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This study investigated correlations between airway size and age, sex, and skeletal patterns; identified airway change trends; and measured volumetric norms in children via cone-beam computed tomography.Four hundred twenty nontreated white patients were stratified by age, sex, and anteroposterior skeletal pattern. The nasopharyngeal airway (NPA), oropharyngeal airway (OPA), and total pharyngeal airway (TPA) volumes were delineated on 3-dimensional digital cephalograms. SPSS (SPSS, Chicago, Ill) was used to run an analysis of variance and post-hoc analyses.The Class III group had significantly larger OPA volumes than Class I and II groups. Male subjects had considerably larger NPA volumes than female subjects. Age was significantly associated with all 3 airway volumes (P 0.05). The young cohort (ages, 9-10 years) had a mean TPA of 11,435.34 ± 484.45 mmAn effect of skeletal classification on OPA and a sex effect on NPA were observed. The annual change in the mean of TPA volume decreased in subjects aged 10-12 years, then rebounded until 14 years. TPA change peaked in female subjects 1 year before male subjects.

Military sexual trauma (MST) is prevalent, and some initial evidence suggests it is associated with impaired employment outcomes. The Veterans Health Administration (VHA) offers supported employment (SE) and Community-Based Employment Services (CBES), which consist of individualized employment support integrated with mental health treatment. The objective of this study was to examine the prevalence and effect of MST on competitive employment outcomes following participation in SE or CBES. Participants were a national set of Veterans who participated in VHA SE or CBES services between 2015 and 2019 and whose medical record contained a completed MST screen (

Peter Levenda, The Dark Lord: H. P. Lovecraft, Kenneth Grant, and the Typhonian Tradition in Magic (Lake Worth, Fl.: Ibis Press, 2013), 352 pp., $35 (hardcover). Henrik Bogdan, ed., Servants of the Star & the Snake: Essays in Honour of Kenneth and Steffi Grant (London: Starfire Publishing, 2018), 360 pp, photographs, £25 (hardcover).

Summary Objective The objective of this study was to investigate the effects of maxillary central incisor (U1) inclination changes on alveolar bone and root length in the 20 Class II division 1 and 20 Class II division 2 (CII div1, CII div2) Caucasian adolescents treated without extraction. Material and methods Forty U1s from each group were assessed for root length and alveolar variables at the crestal, mid-root, and apical levels using sagittal sections obtained from CBCT images pre- and post-treatment. Mixed MANOVAs, Repeated measures MANOVAs, Pearson correlations, and regression analyses were performed. Results The facial bone height did not change significantly after an average of 15 degrees of proclination in the CII div2 group, whereas a statistically significant decrease in the palatal bone height was noted. However, in the CII div1 group, a statistically significant reduction in the facial and palatal bone height was observed with mild crown retroclination. Both groups had a significant decrease in total bone thickness at all levels, more decrease in the CII div2 group after treatment. No statistically significant difference in root length was observed between the groups during treatment. Conclusions The findings support that the flaring of retroclined U1s as a process for normalizing U1 inclination did not harm the facial alveolar bone height in the CII div2 non-extraction treatment. Crown proclination itself was not correlated to the amount of root resorption in Class II div1&2 non-extraction treatments in adolescents.

The aim of this study was to longitudinally evaluate changes in the pharyngeal airway volume in adolescents treated with fixed orthodontic appliances compared to matched untreated adolescents and to assess its impact on airflow resistance.The sample consisted of 16 adolescents (mean start age of 11 years 3 months) who had started and completed treatment at the orthodontic department of the University of Detroit Mercy School of Dental Medicine. This group was compared to a control that consisted of 16 adolescents (mean start age 12 years) who had two CBCTs with no treatment in between for the purpose of regular orthodontic evaluation. Differences in airway volume, length, minimum cross-sectional area, and the average cross-sectional area were calculated.The results indicated that the airway volume increased by 39% and was a statistically significant change (P0.05). Regarding the influence on airflow resistance, the change in cross sectional area was significant in the group treated with fixed orthodontic appliances (P0.03).Adolescents treated with fixed orthodontic appliances do experience an increase in airway volume, as well as a decrease in airway resistance to airflow compared to that in normal growth.

We examined whether caregivers of bipolar patients reporting current suicidal ideation and/or a history of a suicide attempt reported higher levels of burden and/or poorer health compared to caregivers of patients without these suicidality indices. In a cross-sectional design, caregivers (N = 480) associated with (a) patients with current suicidal ideation or (b) patients with a positive lifetime history of at least one suicide attempt, reported lower general health scores than caregivers associated with patients with neither of these indices. Parents of patients with at least one lifetime attempt reported more burden secondary to role dysfunction than spouses. Levels of depression in caregivers varied with whether the caregiver was a spouse or a parent, and whether patients had a history of suicide attempts, current suicidal ideation, or both.

Perlick DA, Gonzalez J, Michael L, Huth M, Culver J, Kaczynski R. Calabrese J. Miklowitz DJ. Rumination, gender, and depressive symptoms associated with caregiving strain in bipolar disorder. Objective: To evaluate the associations between indices of caregiving strain, ruminative style, depressive symptoms, and gender among family members of patients with bipolar disorder. Method: One hundred and fifty primary caregivers of patients enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) participated in a cross-sectional study to evaluate the role of ruminative style in maintaining depressive symptoms associated with caregiving strain. Patient lifetime diagnosis and current episode status were evaluated by the Affective Disorder Evaluation and the Clinical Monitoring Form. Caregivers were evaluated within 30 days of the patient on measures of family strain, depressive symptoms, and ruminative style. Results: Men and women did not differ on depression, caregiver strain, or ruminative style scores. Scores suggest an overall mild level of depression and moderate caregiver strain for the sample. Greater caregiver strain was significantly associated (P

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.

Background Alzheimer's disease (AD) imposes a severe burden upon patients and their caregivers. Severity of psychiatric symptoms and behavioral disturbances is an important determinant of caregivers' experience of burden. These symptoms may be improved with atypical antipsychotic treatment. Objective Data from the Clinical Antipsychotic Trials of Intervention Effectiveness-Alzheimer's Disease (CATIE-AD) trial were used to evaluate the effect of atypical antipsychotics versus placebo on the experiences of caregivers of outpatients with AD. Method We compared the effect of atypical antipsychotic drugs (olanzapine, risperidone, or quetiapine-considered together as a group) versus placebo on the experiences of caregivers of AD outpatients (diagnosed according to DSM-IV-TR). We also evaluated whether improvement in patients' psychiatric and behavioral symptoms mediated the relationship between drug treatment and caregiver burden. The CATIE-AD trial, conducted from April 2001 through November 2004, included outpatients (mean age = 77.9 years [SD = 7.5 years]) in usual care settings and assessed treatment effectiveness over a 9-month period at 42 US sites. In a set of secondary analyses, data from CATIE-AD participants who had at least 1 postbaseline outcome assessment and data from their caregivers were examined in an intention-to-treat (ITT) analysis (N = 361). A phase 1-only analysis was conducted including only observations while patients were receiving the initially randomized drug (N = 153). The Burden Interview, the Beck Depression Inventory, and the Neuropsychiatric Inventory (NPI) Caregiver Distress Scale were used to evaluate caregiver burden. Results In both ITT and phase 1-only analyses, caregivers of patients treated with second-generation antipsychotics scored significantly lower than caregivers of patients receiving placebo on both the Burden Interview (P = .0090) and the NPI Caregiver Distress Scale (P = .0209). These differences appeared to have been mediated by lower levels of agitation, hostility, and psychotic distortions. Conclusion In AD patients with symptoms of psychosis, agitation, or aggressive behavior, medications can have a small but significant impact on caregiver burden.

Background This study evaluated the effectiveness of first- and second-generation antipsychotics in reducing family burden associated with schizophrenia. Methods The family caregivers of 623 SCID-diagnosed patients enrolled in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) randomly assigned to a first-generation antipsychotic (perphenazine) or one of four second-generation drugs (olanzapine, quetiapine, risperidone or ziprasidone) were interviewed about resources provided and stresses experienced at baseline and followed for 18 months. Patient symptoms, side effects and service use were assessed as well. Hierarchical regression analyses evaluated the effect of treatment assignment on four burden factors: problem behavior, resource demands and disruption, impairment in activities of daily living and patient helpfulness. Intention-to-treat analyses with all available observations classified based on initial treatment assignment, including observations after medications changed were followed by secondary analyses excluding observations after the first medication change, i.e. only considering initial medication. Results Despite significant reductions on the problem behavior and resource demands/disruption factors, there were no significant differences between perphenazine and any of the second-generation medications. When only initial treatment period observations were included, patients were perceived as more helpful when medicated with perphenazine as compared to risperidone. In comparisons between second-generation drugs, patients on quetiapine were perceived as more helpful than those on risperidone (p = 0.004). Conclusion In this 18-month randomized trial, there was no evidence of superiority of second-generation antipsychotics in relieving family burden.

To identify caregivers at risk for adverse health effects associated with caregiving, the stress, coping, health and service use of 500 primary caregivers of patients with bipolar disorder were assessed at baseline, 6, and 12 months. K-means cluster analysis and ANOVA identified and characterized groups with differing baseline stress/coping profiles. Mixed effects models examined the effects of cluster, time, and covariates on health outcomes. Three groups were identified. Burdened caregivers had higher burden and avoidance coping levels, and lower mastery and social support than effective and stigmatized caregivers; stigmatized caregivers reported the highest perceived stigma (p < 0.05). Effective and stigmatized groups had better health outcomes and less service use than the burdened group over time; stigmatized caregivers had poorer self-care than effective caregivers. Cluster analysis is a promising method for identifying subgroups of caregivers with different stress and coping profiles associated with different health-related outcomes.

This study aimed to evaluate the association of positive and negative symptoms, as well as of neurocognition to functional status in patients with schizophrenia. Participants were 309 veterans with DSM-IV-diagnosed schizophrenia or schizoaffective disorder who were enrolled in a 12-month double-blind clinical trial and randomized to receive either 5 to 20 mg/d of oral olanzapine or haloperidol. Patients were assessed at study entry and at 3, 6 and 12-months on the PANSS and measures of verbal memory, verbal fluency, fine motor coordination, visual sequencing/set shifting, and conceptual reasoning. Functional status was evaluated by the Heinrichs-Carpenter Quality of Life Scale (QLS) and by days of employment in the past 30. Hierarchical regression models examined the association of functional status with symptomatology and three neurocognitive factors (motor skills, memory and card sorting), controlling for demographics and visit number. A mixed effects model was used to adjust for repeated observations from the same subjects.The PANSS explained 16% additional variance in QLS total score after accounting for demographics and visit number (p.001), while the neurocognitive factors explained only 4% additional variance beyond the effect of symptoms. When neurocognition was entered before symptoms, it explained an additional 8% of the variance on the QLS total score, while the PANSS explained an additional 12% over and above neurocognition.These findings suggest that symptoms may pose an equal or greater impediment to functional capacity independent of neurocognition, at least in younger non-institutionalized people with schizophrenia.

Objective: Little is known about the factors contributing to mental illness stigma among caregivers of people with bipolar disorder. Methods: A total of 500 caregivers of patients participating in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study were interviewed in a cross-sectional design on measures of stigma, mood, burden, and coping. Relatives and friends with bipolar disorder were assessed on measures of diagnosis and clinical status, determined by a days-well measure derived from psychiatrist ratings of DSM-IV episode status. Because patients’ clinical status varied widely, separate models were run for patients who were euthymic for at least threefourths of the past year (well group) and for those who met criteria for an affective episode for at least one-fourth of the previous year (unwell group). Stepwise multiple regression was used to identify patient, illness, and caregiver characteristics associated with caregiver stigma. Results: In the unwell group, greater mental illness stigma was associated with bipolar I (versus II) disorder, less social support for the caregiver, fewer caregiver social interactions, and being a caregiver of Hispanic descent. In the well group, greater stigma was associated with being a caregiver who is the adult child of a parent with bipolar disorder, who has a college education, who has fewer social interactions, and who cares for a female bipolar patient. Conclusions: Mental illness stigma was found to be prevalent among caregivers of persons with bipolar disorder who have active symptoms as well as for caregivers of those who have remitted symptoms. Stigma is typically associated with factors identifying patients as “different” during symptomatic periods. Research is needed to understand how the stigma experienced by caregivers during stable phases of illness differs from the stigma experienced during patients’ illness states. (Psychiatric Services 58:41–48, 2007)

Objectives Over one-third of caregivers of people with bipolar disorder report clinically significant levels of depressive symptoms. This study examined the causal relationship between depression and caregiver burden in a large sample of caregivers of adult patients with bipolar disorder. Methods Participants were 500 primary caregivers of persons with bipolar disorder enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD).This study evaluates the strength and direction of the associations between caregiver burden and depressive symptoms at baseline and at six- and 12-month follow-up using cross-lagged panel analyses, controlling for the clinical status of patients and sociodemographic variables. Results Higher levels of overall caregiver burden at baseline were associated with increased levels of depressive symptoms among caregivers at follow-up (F = 8.70, df = 1,290, p < 0.001), after controlling for baseline caregiver depression, gender, race, age, social support, and patients’ clinical status. By contrast, caregiver depression at baseline was not significantly associated with caregiver burden at follow-up (F = 1.65, p = 0.20). Conclusions Caregiver burden is a stronger predictor of caregiver depressive symptoms over time than the reverse. Interventions that help alleviate caregiver burden may decrease depressive symptoms.

Objective: Despite the fact that autonomic nervous system (ANS) abnormalities are commonly found in adults and predict increased cardiovascular mortality, no studies have assessed ANS function in adults with attention-deficit/hyperactivity disorder (ADHD) taking stimulants. Method: This pilot study evaluated ANS function in adults with ADHD in comparison with an age- and gender-matched control group. Results: The authors found that 4% of the control group had some abnormalities in the ANS in comparison with 24% of the ADHD group. Conclusion: Because the control group had higher levels of exercise fitness, and the level of abnormalities in the ADHD group was comparable with that of the general population, the significance of these findings is unknown. In addition, we did not determine if ANS abnormalities were present in individuals with ADHD who were not on stimulant medications. Further research is warranted to determine if there is any association between ADHD and stimulant use and ANS abnormalities.

Objective Components and correlates of caregiver burden in schizophrenia were studied. Methods The family caregivers of 623 (43 percent) of 1,460 patients with schizophrenia enrolled in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) were interviewed about resources they provided and experiences with patient behavior over the previous month. Patients were independently evaluated on symptoms, quality of life, neurocognition, medication side effects, and service use. Factor analysis reduced the caregiver data into four orthogonal factors assessing perceptions of patient problem behavior, patient impairment in activities of daily living, patient helpfulness, and resource demands and disruptions in the caregiver's personal routine. Results Hierarchical regression analyses demonstrated differential correlates of burden for each factor, explaining 34 percent of variance each for problem behavior and resource demands and disruption, 21 percent for impairment in activities of daily living, and 38 percent for patient helpfulness. Demographic characteristics and patient symptoms explained the greatest proportion of variance, whereas quality of life and service use explained modest variance and patient neurocognition and medication side effects were not significantly associated with burden. Conclusions Results underscore the need for continued intervention with family members after the acute inpatient phase of treatment to address the impacts of symptoms as well as incorporation of skills training into consumer treatment programs to improve consumer contributions to household maintenance.

Objectives: Caring for a relative with schizophrenia or dementia has been associated with reports of caregiver burden, symptoms of anxiety, depression, poor self-rated health, and elevated health service use; however, comparable data for caregivers of relatives with bipolar disorder are lacking. This study reports preliminary data on the health, psychological distress and health service use of caregivers of patients with bipolar disorder. It additionally evaluates the relationship of the level of burden caregivers report experiencing to their use of health services, controlling for level of psychological distress and health status. Methods: Subjects were primary caregivers of 264 patients with Research Diagnostic Criteria-diagnosed bipolar disorder and their bipolar relatives. Caregiver mental health and primary care service use were assessed retrospectively for the 7-month period prior to inpatient or outpatient admission of the bipolar patient. Caregiver depression, anxiety, medical conditions and patient symptomatology were assessed as well. Results: Hierarchical logistic regression analysis demonstrated that caregiver burden significantly increased the likelihood of mental health service use (OR = 13.53, p

Purpose: The objective of this study was to compare the treatment outcomes and stability of patients with Class II malocclusion treated with either functional appliances or surgical mandibular advancement. Material: The early-treatment group consisted of 30 patients (15 girls, 15 boys), with a mean age of 10 years 4 months (range, 7 years 5 months to 12 years 5 months), who received either Frankel II (15 patients) or Herbst appliances (15 patients). The surgical group consisted of 30 patients (23 female, 7 male), with a mean age of 27 years 2 months (range, 13 years 0 months to 53 years 10 months). They were treated with bilateral sagittal split ramus osteotomies with rigid fixation. Lateral cephalograms were taken for the early-treatment group at T1 (initial records), T2 (completion of functional appliance treatment), and Tf (completion of comprehensive treatment). In the surgical group, lateral cephalograms were taken at T1 (initial records), T2 (presurgery), T3 (postsurgery), and Tf (completion of comprehensive treatment). The average times from the completion of functional appliance treatment or surgery to the final cephalograms were 35.8 months and 34.9 months, respectively. A mixed-design analysis of variance was used to compare changes within and between groups. Results: In the functional appliance group, the mandible continued to grow in a favorable direction even after discontinuation of the functional appliance. Both groups had stable results over time. Both groups finished treatment with the same cephalometric measurements. Significant skeletal and soft tissue changes were noted in the treatment groups due to either functional or surgical advancement of the mandible. More vertical relapse was noted in the surgical group than in the functional group. Conclusions: This study suggests that early correction of Class II dentoskeletal malocclusions with functional appliances yields favorable results without the possible deleterious effects of surgery.

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.

The purpose of this study was to determine the magnitude of condylar axis distraction from maximum intercuspation (MI) to centric relation (CR) in a 2-phase treatment group compared with a group of patients treated with a 1-phase gnathologically based treatment approach. More specifically, the difference in condylar axis position measured was the position of the condyles when the teeth meet in maximum intercuspation and that position in which the initial tooth contact occurs in centric relation. The CR registration was obtained after 3 weeks of continuous splint wear to achieve the neuromuscular release necessary to obtain a muscle/joint-guided position rather than a tooth-guided condylar position. Measurements of the vertical, transverse, and anterior-posterior distraction of the articulator's condyles from CR to MI were recorded on a millimetric grid using the Panadent condylar position indicator (CPI; Panadent Corp, Grand Terrace, CA). Study results indicated a statistically significant difference in the magnitude of condylar distraction from CR to MI in only the vertical dimension when comparing patients treated in 2 phases versus those treated with a 1-phase gnathological approach. The vertical CPI discrepancy resulting from the 2-phase approach averaged 1 mm larger than that from the 1-phase approach. Although differences in the magnitude of discrepancies were also found in the anteroposterior (AP) and transverse dimensions, these differences were not statistically significant at P

The purpose of this study was to examine the condylar position indicator(CPI, Panadent Corp, Grand Terrace, CA) readings of 200 consecutively finished patients in a gnathologically oriented practice to determine the nature of the centric relation (CR)-maximum intercuspation (MI) discrepancy pretreatment and posttreatment, in extraction and nonextraction cases as well as to examine the possible effect of skeletal morphologic parameters on treatment outcome. The study consisted of 200 patients, 127 women and 73 men, whose average age was 14 years and 2 months and ranged from 9 years to 55 years old. These patients were treated using the Roth gnathologic treatment philosophy and straight-wire appliance. Finished cases were defined as patients who completed treatment with a gnathologic positioner. Initial records included upper and lower alginate impressions, an estimated face-bow transfer, a maximum intercuspation wax bite using Moyco 10× pink wax (Moyco Industries Inc, Philadelphia, PA) and a preliminary 2-piece Roth power centric CR bite registration using Delar blue wax (Delar Corp, Lake Oswego, Or.). CPI measurements were made on all casts, pretreatment and posttreatment, to record the positional changes of the condylar axes from MI to CR in all 3 planes of space. The measurements were made to the nearest 0.1 of a millimeter with the Panadent optical resolver. A mixed-design analysis of variance was employed using pre- and posttreatment values as the within-subjects factor and skeletal Class, vertical growth pattern as assessed by upper/lower face height ratio values, and extraction or nonextraction as the between-subjects factor. All groups responded to treatment with a statistically significant reduction in MI-CR discrepancy in all 3 planes of space—x, y, and transverse—between pretreatment and posttreatment records ( P

The objective of this retrospective study was to compare the maximumintercuspation (MI) and centric relation (CR) disharmony between 3 groups of postcomprehensive orthodontic patients. In group 1 (gnathologic, n=11), diagnosis, treatment planning, and therapy were assessed and monitored using a gnathological treatment approach by using the Roth straight-wire appliance (A Company, San Diego, CA) and appropriate MI-CR conversions, model mountings, and pregnathologic positioner evaluation. Group 1 patients were evaluated for MI and CR harmony after placement of a gnathologic positioner and 3 weeks of 24-hour gnathological splint wear. Condylar position changes between MI and CR were recorded with the Panadent Condylar Position Indicator (CPI; Panadent Corp, Grand Terrace, CA). Group 2 patients (non-gnathologic, n=14) were treated with a nongnathologic philosophy using the Roth straight-wire appliance. Diagnosis, treatment planning, and therapy were done using hand-held models trimmed to CR and used no gnathologic instrumentation assessment. Patients were evaluated for MI before splint insertion and CR after 3 weeks of 24-hour gnathological splint wear. Group 3 (gnathologic, n=23) had diagnosis, treatment planning, and therapy exactly the same as group 1 (gnathologic); however, MI and CR were assessed before placement of a gnathologic positioner and gnathological splint. Anova and post hoc tests were performed to evaluate statistical significance of the MI-CR discrepancy as measured by CPI differences within and between groups. Post hoc multiple comparisons indicated statistically significant differences at P P

The mandibular anterior repositioning appliance (MARA) is a tooth-borne functional appliance for use in patients with Class II malocclusions; it positions the mandible forward into a Class I occlusion. The aim of this study was to investigate the MARA's dental and skeletal effects on anterior, posterior, and vertical changes in 30 Class II patients. The treatment group consisted of 12 boys with an average age of 11.2 years and 18 girls with an average age of 11.3 years. A pretreatment cephalometric radiograph was taken 2 weeks before treatment, and a posttreatment cephalometric radiograph was taken 6 weeks after removal of the MARA, with an average treatment time of 10.7 months. The mean and standard deviation were calculated for each cephalometric variable, and Student t tests were performed to determine the statistical significance of the changes. The results of the study showed that the MARA produced measurable treatment effects on the skeletal and dental elements of the craniofacial complex. These effects included a considerable distalization of the maxillary molar, a measurable forward movement of the mandibular molar and incisor, a significant increase in mandibular length, and an increase in posterior face height. The effects of the MARA treatment were then compared with those of the Herbst and Fränkel appliances. The treatment results of the MARA were very similar to those produced by the Herbst appliance but with less headgear effect on the maxilla and less mandibular incisor proclination than observed in the Herbst treatment group.

Although many improvements have been made in orthodontic surgical procedures for mandibular retrognathism, relapse continues to occur. This study was designed to compare the stability of rigid and nonrigid fixation between 2 groups of patients who had undergone mandibular advancement surgery via sagittal split ramus osteotomy. Retrospective cephalometric measurements were made on 54 randomly selected orthognathic surgical patients. The patients, 7 males and 47 females, were divided into 2 groups: 28 patients stabilized by means of rigid fixation and 26 patients fixated with interosseous wires. The age of the patients ranged from 15.3 to 49.7 years. Lateral cephalograms were used to evaluate each patient at 3 distinct intervals: 7.0 ± 2.0 days before surgery (T1), 34.4 ± 15.0 days postsurgery (T2), and 458 ± 202 days after sagittal split osteotomy (T3). Eighteen linear and angular measurements were recorded and differences between the 3 time periods were evaluated. Statistical analyses were performed to assess the differences in the 2 fixation types between and within each group at different time intervals. The following measurements showed statistically significant skeletal relapse over time, for the P value.0028: Co-Go, ANS-Xi-Pm, IMPA, overbite, and overjet. The remaining variables showed no statistically significant relapse. The only measurement that showed a statistically significant group difference between T1 and T2 was DC-Xi-Pm. Results of the study led to the following conclusions: there was statistically significant relapse in mandibular length, lower anterior face height, mandibular arc, lower incisor inclination, overbite, and overjet in each group, regardless of the type of fixation. The potential was greater for relapse in patients stabilized with transosseous wiring. Although multifactorial, relapse in overbite and overjet may be a combination of skeletal and dental changes. (Am J Orthod Dentofacial Orthop 2000;118:397-403).

Depression research is sparse with older American Indians, and almost non-existent with Great Lakes American Indians. In our study, 309 Great Lakes American Indian elderly from urban, rural, and reservation settings were interviewed. Two-thirds of the sample were over age 65. Fifty-four percent of the sample completed less than a high school education, and 23 percent completed only a high school education. Depression prevalence and its correlates were examined. The CES-D was used to measure depressive symptomatology, and was found to have good internal consistency in our sample (alpha = .85), Overall, 18.3 percent of the sample scored above the traditional cutoff for depression (16). Both having completed fewer years of formal education and living in an urban area were significant predictors of depression.

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.

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 (MRt), left first molar (MLft), right first premolar (PMRt), and left first premolar (PMLft). 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 MRt, −0.72 mm PMRt, −0.50 mm MLft, and −0.57 mm PMLft (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 MRt (0.63 mm) and PMLFt (0.37 mm) as evidenced by the paired t-test (P < .05).

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.

Introduction The purpose of this study was to report on the clinical outcomes of a 24-month orthodontic residency. Methods One examiner scored 1019 consecutive pretreatment records and 714 consecutive posttreatment records annually over 5 years, using the American Board of Orthodontics discrepancy index and objective grading system. Results The mean discrepancy index scores were 19.63, 14.84, 12.30, 15.72, and 15.39 for years 1 through 5, respectively. The mean objective grading system scores were 31.16, 34.79, 28.55, 26.28, and 22.11 for years 1 through 5, respectively. The residents' completion rates for all cases were 58.9%, 60.5%, 82.7%, 74.4%, 78.2%, and 72.2% for years 1 through 5, respectively. Conclusions The establishment of an annual objective outcomes assessment benefited patients by improving objective grading system scores and reduced the number of transfers between residents (increased case completion rate), thus reducing faculty time for managing many transfer patients.

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.

Objectives: Caring for a relative with schizophrenia or dementia is associated with reports of high caregiver burden, symptoms of depression, poor physical health, negligence of the caregiver's own health needs, elevated health service use, low use of social supports, and financial strain. This study presents the design and preliminary data on the costs and consequences of caring for a relative or friend with bipolar disorder from the Family Experience Study, a longitudinal study of the primary caregivers to 500 patients enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder. Methods: Subjects were primary caregivers of 500 patients with bipolar disorder diagnosed by the Mini International Neuropsychiatric Interview and the Affective Disorder Evaluation. Caregivers were evaluated within 1 month after patients entered Systematic Treatment Enhancement Program using measures of burden, coping, health/mental health, and use of resources and costs. Results: Eighty-nine percent, 52%, and 61% of caregivers, respectively, experienced moderate or higher burden in relation to patient problem behaviors, role dysfunction, or disruption of household routine. High burden caregivers reported more physical health problems, depressive symptoms, health risk behavior and health service use, and less social support than less burden caregivers. They also provided more financial support to their bipolar relative. Conclusions: Burdens experienced by family caregivers of people with bipolar disorder are associated with problems in health, mental health, and cost. Psychosocial interventions targeting the strains of caregiving for a patient with bipolar disorder are needed.

Informal caregiving contributes significantly to the health and well being of chronically ill persons. While a vast literature demonstrates this connection, the cost and financial burden of informal caregiving has received considerably less research attention, especially as it-pertains to bipolar disorder.This paper develops an integrated burden model of informal caregiving, which is contrasted with other more traditional models of caregiving costs, and then uses these models to estimate the financial burden of bipolar disorder. The "goodness" of these various models is measured in terms of their correlation with measures of objective and subjective burden for caregivers of persons with bipolar disorder.The study was an ancillary protocol to the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) and included primary caregivers of 500 people with bipolar disorder. Approximately 96% (n=486) caregivers participated in the study. Caregivers were interviewed at baseline, and six and 12 months after an initial interview. The semi-structured interview included questions on (i) subjective distress; (ii) the types of support and services; (iii) caregiver use of formal and informal services and support; and (iv) contributions received from the relative with bipolar over the past month.The correlations between financial burden and psychological burden measures were positive and statistically significant in cases where all resource costs were measured but adjusted for reciprocated giving and customary generosity (the integrated model). The strength of correlations was greater when time is valued at its opportunity cost (and not imputed) and the caregiving costs based on this valuation approach were logarithmically transformed.The magnitude of the correlations is consistent with the notion that caregiver burden is a coherent construct with multiple different dimensions. Financial burden appears to be a unique dimension that is significantly intercorrelated with psychological measures but is not redundant with them. The robustness of these findings need to be tested with larger samples and across caregiver illness groups.Caregiving is likely to have health and stress-related consequences that increase caregiving costs. Understanding which costs are associated with feelings of burden can be used to inform the design of interventions to minimize the stressful or burdensome aspects of caregiving. Giving back reduces the magnitude of caregiving costs and the sense of psychological burden. Interventions that develop the potential to "give back" are likely to be beneficial for both the caregiver and the care receiver as it increases reciprocity and decreases dependency.Caution is needed in estimating the costs of informal caregiving needs as many costs are possible but their relationship to burden varies in strength and significance. Assumptions related to what is given and received and how this relates to expected patterns of giving and receiving in measuring and determining financial burden and costs are particularly important, as is the valuation of time.

Components and correlates of caregiver burden in schizophrenia were studied.The family caregivers of 623 (43 percent) of 1,460 patients with schizophrenia enrolled in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) were interviewed about resources they provided and experiences with patient behavior over the previous month. Patients were independently evaluated on symptoms, quality of life, neurocognition, medication side effects, and service use. Factor analysis reduced the caregiver data into four orthogonal factors assessing perceptions of patient problem behavior, patient impairment in activities of daily living, patient helpfulness, and resource demands and disruptions in the caregiver's personal routine.Hierarchical regression analyses demonstrated differential correlates of burden for each factor, explaining 34 percent of variance each for problem behavior and resource demands and disruption, 21 percent for impairment in activities of daily living, and 38 percent for patient helpfulness. Demographic characteristics and patient symptoms explained the greatest proportion of variance, whereas quality of life and service use explained modest variance and patient neurocognition and medication side effects were not significantly associated with burden.Results underscore the need for continued intervention with family members after the acute inpatient phase of treatment to address the impacts of symptoms as well as incorporation of skills training into consumer treatment programs to improve consumer contributions to household maintenance.

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.

Combined orthodontic and surgical treatment of severe Class II dentoskeletal deformities with the use of the bilateral sagittal split ramus osteotomy is a routine procedure in orthodontic practices. However, an alternative surgical technique, the total mandibular subapical alveolar osteotomy, could be used for the same purpose. The aim of this investigation was to compare the stability of the sagittal split ramus osteotomy with the total mandibular subapical alveolar osteotomy in the correction of dentoskeletal Class II malocclusions. Forty patients that exhibited Class II dentoskeletal relationships were included in the study. Twenty of these patients had mandibular advancement with the sagittal split ramus osteotomy; the remaining 20 patients had advancement of the whole lower alveolar segment with the total mandibular subapical alveolar osteotomy. The cephalograms studied were taken before the surgical procedure (T1 = 4 weeks before operation), immediately after the procedure (T2 = 10 days after surgery), and 1 year later (T3). The statistical analysis used to assess the results between and within the groups over the different time periods was the analysis of variance. The regression analysis was used to test the interdependence of soft tissue response to hard tissue movement. The results of this study show that both procedures are equally stable when correcting Class II malocclusions. This was proved by the stability of the correction of overjet, B point, and incisor-mandibular plane angle. There were no statistically significant differences between or within the groups in the position of these landmarks over time. There was a statistically significant change in the position of pogonion from T1 to T2 (P

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. (Am J Orthod Dentofacial Orthop 1999;116:563-71)

In this study, the Peer Assessment Rating (PAR) index was used to objectively evaluate early treatment outcomes. Pretreatment and posttreatment casts of 103 consecutively treated patients were analyzed. The mean chronological, skeletal, and dental ages were 9. 82, 9.76, and 9.32 years, respectively. Calibrated examiners scored all models using the PAR ruler. PAR scores were weighed by means of a validation exercise. Cronbach alpha reliability analysis was used to establish the consistency of the subjective rating among 10 orthodontists of the severity of malocclusion. Pearson's correlation coefficient was used to assess the association among the orthodontists and the total PAR scores. Multiple regression analysis was used to determined the optimum weight of the PAR scores. Pretreatment and posttreatment differences were evaluated with t tests. The association between PAR scores and classification of malocclusions and treatment categories was assessed by means of multivariate analysis of variance (MANOVA). A reduction in the PAR index was observed for the mean raw and weighted scores, from 15.82 to 8.82 and from 5.28 to 3.73, respectively (P

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.