Search PubMed⌕ Search

Biomedical subjects

C Wall

Publications and source records attributed to C Wall.

At least 73 records · Page 4Linked to original sources

What should dentists prescribe?

In recent months in Australia the, country's Association has been negotiating with the Federal Government over the rights of dentists to prescribe. The question is not the legal right to order a drug for a patient, but the entitlement of patients to a Government health scheme benefit for the dentist's prescription. The debate has, however, opened up broader questions. What is a reasonable extent of entitlement? What should a dentist be allowed to prescribe?

Australia↗

Governing the profession--us or them?

Most dentists are heartily sick of the George Bernard Shaw quotation 'The professions are a conspiracy against the laity.' It seems to be the first phrase that pops into the mind of a non-professional when the question of self-regulation in the professions is discussed. It makes no difference at all that the true professions--including dentistry--have as a fundamental ethos the priority of a client's interests over the self-interest of the professional. Perhaps the non-professional, in this day and age, is much too hooked on the Gordon Milken ethos 'Greed is good', and assumes that everyone is alike.

Australia↗

Dysplasia and the natural history of cervical cancer: early results of the Toronto Cohort Study.

A sample of 176,808 Pap smears, taken from 70,236 women, was constructed from the records of a large cytopathology laboratory between 1962 and 1981. The prevalence of cervical dysplasia, based on the distribution of initial smear results, rose from 42.7 to 94.9 per 1000 during the study period. The relative risks (RR) for the manifestation of a malignancy (carcinoma in situ or worse) in a subsequent cervical smear were 1.48, 3.42, 20.9 and 71.5 for women with minimal, mild, moderate and severe dysplasia, respectively, compared with the entire cohort. The initial degree of dysplasia for women developing a malignancy was much more likely to be interpreted as moderate (RR = 5.0) or severe (RR = 42.3) than were those for controls. These results are strongly supportive of the hypothesis that the degree of dysplasia is related to the risk of development of cancer of the cervix.

Adult↗

Women's attitudes to screening after participation in the National Breast Screening Study. A questionnaire survey.

A self-administered questionnaire study exploring women's attitudes to breast screening after participation in the Canadian National Breast Screening Study (NBSS) achieved an 82% response rate. Of active respondents (AR) attending two to five screening examinations, 1582 had received annual mammography (MA) and physical examination (PE) of the breasts and 548 received annual PE alone. Of 139 dropouts after the first screening, 105 received MA and PE and 34 received PE alone. Dropout respondents (DR) were significantly less likely than AR to report receiving very prompt (46% versus 66%), very courteous (73% versus 92%), or very competent examinations (74% versus 95%). Although 35% of those allocated to PE expressed disappointment with PE allocation compared with 9% of those allocated to MA, fewer of those allocated PE were prepared to accept MA in the future than those allocated MA (59% versus 73%). Of those who had MA, 36% reported moderate and 9% extreme discomfort from mammography. Almost half of each subgroup--MA allocations, PE allocations, and DR--preferred mammography every 2 to 3 years and 30% preferred mammography restricted to diagnostic purposes. Only 5% of AR reported anxiety after screening. National Breast Screening Study participation was a positive experience for 93%. An intention to do breast self-examination (BSE) was reported by 89% of AR and 79% of DR. Forgetfulness was a major impediment to BSE. Disincentives for screening were excessive distance to center, painful mammography, fear of radiation, lack of time, and preference for own physician. Convenient location, punctual appointments, and courteous and supportive staff should enhance screening compliance.

Adult↗

Vestibular function in periodic alternating nystagmus.

The vestibulo-ocular reflex of 4 patients with periodic alternating nystagmus (PAN) was studied in detail. Rotational testing was used to investigate the horizontal semicircular canal-ocular reflex, canal-otolith interaction, and the dynamic otolith-ocular reflex. Results indicated abnormal gain and phase of the horizontal semicircular canal-ocular reflex during sinusoidal rotation and a variable rate of decay of postrotatory responses. Each patient had abnormal canal-otolith interaction. An enlarged modulation component of the dynamic otolith-ocular response was observed in each patient. This study supports the idea that PAN is caused by an instability in the velocity storage element, a hypothetical neural circuit that perseverates the eye movement response to both vestibular and optokinetic stimulation. Further, we postulate that PAN may be caused by lesions of the cerebellar uvula and nodulus or their connections with the brainstem vestibular nuclei.

Adult↗

Canadian National Breast Screening Study: assessment of technical quality by external review.

Mammograms from the Canadian National Breast Screening Study (NBSS) were reviewed by three external experts to provide an objective evaluation of their technical quality, to establish a model for auditing mammograms in a screening program, and to assess whether NBSS mammograms improved over time. The sample reviewed included 10 randomly chosen mammograms from each of 15 screening centers for each calendar year of their operation between 1980 and 1987. All 830 mammograms were reviewed on two consecutive days in randomized sequence by each reader, and rated 0-3 for each of four criteria including positioning and image quality, with a total possible score of 0-12. Although the mammograms were not in temporal sequence when reviewed, the scores assigned by each reader were significantly higher for mammograms dating from later years. Subjects' ages at entry (40-49 vs 50-59 years) did not affect the score. The largest increase in scores was associated with a 1985 protocol change in which mediolateral oblique positioning replaced straight mediolateral positioning. This study reinforces the importance of monitoring technical quality in screening programs and establishes that the NBSS benefited from technical improvements during its operation. A retrospective review of NBSS mammography by three external reviewers confirmed that technical quality improved from 1980 to 1987. This improvement was associated with improved technology (film, processing, and units) and with the quality assurance programs operating during the NBSS, which identified problems and offered remedies.

Adult↗

The sinusoidal harmonic acceleration rotary chair test. Theoretical and clinical basis.

Sinusoidal harmonic acceleration has become a common method used in diagnostic vestibular testing. When properly used, it can produce normal and abnormal patterns that can be interpreted in the context of the nature of the stimulus and the physiologic processes that describe the responses to it. Thus, the aim of this review is to present specific information regarding the sinusoidal harmonic acceleration stimulus and vestibular physiology in a way that will hopefully aid in test interpretation.

Acceleration↗

Cigarette smoking and breast cancer: case-control studies of prevalent and incident cancer in the Canadian National Breast Screening Study.

Two case-control studies of Canadian women aged 40-59 years are reported investigating the relation of cigarette smoking with initial visit (prevalent) and subsequent visit (incident) breast cancer detection, respectively, within the Canadian National Breast Screening Study. The analysis of prevalent breast cancer (1982-1985), which involved 254 cases and 762 controls, showed no evidence of an elevated risk for women with a history of cigarette smoking, with odds ratios of 0.9 (95% confidence interval (Cl) 0.6-1.5) and 1.2 (95% Cl 0.8-1.8) in premenopausal and postmenopausal subjects, respectively. Similarly, in the incident breast cancer analysis (1981-1987) based on 317 cases and 951 controls, women with a history of cigarette smoking had odds ratios of 1.2 (95% Cl 0.8-2.0) and 1.2 (95% Cl 0.9-1.7) in the premenopausal and postmenopausal categories, respectively. No evidence of dose response or of elevated risk in ex-smokers or current smokers was found in either study. These results persisted despite adjustment for several important variables. The present data demonstrate no association between smoking and prevalent or incident breast cancer in either menopausal category, contradicting the authors' previous finding of a positive association with premenopausal prevalent disease earlier in this screening study. The relation of smoking and breast cancer remains controversial. Further study is required to determine whether an association truly does not exist or whether smoking might have both protective and harmful effects that are mediated through different pathways, thus accounting for the paradoxical findings in the literature to date.

Adult↗

Earth horizontal axis rotational responses in patients with unilateral peripheral vestibular deficits.

We evaluated the vestibulo-ocular reflex (VOR) of five patients with surgically confirmed unilateral peripheral vestibular lesions. Testing used both earth vertical axis (EVA) and earth horizontal axis (EHA) yaw rotation. Results indicated that the patients had short VOR time constants, asymmetric responses to both EVA and EHA rotation, and normal EHA modulation components. These findings suggest that unilateral peripheral vestibular loss causes a shortened VOR time constant even with the addition of dynamic otolithic stimulation and causes an asymmetry in semicircular canal-ocular reflexes and one aspect of otolith-ocular reflexes.

Aged↗

Eyes open versus eyes closed: effect on human rotational responses.

The effect of eyelid closure on the response to rotational vestibular stimulation was assessed by evaluating 16 normal human subjects with both earth vertical axis (EVA) and earth horizontal axis (EHA) yaw rotations with either eyes closed (EC) or eyes open in the dark (EOD). Results indicated that for EVA rotation, the subjects' responses were of larger magnitude and less variable with EOD than with EC. However, for EHA rotation, responses were of larger magnitude and equally variable with EC as compared to EOD. Our data also indicated that the quality of the EHA response with EC was altered because eyelid closure influenced the amount of periodic gaze. We conclude that eyelid closure has an effect upon both canalocular and otolithocular reflexes and suggest that both EVA and EHA rotational testing be performed with EOD rather than with EC.

Adult↗

Influence of gravity on cat vertical vestibulo-ocular reflex.

The vertical vestibulo-ocular reflex (VOR) was recorded in cats using electro-oculography during sinusoidal angular pitch. Peak stimulus velocity was 50%/s over a frequency range from 0.01 to 4.0 Hz. To test the effect of gravity on the vertical VOR, the animal was pitched while sitting upright or lying on its side. Upright pitch changed the cat's orientation relative to gravity, while on-side pitch did not. The cumulative slow component position of the eye during on-side pitch was less symmetric than during upright pitch. Over the mid-frequency range (0.1 to 1.0 Hz), the average gain of the vertical VOR was 14.5% higher during upright pitch than during on-side pitch. At low frequencies (less than 0.05 Hz) changing head position relative to gravity raised the vertical VOR gain and kept the reflex in phase with stimulus velocity. These results indicate that gravity-sensitive mechanisms make the vertical VOR more compensatory.

Animals↗

Incentives for breast self-examination: role of the calendar.

Calendars are generally believed to be useful in promoting compliance with breast self-examination (BSE). To test this belief, calendars were distributed to 1,166 women in the Canadian National Breast Screening Study for comparison with 1,027 other participants who received no calendar. Recipients were asked to note their BSE findings each month on the calendar and to return calendars at the next annual screen. Self-reported BSE frequencies and BSE competence scores revealed no significant difference between the recipients and nonrecipients at three points in time: one year prior to, at time of, and one year after calendar distribution. Only 136 women returned calendars as requested. Their improvement in the test period did not differ significantly from that shown by the control group or the nonreturners. Calendars do not seem to be useful in a population receiving annual screening and BSE instruction.

Adult↗

Electromyographic analysis of knee exercises in healthy subjects and in patients with knee pathologies.

Little information exists about the intensity of contraction required from knee and hip musculature during common therapeutic exercises used for patient populations. This study, therefore, was designed to compare electromyographic data obtained from the vastus medialis, rectus femoris, gluteus medius, and biceps femoris muscles during maximally resisted straight-leg-raising (SLR) exercises with EMG data obtained from the same muscles during quadriceps femoris muscle setting (QS) exercises in healthy subjects and in patients with knee pathologies. Of the 30 participants in the study, 16 had a history of knee injury or surgery. All participants performed randomly ordered trials of the SLR and QS exercises while the EMG data were recorded from surface electrodes and normalized to values derived from maximal effort isometric contraction trials. An analysis of variance demonstrated significantly greater activity (p less than .05) of the vastus medialis, biceps femoris, and gluteus medius muscles during QS exercises than during SLR exercises. The rectus femoris muscle was significantly more active (p less than .05) during SLR exercises than during QS exercises. The study demonstrated remarkably different degrees of muscle activation between the SLR and QS exercises, indicating that the exercise selected will affect the therapeutic intention.

Adult↗

The impact of AIDS on the general practitioner of dentistry.

The AIDS epidemic has caused widespread concern in the community and there has been a corresponding impact on dentistry. Dentists have seen themselves as vulnerable due to frequent exposure to blood and to the salivary pool, which may possibly be infective, either inherently or by reason of blood contamination. The fear of AIDS, affecting the community and the dental profession, has been strongly emotional because of the recorded mortality rates. It is necessary to recognize that screening techniques, however carefully carried out and interpreted, cannot identify all the potential carriers of AIDS. A similar, but much greater risk applies to carriers of hepatitis B virus, since a dentist seeing 20 patients per day will encounter a hepatitis B carrier every 7 days, at the current developed-country levels of prevalence. Four out of five of these carriers will be unaware of their infectious status. It is essential therefore that dentists amend their infection control techniques and regard all contact with blood as potentially infective. The fears of dentists can be assuaged by the realization that well-accepted infection control methods applicable to hepatitis B, are also effective against AIDS. The paper reviews the major considerations to be taken into account in implementing an infection control regimen, and in identifying at-risk groups among patients.

Acquired Immunodeficiency Syndrome↗

Gain and phase of cat vertical eye movements generated by sinusoidal pitch rotations with and without head tilt.

Vertical EOGs were recorded in cats during sinusoidal head pitch from 0.01 to 4.0 Hz with peak velocities of 50 degrees X s-1. The purpose of the experiments was to determine whether dynamic response properties of the vertical vestibulo-ocular reflex (VOR) elicited by pitch with the animal lying on its side (on-side pitch) differ from those resulting from normal (upright) pitch. During on-side pitch (not changing head position with respect to gravity), the vertical VOR gain was 13.5% less than during upright pitch. Thus, the vertical VOR was more compensatory than during on-side pitch. Phase did not differ between the two conditions. The results indicate the importance of interactions between otolith and vertical canal stimulation for vertical eye movement control. The results imply that in micro-gravity, where head tilt does not lead to otolith stimulation as regards gravity, vertical head and eye movements may not be controlled appropriately, leading to vestibular-visual conflicts at the same time that horizontal eye movement controls are normal.

Animals↗

An analysis of asymmetries in cat vertical eye movements generated by sinusoidal pitch.

Asymmetries in the fast and slow components of nystagmus in the cat vertical vestibulo-ocular reflex (VVOR) were analyzed. Sinusoidal pitch stimuli were used in two experimental conditions, one with the animals on their sides and the other with the animals upright. The half-periods of upward and downward slow component position were generally not of equal duration in the on-side condition. Such was not the case for upright pitch where the slow component was symmetric. In addition, the number of fast components in the two directions was not equal with downward-directed predominating regardless of pitch condition. These two results led to the conclusions that gravity plays an essential role in the normal VVOR and fast component asymmetries may be inherent in the reflex.

Animals↗

Changes in breast self-examination behavior in a cohort of 8214 women in the Canadian National Breast Screening Study.

A study cohort of 8214 women was formed from all participants in the Canadian National Breast Screening Study who attended their first three screens after the introduction of a structured evaluation protocol involving eight criteria for breast self-examination (BSE). Self-reported BSE frequency was collected by questionnaire at all three screens. Breast self-examination instruction preceded breast exam at each screen but BSE evaluation occurred only at the second and third screen. Reported monthly BSE frequency increased from 18% to 51% to 55% on first, second, and third screens, respectively. The proportion claiming to do no BSE fell correspondingly: 52%, 16%, and 11%. Compliance with each of the seven other BSE criteria was significantly greater at the third screen than at the second. The mean number of these criteria performed at screen 3 was 5.1 compared with 4.4 at screen 2; older women performed as well as younger. The mean number of criteria performed was associated with BSE frequency at screen 3. The authors conclude that women's BSE behavior can be altered, and that integration of BSE evaluation and instruction into routine medical exams seems feasible and potentially useful.

Adult↗

Sensitivity and specificity of first screen mammography in the Canadian National Breast Screening Study: a preliminary report from five centers.

Sensitivity and specificity of first screen mammography in a randomized screening trial at five centers are reported. A total of 23,101 women underwent mammography; in 139, breast cancer was detected at first screening; in 20, less than 12 months after first screening; and in 47, at second screening. All 206 cancer cases were histologically confirmed, and 174 were defined as being detectable at first screening. Average length of follow-up for all women was 3.2 years. Interpretations of first screen mammograms by the center radiologists were matched to known outcomes. Simultaneous blind review was performed by a single reference radiologist with mammograms from all 206 cancer cases and those of a random sample of 739 women not known to have breast cancer at 15 months or more after initial screening. Overall, the five screening centers achieved a sensitivity of 69% (range, 60%-78%), a specificity of 94% (range, 93%-96%), a positive predictive value of 8.6% (range, 3%-16%), and a negative predictive value of 99.7% (range, 99.6%-99.9%).

Breast Neoplasms↗