Database: EMBASE <: international biomedical and pharmaceutical literature, 1988 - May 2000. [Trial access until 3/2001. Feedback welcome to medical.library@umich.edu] Search Strategy (You Saved Citations 1-149 From Set 73): ----------------------------------------------------------------------------- 1 exp Poverty/ 2051 2 poverty.mp. 2897 3 exp Social class/ 2655 4 exp Socioeconomic factors/ 7678 5 SES.mp. 787 6 exp Minority groups/ 1105 7 exp Ethnic groups/ 7015 8 income:.mp. 8190 9 (socioeconomic adj3 status:).mp. 3389 10 (education: adj3 (level: or status:)).mp. 7278 11 (occupation: adj3 status:).mp. 1310 12 "HEAD START".mp. 70 13 "WIC".mp. 156 14 exp Public assistance/ 4855 15 exp Social welfare/ 863 16 (public adj assistance).mp. 87 17 (welfare adj3 assistance:).mp. 12 18 (welfare adj3 dependenc:).mp. 64 19 (welfare adj3 status:).mp. 204 20 (welfare adj3 recipient:).mp. 37 21 (women adj infant adj2 children).mp. 2 22 medicaid.mp. 3301 23 employment.mp. 8672 24 unemployment.mp. 1860 25 downsiz:.mp. 239 26 down-siz:.mp. 87 27 education/ 11152 28 or/1-27 58067 29 exp Tooth demineralization/ 7492 30 demineralization.mp. 879 31 caries.mp. 1798 32 caires.mp. 0 33 craies.mp. 0 34 careis.mp. 1 35 carise.mp. 0 36 (teeth adj3 cavit:).mp. 32 37 (tooth adj3 cavit:).mp. 97 38 (dental adj3 cavit:).mp. 85 39 (dentin adj3 cavit:).mp. 19 40 (enamel adj3 cavit:).mp. 10 41 (teeth adj3 decay:).mp. 58 42 (tooth adj3 decay:).mp. 58 43 (dental adj3 decay:).mp. 47 44 (dentin adj3 decay:).mp. 0 45 (enamel adj3 decay:).mp. 1 46 (active adj decay).mp. 5 47 (rampant adj3 decay:).mp. 4 48 (recurrent adj3 decay:).mp. 5 49 (white adj spot:).mp. 231 50 carious.mp. 109 51 cariology.ti,ab. 2 52 (non-cavitated adj3 lesion:).mp. 0 53 (noncavitated adj3 lesion:).mp. 1 54 Tooth remineralization/ 788 55 (dental adj3 fissure:).mp. 14 56 (tooth adj3 fissure:).mp. 8 57 (teeth adj3 fissure:).mp. 1 58 caries-free.mp. 29 59 cariesfree.mp. 0 60 Cariogenic agents/ 3 61 precavit:.mp. 2 62 (filled adj3 teeth).mp. 45 63 (filled adj3 tooth).mp. 9 64 (oral adj fissure:).mp. 17 65 (tooth adj3 remineraliz:).mp. 1 66 (teeth adj3 remineraliz:).mp. 5 67 dft.mp. 542 68 dfs.mp. 980 69 dmf:.mp. 1235 70 cariogeni:.mp. 164 71 or/29-70 12313 72 28 and 71 198 73 limit 72 to (human and english language and yr=1990-2000) 149 74 from 73 keep 1-149 149 *************************** <1> UI - 2000171492 AU - Lorenzana ER AU - Rees TD AU - Glass M AU - Detweiler JG IN - Dr. T.D. Rees, Department of Periodontics, Baylor College of Dentistry-TAMUS, P.O. Box 660677, Dallas, TX 75266-0677; United States. TI - Chronic ulcerative stomatitis: A case report. SO - Journal of Periodontology Vol 71(1) (pp 104-111), 2000. AB - Background: Certain mucocutaneous diseases present with painful, ulcerative, or erosive oral manifestations. Chronic ulcerative stomatitis is a newly recognized disease of unknown origin which presents clinically with features of desquamative gingivitis. This report marks only the thirteenth case reported in the world literature. A review of previous reports and studies is presented along with a review of immunofluorescence techniques critical to proper diagnosis. These diseases are difficult to diagnose without the use of immunofluorescence techniques. A 54-year-old Caucasian woman presented with a 2- to 3-year history of stomatitis and dry mouth. Methods: Direct immunofluorescence revealed a speckled pattern of IgG deposits in the basal one-third of the epithelium, while indirect immunofluorescence confirmed the presence of stratified epithelium-specific antinuclear antigen (SES-ANA), both pathognomonic for chronic ulcerative stomatitis. Results: The patient was successfully treated using topical corticosteroid therapy. [References: 19] <2> UI - 2000074953 AU - Vargas CM AU - Macek MD AU - Marcus SE IN - C.M. Vargas, Analys., Epidemiol./Hlth. Prom. Off., National Ctr. for Health Statistics, Centers for Dis. Control/Prevention, 6525 Belcrest Road, Hyattsville, MD 20782; United States. E-Mail: cav5@cdc.gov. TI - Sociodemographic correlates of tooth pain among adults: United States, 1989. SO - Pain Vol 85(1-2) (pp 87-92), 2000. AB - This study presents the sociodemographic distribution of tooth pain and the dental care utilization of affected individuals. Data for adults 20 years of age and over were derived from the 1989 National Health Interview Survey's supplements on dental health, orofacial pain, and health insurance (n=33 073). Prevalence of tooth pain by socioeconomic status (SES) and adjusted odds ratios of reporting tooth pain in the past 6 months and of having no dental visits in the past year among persons reporting pain in the previous 6 months were computed taking into account the survey's complex sample design. Tooth pain in the past 6 months was reported by 14.5% (95% CI 14.0, 15.0) of adults aged 20-64 years and by 7.0% (95% CI 6.1, 7.9) of those 65 years and over. In the younger age group, tooth pain was more likely to be reported by those with low SES than it was by those with high SES; in the older age group, tooth pain was more likely reported by non-Hispanic blacks than it was by non-Hispanic whites or Hispanics. Of those reporting pain, younger and older non-Hispanic blacks and persons with lower educational attainment were more likely not to have a dental visit in the previous 12 months. Persons with low SES characteristics were more likely to report tooth pain and to endure their pain without the benefit of dental care while the pain was present. [References: 24] <3> UI - 2000067040 AU - MacDonald D AU - Torrance N AU - Wood S AU - Womersley J IN - D. MacDonald, EpilepsyAssociation of Scotland, 48 Govan Road, Glasgow G51 1JL; United Kingdom. TI - General-practice-based nurse specialists - Taking a lead in improving the care of people with epilepsy. SO - Seizure Vol 9(1) (pp 31-35), 2000. AB - Epilepsy is almost as common as diabetes and some 750 people with epilepsy die suddenly and prematurely each year. Unfortunately, the management of epilepsy has been much neglected and services often remain fragmented and difficult for patients to understand. We employed a nurse specialist in epilepsy to work with practice nurses in a group of general practices to promote better care, to make patients aware of sources of help and support, and to provide information about issues such as driving, employment and pregnancy. Over 70% of patients with epilepsy attended 'clinics' run by the specialist nurse and many previously unidentified problems were successfully resolved - including misdiagnosis, over-medication and lack of awareness of the side-effects of antiepileptic drugs. Nurse specialists in epilepsy, working with groups of general practices but in collaboration with hospital specialists and voluntary organizations, can take a lead role in facilitating joint working between all those involved in service provision, in training practice nurses and others in the special needs of people with epilepsy and in providing support in hospital clinics. (C) 2000 BEA Trading Ltd. [References: 15] <4> UI - 2000063373 AU - Sinclair HK AU - Bond CM AU - Hannaford PC IN - Dr. H.K. Sinclair, Univ. Dept. Gen. Practice Prim. Care, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY; United Kingdom. E-Mail: h.sinclair@abdn.ac.uk. TI - Pharmacovigilance of over-the-counter products based in community pharmacy: A feasible option?. SO - Pharmacoepidemiology & Drug Safety Vol 8(7) (pp 479-491), 1999. AB - Purpose: With the increasing range of potent medicines available for sale 'over-the-counter' (OTC) in community pharmacies, this feasibility study set out to develop and validate a method for the pharmacovigilance of OTC medicine, using ibuprofen as a model. Method: A trained network of community pharmacies (n = 61) in Grampian, Scotland, tested different methods for recruiting people buying ibuprofen for their own use (pilot 1) and then used the 'best' method to test two methods of follow-up (pilot 2). Results: Recruitment rates - method 1 (pharmacy staff inserted the patient information sheet and recruitment questionnaire in the shop bag of eligible subjects): 18% (41/227) of questionnaires issued; method 2 (staff explained the study and asked eligible subjects to complete the questionnaire outwith the pharmacy): 31% (61/194); method 3 (staff explained the study and asked eligible subjects to complete the questionnaire in the pharmacy): 52% (100/192). A further 200 subjects were recruited in pilot 2. The majority of recruits (n = 402) were female (75%), mean age 43 years (range 18-84 years), 73% drank alcohol, 72% were non-smokers, and 56% were in the two most affluent socio-economic categories. There was a strong association between the drug dose data collected prospectively and that collected retrospectively. The average response to postal follow-up was 80% (315/392) at 1 week and 79% (308/390) at 2 months. Conclusion: The study has confirmed the support of pharmacy personnel in undertaking research and indicated the feasibility of a major pharmacovigilance project of OTC medicines. Copyright (C) 1999 John Wiley and Sons, Ltd. [References: 25] <5> UI - 2000049676 AU - Hattersley JG IN - J.G. Hattersley, 7031 Glen Terra Court S.E., Olympia, WA 98503-7119; United States. TI - The case against fluoridation. SO - Journal of Orthomolecular Medicine Vol 14(4) (pp 185-197), 1999. <6> UI - 2000042766 AU - Green J AU - Neiburger EJ AU - Moss ME AU - Lanphear BP IN - Dr. J. Green, Roche Pharmaceuticals, Nutley, NJ; United States. TI - Blood lead level and dental caries [2] (multiple letters). SO - JAMA Vol 283(4) (pp 476-477), 2000. <7> UI - 2000027386 AU - Hobdell MH AU - Lalloo R AU - Myburgh NG IN - M.H. Hobdell, University of Texas-Houston, Dental Branch, 6516 John Freeman Avenue, Houston, TX 77030; United States. E-Mail: mhobdell@mail.db.uth.tmc.edu. TI - The human development index and per capita gross national product as predictors of dental caries prevalence in industrialized and industrializing countries. SO - Annals of the New York Academy of Sciences Vol 896 (pp 329-331), 1999. <8> UI - 2000015488 AU - Reijneveld SA AU - Stronks K IN - S.A. Reijneveld, TNO Prevention and Health, Department of Public Health, PO Box 2215, 2301 CE Leiden; Netherlands. E-Mail: SA.Reijneveld@pg.tno.nl. TI - The impact of response bias on estimates of health care utilization in a metropolitan area: The use of administrative data. SO - International Journal of Epidemiology Vol 28(6) (pp 1134-1140), 1999. AB - Background. Surveys among the general population are an important method for collecting epidemiological data on health and utilization of health care in that population. Selective non-response may affect the validity of these data. This study examines the impact of response bias on estimates of health care utilization and on risk estimates for utilization in relation to demographic and socioeconomic characteristics, using administrative data on use of health care. Methods. Data on registered health care utilization were extracted from health insurance register and linked to respondents (2934; 62.7%) and non-respondents (1744) in a personal health interview survey among adult residents from the lower two-thirds income bracket in Amsterdam, the Netherlands. Results. Estimates of registered healthcare utilization are higher if based on respondents only, than if they are based on the entire target sample. This goes for prescription drugs, specialist medical care, paramedical care, dental care and medical aids, but not for hospital care. Most risk estimates of registered utilization for background characterisitcs (gender, family composition, marital status, year of settlement, affluence of neighbourhood and ethnicity) differ only slightly and without statistical significance. If different, most estimates based on respondents only are somewhat higher. The largest differences are found for age (average overestimation of risks for age groups 35-64 and 65+ years compared to that of 16-34 years: 16% and 17%, respectively). Conclusions. In this study, response bias affects estimates of registered health care utilization but hardly affects risk estimates of utilization by background characteristics. [References: 33] <9> UI - 1999435959 AU - Milgrom P AU - Hujoel P AU - Grembowski D AU - Fong R IN - Dr. D. Grembowski, Dept. of Health Services, Box 357660, Univ. of Washington, Seattle 98195-7660; United States. E-Mail: grem@u.washington.edu. TI - A community strategy for medicaid child dental services. SO - Public Health Reports Vol 114(6) (pp 528-532), 1999. AB - Objectives. The authors present second-year utilization data and first- and second-year cost data for a community-based program in Spokane County, Washington, designed to increase access to dental care for Medicaid-enrolled children from birth to 60 months of age. Methods. The authors used Medicaid eligibility and claims data for 18,727 children 5 years of age and younger to determine utilization of dental care from January 15, 1996, through January 15, 1997. They also used accounting records from the agencies involved to calculate the first- and second-year costs of the program. Results. A child in the ABCD program was 7.2 times as likely to have at least one dental visit as a Medicaid-enrolled child not in the program. Estimated costs per child with at least one dental visit (in 1995 dollars) were $54.30 for the first year and $44.38 for the second year, or $20.09 per enrolled child for the first year and $18.77 for the second year. Conclusion. Public-private joint efforts are effective in improving access to dental care for Medicaid- enrolled children. [References: 10] <10> UI - 1999423455 AU - Rodrigues CS AU - Watt RG AU - Sheiham A IN - A. Sheiham, Dept. of Epidemiology Public Health, Royal Free Univ. Coll. Med. School, University College London, London WC1E 6BT; United Kingdom. TI - Effects of dietary guidelines on sugar intake and dental caries in 3-year-olds attending nurseries in Brazil. SO - Health Promotion International Vol 14(4) (pp 329-335), 1999. AB - The health outcomes of food and health policies are seldom evaluated. The objective of this study was to assess the effect of adoption of dietary guidelines on sugars by nurseries on levels of sugar consumption and 1-year dental caries increments in low-socio-economic 3-year-old children. Twenty-nine nurseries out of the 50 largest nurseries in Recife, Brazil were randomly selected. Five hundred and ten children (78% of those approached were examined); 245 children attending 12 nurseries adopting guidelines on restriction of sugar intake, and 265 at 17 nurseries without guidelines were assessed. The children's sugar intakes at nursery and at home were assessed by measuring 6 days weighed food intakes at the nursery, and a food inventory completed by the children's mothers. Dental caries were examined using standard WHO criteria. There were statistically significant differences in frequency and weight of sugar intake between children attending nurseries adopting and those not using dietary guidelines (p < 0.001). Children at nurseries adopting guidelines consumed less than half of the amount of sugar consumed in a day by children at non-adopting nurseries; 22.9 versus 53.5 g. Children attending nurseries with guidelines on reduction of sugar intake were 4.87 times more likely to develop caries in 1 year than those attending nurseries with guidelines Children who had a daily sugar intake of more than 32.6 g had nearly three times the risk of developing a high caries increment than those consuming less than 32.6 g. Dietary guidelines for sugar for nurseries are effective in providing menus with lower levels of sugar. Children consuming such menus are much less likely to develop dental caries. [References: 16] <11> UI - 1999394931 AU - Al-Isa AN IN - Dr. A.N. Al-Isa, Dept. Community Med. Behav. Sciences, Faculty of Medicine, University of Kuwait, PO Box 24923, Safat, Code 13110; Kuwait. E-Mail: alisa@hsc.kuniv.edu.kw. TI - Dietary and socio-economic factors associated with obesity among Kuwaiti college men. SO - British Journal of Nutrition Vol 82(5) (pp 369-374), 1999. AB - Obesity has been on the increase among people of the Arabian Gulf countries. Overweight and obesity among 18-29-year-old Kuwaiti men increased by 23.4 and 14.8% respectively, between 1980 and 1993. The objective of the present study was to explore factors associated with overweight and obesity in a sample of 515 Kuwaiti college men studied in 1997. Weight and height were measured. The index of adiposity used was the BMI, which is the weight (kg) divided by the height (m) squared (kg/m2). The men were classified as overweight (BMI > 25 kg/m2) or obese (BMI > 30 kg/m2). The associated factors obtained through questionnaires included age, marital status, governorate, number of siblings, suffering from a chronic disease, subjects' parental obesity, education and occupation, number of major meals eaten, eating between meals, family income, number of servants, number of people living at home, exercising, last dental and physical check-up, dieting, year of study, highest desired degree after college, countries preferred for visiting, and socio-economic status. The results of the study revealed that 38.5 and 11.1% of the students were overweight and obese respectively. Factors that were found to be significantly associated with overweight and obesity among the men included age, marital status, last dental check-up, exercising, subjects' parental obesity, dieting and year of study. Logistic regression analysis of significant associated factors revealed that the same factors contributed to the development of overweight and obesity. [References: 25] <12> UI - 1999357791 AU - Cryer PC AU - Jenkins LM AU - Cook AC AU - Ditchburn JS AU - Harris CK AU - Davis AR AU - Peters TJ IN - Prof. T.J. Peters, Department of Clinical Biochemistry, King's College School Medicine (GKT), London SE5 9PJ; United Kingdom. TI - The use of acute and preventative medical services by a general population: Relationship to alcohol consumption. SO - Addiction Vol 94(10) (pp 1523-1532), 1999. AB - Aims. To investigate the hypothesis that increasing alcohol consumption is accompanied by increasing use of acute, but decreasing use of preventative, medical services among the general population. Design and participants. Health and life-style survey of 41,000 randomly-sampled adults in SE England who self-completed a validated questionnaire covering socio-demographics, alcohol and tobacco usage and use of acute (AandE department and general practitioner) and preventative (dental, optician, mammography and cervical cytology) services: the response rate was 60%. Measurements. Comparative use of acute and preventative health care services by patients with varying consumption of alcoholic beverages. This was estimated by the odds ratio for service use, after correcting for the following confounding variables; age, social class, ethnic group, employment status, whether lives with children or with other adults, whether is a carer, limiting long-term illness, depression status, smoking habit and use of private health insurance. Findings. There was increased use of accident and emergency services by the harmful and intermediate drinking groups compared with the safe drinking group. Male abstainers attended their AandE departments more frequently than 'safe limit' drinkers. With respect to preventative services, both male and female abstainers and harmful drinkers used dental services less than safe limit drinkers. For females, mammography and cervical cytology services were less frequently used by abstainers and by harmful drinkers. Conclusions. This study supports the generally held view that heavy alcohol consumers are disproportionate users of acute medical services but they are relative under-users of preventative medical care services. Alcohol abstainers are also over-users of acute services, but under-users of preventative services. These latter observations are relevant to the claims that moderate alcohol consumers have lower apparent morbidity and mortality rates compared to abstainers. [References: 30] <13> UI - 1999318829 AU - Bakken R AU - Jezewska-Zychowicz M AU - Winter M IN - R. Bakken, 208 Lab Mechanics, Iowa State University, Ames, IA 50011; United States. E-Mail: rbakken@iastate.edu. TI - Household nutrition and health in Poland. SO - Social Science & Medicine Vol 49(12) (pp 1677-1687), 1999. AB - Data from 600 households in the province of Lublin, Poland, are used to assess the relationships among self-rated household health, change in health status, sociodemographic characteristics, food purchasing behavior changes, and health care seeking behaviors. High ratings of health are enjoyed by rural families headed by comparatively young individuals with high education. Average household health is also a function of household changes in food purchasing behavior over the past 5 years and per capita consumption of starch-based foods. Families consuming greater proportions of bread and potatoes and purchasing foods of reduced quality, quantity, and price experience lower average levels of subjective physical health than other families. Reduction or postponement of medical or dental care over the past 5 years did not affect health status in this model. Copyright (C) 1999 Elsevier Science Ltd. [References: 46] <14> UI - 1999285288 AU - Sgan-Cohen HD AU - Horev T AU - Zusman SP AU - Katz J AU - Eldad A IN - H.D. Sgan-Cohen, Department of Community Dentistry, School of Dental Medicine, Hebrew University-Hadassah, P.O. Box 12272, Jerusalem 91120; Israel. TI - The prevalence and treatment of dental caries among Israeli permanent force military personnel. SO - Military Medicine Vol 164(8) (pp 562-565), 1999. AB - A survey was conducted to determine dental caries prevalence and treatment among 1,095 25- to 44-year-old permanent force Israeli military personnel. Caries experience, by decayed, missing, and filled permanent teeth (DMFT), was 11.66, with an average of 1.37 untreated caries, 2.40 extracted teeth, and 7.90 treated teeth. Caries was positively associated with age (p < 0.001). Females demonstrated statistically higher DMFT levels than males (p = 0.009). Negative associations were detected for education levels and untreated and extracted components (p < 0.001), and a positive association was detected for the treated caries component (p < 0.001). Permanent military personnel treated by private dentists exhibited 17.6% untreated caries, compared with 9.4% among personnel treated in the army. Officers had lower levels of untreated caries (8.6%) than others (13.3%). Among the present population, 77% had attended a dental clinic in the preceding 2 years. Permanent force personnel are offered free, comprehensive, and accessible dental treatment. The data emphasize a need for further dental health education. [References: 19] <15> UI - 1999285287 AU - Cook LJ IN - L.J. Cook, Agcy. for Hlth. Care Policy/Research, Department of Health/Human Services, 6000 Executive Boulevard, Rockville, MD 20852; United States. TI - The implications of protocol-based care on dental services in the military. SO - Military Medicine Vol 164(8) (pp 556-561), 1999. AB - Downsizing, limited resources, and increasing costs provide challenges to the military health system. Variations in the diagnosis and treatment of dental disease add to the demands on the delivery system to provide access and ensure quality for uniformed personnel. Evidence-based dentistry is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. An evidence-based practice combines individual clinical expertise with the best external evidence available from systematic review of research findings. It provides a scientific basis for patient care, planning and implementation of health services, and development of health policy. Practice guidelines formulated on scientific evidence can reduce variations in the diagnosis and treatment of various dental conditions. A risk assessment protocol for treating dental caries can reduce operative dental treatment recommended at the initial examination and decrease the need for restorative care during a military career. [References: 32] <16> UI - 1999264161 AU - Silove D AU - Steel Z AU - McGorry P AU - Drobny J IN - D. Silove, Psychiat. Research and Teaching Unit, Health Services Building, Liverpool Hospital, Liverpool, NSW 2170; Australia. TI - Problems Tamil asylum seekers encounter in accessing health and welfare services in Australia. SO - Social Science & Medicine Vol 49(7) (pp 951-956), 1999. AB - Over the last decade, western countries have reduced their intake of refugees, even though a substantial number of persons continue to be displaced by war and persecution. At the same time, there has been a substantial increase in the number of asylum seekers who apply for refugee status after entering western countries without resettlement documents. Evidence is accruing that asylum seekers are at high risk to trauma-related psychiatric and physical disorders. Increasing concerns have been raised, therefore, about the difficulties that asylum seekers face in accessing health and welfare services. The present Australian-based volunteer study compared Tamil asylum seekers (n=62) from Sri Lanka with compatriots (30 refugees; 62 immigrants) on a number' indices relating to difficulties accessing medical, counselling and welfare services. The majority of asylum seekers (>60%) reported serious difficulties accessing medical and dental services and a sizeable minority reported problems obtaining assistance with welfare (40%), counselling (34%), and charity (23%). Difficulties accessing medical and dental services consistently exceeded those reported by refugees and immigrants. In spite of the inevitable sampling limitations, the data support past research as well as clinical impressions in suggesting that asylum seekers are particularly disadvantaged in accessing health care services. [References: 15] <17> UI - 1999220774 AU - Robison VA AU - Mosha HJ AU - Masalu JRP IN - Dr. V.A. Robison, J. Hopkins Sch. of Hyg./Public Hlth., Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205; United States. TI - An evaluation of oral health flip charts in maternal child health clinics in Tanzania. SO - INT J HEALTH PROMOT EDU, Vol 37(2) (pp 47-51), 1999. AB - Objectives: This paper describes a formal evaluation of a project which developed oral health flip charts for use in Maternal Child Health (MCH) clinics in Tanzania. The strengths and limitations of the evaluation are discussed. Methods: Relevance, progress and effectiveness of the flip chart project were measured. Relevance was determined using surveys of MCH nurses, expert opinions of Ministry of Health personnel and case studies of mothers attending MCH clinics. Progress was monitored by tracking the number of MCH Aides trained (592) and the number of flip chart sets distributed (330). Effectiveness was measured by assessing the teaching performance of MCH Aides before and after the flip charts. Effectiveness was also measured in a quasi- experimental design which compared teaching activity in two regions with flip charts and two regions without them. Results: The evaluation design was successful in measuring the progress of the project, and to some extent, project effectiveness. It was less successful in measuring the relevance of the flip charts to rural mothers and the change in teaching performance of MCH Aides. Conclusions: The design and evaluation of appropriate teaching materials is an important component of oral health promotion programmes in developing countries. It is easy to measure indicators such as the number of materials distributed, the number of health workers trained to use them and the number of times materials are used. The challenge is to measure indicators that are more closely related to the desired health outcome of improved oral health habits. [References: 12] <18> UI - 1999218727 AU - Moss ME AU - Lanphear BP AU - Auinger P IN - Dr. M.E. Moss, Dept. of Community/Preventive Med., Univ. of Rochester Medical Center, Box 644, 601 Elmwood Ave, Rochester, NY 14642; United States. E-Mail: moss@prevmed.rochester.edu. TI - Association of dental caries and blood lead levels. SO - JAMA Vol 281(24) (pp 2294-2298), 1999. AB - Context: Experiments show that dental caries rates are higher among lead-exposed animals, but this association has not been established in humans. Objective: To examine the relationship between blood lead levels and dental caries. Design: Cross-sectional survey conducted from 1988 to 1994 that included a dental examination and venipuncture blood lead assay. Setting and Participants: A total of 24901 persons aged 2 years and older who participated in the Third National Health and Nutrition Examination Survey, which assessed the health and nutritional status of children and adults in the United States. Main Outcome Measures: For children aged 2 to 11 years, the sum of decayed and filled deciduous or primary surfaces; for persons aged 6 years and older, the sum of decayed and filled permanent surfaces; for those 12 years and older, the sum of decayed, missing, and filled surfaces. Results: The log of blood lead level was significantly associated with the number of affected surfaces for both deciduous and permanent teeth in all age groups, even after adjusting for sociodemographic characteristics, diet, and dental care. Among children aged 5 to 17 years, a 0.24-mumol/L (5-mug/dL) change in blood lead level was associated with an elevated risk of dental caries (odds ratio, 1.8; 95% confidence interval, 1.32.5). Differences in blood lead level explained some of the differences in caries prevalence in different income levels and regions of the United States. We estimated the population attributable risk of lead exposure to be 13.5% and 9.6% of dental caries occurring in 5- to 17-year-olds exposed to the high and moderate levels, respectively. Conclusions: Environmental lead exposure is associated with an increased prevalence of dental caries in the US population. Findings may help explain the distribution of caries by income and region of the United States. [References: 25] <19> UI - 1999213518 AU - Shiboski CH AU - Palacio H AU - Neuhaus JM AU - Greenblatt RM IN - Dr. C.H. Shiboski, Department of Stomatology, Box 0422, University of California, 513 Parnassus Ave., San Francisco, CA 94143-0422; United States. E-Mail: caro@nanook.ucsf.edu. TI - Dental care access and use among HIV-infected women. SO - American Journal of Public Health Vol 89(6) (pp 834-839), 1999. AB - Objectives. This study sought to identify predictors of dental care use in HIV-infected women. Methods. In a cross-sectional survey of HIV-infected women enrolled in the northern California site of the Women's Interagency HIV Study, dental care use and unmet need were assessed relation to selected variables. Results. Among 213 respondents, who were predominantly Black and younger than 45 years, 43% had not seen a dentist and 53% (among dentate women) reported no dental cleaning in more than a year (although 67% had dental insurance coverage, mainly state Medicaid). Nine percent were edentulous. Among nonusers of dental care, 78% reported that they wanted care but failed to get it. Barriers included fear of and discomfort with dentists, not getting around to making an appointment, and not knowing which dentist to visit. Multivariate analysis showed that lack of past-year dental care was associated mainly with unemployment, a perception of poor oral health, and edentulism. Conclusions. HIV-positive women appear to be underusing dental care services. Fear and lack of information regarding available resources, in addition to unemployment and perception of poor oral health, may be important barriers. [References: 28] <20> UI - 1999213514 AU - Zabos GP IN - G.P. Zabos, Joseph L. Mailman School Health, Columbia University, New York, NY; United States. TI - Meeting primary oral health care needs of HIV-infected women. SO - American Journal of Public Health Vol 89(6) (pp 818-819), 1999. <21> UI - 1999207801 AU - Faggiano F AU - Di Stanislao F AU - Lemma P AU - Renga G IN - F. Faggiano, Department of Public Health, University of Turin, Via Santena 5bis, 10126 Turin; Italy. E-Mail: faggiano@molinette.unito.it. TI - Role of social class in caries occurrence in 12 year olds in Turin, Italy. SO - EUR J PUBLIC HEALTH, Vol 9(2) (pp 109-113), 1999. AB - Background: The objective of the study was to evaluate the social distribution of dental caries and its determinants in the province of Turin, an area of 2,300,000 inhabitants in the north of Italy. Methods: A cross- sectional study was carried out among a representative school-based sample of 11-12 year olds. A total of 734 (84.0% of the starting sample) students were involved. Two questionnaires were submitted (to students and parents) and the children received a dental examination. Dietary and hygiene indicators were calculated and the DMFT index (the number of decayed, missing and filled teeth) was measured using methods recommended by the World Health Organisation (WHO). The education level of the head of family was used as a proxy of social class indicator. Univariate and multivariate analyses were applied to obtain results. Results: Students from disadvantaged families showed: i) a higher tendency to belong to the higher risk group for oral hygiene (RR primary school/university = 2.78); ii) a lower use of dental prevention (RR=0.40 for use of fluoride tablets and RR=0.43 for local applications of fluoride) and iii) a higher consumption of sucrose-sweetened foods (RR=1.17%, ns) when compared with children of graduate parents. The DMFT index was more than double among children whose parents only had a primary school education, compared with those of graduate parents (3.2 versus 1.5). In addition, the percentage of caries-free children increased from 16.4 to 59.1% from the lowest to the highest social group. Conclusions: Large social differences are found in caries experience and in determinants of dental decay. Nevertheless, determinants of caries occurrence seem to explain only a small fraction of inequalities. [References: 37] <22> UI - 1999192035 AU - Shenkin J IN - J. Shenkin, 464 Montauk Avenue, New London, CT 06320; United States. E-Mail: jshenkin@snet.net. TI - The future of dental managed care in the US. SO - Health Policy Vol 47(3) (pp 225-239), 1999. AB - Managed care is slowly becoming more prominent within dental benefit programs, with nearly 30% of insured people participating in a dental managed care plan. This number is expected to increase steadily over time, but not with the same speed that it has with medicine. In combination with the changing demographics of the country and the diminishing supply of dental personnel, managed care will have less power over the dental market place than it has had over medicine. In the future, changes will be dependent on the demand for dental treatment and also the supply of dentists. With increased demand, decreased personnel and a minority of Americans having dental insurance, dentists are in a better position than their medical counterparts. If the influence of managed care is not diminished, the effects on the practice of dentistry will be dramatic. Managed care will eventually introduce outcomes assessment, utilization management, and reduced fees. This will transform the practice of dentistry into a two-tiered system, treating fee-for-service and managed care patients differently. Copyright (C) 1999 Elsevier Science Ireland Ltd. [References: 84] <23> UI - 1999133853 AU - Riley JC AU - Lennon MA AU - Ellwood RP TI - The effect of water fluoridation and social inequalities an dental caries in 5-year-old children. SO - International Journal of Epidemiology Vol 28(2) (pp 300-305), 1999. AB - Background. Many studies have shown that water fluoridation dramatically reduces dental caries, but the effect that water fluoridation has upon reducing dental health inequalities is less clear. The aim of this study is to describe the effect that water fluoridation has upon the association between material deprivation and dental caries experience in 5-year-old children. Methods. It is an ecological descriptive study of dental caries experience using previously obtained data from the British Association for the Study of Community Dentistry's biennial surveys of 5-year-old children. This study examined the following data from seven fluoridated districts and seven comparable non-fluoridated districts in England: 1) dental caries experience using the dmft (decayed, missing, filled teeth) index; 2) the Townsend Deprivation Index of the electoral ward in which the child lived; 3) whether fluoride was present at an optimal concentration in the drinking water or not. Results. A statistically significant interaction was observed between material deprivation (measured by the Townsend Deprivation Index) and water fluoridation (P < 0.001). This means that the social class gradient between material deprivation and dental caries experience is much flatter in fluoridated areas. Conclusion. Water fluoridation reduces dental caries experience more in materially deprived wards than in affluent wards and the introduction of water fluoridation would substantially reduce inequalities in dental health. [References: 30] <24> UI - 1999115875 AU - Giordano PC AU - Harteveld CL AU - Bok LA AU - Van Delft P AU - Batelaan D AU - Beemer FA AU - Bernini LF IN - P.C. Giordano, Department of Human Genetics, Leiden University, Medical Center, Wassenaarseweg 72, 2333 AL Leiden; Netherlands. E-Mail: piero@ruly46.medfac.leidenuniv.nl. TI - A complex haemoglobinopathy diagnosis in a family with both beta [degree] - and alpha( [degree] /+)-thalassaemia homozygosity. SO - European Journal of Human Genetics Vol 7(2) (pp 163-168), 1999. AB - The occurrence of point mutation alpha-thalassaemia and of complex combinations of haemoglobin defects is underestimated. Haemoglobinopathies, the most frequent monogenic recessive autosomal disorder in man, occur predominantly in Mediterranean, African and Asiatic populations. However, countries of immigration with a low incidence in the indigenous population, are now confronted with a highly heterogeneous array of imported defects. Furthermore, the occurrence of severe phenotypes is bound to increase in the near future because of the endogamous growth of the ethnical minorities and the lack of prevention. We describe an Afghan family in which both partners of a consanguineous relationship are carriers of a beta- as well as an alpha-thalassaemia determinant. The combination of defects was revealed by the in vitro measurement of the beta/alpha biosynthetic ratio and was characterised at the DNA level. The molecular defects involved are the Cd5(-CT), a Mediterranean beta [degree] -thalassaemia mutation, and the alpha2( [degree] /+)-thalassaemia AATA(-AA) polyadenylation defect. The alpha-thalassemia defect is a rare RNA-processing mutant described only twice before in heterozygous form in Asian-Indian patients. The mutation suppresses the expression of a alpha2 gene and reduces the expression of the less efficient, 3' located alpha1 gene as well, inducing a near alpha [degree] -thalassaemia phenotype. This defect is now described for the first time in the homozygous condition in one of the children who, in addition to being homozygous for the alpha-thalassaemia point mutation, is also a carrier of the beta [degree] -thalassaemia defect. A previously described homozygous case of the alpha( [degree] /+)-thalassaemia condition, caused by a similar polyadenylation defect, was characterised by a severe HbH disease. However, the patient described here present at 7 years of age with severe caries, like his beta-thalassaemia homozygous brother but without hepatosplenomegaly, haemolysis or severe anaemia. The haematological analysis revealed 9.5 g/dl Hb; 5.4 x 1012/I RBC; 0.33 I/I PCV; 61 fl MCV; 17.6 pg MCH and 6.2% of HbA2. The biosynthetic ratio beta:alpha was 1.6 and no HbH fraction was detectable either on electrophoresis or as inclusion bodies. The parents reported no complications during pregnancy, at birth, or in the neonatal period in rural Afghanistan. We presume therefore that the counterbalancing effect induced by the co-existing beta-thalassaemia defect could have modified a potentially severe perinatal HbH disease into a strongly hypochromic but well compensated 'alpha [degree] -like heterozygous' thalassaemia phenotype. The risk of a severe HbH disease, could have been easily missed in this family which was referred because of a child affected with beta-thalassaemia major. [References: 22] <25> UI - 1999087418 AU - Allison PJ AU - Locker D AU - Feine JS IN - P.J. Allison, Department of Oncology, Faculty of Medicine, McGill University, Montreal, Que.; Canada. E-Mail: pallison@med.mcgill.ca. TI - The relationship between dental status and health-related quality of life in upper aerodigestive tract cancer patients. SO - Oral Oncology Vol 35(2) (pp 138-143), 1999. AB - Although the oral sequelae of treatments for upper aerodigestive tract (UADT) cancers have been well described, very little is known about the relationship between dental status and health-related quality of life (HRQL) in patients with UADT cancer. The aim of this study was to investigate the hypothesis that dental status is a predictor of HRQL in a sample of post- therapeutic UADT cancer patients. A cross-sectional study design was used with a sample of 188 subjects. HRQL was evaluated through the global domain of the EORTC QLQ-C30 instrument and data were collected on sociodemographic, disease, treatment and dental status variables. Linear multiple regression analysis was used to determine those variables with a significant independent association with the HRQL. Two multivariate models were developed each containing age, gender, employment status, cancer site and disease stage, plus either the dental status category 'partially dentate with no prosthesis' (P/NP) (F-value for model = 7.31; P < 0.0001; r2 = 0.20) which predicted a significantly worse HRQL, or the dental status category 'edentulous with prostheses' (E/WP) (F-value for model = 7.56; P<0.0001; r2=0.20) which predicted a significantly better HRQL. Furthermore, the P/NP group reported significantly more 'problems with their teeth' (ANOVA, P = 0.0004), significantly more 'trouble eating' (ANOVA, P = 0.024) and significantly more 'trouble enjoying their meals' (ANOVA, P = 0.01). Although the cross- sectional nature of the data collection and the somewhat crude nature of the dental status variable limit inferences, the results of this study suggest that dental status has an important effect on HRQL in post-therapeutic UADT cancer patients. [References: 37] <26> UI - 1999090413 AU - Flack JM AU - Hamaty M IN - Dr. J.M. Flack, Cardiovasc Epidemiol Clin Apps Prog, Detroit Medical Center, Central Region Hospitals, Detroit, MI 48201; United States. E-Mail: jflack@oncgate.roc.wayne.edu. TI - Difficult-to-treat hypertensive populations: Focus on African-Americans and people with type 2 diabetes. SO - Journal of Hypertension - Supplement Vol 17(1) (pp S19-S24), 1999. AB - The awareness, treatment, and control of hypertension has risen steadily over the past three decades, until the early 1990s. However, blood pressure control to < 140/90 mmHg is attained in fewer than 25% of all hypertensive patients and fewer than 50% of drug-treated hypertensive patients, except for white women. Two special populations, African-Americans and diabetics, share several important attributes. First, they both have a high prevalence of hypertension, including stage 3 hypertension (as defined by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of Hypertension VI: >= 180/110 mmHg), relative to other subgroups. African-Americans have an approximate 8% prevalence of stage 3 hypertension, and elevated systolic blood pressure is highly prevalent among diabetic people, particularly older African-American women. Second, both groups have high levels of blood-pressure-related target-organ damage, which contributes to their inordinately high absolute risk for cardiovascular disease complications (i.e. stroke, congestive heart failure, renal failure) at a given level of blood pressure. Moreover, the reduced natriuretic capacity common to each group contributes to the attenuated efficacy of antihypertensive drug monotherapy, particularly for drug classes other than diuretics and calcium antagonists. These two special populations are also typically salt-sensitive, an intermediate blood pressure phenotype that raises blood pressure medication requirements. This phenomenon has been associated with an attenuation in the normal nocturnal fall in blood pressure. The high absolute risk for cardiovascular disease among diabetics led to the formulation of more aggressive treatment recommendations for antihypertensive drug therapy. In diabetics, blood pressure therapy is initiated at blood pressures >= 130/85 mmHg, and treatment goals are at least to this level, unless proteinuria is >= 1 g/day (in which case the goals are < 125/75 mmHg). The more aggressive treatment targets for diabetics will not be reached with most currently available single antihypertensive agents in many African-Americans. While at best only 50-60% of hypertensive patients can be controlled with single drug therapy, that percentage falls dramatically in persons with stage 3 hypertension and renal insufficiency, thereby necessitating the use of combination drug therapy. Treatment alone is not enough; treatment to goal blood pressure is an essential first step towards optimal target-organ protection. While circulating levels of renin are suppressed, in general, in these special populations, each group manifests an inordinate burden of blood-pressure-related target-organ damage that has been linked to excessive levels of angiotensin II or a reduced bradykinin and nitric oxide tissue effect. The renin-angiotensin-aldosterone-kinin system is therefore an attractive therapeutic target that might conceivably provide target-organ protection over and above that attributable solely to lowering the blood pressure. [References: 45] <27> UI - 1998412777 AU - Boriani G AU - Frabetti L AU - Biffi M AU - Sallusti L IN - G. Boriani, Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna; Italy. E-Mail: cardio1@almadns.unibo.it. TI - Clinical experience with downsized lower energy output implantable cardioverter defibrillators. SO - International Journal of Cardiology Vol 66(3) (pp 261-266), 1998. AB - Background and study objective: Technical improvements in cardioverter defibrillators technology has resulted in decrease in can size coupled with improved electrodes technology. A decrease in maximum energy output allows further decrease in device size. The aim of this study was to evaluate the feasibility of a single lead transvenous implant employing a downsized cardioverter-defibrillator (volume 59 cm3), with a related decrease in maximum energy output (29-31 joules as stored energy and 25-27 joules as delivered energy). Methods and results: Fifty-five patients with ventricular tachyarrhythmias were enrolled in 17 European institutions for implantation. At implantation step-down defibrillation threshold (DFT) was determined and the device was implanted only if a safety margin >=10 joules was maintained between DFT and maximum programmable output. Implantation was performed in 54 of the 55 referred patients (98%) in a single electrode-device configuration. Step-down DFT testing was performed in 44 patients (43 finally implanted) and DFT was 7.77+/-4.41 joules (range 3-20). In 20 of the tested patients (45%) DFT was <=5 joules, in 26 patients (59%) was <=8 joules and in 34 patients (77%) it was <=10 joules. No differences were found in DFT comparing patients with left ventricular ejection fraction <= or >40% or patients treated or not with antiarrhythmic drugs or beta-blockers. Mean implant duration was 85+/-34 min. Conclusions: Employing a downsized cardioverter defibrillator, successful transvenous implantation can be achieved in 98% of the patients, with maintenance of adequate defibrillation safety margins despite a reduction in stored energy to 29 joules. Implantation of the device with a lead-alone configuration allows short implant times and few perioperative complications. [References: 21] <28> UI - 1998389862 AU - Dolan TA AU - Peek CW AU - Stuck AE AU - Beck JC IN - T.A. Dolan, University of Florida, College of Dentistry, JHMHC Box 100405, Gainesville, FL 32610-0405; United States. E-Mail: tdolan@dental.ufl.edu. TI - Functional health and dental service use among older adults. SO - Journals of Gerontology Series A-Biological Sciences & Medical Sciences Vol 53(6) (pp M413-M418), 1998. AB - Background. Although socioeconomic barriers to receiving adequate dental care have been well documented, physical frailty as a risk factor for not visiting the dentist has not been fully explored. This study prospectively examines the relationship between functional health and dental service use, taking into account sociodemographic characteristics, general and dental health status, and prior dental utilization behavior. Methods. Data from a randomized trial of a comprehensive geriatric assessment and prevention program in community-dwelling adults age 75+ years living in Santa Monica, CA, collected between 1988 and 1993, were analyzed. A series of discrete- time proportional hazards models were used to assess the effects of functional status, sociodemographic characteristics, and general health and dental health measures on dental service use. Results. Functional status was negatively associated with dental service use, and the conditional probability of a first visit to the dentist after baseline decreased over time. When additional measures of general health, dental health, and socioeconomic status were introduced, the effect of functional status was mitigated but remained significant. In the most fully specified model, which took dental visitation behavior prior to the beginning of the study into account, the effect of functional limitation remained significant. Conclusions. Even in this relatively well-educated group of older persons with higher than average dental service use, impaired functional status was associated with lower levels of dental service use over time. [References: 23] <29> UI - 1998369377 AU - Robison VA AU - Rozier RG AU - Weintraub JA IN - Dr. V.A. Robison, John Hopkins Sch. Hygiene/Pub. Hlth., Department of Epidemiology, 615 N Wolfe St, Baltimore, MD 21205; United States. E-Mail: vrobison@loxinfo.co.th. TI - A longitudinal study of schoolchildren's experience in the North Carolina dental Medicaid program, 1984 through 1992. SO - American Journal of Public Health Vol 88(11) (pp 1669-1673), 1998. AB - Objectives. This evaluation of a state Medicaid dental program describes dental treatment received, relates treatment needed to treatment received, and describes enrollment and use over an 8-year period. Methods. Three databases were linked: (1) clinical records from a 1986/87 statewide epidemiological survey, providing data on treatment need; (2) Medicaid dental claims from 1984 through 1992, providing data on treatment received; and (3) Medicaid enrollment flies from 1984 through 1992. Results. Half of Medicaid- enrolled children never used dental services. Among users of dental services, 45% and 25% of children needed restorations in primary and permanent teeth, respectively. In this group, 29% had all needs met, 28% had needs partially met, and 43% had no needs met. Forty-six percent of children sought care for only 1 year. Conclusions. Federal guidelines for dental care are not met in this typical Medicaid population of short-term enrollees who use services sporadically. Programs should aim to increase use and ensure that all needed services, especially preventive procedures such as sealants, can be completed within the short period of time a child attends for care. [References: 25] <30> UI - 1998388297 AU - Sandstedt B AU - Kennergren C AU - Schaumann A AU - Herse B AU - Neuzner J IN - Dr. B. Sandstedt, Division of Cardiology, Sahlgrenska University Hospital, S-413 45 Goteborg; Sweden. TI - Short- and long-term performance of a tripolar down-sized single lead for cardioverter defibrillator treatment: A randomized prospective european multicenter study. SO - Pacing & Clinical Electrophysiology Vol 21(11 I) (pp 2087-2094), 1998. AB - A new, thinner (10 Fr) and more flexible, single-pass transvenous endocardial ICD lead, Endotak DSP, was compared with a conventional lead, Endotak C, as a control in a prospective randomized multicenter study in combination with a nonactive can ICD. A total of 123 patients were enrolled, 55 of whom received a down-sized DSP lead. Lead-alone configuration was successfully implanted in 95% of the DSP patients vs 88% in the control group. The mean defibrillation threshold (DFT) was determined by means of a step-down protocol and was identical in the two groups, 10.5 +/- 4.8 [in the DSP group versus 10.5 +/- 4.8] in the control group. At implantation, the DSP mean pacing threshold was lower, 0.51 +/- 0.18 V versus 0.62 +/- 0.35 V (p < 0.05) in the control group, and the mean pacing impedance higher, 594 +/- 110 Omega vs 523 +/- 135 Omega (p < 0.05). During the follow-up period, the statistically significant difference in thresholds disappeared, while the difference in impedance remained. Tachyrhythmia treatment by shock or antitachycardia pacing (ATP) was delivered in 53% and 41%, respectively, of the patients with a 100% success rate. In the DSP group, all 28 episodes of polymorphic ventricular tachycardia or ventricular fibrillation were converted by the first shock as compared to 57 of 69 episodes (83%) in the control group (p < 0.05). Monomorphic ventricular tachycardias were terminated by ATP alone in 96% versus 94 %. Lead related problems were minor and observed in 5% and 7%, respectively. In summary, both leads were safe and efficacious in the detection and treatment of ventricular tachyarrhythmias. There were no differences between the DSP and control groups regarding short- or long-term lead related complications. [References: 34] <31> UI - 1998346085 AU - Bourgeois D AU - Nihtila A AU - Mersel A IN - Dr. D. Bourgeois, Oral Health Programme, Division of Noncommunicable Diseases, World Health Organization, 1211 Geneva 27; Switzerland. TI - Prevalence of caries and edentulousness among 65-74-year-olds in Europe. SO - BULL WHOO, Vol 76(4) (pp 413-417), 1998. AB - Reviewed in this article are epidemiological studies included in the WHO Global Oral Data Bank for noninstitutionalized European adults aged 65-74 years for the period 1986-96. Edentulous percentages, decayed, missing, filled teeth (DMFT) index, and data on the mean number of teeth are presented. At least one representative study had been carried out in 48% of the countries, with the quantity of information from countries with developed market economies being similar to that from countries with economies in transition. The proportion of 65-74-year-olds who were edentulous varied from 12.8% to 69.6%, the mean number of teeth ranged from 15.1 to 3.8, and the DMFT index from 22.2 to 30.2. The observed disparities in the oral health status among older European adults suggest that it may be possible to develop and implement oral health policies that take into account geographical and socioeconomic differences in populations. [References: 15] <32> UI - 1998333517 AU - Brodeur J-M AU - Payette M AU - Bedos C IN - J.-M. Brodeur, dept. medecine sociale preventive, Universite de Montreal, Succ. Centre-ville, CP 6128, Montreal, Que. H3C 3J7; Canada. E-Mail: brodeuje@ere.umontreal.ca. TI - Association of socio-economic variables with the prevalence of dental caries in second and sixth grade Quebec school children from 1989-1990. SO - Canadian Journal of Public Health. Revue Canadienne de Sante Publique Vol 89(4) (pp 274-279), 1998. AB - Objectives: 1) To determine caries risk factors in second and sixth grade Quebec children; 2) To test multivariate models which identify children as belonging to a high prevalence group. Methods: For the 1989-90 Sante Dentaire Quebec survey, 2291 second grade and 2111 sixth grade school children responded to a questionnaire on their personal habits of hygiene and diet and underwent a clinical examination, while their parents answered a questionnaire regarding their family's socioeconomic status. Results: Statistics demonstrate a stronger link between socioeconomic variables and caries prevalence than demographic and sanitary factors. Children emerging from a high socioeconomic milieu have better dental health than children with low socioeconomic standing. The most effective model, however, registers a sensitivity of 65% and a specificity of 66%, revealing the inadequacy of statistical models to accurately identify children in the caries high prevalence group. [References: 45] <33> UI - 1998311700 AU - Chuansumrit A IN - A. Chuansumrit, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok; Thailand. TI - Meeting the needs of haemophilic children in developing countries. SO - Haemophilia Vol 4(4 SUPPL. 2) (pp 19-23), 1998. <34> UI - 1998268000 AU - Levallois P AU - Grondin J AU - Gingras S IN - Dr. P. Levallois, Centre de sante publique de Quebec, 2400 d'Estimauville, Beauport, Que. G1E 7G9; Canada. E-Mail: patrick.levallois@msp.ulaval.ca. TI - Knowledge, perception and behaviour of the general public concerning the addition of fluoride in drinking water. SO - Canadian Journal of Public Health. Revue Canadienne de Sante Publique Vol 89(3) (pp 162-165), 1998. AB - A telephone survey was carried out in 1994, in Quebec City region, among 1006 people living in two municipalities where tap water is fluoridated and 1003 people living in two municipalities where there is no fluoridation. Knowledge of the main benefit associated with the use of fluoride (prevention of tooth decay) drinking water was not different in fluoridated versus non-fluoridated municipalities (20.4% vs 19.4%, p = 0.57). Knowledge of its main disadvantage (increase of dental fluorosis) was very low and similar in both groups (3.1% vs 2.0%, p = 11). Opposition to fluoridation was slightly higher in fluoridated areas (22.0% vs 18.3%, p = 0.04), and the use of fluoridated supplements for children was much less important in fluoridated areas (4.4% vs 12.4%, p = 0.01). No changes in the measures of association (odds ratios) were found after adjustment for the different characteristics of the participants (age, family income, education). Opposition to fluoridation was lower among those who believed their tap water was fluoridated (even if not): 19.9% vs 34.5%, p < 0.01. This study demonstrated that there is still need for public health education on the uses of fluorides. [References: 19] <35> UI - 1998231599 AU - Velly AM AU - Franco EL AU - Schlecht N AU - Pintos J AU - Kowalski LP AU - Oliveira BV AU - Curado MP IN - E.L. Franco, Department of Oncology/Epidemiology, McGill University, Montreal, Que.; Canada. E-Mail: eduardof@oncology.lan.mcgill.ca. TI - Relationship between dental factors and risk of upper aerodigestive tract cancer. SO - Oral Oncology Vol 34(4) (pp 284-291), 1998. AB - We examined the relationship between dental health variables and risk of upper aerodigestive tract (UADT) cancers in a casecontrol study in Southern Brazil. The study population included 717 cases of cancers of the mouth, pharynx, and larynx and 1434 controls matched on age, gender, period of admission and study site. The association with dental factors was investigated by conditional logistic regression using extensive adjustment for a priori and empirical confounders, including tobacco and alcohol consumption, diet and sociodemographic variables. Lifetime use of dentures was not associated with risk of any UADT cancer, but history of oral sores secondary to ill-fitting dentures was associated with cancers of the mouth (odds ratio [OR] = 2.3, 95% confidence interval [CI] 1.2-4.6) and of the pharynx (OR = 2.7, 95% CI 1.1-6.2) among those using dentures. The association for mouth cancers was restricted primarily to an increased risk of tongue neoplasms (OR = 9.1, 95% CI 1.9-43.4). Less than daily tooth brushing frequency was also associated with risk of cancer of the tongue (OR = 2.1, 95% CI 1.0-4.3) and of other parts of the mouth (OR = 2.4, 95% CI 1.0- 5.4). Having broken teeth was not significantly associated with risk of UADT cancer of any site. We conclude that poor oral hygiene due to infrequent tooth brushing and sores caused by dentures are risk factors for cancer of the mouth and that these associations are unlikely to be due to insufficient control of confounding. [References: 25] <36> UI - 1998209170 AU - Angelillo IF AU - Anfosso R AU - Nobile CGA AU - Pavia M IN - I.F. Angelillo, Medical School, University of Reggio Calabria, Via Tommaso Campanella, 88100 - Catanzaro; Italy. TI - Prevalence of dental caries in schoolchildren in Italy. SO - European Journal of Epidemiology Vol 14(4) (pp 351-357), 1998. AB - The caries experience and its potential risk indicators such as socioeconomic status, sweets consumption, toothbrushing habits, dental visit attendance pattern and salivary mutans streptococci (in 12 year old only), were assessed in schoolchildren raised and living in low fluoridated areas (Catanzaro, Italy). Caries-free prevalence in the 6-year-old was 52.9% in their primary dentition; the dmft and dmfs were 2.1 and 5.1, and both DMFT and DMFS were 0.1. Almost 91% of the dmft was attributable to active decay. The proportion of children with a dmft+DMFT <= 1 and the dmft and dmfs were significantly higher in those with low socio-economic status. In the 12- year-old, 52.7% had a history of caries and the DMFT and DMFS were 1.5 and 2.6; the filled component was the dominant proportion. The more likely they visited a dentist for routine checkup, the higher socio-economic status (it was not associated with DMFT), the less frequently they had sweets, and the low level of Streptococcus mutans, the more likely they were caries-free and the less likely they were to have a high DMFT, DMFS, and DT. In the 15-year- old, 68.8% had a history of caries and the DMFT and DMFS were 2.8 and 4.8, with a higher prevalence of the F component. The children who visited a dentist for routine checkup had a significantly lower caries experience, DMFT, DMFS, and DT than the irregular attenders, and those with low socio- economic background were more likely to have a high DMFS. [References: 32] <37> UI - 1998215390 AU - Schoenberg NE AU - Gilbert GH IN - Dr. N.E. Schoenberg, Department of Behavioral Science, College of Medicine Office Building, University of Kentucky, Lexington, KY 40536-0068; United States. TI - Dietary implications of oral health decrements among African-American and White older adults. SO - Ethnicity & Health Vol 3(1-2) (pp 59-70), 1998. AB - Objective. Older African-Americans are at disproportionate risk of chronic, nutritionally-related diseases. To begin to understand factors that may contribute to the disproportionate prevalence of life-threatening illnesses among African-Americans, this study investigates ethnic differences in the prevalence of oral health decrements. Design. The Florida Dental Care Study (FDCS), a longitudinal study of changes in the oral health of 873 subjects age 45+, was used to explore a broad range of oral health status differences between African-American and White adults in the United States. The FDCS consists of clinical and self-reported measures of oral health, sociodemographic information, and other indicators of oral functional status. Results. The prevalence of oral health decrements in this sample using a broad range of clinical and self-reported measures was substantial. African-American elders were at a heightened risk of poor oral health profiles, including having fewer teeth and being more likely to have a carious surface, fractured cusp or incisal edge, severely mobile teeth and severe periodontal levels than their White counterparts. Furthermore, the African-American respondents in our sample were significantly more likely to report a lower self-rated oral health and functioning than their White counterparts. These findings persist regardless of poverty status or educational level, two factors commonly thought to confound racial differences in health outcomes. Conclusion. Our study provides evidence that the widespread prevalence of oral health decrements and accompanying functional disability among this sample of dentate older adults impacts their daily lives. Of particular concern is the oral health status of older African-Americans who may be nutritionally vulnerable due, in part, to these oral health decrements and disabilities. We suggest enhancing the access of health services in order to prevent those oral health decrements that presumably undermine adequate dietary intake. [References: 35] <38> UI - 1998134467 AU - Olsovsky MR AU - Shorofsky SR AU - Gold MR IN - Dr. M.R. Olsovsky, Division of Cardiology, Univ. of Maryland Medical System, Baltimore, MD 21201; United States. TI - Effect of shock polarity on biphasic defibrillation thresholds using an active pectoral lead system. SO - Journal of Cardiovascular Electrophysiology Vol 9(4) (pp 350-354), 1998. AB - Polarity and Biphasic Defibrillation Thresholds. Introduction: The downsizing of implantable defibrillator pulse generators has made pectoral placement routine. A further reduction of defibrillation thresholds (DFTs) may simplify implantation defibrillation testing and allow for smaller, lower output pulse generators while maintaining an adequate defibrillation safety margin. One factor that may affect defibrillation efficacy is shock polarity. Methods and Results: Sixty consecutive patients undergoing dual-coil, active left pectoral defibrillator implantation were evaluated. Paired, biphasic DFTs were measured in normal (RV apex = cathode) and reverse (RV apex = anode) polarity with order of testing randomized. Reverse polarity conferred a 15% reduction of mean DFTs (8.5 +/- 5.0 J normal, 7.2 +/- 4.6 J reverse polarity, P = 0.02). The effect of polarity appeared most pronounced among the patients with a high DFT (<= 15 J) resulting in a 31% reduction with reverse polarity (16.7 +/- 2.5 J normal, 11.5 +/- 5.9 J reverse, P = 0.03). Conclusion: Reversing shock polarity results in significantly lower biphasic DFTs with an active pectoral lead system, particularly in the subgroup of patients with a high normal polarity threshold. Reversing polarity in these patients may simplify acute defibrillation testing and allow for lower output devices. [References: 14] <39> UI - 1998098847 AU - Drum MA AU - Chen DW AU - Duffy RE IN - Dr. D.W. Chen, Bureau of Health Professions, HRSA, US Dept. of Health/Human Services, 5600 Fishers Lane, Rockville, MD 20857; United States. E-Mail: dchen@hrsa.dhhs.gov. TI - Filling the gap: Equity and access to oral health services for minorities and the underserved. SO - Family Medicine Vol 30(3) (pp 206-209), 1998. AB - Background and Objectives: Family physicians and other primary care providers play a pivotal role in preventing oral disease, especially among minority and underserved populations who have limited access to dental services and poorer oral health status. Oral diseases/conditions, such as caries, baby bottle tooth decay, gingivitis, periodontitis, oral pharyngeal malignancies, and orofacial trauma, are prevalent and costly, yet largely preventable. Given their role in promoting and protecting overall health and their historical role in serving minority and underserved families, family physicians occupy a unique position to assure equity, access, and improvement in oral health for all Americans. [References: 26] <40> UI - 1998093612 AU - Duggal MS AU - Curzon MEJ AU - Bailey CC AU - Lewis IJ AU - Prendergast M IN - M.S. Duggal, Division of Child Dental Health, Leeds Dental Institute, Leeds; United Kingdom. TI - Dental parameters in the long term survivors of childhood cancer compared with siblings. SO - Oral Oncology Vol 33(5) (pp 348-353), 1997. AB - There have been a number of reports on the dental health of long term survivors (LTS) of childhood malignancy as compared with normal controls. However, it is usually difficult to identify a meaningful control population as most of these patients are from widely differing geographical areas and socioeconomic status. The aim of this investigation was, therefore, to study the dental health of LTS compared with siblings. 46 LTS who had siblings of a similar age were identified for the study. Both groups were examined for dental caries, gingivitis and enamel defects. There was no statistically significant difference in the mean DMFS of the test and control groups. However, the LTS had a significantly (P=0.006) higher number of decayed surfaces (1.50+/-0.30) as compared with their siblings (0.50 +/-0.20). The LTS also had a significantly higher prevalence of severe gingivitis (1.11 +/- 0.33) compared with controls (0.02 +/- 0.02). There was a significantly higher prevalence of all types of enamel defects in the LTS and fewer teeth with no enamel defect as compared with their siblings, with the mean values being 15.7+/-0.9 and 25.3 +/-0.3, respectively. It was concluded that there was a higher prevalence of untreated dental disease and developmental defects in long term survivors. [References: 13] <41> UI - 1998087763 AU - Vemmer T AU - Gibson SLM AU - Gibson RG AU - Jones C AU - Taylor G AU - Evans D AU - Whittle G AU - Trotter D IN - Dr. T. Vemmer, Munsterstrasse 33, D-22529 Hamburg; Germany. TI - Water fluoridation and tooth decay in 5 year olds (multiple letters) [4]. SO - British Medical Journal Vol 316(7126) (pp 230-231), 1998. <42> UI - 1998053087 AU - Takayama JI AU - Wolfe E AU - Coulter KP IN - Dr. J.I. Takayama, Department of Pediatrics, Campus Box 0374, University of California, San Francisco, CA 94143-0374; United States. TI - Relationship between reason for placement and medical findings among children in foster care. SO - Pediatrics Vol 101(2) (pp 201-207), 1998. AB - Objective. To determine the reasons for placement of children in foster care, the prevalence of medical findings during initial placement, and the relationship between reason for placement and medical findings. The association between placement reasons and parental substance abuse also was explored. Methods. Population-based analysis of medical records of 749 children examined at the Child Protection Center in San Francisco from October 1, 1991, to December 31, 1992. Health evaluations consisted of a clearance examination of children during entry into foster care and a comprehensive examination 3 weeks later. Reasons for foster placement included abandonment, neglect, no available caretaker, physical abuse, sexual abuse, and failed placement. Results. Nearly 50% of children in our study were <6 years of age. Neglect (30%), physical abuse (25%), and no available caretaker (24%) were the most frequent placement reasons, followed by abandonment (9%), failed placement (7%), and sexual abuse (5%). Substance abuse was documented in 30% of parents, 51% when the placement reason was neglect. Medical findings were identified in 60% of children. Among 0 to 6- year-olds, 27% had upper respiratory illnesses, 23% had developmental delay, and 21% had skin conditions; for children 7 to 12 years of age, 32% failed vision screening, 12% had dental caries, and 11% had upper respiratory illnesses; and among 13- to 18-year-olds, 31% failed vision screening and 12% had positive tuberculin skin tests. For younger children, skin conditions were associated with neglect, no available care taker, and failed placement, and developmental delay with neglect and abandonment. For adolescents, history of psychiatric illness was associated with neglect and failed placement. Marks of abuse for all age groups were limited to children who had been physically abused. Three or more diagnoses were identified for [similar] 20% of children who had been neglected or abandoned or had failed placement, compared with 10% of children who had been either physically or sexually abused. Conclusions. Specific medical findings associated with reasons for placement provide health professionals with additional information to assess more accurately the health care needs of children entering foster care. As important, screening tests revealed high rates of vision problems and exposures to tuberculosis, warranting earlier and more comprehensive screening. Finally, children who have endured variations of neglect or failed placement may have more health problems than anticipated previously. [References: 56] <43> UI - 1998015549 AU - Tzimis L AU - Katsantonis N AU - Leledaki A AU - Vasilomanolakis K AU - Kafatos A IN - L. Tzimis, Department of Pharmacy Services, Chania General Hospital 'St. George', 8 Dragoumi str, 73100 Chania, Crete; Greece. TI - Antibiotics prescription for indigent patients in primary care. SO - Journal of Clinical Pharmacy & Therapeutics Vol 22(3) (pp 227-235), 1997. AB - Objective: A drug use evaluation focusing on prescribed antibiotics among Greek indigent and Social Security patients. Method: Four hundred and forty-six indigent patients insured Social Care and 332 patients insured under Social Security Funds were interviewed and their prescription records reviewed. Results: Although 88.5% of indigent patients stated that they had received instructions on antibiotic use and had understood these instructions, only 45.9% could correctly repeat these instructions. Only 9.9% read the enclosed leaflets and 59.4% reported asking the pharmacist for advice, 54.1% of these patients were unaware of the dosage of their medication, and the length of treatment was only written in 13% of cases. The most common disease among indigent patients were respiratory infection (11.7%) and dental problems (10.1%). The latter ranked 11th among the insured patients (3.7%). Tuberculosis (3.3%) was still one of the most common diseases among the indigent patients. Overall, 30.9% of the prescribe daily defined dose (DDD) of medication for the indigent patients were for cardiovascular drugs (16.9% of the cost), 19.5% were for nervous system drugs (8.9% of the cost), 13.5% for gastrointestinal tract drugs (14.1% of the cost) and only 4.3% were antibiotics (but 16.9% of the cost). The most frequently prescribed antimicrobials were penicillins (45.6%), cephalosporins (19.7%), macrolides (12.6%) and quinolones (9.6%). Anti-tuberculous agents made up 13.7% of the antibiotic prescriptions. The most widely prescribed antibiotics were amoxycillin+clavulanate (19.3%), amoxycillin (7.9%), cefaclor (5.6%), clarythromycin (5.1%) and rifampicin+isoniazid (6.3%). Conclusion: The present study emphasizes the need for more information on drug use among indigent patients and their information needs. [References: 17] <44> UI - 1998014775 AU - Lee M-C AU - Lee S-H AU - Chou M-C AU - Yen EYT IN - M.-C. Lee, Department of Family Medicine, Chung Shan Med. Dental College Hosp., Taichung; Taiwan. TI - The experiences of adolescent health care at a college hospital in Taiwan. SO - International Journal of Adolescent Medicine & Health Vol 9(3) (pp 187-202), 1997. AB - An Adolescent Clinic was established at the Department of Family Medicine, Chung Shan Medical and Dental College Hospital, Taichung, Taiwan in January, 1993. From January 1993 through June 1995, there were 518 adolescent patients making 1,319 patient visits with 607 problems identified. Most patients were college students who resided in the local area of the Adolescent Clinic. Ninety five percent of adolescent patients were improved with 3-5% referral rate. Most common health problems seen at the Adolescent Clinic included health maintenance, respiratory problems, mental illness, and digestive conditions. The ten most common conditions identified were upper respiratory infections, periodic health examinations, health counselling, anxiety disorders, adjustment disorders, immunizations, acute gastroenteritis, enemas, peptic ulcer diseases, and hepatitis B carriers. [References: 7] <45> UI - 97341154 AU - Garcia-Closas R AU - Garcia-Closas M AU - Serra-Majem L IN - R. Garcia-Closas, Unidad de Investigacion, Hospital Universitario de Canarias, Tenerife, Canary Islands; Spain. E-Mail: rclosas@huc.rcanaria.es. TI - A cross-sectional study of dental caries, intake of confectionery and foods rich in starch and sugars, and salivary counts of Streptococcus mutans in children in Spain. SO - American Journal of Clinical Nutrition Vol 66(5) (pp 1257-1263), 1997. AB - In this cross-sectional study of 236 schoolchildren living in Manresa, Spain, we evaluated the association between prevalence of dental caries and frequency of consumption of various food groups, including sweetened baked goods and similar foods (rich in starch and sugars) and confectionery (rich in sugars but not starch), using a food-frequency questionnaire. Because Streptococcus mutans is associated with the cariogenicity of carbohydrates, we also evaluated the modification of these associations by salivary counts of this microorganism. Odds ratios (ORs) were used to measure the association between caries and tertiles of consumption. Sex, age, use of fluorides, tooth-brushing frequency, frequency of dental visits, socioeconomic status, and intake of other potentially cariogenic food groups were considered as potential confounders. We did not find a significant association between any of the food groups evaluated and caries prevalence. Failure to detect an association could have been due to the low prevalence of caries in our population (decayed, missing, or filled permanent teeth = 1.3 at age 10.6 y) or to underestimation of the association due to diet misclassification. In this population, the association between consumption of sweetened baked goods and caries appeared to be modified by the numbers or S. mutans [OR = 6.1 (95% CI: 1.6, 23.0) for low compared with high intake in children with moderate- to-high S. mutans counts and OR = 0.3 (95% CI: 0.1, 1.6) for low compared with high intake in children with low S. mutans counts]. These results suggest that a high intake of sweetened baked goods may be a determinant of caries prevalence in children with moderate-to-high salivary counts of S. mutans. [References: 57] <46> UI - 97310674 AU - Peach HG AU - Pearce DC AU - Farish SJ IN - Prof. H.G. Peach, Dept. Public Health Community Med., University of Melbourne, Ballarat Health Services Base Hosp., PO Box 577, Ballarat, Vic. 3353; Australia. E-Mail: a.temperley@phcm.unimelb.edu.au. TI - Helicobacter pylori infection in an Australian regional city: Prevalence and risk factors. SO - Medical Journal of Australia Vol 167(6) (pp 310-313), 1997. AB - Objective: To investigate the prevalence of Helicobacter pylori infection and potential risk factors for infection in an adult Australian population. Design: Cross-sectional study. Setting: Ballarat, a major regional city in Victoria (population, 78,000; 92% born in Australia), November 1994 to July 1995. Participants: 217 adults randomly selected from the electoral roll. Main outcome measures: H. pylori IgG antibody status by enzyme immunoassay; amount of dental plaque; sociodemographic and other potential risk factors; odds ratios for risk factors determined by logistic regression analysis. Results: Age-standardised prevalence of H. pylori infection was 30.6%. After adjustment for age, sex and socioeconomic index, positive H. pylori status was significantly associated with increasing number of tooth surfaces with a high plaque score (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.1-2.7), increasing number of years in a job with public contact (OR, 1.7; 95% CI, 1.3-2.3), blood group B antigen (OR, 3.1; 95% CI, 1.1-9.1), and having lived in a household with more than six members during childhood (OR, 2.5; 95% CI, 1.1-5.5). Negative H. pylori status was significantly associated with increasing education, having ever lived on a farm, and having teeth scaled less than once a year. Conclusions: H. pylori infection is common. Dental plaque may be a reservoir for H. pylori, which is probably transmitted by person-to-person contact, and blood group B antigen may predispose to infection. Community education about effective oral hygiene and adoption of good hygiene practices by those with regular public contact may be important to prevent acquisition and transmission of H. pylori. [References: 24] <47> UI - 97294956 AU - Anonymous TI - Estrogen therapy slows tooth loss. SO - Hospital Practice Vol 32(9) (pp 212), 1997. <48> UI - 97282119 AU - Curzon MEJ AU - Toumba KJ IN - M.E.J. Curzon, Univ. of Leeds School of Dentistry, Leeds LS2 9LU; United Kingdom. TI - Plumbing the depths of dental decay. SO - Natural Medicines Vol 3(9) (pp 956), 1997. <49> UI - 97234781 AU - Tang JMW AU - Altman DS AU - Robertson DC AU - O'Sullivan DM AU - Douglass JM AU - Tinanoff N IN - D.M. O'Sullivan, Univ. of Connecticut Health Center, Department of Pediatric Dentistry, MC1610, 263 Farmington Ave., Farmington, CT 06030-1610; United States of America. E-Mail: osullivan@sun.uchc.edu. TI - Dental caries prevalence and treatment levels in Arizona preschool children. SO - Public Health Reports Vol 112(4) (pp 319-329), 1997. AB - Objectives. To assess the prevalence of dental caries in a large group of preschool children, to determine the extent to which the children received dental treatment, to examine the association between demographic and socioeconomic factors and the prevalence of caries, and to compare these findings with those from previous studies of preschool populations in the United States. Methods. Dental caries exams were performed on 5171 children ages 5 months through 4 years, and a parent or other caregiver was asked to complete a questionnaire giving information about the child and her or his household. The children were recruited from Head Start programs; Women, Infants, and Children (WIC) nutrition programs; health fairs; and day care centers in a representative sample of Arizona communities with populations of more than 1000 people. Results. Of the 994 one-year-old children examined, 6.4% had caries, with a mean dmft (decayed, missing [extracted due to caries], and filled teeth) score of 0.18. Nearly 20% of the 2-year-olds had caries, with a mean dmft of 0.70. Thirty-five percent of the 3-year-olds had caries, with a mean draft of 1.35, and 49% of the 4-year-olds had caries, with a mean draft of 2.36. Children whose caregivers fell into the lowest education category had a mean draft score three times higher than those with caregivers in the highest education category. Children with caregivers in the lowest income category had a mean dmft score four times higher than those with caregivers in the highest category. Children younger than age 3 had little evidence of dental treatment, and most of the children with caries in each age group had no filled or extracted teeth. Conclusions. The data show that dental caries is highly prevalent in this preschool population, with little of the disease being treated. Timing of diagnostic examinations and prevention strategies for preschool children need to be reconsidered, especially for children identified as having a high risk of caries. [References: 40] <50> UI - 97243744 AU - Gold MR AU - Khalighi K AU - Kavesh NG AU - Daly B AU - Peters RW AU - Shorofsky SR IN - Dr. M.R. Gold, Division of Cardiology, Univ. of Maryland Hospital, 22 S. Greene Street, Baltimore, MD 21201; United States of America. TI - Clinical predictors of transvenous biphasic defibrillation thresholds. SO - American Journal of Cardiology Vol 79(12) (pp 1623-1627), 1997. AB - Transvenous lead systems have become routine for defibrillator placement. However, previous studies of clinical predictors of an adequate nonthoracotomy defibrillation threshold (DFT) evaluated monophasic waveforms or more complex lead systems, including subcutaneous patches. Accordingly, this study is a prospective evaluation of the predictors of an adequate biphasic DFT in 114 consecutive patients undergoing cardioverter- defibrillator implantation with a single transvenous lead. For each subject, 38 parameters were assessed, including standard demographic, electrocardiographic, echocardiographic, and radiographic measurements. An adequate DFT (<=20 J) was achieved in 92% of patients. Multivariable analysis revealed 2 independent factors predictive of a high threshold: echocardiographic measurements of left ventricular dilation (odds ratio = 0.16, 95% confidence interval 0.05 to 0.53, p = 0.003) and body size (odds ratio = 0.36, 95% confidence interval 0.17 to 0.73; p = 0.005). No patient with a normal left ventricular end-diastolic dimension had a high DFT, whereas 14% (9 of 66) of those with left ventricular dilation had elevated thresholds. When the DFT cutoff was lowered to 15 J, as is necessary with some downsized pulse generators, an adequate threshold was observed in 84% of patients and the same 2 independent predictors of high thresholds were found. These results indicate that an adequate transvenous DFT can be predicted from simple clinical parameters. [References: 30] <51> UI - 97234127 AU - Sakashita R AU - Inoue M AU - Inoue N AU - Pan Q AU - Zhu H IN - R. Sakashita, Department of Preventive Dentistry, Kagoshima University Dental School, 8-35-1 Sakuragaoka, Kagoshima 890; Japan. E-Mail: reiko@dentlb.hal.kagoshima-u.ac.jp. TI - Dental disease in the Chinese Yin-Shang period with respect to relationships between citizens and slaves. SO - American Journal of Physical Anthropology Vol 103(3) (pp 401-408), 1997. AB - Seventy-one skulls from the Yin-Shang period tombs of Anyang, China, were examined for the incidence of observable dental diseases, including dental caries, alveolar bone resorption (an index of periodontal disease), ante-mortem tooth loss and tooth attrition. Because the remains were excavated from tombs with funerary items, the burials are believed to be of Anyang citizens. Our study indicates carious tooth frequency in the Yin- Shang period was rather low (2.9-4.0%). Periodontal disease frequency was 18.3-26.9%, and ante-mortem tooth loss frequency was 2.0-7.5%. To determine the relative prevalence of overall dental health in the Yin-Shang populations, observations from the 42 male crania were compared to those from 183 male crania of slaves from 'sacrificial pits' from the Yin-Shang period (Inoue et al. [1992] J. Anthropol. Soc. Nippon 100:1-29). Results from this comparison indicate no apparent difference between social classes in younger age groups. However, in the older ages the rates of the ante-mortem tooth loss, periodontal disease and tooth attrition were significantly higher in the citizen sample. The findings would suggest dietary development in the Yin-Shang period was not dissimilar enough between social classes to induce clear differences in dental diseases at least at younger ages. Conversely, it appears there must have been significant differences between social class diets in the earlier phase of the Yin-Shang period to produce the differences in dental disease present in the older samples. [References: 34] <52> UI - 97217652 AU - Krall EA AU - Dawson-Hughes B AU - Hannan MT AU - Wilson PWF AU - Kiel DP IN - Dr. B. Dawson-Hughes, Calcium/Bone Metabolism Laboratory, Jean Mayer USDA, HNRCA at Tuffs University, 711 Washington Street, Boston, MA 02111; United States of America. TI - Postmenopausal estrogen replacement and tooth retention. SO - American Journal of Medicine Vol 102(6) (pp 536-542), 1997. AB - PURPOSE: To determine if estrogen replacement therapy (ERT) is associated with improved tooth retention and lower risk of edentulism (no natural teeth remaining) in a cohort of elderly women. PATIENTS AND METHODS: Subjects were 488 women, aged 72 to 95, who participated in the 23rd examination cycle (1994 to 1995) of the Framingham Heart Study, a population- based study begun in 1948. The number of teeth remaining and their location were recorded by a trained observer. History and duration of ERT were obtained from records kept since cycle 10 (1960 to 1963). Third molars were excluded from all analyses. RESULTS: Women who ever used ERT were younger than nonusers by i year (80 +/- 4 years, n = 184, versus 81 +/- 4 years, n = 304, P = 0.019). Estrogen users had more teeth remaining than nonusers (12.5 +/- 0.8 versus 10.7 +/- 0.8 versus 10.7 +/- 0.6 teeth, P = 0.046, mean +/- SE) after controlling for age, smoking status, and education. Duration of estrogen use was an independent predictor of the number of teeth remaining (P = 0.015) such that each 4.2-year interval of use was associated with an increased mean retention of 1 tooth. Long-term estrogen users (more than 8 years, n = 48) had an average of 3.6 more teeth than women who never used estrogen (14.3 +/- 1.5 versus 10.7 +/- 0.6 teeth, P <0.02). The association with duration of use was present among different types of teeth (incisors, canines, and premolars) but less strong for molars. The odds of being edentulous were reduced by 6% for each 1-year increase in duration of estrogen use (odds ratio = 0.94, P = 0.038, 95% confidence interval = 0.90 to 0.99). CONCLUSIONS: These data suggest that ERT protects against tooth loss and reduces the risk of edentulism. The associations of estrogen use and tooth retention are evident for all but the molars. [References: 30] <53> UI - 97178678 AU - Heimann R AU - Ferguson D AU - Powers C AU - Suri D AU - Weichselbaum RR AU - Hellman S IN - Dr. R. Heimann, Dept. of Radiation/Cell. Oncology, University of Chicago, MC 9006, 5758 S Maryland Ave, Chicago, IL 60637; United States of America. E-Mail: heimann@rover.uchicago.edu. TI - Race and clinical outcome in breast cancer in a series with long-term follow-up evaluation. SO - Journal of Clinical Oncology Vol 15(6) (pp 2329-2337), 1997. AB - Purpose: To compare the outcome at African American (AA) and Caucasian (C) breast cancer patients who had equivalent disease extent and were similarly treated. Patients and Methods: We compared prognostic characteristics, treatment, and outcome of 1,037 C and 481 AA breast cancer patients treated with mastectomy between 1946 and 1987. The median follow-up duration was 15.6 years. Results: During the study period, there was a successive increase in the percent of patients who presented with early breast cancer. Between 1980 and 1987, 35.1% AA versus 47.6% C patients had <= 2-cm tumors and 50.0% AA versus 61.9% C patients were node-negative, while between 1946 and 1959, 27.7% AA and 31.3% C had <= 2-cm tumors and 41.5% AA versus 40.4% C patients were node-negative. The treatments were similar during the study period. The 20-year disease-free survival (DFS) rate of AA compared with C patients with node-negative <= 2-cm, 2.1- to 4-cm, and greater than 4-cm tumors and of patients with one to three and <= four positive nodes was not significantly different. Equal-size tumors had similar proportion of positive axillary nodes in AA compared with C patients. The DFS for AA patients compared with C patients was similar in the periods 1946 to 1959, 1960 to 1969, and 1970 to 1979, but was lower between 1980 and 1987 (P = .02). In multivariable analysis, race was not a significant variable. Conclusion: In this large group of uniformly treated breast cancer patients, race was not an independent factor that influenced outcome. The racial differences seen between 1980 and 1987 are likely because of a larger percent of greater than 2-cm and node-positive tumors in AA patients. Education and access to early diagnosis should reduce or eliminate the racial differences seen. [References: 35] <54> UI - 97171938 AU - Arendorf TM AU - Bredekamp B AU - Cloete C AU - Wood R AU - O'Keefe E IN - Prof. T.M. Arendorf, University of the Western Cape, Faculty of Dentistry, WHO Oral Health Collaborating Centre, Mitchells Plain 7785; South Africa. TI - Intergroup comparisons of oral lesions in HIV-positive South Africans. SO - Oral Diseases Vol 3(SUPPL. 1) (pp S54-S57), 1997. AB - OBJECTIVES: To determine whether there are any differences in the oral manifestations of sub-groups of persons with HIV. These data could provide information for planning of oral health promotion and prevention programmes. DESIGN: A comparative inter-group cross-sectional investigation of the oral manifestations of HIV. Ethnic, gender and sexual orientation differences were taken into consideration. SETTING: Three large general hospitals that offer comprehensive medical investigations and care to persons with HIV. SUBJECTS AND METHODS: A total of 485 HIV-positive adults participated. Clinical examination and, where necessary, swabs or smears of lesions for microbiology, biopsies for histology. MAIN OUTCOME MEASURES: Presence of lesions, associated signs, incidence and type of micro-organisms. RESULTS: A total of 485 HIV-positive persons were examined over a period of 3 years consisting of 225 Blacks, 191 Coloureds (persons of 'mixed' descent) and 69 Whites. Data were analysed using, where relevant, the chi2 test or Fisher's exact test. Heterosexual males revealed a higher prevalence of all oral lesions combined when compared with heterosexual females. A similar finding was evident when HIV-associated periodontal diseases was compared in these two groups. Homosexual males had a higher prevalence of candidal infections than heterosexual males. Coloured heterosexuals had a higher prevalence of oral lesions combined than black heterosexuals. All these results showed statistical significance. CONCLUSIONS: The study tends to show that different patterns of prevalence emerge when inter-group comparisons are made of oral soft tissue diseases evident in HIV-infected South Africans. [References: 24] <55> UI - 97163952 AU - Lewis JM AU - Campain AC AU - Wright FAC IN - J.M. Lewis, Department of Political Science, University of Melbourne, Parkville, Vic. 3052; Australia. TI - Accessibility of and client satisfaction with dental services in Melbourne. SO - Australian & New Zealand Journal of Public Health Vol 21(2) (pp 191-198), 1997. AB - Public dental clinics play an important role in delivering dental services to Australian adults on low incomes. Our objective was to compare the accessibility of and client satisfaction with the two main types of public dental service providers in Victoria and with private practice services. Clients attending the Royal Dental Hospital of Melbourne, Northcote Community Health Centre and private practices in Melbourne were surveyed. The hospital's clients faced the greatest ecological and organisational obstacles, while private clients faced the greatest financial and desirability obstacles. Community centre clients faced fewer ecological and organisational obstacles than hospital clients, with the exception of long waiting times. Private practice clients were more satisfied overall, and had better continuity of care. Private practice clients were more satisfied with access, availability and convenience than community centre clients, who in turn were more satisfied than hospital clients. There was no distinction between private practice and hospital clients on satisfaction with 'pain and treatment', but community centre clients were less satisfied. There was no significant difference between client group evaluations of interaction with the dentist. Regardless of the effects of the Commonwealth Dental Health Program, distinctions between various service types and public clinic types are likely to remain, because of their different settings. The contrast between a central hospital and a community health centre, in terms of the ecological and organisational obstacles to care, points to the advantages of putting dental services close to the communities they serve. [References: 28] <56> UI - 97079624 AU - Rosenheck R AU - Lam JA TI - Homeless mentally ill clients' and providers' perceptions of service needs and clients' use of services. SO - Psychiatric Services Vol 48(3) (pp 381-386), 1997. AB - Objective: Clients' and providers' perceptions of clients' needs were compared in 18 community treatment programs participating in the Access to Community Care and Effective Services and Supports program of the Center for Mental Health Services, a national demonstration project on treatment of homeless persons with mental illness. The study sought to determine whether perceptions differed and whether assessed needs for services were related to service use. Methods: A total of 1,482 clients contacted through community outreach who entered the case management phase of the program after an average of 32 days were given an evaluation interview at entry into the program. The clients and outreach workers identified clients' needs in seven core domains-mental health, general health, substance abuse, public financial support, housing assistance and Support, dental care, and employment. Use of related services in the till days before the case management evaluation was determined. Results: The greatest differences between clients' and providers' perceptions of service needs were in dental and medical services, which were more frequently identified as needs by clients, and in substance abuse and menial health services, which were more frequently identified by providers. Clients' and providers' assessments of need were significantly but not strongly, correlated with each other; and both were correlated with use of mental health and substance abuse services. Conclusions: Mental health service providers are less likely than clients to identify needs for services oilier than mental health services. Service use, at least in the short run, is related to both clients' and providers' assessments of need. [References: 22] <57> UI - 97069148 AU - Nichols WC AU - Seligsohn U AU - Zivelin A AU - Terry VH AU - Arnold ND AU - Siemieniak DR AU - Kaufman RJ AU - Ginsburg D IN - E-Mail: ginsburg@umich.edu. TI - Linkage of combined factors V and VIII deficiency to chromosome 18q by homozygosity mapping. SO - Journal of Clinical Investigation Vol 99(4) (pp 596-601), 1997. AB - Combined Factors V and VIII deficiency is an autosomal recessive bleeding disorder identified in at least 58 families comprising a number of different ethnic groups. Affected patients present with a moderate bleeding tendency and have Factor V and Factor VIII levels in the range of 5-30% of normal. The highest frequency of the mutant gene is found in Jews of Sephardic and Middle Eastern origin living in Israel with an estimated disease frequency of 1: 100,000. We sought to identify the gene responsible for combined Factors V and VIII deficiency using a positional cloning approach. Of 14 affected individuals from 8 unrelated Jewish families, 12 were the offspring of first-cousin marriages. After a genome-wide search using 241 highly polymorphic short tandem repeat (STR) markers, 13 of the 14 affected patients were homozygous for two closely linked 18q markers. Patients and all available family members were genotyped for 11 additional STRs spanning [similar] 11 cM on the long arm of chromosome 18. Multipoint linkage analysis yielded a maximal log of the odds (LOD) score of 13.22. Haplotype analysis identified a number of recombinant individuals and established a minimum candidate interval of 2.5 cM for the gene responsible for combined Factors V and VIII deficiency. The product of this locus is likely to operate at a common step in the biosynthetic pathway for these two functionally and structurally homologous coagulation proteins. Identification of this gene should provide new insight into the biology of Factor V and Factor VIII production. [References: 40] <58> UI - 97058030 AU - Strayer MS AU - Kuthy RA AU - Caswell RJ AU - Moeschberger ML TI - Predictors of dental use for low-income, urban elderly persons upon removal of financial barriers. SO - Gerontologist Vol 37(1) (pp 110-116), 1997. AB - This study examines a low-income, urban elderly population of dental and medical, nondental users. A total of 1,378 medical, nondental users and 2,086 dental users were identified using longitudinal claims data (1983-1992) from a Medicare-waiver program that reimbursed for health care services at cost. Dental users were more likely to be from a younger age cohort (born after 1910, p = .0001) and were more likely to be black (63.3% vs 35.7%,p = .0001) than medical, nondental users. Medical, nondental users had more medical visits (p = .0001), higher medical and pharmacy charges (p = .0001), and more prescriptions (p = .0001) than did the dental users. These findings indicate that among this population of urban elderly, dental users were more likely to be black and have lower medical utilization than nondental users. [References: 33] <59> UI - 97047138 AU - Gift HC AU - Atchison KA AU - Dayton CM TI - Conceptualizing oral health and oral health-related quality of life. SO - Social Science & Medicine Vol 44(5) (pp 601-608), 1997. AB - This investigation considers oral health from a health-related quality of life perspective using a multidimensional concept representing a combination of impairment, function, perceptions, and/or opportunity. A subset of dentate individuals aged 18 and older from a national probability sample of the U.S. was selected for the reported analysis with data available from personal interviews, self-administered questionnaires, and oral examinations. Impairment was represented by clinically assessed active diseases and sequelae of diseases and self-reported acute symptoms. Other domains are represented by self-reported problems with function, perception of control over oral health, satisfaction with teeth, value attributed to oral health, and opportunity to obtain dental care. Principal components analysis with varimax rotation provided a structure to interpret four factors: accumulated oral neglect, self-perceived symptoms and problems, reparable oral diseases, and oral health values and priorities. Approximately 50% of the variance was explained by these four factors. Factor-based scores, envisioned as an index or summary measure representing the combination of variables identified in each factor, were used to assess potential validity. Whites had lower levels of accumulated oral neglect, fewer symptoms, and less reparable oral disease, but similar oral health values, than non-whites. Level of formal education was associated with each of the four factor-based scores. Age was directly associated with accumulated oral neglect, but the youngest age group had significantly more reparable oral diseases. Individuals with a dental visit in the past two years had considerably less accumulated oral neglect, fewer self-perceived problems, less reparable oral disease, and higher values of oral health than those without a dental visit in the past two years. Ordinary least square regressions were performed on each of the four factor-based scores using eight sociodemographic and economic variables. All four regression models were significant, with only the education variable being significant across all models. These analyses provide no evidence for one unique factor representing oral health. Rather, a conceptual framework for oral health appears to be represented by a set of reasonably independent components, including two groups of clinically assessed oral health, which together more fully represent oral health than any one single variable. Conceptualizing and measuring oral health multidimensionally leads us closer to examining it as part of general health. [References: 24] <60> UI - 97033059 AU - Larsson B AU - Johansson I AU - Weinehall L AU - Hallmans G AU - Ericson T TI - Cardiovascular disease risk factors and dental caries in adolescents: Effect of a preventive program in Northern Sweden (the Norsjo project). SO - Acta Paediatrica Vol 86(1) (pp 63-71), 1997. AB - Since 1985 a 10 year prevention programme aiming to reduce cardiovascular diseases (CVD) has been running in the county of Vasterbotten in Northern Sweden. The project started in Norsjo. The present investigation is a study on dietary intake, medical CVD risk factors and dental caries in five cross-sectional groups of 15-year-olds during 5 years (1987-1991) of the 'Norsjo project'. Most of the measured medical and dietary variables followed a similar trend, i.e. a positive trend during the first 3 years (1987-1989) and in the last 2 years (1990-1991) the averages returned towards baseline values. Dental caries prevalence followed a similar trend. Parental educational level did not have a major influence on diet or medical CVD risk factors, but higher caries scores were noted in adolescents with parents with 'low' education compared with adolescents where the parents had higher educational levels. The results from the study also point to the fact that dental caries prevalence together with body mass index may indicate adolescents with CVD risk factors at unfavourable levels. Dietary counselling by dental personnel to adolescents with high caries and moderate obesity can be of advantage in reducing caries risk, as well as risk for development of CVD at higher ages. [References: 29] <61> UI - 97026284 AU - Davidson PL AU - Andersen RM AU - Marcus M AU - Atchison KA AU - Reifel N AU - Nakazono T AU - Rana H TI - Indicators of oral health in diverse ethnic and age groups: Findings from the International Collaborative Study of Oral Health Outcomes (ICS-II) USA research locations. SO - Journal of Medical Systems Vol 20(5) (pp 295-316), 1996. AB - Racial-ethnic group differences are assessed using a standardized set of oral health indicators, as well as various predisposing, enabling and need characteristics collected in the International Collaborative Study of Oral Health Outcomes (ICS-II) USA research locations. The unique data set contains comparable data on African-American, Native American, Hispanic, primarily Mexican-American, and White adults. Age group differences in oral health indicators are also compared in two adult age cohorts (35-44 and 65- 74 years). Since data were collected from geographically diverse regions of the United States, differences in oral health indicators are considered within the context of different dental care delivery systems and external environments. Results indicate that the gap in oral health between Whites and ethnic minority groups is pervasive across research locations and age cohorts. Variation in regional dental care delivery systems and the varying effects of race-ethnicity and age cohort suggest that alternative health promotion strategies will be needed for improving oral health in diverse populations. [References: 46] <62> UI - 97019052 AU - Miura H AU - Araki Y AU - Haraguchi K AU - Arai Y AU - Umenai T IN - H. Miura, Dept. Preventive Community Dentistry, School of Dentistry, Health Sciences University Hokkaido, Ishikari-Tobetsu 1757, Hokkaido 061-02; Japan. TI - Socioeconomic factors and dental caries in developing countries: A cross-national study. SO - Social Science & Medicine Vol 44(2) (pp 269-272), 1997. AB - The purpose of the present study was to analyze statistically correlations between socioeconomic factors and the prevalence of dental caries in developing countries. The DMFT index, which evaluates the incidence of dental caries, showed a positive correlation (P < 0.01) with several socioeconomic factors, such as life expectancy, adult literacy rate, school attendance rate, population employed in the service sector, population aged 15-64 years, and urban population. According to multiple regression analysis, population aged 15-64 years, population employed in the service sector, and urban population were the most influential independent socioeconomic variables, in descending order, with a regression coefficient of 0.635 and a coefficient of determination of 0.404 (P < 0.001). This finding suggests that the prevalence of dental caries in developing countries increases with the degree of urbanization. [References: 15] <63> UI - 96363287 AU - Wish-Baratz S AU - Hershkovitz I AU - Arensburg B AU - Latimer B AU - Jellema LM IN - 700 180 Bloor St. West, Toronto, Ont. M5S 2V6; Canada. TI - Size and location of the human temporomandibular joint. SO - American Journal of Physical Anthropology Vol 101(3) (pp 387-400), 1996. AB - The literature abounds with conflicting data on various morphometric aspects of the temporomandibular joint (TMJ). The purpose of this study was to observe the effects of sex, ethnic group, and edentulism on TMJ osseous morphology and to define possible factors which might influence variation in this structure. TMJs and related craniofacial structures were measured directly on 229 dry skulls and matching mandibles. Analysis of variance, principal component analysis, and cluster analysis were performed. Our results indicate that 1) the anteroposterior-related TMJ dimensions are independent of sex, ethnic group, and edentulism; 2) the transverse TMJ dimension is related to cranial breadth measures; and 3) the projected distance, along a midsagittal plane, between the TMJ and foramen magnum is independent of sex, ethnicity, and edentulism. It is our assertion that the TMJ must not be considered as a single morphological structure but rather viewed as a functional unit with component parts which are subordinate to completely different sets of influences. <64> UI - 96307805 AU - Chen M-S AU - Hunter P IN - Center Health Administration Studies, School Social Service Administration, University of Chicago, 969 E. 60th Street, Chicago, IL 60637; United States of America. TI - Oral health and quality of life in New Zealand: A social perspective. SO - Social Science & Medicine Vol 43(8) (pp 1213-1222), 1996. AB - This study addresses the social dimensions of oral health by relating oral quality of life (i.e. dental symptoms, perceived oral well-being and oral functioning) to oral health status. We propose a conceptual model which postulates that socioeconomic status, oral health behavior and oral health status each influence oral quality of life. Using data from the New Zealand National Oral Health Survey, we describe and analyze oral health status and oral quality of life among children aged 12-13 and adults aged 35-44 and 65-74. The study demonstrates the impact of oral health problems on the oral quality of life of children, middle-aged adults and older adults in New Zealand. The majority have experienced at ]east one dental symptom in the past year. Some of them perceive poor oral health and also dislike the way their teeth/dentures look. Various aspects of their social and physical functioning are adversely affected by oral health problems. The results of multiple regression analyses of oral quality of life demonstrate that perceived general health is a consistent predictor of quality of life. Furthermore, the adults' oral quality of life is positively related to asymptomatic dental visits and negatively related to symptomatic dental visits. Children's oral quality of life is positively related to more frequent brushing and flossing. Oral health status is closely associated with oral quality of life for both adults and children. Analyzing the New Zealand oral quality of life data and reviewing previous research findings using a conceptual model provide the possibility for a more comprehensive and integrated understanding of oral quality of life issues. <65> UI - 96300736 AU - Bokhout B AU - Van Loveren C AU - Hofman FXWM AU - Buijs JF AU - Van Limbeek J AU - Prahl-Andersen B IN - Department of Orthodontics, Academic Ctr for Dentistry Amsterdam, ACTA, Louwesweg 1, NL-1066 EA Amsterdam; Netherlands. TI - Prevalence of Streptococcus mutans and lactobacilli in 18-month-old children with cleft lip and/or palate. SO - Cleft Palate-Craniofacial Journal Vol 33(5) (pp 424-428), 1996. AB - The prevalence of Streptococcus mutans and lactobacilli was determined in 62 18-month-old Dutch children with a cleft lip and/or palate. Plaque and saliva samples were collected, a dental examination was performed, and the parents were interviewed with a structured questionnaire regarding general health, dietary habits, fluoride exposure, and socioeconomic class. Appropriate dilutions of the plaque and saliva samples were cultured on selective media to count all viable bacteria, S. mutans and lactobacilli. S. mutans was detected in the saliva of 45% of the children, and lactobacilli was detected in 16%. Also, S. mutans was detected in 48% of the plaque samples and lactobacilli in 8%. Of all of the variables examined, consumption of more than three snacks and beverages between main meals was significantly associated with presence of S. mutans in saliva. Preoperative infant orthopedic treatment (i.e., wearing an acrylic plate from shortly after birth) was significantly associated with presence of lactobacilli in saliva. The presence of S. mutans in the plaque samples was also significantly associated with presence of lactobacilli in saliva. These results indicate that children with oral cleft are at an increased risk of being infected by S. mutans and lactobacilli at a very early age. Such early colonization indicates a high risk for caries in the primary dentition. <66> UI - 96292919 AU - Clarke M AU - Locker D AU - Murray H AU - Payne B IN - Faculty of Dentistry, University of Toronto, 124 Edward Street, Toronto, Ont. M5G 1G6; Canada. TI - The oral health of disadvantaged adolescents in North York, Ontario. SO - Canadian Journal of Public Health. Revue Canadienne de Sante Publique Vol 87(4) (pp 261-263), 1996. AB - Disadvantaged youth such as the homeless, the unemployed or recent immigrants are thought to be at high risk for dental problems, but data to support this hypothesis are rare. Using interviews and clinical examinations, this study measured the oral health status and treatment needs of a convenience sample of 478 disadvantaged adolescents aged 14 and older in North York, Ontario. Although the results cannot be generalized to the overall population, the data suggested that disadvantaged youth have high rates of oral disease. The adolescents reported a variety of symptoms, including oral pain and low rates of dental visiting. Clinically, high rates of periodontal disease, dental decay and urgent treatment needs were detected. If public health resources are to be directed to those most in need, efforts should be made to identify high-risk groups that may be overlooked in general surveys. Prevention, detection and treatment programs should be considered for high-risk adolescents. <67> UI - 96219045 AU - Kassab C AU - Luloff AE AU - Kelsey TW AU - Smith SM IN - Center for Health Policy Research, Inst. for Policy Research/Evaluation, Pennsylvania State University, University Park, PA 16802; United States of America. TI - The influence of insurance status and income on health care use among the nonmetropolitan elderly. SO - Journal of Rural Health Vol 12(2) (pp 89-99), 1996. AB - The objective of this research is to examine the influence of income and type of insurance coverage on the use of health services among the nonmetropolitan elderly. A model of health service utilization is used as the foundation for examining this issue with data from a telephone survey of a randomly se