SEM analysis of sealant penetration in posterior approximal enamel carious lesions in vivo

PURPOSE: To study the microstructure of sealant penetration in the enamel of in vivo sealed approximal noncavitated incipient caries lesions with and without a preceding bonding step. MATERIALS AND METHODS: A total of 26 proximal noncavitated caries lesions were sealed in vivo, using a sealant in 13 premolars with orthodontic indication of extraction. Each tooth was randomly assigned to mesial or distal surface application of a sealant in the lesion area and in surrounding sound enamel, with or without a bonding system. Four groups were analyzed: a nonbonding group in the lesion area (NBL); a nonbonding group in sound enamel (NBS); a bonding group in the lesion area (BL) and a bonding group in sound enamel (BS). The premolars were extracted after two weeks. All sealed areas were cut and demineralized with 37% hydrochloric acid for 24 h. For each group, the resin tags were observed and measured by scanning electron microscopy. RESULTS: The lesion areas showed a very irregular resin network with twisted and curved tags in contrast to the sound enamel where a regular etching pattern was observed. The length of resin tags in microns for each group (mean +/-SD) was: NBG-L = 4.19 +/- 1.59; NBG-S = 5.49 +/- 2.49; BG-L = 4.57 +/- 1.99; and BG-S = 4.21 +/- 1.87. The differences between the groups were not statistically significant (p = 0.34). Conclusion: The use of a bonding system prior to the application of a pit and fissure sealant on both lesion and sound enamel areas does not increase the resin penetration length under non-contaminated conditions.     

Low IGFBP-1 is a marker of impaired skin vascular response to both endothelial and non-endothelial stimulation in healthy males

Vascular endothelial dysfunction is an early event in the development of atherosclerosis and is also linked to insulin resistance and type 2 diabetes mellitus. Serum IGFBP-1 and IGF can be used as markers of insulin sensitivity and secretion. The aim was to investigate if microvascular reactivity in healthy males with and without heredity of type 2 diabetes mellitus is related to serum levels of IGF-1 and its binding protein IGFBP-1.Thirty-six middle-aged male subjects free of medication, non-smokers and with normal oral glucose tolerance test were investigated. Nineteen of the subjects had known heredity for type 2 diabetes. The groups were matched for age and body mass index. Skin microcirculation was studied with laser Doppler perfusion imaging before and after iontophoretic application of endothelial (acetylcholine (Ach)) and non-endothelial dependent (sodium nitroprusside (SNP)) substances. The microvascular responses to iontophoretic application of Ach and SNP, respectively, were weaker (p = 0.01 and p = 0.02, respectively) in subjects with diabetes heredity than in those without. In subjects without heredity a significant correlation was observed between the peak microvascular responses to Ach (r = 0.57; p < 0.02), SNP (r = 0.51; p < 0.05), and levels of IGFBP-1, while no significant correlation was found in subjects with diabetes heredity. In summary our study shows that healthy male subjects with no heredity for type 2 diabetes have low fasting IGFBP-1 which were associated with impaired microvascular responses to both endothelial and non-endothelial stimulation.     

Socio-economic status and lung cancer risk including histologic subtyping--a longitudinal study

We investigated prospectively the risk of lung cancer in relation to socio-economic status (SES) in 22,387 middle-aged individuals who attended a screening program in the city of Malm?, Sweden between 1974 and 1992. We also examined the relationship between SES and histologic subtype in smokers. By 2003, a total of 550 lung cancer cases had been identified. Relative risks (RR) were calculated with adjustment for age, current smoking, inhalation habits and marital status at baseline in the low SES group compared to high SES group. Among smokers, the RR (95% confidence interval (CI)) for lung cancer in the low SES group of men was 1.39 (1.11-1.73), and women 1.56 (1.04-2.34). Also among smokers, low SES was associated with an increased risk of squamous cell carcinoma in men; RR 1.89 (1.16-2.81) and women; RR 7.10 (1.63-30.86), and with an increased risk of mesothelioma in men RR 9.97 (1.29-76.96). We conclude that low SES groups run an increased risk of lung cancer despite accounting for smoking habits. Furthermore, low SES was positively associated with squamous cell carcinoma and mesothelioma. Our results suggest that the association between low SES and lung cancer could be mediated by unaccounted for smoking exposure, lifestyle or occupational hazards.     

Patient understanding, detection, and experience of COPD exacerbations: an observational, interview-based study

STUDY OBJECTIVES: This study was conducted to gain insight into patients' comprehension, recognition, and experience of exacerbations of COPD, and to explore the patient burden associated with these events. DESIGN: A qualitative, multinational, cross-sectional, interview-based study. SETTING: Patients' homes. PATIENTS: Patients (n = 125) with predominantly moderate-to-very severe COPD (age > or = 50 years; with two or more exacerbations during the previous year). INTERVENTIONS: Patients underwent a 1-h face-to-face interview with a trained interviewer. MEASUREMENTS AND RESULTS: During the preceding year, patients experienced a mean +/- SD of 4.6 +/- 5.4 exacerbations, after which 19.2% (n = 24) believed they had not fully recovered. Although commonly used by physicians, only 1.6% (n = 2) of patients understood the term exacerbation, preferring to use simpler terms, such as chest infection (16.0%; n = 20) or crisis (16.0%; n = 20) instead. Approximately two thirds of patients stated that they were aware of when an exacerbation was imminent and, in most cases, patients recounted that symptoms were consistent from one exacerbation to another. Some patients (32.8%; n = 41), however, reported no recognizable warning signs. At the onset of an exacerbation, 32.8% of patients (n = 41) stated that they reacted by self-administering their medication. Some patients spontaneously mentioned a fear of dying (12.0%; n = 15) or suffocating (9.6%; n = 12) during exacerbations, and effects on activities, mood, and personal/family relationships were frequently reported. Physicians tended to underestimate the psychological impact of exacerbations compared with patient reports. CONCLUSIONS: This study shows that patients with frequent exacerbations have a poor understanding of the term exacerbation. Patient recollections suggest that exacerbation profiles vary enormously between patients but that symptoms/warning signs are fairly consistent within individuals, and are generally recognizable. Exacerbations appear to have a significant impact on patient well-being, including psychological well-being, and this may be underestimated by physicians.     

Increased Risk of Both Ulcerative Colitis and Crohn’s Disease in a Population Suffering from COPD

Chronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation of the airways. In the majority of cases, the inflammation is triggered by tobacco smoke. Smoking also affects the pathogenesis of inflammatory bowel disease (IBD), protecting against ulcerative colitis (UC) and promoting development of Crohn's disease (CD). The present study was undertaken to investigate occurrence of IBD among COPD patients, indicating common inflammatory pathways and shared vulnerability on a genetic basis. The study was designed as a population-based cohort study. All individuals discharged with a diagnosis of COPD from 1987 to 2002 were identified in the Swedish Inpatient Register (n=180,239). Controls and first-degree relatives of both cases and controls were identified using the Multi-Generation Register. Finally, all individuals (n=1,174,557) were compared with the Inpatient Register, identifying discharges with a diagnosis of UC or CD. Hazard ratios (HR) for IBD were determined by Cox proportional hazards regression analysis. COPD patients had a significantly higher risk of both UC (HR 1.83; 95% CI 1.61-2.09) and CD (HR 2.72; 95% CI 2.33-3.18). Among first-degree relatives of COPD patients, there was also an overall increased risk of CD (HR 1.25; 95% CI 1.09-1.43) but not of UC (HR 1.09; 95% CI 0.96-1.23). The kinship of first-degree relatives displayed an increased risk of both UC and CD among siblings (HR 1.49; 95% CI 1.15-1.91 and HR 1.46; 95% CI 1.12-1.89, respectively). The results suggest that COPD and IBD may have inflammatory pathways in common, including genetic variants of genes predisposing for disease.     

Aircraft noise and incidence of hypertension

BACKGROUND: An association between aircraft noise exposure and hypertension prevalence has been suggested but there are no longitudinal studies of this association. Our aim was to investigate the influence of aircraft noise on the incidence of hypertension. METHODS: A cohort of 2754 men in 4 municipalities around Stockholm Arlanda airport was followed between 1992-1994 and 2002-2004. The cohort was based on the Stockholm Diabetes Preventive Program; half of the study subjects had a family history of diabetes. Residential aircraft noise exposure (expressed as time-weighted equal energy and maximal noise levels) was assessed by geographical information systems techniques among those living near the airport. Incident cases of hypertension were identified by physical examinations, including blood pressure measurements, and questionnaires in which subjects reported treatment or diagnosis of hypertension and information on cardiovascular risk factors. Analyses were restricted to 2027 subjects who completed the follow-up examination, were not treated for hypertension, and had a blood pressure below 140/90 mm Hg at enrollment. RESULTS: For subjects exposed to energy-averaged levels above 50 dB(A) the adjusted relative risk for hypertension was 1.19 (95% CI = 1.03-1.37). Maximum aircraft noise levels presented similar results, with a relative risk of 1.20 (1.03-1.40) for those exposed above 70 dB(A). Stronger associations were suggested among older subjects, those with a normal glucose tolerance, nonsmokers, and subjects not annoyed by noise from other sources. CONCLUSION: These findings suggest that long-term aircraft noise exposure may increase the risk for hypertension.     

Local media monitoring in process evaluation. Experiences from the Stockholm Diabetes Prevention Programme

We present a rationale and approach for longitudinal analyses of media coverage and content, and illustrate how media monitoring can be used in process evaluations. Within a community-based diabetes prevention project, the Stockholm Diabetes Prevention Program, we analyzed the frequency, prominence, and framing of physical activity in local newspapers of three intervention and two control municipalities. In total, 2,128 stories and advertisements related to physical activity were identified between the years 1997 and 2002. Although stories about physical activity were relatively few (n = 224), they were prominently located in all five local newspapers. Physical activity was framed rather similarly in the municipalities. Health aspects, however, were expressed to a greater extent in stories in two of the intervention municipalities. A limited portion (14%) of the articles could be linked directly to the program. It is not possible to assess to what extent the program has had a disseminating effect on the newspapers' health-related content in general, due to weaknesses of the process tracking system and limitations of the study design. Implications for the design is that an evaluative framework should be preplanned and include data collection about media relationships, media's interest in public health, media coverage prior to the program and coverage in other media for comparisons of general trends in the reporting. The material and the current database, however, provide a good basis for quantitative content analysis and qualitative discourse analysis to yield information on the type, frequency, and content of health reporting in local newspapers.     

Formoterol used as needed improves health-related quality of life in asthmatic patients uncontrolled with inhaled corticosteroids

Clinical benefits have been shown to occur when using the long-acting beta2-agonist formoterol 4.5 microg for as-needed medication rather than terbutaline 500 microg in patients with unstable asthma taking an inhaled corticosteroid. This study compared their effects on health-related quality of life and the relation with conventional clinical indices in the same population. 362 asthmatics were randomized to use either formoterol 4.5 microg or terbutaline 500 microg as needed, both inhaled via Turbuhaler. The Asthma Quality of Life Questionnaire (AQLQ) was practised at enrolment and completed by 341 patients after randomization and at 4, 8, and 12 weeks. Clinical indices were measured at the same time points. Mean overall AQLQ scores were comparable at baseline, being 4.90 in the formoterol and 4.82 in the terbutaline group and improved during treatment by 0.41 and 0.17 units, respectively (mean difference 0.24, 95% CI 0.08, 0.39, P<0.005). Mean improvement in the symptom domain was 0.49 units when using formoterol. Correlations between changes in clinical indices and changes in AQLQ scores during the 12-week period were weak (maximum r value=0.37). When used for as-needed medication, formoterol 4.5 microg provided an improvement in asthma-specific quality of life and to a somewhat greater extent than the widely used terbutaline 500 microg. The symptom domain in AQLQ showed almost 0.5 units improvement after formoterol, a change that is considered to be clinically relevant.     

A 2-year clinical evaluation of sealed noncavitated approximal posterior carious lesions in adolescents

The objective was to evaluate the clinical performance of a therapeutic sealant to arrest the progression of noncavitated approximal posterior carious lesions. The study population comprised 50 adolescents in whom bitewing radiographs had been taken for diagnosis of caries. Approximal noncavitated lesions in premolars and molars (4d–7m) were selected. One group (n=17) had a sealant placed after tooth separation on all enamel lesions. A second group (n=7) received sealant and fluoride varnish in a split-mouth design. A control group (n=26) received a standard fluoride varnish treatment without tooth separation. Follow-up radiographs were taken after 2 years and were analyzed together with the baseline radiographs in a blind study setting. About 93% of the sealed initial carious lesions showed no progression. The corresponding value for the fluoride varnish control group was 88%. In the split-mouth study, 92 and 88% of the surfaces with enamel caries showed no progression after sealant or fluoride varnish treatment, respectively. The difference between the two treatment procedures was not statistically significant. The incidence rate for the transition from enamel caries to dentin caries or fillings was 3.5–3.9 surfaces/100 years in the sealant groups and 5.9–6.1 surfaces/100 years in the fluoride varnish groups. The results show the potential of sealants to act as a noninvasive treatment of early approximal enamel lesions.