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Background US data on the validity and reliability of the short-form Family Impact Scale (FIS-8; a scale for measuring the impact of a child’s oral condition on his/her family) are lacking. Methods Cross-sectional analysis of data on four-year-old US children taking part in a multi-center cohort study. For child-caregiver dyads recruited at child age 12 months, the impact of the child’s oral condition on the family was assessed at age 48 months using the FIS-8, with a subsample of 422 caregivers (from 686 who were approached). Internal consistency reliability was assessed using Cronbach’s α, with concurrent validity assessed against a global family impact item (“How much are your family’s daily lives affected by your child’s teeth, lips, jaws or mouth?”) and a global oral health item (“How would you describe the health of your child’s teeth and mouth?”). Results Cronbach’s alpha was 0.83. Although gradients in mean scores across ordinal response categories of the global family impact item were inconsistent, there were marked, consistent gradients across the ordinal categories of the global item on the child’s oral health, with scores highest for those rating their child’s oral health as ‘Poor’. Conclusions While the findings provide some evidence for the utility of the FIS in a US child sample, the study’s replication in samples of preschoolers with greater disease experience would be useful.

Dental fluorosis occurs from overingestion of fluoride during tooth formation. However, there is little evidence in the literature on whether or how fluorosis prevalence and severity change over time after tooth eruption. Permanent dentition dental examinations were conducted at ages 9, 13, 17, and 23 as part of the Iowa Fluoride Study, which has followed a cohort from birth. Fluorosis was assessed using the Fluorosis Risk Index (FRI) and Russell’s criteria for differential diagnosis. Measures of fluorosis severity at the person and tooth level were calculated: second highest FRI score at the person level (the maximum FRI score for each tooth was determined and the tooth with the second highest maximum FRI score was used) and highest FRI score at the tooth level. At both the person and tooth levels, a decline in mild to moderate fluorosis severity was observed across adolescence and young adulthood. Across each pair of adjacent examinations at the person level, for participants with a baseline second highest FRI of 0, most participants stayed at 0 (82% to 91%). Many participants with a baseline second highest FRI of 1 had a follow-up score of 0 (47% to 54%), while about a third had a follow-up score of 1 (34% to 38%), and a lower percentage had an increase to a score of 2 (9% to 15%). For participants with baseline second highest FRI score of 2, between 25% and 44% of participants had follow-up FRI scores each of 0, 1, and 2. Similar patterns were observed at the tooth level. These results were consistent with most of the existing, limited literature. Overall, fluorosis severity, which was initially mild to moderate, tended to decline during adolescence and young adulthood. Additional study of how this trend affects esthetic perceptions of fluorosis is warranted.

Understanding the development of the oral microbiota in healthy children is of great importance to oral and general health. However, limited data exist on a healthy maturation of the oral microbial ecosystem in children. Moreover, the data are biased by mislabeling “caries-free” populations. Therefore, we aimed to characterize the healthy salivary and dental plaque microbiome in young children. Caries-free (ICDAS [International Caries Detection and Assessment System] score 0) children ( n = 119) and their primary caregivers were followed from 1 until 4 y of child age. Salivary and dental plaque samples were collected from the children at 3 time points (T1, ~1 y old; T2, ~2.5 y old; and T3, ~4 y old). Only saliva samples were collected from the caregivers. Bacterial V4 16S ribosomal DNA amplicons were sequenced using Illumina MiSeq. The reads were denoised and mapped to the zero-radius operational taxonomic units (zOTUs). Taxonomy was assigned using HOMD. The microbial profiles of children showed significant differences ( P = 0.0001) over time. Various taxa increased, including Fusobacterium, Actinomyces, and Corynebacterium, while others showed significant decreases (e.g., Alloprevotella and Capnocytophaga) in their relative abundances over time. Microbial diversity and child-caregiver similarity increased most between 1 and 2.5 y of age while still not reaching the complexity of the caregivers at 4 y of age. The microbiome at 1 y of age differed the most from those at later time points. A single zOTU ( Streptococcus) was present in all samples ( n = 925) of the study. A large variation in the proportion of shared zOTUs was observed within an individual child over time (2% to 42% of zOTUs in saliva; 2.5% to 38% in dental plaque). These findings indicate that the oral ecosystem of caries-free toddlers is highly heterogeneous and dynamic with substantial changes in microbial composition over time and only few taxa persisting across the 3 y of the study. The salivary microbiome of 4-y-old children is still distinct from that of their caregivers.

Expanded partnership with the medical community is a promising strategy for reducing disparities in dental caries among young children. However, no validated caries risk instrument exists for use in primary health care settings. To help resolve this gap, a 52-item caries risk questionnaire was developed and targeted to primary caregivers (PCGs) to test in a 3-y prospective study. To begin to understand the validity of the questionnaire items, the purpose of this study was to compare responses to the questionnaire based on key demographic characteristics known to be associated with disparities in caries experience (e.g., race/ethnicity and insurance status). A total of 1,323 one-year-old children were recruited primarily through 3 medical research networks. Baseline questionnaire responses were analyzed via logistic regression. The sample was 49% female. Its racial/ethnic makeup was as follows: 13% Hispanic, 37% White, 37% Black, and 13% other or multiracial. Sixty-one percent were enrolled in Medicaid, and 95% resided in urban communities. Mothers represented 94% of PCGs. There were significant differences ( P < 0.05) in baseline responses based on Medicaid status and race/ethnicity. As compared with those not enrolled in Medicaid, children in the Medicaid group were significantly more likely (after adjusting for race/ethnicity) to 1) go to sleep while nursing or drinking something other than water, 2) eat sugary snacks between meals, 3) consume sugary drinks between meals, 4) receive topical fluoride from a health professional, 5) visit the dentist, and 6) not have an employed adult in the household. PCGs of children enrolled in Medicaid were significantly more likely to be the mother, have bleeding gums, eat sugary snacks between meals, consume sugary drinks between meals, eat or drink something other than water before going to bed, and not get regular dental checkups. In conclusion, there are significant differences in caries risk questionnaire responses based on Medicaid status and race/ethnicity that provide construct and criterion validity to the developed caries risk tool (ClinicalTrials.gov NCT01707797).

Expanded partnership with the medical community is an important strategy for reducing dental caries disparities. The purpose of this study was to assess the relationship between fluoride (F) "in office" (drops/tablets and/or varnish), as prescribed or applied by a health care professional by age 1 y, and 1) caries development and 2) presence of other caries risk factors or mediators (e.g., socioeconomic status). Child-primary caregiver (PCG) pairs ( N = 1,325) were recruited in Indiana, Iowa, and North Carolina as part of a longitudinal cohort study to validate a caries risk tool for primary health care settings. PCGs completed a caries risk questionnaire, while children received caries examinations per the criteria of the International Caries Detection and Assessment System at ages 1, 2.5, and 4 y. Baseline responses regarding children's history of F in office were tested for association with other caries risk variables and caries experience at ages 2.5 and 4 y via generalized estimating equation models applied to logistic regression. The sample was 48% female, and many children (61%) were Medicaid enrolled. The prevalence of cavitated caries lesions increased from 7% at age 2.5 y to 25% by age 4 y. Children who received F in office were likely deemed at higher caries risk and indeed were significantly ( P < 0.01) more likely to develop cavitated caries lesions by ages 2.5 and 4 y, even after F application (odds ratios: 3.5 and 2.3, respectively). Factors significantly associated with receiving F included the following: child being Medicaid enrolled, not having an employed adult in the household, child and PCG often consuming sugary drinks and snacks, and PCG having recent caries experience. Increased F in office from a health care provider by age 1 y was associated with known caries risk factors. Most (69%) children had never been to the dentist, suggesting that risk factors could be alerting medical providers and/or parents, thereby affecting in-office F recommendations. Differences among states could also be related to state-specific F-varnish reimbursement policies (ClinicalTrials.gov NCT01707797).

Evaluate retention efforts in an ongoing longitudinal multi-site study to develop a self-administered, simple-to-score caries risk tool to identify young children at risk of developing dental caries through medical settings. Preliminary study data had suggested that expected retention rates within a year of follow up, without any intermediate contact, would be approx. 75% in the target population. 1,326 primary caregiver/infant (1 year ± 3 months) pairs were enrolled at baseline across three study sites (Duke University, Indiana University, University of Iowa). Children were …

Matrix metalloproteinases (MMPs), which degrade extracellular proteins as part of a variety of physiological processes, and their inhibitors have been implicated in the dental caries process. Here we investigated 28 genetic variants spanning the MMP10, MMP14, and MMP16 genes to detect association with dental caries experience in 13 age- and race-stratified (n = 3,587) samples from 6 parent studies. Analyses were performed separately for each sample, and results were combined across samples by meta-analysis. Two SNPs (rs2046315 and rs10429371) upstream of MMP16 were significantly associated with caries in an individual sample of white adults and via meta-analysis across 8 adult samples after gene-wise adjustment for multiple comparisons. Noteworthy is SNP rs2046315 (p = 8.14 × 10−8) association with caries in white adults. This SNP was originally nominated in a genome-wide-association study (GWAS) of dental caries in a sample of white adults and yielded associations in a subsequent GWAS of surface level caries in white adults as well. Therefore, in our study, we were able to recapture the association between rs2046315 and dental caries in white adults. Although we did not strengthen evidence that MMPs 10, 14, and 16 influence caries risk, MMP16 is still a likely candidate gene to pursue.

Background Studies on alcohol abuse are frequently based on patients who meet minimum diagnostic criteria, thus ignoring patients with individual symptoms of harmful or hazardous use. Consequently, we are unable to characterize alcohol-abusing patients with sufficient clarity to effectively focus screening for primary prevention. Objective To determine the prevalence of harmful and hazardous use of alcohol, assess screening instruments for detecting alcohol abuse or dependence, and assess the impact of alcohol use on other diagnoses treated in outpatient settings. Design Survey (cross-sectional study). Setting Hospital-based outpatient clinic. Participants Three hundred randomly selected adults (aged 18 years and older). Main outcome measure Diagnosis of alcohol abuse or dependence based on the Diagnostic Interview Schedule (DIS). Results About 18% met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria of abuse or dependence while almost 50% had at least one symptom of harmful or hazardous use. The T-ACE questionnaire, a modified version of the CAGE questionnaire, was the most effective screening instrument for both men and women. Selected diagnoses, personal characteristics such as family history of alcohol abuse, and self-reported patterns of alcohol use could identify patients likely to meet diagnostic criteria. Conclusions Many symptoms of substance use disorders are not adequately addressed in outpatient practice. Little is known about how alcohol use in varying quantities affects health care utilization and treatment of conditions commonly seen in outpatient medicine. Consequently, we lack a full appreciation of the burden of disease borne by alcohol use and have yet to achieve a universally accepted method of approaching primary and secondary prevention of alcohol-related problems.

Expanded partnership with the medical community is a promising and necessary strategy for reducing disparities in dental caries among young children. The long-term objective of this study is to develop a self-administered, simple-to-score caries risk tool to identify young children at risk of developing dental caries through medical settings. A psychometrically defensible 52-item caries risk questionnaire, targeted to primary caregivers (PCG), was developed (based on …

The morphology of the midgut epithelium cells of Anticarsia gemmatalis (Hübner) larvae is described by light and transmission electron microscopy. The midgut of A. gemmatalis is the largest portion of the digestive tract, with three distinct regions: proximal, media and distal. Its wall is formed by pseudostratified columnar epithelial tissue having four cell types: columnar, goblet, regenerative, and endocrine cells. The columnar cells are numerous and long, with the apical portion showing many lengthy microvilli and the basal portion invaginations forming a basal labyrinth. The goblet cells have a large goblet-shaped central cavity delimited by cytoplasmic projections filled with mitochondria. The regenerative cells present electron-dense cytoplasm and few organelles. The endocrine cells are characterized by electron-dense secretory granules, usually concentrated in the cytoplasm basal region. A morfologia das células epiteliais do intestino médio de larvas de Anticarsia gemmatalis (Hübner) é descrita em microscopia de luz e eletrônica de transmissão. O intestino médio de A. gemmatalis é a maior porção do trato digestivo, apresentando três regiões distintas: proximal, média e distal. Sua parede é formada por um tecido epitelial pseudo-estratificado colunar, com quatro tipos celulares: células colunares, caliciformes, regenerativas e endócrinas. As células colunares, observadas em maior quantidade, são altas, apresentam longas e numerosas microvilosidades na porção apical e na porção basal as invaginações da membrana formam o labirinto basal. As células caliciformes apresentam uma grande câmara central delimitada por projeções citoplasmáticas repletas de mitocôndrias no interior. As células regenerativas têm o citoplasma mais elétron-denso e com poucas organelas. As células endócrinas são caracterizadas pela presença de grânulos secretores bastante elétron-densos concentrados principalmente no citoplasma basal da célula.

Magnocellular (RNm) and parvicellular (RNp) divisions of the cat red nucleus (RN) project to the cervical spinal cord. RNp projects more heavily to upper cervical levels and RNm projects more heavily to lower levels. The cells in RN are active during reaching and grasping, and the differences in termination suggest that the divisions influence different musculature during this behavior. However, the spinal termination may not reflect function because most rubrospinal terminations are to interneuronal regions, which can influence motor neurons at other spinal levels. To test for functional differences between RNm and RNp, we selectively stimulated RNm and RNp as well as the efferent fibers from each region. Electromyographic activity was recorded from seven muscles of the cat forelimb during reaching. The activity from each muscle was averaged over several thousand stimuli to detect influences of stimulation on muscle activity. Stimulation within the RN produced a characteristic pattern of poststimulus effects. The digit dorsiflexor, extensor digitorum communis (edc), was most likely to show facilitation, and several other muscles showed suppression. The pattern of activation did not differ between RNm and RNp. In contrast, stimulation of RNp fibers favored facilitation of shoulder muscles (spinodeltoideus and supraspinatus), and stimulation of RNm fibers favored facilitation of digit and wrist muscles (edc, palmaris longus, and extensor carpi ulnaris). Fiber stimulation produced few instances of poststimulus suppression. The results from fiber stimulation indicate that the physiological actions of RNm and RNp match their levels of spinal termination. The complex pattern of facilitation and suppression seen with RN stimulation may reflect synaptic actions within the nucleus.

The purpose of this study was to assess pacifier use as a risk factor for otitis media during the first year of life.A volunteer cohort of 1,375 infants was recruited from eight hospital postpartum units in Iowa. Parents were asked to provide detailed information on their child's health at 6 weeks, 3, 6, 9 and 12 months of age. Questions were posed concerning occurrence of specific childhood illnesses, including otitis media, at each time point, as well as other factors.Over 70% of children were reported to have experienced one or more episodes of otitis media during their first year of life, with its occurrence much more common during the second six months. Multivariate analyses using Generalized Estimating Equations assessed factors associated with otitis media during the entire 12-month period. These analyses showed that pacifier use, age, male sex, greater number of childcare days, and higher family incomes were significantly associated with occurrence of otitis media.Multivariate analyses found that the occurrence of otitis media was associated with pacifier use, one of few modifiable risk factors for otitis media.

Enamel hypoplasia is of interest to both the clinician and the basic scientist because it may indicate an increased risk for caries and can contribute to the understanding of enamel development. The purpose of this paper is to report the prevalence of enamel hypoplasia and isolated enamel opacities in a cohort of healthy, well-nourished children in Iowa.The study sample consisted of 698 children examined at 4-5 years of age. Individual tooth surfaces were scored for the presence of enamel hypoplasia (EH) and isolated enamel opacities. Prevalence of EH and isolated opacities were determined by tooth type and by gender.Six percent of the children examined had at least one tooth with EH; 27% had at least one tooth with isolated enamel opacities. There was no difference in the prevalence of EH between boys and girls, but significantly more boys than girls had enamel opacities.The prevalence of enamel defects in this study group is comparable to that seen in other studies of normally developed children except that in this study, the primary tooth types most commonly affected with enamel hypoplasia or isolated opacities were mandibular second molars and maxillary second molars, respectively.

Proper dosage of dietary fluoride supplements is important for children without access to optimally fluoridated water to balance dental caries prevention and risks of dental fluorosis. Subsequent to water fluoride assay, compliance by physicians and dentists with the recommended dietary fluoride supplement dosage schedule was determined for 446 children. Approximately one third of child patients and 42% of siblings did not receive the recommended supplement dosage.

This study was performed to assess the actual amount of dentifrice used and ingested and factors associated with use/ingestion among 28 U.S. preschoolers aged 40 to 48 months.Using their regular dentifrice brands/flavors and small child-sized toothbrushes (Oral -B 5), the participants or their parents placed dentifrice on toothbrushes three times to assess the quantity used and its consistency. Their brushing behaviors were observed and the amounts of dentifrice ingested were indirectly measured. Afterward, the parents and children placed a "pea-sized" amount of dentifrice on their toothbrushes.The participants were generally consistent in quantity applied, averaging 0.256 g (range 0.035 g-0.620 g; standard deviation 0.177 g) of dentifrice per brushing. Children, either alone or with parental assistance, placed more dentifrice than either mother or father alone (P = 0.007). The estimated mean ingested fluoride was 0.17 mg F per brushing, an average of 62% of the amount of dentifrice used (range up to 98%). Amount of ingested fluoride was positively associated (P0.05) with the amount of dentifrice used, and negatively associated with parental assistance in brushing. When asked to apply a pea-sized quantity, the mean quantity applied was 0.314 g (range 0.064 g-0.521 g).This study further supports the use of small amounts of dentifrice in young children, because they ingest substantial proportions of dentifrice.

Prolonged duration of non-nutritive sucking behaviors may have consequences in regard to the developing orofacial structures and occlusion. Little is known as to why some children have prolonged sucking habits beyond the first 2 to 3 years of life. This paper reports on non-nutritive sucking patterns among a large cohort of healthy children from birth to 36 months of age and older, and identifies factors predictive of prolonged non-nutritive sucking habits.Over 600 children were followed from birth to at least 36 months of age using mailed questionnaires sent when children reached the ages of 6 weeks, and 3, 6, 9, 12, 16, and 24 months, and then yearly thereafter. Parents answered questions concerning non-nutritive sucking behaviors including use of pacifier and digit sucking. The study categorized children who maintained habits to 36 months of age or older as having prolonged habits, and using multivariate analyses, compared them to children without prolonged habits on various sociodemographic variables.The study found that for over 20% of the children, a non-nutritive sucking habit was prolonged to 36 months of age or older. Factors associated with prolonged sucking habits included older maternal age, higher maternal education level, and having no older siblings.Identifying factors related to prolonged non-nutritive sucking habits may be important in developing and targeting recommendations regarding such behaviors in an effort to prevent malocclusions that result from prolonged sucking habits.

Fluoride may be ingested from a variety of sources, including many foods and beverages. Fluoride intake varies greatly among individuals and is dependent on dietary constituents and use of fluoride products. Although ingestion of toxic amounts of fluoride is rare, the prevalence of dental fluorosis has increased in North America, suggesting that the levels of fluoride ingestion need to be closely monitored. Care should be taken to avoid excessive ingestion of fluoride dentifrice by preschool-aged children by placement of a small, pea-sized quantity on the tooth-brush. Dietary fluoride supplements should be considered a targeted, preventive procedure only for those at elevated caries risk, and before prescribing them, careful consideration should be given to other fluoride sources, including home and child-care water supplies, foods, and beverages.

Introduced to the commercial market 40 years ago, fluoride dentifrice now accounts for nearly all dentifrice purchased in the United States. During this same time, the prevalence and severity of dental caries has declined while dental fluorosis prevalence has increased. While the caries decline can be largely attributed to widespread fluoride dentifrice use, as well as many other sources of fluoride, several recent studies have attributed much of the increase in fluorosis prevalence to early use of fluoride dentifrice. This paper reviews these studies, as well as the efficacy of fluoride dentifrices with lower fluoride concentrations. Finally, recommendations regarding fluoride dentifrice to maintain caries prevention and reduce the risk of dental fluorosis are presented.

This cross-sectional study examined whether referrals from nondental health professionals impacted utilization of dental services by low-income populations.A sample of 309 mothers enrolled in the Women, Infant, and Children (WIC) clinic in Jackson County, Missouri, completed a self-administered, 32-item questionnaire to assess the mother and child's oral health behavior and past use of dental services. Dental utilization, the primary dependent variable, was defined as whether or not the child had ever been to a dentist.Findings showed 27% of the children in the sample had been referred for dental care. Bivariate analysis indicated that a dental referral, age of the child, age of the mother, mother's perceived dental need for the child, household size, number of children in the household, and dental insurance for the child were associated with a child having a dental visit. Logistic regression, however, indicated that only age was significantly related to utilization.The results showed a strong effect of increasing age being related to dental utilization, while additional research is needed to clarify the importance of WIC referrals.

This study compared two techniques for placing sealant in an elementary school setting. Eighty-five children in grades 1 to 4 in two schools were assigned randomly to two sealant treatment groups: 1) acid etch technique (AE), and 2) air abrasion with no acid etch (KCP-1000). Noncarious, nonfilled occlusal, distolingual and buccal pit surfaces of first permanent molars were sealed. A total of 300 teeth received sealants, and 230 were evaluated at 6 months. Rates of complete sealant retention at 6 months were: occlusal surfaces, 97% for AE and 96% for KCP-1000; distolingual surfaces, 82% for AE and 49% for KCP-1000; and buccal surfaces, 77% for AE and 7% for KCP-1000. Differences in complete retention at 6 months between AE and KCP-1000 were not significant for occlusal surfaces (P = 0.14) but were significant for buccal and distolingual surfaces (P0.0001). Results suggest that sealants placed with air abrasion have retention rates for occlusal surfaces similar to AE. More research is needed to identify factors contributing to low retention rates on other surfaces for KCP-1000.

The early use of fluoride dentifrice and use of larger quantities recently have been identified as risk factors for dental fluorosis. However, little is known about fluoride dentifrice use and ingestion among infants and young children whose developing permanent teeth are at risk for dental fluorosis. This paper reports on patterns of fluoride dentifrice use among a birth cohort up to 12 months of age as reported by mothers by written questionnaire. Among those with teeth, percentages whose teeth were brushed at age 6, 9, and 12 months were 12.9%, 36.7%, and 64.5%, respectively. Percentages brushing with fluoride dentifrice were 1.9%, 11.7%, and 31.7%. Among those using dentifrice, the percentages using fluoride dentifrice were 94-97%. Among those using dentifrice, mean estimated quantities of fluoride from dentifrice used per brushing were 0.11, 0.14, and 0.17 mg F (range up to 0.88 mg). Among users, mean quantities of fluoride from dentifrice used per day were 0.21, 0.20, and 0.19 mg F (range up to 1.75 mg). Results suggest that fluoride dentifrice use among infants varies greatly, can be substantial, and can be a risk factor for dental, fluorosis.

The independent contributions of formula and water to the total fluoride (F) intake from the diet of formula-fed infants is not fully documented. Although the precise timing and mechanism by which dental fluorosis occurs has not been fully defined, water F levels can be an important consideration in the risk of dental fluorosis for formula-fed infants. An assessment of 1,308 participants younger than 2 years old revealed that: 81% of homes received public water; 19% received well water; 26% of participants used bottled water; and 11% used some kind of filtration system. In this study, virtually all formulas consumed by the birth cohort and water sources used in the reconstitution of these formulas were assayed for F using a F ion specific electrode and direct read method, except for soy-based formulas, which were analyzed by microdiffusion (modified Taves). Among 78 commercially available bottled waters in Iowa, F levels ranged from 0.02 to 1.36 ppm (mean 0.18 ppm), 83% from 0.02 to 0.16 ppm, 7% from 0.34 to 0.56 ppm, 1% had a F level of 0.88, and 9% had F levels1.0 ppm. Among 47 casein (milk)-based formulas, 16 ready-to-feed (RTF) formulas had levels of 0.04-0.55 ppm F (mean 0.17 ppm), 14 liquid concentrates (LC) reconstituted with distilled water had levels of 0.04-0.19 ppm F (mean 0.12 ppm), and 17 powdered concentrates (PC) reconstituted with distilled water had levels of 0.05-0.28 ppm F (mean 0.14 ppm). The 17 soy-based formulas had a range of 0.04-0.47 ppm F (mean 0.26 ppm).(ABSTRACT TRUNCATED AT 250 WORDS)

In infants, the majority of total ingested fluoride is obtained from water, formula and beverages prepared with water, baby foods, and dietary fluoride supplements. Few studies have investigated the distribution of fluoride intake from these sources among young children at risk for dental fluorosis. The purpose of this study was to assess estimated water fluoride intake from different sources of water among a birth cohort studied longitudinally from birth until age 9 months. Parental reports were collected at 6 weeks, 3 months, 6 months, and 9 months of age for water, formula, beverage, and other dietary intake during the preceding week. Fluoride levels of home and child-care tap and bottled water sources were determined. This report estimates daily quantities of fluoride ingested only from water-both by itself and used to reconstitute formula, beverages, and food. Daily fluoride intake from water by itself ranged to 0.43 mg, with mean intakes < 0.05 mg. Water fluoride intake from reconstitution of concentrated infant formula ranged to 1.57 mg, with mean intakes by age from 0.18 to 0.31 mg. Fluoride intake from water added to juices and other beverages ranged to 0.67 mg, with means < 0.05 mg. Estimated total daily water fluoride intake ranged to 1.73 mg fluoride, with means from 0.29 to 0.38 mg.

PURPOSE: To compare the self-reported confidence and clinical behaviors of primary care residents in treating alcoholism versus hypertension. METHOD: Eighty-five residents, 36 in family medicine and 49 in primary care internal medicine, representing all years of the three-year training programs at two hospitals affiliated with the Brown University School of Medicine, were surveyed in 1988. Self-report questionnaires elicited demographic data and several responses (ranged on scales of 1, not confident or frequent, to 10, very confident or frequent) about the residents' confidence and frequency of use of clinical behaviors with both alcoholic and hypertensive patients. Paired t-tests were used to compare the responses about hypertension with those about alcoholism. RESULTS: Questionnaires were completed by 54 (63.5%) of the residents. No significant difference was found between the residents' responses by sex or program, but there was a significant difference (p < .0001) between the responses with regard to the two disorders. The residents had more confidence about their management of hypertension (a mean score of 8.81 versus 7.95 for alcoholism). They also reported greater use of appropriate clinical behaviors with hypertensive patients (mean scores in the very confident range of 7.5 to 8.2 compared with means in the moderate range of 4.9 to 7.1 for alcoholism). CONCLUSION: Both the family medicine and the internal medicine residents were significantly more confident in managing all aspects of hypertension than in managing alcoholism, and they reported significantly greater frequency in utilizing appropriate clinical behaviors for hypertension than for alcoholism.

Ingestion of fluoride dentifrice by preschool children recently has been identified as a risk factor for dental fluorosis. There are relatively few published studies concerning patterns of fluoride dentifrice use and ingestion among preschool children at greatest risk for dental fluorosis. This paper reviews the literature on dentifrice use and ingestion in an attempt to emphasize to the practitioner the potential importance of this fluoride exposure in fluorosis etiology.

Ingestion of fluoride dentifrice by preschool children recently has been implicated as a risk factor for dental fluorosis. The availability of dentifrices flavored for children could increase fluoride ingestion by young children at risk for dental fluorosis. This article reports results of a pilot study of use of regular-flavored dentifrice and those flavored for children among 29 preschool children. Using a crossover design, larger quantities of fluoride dentifrice specially flavored for children were used compared with the quantities of regular-flavored dentifrice. Pediatric dentists and other health care providers should advise parents to supervise preschoolers' toothbrushing. Preschoolers should use only small, pea-sized quantities of dentifrice to avoid increased risks of dental fluorosis.

Dietary fluoride supplements are recommended for dental caries prevention in children without access to optimally fluoridated water. Previous studies have shown deficiencies in dentists' and physicians' knowledge about dietary fluoride supplementation. Data were collected from dentists, physicians and other healthcare provider groups to assess dietary fluoride supplement knowledge and practices. Pediatricians and dentists were found to be the most knowledgeable concerning the recommended prescribing protocols. Substantial proportions of all practitioner groups had insufficient knowledge about the recommended dosages of dietary fluoride supplements by age, fluoride levels in local water supplies, and the effectiveness of fluoride delivery methods. Baseline knowledge and practices were determined for healthcare provider groups within Arizona.

Between 1984 and 1989, 129 Stage 1 and Stage 2 breast cancer patients were entered into a behavioral study in Pittsburgh. Approximately 70% of these patients had elected to have breast conservation (lumpectomy) surgery, with the remainder choosing mastectomy. Using the Profile of Mood States, a measure of perceived social support, and Karnofsky ratings of physical functional status, patients were assessed 3 to 5 days following surgery and again 3 and 15 months following surgery. The data were analyzed using a repeated-measures analysis of covariance, adjusting for aggressiveness of chemotherapy. Compared to mastectomy patients, patients who received breast conservation surgery were rated as more functional by observers, but they perceived themselves as having less energy and less emotional support, especially over the first 3 months of the recovery period. Because there is accumulating evidence that emotional support may act as a stress buffer in various populations and may have survival value, these findings may be particularly troublesome. This study shows that breast conservation surgery is not a psychosocial panacea. Patients whose breasts are spared, especially younger patients, have psychological symptoms that appear acutely worse in the short run and, in the end, are similar to those of patients who elect to have mastectomies. Therefore, patients choosing lumpectomies are not necessarily psychosocially better off than those electing to have mastectomies. Additionally, these patients, particularly younger patients, may require greater social support and potential mental health interventions than they seem to be receiving.

This paper reports the findings of a study looking at children's fluoride exposures in detail beyond the fluoride content of home drinking water. What emerges are the most clinically relevant questions to ask parents when conducting histories of fluoride exposure of child patients. Dental caries in children has decreased dramatically in the U.S. and other developed countries. At the same time, the prevalence and severity of dental fluorosis in the U.S. may be increasing because of the widespread ingestion of fluoride. Children are vulnerable to fluorosis, according to the results of a fifty-item questionnaire administered to mothers through the University of Iowa. Patients have reported multiple water sources and fluoride levels, use of soy-based formulas, toothpaste ingestion, and dietary fluoride supplements.

A major thrust in research in psychosocial oncology is the study of the interaction of psychologic and physiologic variables. This discussion reviews the current status and future directions of such research. Areas addressed include pain, nausea and vomiting with chemotherapy, sexuality, effects of cancer on psychologic and neuropsychologic function, impact of psychologic factors on cancer and its treatment, and psychoneuroimmunology. In addition, specific recommendations for strategies to facilitate research in these areas of psychosocial oncology are proposed.

Although community water fluoridation has long been recognized as the most efficient, cost-effective method of providing the recommended levels of systemic fluoride, about 46 percent of all Americans do not have such access. Little has been known about the states' programs for providing assays of individual patients water supplies. The status of these programs was surveyed, with collected data showing patterns among the states. Thirty-nine programs (76 percent) reported assay services available, with most of these provided by state laboratories.

In recent studies of 'low natural killer (NK) cell syndrome', low NK activity was measured in individuals who were symptomatic, and therefore a causal relationship between low NK activity and infectious or other disease manifestations could not be concluded. However, preliminary work by members of our collaborative team (S.L. and R.H.) provided some indications for chronic low NK activity preceding and predicting subsequent infectious morbidity. This present study was designed to address this causal question in a larger sample, using a longitudinal design. Subjects were 106 healthy normal volunteers from the community. They were examined medically and psychosocially at baseline, and were then followed over a 6-month interval, with serial monthly assessments over the study period. The results supported our hypothesis that individuals who were currently healthy, but who exhibited a pattern of natural immunity characterized by persistently low NK cytotoxicity would be at risk for development of infectious sequelae over a 6-month follow-up period. The results also showed that younger age and the perception of more severe 'hassles' or stressors also predicted more infectious morbidity during the 6-month study period. Chronological age appeared to have both a direct, as well as indirect (via NK activity) association with illness outcome. Contrary to our expectation, the report of environmental stressors was directly associated with illness outcome, but not indirectly associated with outcome via natural immunity.

1. All children should receive one form of systemic fluoride and appropriate forms of topical fluoride. 2. If a child is not receiving optimally fluoridated water, the physician or dentist should prescribe dietary fluoride supplements (tablets or drops). 3. The correct dosage must be determined based on patient age and fluoride content of the patient's main water source(s). 4. Special attention is necessary concerning fluoride intake for children breast-feeding or consuming infant formula. 5. To determine the correct fluoride dose, these steps should be followed: A. Always have a sample of the main drinking water source (usually home water) analyzed for the fluoride content before prescribing a fluoride supplement, if you do not have other specific knowledge of water fluoride content. The Ohio Department of Health, Division of Laboratories can provide water fluoride-testing services. B. When the fluoride content of the water has been determined, the fluoride level and the child's age should be compared to the Supplemental Fluoride Dosage Schedule to identify the correct supplement dose. 6. The Division of Dental Health, Ohio Department of Health can provide a list of communities that are optimally fluoridated. Please contact: Ohio Department of Health Division of Dental Health 246 N. High Street Columbus, Ohio 43266-0588 (614) 466-4180

Previous work of ours has demonstrated that a significant amount of natural killer (NK) activity variance after surgery in stage I and II breast cancer patients could be accounted for by both the estrogen receptor (ER) status of the tumor and by social factors, namely, perceived social support and seeking social support as a general coping strategy. As considerable evidence has accumulated that social support in both animal and human populations may have survival value, we sought to test the reliability of this regression model, using coping and perceived support factor values obtained at 3 months after surgery to account for concurrent follow-up NK activity in this serially assessed group of patients. It was found that the most significant variable predicting NK activity at follow-up was tumor ER concentration, with higher NK activity associated with ER- status. In addition, seeking social support as a coping strategy, as well as the perceived quality of support, also entered the model to account for a significant amount of NK activity variance (multivariate F = 5.25, p less than 0.001). If, as the literature suggests, NK activity is relevant to breast cancer control, and since ER- tumors have a worse prognosis, we suggest here that perhaps such tumors are resistant to control by NK cells because they lack the ability to attract an accumulation of effector cells to the tumor site, or because blocking factors at the site of the tumor prevent local tumor control at the site of action. The finding related to social support also replicates results from an independent sample of breast cancer patients. This finding, taken together with other evidence that this social variable is associated with longer survival in breast cancer populations, underscores the potential importance of this social support variable. Our findings also suggest one possible immunological variable involved, with potential clinical significance, for this patient population.

The concentration- and voltage-dependent effects of atropine on the fast excitatory post-synaptic current (e.p.s.c.) of bullfrog sympathetic ganglion cells have been analysed and fitted to a kinetic scheme of open-channel blockade. Atropine (1-75 microM) reduced the peak e.p.s.c. amplitude without altering the quantal content or the reversal potential. The e.p.s.c. decay was complex in the presence of atropine, being well fitted by two exponential components. With increasing concentrations of atropine the time constant of the fast component, tau 2, decreased and the time constant of the slow component, tau 1, increased. Over the voltage range -30 to -100 mV tau 2 exhibited little or no voltage dependence and tau 1 increased with hyperpolarization. The amount of charge moved during the e.p.s.c. was reduced as a function of atropine concentration. Driving functions, which represented the rate of channel opening, were derived from e.p.s.c.s both from control and atropine-treated cells. The characteristics of the driving functions did not vary with membrane voltage, but the driving functions were shorter in duration from atropine-treated than control cells. The area under the driving function decreased as a function of atropine concentration. The decay time constants and the amplitude ratio of the exponential components were used to calculate the closing, blocking, and unblocking rate constants, alpha, G, and F. alpha and F remained constant with increasing atropine concentration, but G declined significantly. The voltage dependence of the equilibrium constant, G/F, implied that the transient blocking site for atropine is halfway through the ionic channel. The sequential model does not predict the concentration-dependent decrease in the blocking rate, G, or in the charge moved during an e.p.s.c. We conclude that atropine has an action more complex than simple channel blockade in sympathetic ganglion cells.

Fluoride content of drinking water is an important criterion in prescribing fluoride supplements. The majority of practicing dentists and physicians prescribe fluoride supplements, yet many apparently are unaware of the fluoride levels in their patients' drinking water. Characteristics of North Carolina (NC) dentists, their practices, and their communities were investigated to determine factors associated with whether they requested fluoride assays of their patients' drinking water. Comparisons were made between dentists sampling (assaying) and those not sampling. Licensure renewal files provided characteristics of the 79 pedodontists and 1768 general pracritioners (GP's) active in NC. Eighty-eight GP's (5%) and 26 pedodontists (33%) requested water fluoride analyses between December, 1982, and May, 1983. Significant predictors of fluoride assay request by GP's were the dentist's age, the geographic region of the state, the number of dentists in the practice, and an interaction between geographic region and the number of dentists in the practice. Younger GP's and those with fewer dentists in the practice were more likely to request fluoride assays of patients' water. For pedodontists, dentist's age and geographic region were significant predictors. Additional training concerning the need for water fluoride assay appears necessary, especially among older practitioners.

Four emotionally disturbed adolescents in a short-term residential treatment center participated in a vocationally oriented social skill training program. Didactic instruction, provided in a classroom by a special education teacher, resulted in rapid acquisition of appropriate responses to a supervisor's instructions. However, there was no concomitant change in most students' interpersonal behavior with their work supervisor in the generalization setting. A subsequent intervention, in which students were subjected to role-play training and taught to use a self-monitoring procedure, produced generalized increases in the targeted social skill. In addition to the improvement in the students' responses to instructions, desirable collateral changes also were noted in their responses to critical feedback and to the conversational initiatives of the work supervisor. The use of a multiple baseline research design across pairs of students suggested that the generalized effects were a function of the intervention procedures. The separate effects of the role-play training and the self-monitoring procedures were not isolated in this study. However, it was proposed that the didactic and role-play training might have been responsible for the initial acquisition of the new interpersonal behavior, while the self-monitoring procedure seemed to be implicated in its generalization and maintenance.

This current study is concerned with the identification of the incidence of persistently low natural killer (NK) cell activity in an essentially healthy population of young adults, and the characterization of the psychological profile associated with this pattern of NK activity. Eighty-eight individuals, between the ages of 18 and 44 years, were accrued to this project. Subjects were tested serially, at baseline induction into the study, and at 2 and 4 weeks follow-up. Baseline assessment included a complete physical examination and laboratory work-up in order to exclude anyone ill at the time of enrollment, and to have complete physical status information on all subjects at the time of accrual. NK activity, urinary catecholamine levels and psychological status were also assessed at baseline, and at the specified follow-up intervals. Individuals with low NK activity were operationally defined as those having NK function either below the group mean, or below the group lowest quartile, at baseline and at two follow-up assessments. Results showed that in both univariate analyses, as well as in logistic regression models, age and the perception of environmental stressors or 'hassles' predicted persistently low NK activity. Younger subjects, who perceived environmental events to which they were exposed as more serious in nature, were more likely to exhibit a persistently low NK profile over time than older individuals who perceived daily events as less important to them.