Measuring life stress: A comparison of the predictive validity of different scoring systems for the social readjustment rating scale

Previous literature in the area of life stress has suggested a number of variables that may moderate the amount of stress associated with life events. The present study attempted to determine whether accounting for these variables in the scoring of the Social Readjustment Rating Scale (SRRS), a measure of life stress, would improve the predictive validity of the inventory. Through a random canvassing of residential areas, 107 sets of questionnaires were completed, including a modified SRRS, the Symptom Checklist-90, the Life Satisfaction Index, several health measures, and a demographic data sheet. On the basis of correlational analysis it was concluded that income and level of education are significant predictors of the capacity to cope with stress. By the criteria established for selecting the most appropriate life stress scoring system, it was decided that stress is best measured by asking respondents to check those events in the past year that had been undesirable to them. Theoretical and practical implications of these findings are discussed.     

Improvement in Oral Health–related Quality of Life after Endodontic Treatment: A Prospective Longitudinal Study

Introduction

To date, evidence of the effectiveness of endodontic treatment and criteria of success have mainly been considered in terms of clinical outcome, and there is a lack of information of treatment outcomes from patients' perspectives. This study aimed to assess changes in quality of life after endodontic treatment and to determine if changes in quality of life were associated with changes in patient-perceived oral health and clinical assessments of success.

Methods

This longitudinal study involved 279 subjects. Patient-reported outcome measures based on oral health–related quality of life was assessed using the short form of the Oral Health Impact Profile (OHIP-14). The patients completed the assessments before endodontic treatment and 1 month and 6 months after root canal obturation. A global oral health transition assessment was ascertained by a single (global) item rating of oral health improvement and clinical assessment mainly based on the Periapical Index (PAI) of periapical radiographs.

Results

There were significant changes in OHIP-14 scores over the study period after conventional orthograde endodontic treatment (from pretreatment–6 months postobturation) (P < .001). The magnitude of statistical change (effect size) was moderate (0.61) in the short-term (after 1 month) and large (0.71) in the longer-term (after 6 months). Changes in the OHIP-14 was associated with changes in patient self-rating oral health status (P < .001), which was also associated with changes in PAI scores (P < .05).

Conclusions

Endodontic treatment improves quality of life. The OHIP-14 measure is both sensitive and responsive to endodontic treatment and is likely to be useful in understanding patients' perspectives of outcomes from endodontic care.     

Changes in life quality following third molar surgery--the immediate postoperative period

OBJECTIVES: This study describes patients' perceptions of changes in oral health related quality of life (OHQOL) in the early postoperative period following third molar surgery. METHODS: One hundred patients were enrolled in a prospective cohort study of the surgical removal of lower third molars under local anaesthetic. Two specific oral health related quality of life measures, OHIP-14 and OHQoLUK, were administered to the study group prior to surgery. Standardized surgical and analgesic protocols were followed. Patients kept a diary of changes in life quality each postoperative day (POD) for 7 days, completing both OHIP-14 and OHQoLUK daily. RESULTS: Both oral health related quality of life measures identified a significant deterioration in quality of life on POD1 (P<0.01) and this remained evident on POD2 (P<0.01), POD3 (P<0.01), POD4 (P<0.01) and POD5 (P<0.05). By POD6 and POD7 there was no significant difference in quality of life compared with preoperative status (P>0.05). Deterioration in life quality over the study period was associated with postoperative clinical findings (P<0.05): swelling and trismus. CONCLUSION: The study concludes that there is a significant deterioration in oral health related quality of life in the immediate postoperative period following third molar surgery; particularly during the first five days. This is associated with postoperative clinical findings. This has implication for patients deciding on third molar surgery and informed consent.     

Systematised naevus sebaceus resulting from post‐zygotic mutation in HRAS

Naevus sebaceus has recently been shown to result from post‐zygotic mutations in HRAS, KRAS or occasionally NRAS. We present details of a neonate with extensive naevus sebaceus in whom we identified a pathogenic mutation in HRAS (c.37G > C; p.Gly13Arg), but only in lesional skin DNA, consistent with a mosaic RASopathy. This case highlights the clinicopathological and molecular findings of this naevoid disorder as well as the key issues in the clinical assessment and management of such patients.     

Onset of cardiac function during early mouse embryogenesis coincides with entry of primitive erythroblasts into the embryo proper

When cardiac function and blood flow are first established are fundamental questions in mammalian embryogenesis. The earliest erythroblasts arise in yolk sac blood islands and subsequently enter the embryo proper to initiate circulation. Embryos staged 0 to 30 somites (S) were examined in utero with 40- to 50-MHz ultrasound biomicroscopy (UBM)-Doppler, to determine onset of embryonic heartbeat and blood flow and to characterize basic physiology of the very early mouse embryonic circulation. A heartbeat was first detected at 5 S, and blood vascular flow at 7 S. Heart rate, peak arterial velocity, and velocity-time integral showed progressive increases that indicated a dramatically increasing cardiac output from even the earliest stages. In situ hybridization revealed an onset of the heartbeat coincident with the appearance of yolk sac-derived erythroblasts in the embryo proper at 5 S. Early maturation of the circulation follows a tightly coordinated program.     

Human immunodeficiency virus-infected monocyte-derived macrophages express surface gp120 and fuse with CD4 lymphoid cells in vitro: a possible mechanism of T lymphocyte depletion in vivo.

Monocyte-derived macrophages (MDM) infected in vitro with a macrophage-tropic strain of human immunodeficiency virus (HIV) fused with uninfected, CD4-expressing T lymphoblastoid cells, but not with a subclone of these cells lacking surface CD4. Infected MDM also fused with uninfected autologous and heterologous MDM. Recombinant soluble CD4 protein (rsCD4) (10 micrograms/ml) and full-length recombinant glycosylated gp120 (20 micrograms/ml) each inhibited fusion by 94-99%; the inhibition was dose-dependent. The N-terminal portion of gp120 did not inhibit syncytium formation. Fusion was also inhibited by a monoclonal antibody to an epitope which binds gp120 (S3.5), but not by antibody to an epitope not involved in gp120 binding (OKT4). HIV-infected MDM specifically bound fluorescein-conjugated rsCD4, and virus could be visualized budding from the surface of these cells. HIV-infected MDM express viral gp120 on their surface and fuse with CD4-bearing cells in a fashion similar to lymphoid cells. Macrophages may contribute to CD4 lymphocyte depletion in vivo by this fusion mechanism.     

Impact of emergency medicine faculty on door to thrombolytic time

The objective of this study was to determine the impact of Emergency Medicine (EM) faculty presence on timely thrombolytic therapy for acute myocardial infarction in the Emergency Department (ED). We performed a retrospective study of data regarding acute myocardial infarction patients in the ED of a large urban teaching hospital. Data were collected from January 1, 1998 to December 31, 1999 when EM faculty were not present in the ED and from January 1, 2001 to December 31, 2002 when they were. We compared median time from patient arrival to thrombolytics, percent of patients receiving thrombolytics within 30 min of arrival, and percent of patients with indications for primary revascularization who received it before and after EM faculty presence. The results indicate that EM faculty presence resulted in a decrease in median time from arrival to thrombolytic administration of 17 min (95% CI: 9, 28). Before EM faculty presence, the median time was 44 min as compared to 24 min post-EM faculty presence. Patients received thrombolytic therapy within 30 min 25.8% of the time before EM faculty presence as compared to 65.4% with EM faculty presence; an absolute increase of 39.6% (95% CI: 23.0%, 56.3%). Primary revascularization occurred in 56.9% of eligible patients pre-EM faculty presence and 81.4% post-EM faculty presence; an increase of 24.5% (95% CI: 13.6%, 35.4%). We conclude that the introduction of Emergency Medicine faculty significantly improved the quality of care for acute myocardial infarction patients in a large urban Emergency Department.