Assessing treatment outcomes in two temporomandibular disorder diagnostic categories employing a validated psychometric test.

This study measures the effects of treatment interventions on two classes of temporomandibular disorder (TMD) patients in a dental practice in Ottawa, Canada. Other studies of TMD treatment outcome have employed subjective, largely qualitative and nonquantitative measures of symptom levels to make this type of assessment, rendering such research largely incapable of being replicated. The current study employs the TMJ Scale, a validated and psychometrically-developed symptom inventory, to measure symptom levels before and after treatment.

The psychological effects of multifetal pregnancy reduction.

Objective: To study the psychological effects of multifetal pregnancy reduction.

Design And Setting: Hour-long semistructured telephone interviews with both multifetal pregnancy reduction patients and control subjects.

Patients: Forty-two multifetal pregnancy reduction patients were contacted within 1 year of undergoing the procedure.

Educating preschoolers about sun safety.

Objectives: This feasibility study examined whether a sun safety curriculum designed for and administered to preschoolers affects their cognition (knowledge, comprehension, application) regarding sun safety.

Methods: Twelve classes of 4- to 5-year-olds were recruited from local preschools and randomly assigned to an intervention group or a control group. The intervention group received an investigator-developed sun safety curriculum; the control group did not.

[Treatment of dislocations of the cervical vertebrae in so-called "whiplash injuries"].

It is estimated that between 15 and 30% of car occupants will suffer neck pain after accidents, and many will remain symptomatic for a prolonged period. This has often been attributed to the effect of associated litigation as a financial deterrent to recovery. Conventional treatment uses an old orthopaedic principle of rest until the symptoms resolve and analgesia is widely accepted, although its use is unlikely to influence the ultimate outcome.

Differential expression of GAP-43 mRNA in adult central cholinergic neuronal populations.

The present study addresses a question of differential expression for a 'plasticity' gene within neurons identified by neurotransmitter type. A method combining immunohistochemical localization of choline acetyltransferase (ChAT) with in situ hybridization histochemistry (ISHH) in the same brain sections was used to quantitate the levels of mRNA for the growth-associated protein GAP-43 (neuromodulin) in rat central cholinergic neuronal populations. We found that many cholinergic neurons in the adult rat brain express levels of GAP-43 mRNA comparable to other brain regions noted for their expression of this plasticity gene.

Nitric oxide synthase gene expression in cholinergic neurons in the rat brain examined by combined immunocytochemistry and in situ hybridization histochemistry.

The expression of mRNA for the calmodulin-dependent form of brain nitric oxide synthase (NOS) was examined in cholinergic cells of the rat brain using a method combining in situ hybridization histochemistry with immunocytochemistry for choline acetyltransferase (ChAT) in the same brain sections. We constructed a riboprobe specific for brain NOS by subcloning a 493 bp fragment of the coding region which displayed low homology to other forms of NOS. The general distribution of NOS mRNA was in excellent agreement with previous studies using the full-length probe or NADPH diaphorase histochemistry.

Validating the TMJ scale in a national sample of 10,000 patients: demographic and epidemiologic characteristics.

The accuracy and reliability of the TMJ Scale were originally determined in cross-validation studies on large, research-based patient samples. It had been assumed that the demographic characteristics and test responses of these research-based samples would be representative of the clinical population in which the TMJ Scale would ultimately find use. The present study on more than 10,000 patients that were evaluated for temporomandibular disorders in clinical practice demonstrates that the test scores, demographic variables, and the patterns of symptom severity that characterize the original TMJ Scale research sample accurately represent the general temporomandibular disorder patient population in which the TMJ Scale is now being used.

Appropriate use of predictive values in clinical decision making and evaluating diagnostic tests for TMD.

Temporomandibular disorder literature contains serious misunderstandings and misapplications of statistical concepts, including predictive values, in evaluating diagnostic modalities and in clinical decision making. The use of general population prevalence data for temporomandibular disorders to evaluate positive predictive values of diagnostic modalities is shown to be invalid. The positive predictive value of a diagnostic tool should not be used to evaluate the efficacy of the tool or to confirm the presence of temporomandibular disorders when the pretest likelihood of temporomandibular disorder is low (eg, 10%).

A complete YAC contig of the Prader-Willi/Angelman chromosome region (15q11-q13) and refined localization of the SNRPN gene.

Since a previous report of a partial YAC contig of the Prader-Willi/Angelman chromosome region (15q11-q13), a complete contig spanning approximately 3.5 Mb has been developed. YACs were isolated from two human genomic libraries by PCR and hybridization screening methods.

Pharmacological characterization of the novel cholinomimetic L-689,660 at cloned and native brain muscarinic receptors.

1-Azabicyclo[2,2,2]octane,3-(6-chloropyrazinyl)maleate (L-689,660) reportedly is an agonist with selectivity for M1 and M3 muscarinic receptors. We confirmed this in functional assays of brain muscarinic receptors and of cloned human muscarinic receptors transfected into Chinese hamster ovary (CHO-K1) cells. For stimulation of phosphoinositide turnover in rat cortical and hippocampal dissociated tissue, L-689,660 was a partial agonist (24% and 26% intrinsic activity, respectively, relative to oxotremorine-M) with EC50 values of 71 microM and 118 microM, respectively.

Cardiovascular effects of isoflurane and halothane in young and elderly adult patients.

We have studied the cardiovascular effects of 1 MAC end-tidal concentrations of halothane and isoflurane in young (n = 40) and elderly (n = 40) adult patients using non-invasive techniques. Cardiac output was measured by Doppler ultrasonography. Halothane reduced heart rate, systolic, mean and diastolic arterial pressures and cardiac index in both age groups (P < 0.

Interorganizational exchanges as performance markers in a community cancer network.

Objective: This study examines how "strategic partnerships" between community-based consortia of oncologists and hospitals (CCOPs) and clinical cooperative groups emerge, develop, and influence patient accruals (i.e., the number of patients enrolled in clinical trials) over time.

A trial of structured implicit review of randomly selected peer review organization cases.

Objective: In order to learn more about peer review's acceptability, efficiency, and reliability, we performed structured implicit review with and without use of a structured case review form on a random selection of peer review organization cases.

Methods: We compared the results between methods and with previously obtained review results. Twenty-five charts with physician review completed during the Health Care Financing Administration's Third Scope of Work were randomly selected for rereview.

Cloning of a DNA sequence unique to Clostridium botulinum group I by selective hybridization.

Nucleic acid sequences were isolated from a strain of Clostridium botulinum type A by a selective hybridization method known as deletion enrichment. Nontoxigenic C. sporogenes was used to produce a C.

Measuring the impact of a dental practice on TM disorder symptoms.

This article describes a practical, quantitative method of measuring changes in temporomandibular disorder (TMD) symptoms in a dental practice. It applies the TMJ Scale to produce a number of clinically important measures of treatment effectiveness. Those measures include pre- and post-treatment symptom severity, percent of patients improved, level of improvement, and percent of patients converting to non-symptomatic after treatment.

States' responses to Title II of the Ryan White CARE Act.

Title II of the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act of 1990 provides formula-based grants to States to help them improve the quality, availability, and organization of health care and support services for people with human immunodeficiency virus (HIV) infection. This article reviews State expenditures during the first year of CARE Act funding (April 1991-March 1992) within the context of Title II guidelines and the federally funded grant programs that preceded and helped shape Title II. The authors also discuss future challenges that require development of resources, the assessment of program impact, and the evaluation of the quality and appropriateness of HIV-related services.

Pharmacological characterization of the rat hippocampal muscarinic autoreceptor.

The interactions of both agonists and antagonists with the hippocampal presynaptic muscarinic autoreceptor were studied in a release assay with mechanically dissociated tissue. Muscarinic agonists inhibited potassium-ion-evoked release of [3H]acetylcholine maximally by 30 to 40%. Using partial receptor alkylation, the Kd value for oxotremorine-M was determined to be 2.

Legislative interventions to increase access to screening mammography.

Although numerous studies have established that breast cancer mortality can be significantly reduced through early detection, only a small percentage of women obtain screening mammograms at intervals recommended by the National Cancer Institute, the American Cancer Society, and other major medical organizations. This paper examines the importance of cost as a barrier to routine screening and the state legislative movement to make screening mammography a basic health insurance benefit. Mammography "knowledge, attitudes, and behavior" studies offer conflicting findings on the extent to which cost enters into the decision to have a mammogram.

Binding and functional selectivity of himbacine for cloned and neuronal muscarinic receptors.

The binding potencies for the putative M2-selective antagonist himbacine were determined in radioligand binding and in functional response assays in neuronal tissue and Chinese hamster ovary cells containing transfected muscarinic receptors. Himbacine was shown to bind to all five cloned muscarinic receptor subtypes in the order of potencies: hM2 = hM4 > hM3 > hM1 > hM5 (Kd values were 4, 7, 59, 83 and 296 nM, respectively). Himbacine was shown to bind to M2 receptors in rat heart and brain stem with Kd values of 6.

Application of the MRFIT smoking cessation program to a healthy, mixed-sex sample.

The Multiple Risk Factor Intervention Trial (MRFIT) included a smoking cessation program that was highly successful (40.3% abstinence prevalence rate at 48-month follow-up) when used with other interventions for a male, middle-aged population at high risk for coronary heart disease (CHD). Our study employed the MRFIT cessation program alone with a mixed-sex, mixed-age, healthy population.

Synthesis and in vitro characterization of novel amino terminally modified oxotremorine derivatives for brain muscarinic receptors.

A series of novel 2-substituted acetylenic pyrrolidines and piperidines related to oxotremorine (1) were prepared and evaluated in vitro as muscarinic cholinergic agents at brain M1 and M2 receptors. One analogue, 3-(2-oxo-1-pyrrolidinyl)-1-[2(R)-pyrrolidinyl]-1-propyne hydrogen oxalate (6a), was found to be a partial agonist producing a PI hydrolysis response at cortical M1 receptors approximately 3-fold larger than that produced by 1. The intrinsic activity profile of 6a at brain muscarinic receptors is similar to those of azetidine oxo analogue 2 and dimethylamino oxo analogue.