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Health-related quality of life (HRQOL) assessments made by patients provide a view of dentofacial disharmony and surgical outcome that can inform clinicians in important ways. In this paper, HRQOL as it pertains to patients with dentofacial disharmony and orthognathic surgery is discussed from three perspectives. First, arguments regarding the necessity of studying HRQOL in orthognathic patients are presented. Second, a variety of ways of defining HRQOL are reviewed, and implications for applications to orthognathic surgery are discussed. Finally, various measurement techniques are presented for assessing HRQOL in orthognathic patients. Use of dental HRQOL measures, as well as multi-item, multimeasure techniques, are discussed. For more reliable and comprehensive HRQOL measurement in patients with dentofacial disharmony, multi-item, multimeasurement techniques should be employed. While such techniques place greater demands on patients who are completing paper-and-pencil measures, the resultant low measurement error and comprehensive HRQOL assessment outweighs the risk of subject fatigue.

A sample of 194 patients whose dentofacial disharmonies were severe enough to warrant an orthognathic surgical treatment option completed the SCL-90-R, a 90-item assessment tool used to measure current level of psychological distress. Two global and nine primary dimension scores of psychological distress were computed. The average interpersonal sensitivity, psychoticism, and obsessive-compulsive dimension scores were higher than the nonpsychiatric patient population norms for both males and females, but the confidence intervals for these dimensions were still in the upper end of the normal range of functioning (< 1 SD above the normative mean). No statistically significant differences by gender or age group were observed. Over 15% of the patients were clinically elevated on obsessive-compulsive behavior, interpersonal sensitivity problems, hostility, paranoid ideation, and psychoticism; and 24.7% qualified as a positive diagnosis for a psychiatric disorder. It appears that a surprisingly large number of individuals with dentofacial disharmonies who are seeking treatment consultation are experiencing a level of psychological distress that warrants intervention.

Background: There are few published placebo-controlled clinical trials demonstrating the efficacy of the newer antidepressants in markedly or severely depressed hospitalized patients. This study demonstrates the efficacy of nefazodone compared with placebo in the treatment of patients hospitalized for major depression., Method: Nefazodone and placebo treatment were compared in a 6-week trial of 120 patients hospitalized for DSM-III-R diagnosed major depression (without psychosis) at 2 study centers. Efficacy was evaluated using standard psychiatric rating scales, and patients were monitored for safety., Results: Nefazodone treatment resulted in a significant reduction (p < .01) of the 17-item Hamilton Rating Scale for Depression (HAM-D-17) total score compared with placebo from the end of the first treatment week through the end of the study (-12.2 nefazodone vs. -7.7 placebo). At the end of the trial, significantly more nefazodone-treated patients (50%) than placebo-treated patients (29%) had responded, as indicated by their Clinical Global Impressions-Improvement score (p = .021) or by a > or = 50% reduction in their HAM-D-17 scores (p = .017). Significantly more patients treated with nefazodone (36%) than placebo-treated patients (14%) had a HAM-D-17 score < or = 10 at the end of treatment (p = .004). Significant treatment differences (p < .01) in favor of nefazodone were also seen in the Montgomery-Asberg Depression Rating Scale; the HAM-D retardation, anxiety, and sleep disturbance factors; and HAM-D item 1 (depressed mood). Patients with dysthymia in addition to major depression also showed significant improvement (p < .05) when treated with nefazodone, with significant differences in response rates seen as early as week 2 and through the end of the trial. The mean nefazodone dose was 491 mg/day at the end of week 2 and 503 mg/day at the end of treatment. Nefazodone was well tolerated, and the number of patients discontinuing owing to adverse events was small, with no significant safety issues noted in either treatment group. Fewer nefazodone-treated than placebo-treated patients discontinued owing to lack of efficacy., Conclusion: Nefazodone was superior to placebo in the treatment of marked to severe major depression in patients requiring hospitalization. The clinical benefit of nefazodone was evident as early as the first week of treatment as judged by several measures of efficacy, with significant differences from placebo sustained throughout the trial.

Objectives: Few studies have examined what parents and orthodontists expect from and value about orthodontic treatment. In this study, we designed and tested a questionnaire to outline what drives consumer demand for children's orthodontic care. Further, we present data from the questionnaire to illustrate how expectations and values pertaining to orthodontic treatment relate to sociodemographic variables., Methods: Subjects were 220 Pennsylvania orthodontists and 220 parents at a university orthodontic clinic who were administered a questionnaire designed to assess what parents and orthodontists value about and expect from orthodontic treatment. Items for the questionnaire were developed via a qualitative, telephone interview process. Data were analyzed using factor analysis and reliability analysis for scale development, and analysis of variance for preliminary validity assessment., Results: Through factor analysis, the questionnaire was reduced from 84 to 52 items, and eight scales were examined: expected treatment benefits, expected treatment risks (short- and long-term), expected treatment inconveniences, value of treatment benefits, value of risks (short- and long-term), and value of treatment inconveniences. For parents, the reliability for all scales was in the acceptable range. For orthodontists, only the "short-term risks" scale failed to attain an acceptable reliability. Preliminary validity was assessed through examining relationships between demographic variables and subscale scores. For parents, income, father's education level, and sex of respondent were related to treatment expectations and values. For orthodontists, age, sex, and patient volume were related to treatment values., Conclusions: The questionnaire developed in the present study was found to be practical and reliable for use with providers and consumers of orthodontic care and can be used to explore factors affecting the demand for orthodontic care. Implications of possible unrealistic treatment expectations on the part of orthodontists and parents also are discussed.

Patients whose skeletal disharmony was severe enough to warrant a surgical treatment option completed a 24-item Motives for Treatment questionnaire. Each item was rated from (1) not at all a reason to (4) very much a reason. Items were grouped to form six dimensions. An average score of 3.0 or greater on a given dimension was considered a strong motivation. Of the 135 patients who completed the questionnaire, 16% of the patients had primarily a self-image motivation, 4% primarily an oral function motivation, and 6% strong dual self-image/oral function motivations. Males and females differed significantly on the social well-being and temporomandibular joint (TMJ) dimensions. A strong social motivation occurred 4.5 times more frequently among males than among females, while a higher proportion of females than males reported TMJ concerns. Patients older than 25 scored higher on oral function, future health, and TMJ dimensions. Patients who elected surgery had higher scores on oral function, nasal function, and TMJ dimensions. Approximately 1.5 times as many patients who elected surgery scored on average of 3.0 or higher on the self-image and oral function dimensions.

The New Jersey Collegiate Substance Abuse Program (NJCSAP) provided intensive substances abuse treatment to college students requiring treatment for severe substance use disorders. This study reports the progress of students who received 6 months of treatment of NJCSAP and participated in a research evaluation of the program. Overall, 74.5% of participants who completed the follow-up were abstinent at the 6-month assessment. Including participants who did not complete the follow-up as user yielded a 52.6% rate of abstinence. Students who completed the follow-up experienced decreases in the number of current psychiatric diagnoses met, depressive symptomatology, alcohol and drug problem severity, and family and psychiatric problem severity over the 6 month period. Most students rated the program components as very or moderately helpful and most were attending AA at the 6-month assessment. Result are compared to findings from other programs for adolescents and young adults.

This study examined (1) the relationships between electromyographic-measured nocturnal bruxism, self-reported stress, and several personality variables, and (2) the relationship between belief in a stress-bruxism relationship and self-reported stress. One hundred adult bruxers completed a battery of personality questionnaires, indicated whether they believed in a stress-bruxism relationship, presented for a dental examination, and had dental impressions taken. Subsequently, electromyographic measurements of bruxing frequency and duration were recorded for fifteen consecutive nights. Prior to each night's measurements, subjects indicated their levels of stress for the immediately preceding 24 hours. No overall relationship was established between electromyographic measures and the personality variables nor between electromyographic measures and self-reported stress. Correlations between electromyographic measures and self-reported stress were statistically significant for eight individual subjects. Further, subjects with high levels of stress reported more anxiety, irritability, and depression, and less denial. Subjects who believed in a stress-bruxism relationship reported greater stress.

Objective: This study sought to (1) determine the rates of family history of alcoholism among a community sample, using both specific questions and structured interviews, (2) document conversions from negative (FH-) to positive (FH+) alcoholism diagnoses among parents and grandparents of subjects, and (3) investigate the concordance between interview and questionnaire methods in assessing alcoholism in family members., Method: Information concerning alcoholism among relatives of a sample of 1,201 (620 female) probands was gathered longitudinally over a 13-year period, spanning adolescence into adulthood. At Times 1 through 3 of the study, information was gleaned from personal interviews with subjects, medical health forms and information from subjects' parents, which was used to determine a "best estimate diagnosis." At Time 4, the Family History Research Diagnostic Criteria (FH-RDC) interview was used., Results: The number of subjects having an alcoholic relative increased at each test time with the largest rise occurring at Time 4. Over 80% of subjects whose parent converted to FH+ at Time 4 had previously described that parent as a heavy or problem drinker., Conclusions: The higher than previously seen escalation in FH+ status occurring at Time 4 is speculated to be the result of one or more of the following: an actual increase in the number of relatives becoming alcoholic, a newfound awareness on the part of probands about alcohol-related problems, the fact that a global judgment or single behavior observation provides an inadequate indication of familial alcoholism, or that the FH-RDC may include a more global measure of "alcohol-related problems" or "problem drinking."

The development of a multimethod social problem-solving battery for schizophrenia is described. The battery is unique in that empirical methods were used throughout its development. The battery includes components that tap skills for response generation and response evaluation. The behavioral components of social problem solving are assessed in an extended role-play format. Individuals with schizophrenia and bipolar disorder, as well as nonpatient controls, completed the social problem-solving battery and cognitive measures. Subjects in the schizophrenia group performed more poorly than controls on measures of the ability to generate and evaluate response alternatives, as well as on the role-play test. The two patient groups did not differ in performance on any of the social problem-solving components. Appropriateness of affect was the most powerful predictor of problem-solving effectiveness.

The authors studied the attitudes of 1,000 U.S. dentists toward the treatment of HIV-positive patients. Using a random-sample mail survey, they measured dentists' professional attitudes toward treating HIV/AIDS patients, fear of contagion and negative emotions toward HIV-positive patients. The results indicate that 68 percent of the respondents would treat an HIV-positive patient, even if the possibility for a legitimate referral exists.

University students with serious substance use disorders may require specialized treatment. The New Jersey Collegiate Substance Abuse Program (NJCSAP) was a treatment center developed for this population that allowed students to receive treatment while remaining in the university environment and continuing school. NJCSAP was structured into three levels of care so that clients could be matched to treatment of appropriate intensity. In addition, NJCSAP helped students develop a network of supportive recovering peers and activities on the Rutgers University campus. An evaluation of the client population revealed a group of students with a history of severe substance use and related problems. Implications of the evaluation results are discussed.

Objectives: To determine attitudinal predictors of health-care providers' willingness to treat HIV-infected patients. We also tested the hypothesis that differences between dental and medical students in their expressed desire to treat HIV-infected patients result from differences in their clinical exposure to bloodborne pathogens and their clinical training., Design: A cross-sectional design was used to administer a self-report questionnaire format to preserve subject anonymity., Methods: A questionnaire was used to assess attitudes, knowledge, and behavior associated with the care of HIV-infected patients. Both bivariate statistics and logistic regression techniques were used to determine factors related to the desire to treat HIV-infected patients., Results: Compared with dental students, medical students expressed a greater desire to treat HIV-infected patients. However, the attitudinal predictors of a desire to treat were similar across both groups. The two most important predictors were the degree to which respondents perceived a personal risk of HIV exposure and their sense of professional obligation to treat all patients. Furthermore, knowledge levels were unrelated to desire to treat., Conclusions: These results suggest that educational interventions aimed simply at increasing a provider's knowledge of HIV may not be effective in changing behavior.

Substance abuse is a serious problem in the young adult population, yet there exists a lack of reliable screening measures for use in identifying problem users in this age group. The Rutgers Collegiate Substance Abuse Screening Test (RCSAST) is a 25-item, true/false questionnaire that was created to provide a reliable means of identifying young adult substance abusers. Three groups completed the RCSAST: a clinical sample of 84 young adult, problem substance users; a group of 33 young adults who were referred to an assistance program but were judged not to have a substance use problem; and a control sample of 87 young adult, nonproblem substance users. The RCSAST correctly classified 94% of the clinical subjects as problem users, and 89% of the control subjects as nonproblem users. The difference between the average total scores for the two groups was highly significant. In addition, the RCSAST was able to distinguish between problem and nonproblem users within the sample of subjects who were referred for evaluation. The findings support the use of the RCSAST in identifying young adult substance abusers.

In recent years, increasing numbers of experts have recommended that psychological support be available for cleft children and their parents. Few cleft palate centers however offer comprehensive psychological services. This paper presents some conceptual factors which may contribute to the paucity of psychological treatments available to cleft children and their families. Shortcomings in current concepts of emotional dysfunction in cleft children are discussed, and the effects of conceptual confusion on options for psychotherapy are outlined. Suggested directions in psychotherapy research for cleft children are discussed.

Purpose: To examine how medical students' attitudes and intentions toward the treatment of persons infected with human immunodeficiency virus (HIV) changed as the students progressed through medical school., Method: Similar 44-item self-administered questionnaires, to be completed anonymously, were given to 394 medical students at the University of Michigan Medical School in February 1989, when the students were in their first or second years, and to 378 of the same students in February 1991, when they were in their third or fourth years. Seven subscale variables were created, and their effects on students' willingness to treat HIV-infected patients were assessed. Bivariate statistics and logistic regression were used to relate the dependent and independent variables., Results: In 1989, 201 (51%) of the students responded; in 1991, 208 (55%) responded. The students showed a high--but declining--degree of willingness to care for patients infected with HIV or at high risk of infection. Homophobic attitudes decreased, but so did the students' intentions to follow infection-control guidelines. The students who expressed a career interest in surgery specialties indicated less willingness to provide care for HIV-infected patients, presumably because these students felt that they would be at a higher risk of exposure., Conclusion: Overall, the students' responses indicated that over the two years of the study they became more restrictive in their attitudes toward HIV-positive patients, felt less personal obligation toward caring for these patients, and were less likely to use appropriate infection-control methods to ensure their own safety.

Comorbidity of psychiatric and substance use disorders is prevalent in adult substance abusers and influences the outcome of substance abuse treatment. To study the impact of comorbid disorders, adult subjects are subtyped into primary and secondary abusers. This study assessed comorbidity in young adult substance abusers involved in treatment, and evaluated the utility of the primary/secondary distinction in this population. Over half of the sample met criteria for at least one current psychiatric diagnosis. Subtyping resulted in 20 primary and 34 secondary abusers. The groups differed on gender, age of first problem due to substance use, depressive symptomatology, and reasons for use of alcohol. Secondary abusers reported more severe family and psychiatric problems than did primary abusers. The groups did not differ in the severity of alcohol or drug problems. These results indicate that comorbidity must be evaluated and addressed when treating young adult substance abusers.