Utilization of dental services as a risk factor for periodontitis

The relation between utilization of dental services from community dentists and the extent and severity of alveolar bone loss is reported for a panel of men followed for over 6 years. Oral health data were collected by the Department of Veterans Affairs, Dental Longitudinal Study, which began in 1969 and still continues. Participants have received regular oral examinations approximately every 3 years. A variety of oral health conditions were assessed, including plaque, calculus, gingival inflammation, probing depth, tooth mobility, clinical attachment level, and alveolar bone loss. Utilization data were abstracted from the dental records of dental offices that participants attended from 1979 through 1988. Multivariate modeling as well as comparisons of high utilizers and non-utilizers indicate that utilization of routine diagnostic and preventive services was not predictive of the extent and severity of periodontitis.

Trends in tooth loss among U.S. employed adults from 1971 to 1985

A comparison of data from a 1971-74 study and a 1985-86 study is used to establish trends in tooth loss among adults. The data show that tooth retention among employed U.S. adults improved almost 15 percent in the decade between the two studies, and edentulism was almost cut in half.

Prevalence and demographic correlates of tooth loss among the elderly in the United States

The aging of the United States population and the contribution of tooth loss to oral health make it important to describe tooth loss among the elderly in this country. Data from the National Survey of Oral Health in US Employed Adults and Seniors: 1985-1986, conducted by the National Institute of Dental Research, were analyzed to examine the prevalence and demographic correlates of tooth loss among the elderly. Results show that there were important differences in tooth loss among subgroups of the elderly sample (overall n = 5,649 persons aged 65+ years attending senior centers). The oldest seniors and those with the least education or income were the most likely to be edentulous. The oldest dentulous seniors, blacks, those with the least education or income, and those who lived in New England or the Northeast had the fewest number of teeth present. These findings suggest that efforts to reduce tooth loss among the elderly should target those with the least education and income.

A comparative study of costs for dental services and dentists' income in the United States and Norway

The United States and Norway have approximately the same per capita Gross Domestic Product (GDP) and average personal income, but their per capita health spending patterns are quite different. In 1982, the US spent 6.5% of its total health expenditures on dental services while Norway spent 5.4%. A higher percentage of Norwegian adults see a dentist annually as compared to US adults. In 1984, the mean net income of dentists in private practice was $66,940 in the US and $27,125 in Norway; this is respectively 5 and 1 3/4 times the average per capita income in those countries. The American publicly-employed dentist earned approximately two-thirds of what the American private practitioner made, while still earning approximately 50% more than his Norwegian counterpart. Some basic information concerning the ratios of dentists, specialists, and dental hygienists to the population is given. The relative proportion of women dentists in the two countries is contrasted. Finally, data on graduates from the dental schools, enrollment cuts, and estimated dentist to population ratios by the year 2000 are described to compare future manpower that will be available to the two countries. Several dissimilarities in the political and social systems are described and discussed. It is emphasized that caution should be used when interpreting and comparing data about countries with different dental delivery, political, and social systems.

Low lactate dehydrogenase and high mitochondrial glycerol phosphate dehydrogenase in pancreatic beta-cells. Potential role in nutrient sensing

Nutrient metabolism was examined with regard to insulin secretion in purified rat islet beta- and non-beta-cells, beta-cell lines, and hepatocytes. Lactate dehydrogenase (LDH) activity (nanomoles.min-1.mg protein-1) was remarkably low in the glucose-sensitive INS-1 cell line (15.7) and in beta-cells (22.3). Thus, beta-cell LDH was respectively 8-, 122-, 17-, and 136-fold lower than in islet non-beta, liver, HIT-T15, and RINm5F cells. Plasma membrane lactate transport activity was 3-10-fold lower in beta- or INS-1 cells than in the other cell types. Conversely, mitochondrial glycerol phosphate dehydrogenase was strongly expressed only in beta- and INS-1 cells. The significance of these findings to nutrient recognition was explored using INS-1 cells as a model of native beta-cells. Glucose-stimulated lactate output and glucose utilization were, respectively, 12- and 5-fold lower in INS-1 than in RINm5F cells. Each process was entirely blocked by respiratory chain inhibitors in INS-1 cells, whereas glucose utilization was barely affected and lactate output stimulated in RINm5F cells. Glucose oxidation represented 73% of total utilization in INS-1 cells, but only 9% in RINm5F cells. Absolute rates of glucose oxidation, and the extent of mitochondrial NAD(P) reduction, were similar in the two cell types, and glucose stimulated insulin secretion 1.9-fold in INS-1 and 1.4-fold in RINm5F cells. The mitochondrial substrates, monomethyl succinate, pyruvate, and leucine, each triggered secretion in INS-1 cells. The balance of LDH, plasma membrane lactate transport, and mitochondrial glycerol phosphate dehydrogenase activities therefore appear to be important in beta- and INS-1 cell glucose recognition to ensure that mitochondrial oxidation is the principle fate of pyruvate and NADH produced by glycolysis. The resultant close coupling of glycolysis with mitochondrial oxidation explains the absence in beta-cells of Crabtree and Pasteur effects.

Estimated savings in U.S. dental expenditures, 1979-89

The American public saved more than $39 billion (1990 dollars) in dental expenditures from 1979 through 1989 in contrast to the substantial increases in expenditures in other sectors of the U.S. health care system that have pushed the system to the brink of major reform. The dental savings were estimated after controlling for the influence of economic factors, such as changes in prices, insurance, and income, as well as noneconomic factors that could influence the extent of dental disease in the U.S. population. Results of the analysis confirm the importance of both economic and noneconomic factors in the determination of the savings in dental expenditures.

Stimulated parotid gland flow rates in healthy, elderly dentulous and edentulous individuals

The use of dentures has been associated with increased stimulated parotid salivary flow rates (SPFR). A comparison of SPFRs was made between dentulous subjects having 20+ teeth (n = 190) and edentulous individuals (n = 67). Two different populations were selected, a white group from the Baltimore Longitudinal Study of Aging and an African-American group from the Washington Village Medical Center in Baltimore. Each group was healthy and unmedicated and had a mean age of 70.2 years. SPFR was determined with a Carlson-Crittenden cup and 2% citrate for stimulation. The edentulous subjects did not wear their dentures during salivary collection. The results indicated a significantly lower SPFR in dentate individuals compared with edentulous subjects (p < 0.01). Dentulous men also had a lower SPFR than edentulous men (p < 0.04). In addition, a pre- and postsurgical evaluation of 10 individuals who underwent full mouth tooth extractions revealed no differences in SPFR. These results suggest that edentulism per se does not have a deleterious effect on stimulated parotid salivary flow rates.

Dental care utilization over time

Between 1950 and 1978, per capita real dental expenditures in the U.S. grew at an average annual rate of 3.33%. Between 1978 and 1989 there was virtually no net growth in this measure of dental care utilization. This sharp curtailment of utilization growth has promoted debate about the sources of this change. Possible explanations include, among others, a reduction in dental disease due to increased exposure to fluoridation, the substitution of noncaloric sweeteners for refined sugar, preventive dentistry, , improved oral health habits, an increase in the net price of dental services, and the cost-containment efforts of insurers and employers. Changes have occurred in all of these variables, but little has done to isolate and quantify the individual effects. This decomposition is difficult, in part, because of the lack of an established model for time-series analysis of dental care utilization. A model of dental care demand, incorporating economic factors (out-of-pocket or net dental prices, per capita income, and nondental prices) as well as dietary factors (refined sugar consumption, noncaloric sweeteners, and exposure to fluoridated water), is combined with a simple model of dental care supply within an equilibrium framework. A two-stage estimation procedure is applied, using U.S. aggregate time-series data for the period 1950-89. Results show that economic and dietary factors are significantly related to changes in utilization. Net price and income elasticities of demand exhibit the expected signs and are compatible with estimates from cross-sectional studies. Decreases in cane and beet sugar consumption, facilitated by the increase in the use of noncaloric sweeteners, are associated with reductions in utilization. Fluoridation appears to be weakly but positively related to utilization. There also appears to have been a significant structural shift in demand since 1978. Overall goodness-of-fit is strong and the model accurately tracks the 1978-89 flattening of per capita real dental expenditures. Analysis of the relative contribution of each independent variable suggests that economic, dietary, and structural shift factors have contributed to this curtailment of growth.

Prevalence of insulin self manipulation in young women with insulin dependent diabetes

AIMS

1. To determine the prevalence of insulin self manipulation for the purposes of weight control, in a population based study of young women with insulin dependent diabetes. 2. To compare the North Canterbury prevalence of insulin self manipulation with figures reported in overseas studies.

METHOD

All women with insulin dependent diabetes aged 18 to 30 years inclusive and resident in North Canterbury, were invited to an interview to document their diabetes self-care behaviour. A blood sample was taken at the time of interview for measurement of glycated haemoglobin.

RESULTS

Ninety three percent of eligible women agreed to participate in the study. Twelve of the 69 participating women (17%) admitted to reducing their insulin dose at some time in the past, for the purposes of weight loss. This figure is significantly lower than the 37% (p = 0.047), reported from a British study, and the figure of 39% (p = 0.006), reported from the United States. The median glycated haemoglobin of the twelve subjects who reported manipulating their insulin was slightly higher than that of the remaining 57 subjects, but this difference did not reach statistical significance (79 mmol/mol haem versus 71 mmol/mol haem, p = 0.07).

CONCLUSIONS

The self reported prevalence of insulin manipulation for the purposes of weight loss appears to be lower in North Canterbury, compared to overseas studies. The reason for this difference is unexplained. Health care professionals should nevertheless be aware of this method of weight reduction, as it has been associated with poor diabetes control, clinical eating disorders and possible long term detrimental effects on health.

Absence of Epstein-Barr virus in carcinoma of the cervix

BACKGROUND

Cervical epithelium is known to contain receptors for Epstein-Barr virus (EBV) and is a recognized site of viral shedding. Recent cases of nasopharyngeal carcinoma have been associated with cervical carcinoma, leading to speculation of a possible etiologic link between EBV and cervical carcinoma.

METHODS

This study investigates the presence of EBV in 24 cases of invasive cervical carcinoma (9 adenocarcinomas and 15 squamous cell carcinomas) and 10 cases of cervical intraepithelial neoplasia (4 adenocarcinomas in situ and 6 squamous: 3 CIN II, 3 CIN III), using in situ hybridization.

RESULTS

In one case, EBV was demonstrated in infiltrating lymphocytes adjacent to tumor epithelium, but in no cases did the malignant epithelium show the presence of EBV.

CONCLUSIONS

These results suggest that EBV does not play a role in the etiology of cervical carcinoma, although further studies are needed.

Comparison of Maori and European access to the Christchurch specialist diabetes complication screening clinic

AIMS

To compare Maori and European utilisation of a specialist diabetes complication screening clinic.

METHOD

All subjects attending the Christchurch specialist diabetes complication screening clinic over a 16 month period were asked to complete a questionnaire, which included data on age, ethnicity and diabetes treatment. The frequency of clinic attendance by age and ethnic group was then compared to the number of people in the general population, in the clinic catchment area.

RESULTS

Of the 1356 subjects attending the complications screening clinic over the study period, 1347 completed the questionnaire. 1228 of the 1347 subjects (91.2%) were European and 84 (6.2%) were Maori. In the age range 45-64 years, Maori clinic attendance per 1000 general population was 25.6, compared to 7.57 per 1000 for Europeans. On a population basis, there were thus 3.4 times more Maori than Europeans attending the clinic. This figure is comparable with results from recent studies, which indicate that the prevalence of diabetes in this age range is about 3 to 5 times higher in Maori, compared to Europeans.

CONCLUSIONS

Although this study failed to demonstrate evidence of inequality of health care utilisation, quantitative measures of utilisation are but one dimension of access to health care. Another dimension of health care access discussed in this paper, is the differing health care needs of different ethnic groups.

HLA-DQ beta typing and non-Asp57 alleles in IDDM and nondiabetic subjects in New Zealand

OBJECTIVE

To determine the frequency of IDDM risk-associated HLA-DQ beta alleles in New Zealanders with IDDM and nondiabetic control subjects, and to examine these as susceptibility markers in relation to IDDM incidence.

RESEARCH DESIGN AND METHODS

HLA-DQ beta typing was conducted in 55 juvenile-onset IDDM subjects diagnosed between 1990 and 1992, and 53 nondiabetic control subjects. Allele typing was conducted by a polymerase chain reaction-restriction fragment-length polymorphism technique. All subjects were residents of Canterbury, New Zealand. IDDM incidence data were obtained from the Canterbury, New Zealand, Diabetes Registry.

RESULTS

The frequency of the susceptibility genotype DQ beta *0201/0302 was 43.6 and 5.7% in the IDDM and control groups, respectively, reflecting the increased prevalence of allele 0302 in the IDDM group. Alleles 0301, 0501, and 0602.3 were more prevalent in the control group than the IDDM group. The frequency of non-Asp57 alleles was 90.9 and 61.3% in the IDDM and control groups, respectively. Overall, the HLA-DQ beta allele distribution was similar to reports from other Caucasian populations. The 0- to 19-yr age-specific IDDM incidence rate over the period in which the diabetic subjects were diagnosed was 19.5/100,000 person-yr, the highest levels observed in Canterbury over the last decade. Our relatively high background prevalence of non-Asp57 alleles and high IDDM incidence rates were similar to results from some Scandinavian and other hotspot populations.

CONCLUSIONS

HLA-DQ beta alleles are genetic susceptibility markers in New Zealand, and other Caucasian populations. Peak IDDM incidence levels observed in 1990-1992 in our population are in accordance with a high background population prevalence of non-Asp57 alleles. These results suggest that the high Canterbury incidence rates may be due to a large HLA-DQ beta non-Asp57 at-risk population.

Trends in caries experience in US employed adults from 1971-74 to 1985: cross-sectional comparisons

The evidence for trends in caries experience among adults is examined by use of data from the NCHS NHANES I survey of dental disease, conducted from 1971 to 1974, and the NIDR Survey of Employed Adults and Seniors, conducted in 1985 and 1986. The main findings of the study are: (1) Mean DMF teeth and surfaces have declined among US employed adults who were 18-44 years old in 1985 compared with similar-aged persons in 1971-74; (2) differences in mean DMF teeth and surfaces could not be detected when persons aged 45 or older were compared; (3) missing and decayed components of DMF decreased in all age groups; (4) mean DF teeth decreased in persons under 30 years of age and mean DF surfaces in persons under 35; (5) improvements in DMF were demonstrated by both genders and all regions of the US; (6) all tooth types (anteriors, premolars, and 1st and 2nd molars) showed improvement in DMF; and (7) while employed whites clearly demonstrated an improvement in DMF, a commensurate improvement among employed blacks was not apparent. As measured by the DMF index, caries experience declined in US employed adults under 45 years old between 1971-74 and 1985.

Regulation of collagen synthesis in human dermal fibroblasts in contracted collagen gels by ascorbic acid, growth factors, and inhibitors of lipid peroxidation

Ascorbic acid has been shown to stimulate collagen synthesis in monolayer cultures of human dermal fibroblasts. In the present studies, we examined whether the presence of a collagen matrix influences this response of dermal fibroblasts to ascorbic acid. Fibroblasts and collagen were mixed and allowed to gel and contract for 6 days to form a matrix prior to determining the concentration and time dependence for ascorbic acid to affect collagen synthesis by fibroblasts within the matrix. Collagen synthesis was stimulated at levels at or above 10 microM ascorbic acid and was maximal after 2 days of treatment. This concentration and time dependence is similar to that of cells grown in monolayer cultures. The effects of transforming growth factor-beta (TGF-beta) and fibroblast growth factor (FGF) were also examined in this model. TGF-beta increased and FGF inhibited collagen synthesis in the gels, as has been shown for cells in monolayer cultures. The effects of potential inhibitors of lipid peroxidation induced by ascorbic acid were also examined in these matrices and compared to previous results obtained in monolayer cultures. Propyl gallate, cobalt chloride, alpha,alpha-dipyridyl, and alpha-tocopherol inhibited the ascorbic acid-mediated stimulation of collagen synthesis while mannitol had no effect. Natural retinoids inhibited total protein synthesis without the specific effect on collagen synthesis that was seen in monolayer cultures. These results indicate that ascorbic acid stimulates collagen synthesis in fibroblasts grown in a collagen matrix in a manner similar to that found in monolayer cultures. In contracting collagen gels, however, the magnitude of the effect is less and retinoids do not specifically inhibit collagen synthesis.

Use of insulin for 50 years or more in North Canterbury, New Zealand

Previous reviews of diabetic subjects using insulin for 50 years or more have been based on clinic populations or on individuals receiving medals to mark this achievement. We interviewed all 11 subjects who had been on insulin for 50 years or more, identified from a population-based register of insulin users in North Canterbury, New Zealand. Seven of the 11 subjects had required treatment for micro- or macrovascular disease, but the functional level of the majority of survivors was nevertheless high. Diabetes had a major social impact on only one of the subjects interviewed.

Influence of bed supply and health care organization on regional and local patterns of diabetes related hospitalization

This paper undertakes both a macro- and micro-scale analysis of the influences exerted by the health care system on patterns of hospitalization. The health disorder of diabetes mellitus is used as the case study and the analyses are based on New Zealand data sets. The article first examines the extent to which both the supply and organization of primary and secondary health care affect rates of hospitalization. The macro-scale analysis investigates the applicability of Roemer's Law to regional variations in diabetes hospitalization. The organizational control of hospital utilization via doctor gatekeeping functions and interaction between health services are then examined at the local level. This analysis assumes a population based approach using the Canterbury Register of Insulin-treated diabetic persons as the study population. Diabetes discharge rates were found to be most highly correlated with hospital bed supply in 5 of the 8 years studied (1979-1986). Stepwise regression analysis indicated area rates of diabetes hospitalization were significantly influenced by resource factors even after controlling for differences in the socio-demographic characteristics of the area populations. This confirmed the presence of Roemer's Law at the aggregate level with rates of diabetes hospitalization appearing to have more to do with the availability of medical resources than to population needs. At the local level, hospital admission patterns were found to vary by general practitioner age, practice type found to vary by general practitioner age, practice type and diabetic caseload. Overall, insulin-treated diabetic patients most likely to be hospitalized were those in the care of young doctors new to general practice, and those who attended doctors who had small diabetic caseloads. Solo practitioners had the lowest rates of patient hospitalization. There were marked disparities in patient access to specialist diabetes education and clinical outpatient services by patient age, duration of diabetes and attendance on primary care. Overall, no significant differences were found in the propensity for hospitalization between users and non-users of these specialist services. This does not imply however, service ineffectiveness but rather is indicative of the complexity of the local diabetes care organization and the differing needs of the insulin-treated diabetic population within the community as a whole.

The Tobacco Institute's "It's the Law" campaign: has it halted illegal sales of tobacco to children?

A survey of tobacco retailers was conducted to evaluate the efficacy of the Tobacco Institute's "It's the Law" program, which has the goal of eliminating the illegal sale of tobacco to minors. Only 4.5% (7) of the 156 retailers surveyed were participating in the "It's the Law" program. Eighty-six percent of the retailers who were participating in the program were willing to illegally sell cigarettes to children, compared with 88% (131/149) of the retailers who were not participating.

Temporal variation in incidence of IDDM in Canterbury, New Zealand

OBJECTIVES

To establish the statistical significance of observed variations over the last decade in the incidence of insulin-dependent diabetes mellitus (IDDM) in the 0- to 19-yr-old age-group and to determine whether incidence has increased in Canterbury, New Zealand.

RESEARCH DESIGN AND METHODS

The Canterbury, New Zealand, Diabetes Registry has recorded all incidence cases of diabetes mellitus prospectively since 1982. All IDDM subjects aged 0-19 yr at diagnosis and using insulin are included in the study. Ascertainment is believed to be 100%. Prevalence was recorded at 1 January 1982 and 1 January 1990. Annual incidence for 1982-1990 was determined using age and sex cross-sectional census population denominators. The statistical significance of temporal, age, sex, and seasonal variations in incidence rates was ascertained by Poisson regression models (GLIM statistical software).

RESULTS

Prevalence on 1 January 1990 was 115/100,000. Incidence rates during the 9 yr were periodic, with two major peaks--one in the early 1980s, the other in 1989 continuing into 1990. The temporal variation (P less than 0.02) was not age or sex specific. Incidence rates for boys were three- to fourfold higher during peak versus trough years, with a peak level of 20.7/100,000 in 1990. For girls, there was less variation, with a peak rate of 21.6/100,000 in 1990. There has been no significant increase in IDDM incidence over time. The mean rate of incidence across all age-groups for 1982-1990 was 12.7/100,000 person-yr. A significant seasonal association to the onset of IDDM was found only in boys, with incidence rates being significantly higher in winter than in summer (P less than 0.01).

CONCLUSIONS

IDDM in Canterbury, New Zealand, presents in cycles of incidence peaks and troughs, each spanning 2-3 yr.

Pharmacy promotion of tobacco use among children in Massachusetts

The role played by pharmacies in the promotion and distribution of tobacco to children was assessed in a survey of 100 pharmacies. Of the 100 surveyed, 95 sold tobacco products, 50 advertised tobacco, 42 advertised the cigarette brands that are most appealing to children, and 23 displayed the Camel cartoon advertisements that have been identified as being targeted specifically at children. Candy tobacco products were sold in 22% of the pharmacies. Of the pharmacies selling tobacco, 81% were willing to sell it to minors illegally. The five pharmacies that did not carry tobacco products were independent stores. When compared to chain pharmacies, independent pharmacies more frequently advertised tobacco (p less than 0.05) but were not more likely to sell it to children. The authors contend that pharmacists who sell tobacco violate the profession's Code of Ethics and play an important role in the promotion of tobacco use among children.