Fluoride doped γ-Fe2O3 nanoparticles with increased MRI relaxivity.

Iron oxide nanoparticles (IONs) are being actively researched and experimented with as contrast agents for Magnetic Resonance Imaging (MRI), as well as image-directed delivery of therapeutics. The efficiency of an MRI contrast agent can be described by its longitudinal and transverse relaxivities, r1 and r2. γ-Fe2O3 nanoparticles - doped with fluoride in a controlled manner and functionalised with citric acid - showed a 3-fold increase in r1 and a 17-fold increase in r2 in a magnetic field of 3 T and almost 6-fold increase in r1 and a 14-fold increase in r2 at 11 T. Following fluorination, PXRD shows that the crystal structure of γ-Fe2O3 is maintained, Mössbauer spectroscopy shows that the oxidation state of the Fe cation is unchanged and HREM shows that the particle size does not vary. However, magnetisation curves show a large increase in the coercive field, pointing towards a large increase in the magnetic anisotropy for the fluorinated nanoparticles compared to the un-doped γ-Fe2O3 nanoparticles. Therefore, a chemically induced increase in magnetic anisotropy appears to be the most relevant parameter responsible for the large increase in relaxivity for γ-Fe2O3 nanoparticles.

Parent satisfaction in a nurse led clinic compared with a paediatric gastroenterology clinic for the management of intractable, functional constipation.

AIMS: To assess parent satisfaction with a nurse led clinic for children with intractable, functional constipation compared with a paediatric gastroenterology outpatient clinic. METHODS: A validated questionnaire covering six separate domains in 48 statements (provision of information, empathy with the patient, technical quality and competence, attitude towards the patient, access to and continuity with the caregiver, and overall satisfaction) was employed. For all outcomes, the data were analysed on an intention-to-treat basis. RESULTS: 90/107 (84%) questionnaires were returned: 40/51 (78%) from the paediatric gastroenterology clinic and 50/56 (89%) from the nurse led clinic. Results indicated a high "total" satisfaction with the clinical care, but these were statistically significantly higher in the nurse led clinic compared with the paediatric gastroenterology clinic (median score 8.7 and 7.3 respectively, out of a maximum score of 10). This difference was consistent across all domains when the scores from those attending the nurse led clinic were compared with those attending the paediatric gastroenterology clinic (information median score 8.7 v 7.5; empathy 9.0 v 7.3; competence 9.1 v 8.0; attitude 8.7 v 7.3; access 8.2 v 6.7). All comparisons were highly statistically significant. CONCLUSION: These results provide firm evidence that parents of children with intractable constipation are satisfied with the care they receive in both the paediatric and nursing clinic setting. Parent satisfaction, however, was significantly higher in those attending the nurse led clinic. This study adds further support to the development of a nurse led service to manage intractable, functional constipation in children.

Nurse management of intractable functional constipation: a randomised controlled trial.

AIMS: To evaluate the effectiveness of a nurse led clinic (NLC) compared with a consultant led paediatric gastroenterology clinic (PGC) in the management of chronic constipation. METHODS: Children (age 1-15 years) with functional constipation were randomised following a detailed medical assessment to follow up in either the NLC or PGC. An escalating algorithm of treatment was used as the basis of management in both the NLC and PGC. Main outcome measures were: time to cure at last visit or later confirmed by telephone; time to cure at last visit; and time to prematurely leaving the study. RESULTS: A total of 102 children were recruited, of whom 52 were randomly assigned to NLC and 50 to PGC. Outcome assessment showed that 34 children in the NLC and 25 children in the PGC were confirmed cured at their last visit or later confirmed by telephone. The median time to cure was 18.0 months in the NLC and 23.2 months in the PGC. The probability of being cured was estimated as 33% higher in the NLC compared to PGC (hazard ratio 1.33). Attending the NLC hastened time to cure by an estimated 18.4%. CONCLUSION: Children who attend an NLC are equally as, if not more likely to be cured of intractable constipation, than those attending a PGC and on average their cure will occur sooner. Results suggest that an NLC can significantly improve follow up for children with intractable constipation and highlight the important role for clinic nurse specialists in management of children with gastrointestinal disease.

A two centre study of the dose-response relation for transscleral diode laser cyclophotocoagulation in refractory glaucoma.

BACKGROUND/AIMS: Transscleral diode laser cyclophotocoagulation ("cyclodiode") is widely used to treat refractory glaucoma. The main aims of this study were to investigate the dose-response relation of cyclodiode and to evaluate possible predictive factors that would help establish optimum treatment parameters. METHODS: A retrospective analysis of the case notes of 263 eyes of 238 consecutive patients who underwent transscleral diode laser cyclophotocoagulation at two centres was undertaken. RESULTS: Mean intraocular pressure (IOP) decreased significantly from 40.7 mm Hg (SD 13.7) before cyclodiode therapy to 17.7 mm Hg (SD 10.9) post-treatment, a reduction of 52.6% (p = 0.0001). Following cyclodiode, 89% of patients achieved an IOP of less than 22 mm Hg or a greater than 30% drop in IOP. Hypotony occurred in 9.5% of patients, 76% of whom had neovascular glaucoma. A linear dose relation response was found for the 122 eyes with neovascular glaucoma (p = 0.001) but not for the group as a whole. Treatment failure was associated with male sex (multivariate regression analysis, p = 0.008) and low mean energy per treatment session (univariate analysis alone, p = 0.016). High pretreatment IOP (p = 0.031) and high mean energy per treatment episode (p = 0.001) appeared to be associated with the occurrence of hypotony, although multivariate analysis did not support this finding. CONCLUSION: Cyclodiode therapy is highly effective but there is a significant risk of hypotony, which may be reduced by applying lower energy in cases of very high pretreatment IOP and in neovascular glaucoma. The dose-response association remains unpredictable, although a linear relation was found for neovascular glaucoma.

Presentation, diagnosis and initial management of patients referred to a hospital tooth wear clinic.

Information on presenting complaints, diagnosis and initial management strategy was recorded on a proforma for 114 consecutive patients referred to a hospital tooth wear clinic over a two-year period. Over twice as many male patients were referred as females. Twenty percent of patients had no presenting complaint and the others shared the common complaints concerning appearance, sensitivity and their deteriorating dentitions. The assessment of aetiology identified attrition as the most common cause of tooth wear in the subject group studied. About half the group were prescribed preventative treatment only and the other half were deemed to require restorative dental treatment.

Migraine and masticatory muscle volume, bite force, and craniofacial morphology.

The purpose of this investigation was to compare the masticatory muscle volume, bite force, and craniofacial morphology of migrainous subjects with age- and sex-matched controls. Ten adult dentate migraineurs were matched with 10 dentate age- and sex-matched controls. The groups consisted of nine women and one man (mean age, 43 years; range, 29 to 51 years). Volumetric analysis of the masseter and medial pterygoid muscles was performed using magnetic resonance imaging. Craniofacial morphology was analyzed from standard cephalometric radiographs using 30 angular and linear variables. Recordings of bite force were made using a strain gauge transducer. There was a significant difference in the volume of both masseter and medial pterygoid muscles between the two subject groups (P<.0001), with the muscles of the migraineurs nearly 70% larger. The migraineurs recorded significantly higher maximal bite forces (P<.0001) than did the controls. No significant differences for any craniofacial morphological measurement were demonstrated between the two groups. It was concluded that the migraineurs had larger masseter and medial pterygoid muscle volumes, and greater bite forces than the controls, which could not be explained by any change in craniofacial morphology.

Mortality rates and causes among U.S. physicians.

UNLABELLED: CONTENT/OBJECTIVES: No recent national studies have been published on age at death and causes of death for U.S. physicians, and previous studies have had sampling limitations. Physician morbidity and mortality are of interest for several reasons, including the fact that physicians' personal health habits may affect their patient counseling practices. METHODS: Data in this report are from the National Occupational Mortality Surveillance database and are derived from deaths occurring in 28 states between 1984 and 1995. Occupation is coded according to the U.S. Bureau of the Census classification system, and cause of death is coded according to the ninth revision of the International Classification of Diseases. RESULTS: Among both U.S. white and black men, physicians were, on average, older when they died, (73.0 years for white and 68.7 for black) than were lawyers (72.3 and 62.0), all examined professionals (70.9 and 65.3), and all men (70.3 and 63.6). The top ten causes of death for white male physicians were essentially the same as those of the general population, although they were more likely to die from cerebrovascular disease, accidents, and suicide, and less likely to die from chronic obstructive pulmonary disease, pneumonia/influenza, or liver disease than were other professional white men. CONCLUSIONS: These findings should help to erase the myth of the unhealthy doctor. At least for men, mortality outcomes suggest that physicians make healthy personal choices.

Clinical rest and closest speech positions in the determination of occlusal vertical dimension.

Two subject groups had their mandibular positions determined, using an electrognathograph, at the clinical rest position (CRP) and at the closest speaking position (CSP). They were classified into a toothwear (largely of attritional origin) group (n=30) and a non-toothwear, or normal, group (n=60). The mean CRP deduced for the groups was similar in all three dimensions and found to be just less than 2 mm open from and 0.6 mm posterior to intercuspal position (IP) and approximately in the midline. The CSP, in two dimensions, of the toothwear group was significantly closer to IP than that of the normal group. The vertical component of CRP and CSP was similar for the normal group but CSP was significantly reduced in comparison to CRP for the toothwear group. The most forward component of CSP was significantly more anteriorly placed than was that of CRP. Although there was a pronounced inter-individual variation the results suggest toothwear, of long acting aetiology, has less affect on CRP than on CSP.

Masseter and temporalis muscle EMG levels and bite force in migraineurs.

The purpose of this study was to compare absolute and proportional electromyography (EMG) levels in the masseter and temporalis muscles during performance of a variety of oral functions for migraineurs and age- and sex-matched controls. Both groups consisted of nine women and one man, with a mean age of 43 years (range, 29 to 51 years). Absolute resting EMG levels and those levels during swallowing and speech were not significantly different between the groups, but the levels of the group with migraine were significantly higher during maximum voluntary effort contractions on the anterior teeth and on the posterior teeth for both muscles. When expressed as a percentage of those levels obtained at maximal posterior contraction (ie, proportional levels), no difference in functional activity was demonstrated between groups. It was concluded that the two groups studied had similar levels of EMG activity in the masseter and temporalis muscles during the normal oral functions investigated, but that the group with migraine had higher levels of absolute EMG activity during anterior and posterior maximum voluntary contractions. Furthermore, the group with migraine demonstrated higher levels of anterior and posterior bite force, although not correlated with EMG levels.

Hernia: is it a work-related condition?

BACKGROUND: Development of hernias among active workers is a major occupational problem, however, the work-relatedness of hernias has not been well investigated. It is a difficult question for occupational and primary care physicians who must often address whether a worker with an inguinal hernia should be restricted from work requiring lifting of heavy objects. METHODS: To evaluate the possible work-relatedness of inguinal hernias, a cross-sectional study was performed. The goal of the study was to determine hernia incidence according to occupation with the Annual Survey of Occupational Injuries and Illnesses from the Bureau of Labor Statistics in 1994. Hernia incidence rates (per 10,000 workers) for industry and occupation categories were calculated with the estimates of the number of hernias in males and the employed male workers from the Current Population Survey. Rate ratios (RR) of hernia incidence rates were calculated. RESULTS: In 1994, an estimated 30, 791 work-related hernias in males were reported by US private establishments. The occupation groups with the highest RR were laborers and handlers (RR, 2.47; 95% confidence interval (CI), 2.14-2.80), machine operators (RR, 2.13; 95% CI, 1.81-2.44), and mechanics and repairers (RR, 1.72; 95% CI, 1.43-2.00). CONCLUSIONS: Rate ratios for hernias vary considerably within industries and occupations, with the highest ratios found in industries and occupations involving manual labor. This provides support for the hypothesis that the hernias are work-related, especially in work involving strenuous, heavy manual labor. Am. J. Ind. Med. 36:638-644, 1999. Published 1999 Wiley-Liss, Inc.

Ischemic heart disease mortality and occupation among 16- to 60-year-old males.

Cardiovascular disease is the leading cause of death, and the role of occupation continues to generate interest. Using the National Occupational Mortality Surveillance system, proportionate mortality ratio (PMR) analyses were used to examine the association between occupation and ischemic heart disease among 16- to 60-year-old males. We used data from 1982-1992 from 27 states. Separate analyses were conducted for blue-collar and white-collar occupations. Among the blue-collar occupations with the highest PMRs for ischemic heart disease mortality were sheriffs, correctional institution officers, policemen, firefighters, and machine operators. Physicians (blacks only) and clergy (both races) were among the white-collar occupations with the highest PMRs for ischemic heart disease. Although more study is needed, consideration should be made for targeting high-PMR occupations, with improvement in work organization to reduce occupational stress and promotion of healthy lifestyles through cardiovascular disease prevention programs.

Mandibular incisor position for English consonant sounds.

PURPOSE: The purpose of this study was to describe the mandibular incisor positions for the 24 consonant sounds of the English language. Further aims were to determine if the incisor format for each sound is affected by its position in a word, or by combination with an open or closed vowel. MATERIALS AND METHODS: A total of 30 young adult subjects had their incisal positions determined using an electrognathographic technique during performance of a number of speech tests. RESULTS: The mean values of the 24 consonants, in the vertical direction, showed a range from the intercuspal position of 2.5 mm for a sibilant sound to 11.7 mm for the /H/ sound, and an anteroposterior range of 1.4 mm anterior for a sibilant sound to 1.8 mm posterior for the /M/ sound. The range in the mean lateral dimension was always less than 1 mm on either side of the midline. The placement of a sound in the initial or final position in a word had no effect on the incisal position. The degree of vertical opening was significantly greater for 8 of the consonant sounds when in combination with an open vowel sound. The anteroposterior and lateral positions were unaffected by vowel association. CONCLUSION: The incisor position for consonant sounds is unaffected by initial or final word placement. Some consonant sound positions are affected by combination with an open or closed vowel sound. Sibilant sounds produced a clinically acceptable measure of the most superior and anterior speaking positions in all subjects.

The mandibular speech envelope in subjects with and without incisal tooth wear.

PURPOSE: The purpose of this study was to describe a mandibular envelope of motion during speech for 2 subject groups. One subject group had experienced no tooth wear and the other had incisal tooth wear. The speech envelope was to be described with regard to its maximal dimensions in the vertical, anteroposterior, and lateral directions, and its most superior and anterior positions in relation to intercuspal position. MATERIALS AND METHODS: An electromagnetic method of jaw tracking was employed to record mandibular speech movements for 60 subjects whose teeth exhibited no tooth wear and 30 subjects with incisal dental attrition. The test speech exercise contained all of the word sounds that occur in the English language. The test was recorded 3 times, and mean values for parameters were reported. RESULTS: The speech envelope of the tooth wear group was significantly smaller (Student's t test, P < 0.01) in all 3 dimensions than that of the normal group. The tooth wear group speech envelope was also located closer to the intercuspal position in the vertical dimension (P < 0.01) and was not as anteriorly placed (P < 0.01). In the normal group, correlations were found between the vertical incisor overlap and the most superior speech position (r = 0.48, P < 0.0001), and between the horizontal incisor overlap and the most anterior mandibular speaking position (r = 0.63, P < 0.0001). CONCLUSION: The envelope of mandibular movement during speech differed in dimension and position between the 2 groups investigated.

Occupational dermatitis causing days away from work in U.S. private industry, 1993.

BACKGROUND: Occupational skin disease is an important cause of disability in the workplace. The aim of this report is to estimate the incidence of occupational dermatitis cases that causes days away from work and to characterize the cases. METHODS: The Annual Survey of Occupational Injuries and Illnesses from the Bureau of Labor Statistics collects employer reports on work-related dermatitis. Descriptive data are collected on a sample of the cases that result in days away from work. Estimates of the number of cases and days away from work were calculated by industry, occupation, and exposure source. RESULTS: In 1993, there were an estimated 8,835 cases of occupational dermatitis, a rate of 1.12/10,000 workers. The largest number of cases was in health services, while the highest rate was in agricultural crops. The occupation with the largest number of cases was non-construction laborers. Cleaning/polishing agents caused the largest number of cases. Calcium hydroxide and oxides caused a median of nine days away from work. DISCUSSION/CONCLUSIONS: The survey data show that the effect of occupational dermatitis is substantial in the lives of workers. These descriptive data should be used to target interventions.

Burning mouth in Parkinson's disease sufferers.

OBJECTIVE: The purpose of the study was to determine the prevalence of burning mouth (BM) in a population of Parkinson's Disease (PD) sufferers and also to assess the use of pain profiles in identifying the type of burning sensation experienced. DESIGN: Subjects were surveyed by means of a one shot postal questionnaire for which ethical approval had previously been granted. Anonymity was guaranteed and therefore no attempt was made to follow up non-respondents. MAIN OUTCOME: BM was reported by 24% of respondents. The pain profiles were completed by 17 BM sufferers. CONCLUSION: Burning mouth is reported to occur in 24% of PD sufferers which is 5 times greater than that of the general population. The reason for this is uncertain but the result has implications for the future care of PD patients and indicates the need for increased dental input at PD outpatient clinics.

Cancer mortality among laundry and dry cleaning workers.

A cancer mortality study of 8,163 deaths occurring among persons formerly employed as laundering and dry cleaning workers in 28 states is described. Age-adjusted sex-race cause-specific proportionate mortality ratios (PMRs) and proportionate cancer mortality ratios (PCMRs) were computed for 1979 through 1990, using the corresponding 28-state mortality as the comparison. For those aged 15-64 years, there were excesses in black men for total cancer mortality (PMR = 130, 95% confidence interval (CI) = 105-159) and cancer of the esophagus 1 (PMR = 215, 95% CI = 111-376), and in white men for cancer of the larynx (PMR = 318, 95% CI = 117-693). For those aged 65 years and over, there were statistically nonsignificant excesses for cancer of the trachea, bronchus, and lung in black women (PMR = 128, CI = 94-170) and for cancer of other and unspecified female genital organs in white women (PMR = 225, CI = 97-443). The results of this and other studies point to the need for the effective implementation of available control measures to protect laundry and dry cleaning workers.