Should infants be screened for anaemia? A prospective study investigating the relation between haemoglobin at 8, 12, and 18 months and development at 18 months

AIMS—To investigate the relation between haemoglobin in children followed longitudinally from 8 to 18 months, and developmental outcome at 18months.
METHODS—The Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC) is a longitudinal survey of a geographically defined population of children born in 1991-92. In a randomly selected subsample, blood samples were assayed for Hb at 8, 12, and 18 months; a developmental assessment was carried out at 18 months on 1141 children using the Griffiths Scales of Mental Development.
RESULTS—There was a strong quadratic association between Hb at 8 months and performance on the locomotor subscale at 18 months. Average scores increased with increasing Hb up to 95 g/l; there was little additional developmental benefit in Hb levels beyond 95 g/l. Infants with Hb <95 g/l at 8 months of age scored on average 6 points lower on the locomotor subscale than infants with Hb ⩾ 95 g/l; infants with Hb <90 g/l at 8 months scored 12 points lower on the locomotor subscale than children with Hb ⩾ 90 g/l.
CONCLUSIONS—Low Hb concentrations (⩽ 95 g/l) in 8 month old children are associated with impaired motor development at 18 months. This cut off point corresponds to the 5th centile of Hb at 8 months. The results indicate that if there is an adverse effect of low Hb on developmental outcome, screening may be more effective at 8 months or earlier, rather than after this age. We propose to examine the importance of infant anaemia in relation to more accurate and detailed long term outcomes as the children get older.

     

The influence of interfacial forces and duration of filing on root canal shaping

The aim of this study was to investigate the possible relationship between interfacial forces, duration of instrumentation and effectiveness of root canal shaping by filing. All factors were standardised except the manner of manipulation of the files and the dependent variables (interfacial force and duration of filing). The outcome measured was the final prepared canal shape. The study tested the hypothesis that if interfacial forces and duration of filing had predictive value for effective canal shaping, a relationship between them should be apparent. If it was not, it could be inferred that the remaining uncontrollable variable, "manner of file manipulation" had a dominating influence. 18 operators used a standard filing technique to instrument a root canal each in single rooted teeth matched for anatomy. The teeth were mounted in a custom-made transducer designed to measure laterally applied interfacial forces between file and dentine. The length of time taken with each instrument in the series was measured giving a total duration of instrumentation. The final canal shape measured by standardised "before" and "after" radiographic images of the roots was judged against an "ideal" canal shape calculated from the size of instruments used and based on the preliminary canal shape. Although some trends were revealed, no obvious relationship was demonstrated between interfacial force, duration of filing and final canal shape. Operators clearly used a range of interfacial forces characteristic for each individual and for the different file sizes. Both light and heavy forces could produce a satisfactory canal shape. Use of light or heavy forces did not obviously affect speed of preparation. Tactile discrimination was not dependent on use of light or heavy forces. It was inferred that the "manner of file manipulation" remained undefined and was probably the dominant factor influencing outcome of canal shaping.     

An in vivo investigation into the use of resin-modified glass poly(alkenote) cements as orthodontic bonding agents.

The aim of this study was to investigate the in vivo bonding of orthodontic brackets using two resin-modified glass poly(alkenoate) cements and to compare them with a conventional light-cured diacrylate bonding agent. Twenty consecutive patients attending for bond up appointments took part in this randomized cross-mouth control study. Alternate quadrants were bonded with either Fuji Ortho LC or 3 M Multi-Cure. Transbond [Adhesive Pre-Coated Brackets (APC)] acted as the control in the other quadrants. Failed brackets were rebonded with the same material. Bond failure rates were collected over a 1-year period. The bond failure rates over 1 year were 7.2 per cent for Transbond (APC), 5.9 per cent for 3 M Multi-Cure, and 5.8 per cent for Fuji Ortho LC. Statistically, there was no significant difference between the bond failure rates of the materials and there was no effect of time. This clinical investigation confirmed the suitability of the resin-modified glass poly(alkenoate) cements under test as orthodontic bonding agents.     

The fate and survival of amalgam and preformed crown molar restorations placed in a specialist paediatric dental practice

The fate of 1688 amalgam restorations and 716 preformed crowns placed in permanent and primary molars in a specialist paediatric dental practice over a 10-year period by one operator is reported. For primary molar amalgams, the replacement rate, true failure rate and 5-year survival estimates were, for Class 1 restorations, 16.1%, 3.9%, 73.3%, respectively, with an estimated median survival time greater than 8.5 years, and for Class 2 cavities 14.7%, 11.6%, 66.6%, with an estimated median survival time greater than 7.5 years. For permanent molar amalgams, the replacement rate, true failure rate and 5-year survival estimates were for Class 1 restorations 11.5%, 6.5%, 76.8%, respectively, with an estimated median survival time greater than 9.3 years, and for Class 2 restorations 9.8%, 8.0%, 82.2%, with a median survival time greater than 8.5 years. For all preformed crowns, the replacement rate, true failure rate and 5-year survival estimates were 2.8%, 1.9%, 92.0%, and the estimated median survival time greater than 7.64 years. No relationship was observed between the age of the patient and the age of replaced restorations. No significant difference was found between the survival rates of Class 1 and 2 amalgam restorations in primary or permanent molars, nor between first and second primary molars.     

Factors associated with different hygiene practices in the homes of 15 month old infants.

BACKGROUND: Improved hygiene in Westernised regions of the world may be partly responsible for the increased prevalence of diseases of the immune system, such as asthma and atopy. There is a paucity of data on cleanliness norms in young children in the UK and there has been no attempt to identify factors that influence the adoption of particular hygiene practices in the home. AIMS: To examine levels of hygiene in a contemporary cohort of children and identify social and lifestyle factors influencing hygiene practices in the home. METHODS: The sample under study are participants in the Avon Longitudinal Study of Parents and Children (ALSPAC). Parental self completion questionnaires provided data on hygiene levels in children at 15 months of age, and a hygiene score was derived from these responses. Multivariable logistic regression models investigated associations between high hygiene scores (top quintile) and a number of perinatal, maternal, social, and environmental factors. RESULTS: Maternal smoking during pregnancy, low maternal educational achievement, and living in local authority housing were factors independently associated with high hygiene scores, as was increased use of chemical household products. High hygiene scores were inversely related to living in damp housing and attendance at day care. There were no gender or ethnic differences in hygiene score. CONCLUSION: Important data on cleanliness norms for infants have been presented. The adoption of hygiene practices is influenced to some degree by social, lifestyle, and environmental factors-with higher hygiene scores occurring in more socially disadvantaged groups. Increased use of chemical household products in the more socially disadvantaged groups within ALSPAC has emerged as an important confounder in any study of hygiene and ill health.     

Nurses' attitudes to and perceptions of knowledge and skills regarding evidence-based practice

The study evaluated the effect of an evidence-based practice (EBP) educational programme on attitudes and perceptions of knowledge and skills, of registered nurses, towards EBP. The study was conducted using a quasiexperimental interrupted time series design. Participants were clinical nurses in educational and leadership roles within a Health Service District in south-east Queensland. The data were collected using a self-administered questionnaire at three points. Nurses' belief in the value of EBP for practice was high prior to the programme and did not change subsequently. There was an improvement following the intervention in nurses' attitudes to organizational support for EBP and their perceptions of their knowledge and skills in locating and evaluating research reports. Providing educational courses in a clinical setting is useful in improving clinicians' attitudes to and perceptions of knowledge and skills related to EBP.     

p53 mutations in deep tissues are more strongly associated with recurrence than mutation-positive mucosal margins.

PURPOSE: Application of ultrasensitive diagnostics has shown that small numbers of p53 mutation-positive cells may signify the presence of residual tumor in histologically normal tissues after resection of squamous cell carcinomas arising in the head and neck area. To date, most studies in this area have focused on analysis of tissues at the mucosal aspect of the resection and highlighted the importance of molecular changes in the field with respect to the risk of recurrence. EXPERIMENTAL DESIGN: In the present investigation, we analyzed normal tissues from mucosal and deep surgical margins, referred to as "molecular margins," for the presence of the signature p53 mutation identified for each tumor. RESULTS: The p53 mutation status of these carcinomas did not correlate with clinical or histopathologic variables, but these mutations provided an excellent target for ultrasensitive analysis of margin status. We found that 11 of 16 (68%) of cases with histologically tumor-free (including 9 without dysplasia), but with p53 mutation-positive molecular margins, developed recurrence. The probability of developing local recurrence was significantly higher for the group with p53 mutation-positive margins when compared with the group with clear margins (P = 0.048) and more strongly associated with p53 mutation-positive deep molecular margins than mutation-positive mucosal molecular margins or positivity at both sites (P = 0.009). CONCLUSIONS: This shows that although persistent mucosal fields may contribute to recurrence, clonal p53 mutations in deep tissues are an important cause of treatment failure, and molecular margins from both sites should be analyzed in future prospective series.