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PubMed1986

Intentional replantation of periodontally involved and endodontically mistreated tooth.

This article presents a case in which a tooth was intentionally replanted after it was endodontically mistreated; there was also a severe periodontal involvement. The unusually long period of time that the tooth survived might be attributed to a different approach to the replantation technique, such as occlusion adjustment prior to replantation, preoperative reduction of oral cavity bacteria and of the harmful aerosols commonly found in the dental operatory, placement of a noneugenol periodontal packing under the acrylic splint to prevent residual liquid monomer from seeping into the periodontal space, use of the patient's own blood and no other material to moisten the root while it was out of the socket, a short extraoral period, loose splinting, complete isolation of the operative site in the oral cavity, and completion of periodontal therapy before intentional replantation.

Adult↗
PubMed2001

Income and health: the time dimension.

It is widely recognised that poverty is associated with poor health even in advanced industrial societies. But most existing studies of the relationship between the availability of financial resources and health status fail to distinguish between the transient and permanent impact of poverty on health. Many studies also fail to address the possibility of reverse causation; poor health causes low income. This paper aims to address these issues by moving beyond the static perspective provided by cross-sectional analyses and focusing on the dynamic nature of people's experiences of income and health. The specific objective is to investigate the relationship between income and health for adult participants in the British Household Panel Survey from 1991 to 1996/97. The paper pays particular attention to: the problem of health selection; the role of long-term income; and, the effect of income dynamics on health. The results confirm the general findings from the small number of longitudinal studies available in the international literature: long-term income is more important for health than current income; income levels are more significant than income change; persistent poverty is more harmful for health than occasional episodes; and, income reductions appear to have a greater effect on health than income increases. After controlling for initial health status the association between income and health is attenuated but not eliminated. This suggests that there is a causal relationship between low income and poor health.

Causality↗
PubMed2005

Antithrombotic therapy in hypertension: a Cochrane Systematic review.

Although elevated systemic blood pressure (BP) results in high intravascular pressure, the main complications of hypertension are related to thrombosis rather than haemorrhage. It therefore seemed plausible that use of antithrombotic therapy may be useful in preventing thrombosis-related complications of elevated BP. The objectives were to conduct a systematic review of the role of antiplatelet therapy and anticoagulation in patients with BP, to address the following hypotheses: (i) antiplatelet agents reduce total deaths and/or major thrombotic events when compared to placebo or other active treatment; and (ii) oral anticoagulants reduce total deaths and/or major thromboembolic events when compared to placebo or other active treatment. A systematic review of randomised studies in patients with elevated BP was performed. Studies were included if they were >3 months in duration and compared antithrombotic therapy with control or other active treatment. One meta-analysis of antiplatelet therapy for secondary prevention in patients with elevated BP reported an absolute reduction in vascular events of 4.1% as compared to placebo. Acetylsalicylic acid (ASA) did not reduce stroke or 'all cardiovascular events' compared to placebo in primary prevention patients with elevated BP and no prior cardiovascular disease. Based on one large trial, ASA taken for 5 years reduced myocardial infarction (ARR, 0.5%, NNT 200 for 5 years), increased major haemorrhage (ARI, 0.7%, NNT 154), and did not reduce all cause mortality or cardiovascular mortality. In two small trials, warfarin alone or in combination with ASA did not reduce stroke or coronary events. Glycoprotein IIb/IIIa inhibitors as well as ticlopidine and clopidogrel have not been sufficiently evaluated in patients with elevated BP. To conclude for primary prevention in patients with elevated BP, antiplatelet therapy with ASA cannot be recommended since the magnitude of benefit, a reduction in myocardial infarction, is negated by a harm of similar magnitude, an increase in major haemorrhage. For secondary prevention in patients with elevated BP, antiplatelet therapy is recommended because the magnitude of the absolute benefit is many times greater. Warfarin therapy alone or in combination with aspirin in patients with elevated BP cannot be recommended because of lack of demonstrated benefit. Further trials of antithrombotic therapy are required in patients with elevated BP.

Aspirin↗
PubMedDate not supplied

State personality disorder in social phobia.

To examine the effects of state on personality disorder characteristics, we compared individuals with social phobia before and after psychological intervention. Administration of the Personality Disorder Questionnaire (PDQ-4) before and after treatment allowed for the identification of three groups of patients: (1) individuals who showed elevated PDQ-4 scores but little changes from intake to post treatment (Trait PD group; n = 28); (2) individuals who showed a decrease in PDQ-4 scores from intake to post treatment (State group; n = 33); and (3) a group with no significant personality disorder characteristics at pre or post-treatment (No PD group; n = 32). There were trend differences between the Trait, State and No PD groups for being single, never married (81.5%, 44.4%, and 56.3%, p < .05) and a significant difference for having the generalized form of Social Phobia (96.4%, 88.9%, and 59.4%, p < .0001). The groups also differed in their level of trait anxiety (61.6, 51.2, 44.5, p < .001). Groups also differed in level of the personality measure Harm Avoidance (26.3, 23.3, 19.8, p < .0002). The reduction of personality disorder traits in the State PD groups from intake to post-treatment was not specific to any particular personality disorder or personality disorder cluster. Trait personality appeared to have a higher risk for suicide compared to the other two groups. A State Personality group was identified in individuals with social phobia by following changes in personality pathology from before and after a psychological intervention.

Adult↗
PubMedDate not supplied

Acute exposure of cultured neurones to ethanol results in reversible DNA single-strand breaks; whereas chronic exposure causes loss of cell viability.

AIMS: Ethanol can create progressive neuropathological and functional alterations of neurones. However, the influence of exposure duration is still debated. It is difficult to specify the level of alcohol consumption leading to alcohol-induced brain damage. Moreover, the mechanism of toxicity is assumed to combine direct and metabolically induced effects, although numerous uncertainties remain. Finally, the genotoxic power of ethanol has not fully been investigated in the brain. In the experiment reported herein, primary cultures of neurones were exposed either chronically or acutely to doses of ethanol within the range of blood alcohol levels in intoxicated humans. The impact on the integrity of neurones was assessed by cytotoxicity tests and DNA alterations by single-cell gel electrophoresis (Comet assay) and flow cytometry. Chronic ethanol exposure, even at a low dose, was more harmful to neurones than acute exposure. Both significant reductions in cell viability and DNA alterations were observed in this condition. On the other hand, DNA repair capacities seemed to be preserved as long as the viability measured by specific tests was not affected. Instead, neurones entered a death cell process compatible with apoptosis.

Analysis of Variance↗
PubMed2006

Successful treatment of primitive neuroectodermal tumor-associated microangiopathy with multiple bone metastases.

We report here a 16-year-old male with primitive neuroectodermal tumor (PNET)-associated probable microangiopathy with multiple bone metastases. Laboratory findings excluded the possibility of amegakaryocytic or immune thrombocytopenia and/or disseminated intravascular coagulation. He was first treated with plasma-exchange (PE), followed by platelet transfusions, steroid pulse therapy and combined chemotherapy. PE and steroid pulse therapy reduced his plasma CRP level. Combined chemotherapy drastically increased his platelet count until it had almost normalized without further transfusion. The plasma level of von Willebrand factor-cleaving protease (ADAMTS13) activity measured before PE was not severely deficient (48% of normal) and an unusually large von Willebrand factor multimer (UL-VWFM) was detected. We consider that this therapeutic strategy has the following benefits: (1) reduction of plasma levels of factors that are harmful to both platelet activation and endothelial cell injury; and (2) the safe transfusion of platelet concentrate in thrombotic microangiopathy. This strategy should be confirmed in further cases.

Adolescent↗
PubMed1979

Pollution of the sea and its effects.

Marine pollution has been studied under the following groupings of effects; harm to living resources, hazards to human health, reduction of amenities and interference with other users of the sea. This paper is concerned mainly with the first two categories and their interrelation. Apart from certain seabirds affected by oil, the major stocks of marine animals show no evidence of reduction by pollution. Pollution effects are generally insignificant in relation to other factors governing reproductive success, survival, growth and population size. Even in the North Sea, which has received a greatly increased pollution load during the last three decades, both total production of fish and catch per unit of effort (a measure of abundance) of cod, haddock and plaice increased during the 20 years 1950--69. Very recent decreases have been due to over-exploitation but, except in certain estuaries and immediate coastal waters, direct damage by pollution to marine populations and ecosystems is not evident. Pollution effects can, however, be detected by chemical analysis. The paper examines human health risks arising in the marine environment, particularly from contaminated seafood, especially in relation to sewage pollution, metals such as mercury, cadmium and lead, synthetic organic substances and oil.

Animals↗
PubMed1976

PVC: health implications and production trends.

Poly(vinyl chloride) (PVC) is a complex plastic system. Individual components of the PVC system, including residual vinyl chloride monomer (RVCM) and certain additives, may pose risks of harm to human health. There have been significant reductions in the RVCM content of PVC resin since 1974, reducing the cancer risk of workers in PVC fabrication plants and consumers of PVC products. A "no-effect" level for vinyl chloride monomer (VCM)-induced carcinogenesis has not been found to date; therefore, the significance of human exposure to low levels of RVCM remains to be determined. Exposure to PVC dust may cause pulmonary dysfunctions. Pulmonary and other possible health effects of PVC dust require further study. The PVC plastics system should be characterized as to interactions among its various components and as to interactions of the components and the PVC system as a whole with biological systems.

Air Pollutants, Occupational↗
PubMed2001

[Analysis of German language consumer information brochures on screening for colorectal cancer].

A total of 17 consumer brochures that deal with the screening for colorectal cancer were analysed by two independently working researchers. The aim was to assess the quality of the information as a basis for evidence-based informed decision making using pre-defined evaluation criteria. No brochures fulfilled the necessary criteria. In most brochures there was a lack of transparency of the information process. No data was provided for estimating individual risks of colorectal cancer morbidity or mortality. With respect to the efficacy of screening no data was provided about relative or absolute risk reductions, number needed to screen, number needed to harm, predictive rates and false positive rates. In conclusion, presently available information brochures in Germany do not allow informed decision-making by consumers.

Colonic Neoplasms↗
PubMed1998

[A transsternal method for stopping pulmonary hemorrhage in patients with superior-lobe destructive pulmonary tuberculosis].

A less traumatic and safe way was sought for the superlobular bronchus and artery occlusion that permits the hemostatic effect to be quickly achieved, the risk and duration of the operation to be minimized. The approach consists in the use of transsternal approach instead of a conventional intercostal approach in 5 patients with superlobular fibrotic cavernous pulmonary tuberculosis, its positive effects being lessening of traumatic harm, improving of safety of operation, together with reduction of intraoperative time.

Adult↗
PubMed2004

Therapeutic ultrasound and fracture healing: a survey of beliefs and practices.

OBJECTIVE: To explore current beliefs among senior physiotherapy (PT) students and orthopedic surgeons on the clinical utility of therapeutic ultrasound for assisting fracture healing. DESIGN: Cross-sectional survey. SETTING: University. PARTICIPANTS: Orthopedic surgeons, senior orthopedic surgery residents, and PT students in their final 6 months of study. INTERVENTIONS: Not applicable. Main outcome measures Percentage of respondents reporting specific perceptions on (1) the role of therapeutic ultrasound in fracture healing, (2) clinical use of therapeutic ultrasound for fracture healing, (3) rationale for not using therapeutic ultrasound for healing fractures, and (4) what constitutes a clinically significant difference in fracture healing time. Between-group comparisons were conducted for survey responses. RESULTS: The response rate was 20 of 22 (90.9%) orthopedic surgeons, 5 of 5 (100%) senior orthopedic residents, and 34 of 50 (68.0%) senior PT students. The majority of senior PT students (58.8%) and orthopedic residents and surgeons (60.0%) surveyed reported the belief that therapeutic ultrasound may help in assisting fracture healing in some cases. However, the majority of respondents do not use this modality (60.0% of surgeons, 88.2% of Senior PT students), with most surgeons (32.0%) citing lack of evidence and most senior PT students (58.8%) indicating lack of availability as the predominant barrier. Thirty-two percent of surgeons felt that ultrasound was contraindicated and harmful to healing fractures, or that it was of no use, and 20.5% of PT students reported the belief that ultrasound was contraindicated and was, or may be, harmful to healing bone. Most orthopedic residents and surgeons (52.0%) reported that a reduction in fracture healing time of 4 weeks would be clinically significant versus senior PT students, the majority of whom (64.7%) indicated that a reduction of 2 weeks would be clinically significant. CONCLUSIONS: Some surgeons and PT students believed that therapeutic ultrasound is contraindicated and harmful to healing bone; however, most believed that therapeutic ultrasound may help in assisting fracture healing, in at least some cases. Current usage of this modality is rare, primarily due to the perceived lack of evidence and lack of availability. Large randomized trials are needed to define further the role of ultrasound in fracture healing.

Attitude of Health Personnel↗
PubMed2006

Relationship management therapy for patients with borderline personality disorder.

Relationship management therapy allows patients to choose their own treatment. The model requires that patients who engage in or threaten self-harm or aggressive behavior are discharged from the inpatient part of the program for 24 hours. This study compared mean annual outcome rates for the 27 patients who were consecutively enrolled in the relationship management therapy program from 1998 to 2000. Significant reductions were found in restraint, constant nursing observation, self-harm incidents, and inpatient days. These results fill a gap in the literature about a treatment model that one day could be considered a best practice.

Borderline Personality Disorder↗
PubMed2004

Computer physician order entry and the real world: we're only humans.

BACKGROUND: Computer physician order entry (CPOE) may have significant benefit to reducing medical errors in the hospital setting. The belief in the promise of CPOE has led organizations such as the Leap Frog Group to advocate for the implementation of CPOE in hospitals to improve patient safety. Human factors, or ergonomics, is the study of the interaction between humans and the systems and tools they use. It is unclear whether human factors principles have been applied to commercially available CPOE systems. CONCLUSIONS: CPOE's true utility for preventing medical errors and harm is largely undetermined. The evidence that exists for error reduction with CPOE is in the setting of "homegrown" systems and not commercially available products. The cases portrayed in the two scenarios described in this article were drawn from actual events to illustrate how failure to attend to human factors and human-centered design can create or facilitate errors and harm. RECOMMENDATIONS FOR ORGANIZATIONS IN IMPLEMENTING, CPOE: Organizations implementing CPOE or considering doing so could evaluate potential systems on the basis of evidence for human-centered design. An organization interested in addressing human factors issues as they relate to CPOE might, for example, familiarize itself with the basics of human factors, usability, and with existing evaluation methods for CPOE; involve the people who do the daily work in the evaluation and selection process; and ask potential vendors how they have addressed human factors in their CPOE systems.

Drug Prescriptions↗
PubMed2003

[Benefits and limitations of mammography].

The literature on screening mammography provides ample opportunity for doubt (the sceptics) and dogma (the screening zealots), and can be interpreted to prove both benefit and harm. The benefit of mammography screening, if any, is modest and the balance between beneficial (potentially, a 20% relative reduction in breast cancer mortality with no significant benefit on all-cause mortality) and harmful (physical and psychological morbidity related to the 15-40% missed cancers and the 80-90% false-positive diagnoses) effects is still delicate. The mammogram alone is a modest weapon. Concurrent clinical breast examination is mandatory. Women that are concerned about breast cancer should be fully informed of the potential benefits and risks of screening mammography. These women should benefit from mammography with concurrent clinical breast examination, and possible whole-breast ultrasound in heterogeneously dense and extremely dense breast patterns.

Age Factors↗
PubMed2000

Guideline for the management of chronic asthma in adults--2000 update. South African Pulmonology Society Adult Asthma Working Group.

OBJECTIVE: To make recommendations for the cost-effective management of asthma incorporating recent advances in the understanding and treatment of asthma since the last guideline statement in 1992. The guideline is applicable to adults and children over 12 years of age. OPTIONS: Asthma should be graded according to standard severity criteria. The principle of 'hit early, hit hard' with corticosteroids to achieve rapid control is encouraged; thereafter treatment should be tailed down to the lowest dose of corticosteroids that maintains the aims of asthma treatment. OUTCOMES: The aims of asthma management should be achieved; these include: (i) avoidance of causative and trigger factors; (ii) abolition of symptoms and ability to lead a normal lifestyle; (iii) restoration of normal (or best possible) lung function; (iv) reduction of the risk of severe attacks; and (v) optimisation of treatment with minimal side-effects. EVIDENCE: Based on a selective review of randomised, controlled studies to support an evidence-based approach to treatment. BENEFITS, HARMS AND COSTS: Appropriate management of asthma should lead to a reduction in morbidity and mortality of asthma and a consequent reduction in cost of asthma care. Side-effects of corticosteroids are placed in perspective together with a strategy to minimise these effects. RECOMMENDATIONS: Asthma should be managed with inhaled corticosteroids as the most important anti-inflammatory treatment, except in the case of mild intermittent asthma which may be treated with beta 2 agonists on a pro re nata (prn) basis. It is preferable to add long-acting beta 2 agonists to low-dose inhaled corticosteroids before increasing corticosteroids. Leukotriene receptor antagonists are currently recommended for use in combination with inhaled corticosteroids pending further data on their long-term benefits. Differentiation of asthma from chronic obstructive pulmonary disease (COPD) is important. Early referral to a pulmonologist in difficult cases is encouraged. VALIDATION: Endorsed by the South African Pulmonology Society, the Allergy Society of South Africa and the South African Medical Association. The guideline is compatible with those of other international societies.

Adrenal Cortex Hormones↗
PubMed1999

Prenatal screening and the reduction of birth defects in populations.

OBJECTIVES: Birth defects occur in populations in 3-5% of births. This paper assesses whether population-wide screening programmes for pregnant women would be likely to result in major decreases in the prevalence of birth defects. METHOD: Relevant literature on this question is reviewed and synthesized. RESULTS: Given certain assumptions, a decrease from 3-5 to 2-4% in the prevalence of defects at birth may be possible. The resources required to put in place an appropriately delivered programme to achieve this are substantial. CONCLUSIONS: As well as the potential benefit of a decrease, there are opportunity costs, and potential serious harms. Unless undertaken in a carefully planned and monitored way, a population-based birth defects reduction programme is likely to bring harm and anxiety rather than benefit.

Journal Article↗
PubMed2004

The efficacy of single-session motivational interviewing in reducing drug consumption and perceptions of drug-related risk and harm among young people: results from a multi-site cluster randomized trial.

AIM: To test whether a single session of motivational interviewing (discussing alcohol, tobacco and illicit drug use) would lead successfully to reduction in use of these drugs or in perceptions of drug-related risk and harm among young people. DESIGN: Cluster randomized trial, allocating 200 young people in the natural groups in which they were recruited to either motivational interviewing (n=105) or non-intervention education-as-usual control condition (n=95). SETTING: Ten further education colleges across inner London. PARTICIPANTS: Two hundred young people (age range 16-20 years) currently using illegal drugs, with whom contact was established through peers trained for the project. INTERVENTION: The intervention was adapted from the literature on motivational interviewing in the form of a 1-hour single-session face-to-face interview structured by a series of topics. MEASUREMENTS: Changes in self-reported cigarette, alcohol, cannabis and other drug use and in a range of drug-specific perceptions and other indicators of risk and harm. Measurement at recruitment and follow-up interview 3 months later. FINDINGS: A good follow-up rate (89.5%; 179 of 200) was achieved. In comparison to the control group, those randomized to motivational interviewing reduced their of use of cigarettes, alcohol and cannabis, mainly through moderation of ongoing drug use rather than cessation. Effect sizes were 0.37 (0.15-0.6), 0.34 (0.09-0.59) and 0.75 (0.45-1.0) for reductions in the use of cigarettes, alcohol and cannabis, respectively. For both alcohol and cannabis, the effect was greater among heavier users of these drugs and among heavier cigarette smokers. The reduced cannabis use effect was also greater among youth usually considered vulnerable or high-risk according to other criteria. Change was also evident in various indicators of risk and harm, but not as widely as the changes in drug consumption. CONCLUSIONS: This study provides the first substantial evidence of non-treatment benefit to be derived among young people involved in illegal drug use in receipt of motivational interviewing. The targeting of multiple drug use in a generic fashion among young people has also been supported.

Adolescent↗
PubMedDate not supplied

Effect of some environmental factors on mercury(II) reduction by suspended particulate matter-associated Kluvera cryocrescens biofilms in waterbodies.

To resist the invasion of harmful external substances, microorganisms tend to attach to submerged surfaces in aquatic systems. The current study focused on the influence of environmental factors (e.g., pH value of the culture, oxidation-reduction condition, light, and cultured age of bacteria on the reduction of mercury(II) to elemental mercury (Hg0) that occurred on the surfaces of suspended particulate matter. A simulated biofilm system consisting of bacterium Kluvera cryocrescens separated from suspended particulate matter in the Yangtze River (China), its exopolysaccharide, and kaolinite (BEK) was used to study the transformation of mercury(II) in an aquatic system. The results showed that the reduction of mercury from mercury(II) to elemental mercury was favored in a neutral pH, light, and aerobic surrounding while a low pH, dark, and anaerobic condition inhibited the reaction. Moreover, the reduction capacity of both biofilms and free bacteria decreased with the increase of cultured age. Under all experimental conditions, the reduction capacity of biofilms was lower than that of the free bacteria, suggesting that biofilm, as a microecosystem, might function as a buffer to protect the effect of mercury(II) and the surrounding change on microorganisms.

Aerobiosis↗