Individual-level home values and cancer mortality in a statewide registry

BACKGROUND

Prior work assessing disparities in cancer outcomes has relied on regional socioeconomic metrics. These metrics average data across many individuals, resulting in a loss of granularity and confounding with other regional factors.

METHODS

Using patients' addresses at the time of diagnosis from the Ohio Cancer Incidence Surveillance System, we retrieved individual home price estimates from an online real estate marketplace. This individual-level estimate was compared with the Area Deprivation Index (ADI) at the census block group level. Multivariable Cox proportional hazards models were used to determine the relationship between home price estimates and all-cause and cancer-specific mortality.

RESULTS

A total of 667 277 patients in Ohio Cancer Incidence Surveillance System were linked to individual home prices across 16 cancers. Increasing home prices, adjusted for age, stage at diagnosis, and ADI, were associated with a decrease in the hazard of all-cause and cancer-specific mortality (hazard ratio [HR] = 0.92, 95% confidence interval [CI] = 0.92 to 0.93, and HR = 0.95, 95% CI = 0.94 to 0.95, respectively). Following a cancer diagnosis, individuals with home prices 2 standard deviations above the mean had an estimated 10-year survival probability (7.8%, 95% CI = 7.2% to 8.3%) higher than those with home prices 2 standard deviations below the mean. The association between home price and mortality was substantially more prominent for patients living in less deprived census block groups (Pinteraction < .001) than for those living in more deprived census block groups.

CONCLUSION

Higher individual home prices were associated with improved all-cause and cancer-specific mortality, even after accounting for regional measures of deprivation.

Prostate Cancer Screening and Young Black Men: Can Early Communication Avoid Later Health Disparities?

This study aims to determine if younger men, across racial and ethnic groups, discussed the benefits/risks/harms of PSA screening with health care professionals. Publicly available data were obtained from the Health Information National Trends Survey https://hints.cancer.gov/ in March 2019. Cross-sectional analysis of 518 men between the ages of 18 and 49 years from men who completed the survey between October 2011 and February 2012 (HINTS cycle 4) was performed. We used logistic regression to evaluate the association between race/ethnicity and discussions around PSA. Less than 10% of the participants reported a prior PSA; Black and Hispanic men were more likely compared with White men. Compared with White men, Black and other race men reported receiving less communications from some doctors recommending PSA screening (OR_black: 0.16, 95% CI_black: 0.07-0.38; OR_other: 0.10, 95% CI_other: 0.04-0.25), and that no one is sure PSA testing saves lives (OR_black: 0.49, 95% CI_black: 0.04-6.91; OR_other: 0.17, 95% CI_other: 0.06-0.48). Minority men, while more likely to have had a PSA, were less likely to be told of the harms and benefits of PSA testing, compared with White men. Increasing communication surrounding screening advantages and disadvantages between providers and patients can increase awareness and knowledge among younger men. In a post-COVID-19 environment, communication regarding the return to preventative screenings within vulnerable populations is an important message to convey. Research shows preventive screenings have dropped across all population groups due to the pandemic yet the decline disproportionately affects Black and other minority men.

Self-efficacy and importance of participation reasons as predictors for prostate cancer screening intention in African American men

Objective: African American men have higher lifetime risk of developing prostate cancer (PCa), and face more health burdens from this disease due in part to limited participation in cancer screening. Therefore, it is important to study psychosocial factors associated with screening intention in African American men. Guided by social cognitive theory, the current study aims to examine the role of self-efficacy and importance of participation reasons as predictors of PCa screening intention in African American men.Design: This is a primary analysis using data collected from African American men in northeast Ohio and the Southeastern United States. PCa screening intention and self-efficacy were measured by single-item questions. Importance of participation reasons was measured in four domains: psychological, convenience, awareness, and medical. Hierarchical binary logistic regression was used to predict PCa screening intention in African American men.Results: The sample size was 174. The average age was 46.52. Adding self-efficacy and reasons for participation significantly improved prediction for PCa screening intention in African American men (Δχ² = 55.28, p < .001). The final model had χ² = 69.63 (p < .001). Higher self-efficacy (OR = 2.56, p < .05), more perceived importance of psychological reasons (OR = 2.42, p < .001) and medical reasons (OR = 1.10, p < .05) were significant predictors. Also, the perceived chance of developing PCa predicted higher odds of PCa screening intention.Conclusions: Enhancing self-efficacy might be an important intervention focus for African American men to improve PCa screening intention. In addition, the findings suggest that African American men intend to have PCa screening because they experience worries or physical symptoms, and unlikely because it is convenient to get screening or recommended by family members and friends. Thus, intervention efforts could focus on enhancing PCa knowledge and informed decision-making about PCa screening among African American men.

Randomized controlled trial testing a video-text tobacco cessation intervention among economically disadvantaged African American adults

OBJECTIVE

This pilot study tested the acceptability and short-term outcomes of a culturally specific mobile health (mHealth) intervention (Path2Quit) in a sample of economically disadvantaged African American adults. We hypothesized that Path2Quit would demonstrate greater acceptability, biochemically verified abstinence, and promote nicotine replacement therapy (NRT) use compared with a standard text-messaging program.

METHOD

In a 2-arm pilot randomized trial, adults who sought to quit smoking (N = 119) received either Path2Quit or the National Cancer Institute's (NCI) SmokefreeTXT, both combined with a brief behavioral counseling session plus 2 weeks of NRT. Outcomes included acceptability (intervention evaluation and use), NRT utilization, 24-hr quit attempts, self-reported 7-day point prevalence abstinence (ppa), and biochemically verified smoking abstinence at the 6-week follow-up.

RESULTS

Participants were 52% female/48% male, mostly single (60%), completed ≥ 12 years of education (83%), middle-aged, and 63% reported a household income < $10K/year. Participants smoked 11 (SD = 8.2) cigarettes/day for 25 (SD = 16) years, and reported low nicotine dependence. There were no differences in intervention evaluations or use (ps > .05), yet Path2Quit led to significantly greater NRT utilization at follow-up (p < .05). There was no difference in quit attempts between conditions or 7-day ppa (p > .05). However, Path2Quit resulted in significantly greater carbon monoxide confirmed ppa (adjusted odds ratio [AOR] = 3.55; 95% CI [1.32, 9.54]) at the 6-week follow-up.

CONCLUSIONS

A culturally specific mHealth intervention demonstrated positive effects on NRT use and short-term abstinence. Additional research in a larger sample and with long-term follow-up is warranted. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Prostate cancer screening in Black men: Screening intention, knowledge, attitudes, and reasons for participation

The objective of the present study is to capture the prostate cancer screening intention, knowledge levels, attitudes, and reasons for participation in screening among African American men. African American men aged from 35 to 65 in Georgia, North Carolina, and Ohio were recruited for study (N = 168). Questionnaires were administered using validated instruments. Findings suggest critical needs for community-based social workers to communicate the importance of prostate cancer screening and risk factors among African American men. Increasing the use of culturally relevant community health education might benefit underserved minority men at risk of having prostate cancer.

Medication Therapy Management: 10 Years of Experience in a Large Integrated Health Care System

BACKGROUND

Medication therapy management (MTM) was officially recognized by the federal government in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which requires Medicare Part D plans that offer prescription drug coverage to establish MTM programs (MTMPs) for eligible beneficiaries. Even though the term "MTM" was first used in 2003, pharmacists have provided similar services since the term "pharmaceutical care" was introduced in 1990. Fairview Health Services, a large integrated health care system, implemented a standardized pharmaceutical care service system in 1998, naming it a pharmaceutical care-based MTM practice in 2006.

OBJECTIVE

To present the clinical, economic, and humanistic outcomes of 10 years of delivering MTM services to patients in a health care delivery system.

METHODS

Data from MTM services provided to 9,068 patients and documented in electronic therapeutic records were retrospectively analyzed over the 10-year period from September 1998 to September 2008 in 1 health system with 48 primary care clinics. Patients eligible for MTM services were aged 21 years or older and either paid for MTM out of pocket or met their health care payer's criteria for MTM reimbursement; the criteria varied for Medicaid, Medicare, and commercially insured enrollees. All MTM was delivered face to face. Health data extracted from the electronic therapeutic record by the present study's investigators included patient demographics, medication list, medical conditions, drug therapy problems identified and addressed, change in clinical status, and pharmacist-estimated cost savings. The clinical status assessment was a comparison of the first and most recent MTM visit to measure whether the patient achieved the goals of therapy for each medical condition (e.g., the blood pressure of a patient with diabetes and hypertension will be less than 130/80 millimeters mercury [mmHg] in 1 month; the patient with allergic rhinitis will be relieved of his complaints of nasal congestion, runny nose, and eye itching within 5 days). Goals were set according to evidence-based literature and patient-specific targets determined cooperatively by pharmacists, patients, and physicians. Cost-savings calculations represented MTM pharmacists' estimates of medical services (e.g., office visits, laboratory services, urgent care visits, emergency room visits) and lost work time avoided by the intervention. All short-term (3-month) estimated health care savings that resulted from addressing drug therapy problems were analyzed. The expenses of these avoided services were calculated using the health system's contracted rates for services provided in the last quarter of 2008. The return on investment (ROI) was calculated by dividing the pharmacist-estimated savings by the cost of MTM services in 2008 (number of MTM encounters times the average cost of an MTM visit). The humanistic impact of MTM services was assessed using the results from the second patient satisfaction survey administered in 2008 (new patients seen from January through December 2008) for the health system's MTM program.

RESULTS

A total of 9,068 patient records were in the documentation system as of September 30, 2008. During the 10-year period, there were 33,706 documented encounters (mean 3.7 encounters per patient). Of 38,631 drug therapy problems identified and addressed by MTM pharmacists, the most frequent were a need for additional drug therapy (n = 10,870, 28.1%) and subtherapeutic dosage (n = 10,100, 26.1%). In the clinical status assessment of the 12,851 medical conditions in 4,849 patients who were not at goal when they enrolled in the program, 7,068 conditions (55.0%) improved, 2,956 (23.0%) were unchanged, and 2,827 (22.0%) worsened during the course of MTM services. Pharmacist-estimated cost savings to the health system over the 10-year period were $2,913,850 ($86 per encounter) and the total cost of MTM was $2,258,302 ($67 per encounter), for an estimated ROI of $1.29 per $1 in MTM administrative costs. In the patient satisfaction survey, 95.3% of respondents agreed or strongly agreed that their overall health and well-being had improved because of MTM.

CONCLUSION

Pharmacist estimates of the impact of an MTM program in a large integrated health care system suggest that the program was associated with improved clinical outcomes and cost savings. Patient satisfaction with the program was high.

DISCLOSURES

There was no external funding for this manuscript. The 3 authors are employees of Fairview Pharmacy Services. Ramalho de Oliveira had primary responsibility for the concept and design, writing, and revision of the manuscript, with the assistance of Brummel and Miller. Ramalho de Oliveira performed the data collection, and all 3 authors shared equally in data interpretation.

Simplifying Detection of Copy-Number Variations in Maturity-Onset Diabetes of the Young

OBJECTIVES

Copy-number variations (CNVs) are large-scale deletions or duplications of DNA that have required specialized detection methods, such as microarray-based genomic hybridization or multiplex ligation probe amplification. However, recent advances in bioinformatics have made it possible to detect CNVs from next-generation DNA sequencing (NGS) data. Maturity-onset diabetes of the young (MODY) 5 is a subtype of autosomal-dominant diabetes that is often caused by heterozygous deletions involving the HNF1B gene on chromosome 17q12. We evaluated the utility of bioinformatic processing of raw NGS data to detect chromosome 17q12 deletions in MODY5 patients.

METHODS

NGS data from 57 patients clinically suspected to have MODY but who were negative for pathogenic mutations using a targeted panel were re-examined using a CNV calling tool (CNV Caller, VarSeq version 1.4.3). Potential CNVs for MODY5 were then confirmed using whole-exome sequencing, cytogenetic analysis and breakpoint analysis when possible.

RESULTS

Whole-gene deletions in HNF1B, ranging from 1.46 to 1.85 million basepairs in size, were detected in 3 individuals with features of MODY5. These were confirmed by independent methods to be part of a more extensive 17q12 deletion syndrome. Two additional patients carrying a 17q12 deletion were subsequently diagnosed using this method.

CONCLUSIONS

Large-scale deletions are the most common cause of MODY5 and can be detected directly from NGS data, without the need for additional methods.

Reflection suppression via elastomeric films

Transparent substrates introduce challenges in optical metrology, recording, and microscopy. Backside reflections reduce signal to noise, are recorded as artifacts, or introduce spurious signals. These reflections often need to be suppressed, but large angular and spectral bandwidths preclude the use of anti-reflection (AR) coatings. Using elastomeric materials doped with optical absorbers, we detail a method and a materials set for temporary suppression of Fresnel reflections for multiple substrates spanning wide spectral and angular bandwidths. Tuning the refractive index of the elastomer to match a substrate minimizes reflection and the addition of different absorptive dopants allow for either broadband or wavelength-selective reflection suppression. As performance is limited only by the index mismatch, both spectral and angular performances significantly exceed those of AR coatings. We demonstrate reflection suppression in excess of 30 dB spanning a bandwidth over 500 nm. After use, these light traps may be removed and reused without damaging the substrate.

A new protocol and standard of care for managing open crown margins

Open margins on indirect restorations (such as crowns) are the bane of dentists. Judging margins is a subjective undertaking, and there is no agreement among dentists on "how open is open?" Board actions and lawsuits commonly include charges concerning open margins. Immediate replacement of the offending restoration is claimed as the standard of care, particularly when litigation or state dental board actions are involved. However, repair and monitoring of margins are options that have recently become available. These approaches have been widely accepted and are less invasive alternatives to immediate replacement. Silver diamine fluoride (SDF) has provided new options for the management of margins. SDF, which is inexpensive and easy to apply, kills pathogens; hardens softened dentin (making it more acid and abrasion resistant); and does not stain sound dentin, enamel, or porcelain. SDF does stain any caries black. Except for those with demonstrably grossly open margins, restorations with marginal defects can and should be treated conservatively. Repairing or resealing, where possible, along with continued monitoring of all indirect restorations, has now become the standard of care. If caries develops, the tooth can often be conservatively treated by applying a layer of SDF. Only within the esthetic zones would the option of repair or replacement of the restoration be necessary.

Pain and Hardship Among Older Men: Examining the Buffering Effect of Medicare Insurance Coverage

To better understand the health status of men in the United States, this study aimed to assess the association of hardship on the presence of and pain severity among men 50 years of age and older. Cross-sectional multivariate logistic regression analyses were conducted using the 2010 wave of the Health and Retirement Study (N = 3,174) to assess the association between four hardship indicators and the presence of pain and pain severity among this sample of older men.

Results suggest that the association between the presence of pain and hardship was statistically significant across all four indicators: ongoing financial hardship (CI [1.05, 1.63], p < .05), difficulty paying bills (CI [1.42, 3.02], p < .001), food insecurity (CI [1.46, 3.15], p < .001), and not taking medication due to cost (CI [1.06, 1.66], p < .05), even after adjusting for all demographic factors.

The associations between pain severity and ongoing financial strain (CI [1.23, 2.83], p < .01) and difficulty paying bills (CI [1.02, 3.18], p < .05) were statistically significant. Results also indicate that education was a buffer at all levels. In addition, the interactive effect of hardship and Medicare insurance coverage on pain severity was significant only for ongoing financial strain (CI [1.74, 14.33], p > .001) and difficulty paying bills (CI [1.26, 7.05], p < .05). The evidence is clear that each hardship indicators is associated with the presence of pain and across some of the indicators in pain severity among men aged 50 and older. In addition, these findings stress the importance that Medicare insurance plays in acting as a buffer to alleviate some of the hardships experienced by older men. These findings also highlight the association between the presence of pain and pain severity for the overall quality of life, health outcomes, and financial position of men in later life.

Exploring Ethnic Variation in the Relationship Between Stress, Social Networks, and Depressive Symptoms Among Older Black Americans

The relationship between different types of stressors and depressive symptoms among older Black populations is poorly understood. Even less is known about the social networks that might buffer different stressors on individuals within Black ethnic groups. The purpose of this study was to examine whether there are differences in the relationship between stress and social networks on depressive symptoms by ethnic group while ethnicity functioned as a proxy for culture. Data were drawn from the National Survey of American Life, which includes older African Americans ( N = 837) and Caribbean Blacks ( N = 271). In this survey, the measures of stress were perceived discrimination and material hardship; measures of social networks were social support and social connectedness. The association between perceived discrimination and depressive symptoms was significant for both groups while the association between material hardship and depressive symptoms was only significant for older African Americans. Results also indicate that compared with African Americans, Caribbean Blacks derived greater protective effects against depression from social support and social connectedness in late life.

Pre-screening age African-American males: what do they know about prostate cancer screening, knowledge, and risk perceptions?

Prostate cancer is the most commonly diagnosed cancer among men and the second most common cause of cancer mortality among men in America. African-American men have a mortality rate from prostate cancer twice that of Caucasian men. Although prostate screening remains controversial, it provides an opportunity for the cancer to be detected early when treatment is most effective. Limited research has been conducted regarding prostate cancer awareness and knowledge among African-American men under 50. This article highlights a pilot study assessing the knowledge, attitudes, risk perceptions, and reasons for participating in prostate cancer screening among African-American males between the ages of 30-45. Study findings suggest these participants recognized an awareness of risk factors associated with the disease, yet underestimated their risk of developing the disease. Additionally they present uneven knowledge of the prostate and its function and possess positive perceptions of their general health beliefs and practices. Practice implications and directions for future research regarding prostate cancer among this population are highlighted.

Trimethyltin-induced neurotoxicity: gene expression pathway analysis, q-RT-PCR and immunoblotting reveal early effects associated with hippocampal damage and gliosis

Damage to the CNS results in a complex series of molecular and cellular changes involving the affected targets and the ensuing glial reaction. The initial gene expression events that underlie these cellular responses may serve as early biomarkers of neurotoxicity. Here, we examined gene expression profiles during the initial phase of hippocampal damage resulting from systemic exposure of rats to the organometallic neurotoxicant, trimethyltin (TMT, 8.0 mg/kg, i.p.). Using TMT as a neurodegeneration tool confers several advantages for evaluating molecular events associated with neural damage: 1) regional and cellular targets and time course of damage are known, 2) the blood-brain barrier is not compromised, which limits the contribution of blood-borne factors, e.g. immune, to neural injury responses and 3) known protein and mRNA signatures of TMT-induced neurotoxicity can be used as positive controls to validate novel expression events associated with exposure to this neurotoxicant. Using Affymetrix Gene Chip® to assess gene expression after TMT, combined with Ingenuity Pathway Analysis®, we observed changes consistent for genes known to be affected in hippocampus, while corresponding changes were not detected in cerebellum, a non-target region. In agreement with previous observations, limited changes in expression of inflammation-related genes were observed. Correlated expression profiles were found after exposure to TMT, including changes in gene ontologies associated with neurological disease, cellular assembly and maintenance, as well as signaling pathways associated with cellular stress, energy metabolism and glial activation. Selected gene changes were confirmed from each category by q-RT-PCR and immunoblot analysis. The canonical relationships identified implicate molecular pathways and processes relevant to detection of early stages of hippocampal damage in the TMT model. These observations provide new insight into early events associated with neuronal degeneration and associated glial activation that may serve as the basis for discovery and development of biomarkers of neurotoxicity.

Employment and work schedule are related to telomere length in women

OBJECTIVES

To examine the association of employment and work schedule with shorter DNA telomeres, a marker of cellular ageing and disease risk factor, and consider whether differences were related to health, behaviours and sociodemographic factors, or varied by stress levels or menopausal status.

METHODS

This cross-sectional analysis of 608 women aged 35-74 in the Sister Study examined determinants of relative telomere length (rTL) measured by quantitative PCR in leucocyte DNA. Age-adjusted regression models estimated base pair (bp) rTL differences for current and lifetime schedule characteristics (ie, part-time, full-time or overtime hours; multiple jobs; irregular hours; shiftwork; work at night). Covariates included race, smoking, perceived stress, sleep, physical activity, health and menopausal status, education, marital status, live births, children under 18, measured body mass index and urinary stress hormones.

RESULTS

Compared with non-employed women with moderate or substantial past work histories (n=190), those currently working full-time (n=247; median 40 h/week) had a shorter rTL, an age-adjusted difference of -329 bp (95% CI -110 to -548). Longer-duration full-time work was also associated with shorter rTL (age-adjusted difference of -472 bp, 95% CI -786 to -158 for 20+ vs 1-5 years). Findings were not explained by health and demographic covariates. However, rTL differences for working at least full-time were greater in women with higher stress and epinephrine levels.

CONCLUSIONS

Current and long-term full-time work were associated with shorter rTL, with differences of similar magnitude to smoking and history of heart disease or diabetes. Longitudinal data with specific stress measures are needed to further evaluate the impact of work schedule on rTL.

Medication therapy management: 10 years of experience in a large integrated health care system

BACKGROUND

Medication therapy management (MTM) was officially recognized by the federal government in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which requires Medicare Part D plans that offer prescription drug coverage to establish MTM programs (MTMPs) for eligible beneficiaries. Even though the term "MTM" was first used in 2003, pharmacists have provided similar services since the term "pharmaceutical care" was introduced in 1990. Fairview Health Services, a large integrated health care system, implemented a standardized pharmaceutical care service system in 1998, naming it a pharmaceutical care-based MTM practice in 2006.

OBJECTIVE

To present the clinical, economic, and humanistic outcomes of 10 years of delivering MTM services to patients in a health care delivery system.

METHODS

Data from MTM services provided to 9,068 patients and documented in electronic therapeutic records were retrospectively analyzed over the 10-year period from September 1998 to September 2008 in 1 health system with 48 primary care clinics. Patients eligible for MTM services were aged 21 years or older and either paid for MTM out of pocket or met their health care payer's criteria for MTM reimbursement; the criteria varied for Medicaid, Medicare, and commercially insured enrollees. All MTM was delivered face to face. Health data extracted from the electronic therapeutic record by the present study's investigators included patient demographics, medication list, medical conditions, drug therapy problems identified and addressed, change in clinical status, and pharmacist-estimated cost savings. The clinical status assessment was a comparison of the first and most recent MTM visit to measure whether the patient achieved the goals of therapy for each medical condition (e.g., the blood pressure of a patient with diabetes and hypertension will be less than 130/80 millimeters mercury [mmHg] in 1 month; the patient with allergic rhinitis will be relieved of his complaints of nasal congestion, runny nose, and eye itching within 5 days). Goals were set according to evidence-based literature and patient-specific targets determined cooperatively by pharmacists, patients, and physicians. Cost-savings calculations represented MTM pharmacists' estimates of medical services (e.g., office visits, laboratory services, urgent care visits, emergency room visits) and lost work time avoided by the intervention. All short-term (3-month) estimated health care savings that resulted from addressing drug therapy problems were analyzed. The expenses of these avoided services were calculated using the health system's contracted rates for services provided in the last quarter of 2008. The return on investment (ROI) was calculated by dividing the pharmacist-estimated savings by the cost of MTM services in 2008 (number of MTM encounters times the average cost of an MTM visit). The humanistic impact of MTM services was assessed using the results from the second patient satisfaction survey administered in 2008 (new patients seen from January through December 2008) for the health system's MTM program.

RESULTS

A total of 9,068 patient records were in the documentation system as of September 30, 2008. During the 10-year period, there were 33,706 documented encounters (mean 3.7 encounters per patient). Of 38,631 drug therapy problems identified and addressed by MTM pharmacists, the most frequent were a need for additional drug therapy (n = 10,870, 28.1%) and subtherapeutic dosage (n = 10,100, 26.1%). In the clinical status assessment of the 12,851 medical conditions in 4,849 patients who were not at goal when they enrolled in the program, 7,068 conditions (55.0%) improved, 2,956 (23.0%) were unchanged, and 2,827 (22.0%) worsened during the course of MTM services. Pharmacist-estimated cost savings to the health system over the 10-year period were $2,913,850 ($86 per encounter) and the total cost of MTM was $2,258,302 ($67 per encounter), for an estimated ROI of $1.29 per $1 in MTM administrative costs. In the patient satisfaction survey, 95.3% of respondents agreed or strongly agreed that their overall health and wellbeing had improved because of MTM.

CONCLUSION

Pharmacist estimates of the impact of an MTM program in a large integrated health care system suggest that the program was associated with improved clinical outcomes and cost savings. Patient satisfaction with the program was high.

Invisalign in TMD treatment

The objectives of functional orthodontic treatment include creating a broad smile, pleasing facial profile, and healthy, functional occlusions and temporomandibular joints. Removable orthodontic appliances have long been used in the treatment of some temporomandibular disorders. Invisalign aligners are removable orthodontic appliances. Certain TMJ case types can be treated successfully with Invisalign.

A framework for the concurrent consideration of occupational hazards and obesity

Occupational hazards and obesity can lead to extensive morbidity and mortality and put great financial burden on society. Historically, occupational hazards and obesity have been addressed as separate unrelated issues, but both are public health problems and there may be public health benefits from considering them together. This paper provides a framework for the concurrent consideration of occupational hazards and obesity. The framework consists of the following elements: (i) investigate the relationship between occupational hazards and obesity, (ii) explore the impact of occupational morbidity and mortality and obesity on workplace absence, disability, productivity and healthcare costs, (iii) assess the utility of the workplace as a venue for obesity prevention programs, (iv) promote a comprehensive approach to worker health and (v) identify and address the ethical, legal and social issues. Utilizing this framework may advance the efforts to address the major societal health problems of occupational hazards and obesity.

Clinical and public health assessment of benefits and risks of statins in primary prevention of coronary events: resolved and unresolved issues

Peer-reviewed, evidence-based recommendations for statin use in primary prevention of cardiovascular events are limited. A narrative review of published randomized controlled trials and meta-analyses was conducted to critically appraise the benefits and risks of statins in primary prevention. Statins effectively reduce plasma concentrations of low-density lipoprotein cholesterol, and reduce the risk of cardiovascular events and death. The greatest benefits are observed in high-risk subjects, such as patients with diabetes or hypertension. Serious cardiovascular events should not be included among serious adverse events because they are efficacy outcomes and are dependent on the baseline risk of patients. Rates of specific serious adverse events, such as cancer and rhabdomyolysis, seem to be similar between the statin and control arms of the clinical trials examined. Thus, the benefits of statins in primary prevention outweigh the risks, particularly among high-risk patients. However, the benefit-risk ratio would likely be optimized through interventions designed to increase persistence and adherence in a real-life setting.

Stenotic nasopharyngeal dysgenesis in the dachshund: seven cases (2002-2004)

Medical records of seven dachshunds with congenital nasopharyngeal stenosis from abnormally thickened palatopharyngeal muscles were reviewed. The intrapharyngeal ostium in all cases consisted of only a narrow slit. Dogs were presented with various clinical signs--the most common being dyspnea, expiratory cheek puff, salivation, pharyngeal dysphagia, oral dysphagia (to a lesser extent), and macroglossia. Diagnostic procedures included direct pharyngeal inspection, pharyngeal and thoracic radiography, fluoroscopy, lingual ultrasonography, biopsies in two dogs, and a postmortem examination in one dog. Diagnoses were readily made with radiographs and visual examinations. Macroglossia was confirmed with transcutaneous ultrasonography or a transmandibular finger test.

Magnetic resonance imaging findings of a metastatic chemodectoma in a dog

A 6-year-old, male, Collie-cross was presented with a non-weight bearing right thoracic limb lameness, right m. deltoideus, m. infraspinatus and m. supraspinatus atrophy, and severe neck pain with spasm of the cervical epaxial muscles. MRI revealed complete destruction of the 5th and 6th cervical vertebral bodies with lateral extradural spinal cord compression at the level of the 4th and 5th cervical vertebrae. These lesions were very clearly demonstrated on magnetic resonance images, while only subtle changes were seen on survey radiographs. Post mortem investigation revealed a large heart base chemodectoma with multiple smaller tumours in the cranial mediastinum and a single tumour nodule on the thoracic aorta. The 5th cervical vertebral body had necrotic, haemorrhagic and lytic changes. Histopathology of the heart base tumour, the nodules in the cranial mediastinum and on the thoracic aorta and samples from the 5th cervical vertebra confirmed the presence of a malignant aortic or carotid body tumour originating from the chemoreceptor organs. Diagnostic imaging features and post mortem findings are described. To our knowledge, this is the first report of the magnetic resonance features of a metastatic chemodectoma in a dog.

Changes in echocardiographic variables of left ventricular size and function in a model of canine normovolemic anemia

The objective of this study was to document changes in echocardiographic variables of left ventricular size and function noninvasively during acute normovolemic anemia. This model was developed as a pilot study with the purpose of providing baseline information to investigate the pathophysiology, and more specifically the effect on the heart, of canine babesiosis-induced anemia. The study group comprised of 11 mature healthy Beagle dogs that weighed between 9 and 15 kg. Severe normovolemic anemia was induced over a 3-4-day period by serial bleeding while maintaining normovolemia by autotransfusing plasma and infusing crystalloids. The dogs were then allowed to recover. Preanemic (mean Hct 46.7%, standard deviation [SD] 2.4%) echocardiographic variables of left ventricular performance (Fractional shortening, ejection fraction, end-systolic and end-diastolic ventricular volumes, cardiac index, and heart rate) were compared with those in the severely (mean Hct 15.3%, SD 1.1%), moderately (Hct mean 24.7%, SD 1.5%), and mildly (mean Hct 33.5%, SD 2.5%) anemic states, and between the anemic states. With the exception of end diastolic volume, there was a statistically significant (P < 0.05) increase in all variables in the severely anemic state vs. the preanemic and the mild and moderate anemic states. In concordance with previous invasive models, a hyperdynamic state of the left ventricle develops in response to experimentally induced acute canine normovolemic anemia in the conscious dog. Echocardiography has promise as a noninvasive technique of evaluating the cardiac changes in dogs having canine babesiosis.

Aging, stress and the hippocampus

Functional loss often occurs in many body systems (e.g., endocrine, cognitive, motor) with the passage of years, but there is great individual variation in the degree of compromise shown. The current focus on brain aging will continue because demographic trends indicate that the average lifespan will show a continued increase. There is increasing emphasis on understanding how aging contributes to a decline in brain functions, cognition being a prime example. This is due in part to the fact that dementias and other losses in brain function that sometimes accompany aging cause an obvious decline in the quality of life and these deficits are of more concern as the number of elderly increase. Stress also is a ubiquitous aspect of life and there is now a greater interest in understanding the role of stress and the stress response in brain aging. The key role of the hippocampus and its related brain structures in cognition, as well as in the feedback control of the response to stress, have made this brain area a logical focus of investigation for those interested in the impact of stress on brain aging. Here, we describe how the hippocampus changes with age and we examine the idea that age-related changes in the secretion patterns of the hypothalamic-pituitary adrenal (HPA) axis can contribute to aging of this structure. We also examine the proposal that stress, perhaps due to compromised HPA axis function, can contribute to hippocampal aging through exposure to excessive levels of glucocorticoids. The aging hippocampus does not appear to suffer a generalized loss of cells or synapses, although atrophy of the structure may occur in humans. Thus, age-related cognitive impairments are likely related to other neurobiological alterations that could include changes in the signaling, information encoding, plasticity, electrophysiological or neurochemical properties of neurons or glia. Although excessive levels of glucocorticoids are able to interfere with cognition, as well as hippocampal neuronal integrity, and aging is sometimes accompanied by an increase in these steroids because of inadequate feedback control of the HPA axis, none of these are a foregone consequence of aging. The general preservation of cells and the plastic potential of the hippocampus provide a focus for the development of pharmacological, nutritive or lifestyle strategies to combat age-related declines in the hippocampus as well as other brain areas.

Effects of aging and stress on hippocampal structure and function

Aging is often simply defined as the decline in various body systems and functions (eg, endocrine, cognitive, motor, etc) that occur with the passage of time, although the degree of deterioration can vary greatly across individuals. Increases in average life span have brought a greater focus on brain aging. There is an emphasis on understanding how aging contributes to a decline in brain functions (eg, cognition) because such a decline adversely affects the quality of life. The hippocampus is a key brain structure for cognition and the feedback control of the stress response. Herein we describe how the hippocampus changes with age and we examine the idea that age-related changes in the secretory patterns of the hypothalamic-pituitary adrenal (HPA) axis can contribute to hippocampal aging. We also examine the proposal that cumulative stress, perhaps due to compromised HPA axis function, can contribute to hippocampal aging by subjecting it to exposure to excessive levels of glucocorticoids. The aging hippocampus does not appear to suffer a generalized loss of cells or synapses, although atrophy of the structure may occur in humans. Thus, age-related cognitive impairments are likely related to other neurobiological alterations that could include changes in the signaling, information encoding, and plastic, electrophysiological, or neurochemical properties of neurons or glia. Dysfunction of the HPA axis sometimes occurs with aging, and while excessive glucocorticoids can disrupt cognition as well as hippocampal neuronal integrity, these are not an inevitable consequence of aging. The general preservation of cells and the plastic potential of the hippocampus provide a focus for the development of pharmacological, nutritional, or life-style strategies to combat age-related declines.

Nested reciprocities: the organism-environment system in perception-action and development

The ecological approach to studying perception and action is one in which researchers view the structure in ambient energy arrays surrounding a given organism as being sufficient to specify meaningful environmental properties to that organism. Thus, from this perspective, perception is viewed not as a cognitive achievement but as a lawful state of affairs that exists in an organism-environment system. The approach to studying development known as transactionalism is one in which researchers view the developmental process as the expression of a complex web of endogenous and exogenous factors. Thus, from this perspective, development is not an unfolding of a genetic program, but rather an ongoing exchange among levels of the organism-environment system that continues throughout the life span of the organism. Despite their independent development, these two meta-theoretical approaches have much in common. In each approach, the organism-environment system is the fundamental unit of analysis, and the development of perception and behavior is spread across the multiple levels of this system.

Quantification of regional glial fibrillary acidic protein levels in Alzheimer's disease

OBJECTIVES

Our objectives were to quantify glial fibrillary acidic protein (GFAP) in brains of Alzheimer's disease (AD) cases, and non-AD controls to determine the regions with the most severe gliosis in AD.

MATERIAL AND METHODS

In a case control design, we used an enzyme-linked immunosorbent assay (ELISA) to quantify GFAP in frozen brain from four areas of neocortex in 10 AD cases, 10 age-matched controls, and 10 younger controls from the Honolulu-Asia Aging Study autopsy archive.

RESULTS

Median age at death was 83.5 years for cases and age-matched controls, and 77 years for younger controls. For the AD cases compared with the age-matched controls, levels of GFAP in occipital (P=0.01), parietal (P=0.028), and temporal lobes (P=0.004) (but not frontal) were significantly higher in the cases. The median GFAP excess in AD cases compared with age matched controls was highest in the temporal lobe.

CONCLUSIONS

Regional quantification of GFAP reveals that the glial response is most prominent in the temporal lobe in AD.

Obesity exacerbates chemically induced neurodegeneration

Obesity is a major risk factor associated with a variety of human disorders. While its involvement in disorders such as diabetes, coronary heart disease and cancer have been well characterized, it remains to be determined if obesity has a detrimental effect on the nervous system. To address this issue we determined whether obesity serves as a risk factor for neurotoxicity. Model neurotoxicants, methamphetamine (METH) and kainic acid (KA), which are known to cause selective neurodegeneration of anatomically distinct areas of the brain, were evaluated using an animal model of obesity, the ob/ob mouse. Administration of METH and KA resulted in mortality among ob/ob mice but not among their lean littermates. While METH caused dopaminergic nerve terminal degeneration as indicated by decreased striatal dopamine (49%) and tyrosine hydroxylase protein (68%), as well as an increase in glial fibrillary acidic protein by 313% in the lean mice, these effects were exacerbated under the obese condition (96%, 86% and 602%, respectively). Similarly, a dosage of KA that did not increase glial fibrillary acidic protein in lean mice increased the hippocampal content of this protein (93%) in ob/ob mice. KA treatment resulted in extensive neuronal degeneration as determined by Fluoro-Jade B staining, decreased hippocampal microtubule-associated protein-2 immunoreactivity and increased reactive gliosis in ob/ob mice. The neurotoxic outcome in ob/ob mice remained exacerbated even when lean and ob/ob mice were dosed with METH or KA based only on a lean body mass. Administration of METH or KA resulted in up-regulation of the mitochondrial uncoupling protein-2 to a greater extent in the ob/ob mice, an effect known to reduce ATP yield and facilitate oxidative stress and mitochondrial dysfunction. These events may underlie the enhanced neurotoxicity seen in the obese mice. In summary, our results implicate obesity as a risk factor associated with chemical- and possibly disease-induced neurodegeneration.

Chemically induced neuronal damage and gliosis: enhanced expression of the proinflammatory chemokine, monocyte chemoattractant protein (MCP)-1, without a corresponding increase in proinflammatory cytokines(1)

Enhanced expression of proinflammatory cytokines and chemokines has long been linked to neuronal and glial responses to brain injury. Indeed, inflammation in the brain has been associated with damage that stems from conditions as diverse as infection, multiple sclerosis, trauma, and excitotoxicity. In many of these brain injuries, disruption of the blood-brain barrier (BBB) may allow entry of blood-borne factors that contribute to, or serve as the basis of, brain inflammatory responses. Administration of trimethyltin (TMT) to the rat results in loss of hippocampal neurons and an ensuing gliosis without BBB compromise. We used the TMT damage model to discover the proinflammatory cytokines and chemokines that are expressed in response to neuronal injury. TMT caused pyramidal cell damage within 3 days and a substantial loss of these neurons by 21 days post dosing. Marked microglial activation and astrogliosis were evident over the same time period. The BBB remained intact despite the presence of multiple indicators of TMT-induced neuropathology. TMT caused large increases in whole hippocampal-derived monocyte chemoattractant protein (MCP)-1 mRNA (1,000%) by day 3 and in MCP-1 (300%) by day 7. The mRNA levels for tumor necrosis factor (TNF)-alpha, interleukin (IL)-1beta and IL-6, cytokines normally expressed during the earliest stage of inflammation, were not increased up to 21 days post dosing. Lipopolysaccharide, used as a positive control, caused large inductions of cytokine mRNA in liver, as well as an increase in IL-1beta in hippocampus, but it did not result in the induction of astrogliosis. The data suggest that enhanced expression of the proinflammatory cytokines, TNF-alpha, IL-1beta and IL-6, is not required for neuronal and glial responses to injury and that MCP-1 may serve a signaling function in the damaged CNS that is distinct from its role in proinflammatory events.