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Biomedical subjects

R G Newcombe

Publications and source records attributed to R G Newcombe.

At least 91 records · Page 5Linked to original sources
PubMed2000

Oral health care among nursing home residents in Avon.

OBJECTIVE: To assess personal oral health care standards among frail, elderly and infirm nursing home residents prior to developing and evaluating a health promotion intervention. DESIGN: Descriptive survey, interview and clinical data. SETTING: 22 randomly selected nursing homes in the Bristol area. METHOD: 412 residents with denture(s) and/or natural teeth, and giving informed consent to the study were interviewed about dental attendance and current dental problems. A clinical examination assessed levels of oral and denture hygiene, denture-related stomatitis, gingivitis, calculus and root caries. RESULTS: Less than half the subjects (mean age 84.5 years) were ambulant. Over 70% had not seen a dentist for over 5 years, and 22% reported a current dental problem. Among denture wearers, 82% were unable to clean their dentures; staff cleaned dentures for 64%. Denture-related stomatitis affected 33%, and unhygienic dentures were worn by 95% of subjects. Among dentate subjects (mean number of teeth 11.6), 75% were unable to clean their teeth yet none received regular assistance. On average, two-thirds of each tooth surface were covered in plaque. Gingivitis was moderately severe. Calculus was present in 82% of subjects and root caries in 63% of subjects. CONCLUSIONS: Most residents required help with oral health care but many did not receive it. Residents' levels of plaque and associated dental disease were high. Staff did not effectively perform oral health care appropriate to residents' needs. Further research to evaluate an oral health care training programme for care staff is planned.

Aged↗
PubMed2000

Measles, month of birth, and Crohn's disease.

BACKGROUND: The rise in the incidence of Crohn's disease (CD) suggests the role of an environmental factor in the development of the disease in susceptible individuals. Perinatal exposure to infection has been proposed as such an environmental factor. AIM: To investigate the influence of birth date on the development of CD in later life. PATIENTS AND METHOD: Four registers of patients with CD, diagnosed from 1972 to 1989, were combined, and data from 1624 patients were examined. The birth dates of CD patients were compared with national birth figures for three decades (1941-50, 1951-60, and 1961-70) to avoid temporal changes in birth trends, and year of birth was compared with epidemic measles years between 1951 and 1967. Risk ratios with 95% confidence intervals (CI) and chi(2) tests were performed. RESULTS: There were marginal differences between the birth dates of the CD patients and those predicted from the general population. Further analysis of both season of birth and year halves revealed a very weak association with the first half of the year (relative risk 1.14 (95% CI 1.01-1.30)). There was no association between developing CD and birth during measles epidemics between 1951 and 1967. CONCLUSIONS: In utero or perinatal exposure to seasonal environmental factors are unlikely potential aetiological agents in the later development of CD.

Adult↗
PubMed1999

Development and evaluation of a low erosive blackcurrant juice drink. 3. Final drink and concentrate, formulae comparisons in situ and overview of the concept.

OBJECTIVE: Two previous studies demonstrated that a blackcurrant juice drink with added calcium produced little erosion of enamel in vitro and in situ by comparison with other low pH fruit drinks. The primary aim of this study was to demonstrate that the final formulation drink and concentrate were of similar low erosivity. Secondary aims were to provide more data on the erosivity of other fruit drink concentrates and whether erosion was influenced by anterior and posterior palate siting of enamel specimens. METHOD: The study was a single centre, single blind, randomised placebo controlled 5 cell crossover design involving 15 volunteers. The test drinks were blackcurrant juice/calcium concentrate, blackcurrant juice/calcium drink, proprietary apple & blackcurrant juice concentrate, proprietary orange drink concentrate and water. Four enamel samples were retained in situ, 2 anterior palate and 2 mid/posterior palate, on upper removable acrylic appliances. Drinks were 250 ml volumes consumed 4 times per day during 15 working days. Concentrates were diluted 50 ml in 200 ml water. Measurements of enamel loss were made on one anterior and one posterior sample on days 2, 5, 10 and 15 by profilometry. RESULTS: One subject approached the 20 microns erosion limit by day 10 on the orange drink and was withdrawn from that cell. Differences in mean erosion between anterior and posterior sites were variable and small. By day 15 the mean losses of enamel averaged over anterior and posterior were blackcurrant/calcium concentrate 0.28 micron, blackcurrant/calcium drink 0.35 micron, apple & blackcurrant concentrate 2.04 microns. orange concentrate 8.29 microns and water 0.08 micron. Except at day 15 for the blackcurrant/calcium drink the erosion by the blackcurrant/calcium formulations was not significantly different from water at any time point. Erosion by the apple & blackcurrant and orange concentrate drinks was highly significantly greater than the blackcurrant/calcium drinks at all but the 2 day time point for the apple & blackcurrant concentrate drink compared to the blackcurrant/calcium drink. CONCLUSIONS: All data thus far indicate that dependant on tooth site susceptibility and the specific drink, the consumption of standard low pH fruit drinks could result in 1 mm loss of enamel in periods ranging from as little as 2 years to 20 years. Similar erosion by the low pH blackcurrant drinks with added calcium would take in excess of 100 years.

Adult↗
PubMed1999

Development and evaluation of a low erosive blackcurrant juice drink in vitro and in situ. 1. Comparison with orange juice.

OBJECTIVE: The aim of this study was to determine whether an experimental blackcurrant juice drink with added calcium was less erosive to enamel both in vitro and in situ compared with a proprietary orange juice product. METHODS: The study was a single centre, blind, randomised, placebo controlled three cell crossover design. An intra oral appliance capable of retaining one enamel sample in situ was constructed and worn by 12 volunteers. The drinks under test were orange juice, the experimental blackcurrant juice drink with calcium and water. Drinks were consumed as 250 ml volumes four times during the working day under supervision for 15 days. The same methodology was modelled in vitro. Measurements of enamel loss were made by profilometry. RESULTS: Water, the experimental blackcurrant juice drink and orange juice produced 0.19, 0.41 and 2.54 microns loss of enamel respectively in situ and 0.0, 5.2 and 22.18 microns loss of enamel respectively in vitro. All differences between pairs of drinks in situ and in vitro were statistically significant. CONCLUSIONS: Data using this model in situ were only available for orange juice and this was therefore considered as a positive control with water a placebo control. The results have demonstrated that the experimental blackcurrant juice drink with calcium is markedly less erosive than orange juice, particularly and importantly in situ. The experimental blackcurrant juice drink has limited erosive potential to teeth and deserves further comparative investigation and development as a low pH fruit drink for public consumption.

Adult↗
PubMed1999

Development and evaluation of a low erosive blackcurrant juice drink. 2. Comparison with a conventional blackcurrant juice drink and orange juice.

OBJECTIVE: A previous study demonstrated that an experimental low pH blackcurrant juice drink with calcium was markedly less erosive to enamel both in situ and in vitro than orange juice. Further development of the experimental blackcurrant juice drink formula has occurred and the aims of the present studies were two fold. Firstly, to confirm the low erosivity of the modified formulation and secondly, to provide more comparative data with other acidic fruit drink products. METHOD: The study was a single centre, single blind, randomised placebo controlled 4 cell crossover design involving 12 healthy volunteers. The test drinks were orange juice, water, experimental blackcurrant juice drink with calcium and a proprietary blackcurrant juice drink. Enamel samples were retained in situ at the mid palatal regions using intraoral appliances and exposed to 250 ml volumes of the drinks 4 times per day during 15 working days. Measurements of enamel loss were made by profilometry. The same method was modelled in vitro. RESULTS: By day 15 the mean losses of enamel in situ for orange juice, water, experimental blackcurrant juice drink with calcium and blackcurrant juice drink were 1.70, 0.05, 0.44 and 2.75 microns respectively. At all bar one measurement, the loss of enamel was significantly greater for all fruit drinks compared to water. Losses caused by the blackcurrant juice drink with calcium were significantly less than the other two fruit drinks at all time points. Losses of enamel by day 15 in the study in vitro were 13.02, 0.00, 1.78 and 39.02 microns respectively. The blackcurrant juice drink with calcium was not significantly different from water at days 3 and 6, otherwise all pairwise comparisons for differences between the 4 drinks at each time period were significant. CONCLUSIONS: The methodologies in situ and in vitro again appear to correlate in ranking the order of erosivity of drinks. The data particularly from the study in situ allude to the very low comparative erosivity of the further modified experimental blackcurrant juice drink with calcium and support the further development of such drinks for public consumption.

Adult↗
PubMed1999

An evaluation of video instruction for an electric toothbrush. Comparative single-brushing cross-over study.

Instructions on the use of electric toothbrushes are usually derived from the written and/or diagrammatic leaflets provided with the device or perhaps less often instruction from a professional. Videos are now widely used for information transfer and the direction of physical activities. The aim of this study was to determine whether video instruction in the use of an electric toothbrush could promote efficient use of the device. The 2-min video demonstrated the use of an oscillating, rotating electric toothbrush used by a hygienist for 15 s in each buccal and lingual quadrant. A voice-over directed the observer to follow the hygienist's movements. The study was planned as a 2-phase, single-examiner blind, randomised, cross-over study accepting there would be confounding of the 2nd period by carry-over from the 1st. A group of 24 healthy volunteers participated who had average oral hygiene and never used an electric toothbrush. 12 subjects received the video first (VN) and 12 subjects the instructional leaflet with the device (NV). Single brushings were performed after suspending tooth cleaning for 48 h. Plaque was scored before and after brushing. A 2-week washout period was permitted before the crossover. In period 1, plaque removal with the video was overall significantly greater than with written instructions. The effects for posterior teeth were greater than anterior and comparison between groups for posterior minus anterior differences were highly significant in favour of the VN group. In period 2, the effect of period was dominant with both groups achieving greater plaque removal in period 2 than period 1. Plaque removal by group VN remained considerably greater than group NV Despite the confounding influences of carry-over in this particular design of study, the results support the idea that video instruction for electric toothbrushes could be a simple and efficient way of improving plaque removal by these devices. The methodology needs to be verified in a home-use type of investigation.

Adult↗
PubMed1999

Conversion of plaque-area measurements to plaque index scores. An assessment of variation and discriminatory power.

Plaque areas recorded graphically or photographically provide a permanent record of plaque accumulations on teeth at a moment in time. As such, these records could be re-evaluated and converted into other index scores. The purpose of this study was to determine the reproducibility of scoring a plaque index from previously recorded plaque areas and to compare such scores with the original scores of the same index. A randomised blind, crossover study comparing 5 treatments for plaque inhibition scored by plaque area and index was chosen. 2 examiners, the original scorer PRH and another, NC, 2x scored the plaque area tooth charts according to the criteria of the plaque index system used in the original study. Standard deviations of the differences showed intra-examiner repeatability to be high particularly for the original examiner. Inter-examiner reproducibility for the original index scores was considered good but less than for intra-examiner repeatability. Correlation coefficients were complimentary to the differences analysis, being very high within examiners and less high for between examiners and original and rescored index. Separation between distributions of plaque area measurements for consecutive values of the index were particular good for scores 2 versus 3 and 3 versus 4 and less good for 1 versus 2 and 4 versus 5. Reanalysis of the study for treatment differences using rescored data revealed a similar level of significance as using the original data. Rescored index had similar discriminatory power for the study as plaque area and original plaque index when both were derived from the same buccal tooth surfaces. However, discriminatory power was less by comparison with original plaque index derived from the buccal surfaces of all teeth. It is concluded that plaque area provides a permanent record of plaque distribution which can be converted into index data at a later date. Such data collection could make possible comparisons between studies using different indices.

Cross-Over Studies↗
PubMed1999

Comparison of video and written instructions for plaque removal by an oscillating/rotating/reciprocating electric toothbrush.

A previous crossover study showed that a watch-and-follow instructional video improved plaque removal by an electric toothbrush compared to the use of the instructional leaflet. This study employed a parallel design to assess the value of an instructional video for plaque removal by a new model oscillating/rotating/reciprocating electric toothbrush. 2 groups of 26 dentate subjects with average oral hygiene, who had never used an electric toothbrush, participated in this single blind, randomised parallel group designed study. On day 1 of the study, subjects received a professional prophylaxis to remove all plaque. Oral hygiene measures were then suspended and subjects returned on day 3 when a prebrushing plaque score was recorded by plaque index and area. Subjects withdrew and either read the manufacturers instructional leaflet (group L) or observed the instructional video (group V). Groups L and V then performed toothbrushing with toothpaste for 2 minutes and with group V brushing in time with the instructional video. Post-brushing plaque indices and areas were then recorded. Whole mouth, lingual, upper, lower, anterior and posterior but not buccal % reductions in plaque index and area were significantly greater in group V compared to group L. % plaque removal was also significantly greater by area at mid and distal sites but not mesial sites. Whole-mouth plaque reductions were 10% greater in group V but reached >15% at lingual surfaces. Within group differences in plaque removal at paired sites e.g., buccal/lingual, remained similar, suggesting that further improvement could be achieved by modifying the video to devote more time to the difficult-to-clean areas. In conclusion, in the early period of learning the use of an electric toothbrush, plaque removal can be improved by using an instructional video. Such watch-and-follow video routines could be extended to other areas of oral hygiene practices.

Adult↗
PubMed1999

Oral folate enhances endothelial function in hyperhomocysteinaemic subjects.

BACKGROUND: Elevated plasma homocysteine (Hcy) is a risk factor for vascular disease. A postulated mechanism is vascular endothelial damage by homocysteine. Hcy levels are inversely related to blood concentrations of folate and can be lowered by folate supplements. The effect of oral folic acid on endothelial function was investigated in healthy adults with mild hyperhomocysteinaemia. PATIENTS AND METHODS: Eighteen healthy subjects (Hcy > 13 micromol L-1 at entry), from a screening population of 890 volunteers, were entered into a randomised double-blind placebo-controlled crossover study of oral folic acid (5 mg daily for six weeks) with a six week interval between treatments. Flow-mediated (endothelium-dependent) and (endothelial-independent) glyceryl trinitrate (GTN)-mediated brachial artery dilatation were measured by high resolution wall tracking. RESULTS: Folate supplementation enhanced endothelium-dependent responses (+0.08 +/- 0.05 vs. +0.04 +/- 0.04 mm, P = 0.015) but endothelium-independent responses (GTN) were unchanged. Folate reduced Hcy (8.7 +/- 2.5 vs. 12.1 +/- 3.6 micromol L-1). CONCLUSION: High dose folic acid supplementation enhances endothelium-dependent vascular function and lowers plasma Hcy. This provides preliminary evidence that folate may have beneficial cardiovascular effects in adults with mild hyperhomocysteinaemia.

Administration, Oral↗
PubMed1999

Interventions to improve uptake of breast screening in inner city Cardiff general practices with ethnic minority lists.

OBJECTIVE: To increase the uptake of breast screening in three inner city GP practices with a high proportion of ethnic minority patients. SETTING: The study was carried out in May and June 1997 in the South East Wales division of Breast Test Wales (BTW). Three inner city general practices in Cardiff, with a low uptake in the previous round of breast screening and a high proportion of ethnic minority women on their lists, were targeted to receive interventions to increase uptake. This preliminary study was not randomized but sought to offer insights into the interventions which may be worth pursuing and the groups that are harder to reach. DESIGN INTERVENTIONS: identification of ethnic language groups; GP endorsement letter; translated literature including: multilingual leaflet, GP letter, screening invitation; transport to the screening centre; language support. RESULTS: Of 369 women invited, 187 attended for screening. This gives an uptake of 50.7% compared with an uptake of 35.2% in the previous screening round, a statistically significant increase of 15.5%. (95% CI +8.2% to +22.5%). CONCLUSION: Findings show that translated literature, GP endorsement letter and language support by linkworkers were beneficial. The provision of free transport was ineffective and under-utilized. Uptake was highest amongst Urdu and Gujarati speaking groups and lowest for Bengali and Somali speakers which are hardest to reach. There is scope for improving the attendance rate amongst ethnic minority groups but this can costly.

Breast Neoplasms↗
PubMed1999

A comparison of two rapid whole-blood tests and laboratory serology, in the diagnosis of Helicobacter pylori infection.

OBJECTIVE: To compare two rapid whole-blood serology tests for Helicobacter pylori and a laboratory serology assay against a gold standard. DESIGN: Prospective comparison of tests in 81 patients. SETTING: A hospital rapid access endoscopy clinic. PARTICIPANTS: Dyspeptic patients requiring assessment of H. pylori status. INTERVENTIONS: Measurement of H. pylori antibody status by Quickvue One-step, Helisal, and Premier H. pylori test; 13C urea breath test for H. pylori, and gastric biopsies for histology, culture and rapid urease test. MAIN OUTCOME MEASURE: Sensitivity and specificity of Quickvue One-step, Helisal and Premier tests, compared to a gold standard based on 13C urea breath test, biopsy culture, histology and urease test. RESULTS: The Quickvue assay has significantly greater sensitivity (81%) than Helisal (67%), but without appreciable loss of specificity (86% and 93%, respectively). The Premier laboratory assay is significantly more sensitive than both of the rapid blood tests (96%), with comparable specificity to the Quickvue assay. CONCLUSION: The rapid serology tests used in this study are quick and convenient to use, but do not approach the sensitivity of a laboratory assay in detecting H. pylori status in this group of dyspeptic patients attending an endoscopy clinic.

Adolescent↗
PubMed1999

Rectal carcinoma: thin-section MR imaging for staging in 28 patients.

PURPOSE: To evaluate the accuracy of thin-section magnetic resonance (MR) imaging (in-plane resolution, 0.6 x 0.6 mm) in the preoperative assessment of the depth of extramural tumor infiltration, which is a major prognostic indicator in rectal cancer. MATERIALS AND METHODS: In a prospective study of 28 consecutive patients, preoperative MR imaging was performed. The tumor stage according to the TNM classification system and the measured depth of extramural tumor invasion in matched MR images and histopathologic slices were compared. RESULTS: Preoperative MR imaging correctly indicated the histopathologic tumor stage in all 25 patients in whom comparisons were possible. The difference between the depth of extramural tumor measured on preoperative MR images and corresponding measurements on histopathologic slices of the resection specimen ranged from -5.0 mm to +5.5 mm (mean difference, +0.13 mm; 95% CI: -2.72, +2.98 mm), indicating good agreement. The mesorectal fascia, and the relation of the tumor to it, could be visualized in every case. In all five patients with involvement of the circumferential excision margins of resection specimens, extensive extramural invasion was identified on preoperative MR images. CONCLUSION: Preoperative thin-section MR imaging accurately indicates the tumor stage of rectal cancer and depth of extramural tumor infiltration. It provides valuable information for identifying T3 tumors for preoperative adjuvant therapy in patients who are at high risk of failure of complete excision.

Female↗