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Biomedical subjects

S M Levy

Publications and source records attributed to S M Levy.

At least 37 records · Page 2Linked to original sources
PubMed1996

Assessing fluoride concentrations of juices and juice-flavored drinks.

Few studies have investigated fluoride exposures from juices and juice-flavored drinks manufactured with water. In this study, the authors analyzed 532 juices and juice drinks for fluoride. Fluoride ion concentrations ranged from 0.02 to 2.80 parts per million, in part because of variations in fluoride concentrations of water used in production. Children's ingestion of fluoride from juices and juice-flavored drinks can be substantial and a factor in the development of fluorosis.

Beverages↗
PubMed1995

Dimethyl sulfoxide does not trigger urine histamine release in interstitial cystitis.

OBJECTIVES: Dimethyl sulfoxide (DMSO), an agent that provides symptomatic relief in patients with interstitial cystitis (IC) works via an unknown mechanism. We investigated whether DMSO acts as a chemical stimulant of mast cell degranulation. METHODS: A radioimmunoassay (RIA) specific for histamine was used to test this hypothesis. Twelve women with strictly diagnosed IC were treated with intravesical instillations of DMSO. Treatments were repeated at varying intervals, and each patient received three to six treatments. Urine histamine levels were measured before and after each intravesical instillation of DMSO. Dilutional effects of DMSO were corrected for by conversion of urine histamine concentration to urine histamine:creatinine ratio. RESULTS: The RIA was unaffected by the addition of DMSO to urine. No consistent change in the urine histamine:creatinine ratio following DMSO instillation was found. Trend analysis revealed no trend in the histamine:creatinine ratio with time. CONCLUSIONS: The relief of symptoms reported in 50% to 77% of patients treated with intravesical DMSO is not related to detectable mast cell release of histamine. Other mechanisms of action must be investigated to explain the beneficial effect of this agent.

Administration, Topical↗
PubMed1995

Sources of fluoride intake in children.

Wide variations in fluoride intake among children make estimating fluoride intake difficult. This paper discusses the various sources of fluoride intake among children, beginning with a review of the fluoride concentrations of water and other beverages, foods, and therapeutic fluoride products. A review of previous studies' estimates of fluoride intake from diet, dentifrice, fluoride supplements, fluoride mouthrinses, and gels, as well as total fluoride intake also is presented. Then, estimates of fluoride intake among young children of different age groups are summarized, and examples demonstrating the high level of variability of fluoride intake, both from individual sources and in total, are presented. Lastly, this paper discusses the implications of our current level of knowledge of children's fluoride intake, and presents recommendations for the use of fluoride for children in light of this current knowledge. The major recommendations are that: (1) the fluoride content of foods and beverages, particularly infant formulas and water used in their reconstitution, should continue to be monitored closely in an effort to limit excessive fluoride intake; (2) ingestion of fluoride from dentifrice by young children should be controlled, and the use of only small quantities of dentifrice by young children should be emphasized; and (3) dietary fluoride supplements should be considered a targeted preventive regimen only for those children at higher risk for dental caries and with low levels of ingested fluoride from other sources.

Adolescent↗
PubMed1995

Risk factors for dental fluorosis in pediatric dental patients.

OBJECTIVES: Concerns have been raised recently about whether a substantial amount of dental fluorosis is resulting from the increased use of fluoride from various sources. The purposes of this study were to determine the prevalence and severity of dental fluorosis in a sample of pediatric patients seeking dental treatment in a university pediatric dental clinic and to evaluate sources of fluoride as risk factors for dental fluorosis. METHODS: A convenience sample of 157 children aged 8 to 17 years were examined for dental fluorosis using the Tooth Surface Index of Fluorosis (TSIF). Fluoride history questionnaires assessing previous exposure to fluoride during the first eight years of life were completed by the children's parents. Fluoride exposures were compared among 54 cases and 54 matched controls using a case-control retrospective design. RESULTS: Fluorosis was found in 72 percent of the children, but was generally quite mild. The risk of fluorosis was significantly greater for children who had greater exposure to fluoridated water and who used larger amounts of fluoridated toothpaste up to age eight. CONCLUSIONS: This study provided evidence that increased use of fluoride toothpaste may be a risk factor for dental fluorosis. The results suggest prudent use of dentifrice by young children to minimize the risk of fluorosis.

Adolescent↗
PubMed1995

Infants' fluoride intake from drinking water alone, and from water added to formula, beverages, and food.

In infants, the majority of total ingested fluoride is obtained from water, formula and beverages prepared with water, baby foods, and dietary fluoride supplements. Few studies have investigated the distribution of fluoride intake from these sources among young children at risk for dental fluorosis. The purpose of this study was to assess estimated water fluoride intake from different sources of water among a birth cohort studied longitudinally from birth until age 9 months. Parental reports were collected at 6 weeks, 3 months, 6 months, and 9 months of age for water, formula, beverage, and other dietary intake during the preceding week. Fluoride levels of home and child-care tap and bottled water sources were determined. This report estimates daily quantities of fluoride ingested only from water--both by itself and used to reconstitute formula, beverages, and food. Daily fluoride intake from water by itself ranged to 0.43 mg, with mean intakes < 0.05 mg. Water fluoride intake from reconstitution of concentrated infant formula ranged to 1.57 mg, with mean intakes by age from 0.18 to 0.31 mg. Fluoride intake from water added to juices and other beverages ranged to 0.67 mg, with means < 0.05 mg. Estimated total daily water fluoride intake ranged to 1.73 mg fluoride, with means from 0.29 to 0.38 mg.

Beverages↗
PubMed1995

Infants' fluoride ingestion from water, supplements and dentifrice.

Concerns about dental fluorosis and the paucity of detailed fluoride intake data prompted this longitudinal study of fluoride intake in infants from birth to 9 months of age. On average, water fluoride intake greatly exceeded that from dietary fluoride supplements or fluoride dentifrice. However, fluoride supplements and dentifrice contributed substantial proportions of fluoride intake among children using them. Some children had estimated fluoride intake from water, supplements and dentifrice that exceeded the recommended "optimal" intake (a level that has yet to be determined scientifically). Practitioners should estimate fluoride ingestion from all these sources if considering systemic fluoride supplementation.

Animals↗
PubMed1994

Review of fluoride exposures and ingestion.

The literature on fluoride intake/ingestion was reviewed critically to determine the current exposure to fluorides for children living in non-fluoridated and fluoridated areas in North America. Fluoride from all sources except mouthrinses and professionally applied topical fluorides was considered, including ingestion from foods and beverages, as well as intake from the use of fluoride dentifrice and dietary fluoride supplements. Data from all of these sources were used to produce estimates of mean daily ingestion. Studies consistently have identified substantial variation in ingestion among individuals. These analyses demonstrated that a substantial proportion of individuals had exposure or ingestion well beyond that of the mean for each source, and often 10-20% received up to several times as much exposure as the mean. Some children probably ingest sufficient fluoride from a single source to exceed the "optimal" fluoride intake recommended from all sources, and are therefore at increased risk of fluorosis. This review highlighted the substantial variation and complexity of fluoride ingestion. Appropriate consideration of these aspects is warranted in efforts to ensure a margin of safety favoring dental caries prevention while limiting objectionable fluorosis.

Child↗
PubMed1994

Surveying smokeless tobacco use, oral lesions and cessation among high school boys.

We surveyed 821 Iowa teenage boys to establish patterns of smokeless tobacco use, occurrence of oral lesions and the effect of lesions on attitudes about quitting, current use and plans for future use. Results suggest that young ST users who currently have a lesion or have experienced lesions may be particularly receptive to discussion of quitting options and other information about ST health effects. Dentists and other oral health professionals should initiate ST intervention when establishing a lesion history or on discovering a lesion at examination.

Adolescent↗
PubMed1993

Comparison of primary care residents' confidence and clinical behavior in treating hypertension versus treating alcoholism.

PURPOSE: To compare the self-reported confidence and clinical behaviors of primary care residents in treating alcoholism versus hypertension. METHOD: Eighty-five residents, 36 in family medicine and 49 in primary care internal medicine, representing all years of the three-year training programs at two hospitals affiliated with the Brown University School of Medicine, were surveyed in 1988. Self-report questionnaires elicited demographic data and several responses (ranged on scales of 1, not confident or frequent, to 10, very confident or frequent) about the residents' confidence and frequency of use of clinical behaviors with both alcoholic and hypertensive patients. Paired t-tests were used to compare the responses about hypertension with those about alcoholism. RESULTS: Questionnaires were completed by 54 (63.5%) of the residents. No significant difference was found between the residents' responses by sex or program, but there was a significant difference (p < .0001) between the responses with regard to the two disorders. The residents had more confidence about their management of hypertension (a mean score of 8.81 versus 7.95 for alcoholism). They also reported greater use of appropriate clinical behaviors with hypertensive patients (mean scores in the very confident range of 7.5 to 8.2 compared with means in the moderate range of 4.9 to 7.1 for alcoholism). CONCLUSION: Both the family medicine and the internal medicine residents were significantly more confident in managing all aspects of hypertension than in managing alcoholism, and they reported significantly greater frequency in utilizing appropriate clinical behaviors for hypertension than for alcoholism.

Alcoholism↗
PubMed1993

Dentifrice use among preschool children.

Ingestion of fluoridated dentifrice by young children may be a major contributing factor to dental fluorosis, prevalent in the United States. Brushing habits of a small group of preschoolers were monitored to document parental involvement and amounts of dentifrice used.

Child, Preschool↗
PubMed1992

Mastectomy versus breast conservation surgery: mental health effects at long-term follow-up.

Between 1984 and 1989, 129 Stage 1 and Stage 2 breast cancer patients were entered into a behavioral study in Pittsburgh. Approximately 70% of these patients had elected to have breast conservation (lumpectomy) surgery, with the remainder choosing mastectomy. Using the Profile of Mood States, a measure of perceived social support, and Karnofsky ratings of physical functional status, patients were assessed 3 to 5 days following surgery and again 3 and 15 months following surgery. The data were analyzed using a repeated-measures analysis of covariance, adjusting for aggressiveness of chemotherapy. Compared to mastectomy patients, patients who received breast conservation surgery were rated as more functional by observers, but they perceived themselves as having less energy and less emotional support, especially over the first 3 months of the recovery period. Because there is accumulating evidence that emotional support may act as a stress buffer in various populations and may have survival value, these findings may be particularly troublesome. This study shows that breast conservation surgery is not a psychosocial panacea. Patients whose breasts are spared, especially younger patients, have psychological symptoms that appear acutely worse in the short run and, in the end, are similar to those of patients who elect to have mastectomies. Therefore, patients choosing lumpectomies are not necessarily psychosocially better off than those electing to have mastectomies. Additionally, these patients, particularly younger patients, may require greater social support and potential mental health interventions than they seem to be receiving.

Adaptation, Psychological↗
PubMed1992

Provider compliance with recommended dietary fluoride supplement protocol.

Proper dosage of dietary fluoride supplements is important for children without access to optimally fluoridated water to balance dental caries prevention and risks of dental fluorosis. Subsequent to water fluoride assay, compliance by physicians and dentists with the recommended dietary fluoride supplement dosage schedule was determined for 446 children. Approximately one third of child patients and 42% of siblings did not receive the recommended supplement dosage.

Adolescent↗
PubMed1991

Physiologic and psychobehavioral research in oncology.

A major thrust in research in psychosocial oncology is the study of the interaction of psychologic and physiologic variables. This discussion reviews the current status and future directions of such research. Areas addressed include pain, nausea and vomiting with chemotherapy, sexuality, effects of cancer on psychologic and neuropsychologic function, impact of psychologic factors on cancer and its treatment, and psychoneuroimmunology. In addition, specific recommendations for strategies to facilitate research in these areas of psychosocial oncology are proposed.

Adult↗
PubMed1991

Persistently low natural killer cell activity and circulating levels of plasma beta endorphin: risk factors for infectious disease.

Beta endorphin levels were quantitated in plasma samples obtained from normal subjects (n = 81, 37% males and 63% females, age range 18-45 years) as a component of a prospective study examining the relationship of illness morbidity to natural killer cell activity and psychological indices of stress. The present study was designed to test whether beta endorphin levels contributed additionally to the explanation of illness outcome variance. In the larger study, persistently low NK (LNK) activity was associated prospectively with higher illness morbidity. The findings reported here suggest that the observed LNK activity might be affected by circulating levels of plasma beta endorphin, as lower endorphin levels predicted the LNK pattern, which in turn, predicted higher illness morbidity.

Adolescent↗
PubMed1991

Immunological and psychosocial predictors of disease recurrence in patients with early-stage breast cancer.

Ninety women with recently diagnosed stage I or stage II breast cancer who had been admitted to the NIH Clinical Center and were participating in a randomized trial were entered onto this behavioral immunology protocol. Patients were immunologically and psychosocially assessed at baseline (approximately 5 days after surgery) and again at 3 and 15 months post surgery. All of the patients were followed up for a minimum of 5 years, and 60% of the patients were followed for 7 years or longer. Twenty-nine women in the study group reported disease recurrences over the entire follow-up period. Causal path modeling statistical techniques showed that natural killer (NK) cell activity was a strong predictor of disease outcome when the outcome variable was defined as recurrence v nonrecurrence of disease (chi 2 = 6.9, p less than .001). Higher NK cell activity at follow-up predicted disease-free survival over the follow-up period. When the disease outcome variable was operationally defined as time to recurrent disease, the psychosocial factors were more strongly predictive of the rate of disease progression for those who had a recurrence (chi 2 = -4.1, p less than .01), but NK cell activity was seemingly less relevant in this latter case. Overall, these findings suggest that including mood and potentially relevant immunological variables, along with important biological prognostic variables, in multivariate and prospective models such as those examined in this study, potentially contributes more to the explanation of greater outcome variance of early-stage breast cancer than has been believed in the past.

Adult↗
PubMed1991

Persistently low natural killer cell activity, age, and environmental stress as predictors of infectious morbidity.

In recent studies of 'low natural killer (NK) cell syndrome', low NK activity was measured in individuals who were symptomatic, and therefore a causal relationship between low NK activity and infectious or other disease manifestations could not be concluded. However, preliminary work by members of our collaborative team (S.L. and R.H.) provided some indications for chronic low NK activity preceding and predicting subsequent infectious morbidity. This present study was designed to address this causal question in a larger sample, using a longitudinal design. Subjects were 106 healthy normal volunteers from the community. They were examined medically and psychosocially at baseline, and were then followed over a 6-month interval, with serial monthly assessments over the study period. The results supported our hypothesis that individuals who were currently healthy, but who exhibited a pattern of natural immunity characterized by persistently low NK cytotoxicity would be at risk for development of infectious sequelae over a 6-month follow-up period. The results also showed that younger age and the perception of more severe 'hassles' or stressors also predicted more infectious morbidity during the 6-month study period. Chronological age appeared to have both a direct, as well as indirect (via NK activity) association with illness outcome. Contrary to our expectation, the report of environmental stressors was directly associated with illness outcome, but not indirectly associated with outcome via natural immunity.

Adolescent↗