THE PROJECTED FINANCIAL SAVINGS IN DENTAL RESTORATIVE TREATMENT; THE RESULT OF CONSUMING FLUORIDATED WATER

The writers of this report provide readers with an interesting estimate of the savings that might accrue in a national dental health program when universal fluoridation of drinking water maintains.     

Gender Differences in Quality of Life of Patients with Rectal Cancer. A Five-Year Prospective Study

To determine how quality of life changes over time and to assess gender-related differences in quality of life of rectal cancer patients we conducted a 5-year study. Little is known about how quality of life (QoL) changes over time in patients after surgery for rectal cancer, and whether gender of the patients is associated with a different perception of QoL. The aim of this study was to assess prospectively, changes in quality of life after surgery for rectal cancer, with a focus on gender related differences. Over a 5-year period, the EORTC-QLQ-C-30 and a tumor-specific module were prospectively administered to patients before surgery, at discharge, 3, 6, 12, and 24 months postoperatively. Comparisons were made between female and male patients. A total of 519 patients participated in the study, 264 men and 255 women. The two groups were comparable in terms of surgical procedures, adjuvant treatment, tumor stage, and histology. Most QoL scores dropped significantly below baseline in the early postoperative period. From the third month onward, global health, emotional and physical functioning, improved. Female gender was associated with significantly worse global health and physical functioning and with higher scores on treatment strain and fatigue. Men reported difficulties with sexual enjoyment; furthermore, over time, sexual problems created high levels of strain in men, worse than baseline levels in the early postoperative period. These problems tended to continue over the course of time. The findings in this study confirm that QoL changes after surgery and differs between men and women. Women appear to be affected by impaired physical functioning and global health. Female gender is associated with significantly higher fatigue levels and increased strain values after surgery. Through impaired sexual enjoyment, men are put more under strain than woman.     

Loss-framed minimal intervention increases mammography use

INTRODUCTION: Although mammography is the most effective early detection breast cancer screening technology available, it is underutilized. This study was conducted to test the effectiveness of a loss-framed minimal intervention to increase mammography use. Loss-frame refers to a communication strategy in which messages are framed from the perspective of what a person has to lose by not taking a particular behavioral action. METHODS: Participants were medically un- and underinsured women 50-64 years old who called one of two urban clinics randomly selected based on demographic statistical equivalency. The women who participated telephoned to inquire about a mammogram during the 6-month study period. The group randomly designated as the experimental group received a loss-framed message conveyed by trained staff telephonically. Members of the comparison group received the "usual" communication, also conveyed telephonically. In the experimental group, 31 of 112 (27%) women who inquired received mammograms, whereas 157 of the 992 (16%) comparison group women who inquired received mammograms. RESULTS: The odds of a mammogram, adjusted for race and breast cancer symptoms, significantly increased for the experimental (odds ratio [OR] = 1.914, chi2 = 7.48, p = .0063, 95% confidence interval [CI] 1.20-3.05) versus comparison group. CONCLUSIONS: A loss-framed, in-reach, minimal intervention approach holds promise as a mammography promotion strategy.     

Dental Health Education for the Mentally and Physically Handicapped

Dental disease is one of the most common health problems of Americans. It is one of the many health problems that handicapped children have in common with their non-handicapped peers. Research indicates that handicapped children have significantly more decayed and missing teeth than non-handicapped students. Methods of improving the dental health of handicapped children were explored. These methods included teacher education, development of special instruments, development of a directory of dentists who would treat the handicapped, and the role that parents should play in the dental health program. The plight of dental health care in the handicapped will continue unabated until health educators become more active in health education for all segments of the school population.     

Drug Interactions—A Review

The mechanisms of drug interactions are varied and may include herbal supplements and foods, as well as other drugs. As the number of drug interactions increase, it is important to have on-hand drug interaction resources available to ensure patient safety. Several current comprehensive references include Lexi-Interact (published by Lexicomp), DRUG–REAX (published by Micromedex), the Natural Medicines Comprehensive Database (published by the Pharmacists' Letter and Physician's Letter), and the cyp450 resource http://medicine.iupui.edu/flockhart/table.htm. Many of these references are available in online or PDA versions. Being informed about the potential for drug interactions is the best way to prevent them from occurring. Moreover, the ED physician must be able to recognize drug interactions to identify and remove the offending agent. Understanding the mechanisms of drug interactions will assist all clinicians in avoiding these serious, often preventable, events.     

Transition-Clinic—

Zusammenfassung Im Kindesalter beginnende chronische rheumatische Erkrankungen bleiben oft bis in das Erwachsenenalter aktiv und sind mit Einschränkungen auf körperlicher, funktioneller und sozialer Ebene verbunden. Die medizinische und psychosoziale Betreuung der Patienten muss also über das Jugendalter hinaus fortgeführt werden, was einen Wechsel von der kind-zentrierten in die erwachsenen-orientierte Gesundheitsbetreuung erforderlich macht. Jugendliche und junge Erwachsene geplant, individuell ausgerichtet und gut koordiniert in die erwachsenen-medizinische Betreuung zu überführen (=Transition), ist relevant für deren zukünftige Partizipation in der Gesellschaft und gehört heute zu einer guten klinischen Praxis. Im Rahmen der medizinischen Begleitung rheumakranker Jugendlicher beim Übergang in das Erwachsenenalter müssen neben krankheitsspezifischen Aspekten auch die entwicklungsbedingten Besonderheiten dieses Lebensabschnittes berücksichtigt werden. Die derzeitigen Betreuungsangebote für rheumakranke Jugendliche und junge Erwachsene in Deutschland sind unzureichend. Pädiatrische und internistische Rheumatologen sollten in enger Zusammenarbeit spezielle Betreuungskonzepte für diese Patientengruppe etablieren.     

A Prospective Analysis of the Effect of Blue-Dye Volume on Sentinel Lymph Node Mapping Success and Incidence of Allergic Reaction in Patients With Breast Cancer

Background This study examined whether the volume of isosulfan blue dye used in sentinel lymph node (SLN) mapping in breast cancer is related to the SLN identification rate or to the incidence of allergic reactions.Methods From January 2001 to November 2002, 1728 breast cancer patients underwent 1832 SLN mapping procedures with the combined technique of intraparenchymal blue dye and intradermal radioisotope. Details of each procedure and all allergic reactions were prospectively recorded. Bilateral synchronous SLN procedures were considered as one dye exposure but as two distinct procedures for determining mapping success. Dye-only success was defined as the proportion of cases in which the SLN was identified by blue dye alone. Overall dye success was defined as the proportion of cases in which the SLN was identified by blue dye with or without isotope.Results When stratified by volume of blue dye, there were no significant differences in dye-only successes, overall dye successes, or mapping failures. Allergic reactions were documented in 31 (1.8%) of 1728 patients. Hypotensive reactions occurred in 3 (.2%) of 1728 patients; 2 (.1%) required pressor support. There was a nonsignificant trend toward fewer allergic reactions with smaller volumes of blue dye.Conclusions In combined-technique SLN mapping protocols for breast cancer, using smaller volumes of blue dye may represent a means of optimizing the safety of the procedure without compromising its success.