Proportion and extent of manifestation of molar‐incisor‐hypomineralizations according to different phenotypes

Objective: This epidemiological study aimed to assess the proportion and extent of manifestation of enamel hypomineralization, including molar‐incisor‐hypomineralization (MIH), in the permanent and primary dentition. Methods: A total of 693 children enrolled in an ongoing birth cohort study (GINIplus‐10) were examined at their 10‐year follow‐up. Enamel hypomineralization was scored in the primary and permanent dentition on a tooth‐ and surface‐related level based on the criteria of the European Academy of Paediatric Dentistry (EAPD). Children were grouped according to their distribution pattern of enamel hypomineralization: children with a minimum of one hypomineralized tooth in the primary dentition (ht ≥ 1) and permanent dentition (HT ≥ 1); with a minimum of one hypomineralization on at least one first permanent molar (MIH); and with hypomineralization on at least one first permanent molar and permanent incisor (M + IH). For each group, the mean values of hypomineralized primary teeth (ht), permanent teeth (HT), and permanent surfaces (HS) were calculated. Results: The proportion of affected children was 36.5 percent (HT ≥ 1), 14.7 percent (MIH), and 9.4 percent (M + IH); 6.9 percent of the subjects had a minimum of one affected primary tooth (ht ≥ 1). The mean number of hypomineralized permanent teeth and surfaces were 2.3HT/2.9HS (HT ≥ 1), 3.4HT/4.8HS (MIH), and 4.2HT/5.9HS (M + IH). The mean number of hypomineralized primary teeth amounted to 0.1ht in the entire study population. Conclusions: Enamel hypomineralization can be detected frequently in this study sample. Children with M + IH showed the highest number of affected teeth and surfaces followed by those with MIH.     

The impact of poison control centers on poisoning-related visits to EDs--United States, 2003

Purpose

This study analyzes the association between center usage rates and the rates of nonadmitted visits to emergency departments (EDs) for poisoning.

Basic Procedures

With a log-normal regression model, we analyzed the association between the number of human exposure calls per hospitalized poisoning patient and the number of nonhospitalized ED visits. The data were from 14 states at county level.

Main Findings

A 1% higher poison control center (PCC) human exposure call rate for unintentional poisoning is associated, but not necessarily causally, with a 0.18% lower ED visit rate (P < .0001). If the observed association is causative, 15.5 PCC human poison exposure calls prevent one nonadmitted ED visit, yielding a $205 net cost saving and a benefit-cost ratio of 1.4. The savings ignore any reduction in hospital admissions.

Principal Conclusions

Increased PCC exposure calls appear to be associated with reduced ED use for unintentional poisoning and appear to reduce net medical spending.     

Early postnatal hospital discharge: the consequences of reducing length of stay for women and newborns

The objective of this study is to examine the literature and identify most salient outcomes of early postnatal discharge for women, newborns and the health system. An electronic search strategy was designed including the following sources: Web of Science, Scopus, ProQuest and PubMed/MEDLINE, using the following terms: (early AND discharge) OR (length AND stay) AND (postpartum OR postnatal) AND (effect* OR result OR outcome). Content analysis was used to identify and summarise the findings and methods of the research papers. The evidence available is not enough to either reject or support the practice of early postnatal discharge; different studies have reported different outcomes for women and newborns. The need of systematic clinical research is discussed.     

CT screening for lung cancer

The Early Lung Cancer Action Project (ELCAP) recently demonstrated that earlier diagnosis of lung cancer can be achieved with CT, and these results have led to considerable demand for CT screening. The advisability of screening seems obvious, as screening has been shown to provide for lung cancer treatment at a relatively early stage, leading to a better chance to avert death from lung cancer than when treatment is prompted by symptoms and/or signs. There are, however, countervailing ideas that CT lung cancer screening has not yet been demonstrated to 'save lives.' Further, it has been stated that CT screening has a notable problem of "overdiagnosis," meaning that screening finds lesions that are not life threatening, leading to unnecessary surgery. These concerns have led to the argument that assessing 'lives saved,' as well as the effects of overdiagnosis, can only be achieved with a randomized, controlled trial comparing CT screening with no screening, using a mortality endpoint. To this end, the National Lung Screening Trial (NLST) has been funded. This randomized, controlled trial is the most expensive screening study ever proposed. It compares CT screening with chest X-ray screening, and its designers envision that it will provide an answer about the benefit of CT screening, or lack thereof, in about 10 years. We do not question the value of the randomized design of 'treatment' trials for comparing competing interventions (treatments), but we have serious concerns about the use of randomization in the evaluation of a diagnostic test, such as CT. We feel that randomization is not necessary for evaluating a diagnostic test and may generate misleading results. Rather, we feel that the desired information is how often and how early is the disease diagnosed using that test. The purpose of this article is to raise the general level of concern about the underpinnings of such randomized 'screening' trials, and to convey some of the evidence that led to our pessimism about the NLST.