Argy Polychronopoulou

The epidemiology of ovarian cancer in Greece: A case-control study☆

One hundred and fifty women with common malignant epithelial tumors of the ovary (cases) and 250 comparison women hospitalized for various orthopedic conditions were interviewed regarding demographic, reproductive, socio-economic and biomedical characteristics, including their use of coffee, tobacco, alcohol, drugs and exogenous estrogens. The data were analyzed with standard X2 procedures and by modelling relative risk (r) through multiple logistic regression. The main results are as follows: women with ovarian cancer had fewer liveborn children (one-tailed, P congruent to 0.13, for women with 4+ children, r = 0.6) and later menarche (P congruent to 0.02, for women with age at menarche 15+, r = 1.9) and menopause (P congruent to 0.07, for women with age at menopause 50+, r = 1.5); they were slightly taller and heavier (P congruent to 0.15 and 0.30 respectively); they belonged to smaller sibships (P congruent to 0.05); they reported more frequently than controls familial occurrence of ovarian, endometrial and breast cancer (P less than 0.05 in each instance); they were regular consumers of alcoholic beverages more frequently than controls, and the excess was both statistically significant (P congruent to 0.02) and dose-related; they were regular users of coffee slightly more frequently than controls (r = 1.2) but the excess was small and it was neither statistically significant nor dose-related (P congruent to 0.27); and they reported less frequently than controls the use of oral contraceptives (relative risk for users, 0.4; 95% confidence interval, 0.1-1.1).

External apical root resorption in patients treated with conventional and self-ligating brackets

INTRODUCTION Our aim was to comparatively investigate the amount of external apical root resorption (EARR) between conventional and passive self-ligating brackets. METHODS Ninety-six patients were selected from a pool of patients satisfying the following inclusion criteria: no evidence of resorption on the pretreatment panoramic radiographs; no contributing history of trauma; no dilacerations of lateral incisor roots, maxillary anodontia, and impacted canines; complete root formation at the start of treatment; intact and caries-free maxillary incisors; and no endodontically treated incisors. Patients received treatment with either a passive self-ligating bracket system or a conventional edgewise appliance, both with a 0.022-in slot. EARR of the maxillary incisors was evaluated on panoramic radiographs, taken before and after orthodontic treatment measured in millimeters. Distortion of measurements caused by panoramic radiographs was investigated by using a calibrated periodontal probe attached to the lateral incisor, and the extent of magnification was estimated to be 14%. Statistical comparisons of EARR between appliance type, age, sex, extraction treatment, and duration of treatment were investigated with univariate and multivariate regression modeling. RESULTS Overall, no difference was found in the amount of EARR between appliance systems. Age, sex, and extraction treatment were not reliable predictors of EARR, but a positive association between EARR and duration of treatment was observed. CONCLUSIONS No difference should be expected for root resorption between conventional and passive self-ligating brackets.

An assessment of quality characteristics of randomised control trials published in dental journals

OBJECTIVES The purpose of this study was to investigate the quality of reporting of randomised clinical trials (RCTs) published in dental specialty journals. METHODS The journals possessing the highest impact factor (2008 data) in the six major dental specialties were included in the study. The contents of the 24 most recent issues of each journal were hand-searched and research articles identified as randomised controlled trials (RCTs) were selected. Quality evaluation was performed using the modified Consolidated Standards of Reporting Trials (CONSORT) statement checklist. The data were analysed using descriptive statistics followed by univariate and multivariate examination of statistical associations (alpha=0.05). RESULTS Ninety-five RCTs were identified with generally suboptimal scores on quality reporting on key CONSORT areas. Significant differences were found among journals with the Journal of Clinical Periodontology achieving the highest score, followed by the American Journal of Orthodontics and Dentofacial Orthopedics. There was a positive association between quality score and number of authors, involvement of statistician/epidemiologist, and multicentre trials. CONCLUSIONS The quality scores of RCTs in major dental journals are considered suboptimal in key CONSORT areas. This receives critical importance considering that improved quality of RCTs is a fundamental prerequisite for improved dental care.

Mandibular dental arch changes associated with treatment of crowding using self-ligating and conventional brackets

The purpose of this study was to investigate the effect of treatment of mandibular crowding with self-ligating and conventional brackets on dental arch variables. Fifty-six patients were selected from a pool of subjects satisfying the following inclusion criteria: non-extraction treatment in the mandibular or maxillary arches, eruption of all mandibular teeth, no spaces and an irregularity index greater than 2 mm in the mandibular arch, and no adjunct treatment such as etxra- or intraoral appliances. The patients were assigned to two groups: one group received treatment with the self-ligating bracket and the other with a conventional edgewise appliance, both with a 0.022 inch slot. Lateral cephalometric radiographs obtained at the beginning (T1) and end (T2) of treatment were used to assess the alteration in mandibular incisor inclination, and measurements of intercanine and intermolar widths were made on dental casts to investigate changes associated with the correction. The results were analysed with bivariate and multivariate linear regression analysis in order to examine the effect of the bracket systems on arch width or lower incisor inclination, adjusting for the confounding effect of demographic and clinical characteristics. An alignment-induced increase in the proclination of the mandibular incisors was observed for both groups; no difference was identified between self-ligating and conventional brackets with respect to this parameter. Likewise, an increase in intercanine and intermolar widths was noted for both bracket groups; the self-ligating group showed a higher intermolar width increase than the conventional group, whereas the amount of crowding and Angle classification were not significant predictors of post-treatment intermolar width.

A PRISMA assessment of the reporting quality of systematic reviews in orthodontics

OBJECTIVES To assess the reporting quality of Cochrane and non-Cochrane systematic reviews (SR) in orthodontics and to compare the reporting quality (PRISMA score) with methodological quality (AMSTAR criteria). MATERIALS AND METHODS Systematic reviews (n  =  109) published between January 2000 and July 2011 in five leading orthodontic journals were identified and included. The quality of reporting of the included reviews was assessed by two authors in accordance with the PRISMA guidelines. Each article was assigned a cumulative grade based on fulfillment of the applicable criteria, and an overall percentage score was assigned. Descriptive statistics and simple and multiple linear regression analyses were undertaken. RESULTS The mean overall PRISMA score was 64.1% (95% confidence interval [CI], 62%-65%). The quality of reporting was considerably better in reviews published in the Cochrane Database of Systematic Reviews (P < .001) than in non-Cochrane reviews. Both multivariable and univariable analysis indicated that journal of publication and number of authors was significantly associated with the PRISMA score. The association between AMSTAR score and modified PRISMA score was also found to be highly statistically significant. CONCLUSION Compliance of orthodontic SRs published in orthodontic journals with PRISMA guidelines was deficient in several areas. The quality of reporting assessed using PRISMA guidelines was significantly better in orthodontic SRs published in the Cochrane Database of Systematic Reviews.

Risk factors for childhood poisoning: a case-control study in Greece.

OBJECTIVES: To identify child or family related risk factors for unintentional childhood poisoning in Greece and to explore whether product specific poisonings might have special features that make them amenable to preventive interventions. SETTING: A case-control study was undertaken in Athens, Greece in 1995. Cases were 100 consecutive children brought with poisoning to the emergency clinics of the two university affiliated childrens hospitals. For every case two age, gender, and hospital matched controls were chosen from among children brought to the outpatient clinics of these hospitals on the same date. METHODS: All children and their guardians were interviewed by the same person using a standard questionnaire that covered demographic, socioeconomic, behavioral, and past injury characteristics. Information was also obtained concerning type and conditions of poisoning for cases. Statistical analysis was undertaken by modeling the data using conditional logistic regression. RESULTS: Socioeconomic factors were not important risk indicators in these data but children living with other than both parents were at increased risk (odds ratio (OR) = 4.7, p = 0.08), as were children with a history of previous poisoning that required medical care (OR = 5.1, p = 0.05). Unintentional poisonings caused by chewing or swallowing cigarettes were concentrated in families where both parents were smokers. CONCLUSIONS: Absence of a parent appears to be associated with increased likelihood of childhood poisoning. The importance of product accessibility is underlined by the concentration of tobacco poisoning among children of parents who were both smokers. In the cultural context of this study, sociodemographic factors do not appear to represent demonstrable risk factors. Instead, control of childhood poisoning should be concentrated on safe packaging, storage, and disposal of potentially hazardous products.

Cochrane and non-Cochrane systematic reviews in leading orthodontic journals: a quality paradigm?

The aims of this study were to assess and compare the methodological quality of Cochrane and non-Cochrane systematic reviews (SRs) published in leading orthodontic journals and the Cochrane Database of Systematic Reviews (CDSR) using AMSTAR and to compare the prevalence of meta-analysis in both review types. A literature search was undertaken to identify SRs that consisted of hand-searching five major orthodontic journals [American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, European Journal of Orthodontics, Journal of Orthodontics and Orthodontics and Craniofacial Research (February 2002 to July 2011)] and the Cochrane Database of Systematic Reviews from January 2000 to July 2011. Methodological quality of the included reviews was gauged using the AMSTAR tool involving 11 key methodological criteria with a score of 0 or 1 given for each criterion. A cumulative grade was given for the paper overall (0-11); an overall score of 4 or less represented poor methodological quality, 5-8 was considered fair and 9 or greater was deemed to be good. In total, 109 SRs were identified in the five major journals and on the CDSR. Of these, 26 (23.9%) were in the CDSR. The mean overall AMSTAR score was 6.2 with 21.1% of reviews satisfying 9 or more of the 11 criteria; a similar prevalence of poor reviews (22%) was also noted. Multiple linear regression indicated that reviews published in the CDSR (P < 0.01); and involving meta-analysis (β = 0.50, 95% confidence interval 0.72, 2.07, P < 0.001) showed greater concordance with AMSTAR.

Reporting quality of abstracts of randomized controlled trials published in leading orthodontic journals from 2006 to 2011

INTRODUCTION Optimal reporting of randomized trials and abstracts enhances transparency and facilitates assessment and identification of trials. The purpose of this study was to investigate the quality of reporting of abstracts of randomized controlled trials published in orthodontic journals. METHODS Electronic searches with supplementary hand searching to identify randomized controlled trials in the American Journal of Orthodontics and Dentofacial Orthopedics, the Angle Orthodontist, the European Journal of Orthodontics, and the Journal of Orthodontics from 2006 to 2011 were undertaken. The completeness of abstract reporting was evaluated with a modified CONSORT for abstracts statement checklist. The data were analyzed by using descriptive statistics followed by univariate and multivariate examinations of statistical associations (P = 0.05). RESULTS Abstracts of 117 randomized controlled trials were identified and assessed. Most were published in either the American Journal of Orthodontics and Dentofacial Orthopedics (53%) or the Angle Orthodontist (23%); most abstracts (85.5%) were structured. The mean overall reporting quality score was 60.2%. In relation to individual quality items, most abstracts demonstrated clear reporting of interventions (97.4%), objectives (93.2%), and number of participants randomized (95.7%). Insufficient reporting of randomization procedures, allocation concealment, blinding, and failure to report confidence intervals and harms were almost universal. Registrations of randomized controlled trials and sources of funding were not reported in any of the identified abstracts. The highest reporting score was noted in the Journal of Orthodontics (66%; 95% confidence interval, 63.5-68.7). CONCLUSIONS The quality of reporting of abstracts of randomized controlled trials in orthodontic journals is suboptimal. In view of the primacy of research abstracts, efforts should be made to improve their reporting.

Active or passive self-ligating brackets? A randomized controlled trial of comparative efficiency in resolving maxillary anterior crowding in adolescents

INTRODUCTION Our aim was to compare the time required to complete the alignment of crowded maxillary anterior teeth (canine to canine) between Damon MX (Ormco, Glendora, Calif) and In-Ovation R (GAC, Central Islip, NY) self-ligating brackets. METHODS Seventy patients from the first authors office were included in this randomized controlled trial by using the following inclusion criteria: nonextraction treatment on both arches, eruption of all maxillary teeth, no spaces in the maxillary arch, no high canines, maxillary irregularity index greater than 4 mm, and no therapeutic intervention planned involving intermaxillary or other intraoral or extraoral appliances including elastics, maxillary expansion appliances, or headgear. The patients were randomized into 2 groups: the first received a Damon MX bracket; the second was bonded with an In-Ovation R appliance, both with a 0.022-in slot. The amount of crowding of the maxillary anterior dentition was assessed by using the irregularity index. The number of days required to completely alleviate the maxillary anterior crowding in the 2 groups was investigated with statistical methods for survival analysis, and alignment rate ratios for appliance type and crowding level were calculated with the Cox proportional hazard regression. An analysis of each protocol was performed. RESULTS No difference in crowding alleviation was found between the 2 bracket systems. Higher irregularity index values were associated with the increased probability of delayed resolving of crowding. CONCLUSIONS The use of passive or active self-ligating brackets does not seem to affect treatment duration for alleviating initial crowding.

Are clustering effects accounted for in statistical analysis in leading dental specialty journals

OBJECTIVES In dental research multiple site observations within patients or taken at various time intervals are commonplace. These clustered observations are not independent; statistical analysis should be amended accordingly. This study aimed to assess whether adjustment for clustering effects during statistical analysis was undertaken in five specialty dental journals. METHODS Thirty recent consecutive issues of Orthodontics (OJ), Periodontology (PJ), Endodontology (EJ), Maxillofacial (MJ) and Paediatric Dentristry (PDJ) journals were hand searched. Articles requiring adjustment accounting for clustering effects were identified and statistical techniques used were scrutinized. RESULTS Of 559 studies considered to have inherent clustering effects, adjustment for this was made in the statistical analysis in 223 (39.1%). Studies published in the Periodontology specialty accounted for clustering effects in the statistical analysis more often than articles published in other journals (OJ vs. PJ: OR=0.21, 95% CI: 0.12, 0.37, p<0.001; MJ vs. PJ: OR=0.02, 95% CI: 0.00, 0.07, p<0.001; PDJ vs. PJ: OR=0.14, 95% CI: 0.07, 0.28, p<0.001; EJ vs. PJ: OR=0.11, 95% CI: 0.06, 0.22, p<0.001). A positive correlation was found between increasing prevalence of clustering effects in individual specialty journals and correct statistical handling of clustering (r=0.89). CONCLUSIONS The majority of studies in 5 dental specialty journals (60.9%) examined failed to account for clustering effects in statistical analysis where indicated, raising the possibility of inappropriate decreases in p-values and the risk of inappropriate inferences.