Sandre F. McNeal

Is there an association between pre-existing sleep apnoea and the development of glaucoma?

Aim: To determine if sleep apnoea is associated with an increased risk of developing glaucoma. Methods: This was a nested case-control study. Patients seen at the Veterans Affairs Medical Center (BVAMC) in Birmingham, Alabama, with newly diagnosed glaucoma (cases) between 1997 through 2001 were selected (n = 667) and age matched with non-glaucomatous controls (n = 6667). Patient information was extracted from the BVAMC data files containing demographic, clinical, and medication information. An index date was assigned to the glaucoma subjects corresponding to the time of diagnosis. Patients who had a glaucoma diagnosis before the observation period of the study were excluded. 10 controls were randomly selected for each case and matched on age (plus or minus 1 year) and an encounter on or before the index date of the matched case. Ihe main outcome measures were crude and adjusted relative risks for the association between the previous diagnosis of sleep apnoea and the development glaucoma. Adjustment was performed for the associations of diabetes, lipid metabolism disorders, hypertension, cardiovascular disease, cerebrovascular disease, arterial disease, and migraines. Results: Individuals who developed glaucoma were more likely to have a previous sleep apnoea diagnosis relative to control subjects. However, this finding was of borderline significance at an alpha of 0.05 (p value = 0.06, odds ratio = 2.20, 95% confidence intervals 0.967 to 5.004). Following adjustment for other potential risk factors, no significant difference was seen (p value = 0.18, odds ratio = 1.80, 95% confidence interval 0.76 to 4.23). Conclusions: This nested case-control study does not support a large impact of sleep apnoea on the eventual development of glaucoma relative to other putative risk factors.

Effect of lowering the pH of sodium hypochlorite on dissolving tissue in vitro.

Sodium hypochlorite (NaOCl), a common antimicrobial and tissue-dissolving irrigant, comes from the manufacturer at pH 12. When the pH is lowered, NaOCl becomes more antimicrobial. The aim of this study was to examine what effect lowering the pH has on the property of tissue dissolution. Seven groups were tested for dissolving porcine muscle tissue at varying pH, concentrations, and times. When groups were examined solely by pH, there was no significant difference between the pH 12 and 9 groups, but a statistically significant level was found between pH 12 and 9 versus the pH 6 groups (P < .05). Higher concentrations and greater time periods all led to greater amounts of tissue dissolution.

Changes in intendedness during pregnancy in a high-risk multiparous population.

Objectives: Our objectives were to determine whether pregnancy intendedness changes as the pregnancy progresses and, if so, in what direction. Methods: Intendedness questions similar to those used in the 1988 National Survey of Family Growth were administered in the second trimester of pregnancy (16–18 weeks) and again in the third trimester (30–32 weeks) to a population of 1223 low-income women who were medically at high risk. Information was also collected on characteristics identified in previous studies as being associated with intendedness. Changes in reported intendedness status were categorized as positive if the woman switched from unwanted to mistimed or intended or from mistimed to intended. Changes were categorized as negative if the woman switched from intended to mistimed or unwanted or from mistimed to unwanted. Results: Among the 436 women who reported an intended pregnancy at midpregnancy, 79.1% still reported the pregnancy as intended in late pregnancy, while 15.9% moved to mistimed and 6.4% to unwanted. Of the 601 women who reported a mistimed pregnancy in midpregnancy, 80.9% still reported it as mistimed in late pregnancy, with 13.9% switching to intended and 5.2% switching to unwanted. Of the 186 women who reported an unwanted pregnancy at midpregnancy, 62.9% remained unwanted, 30.7% switched to mistimed, and 6.4% switched to intended. Conclusions: This study indicates that intendedness is not fixed during pregnancy. Between the first and the second administration of the intendedness questions, 275 (22.5%) of the women changed their responses and the larger percentage (12.5%) changed them in a positive direction. These findings have both policy and clinical implications.

Relationship of psychosocial status to low prenatal weight gain among nonobese black and white women delivering at term

Objective To examine the association of six indices of psychosocial well-being with low prenatal weight gain. Methods Scales assessing depression, trait anxiety, stress, mastery, self-esteem, and social support were self-administered at mid-pregnancy to 536 black and 270 white low-income, nonobese, multiparous women who subsequently delivered at term. All women had one or more risk factors for fetal growth restriction. The association of individual scale scores with prenatal weight gain values below current Institute of Medicine guidelines was examined while controlling for sociodemographic and reproductive variables, and for time between last weight observation and delivery. Results None of the scales were associated with low gain among black women. Among white women, poor scores (worst quartile) on four of the scales were associated with increased adjusted odds ratios for low gain, including 2.5 for high trait anxiety, 3.0 for increased levels of depression, 3.9 for low mastery, and 7.2 for low self-esteem. When scale scores and weight gain were examined as continuous variables, poor scores on five of the six scales were associated with lower weight gain values among white women (scores on the stress scale were the exception). Conclusion These data suggest an important role for psychosocial factors in the etiology of low prenatal weight gain among white women but show no such role for black women. Along with reports of wide inter-individual variability in the energy costs of pregnancy, these data also suggest that attempts to manipulate pregnancy weight gain through dietary means will meet with variable success until psychosocial and other factors affecting prenatal energy intake and/or utilization are further delineated.

Prenatal weight gain within upper and lower recommended ranges: Effect on birth weight of black and white infants**

Objective To that end examine differences in birth weight among the term infants of black and white women with weight gains in the upper or lower half of recommended ranges. Methods Birth weight (mean, low [at or below 2500 g], and suboptimal [2501–2999 g]) among term infants of 2219 black and 3966 white low-income women was compared with maternal prenatal weight gain classified according to four categories: below, within the lower or upper halves, and above the recommended ranges for pregravid body mass index (BMI) category (low, normal, high). Results Adjusted mean birth weights among the infants of women with prenatal weight gain in the upper versus lower half of the recommended ranges were higher among white women with normal BMI (3307 g upper half, 3199 g lower half, P = .0001) but not among black women with normal BMI (3180 g upper half, 3105 g lower half, not significant). Logistic regression analyses revealed that prenatal weight gain in the upper compared with the lower half of the recommended ranges was associated with a decreased adjusted odds ratio (OR) for low (but not suboptimal) birth weight among the infants of white women (OR 0.4, 95% confidence intervals [CI] 0.2,0.9) but not of black women (OR 1.2; 95% CI 0.4,3.3). Conclusion These preliminary observations do not provide support for the presence of ethnic group-specific recommendations within guidelines for prenatal weight gain.

Spiritually Based Intervention to Increase Colorectal Cancer Screening Among African Americans: Screening and Theory-Based Outcomes From a Randomized Trial

Colorectal cancer screening has clear benefits in terms of mortality reduction; however, it is still underutilized and especially among medically underserved populations, including African Americans, who also suffer a disproportionate colorectal cancer burden. This study consisted of a theory-driven (health belief model) spiritually based intervention aimed at increasing screening among African Americans through a community health advisor-led educational series in 16 churches. Using a randomized design, churches were assigned to receive either the spiritually based intervention or a nonspiritual comparison, which was the same in every way except that it did not contain spiritual/religious content and themes. Trained and certified peer community health advisors in each church led a series of two group educational sessions on colorectal cancer and screening. Study enrollees completed a baseline, 1-month, and 12-month follow-up survey at their churches. The interventions had significant pre–post impact on awareness of all four screening modalities, and self-report receipt of fecal occult blood test, flexible sigmoidoscopy, and colonoscopy. There were no significant study group differences in study outcomes, with the exception of fecal occult blood test utilization, whereas those in the nonspiritual intervention reported significantly greater pre–post change. Both of these community-engaged, theory-driven, culturally relevant approaches to increasing colorectal cancer awareness and screening appeared to have an impact on study outcomes. Although adding spiritual/religious themes to the intervention was appealing to the audience, it may not result in increased intervention efficacy.

The impact of cataract surgery on depression among older adults

CONTEXT Aged-related cataract is the leading cause of vision impairment in the elderly. Elderly individuals with cataract not only suffer from the difficulties in daily activities, but also are more prone to depression. OBJECTIVE To examine the impact of cataract surgery on depression among older adults. DESIGN Longitudinal follow-up study. SETTING Outpatient ophthalmology and optometry clinics in Birmingham, Alabama. PATIENTS Potential subjects were identified through consecutive chart review of patients seen in 10 ophthalmology and 2 optometry clinics. Three groups of individuals were identified: cataract patients who underwent surgery, cataract patients who did not undergo surgery, and patients without cataract. MAIN OUTCOME MEASURE Depressive symptoms as measured by the Center for Epidemiological Studies-Depression Scale (CES-D). RESULTS There was no significant difference between the baseline and follow-up CES-D scores within each group. The unadjusted CES-D score changes did not differ significantly among the three groups. Adjustment for visual acuity and contrast sensitivity in the better and worse eyes, co-morbid conditions, age, gender, and education did not alter this pattern of results. CONCLUSIONS Cataract surgery does not appear to have an effect on reducing depressive symptoms in elderly people.

Volumetric expansion of gutta-percha in contact with eugenol.

The aim of this study was to compare the volumetric expansion of gutta-percha in the presence of eugenol or physiologic saline over time. Sections of gutta-percha cones were scanned to determine their total volume and surface area. They were then placed in sealed test tubes with either 2 microL eugenol or 2 microL saline and allowed to soak for 24 hours, 7 days, or 30 days. The results were scanned again to determine the volumetric changes in the material after placement in the test solutions. The results were statistically analyzed by using t tests and analysis of variance. Specimens soaked in eugenol showed a dramatic increase in volumetric expansion versus the saline group at all time periods. Sealers that incorporate eugenol could be attributed to gutta-percha volumetric expansion over time, thereby creating a better seal of the obturation material.

Low Prenatal Weight Gain Among Adult WIC Participants Delivering Term Singleton Infants: Variation by Maternal and Program Participation Characteristics

Objective: To determine the association of maternal and prenatal WIC program participation characteristics with low prenatal weight gain among adult women delivering liveborn, singleton infants at term. Methods: WIC program data for 19,017 Black and White Alabama women delivering in 1994 were linked with birth certificate files to examine the association of anthropometric, demographic, reproductive, hematologic, behavioral and program participation characteristics with low prenatal weight gain. Results: One third (31.0%) had low prenatal weight gain as defined by the Institute of Medicine. The incidence of low weight gain was increased among women who had < 12 years of education, were single, Black, anemic, had low or normal pre-pregnancy body mass index (BMI), increased parity, interpregnancy intervals ≤ 24 months, used tobacco or alcohol, or entered prenatal care or WIC programs after the first trimester. After adjusting for selected maternal characteristics, the adjusted odds ratios (AOR) for low weight gain were increased with short interpregnancy intervals (AOR 1.21 to 2.20); tobacco use (AOR 1.16 to 1.40), anemia (AOR 1.20 to 1.25), and second trimester entry into prenatal care (AOR 1.14 to 1.20); the size of the AORs and 95% confidence intervals varied by BMI and racial subgroup. Conclusions: The results of this study suggest that WIC interventions targeting low prenatal weight gain be focused on risk factors present not only during pregnancy, but during the pre- and interconceptional periods as well. Interventions should target low BMI, tobacco use, and anemia, and include attention to nutrition screening and risk reduction among women in postpartum and family planning clinic settings.

Comparison of root canal preparation using reciprocating Safesiders stainless steel and Vortex nickel-titanium instruments

OBJECTIVE The aim of the present study was to assess several parameters related to the clinical usage of 2 root canal preparation instruments: Vortex .06 rotary nickel-titanium instruments, and Safesiders reciprocating stainless steel instruments. STUDY DESIGN Fifty extracted mandibular molars with mesial root canal curvatures between 20° and 50° were divided into 2 groups and embedded in acrylic resin inside a modified Bramante muffle system. All root canals were prepared to ISO size 40 using either Vortex .06 rotary nickel-titanium-instruments in a low-torque motor or Safesiders stainless steel instruments in a proprietary reciprocating handpiece. The following parameters were evaluated: straightening of curved root canals, working safety issues (perforations, instrument breakages, canal blockages, loss of working length), postpreparation root canal cross-section, and working time. RESULTS The Vortex .06 instruments maintained canal curvatures well, with the mean degree of straightening recorded as 0.72°. Safesiders instruments demonstrated significantly more canal straightening, with the mean degree of straightening recorded as 15.5°. More than 90% of the root canals prepared with the Vortex .06 instruments resulted in a round or oval cross-section, whereas the Safesiders instruments produced round or oval cross-sections 60% of the time. Neither of the 2 instruments could effectively prepare 100% of the root canal circumference. The area of dentin removed and the remaining dentin thicknesses from each region were similar for the 2 groups. Six procedural incidents were recorded for the Vortex .06 group, compared with 19 for the Safesiders group. There were no instrument fractures recorded in either group. Mean working time was significantly shorter for Vortex .06 (279 s) than for Safesiders (324 s). CONCLUSIONS Vortex .06 maintained the original root canal curvatures well, whereas Safesiders instruments demonstrated significant straightening and irregular preparation shapes when used in sizes larger than ISO 20. Preparation of the complete circumference of the root canal was not possible with either system. Fewer procedural errors occurred with the Vortex instruments.