Richard Kaczynski

Stability of orthopedic and surgically assisted rapid palatal expansion over time

At the present time no reports are available on the stability between orthopedic and surgically assisted rapid palatal expansion. This study was designed to examine and compare the dental and skeletal changes over time for both orthopedic maxillary expansion and surgically assisted palatal expansion. The study was divided into two groups. Group one was orthopedically expanded and consisted of 14 males and 10 females. The ages ranged from 6 years to 12 years with a mean of 8.5 years. Group two received surgically assisted rapid palatal expansion and consisted of 12 males and 16 females with ages ranging from 13 years to 35 years and a mean age of 19.25 years. All 52 subjects were white, from the same geographic area, and were treated by the same two operators. Dental models and posterior anterior cephalograms were obtained immediately before and after expansion, at removal of the expansion device, and 1 year after removal of the appliance. A repeated measures analysis of variance test was applied to assess changes over time between groups. The surgical and nonsurgical techniques displayed similar trends over time although the surgical group contained a greater quantity of expansion. Both the orthopedic and the surgical groups showed stable results.

Photographic analysis of facial changes associated with maxillary expansion.

Previous studies on the effects of surgical and rapid palatal expansion have been largely based on general skeletal and dental findings ascertained from radiographs and casts. The aim of this study was to measure and compare the soft tissue changes of the face during the expansion process and to determine the stability of any changes 1 year later. The sample consisted of 44 patients with unilateral or bilateral posterior crossbites. Twenty-four of the patients required a surgically assisted expansion procedure, and a second group of 20 patients were treated with orthopedic expansion. Ten measurements were made from standardized frontal facial photographic slides at 5 intervals of treatment: initial, bond appliance, stop expansion, debond appliance, and 1 year retention. Differences over time between the surgical and nonsurgical groups were analyzed by a 2 way multivariate analysis of variance (MANOVA) and post hoc t tests. Differences between initial and 1 year retention were found in the nasal widths (P <.001) of both surgical and nonsurgical groups. Other significant changes and trends were discussed.

Structure of a depression measure among American Indian elders: Confirmatory factor analysis of the CES-D scale

This research examines differences in depressive symptomology among urban, rural off-reservation, and reservation-residing American Indians, age 55 years or older, of the eastern Great Lakes region. It analyzes the measurement structure of one commonly used depression scale, the Center for Epidemiological Studies Depression Scale, and tests alternative models for the full sample (N = 277) as well as the three residential strata. Findings show that a 12-item version developed by Liang et al. for use with Mexican Americans provided a superior fit over the original 20-item version. The shortened scale included items more conceptually valid for this American Indian population. Furthermore, tests of invariance revealed that only the 12-item version had similar factor structures and factor loadings across the three residential strata.

Cone beam computed tomography evaluation of changes in the naso-maxillary complex associated with two types of maxillary expanders.

OBJECTIVE To test the hypothesis that there were no differences in the skeletal and dental effects of banded vs bonded expanders when evaluated using cone beam computed tomography (CBCT). MATERIALS AND METHODS The experimental sample consisted of 23 patients: 13 (seven male, six female; mean age  =  12.6 ±1.8 years) and 10 (five male, five female; mean age  =  13.5 ± 2.1 years) treated with banded and bonded maxillary expanders, respectively. CBCT images were taken at T1 (pretreatment) and T2 (immediately after expansion) to evaluate the changes in the naso-maxillary complex. Relationships between and within groups were assessed using analysis of variance. If the results were significant, post hoc t-tests were used to determine where the significant differences occurred. RESULTS Regardless of the appliance, the maxilla was expanded equally at the level of the canines and first and second premolars. At the level of the first molars, more dental tipping and alveolar bending were evident in the banded expander group. Both appliances equally increased the skeletal and soft tissue dimensions of the nasal cavity and maxillary sinus volume. The posterior airway volume did not significantly change with either method of expansion. CONCLUSIONS The hypothesis was rejected. Both appliances expanded the maxilla similarly. However, in the banded group, more dental tipping and alveolar bending occurred at the level of the first molars. Maxillary expansion affected the palatal suture and demonstrated anterior and posterior skeletal widening of the nasal cavity, with corresponding soft tissue changes and increased airway volume.

Integrating medical and substance abuse treatment for addicts living with HIV/AIDS: evidence-based nursing practice model.

Forty‐five active substance abusers with HIV/AIDS voluntarily participated in a substance abuse treatment research study with interviews at intake, 6 months and 12 months. These participants were engaged in treatment for a minimum of 45 days and a maximum of 90 days. The study used a nursing model of care, The Personalized Nursing LIGHT model, to integrate treatment for HIV/AIDS with substance abuse treatment. The LIGHT model seeks to enhance patient well being directly and thereby to support interventions that decrease substance use and improve management of chronic disease. The substance abuse treatment team included a nurse who used the LIGHT model and coordinated an integrated care protocol. The nurse accompanied clients on visits to their physicians for HIV treatment and facilitated the integration of medical recommendations with the substance abuse treatment. Six‐month posttest data were gathered on all 45 participants and 12‐month posttest interviews were accomplished with 29 of them. At 6 months, 78% of the respondents (35/45) reported no drug use in the past 30 days, and, at 12 months, 79% (23/29) were drug free for the past month. Significant decreases from intake to 6 months were detected on Addiction Severity Index (ASI) composite scores for drug use (p < 0.01), alcohol use (p < 0.04), medical severity (p < 0.02), psychiatric severity (p < 0.01), legal problems (p < 0.04), and employment difficulty (p < 0.01). Improvement of 6‐month drug use composite scores was related significantly to treatment duration (R = 0.42; p < 0.01). Significant decreases in ASI measures of drug use (p < 0.01), alcohol use (p < 0.01), employment difficulty (p < 0.01), and family/social problems (p < 0.01) also occurred at 12 months. Well being, as measured by a Global Well Being Index, was found to improve significantly at 6 months (p < 0.02) and 12 months (p < 0.07). Concurrently, significant improvement was observed on Medical Outcomes Study‐36‐Item Short‐Form Health Survey (SF‐36) measures of general health and health functioning. These changes were noted at 6 months in the general health (p < 0.02), mental health (p < 0.01), social functioning (p < 0.01), role/emotional status (p < 0.04), and vitality (p < 0.01) subscales. At 12 months, the social functioning (p < 0.01) subscale responses were further decreased.

American Indian Elders and Depression: Short-and Long-Term Effects of Life Events

This research examines stressful life events as predictors of psychological problems among a population of older American Indians of the Great Lakes region. It assumes that meaning attached to these events is not culture-free. The data used are from a longitudinal study of 309 American Indians age 55 and older who were interviewed at two time periods in three distinct strata: urban, rural (off-reservation), and reservation. Life events are measured by the presence and perceived severity of 19 discrete events. Hierarchical regression analysis is used to determine the influence of life events on depression after controlling for sociodemographic factors, functional ability, and comorbidity at both Time 1 and 18 to 24 months later at Time 2. Although Time 1 depression accounts for most of the variance at Time 2, comorbiditywas also a significant predictor over time. Whereas life stress has a short-term effect on mental health, the burden of comorbidity increases over time.

Substance abuse prevention for second graders: Are they too young to benefit?

This article describes an evaluation of an early elementary substance abuse prevention program designed to provide information about alcohol and other drugs and to augment psychosocial skills. The second-grade classrooms from one school (3 classes; 55 students) were randomly assigned to either the control or experimental group. A pretest-posttest design and covariate analyses of variance were used. Program participants scored significantly higher than control group members at the posttest on a knowledge test with questions based directly on program material. Program participants also expressed significantly more negative attitudes about the effects of alcohol use than did control group members. There were no consistent, significant differences between the control and experimental groups at the posttest on measures of self-esteem, coping skills, decision making, peer pressure resistance, or help seeking. The early elementary school years are a critical point in the development of attitudes about substance use and psychosocial skills. Curriculum additions are proposed to increase the likelihood that programs designed for young children will be effective.

CBCT assessment of alveolar buccal bone level after RME.

OBJECTIVE To evaluate the maxillary alveolar buccal bone levels after expansion with banded and bonded expanders, using cone-beam computed tomography (CBCT). MATERIALS AND METHODS The population sample consisted of 22 patients who required expansion during their comprehensive treatment; 10 patients (five males and five females) with a mean age of 13.5 years (CVMS 3) had bonded hygienic expanders, and 12 (six males and six females) with a mean age of 12.6 years (CVMS 3) had banded hyrax expanders. CBCT was taken both before (T1) and 6 months after last activation (T2). Measurements were made for buccal bone thickness (BT), buccal marginal bone level (MBL), and bone thickness level (BTL) at the right first molar (M(Rt)), left first molar (M(Lft)), right first premolar (PM(Rt)), and left first premolar (PM(Lft)). A mixed-design analysis of variance assessed differences between and within the groups. Post hoc t-tests were completed on significant analysis of variance results to determine where differences occurred. RESULTS Analysis of variance revealed no significant differences between or within the two groups. BT significantly decreased horizontally following rapid maxillary expansion. The amount of bone lost was -0.59 mm M(Rt), -0.72 mm PM(Rt), -0.50 mm M(Lft), and -0.57 mm PM(Lft) (P < .003). CONCLUSIONS There was no significant difference between or within the two groups. Buccal bone loss in the vertical dimension (MBL) only showed significance in the banded group for M(Rt) (0.63 mm) and PM(LFt) (0.37 mm) as evidenced by the paired t-test (P < .05).

Testing a Symmetrical Model of Caregiving Outcomes During Recovery from Heart Attacks

This study focused on predictors of psychological distress among caregivers to elderly patients with heart disease using a symmetrical model of caregiving stress. Based on a 1-year longitudinal study of 104 caregiver-care receiver dyads, findings indicate that caregivers continue to face challenges a year after the initial heart attack. Psychological distress of the recovering heart patient plays an important role in predicting caregiver psychological distress. In contrast, patient cardiac symptoms and functional limitations showed no effects. Among caregiver characteristics, physical health, prior psychological distress, and caregiver burden were significant predictors of caregiver psychological distress. Finally, caregiving hours displayed an unexpected negative direct effect on caregiver distress. However, the indirect effect of caregiving hours on distress (via burden) was in the expected positive direction. These data support the usefulness of symmetrical models that consider characteristics of both members of the caregiving dyad in predicting caregiving outcomes.

Assessment of pretreatment orthodontic patients using the BANA test

Ninety-two subjects were tested before orthodontic mechanotherapy for the presence of three putative periodontopathogens-Porphyromonas gingivalis, Treponema denticola, and Bacteroides forsythus-with the BANA test (PerioScan Oral-B). The sample ranged from 9 to 16 years, with a mean age of 13.1 years, and consisted of 51% girls and 49% boys; 48% African American, 46% white, 4% Asian, and 2% Hispanic. Unlike other BANA studies that examined children and adolescents with a 15-minute incubation time, this research used a 5-minute incubation time to increase the specificity and to reduce the false positives obtained from the PerioScan cards. No statistically significant difference was found between the age, gender, or race of the patients and the levels of the three putative periodontopathogens. A Friedman two-way analysis of variance assessed the BANA levels for three groups of teeth: molars, incisors, and premolars. The central incisors and first molars had a significantly higher percentage of positive BANA readings than the first premolars at p < or = 0.05. The clinical importance of this finding has yet to be determined, however, because the central incisor and first molar are the first permanent teeth to erupt, a possible association between dental emergence time and the rate of infection with various organisms may be postulated. In a pilot study, 10 patients from a statistically comparable pretreatment group were assessed longitudinally at two separate collection times separated by 4 months. The Wilcoxon signed rank test indicated no significant changes in these patients over the 4-month period.