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PubMed2004

Use of oral contraceptives, alcohol, and risk for invasive breast cancer.

The aim of our study was to examine how the use of oral contraceptives (OCs) interact with alcohol on breast cancer risk within the large prospective follow-up study, Norwegian Women and Cancer Study. Between 1991 and 1997, women aged 30 to 70 years were drawn at random from the central person register and mailed an invitation. Follow-up information was collected throughout 2001 by linkage to national registries. Only women (n = 86,948) with complete information on alcohol consumption and duration of OC use were included in the present analysis. A total of 1,130 invasive breast cancers were diagnosed during 618,638 person-years of follow-up. Consumption of > or =10.0 g/d alcohol was associated with a breast cancer relative risk (95% confidence interval) of 1.69 (1.32-2.15), consistent with a linear relationship (P for trend < 0.0001). Among alcohol consumers, an excess risk of breast cancer was observed for total duration of OC use only among women who consumed <5 g/d alcohol (P for trend = 0.0009). We observed a negative interaction between duration of OC use and alcohol consumption effects (P for interaction = 0.01). After stratification on menopausal status, the association between high alcohol intake and breast cancer was more prominent among postmenopausal women than among premenopausal women (P for heterogeneity = 0.01). No interaction between alcohol and duration of OC use were significant after stratification on menopausal status. Our findings in conjunction with biological data imply that alcohol and OCs have antagonistic effects on breast cancer risk through a common pathway. Whether the interactive effect differs according to menopausal status remains unclear and needs further investigations.

Adult↗
PubMed2005

Maxillomandibular relationship philosophies for prosthodontic treatment: a survey of dental educators.

STATEMENT OF PROBLEM: A variety of treatment philosophies persist concerning the need for coincidence of centric occlusion (CO) and maximum intercuspation (MI) in prosthodontic restoration; however, no consensus exists. PURPOSE: The purpose of this study was to determine the philosophies of dental educators throughout the United States at both the predoctoral and postdoctoral levels and to compare their attitudes toward desirable maxillomandibular relationships in defined clinical situations. MATERIAL AND METHODS: A survey was constructed with 5 clinical scenarios presented describing patients with a difference between maximum intercuspation and centric occlusion. The survey was mailed to 171 dentists involved in either predoctoral or postdoctoral dental programs in the United States; including 56 dental schools; the Army, Navy, and Air Force postdoctoral programs; 8 Department of Veterans Affairs postdoctoral programs; and 7 hospital-based programs. Descriptive statistics of the responses were provided. Chi-squared (alpha=.05) and Fisher's exact test analyses (alpha=.05) comparing predoctoral and postdoctoral program responses for each question were performed. RESULTS: Forty-three predoctoral dental school program responses were received. Forty-one postdoctoral program directors, including the dental school-based programs, 3 armed service branches, 2 Veterans Administration programs, and 1 hospital-based program responded to the survey. Fifteen respondents indicated that they represented both predoctoral and postdoctoral programs, and these data were deleted from the sample. Summarized results for each question reflect on whether the clinicians philosophically believed patients were better off with the elimination of an existing occlusal interference between MI and CO or not. There was no statistically significant difference seen between the predoctoral and postdoctoral responses. CONCLUSION: The controversy regarding the preferred mandibular position for treatment of dentulous and partially edentulous patients continues among dental educators at both the predoctoral and postdoctoral levels in the United States.

Attitude of Health Personnel↗
PubMed2004

Use of the basic periodontal examination and radiographs in the assessment of periodontal diseases in general dental practice.

OBJECTIVES: The aims of this study were to investigate (1) the use of the basic periodontal examination (BPE) by general dental practitioners (GDPs) and their selection of radiographs for the assessment of periodontal disease and (2) whether this selection concurred with existing selection (referral) criteria. METHODS: Three mailings of a self-completion questionnaire were sent to 800 GDPs working in the National Health General Dental Service in England and Wales. Dentists were presented with six clinical scenarios for which they were asked to describe their use of radiographs. RESULTS: Ninety-one percent of dentists reported that they used the BPE in new patients, with 56% using it for all patients; 84% of dentists used BPE in recall patients. BPE use was related to the dentists' age and postgraduate qualifications. There was a wide variation in the radiographic views used for periodontal disease assessment. The choice of radiographs was not generally in line with the Faculty of General Dental Practitioners (UK) 1998 selection criteria, particularly for the clinical scenarios of pocketing >5 mm, irregular pocketing or pockets associated with teeth with heavy restorations. Sixty seven percent of dentists concurred with recommendations for radiographs for a suspected periodontal-endodontic lesion. CONCLUSIONS: A majority of dentists reported clinical screening for periodontal diseases using the BPE. There was considerable variation in the selection and use of radiographs and practice was not in line with existing guidelines for many clinical situations. Evidence-based referral criteria should be actively promoted to ensure high standards of radiographic practice in general dental practice.

Adult↗
PubMed2000

Australian dentists' views on toothbrush wear and renewal.

The purpose of this study was to survey the views of Australian dentists on toothbrush wear, toothbrush renewal periods and recommendations to patients and to investigate the relationship between dentists' views on patients' toothbrush renewal intervals and dentists' own renewal habits. Questionnaires were mailed to 5,596 Australian general dental practitioners and replies received from 3,406 (61 per cent response rate). The majority of respondents (85.7 per cent) felt patients should renew their toothbrushes more often. However, only 45.3 per cent usually made a recommendation to their patients as to when they should renew their toothbrush and only 41.7 per cent thought patients actually followed such recommendations. Most respondents (56.6 per cent) thought the average adult patient should renew a toothbrush every two-three months. A renewal period of one month or earlier was recommended by 23.8 per cent of dentists; four-five months by 8 per cent; and six months or longer by 11.5 per cent. A highly significant correlation was found between the renewal periods recommended for patients and the intervals selected by the dentists for their personal brushes (p < 0.001; chi-square test). Bending and splaying of bristles was the sign identified by the majority of dentists (70 per cent) as indicating the need for a new brush. The findings suggest dentists' recommendations concerning toothbrush renewal intervals may be based on their own toothbrush renewal habits. It is also concluded that dentists think patients comply poorly with their recommendations on toothbrush renewal.

Adult↗
PubMed2006

An evaluation of the American College of Surgeons' ultrasound education program.

BACKGROUND: Ultrasound has a wide variety of applications in surgery, but until recently few surgeons received any formal training in its use. To facilitate incorporation of ultrasound into surgical practice, the American College of Surgeons (ACoS) developed an ultrasound educational program. The purpose of this study was to evaluate the impact and effectiveness of the ACoS ultrasound education program. METHODS: A survey was mailed to all surgeons who had completed at least one of several ultrasound courses offered by the ACoS from 1998 to 2002. RESULTS: A total of 1,791 surveys were mailed out and 873 completed surveys were returned. Sixty-five percent (576) of respondents reported using ultrasound in their practices after these educational courses. Of those performing ultrasound examinations, 267 did so in one clinical area and 309 in more than one. The most common examination was breast (369 surgeons); vascular, acute/trauma, abdominal, intraoperative/laparoscopic, and head/neck were utilized fairly equally (100-200 surgeons). The number of examinations performed by surgeons before they felt competent was between 11 and 20 and did not vary by the type of ultrasound examination. Of the 267 surgeons performing ultrasound in one clinical area, 176 performed ultrasound-guided procedures. Most surgeons had access to 2 ultrasound machines, but 386 (67%) were restricted from performing ultrasound in certain locations. CONCLUSIONS: The ACoS ultrasound courses are extremely popular and have contributed to the increasing use of ultrasound in surgical practice. Surgeons successfully use ultrasound in their practices including performance of ultrasound-guided procedures but are restricted from using ultrasound in certain patient care areas. Since many surgeons received prior and/or additional training outside of the ACoS, there is a need to facilitate export of ACoS courses to other venues and to focus on incorporating ultrasound training into surgical residency programs.

Chi-Square Distribution↗
PubMed2001

Changes in attitudes and practices of optometrists in their management of diabetic retinopathy after the release of NHMRC guidelines. National Health and Medical Research Council.

The purpose of this study was to document attitudes and practices of Australian optometrists in their management of diabetic retinopathy prior to the release of the National Health and Medical Research Council (NHMRC) Clinical Practice Guidelines for the Management of Diabetic Retinopathy and at two time points following their release. A self-administered questionnaire was mailed to a stratified random sample of 500 Australian optometrists at the three time points. The same sample was used for the first two surveys and a new random sample was drawn for the second follow-up survey. The response to the three questionnaires was 86%, 80% and 84%, respectively. More than 90% of optometrists reported receiving a copy of the guidelines and 82% reported receiving the supplementary Retinopathy Chart. Fifty-seven per cent reported having read the guidelines at least once in entirety and 65% reported that they refer to the Retinopathy Chart at least monthly in their clinical practice. There was a significant decrease in the number of optometrists who reported that patient unwillingness to be dilated and their fear of precipitating angle closure glaucoma were moderate or major barriers to performing dilated ophthalmoscopy. Concomitantly, the percentage of optometrists who reported that they often or always perform dilated ophthalmoscopy on new patients with diabetes increased significantly from 74.5% (95% confidence limit = 70.2, 78.8) to 81.5% (95% confidence limit = 77.5, 85.5). There have been some significant changes in the self-reported management practices of optometrists in relation to diabetic retinopathy since the release of the NHMRC guidelines and Retinopathy Chart.

Attitude to Health↗
PubMed2004

Clinical practice characteristics and preconception counseling strategies of health care providers who recommend alcohol abstinence during pregnancy.

OBJECTIVE: National initiatives on fetal alcohol syndrome in Canada and the United States aimed at prevention, identification, and treatment of individuals who are affected by alcohol exposure in utero recommend that women abstain from consuming alcohol during pregnancy. Health care providers are key educators regarding appropriate alcohol use. The objective of this study was to describe characteristics of physicians who recommend alcohol abstinence during pregnancy with regard to knowledge of fetal alcohol syndrome and preconception counseling strategies. METHODS: A survey was mailed to Canadian physicians and midwives between 2001 and 2002. Participants consisted of a national random sample of 1090 Canadian obstetricians and gynecologists, midwives, and family physicians who were current members of provincial and national professional organizations. The main outcome measure was questionnaire responses to knowledge, prevention, and diagnosis of issues related to alcohol use during pregnancy. RESULTS: Response rates ranged from 31.1% among family physicians to 63.5% among midwives. Overall, 91.2% of providers recommended abstinence from alcohol during pregnancy. These providers were significantly more likely to believe that there is sufficient information about alcohol use and that clients were interested in discussing alcohol (p < 0.05). They were also significantly more likely to discuss depression, personal alcohol use, partner's use of alcohol, and family history of alcohol misuse with women of childbearing age (p < 0.05). Once a patient became pregnant, fewer practice differences were noted, although those who recommended alcohol abstinence were significantly more likely to take clinical action when pregnant patients were consuming moderate amounts of alcohol (p < 0.05). CONCLUSIONS: It is encouraging that almost 90% of Canadian health care providers recommend abstinence from alcohol during pregnancy. However, differences in clinical practice exist between providers who recommend alcohol abstinence during pregnancy as compared with those who recommend a "glass in moderation."

Alcohol Drinking↗
PubMed2005

Sexual experience of female partners of men with erectile dysfunction: the female experience of men's attitudes to life events and sexuality (FEMALES) study.

INTRODUCTION: Much research has explored the experience of erectile dysfunction (ED) among men with ED, but far less attention has been paid to the perceptions and sexual experiences of the female partners of men with ED. AIM: The objective of this study was to characterize the attitudes, beliefs, and sexual experience of female partners of men with erectile difficulties. METHODS: Female partners of men with ED who had participated in the Men's Attitudes to Life Events and Sexuality (MALES) study were recruited for this research via mail or Internet, after their male partners consented to this contact. Female partners of men with ED (N = 293) responded to questionnaire measures assessing their frequency of sexual activity and the nature of their sexual experience, both before and after the development of their partner's ED, and in relation to their partner's use of phosphodiesterase type 5 (PDE5) inhibitors. RESULTS: Women reported engaging in sexual activity significantly less frequently after their partner developed ED in comparison with before (P < 0.001). Moreover, significantly fewer women experienced sexual desire, arousal, or orgasm "almost always" or "most times," and significantly fewer women reported satisfaction with their sexual relationship after their partner developed ED, compared with before (P < 0.001). Decreases in female sexual satisfaction and frequency of orgasm were significantly related to the male partner's self-reported severity of ED (P < 0.01). The proportion of women who experienced sexual desire, arousal, and orgasm "almost always" or "most times" was significantly higher in the group whose partners were currently using a PDE5 inhibitor (P < 0.05). CONCLUSION: Erectile dysfunction has significant adverse effects on the female partner's sexual experience. Women with partners who were currently using PDE5 inhibitors had a more satisfying sexual experience than those whose partners did not use a PDE5 inhibitor.

Adult↗
PubMed2000

Four-year longitudinal course of TMD symptoms in an adult population and the estimation of risk factors in relation to symptoms.

AIMS: To investigate the natural course of symptoms of temporomandibular disorders (TMD) in a non-patient population and to estimate the strength of the relationship between several hypothesized risk factors and precipitation and perpetuation of the symptoms. METHODS: A total of 672 randomly selected citizens of Okayama City was requested to answer the same self-administered questionnaire that they had answered 4 years earlier. The mailed questionnaire failed to reach 58 subjects at the second survey, and 367 of the remaining subjects (59.8%) responded. The fluctuation of TMD symptoms was assessed by comparison of 6 pairs of answers for questions regarding temporomandibular joint (TMJ) pain, limitation of mouth opening, TMJ noise, headache, neck pain, and shoulder stiffness. Six factors (age under 40, female, clenching habit, history of extrinsic trauma, sleep disturbance, and family history of TMD) were tested for their relative risk in precipitating and perpetuating each TMD symptom by the use of its confidence interval to define significance. RESULTS: The incidence of TMD symptoms ranged from 6.1% (TMJ pain) to 12.9% (TMJ noise). More than half of the subjects who had reported TMJ and neck pain at the initial survey no longer reported these symptoms at the second survey, whereas TMJ noise and shoulder stiffness remained in more than 70% of the subjects. Individuals under 40 years old had a 3.3:1 increased risk of precipitating TMJ noise (P < 0.01), individuals with a history of extrinsic trauma had a 2.85:1 increased risk of precipitating limited mouth opening (P < 0.01), and females had a 2.81:1 increased risk of perpetuating TMJ pain (P < 0.01). CONCLUSION: The possible etiologic significance of these factors in TMD should be validated by future research.

Age Distribution↗
PubMed1993

Nordic dentists' opinions on the safety of amalgam and other dental restorative materials.

The safety of amalgam and other restorative materials has caused concern among dental patients in recent years. The aim of this study was to obtain information on dentists' perceived competence in handling different filling materials and their opinions on the safety of these. A random sample of practising dentists in Denmark, Finland, Norway, and Sweden received a mail questionnaire in spring 1990. Answers were received from 1732 dentists (65%). The study showed that the respondents believed that their theoretic knowledge and clinical skills were generally at a high level regarding restorative materials. The risks of the side-effects of gold, ceramic materials, and glass ionomer were considered to be low by about 90% of the respondents. Amalgam was considered to be significantly more hazardous by the Swedish respondents than the others. Interestingly, composite was considered to be associated with a high risk of side-effects by about half of the dentists in all Nordic countries. The dentists' opinions were not found to be greatly influenced by their sex, age, or place of residence but rather by their country and service sector. Against the background of the present lack of scientific evidence on the hazardousness of amalgam or other restorative materials for patients' general health, these findings indicate that dentists are influenced by discussions in the mass media about dental treatment and materials and, of course, by the guidelines given by the health authorities in their own countries. Few dentists were shown to be concerned about occupational risks associated with the use of amalgam, and they had not had their own amalgam fillings replaced.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude of Health Personnel↗
PubMed1999

Hepatitis B prevalence and infection control among dental health care workers in a community in South Korea.

OBJECTIVES: The objectives of this study were to investigate the prevalence of hepatitis B vaccine and use of infection control procedures by dental health care workers in Taegu, South Korea. METHODS: Information was obtained with a mailed questionnaire sent to 300 private dental practices. Surveys were received from 177 dentists, 104 dental hygienists, and 46 dental assistants. All dental health care workers were asked to donate a blood sample for analysis of hepatitis B surface antigen (HBsAg) and antibody (anti-HBs). RESULTS: Vaccination against hepatitis B virus was reported by 63 percent of the respondents. About 40 percent of all participants answered that they were anti-HBs positive, while another 43 percent did not know their status. About 89 percent of dentists reported that they wore a mask with all patients, while hygienists (13.6%) and assistants (13.0%) were less likely to do so. Reported use of gloves (4.5%) and protective eyewear (14%) with all patients was extremely low in every group. Among the 56 dentists who were tested for HBV markers, 23 did not receive the vaccine against hepatitis B, and 13 percent (3 of 23) were positive for HBsAg as carriers. CONCLUSIONS: About 37 percent (120 of 327) of dental health care workers surveyed in this study in Korea did not receive the vaccine against HBV infection. Basic barrier techniques to prevent cross-contamination were not being used consistently. Nationwide guidelines for barrier techniques and hepatitis vaccinations should be developed and disseminated to dental personnel.

Chi-Square Distribution↗
PubMedDate not supplied

Beliefs about breast cancer risk and use of postmenopausal hormone replacement therapy.

BACKGROUND: Postmenopausal hormone replacement therapy (HRT) decreases the risks of coronary heart disease and osteoporosis, but increases the risk of breast cancer. Although only 20-30% of postmenopausal women in the United States take HRT, the relationship between breast cancer risk perception and use of HRT is not known. OBJECTIVE: To assess the impact of belief that HRT increases breast cancer risk and high perceived risk of breast cancer on the use of HRT. DESIGN: Cross-sectional mailed survey. PARTICIPANTS: 189 randomly selected postmenopausal women from a general internal medicine practice in the Philadelphia area. MAIN RESULTS: Of the 268 women (67%) who returned surveys, 189 were postmenopausal; 70 (37%) were currently using HRT and 21 (11 %) had previously used HRT. Respondents' mean age was 59.6 years; 64% were Caucasian, and 33% had completed college. Fifty-nine women (33%) thought HRT increased the risk of breast cancer, 22 (12%) thought it did not, and 100 (55%) were unsure. Mean perceived lifetime risk of breast cancer was 31% (range 0%-100%). After multivariate adjustment, current use of HRT was inversely associated with age (OR 0.96 for each one-year increase, 95% CI 0.940.98), and positively associated with Caucasian race (OR 2.73, 95% CI 1.40-5.32). Use of HRT was not associated with belief that HRT increases the risk of breast cancer, breast cancer risk perception, or perceived severity of breast cancer. CONCLUSIONS: Belief that HRT increases the risk of breast cancer and high perceptions of breast cancer risk may not be important barriers to use of HRT. Efforts to improve decision making about HRT should focus on previously established barriers, such as perceptions of menopause and lack of physician discussion, rather than misconceptions about breast cancer risk.

Attitude to Health↗
PubMed2005

Food offerings in Marshfield area businesses: a survey conducted in collaboration with the healthy lifestyles--Marshfield Area Coalition.

PURPOSE: To survey Marshfield area businesses to determine the types of foods currently available to employees at the workplace and the potential need for nutrition information to facilitate the ordering of healthy food options at workplaces. METHODS: A 2-page self-administered questionnaire was mailed to all businesses registered with the Marshfield Area of Chamber of Commerce. Questionnaires were mailed a second time to non-responders to improve the response rate. The questionnaire included items about foods available to employees at the workplace, cooking and eating facilities available to employees, and reasons for food choices made. Data were entered into an Excel spreadsheet, verified against the hard copies and transferred to SPSS for analysis. RESULTS: Completed questionnaires were returned by 249 businesses (41.1% participation). The reported number of minutes that most employees take for their lunch ranged from 0 to 60 (median = 30). Eighty-one percent of businesses (n = 184) reported that most employees take 30 or more minutes for their lunch. Respondents were asked to list the most common menu items purchased for consumption on-site. One hundred fifteen respondents listed sandwiches (46.2%), 101 listed pizza (40.6%), 30 listed salad (12.0%), and 17 listed various sweets (6.8%). Employees were thought to be less likely than managers to select foods lower in calories if the foods are more expensive. DISCUSSION: There is great potential to improve the health of employees through the provision of nutrition information to businesses. The survey employed in the current study can be used again in the future to track changes after implementation of worksite initiatives through the Business and Industry Committee of the Healthy Lifestyles--Marshfield Area Coalition.

Chi-Square Distribution↗
PubMed2006

Suicidal ideation in multiple sclerosis.

OBJECTIVE: To examine risk factors for suicidal ideation among people with multiple sclerosis (MS). DESIGN: Cohort study linking computerized medical records with a mailed self-report survey. SETTING: Veteran's Health Administration (VHA) region covering the northwestern United States. PARTICIPANTS: VHA patients with MS (N=445) who returned mailed surveys. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Suicidal ideation is assessed by the Patient Health Questionnaire (PHQ) suicide item with suicidal ideation more than half the days considered persistent. RESULTS: One hundred thirty-one (29.4%) of 445 respondents (95% confidence interval [CI], 25.4%-33.9%) endorsed suicidal ideation, and 35 (7.9%; 95% CI, 5.7%-10.8%) endorsed persistent suicidal ideation over the last 2 weeks. In bivariate analyses, suicidal ideation was associated with younger age, earlier disease course, progressive disease subtype, lower income, not being married, lower social support, not driving, higher levels of physical disability (mobility, bowel, bladder), and depression. Analyses on persistent suicidal ideation yielded similar results. In fully adjusted multivariate logistic regression, only depression severity and bowel disability were independently associated with suicidal ideation. Only depression severity was independently associated with persistent suicidal ideation. By using the 2-question depression screen (U.S. Preventive Services Task Force) consisting of the depression and anhedonia items from the PHQ-9, sensitivity and specificity were marginal for suicidal ideation (65.6% and 79.9%) but acceptable for persistent suicidal ideation (88.6% and 71.2%). CONCLUSIONS: Suicidal ideation is common among VHA patients with MS, and depression severity is the best risk marker. Brief screening for depression in MS should include the assessment of suicidal ideation.

Chi-Square Distribution↗
PubMed2003

Association of boiled and filtered coffee with incidence of first nonfatal myocardial infarction: the SHEEP and the VHEEP study.

OBJECTIVES: To evaluate the influence of consumption of filtered and boiled coffee, on the incidence of first nonfatal myocardial infarction. DESIGN: Population-based case-control study. SETTING AND SUBJECTS: The study base consisted of the population 45-65/70 years-old in two Swedish counties, Stockholm and Västernorrland, 1992/93-94. In all, 1943 cases of first nonfatal myocardial infarction were identified. For each case one control was selected from the study base concurrently with disease incidence by matching the sex, age and place of residence of the case. Information about coffee consumption and other factors was obtained by mailed questionnaire and a medical examination. The participation rate was 85% amongst cases and 74% amongst controls. RESULTS: Men with a reported consumption of 7-9 dL filtered coffee per day showed an increased incidence of first myocardial infarction compared with consumers of 3 dL day-1 or less (RR: 1.32; 95% CI: 1.03-1.70). A consumption of at least 10 dL day-1 was associated with an RR of 1.93 (95% CI: 1.42-2.63) for filtered and 2.20 (95% CI: 1.17-4.15) for boiled coffee. Amongst women, no clear association was seen between consumption of filtered coffee and myocardial infarction but consumption of boiled coffee tended to be related to an increased incidence. Comparing subjects drinking boiled coffee with those drinking filtered coffee and adjusting for the amount consumed gave an increased incidence for boiled coffee amongst both men (RR: 1.41; 95% CI: 1.07-1.80) and women (RR: 1.63; 95% CI: 1.04-2.56). CONCLUSIONS: Consumption of boiled coffee appears to increase the incidence of first nonfatal myocardial infarction. This increased incidence is consistent with randomized trials showing an adverse impact of boiled coffee on blood lipids.

Aged↗
PubMed2005

Long-term outcomes after gastric bypass.

BACKGROUND: While a great deal has been published regarding the short- and medium-term outcomes of gastric bypass surgery, much less information is available regarding long-term follow-up. Such information would be valuable in changing attitudes towards this surgery. METHODS: 342 severely obese patients underwent gastric bypass between June 1990 and April 2003 by a single surgeon. Careful preoperative documentation and follow-up have been maintained on a computerized database. Where necessary, recent followup information has been gained by mailed questionnaire and blood tests. RESULTS: Follow-up data from within the last 12 months is available for 88% of patients. Follow-up time ranges from 0-14 years, with a median of 48.6 months. Of those lost to follow-up, only 24 (7%) have <12 months follow-up. The series includes 261 females and 81 males. Preoperative BMI ranged from 28-99 (median 44). Before surgery, hypertension was present in 138, type 2 diabetes in 62, and dyslipidemia in 265. There was no 30-day peri-operative mortality. Three life-threatening complications occurred. BMI and % excess weight loss after 1, 2, 5 and 10 years were 28.7 and 89%, 28.3 and 87%, 31.2 and 70% and 31 and 75%, respectively. At most recent follow-up, 62% of those with hypertension before surgery were cured and 25% had improved. 85% of those with type 2 diabetes were cured and 10% had improved. No patients with impaired glucose tolerance had progressed to diabetes. 34% of those with dyslipidemia were cured and 38% had improved. CONCLUSION: The excellent outcomes, in terms of weight loss and improvement in co-morbidities, seen in both the short- and medium-term after gastric bypass, are well maintained into the longer-term.

Adaptation, Physiological↗
PubMed2000

Variations in self-reported health status: results from a New Zealand survey.

AIMS: To report measures of the self-reported health of a sample of the New Zealand adult population elicited using the EuroQol Group's EQ-5D questionnaire, and to investigate variations in these measures, according to respondents' socio-demographic characteristics. METHODS: Personal health status questions were included in a self-completed postal questionnaire mailed to a non-stratified sample of 3000 New Zealanders, selected at random from the electoral roll. 1350 questionnaires were completed and returned. Each respondent rated their health on the five EQ-5D dimensions- mobility, self care, usual activities, pain/discomfort and anxiety/depression- and assigned a global score to their profile. RESULTS: Pain/discomfort was the most commonly experienced health problem, with 41% of all respondents and 63% of over-70 year olds reporting moderate or extreme problems. Just 4.5% of respondents reported problems with self-care. Respondents were more likely to report problems on each of the five dimensions and to have a lower global score if they smoked, if they were unemployed, a houseworker or retiree, and if their education did not continue past the minimum school leaving-age, or they did not have a degree or equivalent qualification. Problems on all dimensions were more common the older the respondent, and the global score was lower for over-70 year olds than for younger people. Neither the global score nor the incidence of problems on any of the dimensions was related to sex or ethnicity. CONCLUSIONS: The EQ-5D is a potentially useful instrument for monitoring health in the New Zealand context. Further research to explore its validity and reliability, particularly for Maori, would be valuable.

Adult↗
PubMed2001

Effect of orthognathic surgery on the temporomandibular joint in patients with anterior open bite.

This study examined the prevalence of temporomandibular joint (TMJ) signs and symptoms in patients with anterior open bite. The influence of orthognathic surgery on the TMJ in these patients and the interaction of occlusal and psychologic variables on the presence and/or persistence of pain was studied. A retrospective survey of 83 patients with an anterior open bite who underwent orthognathic surgery was carried out. Records were examined for the prevalence of abnormal TMJ signs and symptoms, including pain. A survey was mailed to these patients that consisted of: (1) the TMJ Scale, (2) the Symptom Checklist 90 (SCL90), (3) the Spielberger State-Trait Anxiety Inventory (STAI), and (4) a visual analog scale on which patients indicated their degree of satisfaction with the procedure. Thirty-seven (42%) patients responded to the survey, and 13 (15%) also attended a clinical and radiographic examination. Multiple regression analysis was used for statistical analysis of the factors contributing to the presence and/or persistence of pain. In the preoperative group, the prevalence of pain was 32%, dysfunction 40%, and limitation of opening 7%. Age and gender were significantly associated with the presence of pain. The overall prevalence of abnormal TMJ signs and symptoms was not significantly different after orthognathic surgery. An abnormal psychologic profile was the most significant factor associated with the presence and/or persistence of pain. It is concluded that that the prevalence of temporomandibular disorders in anterior open bite patients increases with age, is significantly higher in females, and is not influenced by other occlusal variables. Furthermore, orthognathic surgery does not significantly influence temporomandibular disorders in patients with anterior open bite. Female patients, particularly those with an abnormal psychologic profile, are at a higher risk of persistent postoperative TMJ pain.

Adolescent↗