Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Reclassification”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 1,099 records · Page 61Linked to original sources
PubMed2006

Section 5(2) Mental Health Act 1983: does teaching make a difference?

There have been well-documented misunderstandings about the use and powers of section 5(2) of the Mental Health Act (MHA) 1983, however there are no published studies looking at how education of the clinicians involved affects any outcome measures. The aim of this study was to examine the impact of training junior doctors in the correct use and powers of section 5(2) of the MHA 1983. Data was collected before and after teaching junior doctors in Nottingham. There were proportionally fewer section 5(2)s MHA 1983 implemented by junior doctors after the teaching. A suggested gold standard for reclassification rates was found and trends in better practice are also reported. Teaching junior doctors about section 5(2) MHA 1983 increases the proportion of senior doctors implementing the section and this should improve patient care. All junior doctors should receive specific teaching about section 5(2) at the start of their training.

Commitment of Persons with Psychiatric Disorders↗
PubMed2006

The molecular phylogeny of the genus Rhizopus based on rDNA sequences.

In order to establish the molecular phylogeny of the genus Rhizopus, three molecules of the ribosomal RNA-encoding DNA (rDNA), complete 18S, internal transcribed spacer (ITS)1-5.8S-ITS2, and 28S D1/D2 regions of all the species of the genus were sequenced. Phylogenetic trees showed three major clusters corresponding to the three groups in the current morphological taxonomy, microsporus-group, stolonifer-group, and R. oryzae. R. stolonifer var. lyococcos was clustered independently from the major clusters. R. schipperae clustered differently in all trees. Strains of R. sexualis had multiple ITS sequences. A. rouxii clustered with R. oryzae. These results indicate the possibility of molecular identification of species groups using rDNA sequencing. Reclassification of the genus might be appropriate.

Base Sequence↗
PubMed1999

Classification and behavior of canine mammary epithelial neoplasms based on life-span observations in beagles.

As part of a study of the effects of low-level radiation, 1,343 Beagles, including 671 males and 672 females, were evaluated over their full lifetime for the occurrence of mammary neoplasia; there were 139 control males and 138 control females and 532 irradiated males and 534 irradiated females. All nodules found in surgical specimens or at necropsy were evaluated histologically. The overall incidence, metastasis and recurrence rates, and contribution to mortality of mammary neoplasms were determined. Based on this unique opportunity to correlate morphologic characteristics with ultimate biological behavior of all mammary tumors in a defined canine population, we propose a histogenetically based reclassification of epithelial mammary tumors. Of the 672 female dogs, 70.8% (476) had at least one mammary neoplasm; 60.7% (408) had more than one. Two male dogs had mammary neoplasms. Of 1,639 mammary carcinomas in the 672 females, 18.7% (307) were classified as ductular carcinomas (arising from the small interlobular or intralobular ductules), whereas 80.7% (1,322) were classified as adenocarcinomas of other histogenetic origin. Of 73 fatal carcinomas, ductular carcinomas accounted for 48 fatalities (65.8%), whereas other adenocarcinomas accounted for only 20 fatalities (27.4%). Radiation had no effect on this ratio. Ductular carcinomas also had a higher rate of metastasis than did adenocarcinomas. Existing classifications of mammary carcinomas do not recognize the characteristic morphologic features, the degree of malignancy, and the prognostic importance of these ductular carcinomas. Metastasis rates did not differ between simple and complex carcinomas or between those lesions and adenocarcinomas in mixed tumors. True carcinosarcomas metastasized more frequently (100%, or 5/5) than did adenocarcinomas in mixed tumors (34.4%, or 22/64), emphasizing the importance of not lumping these tumors under the classification of malignant mixed tumors.

Adenocarcinoma↗
PubMed2004

Optimization of BMD measurements to identify high risk groups for treatment--a test analysis.

INTRODUCTION: The aim of this study was to develop a methodology to optimize the role of BMD measurements in a case finding strategy. We studied 2113 women > or = 75 years of age randomly selected from Sheffield, UK, and adjacent regions. Baseline assessment included hip BMD and clinical risk factors. Outcomes included death and fracture in women followed for 6723 person-years. MATERIALS AND METHODS: Poisson models were used to identify significant risk factors for all fractures and for death with and without BMD and the hazard functions were used to compute fracture probabilities. Women were categorized by fracture probability with and without a BMD assessment. A 10-year fracture probability threshold of 35% was taken as an intervention threshold. Discordance in categorization of risk (i.e., above or below the threshold probability) between assessment with and without BMD was examined by logistic regression as probabilities of re-classification. Age, prior fracture, use of corticosteroids, and low body mass index were identified as significant clinical risk factors. RESULTS: A total of 16.8% of women were classified as high risk based on these clinical risk factors. The average BMD in these patients was approximately 1 SD lower than in low-risk women; 21.5% of women were designated to be at high risk with the addition of BMD. Fifteen percent of all women were reclassified after adding BMD to clinical risk factors, most of whom lay near the intervention threshold. When a high probability of reclassification was accepted (without a BMD test) for high risk to low risk (p1< or = 0.8) and a low probability accepted for low to high risk (P2 < or = 0.2), BMD tests would be required in only 21% of the population. CONCLUSION: We conclude that the use of clinical risk factors can identify elderly women at high fracture risk and that such patients have a low average BMD. BMD testing is required, however, in a minority of women--a fraction that depends on the probabilities accepted for classification and the thresholds of risk chosen. These findings need to be validated in other cohorts at different ages and from different regions of the world.

Absorptiometry, Photon↗
PubMed1991

Measurement of sleep-related breathing disturbances in epidemiologic studies. Assessment of the validity and reproducibility of a portable monitoring device.

The feasibility and reliability of measuring sleep-related breathing disorders with a portable monitor (PM) were assessed in a heterogeneous population, consisting of 31 patients recruited from a sleep laboratory and pulmonary disease clinic, 16 participants in a genetic-epidemiologic study of sleep apnea, and four volunteers with no specific sleep complaints. The validity of measurements made by the PM was assessed with comparisons of respiratory parameters made with the PM to those determined with in-hospital polysomnography (PSG) (25 studies). Reproducibility was assessed in 29 subjects who underwent in-home monitoring on two occasions. There was a high level of agreement between the number of respiratory events (apneas or hypopneas) per hour of estimated sleep (respiratory disturbance index, RDI) recorded with the PM and PSG and log-transformed (r = 0.96). Using a RDI of greater than or equal to 10 to define "abnormality," 20 of the 21 subjects who would have been classified as abnormal with PSG were classified similarly with use of the PM. A similar high level of agreement was demonstrated for the log-transformed RDI determined with replicate in-home studies (r = 0.94). No evidence of a "first-night effect" for the RDI was suggested in studies performed with the PM; ie, RDI was 18.4 +/- 27.7 and 17.4 +/- 25.7 (mean +/- SD) for first and second night studies, respectively (p = 0.21). A second compared with an initial study with the PM would have resulted in reclassification of abnormality based on an RDI of greater than or equal to 10 in one subject. These findings suggest that measurement of the RDI with in-home monitoring provides a valid and highly reproducible index for assessment of sleep-related respiratory disturbances for use in epidemiologic studies of general populations.

Adult↗
PubMed1997

Reproducibility of the histologic diagnosis of pneumonia among a panel of four pathologists: analysis of a gold standard.

STUDY OBJECTIVE: To establish a histologic diagnosis of pneumonia by consensus of a panel of pathologists, to test the interobserver and intraobserver variation in the histologic diagnosis of pneumonia, to compare the diagnostic accuracy of diagnosing pneumonia with and without preselected histologic criteria, and to establish more specific histologic criteria for the diagnosis of pneumonia. METHODS: The study group consisted of 39 patients who died after a mean of 14 days of mechanical ventilation. A postmortem open lung biopsy was performed on all patients. The tissue was reviewed independently by four pathologists who categorized the slides from each patient as showing or not showing pneumonia. Interobserver variation was calculated using the kappa statistic. Six months following the initial evaluation, the same slides were resubmitted to one of the pathologists for reevaluation to look for intraobserver error. Finally, the slides were reviewed and categorized by the criteria of Johanson et al into no pneumonia, mild, moderate, or severe bronchopneumonia. A comparison was made of the patients selected as demonstrating histologic pneumonia by each of the examinations. RESULTS: The reliability coefficient (kappa) measuring agreement among the four pathologists was good at 0.916. However, the prevalence of pneumonia as determined by each of the four pathologists varied; pathologist A, 15 of 39 (38%); pathologist B, 12 of 39 (31%); pathologist C, 9 of 39 (23%); and pathologist D, 7 of 39 (18%). Resubmitting the same slides to the same pathologist 6 months later resulted in reclassification of 2 of 39 patients. Using the histologic criteria of Johanson and colleagues, 14 patients were selected as having pneumonia compared with only nine patients selected by consensus of three of four pathologists. CONCLUSIONS: Recognition of histologic pneumonia varies among pathologists. The preselected criteria of Johanson and colleagues detected histologic pneumonia in eight of nine patients picked by consensus of pathologists, but six additional patients classified as "no histologic pneumonia" by the consensus of pathologists were judged to have histologic pneumonia by these criteria. The results established the necessity for standardization of histologic criteria for studies using biopsy as the gold standard for bacterial pneumonia. An atlas showing the criteria used in our selection was developed.

Aged↗
PubMed2001

Typical and atypical pulmonary carcinoids : outcome in patients presenting with regional lymph node involvement.

STUDY OBJECTIVE: Typical pulmonary carcinoid tumors are well-differentiated neuroendocrine tumors that are associated with good patient survival rates, while atypical carcinoid tumors are more aggressive and have worse patient survival rates. Because these tumors rarely involve the thoracic lymph nodes at presentation, it is currently unknown to what extent the presence of thoracic lymph node metastases at the time of diagnosis influences patient survival. METHODS: A computerized search of the medical records for pulmonary carcinoid tumor at the Mayo Clinic from 1976 to 1997 revealed 517 patients, from which we identified 36 patients with pulmonary carcinoid tumors involving regional thoracic lymph nodes but without distant disease. For each patient, we reviewed the tumor histology, stage, and outcome. In addition, because the histologic criteria for the diagnosis of carcinoid tumors had changed significantly during the time of the study, we reexamined all of the histologic specimens using the current World Health Organization (WHO) criteria for classifying pulmonary neuroendocrine tumors. RESULTS: After reclassification with the WHO criteria for neuroendocrine tumors, 23 patients had typical carcinoid tumors with thoracic lymph node involvement. At the last follow-up, 19 patients had no evidence of disease (NED), 2 patients had developed systemic metastases (SM) and are still alive, and 2 patients had died. Eleven patients had atypical carcinoid tumors with thoracic lymph node involvement. At the last follow-up, four patients had NED, seven patients had developed SM within a median time of 17 months, and six patients with SM died shortly thereafter (median survival time, 25.5 months), while one is still alive. Two patients had been reclassified with large cell neuroendocrine carcinoma at the time of this review; both of these patients had developed SM (at 4 months and 21 months after diagnosis) and had died (at 15 months and 21 months after diagnosis, respectively). CONCLUSIONS: These data suggest that patients with atypical pulmonary carcinoid tumors with regional lymph node metastases have a high likelihood of developing recurrent disease if treated with surgical resection alone and have significantly worse outcome (p < 0.001) compared to those patients with typical carcinoid tumors with thoracic lymph node involvement.

Adolescent↗
PubMed2003

Genotypic, phenotypic, biochemical, physiological and pathogenicity-based categorisation of Acanthamoeba strains.

The genus Acanthamoeba includes more than 20 morphological species, but classification is problematical. Recently, the discovery of substantial interstrain differences in ribosomal DNA (rDNA) sequences has prompted questions about the relatedness of strains of the same species. In this study, therefore, we have investigated relationships between two isolates of A. polyphaga, CCAP 1501/3c and ATCC 30871, using morphological, biochemical, physiological, molecular and cytotoxicity assays. We observed that A. polyphaga ATCC 30871 exhibited up to six arms in endocyst while A. polyphaga CCAP 1501/3c exhibited a maximum of 5 arms thus indicating their position in group 2 and 3, respectively. Acanthamoeba polyphaga ATCC 30871 exhibited growth at 37 degrees C and growth on 1M mannitol plates while A. polyphaga CCAP 1501/3c did not. In addition, both isolates exhibited differences in isoenzyme banding patterns and rDNA restriction fragment polymorphisms. More importantly, A. polyphaga ATCC 30871 produced cytotoxicity on corneal epithelial cells while A. polyphaga CCAP 1501/3c had no effects, suggesting differences in pathogenicity. Thus, all the results provide evidence for significant differences between the strains and further provided the basis for reclassification of the isolates. Implications of these results in the clinical diagnosis of pathogenic Acanthamoeba are discussed.

Acanthamoeba↗
PubMed1997

[Intraoperative EEG monitoring using a neural network].

OBJECTIVE: To introduce a new EEG parameter for monitoring a patient's cerebral status during anaesthesia. METHOD: EEG epochs (channel C3 P3, duration 30 see per epoch) yield patterns used as the training input of a self-organising neural network (neural gas algorithm). Each pattern contains spectral components. An additional "suppression parameter" reflects the proportion of flat curves during an EEG epoch and reduces the shortcomings of spectral analysis. The enhanced pattern vector enables the recognition of burst-suppression periods representing depressed cerebral activity during anaesthesia. Following training with 25549 EEG epochs ¿recorded in 196 consenting patients in the period beginning 5 minutes before induction of anaesthesia to extubation¿ the network knows 125 basic patterns (neural clusters). The neural clusters are responsible for different stages of anaesthesia: some neurons are activated by EEG epochs of awake patients, others are stimulated by deep stages. The homogeneity of the EEG epochs of cluster is checked. The portion of the EEG epochs not recognised by the network (7.5%) contains heterogeneous and sporadic patterns (mainly outlines caused by artefacts). RESULTS: In comparison with commonly used variables of anaesthesiological EEG monitoring (spectral edge or median frequency) neural discriminant analysis achieves better discrimination between awake and deeply anaesthetised stages (reclassification of 96% vs. 70%). On the basis of 56 complete sequences of patterns (from the beginning of the infusion of anaesthetics to the occurrence of burst suppression) a trend value of between 0.0 and 100.0 is assigned to each neural cluster. In contrast to existing methods, induction of anaesthesia causes a strictly linear increase in the electroencephalographic trend. CONCLUSIONS: Detailed neural cluster and discriminant analysis on the basis of the model described leads to an improved EEG parameter which better reflects the hypnotic effects of anaesthetic agents and arousal reactions caused by pain stimuli. Misclassifications of awake and anaesthetised stages are reduced. The neural network learns to recognize the complex changes in EEG patterns during induction of anaesthesia with different agents.

Adult↗
PubMed2001

Novel approaches to treat muscular dystrophies.

Muscular dystrophies (MD) are a clinically and genetically heterogeneous group of skeletal muscle-wasting diseases. Mutations in the dystrophin gene result in dystrophin deficiency, which constitutes the pathogenic basis of Duchenne and Becker MD (DMD and BMD). Several MD are caused by mutations in other recently identified genes coding for proteins linked to the sarcolemma, the nuclear envelope or the contractile apparatus. In addition, several MD have been mapped to different chromosomal loci and for most of them, the identification of the molecular defect is underway. The immediate result is an ongoing reclassification of the MD into disorders defined not by clinical characteristics but specific genetic mutations. At present, therapy of MD is based on symptomatic treatment and supportive care. Convincing evidence for clinical efficacy is only available for corticosteroids that also suffer from frequent and severe side effects. Up to now, curative therapy is not available, although promising new molecular therapies are under investigation in animal models of MD. Current treatment strategies are discussed and a perspective for effective molecular therapy is given.

Adrenal Cortex Hormones↗
PubMed2001

Applied neurogenomics.

Neurogenomics, the study of the genes of the nervous system, has applications in basic research, in the pharmaceutical industry and in the management of neurological disorders. Basic research applications include molecular neuropathology, the detection of genes for neurological disorders, the study of gene expression in the CNS and creation of transgenic models of neurological disorders. Pharmaceutical applications may be in the areas of molecular neuropharmacology, the discovery of new drugs for neurological disorders, gene therapy and the development of personalised medicines based on pharmacogenomics. Clinical applications in neurology include the redefinition and reclassification of diseases, molecular diagnostics and the integration of diagnostics with therapeutics. Various methods for the study of genes and gene expression are described. Genes have been identified for only a limited number of neurological disorders so far. The discovery of genes defective in neurological disorders would facilitate drug discovery, molecular diagnostics and gene therapy diseases. There is a trend towards the integration of diagnosis, genetic screening, prevention, treatment and monitoring of therapy of neurological disorders, which will be facilitated by neurogenomics. Pharmacogenomics-based personalised medicines are anticipated to be part of medical practice by the end of the first decade of the 21st century, and neurogenomics will contribute to the development of personalised medicines for diseases of the CNS.

Animals↗
PubMed2004

Changes of diurnal rhythm and levels of total and free testosterone secretion from pre to late puberty in boys: testis size of 3 ml is a transition stage to puberty.

OBJECTIVE: To establish levels for comparison for 24-h total and free serum testosterone in prepubertal boys and throughout pubertal development. DESIGN: The study subjects were 55 healthy boys, aged 5.0-18.6 years, who underwent serial sampling one or more times during their pubertal development. METHODS: Testicular volumes were determined by orchidometer. Serum testosterone was measured by a modified RIA (detection limit, 0.03 nmol/l). Free testosterone was calculated (calc-FT) using a formula derived from the law of mass action. RESULTS: Significant increases in testosterone and calc-FT concentrations in boys were found between testis volumes of 1 ml to 2 ml, 2 ml to 3 ml, 6 ml to 8 ml, and 10 ml to 15 ml. No differences were found between testis volumes of 3, 4, 5 and 6 ml neither were there differences between 8 and 10 ml, or between 15, 20 and 25 ml. Boys who had reached their final height had higher calc-FT values than boys who had the same pubertal development but had not reached their final height. Based on the results, puberty was classified into six stages: pre1 (testis, 1 ml), pre2 (testis, 2 ml), early (testis, 3-6 ml), mid (testis, 8-12 ml), late1 (testis,15-25 ml, not reached final height) and late2 (testis, 15-25 ml, reached final height). Serum testosterone was secreted with a diurnal variation in prepuberty and during puberty. The increase of testosterone in the morning hours started earlier in pubertal than in pre-pubertal boys. The most pronounced diurnal rhythm was found in early and in mid puberty. CONCLUSION: Using a sensitive method, and a pubertal reclassification, we have established levels for comparison of testosterone and calc-FT in prepubertal and pubertal boys. The existence of data for comparison forms the basis for future studies on pubertal disorders.

Adolescent↗
PubMed2006

Clinical classification of tetanus patients.

The authors propose a clinical classification to monitor the evolution of tetanus patients, ranging from grade I to IV according to severity. It was applied on admission and repeated on alternate days up to the 10th day to patients aged > or = 12 years admitted to the State University Hospital, Recife, Brazil. Patients were also classified upon admission according to three prognostic indicators to determine if the proposed classification is in agreement with the traditionally used indicators. Upon admission, the distribution of the 64 patients among the different levels of the proposed classification was similar for the groups of better and worse prognosis according to the three indicators (P > 0.05), most of the patients belonging to grades I and II of the proposed classification. In the later reclassifications, severe forms of tetanus (grades III and IV) were more frequent in the categories of worse prognosis and these differences were statistically significant. There was a reduction in the proportion of mild forms (grades I and II) of tetanus with time for the categories of worse prognostic indicators (chi-square for trend: P = 0.00006, 0.03, and 0.00000) whereas no such trend was observed for the categories of better prognosis (grades I and II). This serially used classification reflected the prognosis of the traditional indicators and permitted the comparison of the dynamics of the disease in different groups. Thus, it becomes a useful tool for monitoring patients by determining clinical category changes with time, and for assessing responses to different therapeutic measures.

Adolescent↗
PubMed2005

Molecular characterization of isosporoid coccidia (Isospora and Atoxoplasma spp.) in passerine birds.

Prevalence and disease caused by isosporoid coccidia in passerine birds are well recognized, but confusion about the life cycles of the parasites has led to taxonomic inconsistencies. In this study, we characterized segments of the chromosomal small and large-subunit ribosomal RNA (rRNA) genes of coccidial parasites from 23 species of passerine birds, as well as heat shock protein 70, apicoplast rRNA, and chromosomal 5.8s rRNA genes from a subgroup of these animals, and we correlated genetic data with morphologic findings for different parasite developmental stages, host phylogeny, and overall taxonomic relations within the phylum Apicomplexa. Our findings indicate that isosporoid coccidia of passerine birds are monophyletic but exhibit substantial diversity, with most avian species having one or several unique parasite lineages that underwent synchronous speciation with their hosts, interrupted by sporadic episodes of lateral transmission across species and families. Molecular analyses support a homoxenous life cycle, with sexual forms occurring chiefly in the intestines and asexual merozoites present systemically. Rarely, extraintestinal sexual stages can occur. The passerine coccidia are genetically most closely related to species of Eimeria rather than Isospora. We suggest that these parasites, whether identified from blood merozoite stages or fecal oocysts, be provisionally grouped as a homogeneous clade of individual species in a single taxon and formally named when reliable criteria allowing reclassification of related genera in the suborder Eimeriina are clarified.

Animals↗
PubMed2006

Effect of organic solvent exposure on chronic kidney disease progression: the GN-PROGRESS cohort study.

It has been suggested that solvent exposure may have a role in the progression of glomerulonephritis (GN) to ESRD, but this has never been tested with an appropriate cohort study design. A total of 338 non-ESRD patients with a first biopsy for primary GN between 1994 and 2001 were included: 194 IgA nephropathies (IgAN), 75 membranous nephropathies (MN), and 69 FSGS. ESRD, defined as an estimated GFR <15 ml/min per 1.73 m2 or dialysis, was registered during a mean follow-up period of 5 yr. Patients' lifelong solvent exposures before and after diagnosis were recorded by interview and assessed by industrial hygienist experts. Cox models were used to estimate adjusted hazard ratios (HR) of ESRD related to exposures. Overall, 15 and 14% of the patients had been exposed at a low and a high level before diagnosis, respectively. Forty-two with IgAN, 12 with MN, and 22 with FSGS reached ESRD. A graded relationship was observed for MN (age- and gender-adjusted HR [95% confidence interval] for low exposure versus none was 3.1 [0.5 to 18.2] and for high exposure versus none was 8.2 [1.9 to 34.7]) and for IgAN (1.6 [0.7 to 3.9] and 2.2 [1.0 to 4.8]) but not for FSGS. Solvent risk was mediated only partly by baseline proteinuria: Adjusted HR for high exposure versus none was 5.5 (1.3 to 23.9) for MN and 1.8 (0.8 to 3.9) for IgAN. In patients with IgAN, there was a trend in increasing HR with exposure duration before and its persistence after diagnosis. These findings support the hypothesized association of solvent exposure with the progression of GN to ESRD. They should prompt clinicians to give greater attention to patients' occupational exposures and possibly to consider professional reclassification.

Adult↗
PubMed2004

Why ethnic designation matters for stroke rehabilitation: comparing VA administrative data and clinical records.

Using existing administrative data to look at issues of ethnic disparities in rehabilitation-related outcomes may lead to misleading results. Problems can emerge from apparently small issues of reliability that are magnified by reclassification of ethnic designation and missing data in complete-subject analyses. We compared the reliability of ethnic assignment in Department of Veterans Affairs (VA) medical rehabilitation records for stroke patients with administrative records; reclassified the racial identifier from the administrative data in two ways; and examined the different sources of ethnic information in relation to severity, length-of-stay, disability assessment, and discharge disposition. Our results show how small changes increase the potential for Type II error when describing ethnic differences in outcomes or using ethnicity as a predictor with dichotomous response variables. We discuss our results with reference to the literature on ethnic classification and underline the importance of initiatives for improved data collection on ethnicity in VA data sources and in rehabilitation research.

Databases, Factual↗
PubMed1999

Development of a classification system for periodontal diseases and conditions.

Classification systems are necessary in order to provide a framework in which to scientifically study the etiology, pathogenesis, and treatment of diseases in an orderly fashion. In addition, such systems give clinicians a way to organize the health care needs of their patients. The last time scientists and clinicians in the field of periodontology and related areas agreed upon a classification system for periodontal diseases was in 1989 at the World Workshop in Clinical Periodontics. Subsequently, a simpler classification was agreed upon at the 1st European Workshop in Periodontology. These classification systems have been widely used by clinicians and research scientists throughout the world. Unfortunately, the 1989 classification had many shortcomings including: 1) considerable overlap in disease categories, 2) absence of a gingival disease component, 3) inappropriate emphasis on age of onset of disease and rates of progression, and 4) inadequate or unclear classification criteria. The 1993 European classification lacked the detail necessary for adequate characterization of the broad spectrum of periodontal diseases encountered in clinical practice. The need for a revised classification system for periodontal diseases was emphasized during the 1996 World Workshop in Periodontics. In 1997 the American Academy of Periodontology responded to this need and formed a committee to plan and organize an international workshop to revise the classification system for periodontal diseases. The proceedings in this volume are the result of this reclassification effort. The process involved development by the Organizing Committee of an outline for a new classification and identification of individuals to write state-of-the-science reviews for each of the items on the outline. The reviewers were encouraged to depart from the preliminary outline if there were data to support any modifications. On October 30-November 2, 1999, the International Workshop for a Classification of Periodontal Diseases and Conditions was held and a new classification was agreed upon (Fig. 1). This paper summarizes how the new classification for periodontal diseases and conditions presented in this volume differs from the classification system developed at the 1989 World Workshop in Clinical Periodontics. In addition, an analysis of the rationale is provided for each of the modifications and changes.

Humans↗
PubMed1988

Divergence of the recent trends in coronary mortality for the four major race-sex groups in the United States.

Since 1976 there has been a leveling off or slowdown in the rate of decline in coronary heart disease (CHD) mortality. The age-adjusted absolute annual rate of decline in CHD mortality rates during 1968-75 (delta rate/100,000 population/year) was virtually identical for White males (-7.54), Black males (-7.85), and Black females (-7.20), and somewhat lower for White females (-4.25). During 1976-85, however, the secular trends diverged considerably. Age-adjusted rates continued to decline at the same annual rate for White males, while the decline was approximately half as steep for the other three race-sex groups. During 1976-85 there was also a leveling off in the average annual per cent change in age-adjusted CHD mortality for Black males and females and White females when compared to 1968-75, while there was no change for White males. As a result, more than 40,000 White and Black females and Black males died of CHD in 1985 than would have died if CHD rates would have continued to decline at the 1968-75 trends. All comparisons were based on a reclassification of cause-of-death codes to maximize comparability between the 8th and 9th Revisions of the International Classification of Disease. These results suggest that the factors which have led to the continued decline in coronary heart disease may not have influenced all the demographic groups in this country equally over the last decade.

Adult↗