The clinical outcome of skeletal anchorage in interceptive treatment (in growing patients) for class III malocclusion.

A systematic review of the literature was performed regarding the clinical outcome (effectiveness) of bone anchorage devices in interceptive treatment for class III malocclusion. A search of Embase, PubMed and Web of Science databases yielded 285 papers. An additional two articles were retrieved through manual searching of the reference lists. After initial abstract selection, 32 potentially eligible articles were screened in detail, resulting in a final number of eight articles included in this review. Insufficient evidence was found regarding the effects of skeletal anchorage in interceptive class III treatment to support definitive conclusions on long-term skeletal effects and stability. In the short term, it seems that bone anchors can provide more skeletal effect with less dentoalveolar compensations and less unwanted vertical changes. This does not always exclude the use of a face mask. The use of miniscrews as skeletal anchorage device does not seem to provide more skeletal effect, although it could minimize the unwanted dental effects in the upper jaw. No information regarding the need for orthognathic surgery, orthodontic treatment time or patient compliance and complications was found in the selected articles.

Glucose impairment and ghrelin gene variants are associated to cognitive dysfunction.

BACKGROUND AND AIMS: Cognitive state and brain volume have been related to body mass index, abdominal fat, waist-hip ratio, components of metabolic syndrome (MS) and ghrelin. Genetic variations within the ghrelin gene have been recently associated to MS. The aim of our study was to investigate cognitive state by Mini-Mental State Examination (MMSE) in relation to MS components (ATP-III criteria) and ghrelin gene polymorphisms in dwelling individuals aged ≥70. METHODS: 280 subjects (137 men/143 women, age 77.03 ± 5.92) from the Mataró Ageing Study were included. Individuals were phenotypically characterized by anthropometric variables, lipids, glucose, blood pressure and MMSE. SNPs -501AC (rs26802), -994CT (rs26312), -604GA (rs27647), M72L (rs696217) and L90G (rs4684677) of the ghrelin gene were studied. Genotypes were determined by polymerase chain reaction and SNapshot minisequencing. RESULTS: 22.1 % had MMSE <24. MMSE <24 was associated with age (p < 0.001), female gender (p = 0.016), low education (p < 0.001) and glucose impairment or diabetes (p = 0.040). MMSE was influenced by obesity, central obesity, MS and glucose impairment. This latter association remained significant after adjustment by gender, age, alcohol, educational level, GDS and ApoE genotype (p = 0.009). Ghrelin SNPs were associated to MMSE: M72L C/A genotype showed lower score than C/C (p = 0.032, after adjusting for confounders 0.049); L90G A/T genotype showed lower score than A/A (p = 0.054, after adjusting 0.005). MMSE <24 was associated to L90G (39.1 % in A/T genotype vs 19.3 % in A/A, p = 0.026, after adjusting for confounders p = 0.002, OR 6.18 CI 1.93-21.75). CONCLUSIONS: Glucose impairment and L90G Ghrelin gene variant influence cognitive function in old dwelling individuals participating in the Mataró Ageing Study.

Identification of novel SLC3A1 gene mutations in Spanish cystinuria families and association with clinical phenotypes.

Cystinuria is an inherited metabolic disease characterized by an abnormal urinary excretion of cystine and dibasic amino acids, leading to kidney stone formation. Incidence of cystinuria in the Mediterranean Spanish population is one of the highest in the world. In view of the low prevalence of previously reported mutations in the SLC3A1 gene, analyses to identify novel variants were carried out on 20 cystinuria families. Additionally, we investigated the possible association between these molecular variants and clinical phenotypes. Genomic DNA from 48 cystinuria patients, 44 healthy relatives and 81 unrelated controls from the East Mediterranean coast of Spain was screened by conformation sensitive gel electrophoresis. Abnormal patterns were confirmed by nucleotide sequence determination and by further restriction fragment-length polymorphism. We only found 11 genetic variants within the SLC3A1 gene: five known polymorphisms (114C > A, 231T > A, 1136 + 3delT, 1332 + 7T > C and 1338G > A), four point mutations (M467T, R452W, I105R and Y461X), one single base pair deletion (1767delA) and one 2-bp insertion (1670insAT). Two of these genetic variants (I105R and 1670insAT) were described for the first time. All mutations but one were detected in families classified as Type I cystinuria due to the transmission pattern of the disease. Association analyses revealed that 231T > A (M467T), 1136 + 3delT and 1332 + 7T > C genetic variants were statistically related with urinary amino acid excretion in cystinuria patients. Although some molecular variants within the SLC3A1 gene were associated with clinical traits in cystinuria patients, the low detection rate of mutations in this gene strongly suggests that variation of the SLC3A1 is not the major genetic factor contributing to cystinuria in this Mediterranean population.

Educating the next generation of dentists.

A new vision for dental education is being shaped by (1) future dentists' need to keep pace with rapid developments in medicine and biomedical science, and changing health-care delivery mechanisms that will transform dentistry; (2) dissatisfaction with unintended, undesirable consequences of traditional approaches to dental education that do not integrate biomedical/clinical, behavioral, ethical, and population perspectives in clinical practice, and fail to cultivate the skills and values which support lifelong learning; (3) new developments in cognitive science demonstrating learning environments' need to be more student-centered, to emphasize active learning strategies, and teach students to use the scientific method to resolve clinical problems. These changes will require efforts in faculty development, and have implications for the administration and function of dental schools.

Tutor and student perceptions of the tutor's role in problem-based learning.

The role of the tutor in problem-based learning (PBL) differs dramatically from the traditional teaching role with which dental students and faculty are familiar. In this investigation, the dimensionality and complexity of the tutor role were assessed by first- and second-year dental students and by the tutors themselves using a twenty-four-item Likert-type questionnaire that served as one component of a comprehensive web-based assessment tool, the PBL-Evaluator. Evaluations were completed after each PBL case over a period of one and a half years by one class of students and for half a year by a second class. Exploratory principal components analyses of the responses to the questionnaire revealed a more complex factor structure for tutors than for students. While a five-factor solution was required for the tutors, a simpler two-factor solution sufficed for both groups of first-year students, and a three-factor solution was necessary for the second-year students. Although tutors displayed a more nuanced perspective on their performance than did students, items related to tutor modeling of professional conduct within tutorials consistently emerged as important for both.

Assessing ethics and professionalism in dental education.

The foundation for the development of ethical sensitivity and the capacity for reflective reasoning about ethical dilemmas must be established early during professional training. At Indiana University School of Dentistry, two assessment tools, the Dental Ethical Sensitivity Test (DEST) and the Defining Issues Test (DIT) are being employed to help measure student achievement and enhance their skills in this area. Evidence suggests that both small-group discussion and case-based problem solving involving ethical issues improve scores on these measures. It is imperative that opportunities to recognize, analyze, and discuss ethical issues are integrated throughout the dental student's educational program.

Dissociative identity disorder and the sociocognitive model: recalling the lessons of the past.

In a recent article in this journal, D. H. Gleaves (1996) criticized the sociocognitive model (SCM; N. P. Spanos, 1994) of dissociative identity disorder (DID) and argued in favor of a posttraumatic model (PTM) in which DID is conceptualized as a consequence of childhood abuse and other traumatic events. The present authors demonstrate that (a) many of Gleaves's arguments were predicated on misunderstandings of the SCM, (b) scrutiny of the evidence regarding the psychopathology and assessment of DID raises questions concerning the PTM's conceptual and empirical underpinnings, (c) the treatment literature suggests that iatrogenic factors play an important role in the etiology of DID, and (d) the evidence linking child abuse to DID is more problematic than implied by Gleaves. The present authors conclude that Gleaves's analysis underemphasized the cultural manifestations of multiple role enactments and that the history of DID imparts a valuable lesson to contemporary psychotherapists.

[Familial defect of apo B-100 in subjects with clinically diagnosed primary hypercholesterolemia: identification of the first family with this disorder in Spain]. / Estudio del defecto familiar de la apo B-100 en sujetos con el diagnóstico clínico de hipercolesterolemia primaria: identificación de la primera familia afectada en España.

BACKGROUND: The aim of our study was to screen mutations responsible of FDB in subjects with primary hypercholesterolemia. MATERIAL AND METHODS: We have screened R3500Q and other mutations (PCR-SSCP analysis) in 110 subjects with primary hypercholesterolemia from the Valencia area (Spain), 95 of them with familial hypercholesterolemia (FH) and 15 with poligenic hypercholesterolemia (PHC). RESULTS: One out of 95 subjects carried the R3500Q mutation. We have searched in the family and have identified another affected subject. CONCLUSIONS: We have identified the first affected Spanish family from FDB. The prevalence of R3500Q mutations was of 1% in FH subjects in this series.

Hypnotic control of pain: historical perspectives and future prospects.

Hypnotic analgesia has occupied a pivotal place in experimental and clinical hypnosis. It emerged early in the 19th century when effective clinical techniques for pain management had not yet developed, and the relief of pain and suffering had not even become a well-defined social goal. Its acceptance was further complicated by political struggles surrounding the humanitarian transformation of medicine during this era as well as a redefinition of the physician-patient relationship that wrested control from the patient. The initial struggle for professional acceptance was won only when the debate became almost entirely localized within the professional community. Acceptance of hypnosis by professional organizations has been followed by alternating periods of interest and indifference. While the evidence for the powerful effects of suggestion and related variables has often been observed and reported in nonhypnotic contexts, their relationship to hypnotic phenomena has often not been appreciated. Since the mid-20th century, scientific information about hypnotic analgesia has grown substantially and has had significant influence on strategies for acute and chronic pain management. If recent calls for its wider application in pain management are to succeed, it will require additional data from clinical populations and a balanced and scientifically prudent approach by its advocates.

The state of the "state" debate in hypnosis: a view from the cognitive-behavioral perspective.

For most of the past 50 years, hypnosis research has been driven by a debate about whether hypnotic phenomena can be best described and understood as the product of an altered state of consciousness. The meanings of some of the pivotal concepts in this debate and the nature of the phenomena that gave rise to them were ambiguous at the outset and led to misconceptions and surplus meanings that have obscured the debate through most of its history. The nature of the posited hypnotic state and its assumed consequences have changed during this period, reflecting the abandonment of untenable versions of hypnotic state theory. Carefully conducted studies in laboratories around the world have refined our understanding of hypnotic phenomena and helped identify the critical variables that interact to elicit them. With the maturation of the cognitive-behavioral perspective and the growing refinement of state conceptions of hypnosis, questions arise whether the state debate is still the axis about which hypnosis research and theory pivots. Although heuristic value of this debate has been enormous, we must guard against the cognitive constraints of our own metaphors and conceptual frameworks.

What should biomedical sciences education in dental schools achieve?

Education for the first professional degree in dentistry is intended to produce graduates capable of offering a wide range of high quality dental services to the general public. More than that, it is expected that graduates will be firmly grounded in the scientific basis for their professional practices and be equipped to evaluate critically and integrate selectively new scientific findings that emerge during their professional lifetimes. In addition, they are expected to be able to work effectively with diverse patient populations and to conduct their practices with a high level of sensitivity to the ethical and psychosocial dimensions of patient care. Indiana University School of Dentistry has undergone a process of curriculum reform that has yielded a new first professional degree program. Its hallmarks are large, multidisciplinary courses (seven courses in the first two years) that are taught using a variety of strategies including problem-based learning in small groups as well as lectures. The biomedical sciences curriculum is concept-based. Students will demonstrate their understanding of science concepts and methods by applying them to the solution of research and health care problems. Biomedical sciences will be taught at a level that will provide a comprehensive understanding of the functioning of the human body in health and disease, allow students to assimilate the coming revolution in molecular medicine, and selectively use new diagnostics, preventives, and therapeutics that evolve as molecular biological technologies yield solutions to current medical and dental problems. Using the biomedical sciences curriculum as a vehicle, we will also achieve the goal of training dentists as critical thinkers, problem solvers, lifelong learners, and ethical practitioners, skillful in peer and self-evaluation, and cognizant of the psychosocial as well as biomedical perspective of health and disease.

Early response to the effect of iron fortification in the Venezuelan population.

In Venezuela a severe economic crisis beginning in 1983 provoked a progressive reduction of the quality and quantity of food consumed by the low socioeconomic strata of the population. In these strata, which represent > or = 80% of the Venezuelan population, we had seen a continuous increase in the prevalence of iron deficiency during that recent decade. As a result, in 1993 the Venezuela Government created the Special Commission for Enrichment of Foods. That same year a fortification program began in which precooked yellow and white maize and wheat flours were enriched with 20 and 50 mg Fe (as ferrous fumarate)/kg flour, respectively. The corn flour was also enriched with vitamin A, thiamine, riboflavin, and niacin, whereas the wheat flour was enriched with these same vitamins, except vitamin A. These two cereals represent 45% of the total energy consumed daily by the low socioeconomic strata of the population. A preliminary survey carried out in Caracas in 1994 in a population of 307 children aged 7, 11, and 15 y showed that the prevalence of iron deficiency determined by measuring the serum ferritin concentration and the prevalence of anemia were reduced from 37% and 19%, respectively, in 1992 to 15% and 10%, respectively in 1994.

Recent advances in the application of hypnosis to pain management.

In this paper I examine the clinical use of hypnosis for pain management from a cognitive-behavioral perspective. This perspective emphasizes the multifaceted nature of hypnotic interventions and the importance of patients' attitudes, expectations, and beliefs in modulating the pain experience. Special attention is given to identifying ways of combining cognitive and contextual variables to maximize clinical outcomes. Since this approach does not pivot around the concept of a hypnotic trance state, we look elsewhere in our quest to understand the nature of pain modulation in the hypnotic context. Freedom from a theoretical commitment to the hypnotic trance state is seen as opening new avenues for the development of effective clinical interventions.

Spontaneous cognitive strategies for the control of clinical pain and stress.

The spontaneous cognitive strategies employed by 75 patients undergoing dental extractions or mandibular block injections were elicited using a structured interview. Interest focused on the relationship between these strategies and several personality variables, including state and trait anxiety, locus of control, and absorption. In addition, the effect of strategy utilization on perceived pain and stress was assessed. Fourty-four percent of the patients employed cognitive strategies designed to minimize pain and stress, while 37% catastrophized, engaging in cognitive activity which exaggerated the fearful aspects of their experience. Only 19% of the patients denied any cognitive activity during the clinical procedure, and many of these used noncognitive coping strategies. Discriminant analysis revealed that situational anxiety was associated with the use of cognitive coping strategies. Catastrophizing was associated with increasing age, past dental stress, and higher levels of stress vulnerability (high trait anxiety and external locus of control). Copers reported less stress than catastrophizers but not less pain.

Hypnosis in the treatment of sexual dysfunction.

Recent reports suggest that hypnosis may be a useful technique for the treatment of sexual dysfunction. Five distinct strategies for the utilization of hypnosis in sex therapy can be identified: (1) as a diagnostic tool, (2) to improve self-confidence, (3) as an adjunct to behavior therapy, (4) for the direct removal of symptoms, and (5) to facilitate the resolution of neurotic conflicts. Case reports documenting these applications of hypnotic procedures typically fail to include significant information regarding patient variables, symptomatology, the nature of the therapeutic intervention, and criteria for improvement. Although the conclusions provided by these case studies are encouraging, it is essential that the efficacy of hypnotic techniques in sex therapy be evaluated by controlled studies.