Function of the masticatory system in 20 patients with mandibular hypo- or hyperplasia after correction by a sagittal split osteotomy

Twenty patients with malocclusions were examined for signs and symptoms of craniomandibular disorders (CMD) before surgical correction of their anomalies. Such signs and symptoms were very common and were in many patients the main reason for requesting treatment. Eight patients had rigid and 12 non-rigid fixation. All patients were re-examined 1 year after surgery. This examination showed a statistically significant improvement of signs and symptoms of CMD but those who had had non-rigid fixation showed a statistically significant impairment in maximal mouth opening while no such change was noted in those treated with rigid fixation. Eight patients reported significant reduction of their recurrent headaches. It is concluded that surgical correction of malocclusion has a beneficial effect not only on the aesthetic appearance and dental occlusion but also on signs and symptoms of CMD.     

Heavy lifting during pregnancy--a hazard to the fetus? A prospective study

The influence of heavy lifting during pregnancy on gestational age, birthweight and the risk of fetal death (spontaneous abortion or stillbirth) was investigated in a prospective study of 3906 occupationally active women. Information on exposure was collected at the women's first contact with the antenatal care centres in Orebro County from October 1980 to June 1983. Logistic and linear regression were used to analyse the data, allowing for several non-occupational factors in the models. Women who reported heavy lifting did not have in general more unfavourable outcomes than other women, although the risk estimates varied between different occupational categories. Lifting of weights greater than or equal to 12 kg more than 50 times per week increased the risk of pre-term birth (less than 37 weeks of gestation--odds ratio 1.7), but only among women who stopped working before the 32nd week of pregnancy. Unfavourable outcomes were more common among those who reported chemical exposure during pregnancy. The preventive routines and regulations in Sweden may have helped to reduce possible risks from heavy lifting during pregnancy.     

Long-term follow up of workers exposed to solvents.

Long term occupational exposure to organic solvents may cause adverse effects to the central nervous system. This collaborative study between six Swedish departments of occupational medicine examines the overall prognosis in terms of working capacity, symptoms, and psychometric test performance for individuals occupationally exposed to organic solvents. After re-analyses of the data from an initial clinical investigation of 111 men, the subjects were divided into two subgroups: one group of 65 with symptoms but no impairment on the tests and one group of 46 with toxic encephalopathy (symptoms and test impairment). At least five years after the initial examination the subjects were asked to attend a re-examination that included a structured medical interview and a psychometric investigation. The results indicate that effects on the central nervous system persist even when exposure has ceased. In the group of 46 more men had stopped working and were receiving sickness or early retirement pensions. This group also had reduced activity levels with regard to everyday life, leisure activities, and education or training and more neuropsychiatric symptoms. There was no support for the view that a solvent induced toxic encephalopathy is a progressive disease comparable with presenile dementia such as Alzheimer's disease or Pick's disease. If a worker was removed from exposure when he presented symptoms without signs of impairment in intellectual function recovery was seen in most cases.     

Association Between Changes in Habitual Physical Activity and Changes in Bone Density,Muscle Strength,and Functional Performance in Elderly Men and Women

OBJECTIVES: To investigate the long‐term effects of habitual physical activity on changes in musculoskeletal health, functional performance, and fracture risk in elderly men and women. DESIGN: Ten‐year prospective population‐based study. SETTING: Malmö‐Sjöbo Prospective Study, Sweden. PARTICIPANTS: Participants were 152 men and 206 women aged 50, 60, 70, and 80 who were followed for 10 years. MEASUREMENTS: Distal radius bone mineral density (BMD) (single photon absorptiometry), upper limb muscle (grip) strength, balance, gait velocity, occupational and leisure‐time activity, and fractures (interview‐administered questionnaire) were reassessed after 10 years. Annual changes for all measures were compared between participants with varying habitual physical activity histories at baseline and follow‐up: inactive–inactive (n=202), active–inactive (n=47), inactive–active (n=49), and active–active (n=60). Data for men and women were pooled, because there were no sex‐by‐activity group interactions. To detect possible differences in fracture incidence between the varying habitual activity groups, participants were classified into two activity groups based on their activity classification at baseline and follow‐up: inactive:less active versus active:more active. RESULTS: The annual rate of bone loss was 0.6% per year less in individuals classified as active at both time points than in those classified as inactive at both time points (P<.01). Similar results were observed for balance, but there was no effect of varying habitual activity on changes in muscle strength or gait velocity. There were also no differences in fracture incidence between individuals categorized as active:more active and those categorized as inactive:less active during the follow‐up (adjusted hazard ratio=0.90, 95% confidence interval (CI)=0.42–1.90). CONCLUSION: This study showed that elderly men and women who maintained a habitually active lifestyle over 10 years had lower bone loss and retained better balance than those who remained habitually inactive.     

A follow-up study of patients with subjective symptoms related to dental materials

OBJECTIVES: The extent to which substances released from dental materials cause adverse health effects and whether removal of dental materials results in improvement of health is a matter of dispute. The aim of the study was to investigate changes in the intensity of subjective symptoms after replacement of dental materials in patients referred for adverse reactions related to dental materials, and to compare the profiles of symptoms with those found in the general population. METHODS: Information was obtained from 142 patients referred to the Dental Biomaterials Adverse Reaction Unit in Bergen, Norway. At the time of examination, all patients completed a questionnaire regarding a range of subjective symptoms. A follow-up questionnaire was sent to all patients 1 to 2 years later. Similar questionnaires were sent to a reference group of 800 persons drawn from the general population. RESULTS: The follow-up questionnaires were completed and returned by 84 patients, and 441 persons in the reference group. The patient group presented higher symptom indices than the reference group (P<0.001). Generally, there was some decrease in the intensity of different symptoms in patients who had replaced dental materials. The decrease was evident regarding intraoral symptoms (P=0.022) and total symptom index (P=0.041). The group of patients who had replaced materials still had significantly higher symptom indices than those of the reference group. Patients who had not replaced dental materials did not present any reduction in symptom indices. CONCLUSION: The pattern of symptoms was similar for the groups investigated. At the group level, the intensity of local and some general subjective symptoms was reduced after replacement of the materials, but not to the level found in the general population.     

Pelvic floor muscle training is effective in women with urinary incontinence after stroke: a randomised, controlled and blinded study

AIMS: The aim of this study was to evaluate the effect of Pelvic Floor Muscle Training (PFMT) in women with urinary incontinence (UI) after ischemic stroke. MATERIALS AND METHODS: Three hundred and thirty-nine medical records of stroke patients were searched. Twenty-six subjects were randomised to a Treatment Group (14 subjects) or a Control Group (12 subjects) in a single blinded, randomised study. The intervention included 12 weeks of standardised PFMT. The outcome measures were: (1) diary recording the frequency of voiding, the number of incontinence episodes and used pads; (2) 24-hr home pad test; and (3) vaginal palpation of pelvic floor muscle evaluating function, strength, static and dynamic endurance. RESULTS: Twenty-four subjects with urge, stress and mixed stress/urge incontinence, completed the study, 12 in each group. A significant improvement in frequency of voiding in daytime (Treatment Group/Control Group: 7/8 at pre-test, 6/9 at post-test (median values), P=0.018), 24-hr pad test (Treatment Group/Control Group: 8/12 to 2/8 g P=0.013) and dynamic endurance of pelvic floor muscle (Treatment Group/Control Group: 11/20 to 20/8 contractions of Pelvic Floor Muscle, P=0.028) was demonstrated in the Treatment Group compared to the Control Group. A significant improvement in frequency of voiding in daytime (decreased from seven to six, P=0.036), pelvic floor muscle function (P=0.034), strength (P=0.046), static endurance increased from 9 to 30 sec (P=0.028) and dynamic endurance increased from 11 to 20 contractions (P=0.020) was also demonstrated within the Treatment Group, but not in the Control Group. CONCLUSION: PFMT had a significant effect in women with UI after stroke measured by diaries, pad tests and vaginal palpation.     

Long term effects of oestrogen therapy on bone loss in postmenopausal women: a 23 year prospective study

Objective   To determine the long term effect of oestrogen therapy on bone loss after menopause.
Design   Prospective observational study over 23 years.
Setting   Malmö, Sweden.
Subjects   Twenty-eight women taking oestrogen and 196 women not taking oestrogen during the follow up.
Methods   Bone mineral density of the forearm was measured by single-photon absorptiometry at age 48 and 72 years. Use of oestrogen therapy was noted.
Main outcome measure   Rate of forearm bone loss between the age of 48 and 72 years.
Results   Women taking oestrogen, for a median of 17 years (range 4 to 26), had 8.7 percentage points (95% CI 3.8–13.5) lower rate of bone loss compared with women not taking oestrogen during the same period. Each year of oestrogen therapy reduced the rate of bone loss by 0.8 percentage points (95% CI 0.2–1.4).
Conclusions   The use of oestrogen seems to reduce the rate of bone loss over a period of 23 years, and the longer the duration of the therapy, the less bone loss.     

Young women with genital prolapse have a low collagen concentration

BACKGROUND: Genital prolapse is a common and handicapping form of pelvic floor dysfunction. To explain its genesis as a result of endopelvic connective tissue weakness, the collagen state was analyzed in women with and without genital prolapse. METHODS: Punch biopsies from the paraurethral ligaments were obtained during the operation from 22 women undergoing surgery for genital prolapse. As controls, similar biopsies were taken from 13 women who underwent gynecologic surgery for other benign reasons. Collagen concentration as hydroxyproline and its extractability by pepsin digestion were studied in relation to age by multiple regression, two-way anova, Levene's test, and Student's t-test. Histological examination was also performed. RESULTS: Women, younger than 53 years, with genital prolapse had a 30% lower collagen concentration than age-matched controls, which reached significance, P = 0.01. The extractability by pepsin digestion, an indicator of cross-links in the collagen molecule, did not significantly differ between groups. It did, however, decrease significantly with age in both prolapse patient and control groups. Morphology supported these findings with a less-dense extracellular matrix composition subepithelially in genital prolapse compared to a healthy control. CONCLUSION: For the first time, we show that young women with genital prolapse have a decreased collagen concentration, suggesting a different organization of the endopelvic connective tissue extracellular matrix. Furthermore, these alterations differ from those earlier found in younger women with stress urinary incontinence.     

Perceived muscular tension,emotional stress,psychological demands and physical load during VDU work

Objectives The aim of this study was to investigate whether perceived muscular tension, psychological demands and emotional stress were associated with physical load or working technique during visual display unit (VDU) work.Methods Subjects (28 women and 29 men) from two different organisations volunteered to participate in the study. The study design was cross-sectional, and the data were assessed when the subjects performed their usual work tasks at their usual work place. Multivariate linear and logistic regression models were used to investigate possible associations. The different outcome variables were: median muscle activity and muscular rest in the trapezius muscle bilaterally, wrist movements and working technique. The different explanatory variables were: perceived muscular tension (binary), emotional stress (binary), psychological demands (binary), organisation (binary) and gender (binary). Age (continuous) and present musculoskeletal pain (binary) were also controlled for in the multivariate models. Electromyography (EMG) and electrogoniometers were used to assess the physical load, and the data collection time was 15 min. An ergonomic checklist was used to assess working technique, i.e. work with lifted shoulders.Results Subjects who perceived muscular tension at least a few times per week the month before the measurements were made worked with higher muscle activity [expressed as per cent of a reference voluntary electrical activity (% RVE)] in the trapezius muscle bilaterally (5% RVE, P=0.05). High emotional stress during the measurement was associated with higher muscle activity in the trapezius muscle on the side not operating the computer mouse (8% RVE, P=0.006). Subjects who reported high levels of emotional stress worked more often with lifted shoulders (odds ratio 6.0, 95% CI 1.2–28.9). However, when present musculoskeletal pain was included in the multivariate model the odds ratio for high emotional stress decreased to 4.5 (95% CI 0.9–23.2).Conclusions Perceived muscular tension and emotional stress were associated with physical load, in terms of muscle activity in the trapezius muscles, during VDU work in ordinary occupational settings.     

Human prenatal and postnatal exposure to polybrominated diphenyl ethers,polychlorinated biphenyls,polychlorobiphenylols, and pentachlorophenol

The aim of this study was to determine human prenatal and postnatal exposures to polybrominated diphenyl ethers (PBDEs), polychlorinated biphenyls (PCBs), hydroxylated metabolites of PCBs (polychlorobiphenylols; OH-PCBs), and pentachlorophenol (PCP). The median PBDE fresh-weight concentrations in maternal and cord blood plasma and in breast milk were 24, 4.3, and 75 pg/g, respectively. The PCB concentrations were approximately 60 times higher in each compartment (1,560, 277, and 4,310 pg/g, respectively). Calculated on a lipid weight basis, the levels were comparable in maternal blood plasma and breast milk. In contrast to PCBs, differences were found between PBDE congener distribution in maternal and cord blood plasma. The OH-PCBs constituted up to 26% of the PCB levels in maternal blood plasma and 53% in cord blood plasma, with levels of 120 and 88 pg/g fresh weight, respectively, and in breast milk 3 pg/g. The corresponding concentrations for PCP were 2,830, 1,960, and 20 pg/g. The ratios of PCB to OH-PCB were 13, 3, and 1,400 in maternal, cord plasma, and breast milk, respectively. It is evident that prenatal exposures occur for all the analytes. Moreover, the exposure continues after birth via breast milk. However, levels of OH-PCBs and PCP in breast milk are low compared with levels in blood plasma. Exposures to both PCBs and PBDEs, and in particular to the endocrine-active halogenated phenolic compounds, are of concern and implicate a potential risk for developmental disturbances.