Periodontal disease and incident diabetes: a seven-year study

Diabetes is associated with a high prevalence of periodontal disease, but little is known about the effects of periodontal disease on incident diabetes. In total, 5848 non-diabetic individuals aged 30-59 yrs who completed a health examination were analyzed in this study. They were divided into three categories: no pathological pockets, moderate periodontitis, or severe periodontitis. Incident diabetes was defined as newly diagnosed cases with fasting plasma glucose > 125 mg/dL. Cox proportional hazards models estimated the effect of periodontitis on incident diabetes during a seven-year follow-up period. Moderate and severe periodontitis was significantly associated with an increased risk of diabetes in unadjusted analyses, but the magnitude of the association decreased after full adjustment [hazard ratio (HR) = 1.00, 95% confidence interval (95% CI) = 0.77-1.30 and HR = 1.28, 95% CI = 0.89-1.86, respectively]. Our findings do not indicate an apparent association between periodontitis and incident diabetes, although there was a tendency for increased risk.

Cross-sectional study on respiratory effect of toner-exposed work in manufacturing plants, Japan: pulmonary function, blood cells, and biochemical markers

The aim of the study is to examine the relationship between toner-exposed work and health indices related to respiratory disorders and to confirm the baseline of a cohort study to clarify the effect of toner exposure in manufacturing plants. Subjects were 1614 male workers (809 toner-exposed workers and 805 referents) who were engaged in toner manufacturing plants in Japan (Fuji Xerox Co., Ltd). The age of subjects was from 19 to 59 years, and the average age was 40.2 years(median 40 years, SD 7.67). We conducted a pulmonary function test (PEFR, VC, FVC, FEV(1.0)%, V25/Ht) and a blood cell test (RBC, Hb, Hct, Plt, WBC, cell contents of WBC) and measured biochemical indices in blood (ALT, AST, gamma-GTP, CRP, IgE) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) in urine. Student t-test and logistic regression analysis were applied to compare between the toner-exposed workers and the referents and to analyze the relationship among indices of effects and independent factors. There was no significant difference between the two groups in blood cell count and biochemical indices. Inflammation- and allergy-related markers such as 8OHdG and IgE also showed no significant difference between toner-exposed workers and the referents. The influence of smoking on pulmonary function indices was observed, but there was no relationship between the pulmonary function and toner-exposed work. In this article, we report a preliminary cross-sectional analysis in the subjects of a cohort study. No difference in pulmonary function indices was observed between the toner-exposed workers and the referents, and there was no consistent relationship between the exposure status and examined indices; however, the prevalence of subjective respiratory symptoms was higher in the exposed workers as presented in another report. Further analysis is important in the ongoing cohort study to clarify the effect of toner exposure on respiratory systems.

The Effects of Smoking on Dental Care Utilization and Its Costs in Japan

Smoking has been established as an important risk factor for periodontal disease and tooth loss. The purpose of this study was a prospective evaluation of the effects of smoking on dental care utilization and its costs, based on data from 5712 males aged 20–59 yrs. Age, dental health behavior, and history of diabetes were adjusted in a multivariate analysis. Current smokers accrued 14% higher dental care costs than never-smokers over a five-year period. This difference in annual dental care costs was mainly attributable to the increased percentage of participants in the ‘higher dental care cost’ category among current smokers. There was no clear trend identified for the dose-dependent effects of smoking on dental care utilization and its costs. Past smokers incurred lower dental care costs compared with current smokers. Smoking may have played a key role in the increment of dental care utilization and its costs via deterioration in oral conditions.

Cigarette smoking, alcohol drinking, and oral and pharyngeal cancer mortality in Japan

OBJECTIVES

To prospectively examine the association of cigarette smoking and alcohol drinking with oral and pharyngeal carcinogenesis, we analyzed data from a nation-wide large-scale cohort study in Japan.

METHODS

A total of 34 136 men and 43 711 women aged 40-79 years were included in the study. The Cox proportional hazard model was used to estimate the relative risk (RR) and 95% confidence interval (95% CI) of oral and pharyngeal cancer for smoking and drinking by sex, while adjusting for age, consumption of green tea, preference for salty foods, and consumption of green yellow vegetables.

RESULTS

Current smokers were found to have a higher risk of death caused by oral and pharyngeal cancer compared with non-smokers in both sexes: the RR was 2.6 (95% CI: 1.0-6.7) in men and 8.2 (95% CI: 2.1-32.1) in women. Men who drank more than 46 g ethanol per day had an approximately threefold increased risk of oral and pharyngeal cancer. Simultaneous exposure to both factors was significantly associated with an elevated risk of oral and pharyngeal cancer (RR: 3.3, 95% CI: 1.1-9.6).

CONCLUSIONS

The result supports the carcinogenic effect of cigarette smoking and alcohol drinking on the oral cavity and pharynx.

Oral Symptoms Predict Mortality: a Prospective Study in Japan

Several studies have reported positive associations between oral infections and systemic diseases. The purpose of the present study was to evaluate the effects of oral symptoms on mortality from cardiovascular disease (CVD) and pneumonia. Using data from a cohort study in Japan, we analyzed 4,139 individuals aged 40–79 years. The baseline questionnaire included the following items related to oral symptoms: ‘sensitive teeth’, ‘difficulty in chewing tough food substances’, ‘bleeding gums’, and ‘mouth feels sticky’. We used the Cox proportional hazard model to estimate hazard ratios (HRs) and 95% confidence intervals (95%CIs) for mortality, after adjustments for lifestyle, socio-economic factors, and history of diseases. Persons complaining that their ‘mouth feels sticky’ had a two-fold higher risk of pneumonia (HR = 2.1; 95%CI, 1.2–3.6), while those complaining of ‘sensitive teeth’ had a lower risk of CVD (HR = 0.4; 95%CI, 0.2–0.9). Some oral symptoms may be predictors of mortality from pneumonia and CVD.

Development of a shortened Japanese version of the Oral Health Impact Profile (OHIP) for young and middle-aged adults

OBJECTIVE

The aim of this paper is to develop a short version of the Japanese OHIP (OHIP-J) appropriate for use in young and middle-aged adults, and to evaluate its properties using cross-sectional data.

METHOD

A study population of 8,658 workers aged 20-59 years rated their oral health by means of a self-administered questionnaire. Using a factor analysis approach, a shortened version of OHIP-J was derived. Internal consistency, floor effect, and construct validity were determined.

RESULTS

We derived a subset of 18 items from OHIP-J (OHIP-JA18), grouped into four subscales: "functional limitation", "physical pain", "psychological discomfort", and "disability & handicap". All four subscales had acceptable internal consistency (Cronbach alpha > 0.79). OHIP-JA18 demonstrated an acceptable floor effect, which was determined by the proportion of subjects who obtained a 0 score (< 30%); however, the floor effect of the ordinary shortened version based on OHIP-14 (OHIP-J14) was not acceptable. We confirmed the conceptual framework of OHIP-JA18 that "disability & handicap" is affected by "functional limitation", "physical pain" and "psychological discomfort", because the model fitted the data moderately well by structural equation modeling (SEM) analysis (GFI = 0.90, RMSEA = 0.08).

CONCLUSIONS

OHIP-JA18 demonstrated acceptable measurement parameters to justify its use in outcome assessment for oral health related quality of life (OHQOL) in young and middle-aged adults in Japanese workers. Further studies will be needed to evaluate an intervention such as worksite health promotion.

Chromosomal congenital anomalies and residence near hazardous waste landfill sites

Previous findings of the EUROHAZCON study showed a 33% increase in risk of non-chromosomal anomalies near hazardous waste landfill sites. Here, we studied 245 cases of chromosomal anomalies and 2412 controls who lived near 23 such sites in Europe. After adjustment for confounding by maternal age and socioeconomic status, we noted a higher risk of chromosomal anomalies in people who lived close to sites (0-3 km) than in those who lived further away (3-7 km; odds ratio 1.41, 95% CI 1.00-1.99). Our results suggest an increase in risk of chromosomal anomalies similar to that found for non-chromosomal anomalies.

Evaluation of oral health promotion in the workplace: the effects on dental care costs and frequency of dental visits

An oral health promotion program has been conducted since 1989 at a shipyard in Japan.

AIMS

The purpose of the present study was to assess the impact of oral health promotion in the workplace in terms of dental care costs and frequency of dental visits.

METHODS

This program consisted of orientation, an initial regimen, and group counseling. The initial regimen included an evaluation of each participant's oral health status, and instruction concerning oral hygiene, and prevention of oral disease. The participants were selected with each unit being a preexisting peer group. Eighty-seven participants were compared with 216 control subjects in terms of annual dental care costs and frequency of dental visits in four periods: the 1-year period before the program, the 1st year after the program, the 2nd year after, and the 3rd year after.

RESULTS

The annual mean dental care cost in the participant group for the year prior to the program was higher than that in the control group (21,317 vs. 17,116 yen). In the 1st year after the program, the difference increased (26,642 vs. 19,481 yen). In the 2nd and 3rd years after the program, dental care costs in the participant group were lower than those in the control group (2nd year: 18,305 vs. 22,841 yen, 3rd year: 16,911 vs. 21,920 yen).

CONCLUSIONS

It can be concluded that this oral health promotion program in the workplace contributed to saving of costs associated with dental care. The workplace can be regarded as a key area for implementation of an oral health care system to make good use of limited resources.

[Pathogenesis mechanism in ear fullness in otosclerosis]

To clarify the mechanism underlying ear fullness in otosclerosis, we studied the relationship between clinical features and examinations. Subjects were 116 otosclerosis patients (140 ears). The presence or absence of ear fullness was judged from a questionnaire in initial diagnosis or a chart description. Ear fullness was observed in 44 ears (31%) and absent in 96. The averaged air and bone conduction hearing levels (500 Hz-4 k Hz) in initial diagnosis were significantly lower in the group with ear fullness. The difference in averaged hearing was mainly apparent at 2 k Hz and 4 k Hz. The difference in hearing at lower frequencies (125 Hz, 250 Hz, and 500 Hz) and higher frequencies (2 k Hz, 4 k Hz, and 8 k Hz) was significantly larger in the group of ear fullness. From these results, we postulated that ear fullness in otosclerosis is caused by fixation of the stapes. The psychoacoustic abnormal sensation caused by lower input of lower-frequency sound or incomplete fixation of the stapes may cause ear fullness. Further study is needed to clarify the pathogenesis of ear fullness in different ear pathologies.

[Epidural abscess associated with epidural block in a patient with immunosuppressive disease]

A patient with myeloproliferative disorders and diabetes mellitus received epidural block twice for treatment of the low back and leg pain. The drugs used were 1% mepivacaine 4 ml for the first and 1% mepivacaine 6 ml and dexamethazone 4 mg for the second on the next day. Epidural abscess was noticed 2 days later when pus was aspirated through a block needle. MRI revealed the abscess localized at L5/S1. Intensive treatment including epidural drainage and antibiotics succeeded in healing the abscess. Use of epidural block for immunocompromized patients should be decided carefully.

[Effect of controlled hypotension induced by prostaglandin E1 on evoked spinal cord potential and spinal cord blood flow]

We evaluated the effect of controlled hypotension induced by PGE1 on evoked spinal cord potential (ESCP) and spinal cord blood flow (SCBF) in 14 patients undergoing laminectomy or laminoplasty. They were divided into two groups: hypotensive group (group H), non-hypotensive group (group N). Controlled hypotension was induced with PGE1 to maintain mean arterial blood pressure at 55-60 mmHg for 45 min. The amplitude and latency of the N 1 potential were analyzed, and the SCBF was estimated by laser doppler flowmeter. There were no significant differences in ESCP and SCBF. These results suggest that controlled hypotension by PGE1 maintained normal local spinal cord blood flow autoregulation.

[Effect of worksite dental health program on periodontal status--evaluation by CPITN and bleeding on probing at each tooth]

A dental health promotion program which aimed to prevent periodontal disease was carried out at a shipyard in Nagasaki Prefecture. Repeated tooth cleaning instruction and prophylaxis were conducted in order to adopt proper oral hygiene habits. The first 3 months of this program included 'Initial instruction,' and 'Regular instruction' were given every 6 months in following 2 years. The oral examination was carried out before and after Initial instruction, and at each Regular instruction. The effect of this program was evaluated by 2 measures: CPITN and Bleeding on probing. After this program, the rate of teeth with pockets 4 -5 mm deep or deeper (CPITN 3, 4) was decreased. In contrast, the rate of teeth with no sign of periodontal disease (CPITN 0) was increased remarkably: the percentage increased from 8% preinitial instruction to 40% with regular instruction. Both the rate and grade of teeth with bleeding on probing were decreased. These results indicated that this program was helpful in improving the periodontal status. CPITN and Bleeding on probing at each tooth as an evaluation measure made our analysis more detailed.

Effects of hemodilution during controlled hypotension of hepatic, renal, and pancreatic function in humans

STUDY OBJECTIVE

To evaluate the effects of hemodilution during controlled hypotension on, the hepatic renal, and pancreatic function in the clinical setting.

DESIGN

Randomized, prospective study.

SETTING

Inpatient surgery at Rosai Hospital.

PATIENTS

20 ASN status I and II patients scheduled for total hip arthroplasty.

INTERVENTIONS

Hemodilution was carried out after induction of anesthesia, in which drawn blood was replaced with dextran solution to achieve final hematocrit (Hct) of 31% Group A = mild hemodilution group, N = 10) or 23% (Group B = moderate hemodilution group, N = 10). In both groups, controlled hypotension was induced with prostaglandin in (PGE1) to maintain mean arterial blood pressure at 55 mm Hg for 80 minutes.

MEASUREMENTS AND MAIN RESULTS

Measurements included arterial ketone body ratio AKBR, aceto-acetate/3-hydroxybutyrate) for hepatic cellular function, pancreatic phospholipase A2 (P-PLA2) for pancreatic cellular function, and urine N-acetyl-beta-D-glucosaminidase (NAG index) for cellular function of the renal tubule. These indices were measured before hemodilution, after hemodilution, 80 minutes after starting hypotension, 60 minutes after recovery of normotension, and on the first postoperative day. Neither AKBR nor P-PLA2 showed a significant change throughout the time course of the study in either group. Urine-NAG index showed a significant increase in moderate hemodilution group at 60 minutes after recovery of normotension (+ 136%) and on the first postoperative lay (+ 149%) compared with prehemodilution value, whereas it showed no significant change in the mild hemodilution group. Blood urea nitrogen and serum creatinine measured postoperatively were within normal range.

CONCLUSIONS

PGE1 induced hypotension combined with moderate hemodilution using dextran, such as 23% of Net value maintains hepatic and pancreatic function but causes damage to the renal tubular cells.

The natural history of Down syndrome conceptuses diagnosed prenatally that are not electively terminated

The pregnancy outcomes on cases of Down syndrome diagnosed prenatally in which the mother did not elect termination were evaluated in data reported to a comprehensive Register of Down syndrome for England and Wales for 1989-94. In the 168 cases in which placental biopsy was not used, the overall rate of spontaneous loss was 35%, but this figure masks considerable heterogeneity by gestational stage at ascertainment. Data on ages at diagnostic procedure and on pregnancy termination enabled a more precise survival analysis. The loss rates were approximately 50% for those fetuses ascertained at 15-17 completed wk, 43% at 18 wk, 31% at 19 wk, 25% at 20 wk, and then a leveling off at approximately 20%-25% for fetuses ascertained at 21-28 completed wk. For fetuses ascertained prior to 18 wk, there was no evidence that maternal age was associated with fetal loss, consistent with earlier reports. At 18 wk and after, however, maternal age was on the average approximately 3 years greater in fetuses that were lost. Comparison of successive gestational birth cohorts provided no evidence in these 168 cases that the diagnostic procedure itself had any effect on loss or that selective ascertainment of mothers in risk of loss had any effect on the results. In contrast, in the 21 cases in which placental biopsy had been undertaken, the overall loss rates were not only higher when appropriate comparisons could be made, but there was some evidence for selective ascertainment and/or procedure-associated losses.(ABSTRACT TRUNCATED AT 250 WORDS)

Down's syndrome births and pregnancy terminations in 1989 to 1993: preliminary findings

OBJECTIVE

To investigate changes in the numbers of Down's syndrome births and terminations of pregnancies from 1989 to 1993.

DESIGN

Data from a national register of cytogenetic diagnoses of karyotypes associated with Down's syndrome were analysed to obtain observed numbers of births and terminations of pregnancies known to be affected. Allowance was made for those cases diagnosed prenatally for whom the eventual outcome of the pregnancies had not yet been ascertained.

RESULTS

There has been an increase over the study years in the number of cytogenetic diagnoses of Down's syndrome from 1063 in 1989 to 1137 in 1993, despite an overall fall in births in England and Wales. This is largely due to the increase in antenatal screening and diagnosis, but in part also due to the rise in numbers of pregnancies at increased maternal ages. The rise in prenatally diagnosed cases, of which 92% end in termination, has been accompanied by a fall in both the estimated numbers of affected live births, from 764 in 1989 to 615 in 1993, and the rate per 1000 total live births in the same years from 1.1 to 0.9.

CONCLUSIONS

Better and speedier information on the outcome of prenatally diagnosed cases of congenital anomalies such as Down's syndrome would improve the quality of information available for those auditing genetic services or those planning for the care of survivors.

Thiazolidine derivatives ameliorate high glucose-induced insulin resistance via the normalization of protein-tyrosine phosphatase activities

The mechanisms for the insulin resistance induced by hyperglycemia were investigated by studying the effect of high glucose concentration (HG) and its modulation by thiazolidine derivatives, on insulin signaling using Rat 1 fibroblasts expressing human insulin receptors (HIRc). Incubating HIRc cells in 27 mM D-glucose for 4 days impaired the insulin-stimulated phosphorylation of pp185 and receptor beta-subunits. Both protein kinase C activities and phorbol dibutyrate binding to intact cells were unchanged; however, cytosolic protein-tyrosine phosphatase (PTPase) activity increased within 1 h prior to the impairment of insulin receptor kinase in HG cells (Maegawa, H., Tachikawa-Ide, R., Ugi, S., Iwanishi, M., Egawa, K., Kikkawa, R., Shigeta, Y., and Kashiwagi, A. (1993) Biochem. Biophys. Res. Commun. 197, 1078-1082). Increased PTPase activity was consistent with a 2-fold increase in the amount of PTP1B, and anti-PTP1B antibody inhibited this increment of cytosolic PTPase activity in HG cells. Co-incubating cells with pioglitazone prevented these abnormalities in cytosolic PTPase, the PTP1B content and the impaired phosphorylation of pp185 and receptor beta subunits in HG cells. Finally, HG cells had impaired insulin-stimulated alpha-amino-isobutyric acid uptake, which was ameliorated by exposure to thiazolidine derivatives. In conclusion, exposing cells to high glucose levels desensitizes insulin receptor function, and thiazolidine derivatives can reverse the process via the normalization of cytosolic PTPase, but not of protein kinase C.

High glucose condition desensitizes insulin action at the levels of receptor kinase

The mechanisms for the insulin resistance induced by hyperglycemia were investigated by studying the in vitro effects of a high glucose concentration on insulin signaling with Rat 1 fibroblasts expressing human insulin receptors (HIRc). Incubation of HIRc cells for 4 days in 27 mM D-glucose led to impaired insulin-stimulation of both alpha-aminoisobutyric acid uptake (AIB) and phosphorylation of pp185 and receptor beta-subunits in vivo. In vitro autophosphorylation and tyrosine kinase activities toward poly Glu80 Tyr20 of insulin receptors from cells exposed to high glucose media (HG) were also impaired (46-48% of control), although the binding of insulin to HG cells was unchanged. One possible explanation for these high glucose effects is that they are mediated by the activation of protein kinase C (PKC). However, a 4-day-high glucose culture had no effect on cytosolic and membrane PKC activities or on phorbol dibutyrate binding to whole cells. This is in accordance with the orthophosphate labeling study, in which basal autophosphorylation activity in HG cells did not increase, suggesting that phosphorylation of serine and threonine residues in the basal state might not increase in HG cells. These results indicate that in cells exposed to high glucose, desensitization of insulin receptors was induced via several intracellular events, but might not be due to persistent activation of PKC in HIRc cells.

Monitoring trends in prenatal diagnosis of Down's syndrome in England and Wales, 1989-92

The national register of chromosomal anomalies that lead to Down's syndrome has enabled the monitoring of change in prenatal diagnosis for this condition, and the factors which affect the change. The proportion of cases of cytogenetically diagnosed Down's syndrome in England and Wales detected prenatally rose to 46% in 1991-2 from 31% in 1988-9, a 1.5-fold increase (95% confidence interval 1.3 to 1.7). The increase was confined to mothers under 40 years and was due to the introduction of screening by maternal serum analysis and ultrasound. Over a quarter of affected pregnancies in women aged 25-29 were detected prenatally in 1991-2 compared with less than 10% in 1988-9. Analysis of the data showed regional differences in prenatal diagnosis rates, and in the length of time elapsing between the diagnostic test and termination of an affected pregnancy. An inexplicable finding was that this period varied with the sex of the fetus, being on average a day longer for females than for males.

High glucose condition activates protein tyrosine phosphatases and deactivates insulin receptor function in insulin-sensitive rat 1 fibroblasts

To investigate the mechanism for the impairment of insulin receptor kinase activity induced by high glucose (HG) in Rat 1 fibroblasts that expressed human insulin receptors (HIRc), we measured protein tyrosine phosphatase (PTPase) activity in HG cells. Incubating HIRc cells for 4 days in 27 mM D-glucose (HG) stimulated cytosolic PTPase activities, but not particulate PTPase activity as determined by two methods using the dephosphorylation of insulin receptors. Furthermore, PTP1B, a major non-transmembrane PTPase in the cytosolic fraction, was increased in HG cells according to Western blots. These results indicate that desensitization of insulin receptor function by a high glucose condition is associated with the activation of PTPase activity.

Results of first year (1989) of a national register of Down's syndrome in England and Wales

OBJECTIVE

To examine the feasibility of a national register of Down's syndrome and its effectiveness in evaluating prenatal screening for the syndrome.

DESIGN

Information for the register was obtained from all eligible cytogenetic laboratories on relevant cytogenetic diagnoses, including date and place of birth or termination, maternal age, indication for karyotyping, and type of diagnostic test used.

SETTING

Cytogenetic laboratories in England and Wales.

SUBJECTS

All fetuses with trisomy 21 diagnosed prenatally and live births with Down's syndrome diagnosed at birth.

MAIN OUTCOME MEASURES

Number of prenatal and postnatal diagnoses of Down's syndrome. National and maternal age specific prevalence of Down's syndrome.

RESULTS

For 1989 there were 1060 registrations--323 prenatal diagnoses and 737 postnatal diagnoses--after exclusion of postnatally diagnosed miscarriages and stillbirths. The estimated national rate of affected births for mothers resident in England and Wales was 1.4/1000 live births, assuming no terminations of affected pregnancies and after correction for natural losses which would have occurred in the absence of termination. The corrected maternal age specific rates were close to those found in previous population based studies. The proportion of affected pregnancies diagnosed prenatally in mothers aged 35 to 39 was 44%, and for those aged 40 or more it was 71%. Abnormal findings on ultrasonography played an unexpectedly important part in initiating cytogenetic investigation (13% of the prenatal diagnoses).

CONCLUSIONS

The findings establish the feasibility of a national Down's syndrome register and its use in evaluating prenatal screening services. Together with information held by the Office of Population Censuses and Surveys on congenital malformations, data from the register will permit studies of environmental variables affecting the prevalence of the syndrome.