment: initial, bond appliance, stop expansion, debond appliance, and 1 year retention. Differences over time between the surgical and nonsurgical groups were analyzed by a 2 way multivariate analysis of variance (MANOVA) and post hoc t tests. Differences between initial and 1 year retention were found in the nasal widths (P <.001) of both surgical and nonsurgical groups. Other significant changes and trends were discussed.

Early treatment outcome assessed by the Peer Assessment Rating index.

In this study, the Peer Assessment Rating (PAR) index was used to objectively evaluate early treatment outcomes. Pretreatment and posttreatment casts of 103 consecutively treated patients were analyzed. The mean chronological, skeletal, and dental ages were 9. 82, 9.76, and 9.32 years, respectively. Calibrated examiners scored all models using the PAR ruler. PAR scores were weighed by means of a validation exercise. Cronbach alpha reliability analysis was used to establish the consistency of the subjective rating among 10 orthodontists of the severity of malocclusion. Pearson's correlation coefficient was used to assess the association among the orthodontists and the total PAR scores. Multiple regression analysis was used to determined the optimum weight of the PAR scores. Pretreatment and posttreatment differences were evaluated with t tests. The association between PAR scores and classification of malocclusions and treatment categories was assessed by means of multivariate analysis of variance (MANOVA). A reduction in the PAR index was observed for the mean raw and weighted scores, from 15.82 to 8.82 and from 5.28 to 3.73, respectively (P <.001). Twenty percent of the sample greatly improved the PAR index, by a 70% reduction.3 Forty-eight percent improved scores by at least a 30% reduction.4 The remaining 32% did not reduce scores by at least 30%. Subjects with both Class I and Class II malocclusions reduced their scores similarly. There was no statistically significant association between reduction of PAR scores and treatment modalities.

Stability of orthopedic and surgically assisted rapid palatal expansion over time.

At the present time no reports are available on the stability between orthopedic and surgically assisted rapid palatal expansion. This study was designed to examine and compare the dental and skeletal changes over time for both orthopedic maxillary expansion and surgically assisted palatal expansion. The study was divided into two groups. Group one was orthopedically expanded and consisted of 14 males and 10 females. The ages ranged from 6 years to 12 years with a mean of 8.5 years. Group two received surgically assisted rapid palatal expansion and consisted of 12 males and 16 females with ages ranging from 13 years to 35 years and a mean age of 19.25 years. All 52 subjects were white, from the same geographic area, and were treated by the same two operators. Dental models and posterior anterior cephalograms were obtained immediately before and after expansion, at removal of the expansion device, and 1 year after removal of the appliance. A repeated measures analysis of variance test was applied to assess changes over time between groups. The surgical and nonsurgical techniques displayed similar trends over time although the surgical group contained a greater quantity of expansion. Both the orthopedic and the surgical groups showed stable results.

Assessment of pretreatment orthodontic patients using the BANA test. N-benzoyl-DL-arginine-naphthylamide.

Ninety-two subjects were tested before orthodontic mechanotherapy for the presence of three putative periodontopathogens-Porphyromonas gingivalis, Treponema denticola, and Bacteroides forsythus-with the BANA test (PerioScan Oral-B). The sample ranged from 9 to 16 years, with a mean age of 13.1 years, and consisted of 51% girls and 49% boys; 48% African American, 46% white, 4% Asian, and 2% Hispanic. Unlike other BANA studies that examined children and adolescents with a 15-minute incubation time, this research used a 5-minute incubation time to increase the specificity and to reduce the false positives obtained from the PerioScan cards. No statistically significant difference was found between the age, gender, or race of the patients and the levels of the three putative periodontopathogens. A Friedman two-way analysis of variance assessed the BANA levels for three groups of teeth: molars, incisors, and premolars. The central incisors and first molars had a significantly higher percentage of positive BANA readings than the first premolars at p < or = 0.05. The clinical importance of this finding has yet to be determined, however, because the central incisor and first molar are the first permanent teeth to erupt, a possible association between dental emergence time and the rate of infection with various organisms may be postulated. In a pilot study, 10 patients from a statistically comparable pretreatment group were assessed longitudinally at two separate collection times separated by 4 months. The Wilcoxon signed rank test indicated no significant changes in these patients over the 4-month period.