Scintigraphic diagnosis of tricuspid regurgitation

The authors describe a simple technique for diagnosis of tricuspid regurgitation. Red blood cells were labeled in vivo with 99mTc and 22 patients were studied with ECG-gated blood-pool imaging of the liver. A single region of interest was manually drawn around the liver and a time-activity curve obtained. The per cent change in liver counts during the cardiac cycle was found to be significantly higher in the 12 patients with tricuspid regurgitation (Group I) (mean, 4.04 +/- 1.6%; range, 1.3-21.4%) compared with the 10 controls (Group II) (mean, 0.35 +/- 0.16%; range, 0.013-1.3%) (p less than 0.05). Using a 1% change in liver counts as the criterion of a positive study, all 12 cases in Group I were diagnosed correctly, but there was one false positive in Group II; thus the sensitivity was 100% and the specificity 90%.     

Effectiveness of HIV prevention in Ontario, Canada: a multilevel comparison of bisexual men

OBJECTIVES: We examined the effectiveness of community-level HIV prevention programming for men who have sex with men. METHODS: We used multilevel methods to examine unprotected intercourse by bisexual men (n = 1016) with male and female partners in geographic regions with and without HIV prevention programming. RESULTS: Men living in geographic regions with HIV prevention programming had significantly less frequent unprotected homosexual intercourse with both casual and regular partners. In contrast, no differences were observed for unprotected heterosexual intercourse. CONCLUSIONS: This study provides evidence supporting the effectiveness of community-level HIV prevention programming and the need for its broader implementation. The study also demonstrates the suitability of multilevel methods for examining the effectiveness of community-level public health programs.     

Indications for lateral retinacular release in total knee replacement

The rule of no thumb test was compared with the towel clip test in determining the need for lateral retinacular release in 200 consecutive primary total knee replacements. The towel clip test was positive in 13 knees (6.5%) and the rule of no thumb test was positive in 78 knees (39%). Using a positive towel clip test as the indication for lateral retinacular release, there was no radiographic evidence of patellar tilt, subluxation, or dislocation in any knee at 6 months postoperatively. Therefore, the rule of no thumb test falsely predicted the need for lateral release in 65 knees (32.5%). The authors advocate the towel clip test to determine the need for lateral retinacular release.     

Oral health-related quality of life and life-space mobility in community-dwelling older adults

OBJECTIVES: To quantify the associations between measures of oral health–related quality of life (OHRQoL) and life‐space mobility (LSM) in community‐dwelling older adults. DESIGN: Cross‐sectional study using a 54‐item OHRQoL questionnaire. SETTING: Five counties in central Alabama: Jefferson and Tuscaloosa (urban), and Bibb, Hale, and Pickens (rural). PARTICIPANTS: The 288 dental study volunteers were recruited from participants in the University of Alabama at Birmingham Study of Aging, a longitudinal study of mobility in community‐dwelling adults aged 65 and older. MEASUREMENTS: Participants completed an in‐home interview about their OHRQoL and LSM. Life‐space was assessed by asking questions about where and how often participants got to areas ranging from the home to beyond town and the degree of independence in getting there. Unadjusted and adjusted regression models were used to quantify associations between OHRQoL and LSM. Other factors examined were age, race, sex, income, education, residence, transportation difficulty, marital status, depressive symptoms, and comorbidity. RESULTS: Unadjusted and adjusted analyses suggested significant associations between OHRQoL and LSM in oral functional limitation, oral pain and discomfort, oral disadvantage, and self‐rated oral health. CONCLUSION: OHRQoL decrements that participants reported were associated with less LSM, suggesting that perceptions of oral well‐being have a significant effect on mobility and the social participation of older adults.