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PubMed2005

Judging a book by its cover: descriptive survey of patients' preferences for doctors' appearance and mode of address.

OBJECTIVE: To document patients' preferred dress styles of their doctors and modes of address. DESIGN: Descriptive survey. SETTING: Inpatients and outpatients at a tertiary level hospital, New Zealand. PARTICIPANTS: 202 inpatients and 249 outpatients, mean age 55.9 (SD 19.3) years. MAIN OUTCOME MEASURES: Ranking of patients' opinions of photographs showing doctors wearing different dress styles. A five point Likert scale was used to measure patient comfort with particular items of appearance. RESULTS: Patients preferred doctors to wear semiformal attire, but the addition of a smiling face was even better. The next most preferred styles were semiformal without a smile, followed by white coat, formal suit, jeans, and casual dress. Patients were more comfortable with conservative items of clothing, such as long sleeves, covered shoes, and dress trousers or skirts than with less conservative items such as facial piercing, short tops, and earrings on men. Many less conservative items such as jeans were still acceptable to most patients. Most patients preferred to be called by their first name, to be introduced to a doctor by full name and title, and to see the doctor's name badge worn at the breast pocket. Older patients had more conservative preferences. CONCLUSIONS: Patients prefer doctors to wear semiformal dress and are most comfortable with conservative items; many less conservative items were, however, acceptable. A smile made a big difference.

Adult↗

PubMed2005

Preschool vision screening tests administered by nurse screeners compared with lay screeners in the vision in preschoolers study.

PURPOSE: To compare the performance of nurse screeners with that of lay screeners in administering preschool vision screening tests. METHODS: Trained nurse and lay screeners administered the Retinomax Autorefractor (Right Manufacturing, Virginia Beach, VA), SureSight Vision Screener (Welch Allyn, Inc., Skaneateles Falls, NY), crowded Linear Lea Symbols visual acuity (VA) test at 10 ft (Precision Vision, Inc., La Salle, IL), and Stereo Smile II test (Stereo Optical, Inc., Chicago, IL) to 3- to 5-year-old Head Start participants. Lay screeners also administered a crowded Single Lea Symbols VA test at 5 ft (Good-Lite, Inc.). Screening results were compared with the classification of the children according to the presence of one or more of four conditions (amblyopia, strabismus, significant refractive error, and unexplained reduced VA) based on the results of a gold standard eye examination by study-certified optometrists and ophthalmologists. The primary outcome measure was sensitivity for detecting children with one or more targeted conditions at 0.90 specificity. RESULTS: Nurse screeners achieved slightly higher sensitivities with the Retinomax, SureSight, and Stereo Smile II tests than did lay screeners; however, most differences were small and not statistically significant. Nurse screeners achieved significantly higher sensitivity with the Linear Lea Symbols VA test than did lay screeners. Lay screeners achieved strikingly higher sensitivity with the Single Lea Symbols VA test than did nurse or lay screeners using the Linear Lea Symbols VA test. Combining the Stereo Smile II test with each of the other tests did not result in improved sensitivities for detecting one or more targeted conditions. CONCLUSIONS: Nurse and lay screeners can achieve similar sensitivity, when specificity is set at 0.90, for detecting preschool children in need of a comprehensive eye examination.

Allied Health Personnel↗

PubMed1999

Children's and parents' visual perception of physicians.

The purpose of this study is to evaluate the child's and parents' visual perception of physicians. To do this, 50 children and their parents were asked which physician they preferred, when shown eight pairs of photographs. Four characteristics were tested twice, white coat versus no white coat, smile versus stern face, cartoon posters versus no posters, and standing versus stooping. We found that both children and parents preferred the smiling physician and the physician with cartoon posters on the wall. Surprisingly 54% of children preferred the physician in the white coat, whereas only 35% of parents preferred the white coat. Sixty-eight percent of children also preferred the standing physician compared with only 41% of parents. There was little correlation between the parent's and child's answers. The results did not differ significantly with age, gender, or number of hospitalizations. In conclusion our study did not confirm the popular belief that children are afraid of physicians in white coats, although children did strongly prefer physicians who smiled and those with cartoon posters on the wall.

Adult↗

PubMed1976

A behavioral phenotype in the de Lange syndrome.

The behavior of nine patients with the de Lange syndrome was studied using videotape, a recording protocol of eight standardized stimulus conditions, and a visual, digital time reference which permitted precise coding and quantitative analysis. These patients avoid or reject social interactions and physical contact, and they do not distinguish in this between a stranger and the mother or her substitute. Social interactions with the adult stranger were scored in patients 1-7 as negative for 28-56 sec/min, whereas they were positive for 1-6 sec/min. Statistical significance was at the level of P less than 0.01. In the case of the mother negative responses ranged from 21-45 sec/min and positive from 3-27 sec/min. The patients exhibit infrequent facial expressions of emotion, and frequently display stereotypic movements. On the other hand, vestibular stimulation or vigorous movement appeared to be an effective means of eliciting pleasurable responses. When held in arms in the vertical position only one of nine children smiled at all and the frequency for that child was 0.8/min. When the child was bounced vigorously in the same position, all smiled but who was too large to be bounced. In the eight the frequency of smiling ranged from 0.8-3.6/min. The data obtained indicate that a specific behavioral phenotype is associated with this syndrome.

Adolescent↗

PubMed1999

The role of cosmetic dentistry in restoring a youthful appearance.

BACKGROUND: Dentistry is faced with a population that is getting older and keeping more of its natural teeth. Smiles show physical and esthetic signs of aging. Advances in the area of cosmetic dentistry now offer the dental profession new opportunities in conservative and esthetic restorative procedures that have the potential to reverse the signs of dental aging, thereby making patients appear younger. CASE DESCRIPTION: The physical and esthetic attributes of an aged dentition are identifiable. Tooth wear over time alters the appearance of the teeth and smile in a way that is perceptible to dentists and laypeople. Bonding and adhesive ceramic restorative procedures have the potential of reversing the esthetic manifestations of the aging process for teeth. Specific diagnostic tools, including a composite resin mock-up and construction of an incisal putty matrix, allow for previsualization of possible treatment outcomes and allow clinicians to resolve occlusal as well as esthetic treatment concerns before initiating actual treatment. CLINICAL IMPLICATIONS: The ability to make patients look younger through cosmetic enhancement of teeth and smiles has tremendous implications for the future practice of dentistry. Dentists who have the training and skills to meet the increasing demand for esthetic procedures by patients seeking to restore a youthful appearance may find an expanded role within their practices for this type of treatment.

Dental Veneers↗

PubMed2006

Use of the ACE inhibitor zofenopril in the treatment of ischemic heart disease.

Zofenopril, an inhibitor of the angiotensin-converting enzyme (ACE), has recently been widely introduced into the pharmaceutical market. Its clinical safety and efficacy has been demonstrated in patients with hypertension and in patients with acute myocardial infarction (AMI). The Survival of Myocardial Infarction Long-term Evaluation (SMILE) project provided valuable information regarding the safety of early onset ACE inhibition with zofenopril after AMI and a greater perception of the early and late benefits. The SMILE-I study demonstrated that most benefits of ACE inhibition may be obtained early after AMI and persist after discontinuation of treatment. The SMILE-II study demonstrated that early zofenopril treatment (initiated <12 h) is safe and associated with a low rate of severe hypotension in thrombolyzed patients with acute myocardial infarction when administered in accordance with an adequate dose-titration scheme. Many other studies of clinical ACE-inhibitors (ACEIs) over the last 30 years have provided us with information in order to understand the effects of ACEIs and have demonstrated that patients benefit from ACEI treatment at different stages of the pathophysiological continuum of cardiovascular diseases. The current guidelines recommend that ACEIs should be used for routine secondary prevention in all patients with coronary artery disease and should be considered for all other patients with coronary or other vascular disease unless contraindicated.

Angiotensin-Converting Enzyme Inhibitors↗

PubMed2003

Are facial expressions reproducible?

OBJECTIVES: To determine the extent of reproducibility of five facial expressions. DESIGN: Thirty healthy Caucasian volunteers (15 males, 15 females) aged 21 to 30 years had 20 landmarks highlighted on the face with a fine eyeliner pencil. Subjects were asked to perform a sequence of five facial expressions that were captured by a three-dimensional camera system. Each expression was repeated after 15 minutes to investigate intrasession expression reproducibility. To investigate intersession expression reproducibility, each subject returned 2 weeks after the first session. A single operator identified 3-dimensional coordinate values of each landmark. A partial ordinary procrustes analysis was used to adjust for differences in head posture between similar expressions. Statistical analysis was undertaken using analysis of variance (linear mixed effects model). RESULTS: Intrasession expression reproducibility was least between cheek puffs (1.12 mm) and greatest between rest positions (0.74 mm). The reproducibility of individual landmarks was expression specific. Except for the lip purse, the reproducibility of facial expressions was not statistically different within each of the two sessions. Rest position was most reproducible, followed by lip purse, maximal smile, natural smile, and cheek puff. Subjects did not perform expressions with the same degree of symmetry on each occasion. Female subjects demonstrated significantly better reproducibility with regard to the maximal smile than males (p =.036). CONCLUSIONS: Under standardized conditions, intrasession expression reproducibility was high. Variation in expression reproducibility between sessions was minimal. The extent of reproducibility is expression specific. Differences in expression reproducibility exist between males and females.

Adult↗

PubMed1987

Effects of pet and/or people visits on nursing home residents.

A previous study by the author supported the recently popular idea that live pet-visits increased desirable behaviors in nursing home residents such as smiling and alertness, but it also suggested that people-visits may be even more effective. The purpose of the present study was therefore to compare the effects of different visiting programs (people-alone, people-plus-pets, pets-alone and no visit) on the behaviors of nursing home residents (proximity, talking, smiling, ambulation, alertness). All three visiting programs of people-alone, people-plus-pets, and pets-alone increased the behaviors of smiling and alertness in comparison to control conditions in the nursing home lounge. Close proximity to the person-alone visitor was, however, associated with the greatest number of positive resident behaviors. Future research is suggested to examine the characteristics that make effective pet and person visitors for nursing home residents.

Aged↗

PubMedDate not supplied

[Preterm neonates treated in intensive care units: development of interaction behavior in the first year of life]

OBJECTIVE: The aim of this research was to characterize the interaction during the first year of preterm infants whose weight was lower than 2000g and who had been in neonatal intensive care units for at least 10 days. METHOD: Fifty-three infants were observed during a year, twenty-one being boys and thirty-two girls. These infants were assessed regarding seventeen kinds of behavior which we considered important in person to person relationship, i.e., behavior which led to interaction or maintained it. In our analysis we considered the age at which the child was seen, sex, weight at birth, new born classification, time of hospitalization and neurological diagnosis.RESULTS: An analysis of the results showed that there was an evolution in the way preterm infants interacted although the progress was smaller than the one of their pair terms. The occurrence of communicative behavior was not affected by sex, weight at birth or newborn classification (adequate or small for gestational age). The postnatal time of hospitalization affected the occurrence of the behavior smiles to the reflected image in mirror. The infants diagnosed as being neurologically impaired showed a statistically significant smaller occurrence of behaviors: respond to smiles and speech by smiling, play peek-a-boo, protest at mothers departure, point to desired objects and carry out given orders. CONCLUSIONS: The infants diagnosed as having neurological disabilities showed a delay in more complex forms of interaction. The infants with more than 35 days of hospitalization showed alteration in the self-body construction, related to personality build up.

Journal Article↗

PubMed1998

Baby boomers make cosmetic dentistry boom.

Baby Boomers want to stay younger longer. As they age, a healthy attractive smile becomes much more important to their appearance. Nothing conveys good health and maintenance like aesthetically pleasing teeth. Because the timing is perfect for cosmetic dentistry, there is no reason for people to not have a great smile. Smile-Vision and the latest cosmetic dentistry techniques and materials helped the case patient first see and then become the person he wanted to be. His teeth look and feel better, resulting in a more confident appearance. (Figures 14 through 16).

Adult↗

PubMed2000

Altered passive eruption.

Biologic contributions to the smile play an important role in esthetics. The impact of the gingival complex on the esthetic qualities of a smile are significant, and both patients and dentists are developing a greater appreciation for the impact of gingiva on the beauty of a smile. Historically, the focus of periodontal therapy has been on managing patients with longer-appearing teeth secondary to attachment loss through pathology or as a result of periodontal surgery. Nevertheless, early diagnosis and treatment, as well as modern techniques and materials, have helped periodontology evolve to a point where such problems occur less frequently.

Epithelial Attachment↗

PubMed1992

Adult tactile stimulation during face-to-face interactions modulates five-month-olds' affect and attention.

3 studies were designed to investigate infant responses to tactile stimulation during brief adult-infant interaction using a modified still-face (SF) procedure. When adults pose a neutral SF expression, infants decrease gazing and smiling at the adults, and some increase grimacing, relative to normal interaction periods. This SF effect was substantially reduced in Study 1 when mothers or strangers continued to touch infants during the SF period. In Studies 2 and 3, tactile versus visual and active versus passive aspects of adult touch were isolated during different SF periods. Visible, active adult hands unaccompanied by touch elicited infant attention, but not smiling, during the SF period. By contrast, active, not passive, adult touch substantially reduced the SF effect, even when the adult's hands were invisible. In the latter condition, infants continued to gaze and smile at the adult's SF. Thus, adult facial expressions are not the only modulator of infant affect and attention during social exchanges; adult touch appears to play an active role.

Adult↗

PubMed2006

[Free micro-vascular muscle transplantation for the treatment of late facial paralysis using extensor digitorum brevis and extensor hallucis brevis].

OBJECTIVE: To investigate the result of free vascular transplantation of denervated extensor digitorum brevis and extensor hallucis brevis for the treatment of late facial paralysis. METHODS: From April 2003 to April 2005, 26 cases of facial paralyses were treated by transplantation of denervated extensor digitorum brevis and extensor hallucis brevis. During operation, the ends of the tendons were fixed at ala nasi, middle point of nasal labial fold,oral commissure and chin; the muscle belly were put around the masseter nerve to correct the nasal and oral deformity, microsurgery was applied to anastomose the tarsus lateral vessels to the superficial temporalis vessels or the facial vessels. The result of the operation was evaluated by the Standard of Douglas Harrison and the Paresis Assessment scoring system of Stennert. RESULTS The static appearance was satisfactory in 26 cases after operation, the bilateral oral commissure was symmetry and the dynamic appearance was greatly improved 6 months after operation. Among the 23 cases whose disease history was above 2 years, all could smile naturally and show their teeth symmetrically except 1 case who could only move the oral commissure. Among the 3 cases whose disease history was less than 2 years, one could smile naturally and show his teeth symmetrically, one could smile but could not show his teeth symmetrically, another could move oral commissure but have no motion appearance. The result was evaluated as "+++" according to Standard of Douglas Harrison, accounting for 88% (23/26). Evaluated according to the Paresis Assessment scoring system of Stennert, the difference before operation and after operation was more than 5, accounting for 86% (22/26). CONCLUSION: The free vascular transplantation of denervated extensor digitorum brevis and extensor hallucis brevis can reconstruct the oral appearance for the treatment of late facial paralysis.

Adolescent↗

PubMed1990

Current trends in the treatment of established unilateral facial palsy.

A unilateral facial palsy can be considered established and therefore unlikely to recover, if a year has passed since the injury which initiated it. Fascial slings and muscle transfers have still a place in maintaining static position and preventing the mouth swinging to the animated side on smiling. They do not, however, produce a smile responsive to emotion. Crossed facial nerve grafting is rather unreliable and rarely produces a symmetrical smile. Since the mid 1970s vascularised muscle grafts have been employed to compensate for the degeneration of the paralysed facial musculature. The pectoralis minor is a particularly suitable muscle for transplantation to the face because of size and shape. Experience with these techniques and the results of the first 30 cases using this muscle are presented.

Adult↗

PubMed1997

Early predictors of neurodevelopmental outcome in high risk infants.

OBJECTIVE: To find out a few simple and easily elicitable items at three and six months of age that can predict neurodevelopmental outcome at one year in high risk babies. DESIGN: One year longitudinal follow up study. SETTING: Hospital based study including inborn and outborn infants discharged from the Neonatal Intensive Care Unit (NICU) of a referral hospital, followed up in a High Risk Clinic. METHODS: Sixty high risk babies were followed up longitudinally for a period of one year. A detailed neurodevelopmental examination was done with special attention to the following items-axillary suspension, head support, social smile, disappearance of primitive reflexes and neurobehavior at three months age while pull to sit, rolling over, sitting momentarily without support, transfer of objects and voluntary reach were evaluated at six months age. Bayley Scales of Infant Development (Baroda Norms) was used for assessing the outcome at one year. RESULTS: Babies with absence of social smile, abnormal neurobehavior at three months and absent pulling to sit position, absent voluntary reach, and absent transfer of objects, remained delayed at one year. The specificity of each of these items was 100%. These items had a positive predictive value of 100%. CONCLUSIONS: Inability to achieve social smile and abnormal neurobehavior at three months age and absence of pulling to sit position, transfer of objects and voluntary reach at six months age, warrant early intervention. These items are easy to elicit, do not require any special kit or elaborate training. Hence these items can be tested even by those working at the primary level or in office practice.

Adaptation, Physiological↗

PubMed1997

Creating facial harmony with cosmetic dentistry.

With the increased awareness that optimal cosmetic dentistry can have on self-image, self-esteem, and self-confidence, patients are no longer just wanting to close gaps or whiten their smiles. Patients are becoming very conscious of the size, proportion, and position of their teeth as related to their smile and face. By incorporating the art and science of cosmetic dentistry into our enhancement therapy, we are able to create excellent results on a consistent basis. This review explores the impact that cosmetic dentistry can have on creating facial harmony. The discussion demonstrates the importance of a proper esthetic diagnosis as well as a thorough bioesthetic evaluation of each patient. This review also stresses the importance of an objective and subjective assessment and how a detailed evaluation of each patient can help create harmonious and natural smiles.

Beauty↗

PubMed1985

Margin placement of esthetic veneer crowns. Part IV: Postoperative patient attitudes.

Ninety-one subjects with a total of 196 esthetic veneer crowns with visible gingival margins were surveyed. An esthetic analysis of crown margins showing with a normal smile and an exaggerated smile was performed and recorded. Patient satisfaction or dissatisfaction with the esthetic veneer crowns was assessed. The conclusions of this study support the results reported in the first three parts of this study, indicate that satisfactory results can be obtained on many individuals when the crown margins of esthetic veneer crowns are placed supragingivally, and support the philosophy that individual patient education and analysis are essential to the selection of optimum margin placement when esthetic veneer crowns are the treatment of choice.

Attitude↗

PubMed2005

Botulinum toxin type A in the treatment of excessive gingival display.

PURPOSE: One cause of excessive gingival display is the muscular capacity to raise the upper lip higher than average. Several surgical procedures have been reported to improve the condition, but surgery always involves risk and is costly. Botulinum toxin type A (BTX-A) (Botox; Allergan, Irvine, Calif) has been studied since the late 1970s for the treatment of several conditions associated with excessive muscle contraction or pain. This clinical pilot study was performed to determine whether BTX-A injections would reduce excessive gingival display. MATERIAL: Five subjects with excessive gingival display due to hyperfunctional upper lip elevator muscles were treated with BTX-A injections. RESULTS: This treatment modality was effective, producing esthetically acceptable smiles in these patients. The improvements lasted 3 to 6 months. CONCLUSIONS: Injection with BTX-A at preselected sites is a novel, cosmetically effective, minimally invasive alternative for the temporary improvement of gummy smiles caused by hyperfunctional upper lip elevator muscles.

Adolescent↗