What do patients with diabetes and diabetologists--especially those in private practice--expect from the new technologies for diabetes care in the future?

Thanks to the high volume of patients'consultations delivered, and especially in private practice, diabetologists are able to accurately describe the expectations of diabetic patients with the new and mostly future technologies. In addition, diabetologists are also able to imagine how these technologies will change their medical practices in future.

Oral hygiene and gingival health in Flemish pre-school children

OBJECTIVES

The study aimed to describe oral hygiene habits, oral hygiene status and gingival health in Flemish pre-school children and to explore factors associated with these clinical oral health variables.

METHODS

Cross-sectional data from 1,071 3-year-old and 1,119 5-year-old children from four geographical areas in Flanders (Belgium) were analysed Buccal plaque accumulation and gingival health were assessed on six index teeth. Data on oral hygiene and dietary habits, oral health behaviour and socio-demographic variables were obtained through questionnaires.

RESULTS

34% of 3-year-olds and 25% of 5-year-olds started brushing before the age of one, 17% of 3-year-olds and 23% of 5-year-olds brushed twice a day. Roughly, 30% of 3-year-olds and 37% of 5-year-olds presented with visible plaque accumulation. In both age groups, only 3 to 4% of children presented with signs of gingival inflammation. Multiple logistic regression models revealed that in both age groups children whose mothers had a college or university degree, had a smaller chance of presenting with visible plaque than children whose mothers had a lower educational level. With gingival health as dependent variable, multiple logistic regression analysis confirmed the major association between bacterial plaque accumulation and the presence of gingivitis. In the oldest age group, children's former exposure to passive smoking was also significantly associated with gingivitis.

CONCLUSION

Parents should be motivated to start brushing at an early age and brush thoroughly in order to maintain good oral health in their offspring. Special attention should go to children raised by mothers with a lower educational level.

GISELE: a resonant ionization laser ion source for the production of radioactive ions at GANIL

SPIRAL2 is the new project under construction at GANIL to produce radioactive ion beams and in particular neutron rich ion beams. For the past 10 yr SPIRAL1 at GANIL has been delivering accelerated radioactive ion beams of gases. Both facilities now need to extend the range of radioactive ion beams produced to condensable elements. For that purpose, a resonant ionization laser ion source, funded by the French Research National Agency, is under development at GANIL, in collaboration with IPN Orsay, University of Mainz (Germany) and TRIUMF, Vancouver (Canada). A description of this project called GISELE (GANIL Ion Source using Electron Laser Excitation) is presented.

Latest developments at GANIL for stable and radioactive ion beam production

In the frame of the SPIRAL II (Système de Production d'Ions Radioactifs Accélérés en Ligne Partie II) project, several developments of stable and radioactive ion production systems have been started up. In parallel, GANIL has the ambition to preserve the existing stable and radioactive beams and also to increase its range by offering new ones. In order to identify the best directions for this development, a new group called GANISOL has been formed. Its preliminary conclusions and the latest developments at GANIL are presented.

Development of a surface ionization source for the SPIRAL 2 project

Development of new radioactive beams, and thus of new target ion sources (TISs) for isotope-separator-on-line production systems are in progress at GANIL for the SPIRAL 2 project. The efficiency and time response measurements of each step in the production process are crucial to predict and maximize the available yields, in particular, for short lived isotopes. This paper presents a method for measuring these quantities that makes use of a stable alkali chopped beam of controlled intensity. This method was applied to surface ionization source test for high efficiency. Results of recent experiments are presented that include ionization efficiency measurements for Cs, Rb, K, Na, and Li with a graphite and rhenium ionizer and dwell time of these alkalis on graphite. The results enabled to design a first surface ionization source prototype which will be installed in the SPIRAL 2 TIS.

Parental smoking behavior and caries experience in preschool children

OBJECTIVES

The study aimed to explore the association between parental smoking behavior and caries experience in young children, taking into account the socioeconomic status and oral health-related behavior.

METHODS

Cross-sectional data from 1250 3-year-old and 1283 5-year-old children from four geographical areas in Flanders (Belgium) were analyzed. Children were examined at school by trained dentist-examiners, using standard criteria and calibrated examination methodology. Data on oral hygiene and dietary habits, oral health behavior, sociodemographic variables, and parental smoking behavior were obtained through structured questionnaires, completed by the parents.

RESULTS

Visible caries experience (i.e. d(3)mft > 0) was seen in 7% of 3-year olds and 31% of 5-year olds. In both age groups, 30% of the parents reported smoking behavior. Univariable logistic regression analysis with caries prevalence as the dependent variable, revealed that parental smoking was a significant independent variable. After controlling for age, gender, sociodemographic characteristics, oral hygiene, and dietary habits, the effect of family smoking status was no longer significant in 3-year-old children (OR = 1.98; 95% CI: 0.68-5.76). In 5-year olds the significant relationship between parental smoking behavior and caries experience persisted after adjusting for the other evaluated variables (OR = 3.36; 95% CI: 1.49-7.58).

CONCLUSION

The results of this study illustrate the existence of a significant association between parental smoking behavior and caries experience in 5-year-old children.

Measuring oral health behaviour in Flemish health care workers: an application of the theory of planned behaviour

OBJECTIVE

This study describes the development and validation of a questionnaire to measure the determinants of oral health related behaviour in health care workers, based on the Theory of Planned Behaviour (TPB).

RESEARCH DESIGN

A preliminary questionnaire was drafted containing 78 self report items measuring three behaviours related to oral health (i.e. dietary habits, oral hygiene habits and dental attendance), as well as the attitudes, perceived social norms and self-efficacy for each behaviour. The questionnaire was completed by 201 health care workers for the initial validation and 966 other health care workers for a replication.

OUTCOMES

A principal component analysis with Procrustes rotation toward an a priori three component structure on the original sample yielded high congruence measures for reported dental attendance, but not for dietary habits and oral hygiene habits. Subsequent exploratory Varimax rotations and discarding of redundant items resulted in three component solutions explaining 43% of the variance in dietary habits, 57% in oral hygiene habits and 66% in dental attendance, respectively. For all three behaviours, these components corresponded to the dimensions of the TPB. Internal consistency of the scales was satisfactory, with Chronbach's alpha's ranging from 0.51 to 0.87. Scale scores accounted for a significant proportion of the variance in the intention to avoid sweet snacks, to brush teeth, and to attend dental check-ups, and of the frequency of consumption of sweet drinks and frequency of brushing. A confirmatory factor analysis on the larger sample of 966 health care workers provided excellent goodness of fit indices, confirming the construct validity of the scales.

Development of a 1+/N+ setup for the production of multicharged radioactive alkali ions in SPIRAL

In the framework of the production of radioactive ion beams by the isotope separator online method, a new system has been developed at GANIL/SPIRAL I to produce multicharged alkali ions. The principle, referred to as the "direct 1+/N+ method," consists of a surface ionization source associated with a multicharged electron-cyclotron-resonance ion source without an intermediate mass separator. This new system has been tested online using a (48)Ca primary beam at 60.3 A MeV. The experimental evidence of the direct 1+/N+ process has been obtained for a potential difference between the two sources of 11 V and with a 1+/N+ charge breeding efficiency of 0.04% for (47)K(5+). This value is significantly lower than the value of 6% obtained for stable K ions with the standard 1+/N+ method. A possible explanation is given in the text.

The radioactive ion beam production systems for the SPIRAL2 project

The SPIRAL2 project, currently under construction at GANIL, will include an isotope separator on line based facility for the production and acceleration of radioactive ion beams. A superconducting linear accelerator will accelerate 5 mA deuterons up to 40 MeV and 1 mA heavy ions up to 14.5 MeV/u. These primary beams will be used to bombard both thick and thin targets. We are investigating three different techniques to produce the radioactive ion beams: (1) the neutron induced fission of uranium carbide, (2) the direct interaction of deuterons in a uranium carbide target, and (3) the interaction of a heavy ion beam with a target. All these production systems will be coupled to an ion source. Four kinds of ion sources are foreseen for the ionization of the radioactive atoms: an electron cyclotron resonance ion source, a surface ionization ion source, a forced electron beam induced arc discharge ion source, and a laser ion source depending on the characteristics of the desired radioactive ion beam in terms of intensity, efficiency, purity, etc. A presentation of the SPIRAL2 project and of the different production systems is given.

Status report of stable and radioactive ion beam production at GANIL

GANIL has been producing many stable and radioactive ion beams for nearly 25 years. Constant progresses have been made in terms of intensity, stability, and reliability. The intensity for some stable metallic beams now exceeds or approaches the p microA level at an energy up to 95 MeV/u, e.g., 1.14 p microA for (36)S (65% enriched) at 77 MeV/u, 0.35 p microA for (58)Ni (63% enriched) at 74 MeV/u. Some recent results with Magnesocene using the metallic ions from volatile compounds method should also make possible the production of metallic beams with an intensity greater than 1 p microA. This has still to be measured. The ISOL facility SPIRAL I has been in operation for almost six years. Up to now, 17 exotic He experiments have been done with 14 target/ion-source (TIS) units; 19 other experiments (with O, Ne, Ar, and Kr) have been achieved with 14 TISs. Statistics show a fairly good ratio of available beam time to scheduled beam time. The radioactive beams and available intensities are compiled in this report. Future developments on radioactive ion beam production are briefly presented, while more details will be discussed elsewhere at this conference.

Effect of caries experience in primary molars on cavity formation in the adjacent permanent first molar

This study sought to address the influence of a sound versus affected first and/or second deciduous molar on the incidence of visible caries experience in the adjacent permanent first molar. Clinical and questionnaire data were obtained from a 6-year prospective oral health screening project in Flanders, Belgium (Signal-Tandmobiel project), where 4,468 children (born in 1989) were examined annually during their primary school time. A multiple survival model allowing for dependent data with possible censoring was applied. The impact of timing of tooth emergence (determining the period at risk), gender, presence of sealants and reported oral hygiene habits was also considered. Cavity formation in permanent first molars was clearly influenced by the status of the adjacent primary molars;the effect of the second deciduous molar was most pronounced. Moreover, if both deciduous molars experienced caries and the child presented with poor oral hygiene, a peak in cavity formation of the permanent first molar 1-2 years after emergence was noticed. On the other hand, if a child presented with good oral hygiene, no peak was observed; caries risk increased slightly over time. No significant benefit from restoring primary molars could be demonstrated, possibly because of methodological limitations.

Variables associated with oral hygiene levels in 7-year-olds in Belgium

OBJECTIVES

The present investigation aimed to delineate the extent of the correlation between each of a number of possible associated variables and the amount of plaque (as measured by a plaque index) present in 7-year-old Flemish children and to investigate the potential relation between caries experience and the amount of dental plaque.

PARTICIPANTS

A sample of 4,468 children representative of children living in Flanders and born in 1989 was obtained. Their mean age was 7.1 (SD = 0.4) years with a boys/girls ratio of 51.8%-48.2%.

METHODS

Analyses were performed with ordinal plaque index outcome, considering the children's school (i.e. class) as a random effect. Random effect models were estimated with the SAS procedure Proc NLMIXED.

RESULTS

From the multiple logistic regression analysis, it could be concluded that the older the subjects the more dental plaque was observed (OR = 1.35; CI 1.08-1.68; p = 0.0081). Moreover, four explanatory variables could be identified as significant determinants for dental plaque in the mixed dentition: 'start of brushing after the age of 2' (OR = 1.161; CI: 1.09-1.23; p < 0.0001), 'brushing frequency of < 1x/day' (OR = 1.369; CI: 1.012-1.66; p = 0.0019), 'more than two in between meal snacks' (OR = 1.18; CI: 1.023-1.36; p = 0.0111) and 'daily intake of sugar containing drinks' (OR = 1.24; CI: 1.08-1.42; p = 0.0023). Further, being male was associated with a higher amount of plaque (OR = 1.16; CI: 1.00-1.34; p = 0.0506) and finally, a weak but significant correlation (Spearmans' rho: r = 0.23, p < 0.0001) between caries experience and the amount of cervical plaque was shown.

CONCLUSION

The amount of cervical plaque in the mixed dentition was significantly related to variables associated with oral hygiene and dietary habits. A low but significant correlation between the amount of dental plaque and caries experience was observed.

Modelling tooth emergence data based on multivariate interval-censored data

Studies on emergence of (permanent) teeth are published regularly in the dental literature. Besides descriptive statistics (mean or median values) on emergence times, comparisons between boys and girls are of interest. Gender comparisons are intersubject analyses, but also intrasubject questions, like 'Is there a left-right symmetry with respect to the mean (median) emergence times?' are of interest. Studies on emergence times most often are faced with interval-censored data. We will extend a GEE-type test proposed by Huster et al. for bivariate right-censored data to the multivariate setting with interval-censored data. Central to our paper is to provide appropriate statistical models to resolve some dental questions on emergence. The analyses are based on data from the longitudinal Signal-Tandmobiel study.

[Factors determining dental plaque and their relation to the assessment of caries among 7-year-old Flemish children]

The present investigation aimed to assess the impact of a number of variables on the variation on the amount of dental plaque present in the mixed dentition of 7-year-old Flemish children and to investigate a potential correlation between caries experience and the amount of dental plaque. Analyses were performed with ordinal plaque index as outcome measure, considering the children's school (i.e. class) as a random effect. This random effect turned out to be of great importance when dealing with large clustered samples. From the multiple logistic regression analysis, it was concluded that the older the subjects the more dental plaque was observed (or = 1.35; CI: 1.08-1.68; P = 0.0081). Four exploratory variables, could be identified as important risk indicators for dental plaque accumulation in the mixed dentition: 'start of brushing after the age of 2 years' (or = 1.161; CI: 1.09-1.23; P < 0.0001), 'brushing frequency of < 1 x/day (or = 1.37; CI: 1.12-1.66; P = 0.0019), more than two in between meal snacks (or = 1.18; CI: 1.03-1.36; P = 0.02) and daily intake of sugar containing drinks (or = 1.24; CI: 1.08-1.42; P = 0.002). Further, being male was linked to a higher amount of plaque (or = 1.16; CI: 1.00-1.34; P = 0.0506). Finally a weak but significant correlation (spearman's rho: r = 0.23; P < 0.0001) between caries experience and the amount of cervical plaque was shown.

[In the interests of taking one's time even when one reads a scientific article! Critical review of the literature on tooth eruption]

Nowadays everybody has access to the medical literature, not only through the libraries of the universities, but even more conveniently via Medline and Pubmed. It is very tempting only to read abstracts and summaries instead of "wasting time" by reading the whole article. Reading the article itself however enables the reader to select only these articles that have a good methodological and statistical basis. In this contribution several topics will be discussed that may help the reader to read scientific articles with a critical mind: definitions, quality of the data, study concepts, composition of the sample, control group, statistical analysis, sample size and interpretation of the results. Different items are exemplified with articles that deal with the emergence of permanent teeth.

Short-term clinical study comparing supragingival plaque removal and gingival bleeding reduction of the Philips Jordan HP735 to a manual toothbrush in periodontal patients in a maintenance program

The Philips Jordan HP735 was compared to a manual brush for plaque removal efficacy and reduction of gingival bleeding. Subjects in a periodontal maintenance program were randomly divided into two groups; Group I (n = 27), average age 36.9 years, brushed with the manual brush; and Group II (n = 22), average age 32.9 years, brushed with the Philips Jordan HP735 electric brush. A dichotomous plaque and bleeding index was used at six sites on all teeth at baseline, three, six and nine weeks. The subjects did not use any other cleaning devices during the study. No significant statistical difference in plaque score or bleeding score was found between the two groups at baseline. Plaque scores did not statistically significantly decrease over time in either group, and there was no significant difference in plaque removal between groups during the study. The bleeding index decreased significantly in the electric toothbrushing group; however, due to the large variation in bleeding scores between subjects, the difference in the number of bleeding sites was not statistically significant between the two groups. In conclusion, in a group of periodontal patients in a maintenance phase, using an electric toothbrush did not significantly enhance plaque removal, but did decrease bleeding compared to baseline. The difference in bleeding percentages was not statistically significant compared to a manual brush.

[Diabetes before pregnancy, apropos of 143 cases]

OBJECTIVE

The authors want to appraise the management of diabetes prior to pregnancy in a local population treated in the Lille University Hospital.

METHOD

This is a retrospective study of 143 pregnancies occurring in 111 patients with diabetes prior to pregnancy, between 1987 and 1997, in the Obstetrics Department at the Lille University Hospital.

RESULTS

Only one-third of the patients benefited from preconception management; the stability of diabetes during the first trimester was satisfactory in 50% of the cases. The maternal complications are represented by preeclampsia (20%), metabolic complications specific to diabetes (hypoglycemia, ketoacidosis), the aggravation or the emergence of a retinopathy (10%) and polyhydramnios (19%). Concerning the termination of the pregnancies, of the 147 fetuses (four twin pregnancies), 140 newborns in good health, two neonatal deaths, three in-utero deaths and two therapeutic terminations of pregnancy were observed. The fetal malformation rate was 9.5% (14 cases/147). The cesarean section rate was 63%, whereas the fetal macrosomatia rate was 35%, with dystocia in 26% of the deliveries (outside of planned cesareans). Three shoulder dystocia were observed (two requiring the Jacquemier's maneuver and one with transitory plexus brachial palsy for a newborn weighing 5,650 g).

CONCLUSION

The authors conclude that preconception management (one-third of the patients in this series) and management of during the first trimester of pregnancy (50% in this series) was insufficient. This fact is perhaps due to the confusion, for many practitioners, with gestational diabetes, which is a very mediatized affection, though much less severe for the fetus and mother.

Characterization of mutations in the gene doublecortin in patients with double cortex syndrome

Mutations in the X-linked gene doublecortin, which encodes a protein with no dear structural homologues, are found in pedigrees in which affected females show "double cortex" syndrome (DC; also known as subcortical band heterotopia or laminar heterotopia) and affected males show X-linked lissencephaly. Mutations in doublecortin also cause sporadic DC in females. To determine the incidence of doublecortin mutations in DC, we investigated a cohort of eight pedigrees and 47 sporadic patients with DC for mutations in the doublecortin open reading frame as assessed by single-stranded conformational polymorphism analysis. Mutations were identified in each of the eight DC pedigrees (100%), and in 18 of the 47 sporadic DC patients (38%). Identified mutations were of two types, protein truncation mutations and single amino acid substitution mutations. However, pedigrees with DC displayed almost exclusively single amino acid substitution mutations, suggesting that patients with these mutations may have less of a reproductive disadvantage versus those patients with protein truncation mutations. Single amino acid substitution mutations were tightly clustered in two regions of the open reading frame, suggesting that these two regions are critical for the function of the Doublecortin protein.

The results of computer-assisted ambulatory 16-channel EEG

The objective of this study was to examine the results of 16-channel computer-assisted outpatient long-term EEG monitoring (CO-LTM) and to compare those results to previously published reports using 4- and 8-channel ambulatory cassette-based continuous recordings. Patients were referred to a community-based outpatient EEG service for further diagnostic evaluation using this 16-channel bipolar recording system. 344 patients were recorded for an average of 1.4 days. EEG was reviewed for the presence of patient identified events, computer identified interictal and ictal abnormalities, and periodic time samples. A push-button recording that signified a clinical event was obtained in 166 patients (48.3%); 41 (11.9%) of these recordings included a seizure and 125 (36.3%) showed no EEG changes during the habitual event. An EEG abnormality was identified by the computer in an additional 90 recordings (26.2%), for an overall clinical usefulness of 74.4%. Among the 191 patients referred with previously normal routine EEGs, a total of 129 (67.5%) of these recordings were useful. 48 (25.1%) of these tracings were abnormal and an additional 81 push-button events (42.4%) showing no changes from background EEG were recorded. In conclusion, computer-assisted outpatient EEG monitoring provides good success rates for clinically useful information.

[Postpartum thyroiditis. 31 cases]

Postpartum thyroiditis. 31 cases. Between 1977 and 1986, 29 women consulted in three internal medicine and endocrinology departments for clinical disorders which could be ascribed to 31 episodes of thyroiditis developed within 9 months of giving birth. Thyroiditis was diagnosed clinically on the basis of acute diffuse (11 cases) or nodular (7 cases) goitre formation, signs of dysthyroidism (16 cases) revealed by menstrual disturbances and/or galactorrhoea (11 cases). A thyrotoxic episode was observed in 9 patients; it was either without sequelae (5 cases) of followed by transient hypothyroidism (4 cases). In other patients transient hypothyroidism was observed in 11 cases and permanent hypothyroidism in 5 cases. Six patients showed no sign of dysthyroidism, and the diagnosis was made by immunological, cytological and/or histological examination of the thyroid gland. Circulating anti-thyroid antibodies were present in two-thirds of the patients. The results of radioisotope scanning varied according to the stage of the disease. In these patients, only the absence of goitre was predictive, in 4 out of 5 cases, of subsequent permanent hypothyroidism; in all other patients the prognosis was highly favourable, even without specific treatment.

Current concepts in primary hyperparathyroidism

622 patients were operated on between 1966 and 1988. Urolithiasis was the most common presenting symptom (26%) but routine measurements of serum calcium led to detect 50% cases. At present, the disease is three times more frequent in women than in men. Estrogenic deprivation, neck irradiation (3.4%) and lithium therapy favor the occurrence of hyperparathyroidism (HPT); frequent association with goiter (19.8%), diabetes (8.3%) and multiple endocrine neoplasia (3.5%) has been noticed. Bone Gla protein concentrations correlate with calcium and HPT blood concentrations but do not reflect the severity of bone damage. Dual photon absorptiometry is now available for quantification and follow-up of bone demineralization, especially in asymptomatic forms of HPT.

Long term treatment with the somatostatin analog SMS 201-995 in a patient with a thyrotropin- and growth hormone-secreting pituitary adenoma

A patient with a mixed pituitary tumor secreting TSH and GH was treated, starting 3 months after partial adenomectomy, with the somatostatin analog SMS 201-995 for 8 months. Somatostatin itself inhibited TSH, GH, and alpha-subunit release by the tumor both in vivo and in vitro. Long term treatment with twice daily sc injections of SMS 201-995 resulted in decreased TSH secretion and lower serum thyroid hormone levels. However, euthyroidism was achieved only when the patient was treated with three daily 200-micrograms injections of SMS 201-995. After 30 weeks of SMS 201-995 therapy, TSH secretion increased, while GH secretion remained suppressed. After withdrawal for 6 months, SMS 201-995 (100 micrograms, sc, twice daily) again completely inhibited TSH secretion. SMS 201-995 did not alter the volume of the residual adenomatous tissue. We conclude that SMS 201-995 may be a valuable therapeutic agent for the management of patients with a thyrotroph adenoma. However, desensitization may occur during long term treatment.