Subjects In Comparison Group Research Articles

Karakteristike mikrobiocenoze i produkcija hidrogen-peroksida od strane simbiotičkih organizama gingive kod adolescenata sa kataralnim gingivitisom i hroničnim gastroduodenitisom

Introduction. The key links in the etiology and pathogenesis of periodontal tissue diseases are the quantitative and qualitative changes in the composition of the microflora of the oral cavity, with the simultaneous deterioration of oral hygiene, and reduction of local and general immunity, which occurs more often in the presence of somatic diseases. Aims. The aim of the paper was to study the features of the microbiocenosis of periodontal tissues and the production of hydrogen peroxide by gum symbionts in adolescents with catarrhal gingivitis and chronic gastroduodenitis. Methods. The condition of the microbiocenosis of the gums of 83 adolescents from 12 to 18 years, which was divided into groups depending on the diagnosed catarrhal gingivitis and chronic gastroduodenitis, was studied. Bacteriological examination was performed to isolate pure cultures of microorganisms and to identify them according to generally accepted microbiological methods. The ability of the selected cultures to produce hydrogen peroxide was studied on an indicator medium with potassium-iodine-starch system, by the iodometric method. Results. The results of microbiological studies showed significant changes in qualitative and quantitative indicators of the microbiocenosis of the gingival mucosa in the affected area of patients with gingivitis, compared with dentally and somatically healthy individuals in the control group. In the group of clinically healthy adolescents, hydrogen peroxide producers were found on the mucous membrane of the gums only in 5.0 ± 1.15% of the examinees. In catarrhal gingivitis, hydrogen peroxide producers were found in 52.4 ± 2.4 % of the examined main group subjects (p < 0.01) and in the 50.0 ± 2.5 % of the examined comparison group subjects (p < 0.01). Conclusion. Among adolescents with catarrhal gingivitis, which occurs on the background of chronic gastroduodenitis, there were more pronounced quantitative and qualitative changes in the microbiocenosis of the gums. The hydrogen peroxide produced by them can act as an additional damaging factor in the pathogenesis of the inflammatory process of the gingival area.

Using pharmacopuncture for chronic tension-type headache treatment

Objective: assessing pharmacopuncture effect on pain syndrome and level of anxiety-depressive disorders in patients with chronic tension-type headache (CTTH). Materials and methods. An open-label controlled trial was conducted on 95 CTTH patients split among two groups by means of adaptive randomization. The comparison group subjects were receiving 35-70 mg/day of amitriptyline and 450 mg/day of tolperisone, while patients of the treatment group were assigned 2-4 courses of pharmacopuncture by the original method. The results were evaluated on the basis of the scores obtained via Visual Analogue Scale (VAS), McGill Pain Questionnaire, Beck Depression Inventory (BDI), and State-Trait Anxiety Inventory (STAI) sensu Ch. Spielberger and Yu. Khanin. Results. Patients in both clinical groups were inclined to a positive evaluation of received treatment. Based on the results of McGill Pain Questionnaire, we determined both affective and sensory pain descriptors, with a predominance of the latter. Both groups exhibited moderate depressive symptoms according to BDI of the psychological status. Prevalence of trait anxiety over reactive anxiety was determined by STAI. According to VAS, pain intensity after the treatment declined from 5.26±0.87 to 1.7±0.78 points (p<0.05) and from 5.17±0.78 to 1.65±0.79 (p<0.05) in the comparison group versus the treatment group. An improvement of anxiety and depression indicators was detected. Conclusion. Our results have demonstrated that pharmacopuncture is very promising in treating CTTH patients

Biochemical predictors of cartilaginous tissue metabolic disorders for early osteoarthrosis evidence diagnostics.

The complete laboratory and clinical instrumental examination was conducted, it included serum COMP test, circadian excretion of type II collagen C-terminal telopeptides Urine CartiLaps (СТХ II) and Т2 relaxometry in 29 patients of both sexes of the main group with early (0-I) X-ray osteoarthrosis stages, 30 subjects of comparison group with no X-ray osteoarthrosis evidences aged 44.7±5.9 years and 25 healthy subjects aged 26.3±2.6 years of the control group. The increase (р<0,05) of COMP and Urine CartiLaps levels as well as the increase of Т2 relaxation signal was found at early osteoarthrosis evidences. It was proven that there was (р<0.01) a connection (R=0.8) between COMP and Urine CTX II levels as well as (р<0.05) results of Т2 relaxometry (R=0.8). It was proven that collagen anisotropy and formation of chondromalacia areas as Т2 relaxometry showed in patients with early OA evidences were connected with accumulation of serum COMP and increase of type II collagen circadian renal excretion. The combination of laboratory and radiological methods of articular hyaline cartilage assessment may be used for finding early osteoarthrosis stages.

Post-infectious fatigue following Puumala virus infection

Background: Puumala virus infection or nephropathia epidemica (NE) is common in northern Sweden. NE causes haemorrhagic fever with renal syndrome. Most patients make a full recovery, but a convalescent phase with fatigue has been reported. Although post-infectious fatigue has been demonstrated for other viral infections, it is not well studied in relation to NE. This study assessed recovery time and levels of fatigue in former NE patients, as compared to the general population.Methods: NE patients diagnosed in northern Sweden between 2007 and 2011, together with a comparison sample from the general population, answered a questionnaire on demographic and health-related factors, including the Fatigue Severity Scale (FSS), and characteristics of NE infection. Self-reported recovery time was assessed, and fatigue levels were compared across the two groups by multiple linear regression, stratified by gender.Results: In total, 1132 NE patients and 915 comparison group subjects participated. Time to complete recovery was reported to exceed 3 months for 47% and 6 months for 32% of the NE patients. Recovery time differed by gender and age. NE patients had significantly higher FSS scores than the comparison group. Differences were greater among women than men, and adjustments for current illness, body mass index, smoking and current residence only slightly modified the estimates.Conclusions: Individuals with previous NE infection show higher fatigue scores than non-infected individuals, even 5 years following the infection. Full recovery takes half a year or longer for a substantial proportion of former NE patients.

THE CHANGE IN STRESS RESISTANCE OF THE STUDENTS WHEN APPLYING TRANSCRANIAL ELECTROSTIMULATION

Aim. To determine the transcranial electrostimulation effect on stress resistance of students, according to N.V. Kirsheva, N.V. Ryabchikova test. Materials and methods . 127 medical students (50 boys and 77 girls aged from 19 to 22) were observed. All the students were practically healthy. They were divided into the main group (78 people) and the comparison group (49 people). The students of the main group underwent transcranial electrostimulation (TES): 22 people got 2 sessions a week, 56 people got 5 sessions a week. The of stress resistance in the main group was determined according to N.V. Kirsheva, N.V. Ryabchikova test before and after TES. In the comparison group, the of stress resistance was determined the same way. TESs were conducted with the Transair-03 apparatus. The results of the study were determined for the normal distribution using the computer program STATISTIKA 6.0 and processed with parametric methods. Results. In the comparison group subjects had moderate and low levels of stress resistance. There were no significant changes in the levels of stress resistance in the initial state and a week later. After two TES sessions the number of students with of stress-resistance decreased by 3 people, and the number of students with of stress resistance increased by 3 people. There were no statistically significant differences in the of stress resistance. During five TES sessions the of stress resistance in 26 people increased from medium to high. Number of points after TES decreased by 10.3%, which indicated an increase in the of stress resistance. No gender differences were taken into account. The interpretation of the test results by NV. Kirsheva, N.V. Ryabchikova showed of stress resistance in 13 subjects at a above average, in 2 subjects. After 5 TES sessions, 15 subjects had higher than average level, 19 subjects had level, 7 subjects had very high level. Conclusion . Thus, there is a reliable increase in stress resistance in practically healthy medical students of both sex at the end of the academic year after 5 TES sessions a week. Subjects who had medium and levels of stress resistance before TES got of stress resistance after TESs, which also changed qualitatively: proper level increased and very level of stress resistance appeared.

Improvement of postpartum depression and psychosis after electroconvulsive therapy: A population-based study with a matched comparison group

IntroductionElectroconvulsive therapy (ECT) is used to treat postpartum depression and psychosis based on clinical experience and small observational studies. AimsThe primary aim was to test the hypothesis that the response rate to ECT for depression and psychosis is higher during the postpartum period than outside this period. The secondary aim was to identify predictors of a response to ECT during the postpartum period. Materials and methodsCases with postpartum depression and/or psychosis received ECT within 6 months of delivery. A matched comparison group with depression and/or psychosis (not within the postpartum period) was identified from the Swedish National Quality Register for ECT. The improvement 1 week after ECT was classified according to the Clinical Global Impressions Scale – Improvement scale (CGI-I) as responder (CGI-I score 1–2) or non-responder (CGI-I score 3–7). Results185 cases and 185 comparison group subjects were included (46% with psychosis in each groups). More cases (87.0%) than comparison group subjects (73.5%) responded to ECT (p = 0.001). Adjusted binary regression analysis revealed that more severe symptoms prior to treatment were the only statistically significant predictor of response. LimitationsThere was no control group without ECT treatment. ConclusionThe response rate of those with postpartum depression and/or psychosis to ECT was high. The response rate of patients with psychosis or depression was higher during the postpartum period than outside it. This study supports the use of ECT for severe forms of postpartum depression and/or psychosis.

Non-pulmonary vein mediated atrial fibrillation: A novel sub-phenotype.

BackgroundAtrial fibrillation (AF) is a mechanistically heterogeneous disorder, and the ability to identify sub-phenotypes (“endophenotypes”) of AF would assist in the delivery of personalized medicine. We used the clinical response to pulmonary vein isolation (PVI) to identify a sub-group of patients with non-PV mediated AF and sought to define the clinical associations.MethodsSubjects enrolled in the Vanderbilt AF Ablation Registry who underwent a repeat AF ablation due to arrhythmia recurrence were analyzed on the basis of PV reconnection. Subjects who had no PV reconnection were defined as “non-PV mediated AF”. A comparison group of subjects were identified who had AF that was treated with PVI-only and experienced no arrhythmia recurrence >12 months. They were considered a group enriched for “PV-mediated AF”. Univariate and multivariable binary logistic regression analysis was performed to investigate clinical associations between the PV and non-PV mediated AF groups.ResultsTwo hundred and twenty nine subjects underwent repeat AF ablation and thirty three (14%) had no PV reconnection. They were compared with 91 subjects identified as having PV-mediated AF. Subjects with non-PV mediated AF were older (64 years [IQR 60,71] vs. 60 [52,67], P = 0.01), more likely to have non-paroxysmal AF (82% [N = 27] vs. 35% [N = 32], P<0.001), and had a larger left atrium (LA) (4.2cm [3.6,4.8] vs. 4.0 [3.3,4.4], P = 0.04). In univariate analysis, age (per decade: OR 1.56 [95% CI: 1.04 to 2.33], P = 0.03), LA size (per cm: OR 1.8 [1.06 to 3.21], P = 0.03) and non-paroxysmal AF (OR 8.3 [3.10 to 22.19], P<0.001) were all significantly associated with non-PV mediated AF. However, in multivariable analysis only non-paroxysmal AF was independently associated with non-PV mediated AF (OR 7.47 [95% CI 2.62 to 21.29], P<0.001), when adjusted for age (per decade: OR 1.25 [0.81 to 1.94], P = 0.31), male gender (OR 0.48 [0.18 to 1.28], P = 0.14), and LA size (per 1cm: 1.24 [0.65 to 2.33], P = 0.52).ConclusionsNon-paroxysmal AF was the only clinical variable found to be independently associated with non-PV mediated AF. We demonstrated that analysis of AF ablation outcomes data can serve as a tool to successfully identify a sub-phenotype of subjects who have non-PV mediated AF.Clinical trial registrationClinicalTrials.gov ID # NCT02404415.

Septic Arthritis in Adults in a Tertiary Care Center

ObjectiveTo describe the history, clinical features and microorganisms involved in a group of adult subjects with and without septic arthritis (SA) at a tertiary care in Mexico. Material and methodsA cross-sectional descriptive study was conducted on 96 adults with clinical suspicion of AS in one or more joints. In all cases synovial fluid arthrocentesis and culture was performed. The comparison group subjects were culture negative. A descriptive statistical analysis and binary logistic regression model was performed between the variables associated with the development of AS. A value of P≤.05 was significant. ResultsA total of 49 out of 96 subjects had a positive culture, mostly of the monoarticular type (96%; P=.02). The knee was the most common site (61%; P=.06) and pain was the main clinical manifestation (59%; P=.001). Staphylococcus was the most common etiological agent (65%; P<.001). The risk factors revealed in the final regression model were SA the history of joint disease (OR=25; P=.03) and volume increase (OR=13.16; P=.06). Functional limitation (OR=8.54; P=.04) showed a significant risk among borderline for SA. ConclusionsOur results are consistent with previous studies, and can be generalized to geographical areas with similar clinical features to those observed in this study.

Artritis séptica en un centro de adultos de tercer nivel de atención

ObjectiveTo describe the history, clinical features and microorganisms involved in a group of adult subjects with and without septic arthritis (SA) at a tertiary care in Mexico. Material and methodsA cross-sectional descriptive study was conducted on 96 adults with clinical suspicion of AS in one or more joints. In all cases synovial fluid arthrocentesis and culture was performed. The comparison group subjects were culture negative. A descriptive statistical analysis and binary logistic regression model was performed between the variables associated with the development of AS. A value of P≤.05 was significant. ResultsA total of 49 out of 96 subjects had a positive culture, mostly of the monoarticular type (96%; P=.02). The knee was the most common site (61%; P=.06) and pain was the main clinical manifestation (59%; P=.001). Staphylococcus was the most common etiological agent (65%; P<.001). The risk factors revealed in the final regression model were SA the history of joint disease (OR=25; P=.03) and volume increase (OR=13.16; P=.06). Functional limitation (OR=8.54; P=.04) showed a significant risk among borderline for SA. ConclusionsOur results are consistent with previous studies, and can be generalized to geographical areas with similar clinical features to those observed in this study.

Addressing Depression in a Long-term Care Setting: A Phase II Pilot of Problem-solving Treatment

PurposeThis was a Phase II pilot study of a problem-solving treatment (PST) to address subsyndromal depression in residents of long-term care facilities. Our goal was to demonstrate PST implementation feasibility and to identify PST’s potential for reducing depressive symptoms in this geriatric health care setting. MethodsEligible participants were randomized to receive a PST treatment (six 1-hour sessions) or a social contact comparison (6 “friendly” visits) after an initial baseline assessment. Follow-up assessments occurred 7 weeks later (after treatment) and 2 months posttreatment. The basic analytic approach was based on an intention-to-treat analysis. FindingsWe enrolled 21 elderly subjects in the PST group and 16 elderly subjects in the social contact comparison group. The PST group experienced a decline in depression scores compared with the social contact group. Although not statistically significant (likely due to the small sample size), PST was associated with decreased depressive symptom scores for those who were able to complete the intervention. Implementation proved to be difficult in terms of study recruitment and intervention acceptance and adherence. ImplicationsThese study findings point to the potential benefits of an integrated mental health component in long-term care, involving rehabilitation professionals who are already working with the older adults in both postacute/short-stay and long-stay settings.

요양보호사를 위한 노인의 성 교육 프로그램의 효과

본 연구의 목적은 노인의 성에 대한 교육프로그램이 요양보호사의 노인의 성에 대한 지식과 태도에 미치는 효과를 규명하는데 있다. 비동등성 대조군 사전 ?사후 유사 실험연구로써 사전, 중재 후로 구성 되어져 있다. S시 요양시설에 근무 하고 있는 요양보호사 중 실험군 26명 대조군 28명으로 총 54명을 선정하여 총 4주 교육 프로그램을 적용한 후 그 효과를 검증하였다. 자료 분석 방법은 SPSS PC? 19.0 Windows을 이용하여 χ²-test, t-test, ANOVA로 분석하였다. 연구 결과는 실험군에서 노인의 성에 대한 지식이 증가하고 태도가 긍정적으로 변화되었다. 이상의 연구 결과를 근거로 요양보호사에게 실시한 노인의 성에 대한 교육 프로그램은 노인의 성에 대한 올바른 지식을 향상시키고 긍정적인 태도로 변화시킬 수 있는 중재 프로그램으로써 실무에 활용될 수 있을 것이다.

Eyestrain in working children of footwear making units of Agra, India

Children of footwear making units are working in the soling process. The process includes fixing of upper part with the sole of the footwear. The adhesives contain a mix of organic solvents, which are released in the working environment and cause irritation and lacrimation of eyes. In addition poor illumination and ventilation further aggravates the eyestrain. The present study was carried out to find out the prevalence and the associated factors of eyestrain in working children of footwear making units. The study included 139 exposed and 160 comparison group subjects. Self-reported eyestrain was recorded through personal interview. The prevalence of eyestrain in child laborers was 25.9%, which was significantly more than the 12.4% prevalence in comparison group subjects (P=0.01). Working children of footwear making units were at 2.4 times higher risk of developing eyestrain as compared to comparison group subjects, though statistically non significant. Significantly higher proportion of eyestrain was reported in those aged >12 years, males and those working daily for >4 hours. The higher prevalence of eyestrain in the working children of footwear units may be attributed to exposure to workplace factors.

Morbidities in the Glass Factory Workers of Central India.

Introduction: The health hazard of glass factory has been enlisted in ILO encyclopedia. Morbid conditions in glass factory workers are injuries, heat exhaustion, respiratory morbidity, ophthalmic morbidity, nephrolithiasis etc. Objective: To estimate the prevalence of morbidity in the glass factory workers and compare it with comparison group. Materials and methods: Cross-sectional study with comparison group, which was matched for age, sex and socio-economic status, unexposed to similar working environment from adjacent area. The Glass Factory is situated at Kamptee Road, Nagpur. 263 workers were studied along with 263 comparison group. Interview technique, general observation was used for data collection by using Pre-designed Proforma. Sampling design was Convenience sampling Technique. Statistical analysis was done with Epi Info 2002. Results: Total morbidities were 442 and 153 in the workers and in the comparison group respectively. Mean no. of morbidity in the worker was 1.7 with SD 0.94 and in the comparison group it was 0.6 with SD 0.83. The difference was statistically significant (Z=13.76, p<0.01, highly significant). Of the total morbidities i.e. 442 in workers, injury constituted 251 (56.9%). Incised injury 156 (59.3%) in the workers and 32 (12.2%) in the comparison group. Conclusion: Prevalence of injury and effect of environment in the workers of Glass Factory was more than subjects in comparison group.

The economic burden of advanced liver disease among patients with Hepatitis C Virus: a large state Medicaid perspective

BackgroundChronic hepatitis C virus (HCV) may progress to advanced liver disease (ALD), including decompensated cirrhosis and/or hepatocellular carcinoma (HCC). ALD can lead to significant clinical and economic consequences, including liver transplantation. This study evaluated the health care costs associated with ALD among HCV infected patients in a Medicaid population.MethodsUsing Florida Medicaid claims data, cases were patients with at least 1 diagnosis of HCV or prescription therapy for HCV (ribavirin plus interferon, peginterferon, or interferon alfacon-1) prior to an incident ALD-related diagnosis (“index event”) between 1999 and 2007. ALD-related conditions included decompensated cirrhosis, HCC, or liver transplant. A cohort of HCV patients without ALD (comparison group subjects) were matched 1-to-1 based on age, sex, and race. Baseline and follow-up were the 12 months prior to and following index, respectively; with both periods allowing for a maximum one month gap in eligibility. For both case and comparison patient cohorts, per-patient-per-eligible month (PPPM) costs were calculated as total Medicaid paid amount for each patient over their observed number of eligible months in follow-up, divided by the patient’s total number of eligible months. A generalized linear model (GLM) was constructed controlling for age, race, Charlson score, alcoholic cirrhosis, and hepatitis B to explore all-cause PPPM costs between study groups. The final study group included 1,193 cases and matched comparison patients (mean age: 49 years; 45% female; 54% white, 23% black, 23% other).ResultsThe majority of ALD-related diagnoses were for decompensated cirrhosis (92%), followed by HCC (6%) and liver transplant (2%). Cases had greater comorbidity (mean Charlson score: 3.1 vs. 2.3, P < 0.001). All-cause inpatient use up to 1-year following incident ALD diagnosis was significantly greater among cases with ALD (74% vs. 27%, P < 0.001). In the GLM, cases had 2.39 times greater total adjusted mean all-cause PPPM costs compared to the comparison group ($4,956 vs. $1,735 respectively; P < 0.001). Among cases, mean total unadjusted ALD-related costs were $1,356 PPPM, which were largely driven by inpatient costs ($1,272).ConclusionsOur results suggest that among patients diagnosed with HCV, the incremental costs of developing ALD are substantial, with inpatient stays as the main driver of these increased costs.

Dietary Baked Milk Accelerates the Resolution of Cow’s Milk Allergy in Children

To evaluate outcomes of children with cow’s milk allergy that incorporate extensively heated (baked) milk products into the diet.Eighty-nine subjects aged 0.5 to 21 years were recruited from a large academic pediatric allergy clinic. Subjects were diagnosed with milk allergy based on a positive skin prick test (SPT) or detectable serum milk-specific immunoglobulin (Ig) E and history of allergic reaction to milk. Subjects were also included if milk-specific IgE or SPT responses were >95% of predicted value for clinical reactivity.Subjects underwent an initial baked milk oral challenge with a muffin containing 1.3 g of milk protein baked at 350°F for 30 minutes. Subjects who were reactive to baked milk (n = 23) were instructed to completely avoid all forms of milk and were offered a repeat challenge ≥6 months from the initial challenge. Patients who were tolerant to baked milk (n = 65) were instructed to incorporate baked milk products daily into their diets. After ≥6 months, these patients were offered challenges to baked cheese products (cheese pizza with 4.6 g of milk baked at 425°F for >13 minutes). After 6 months of tolerating baked cheese, subjects were offered challenges to unheated milk. A historical comparison group of subjects who fulfilled the inclusion criteria but were not initially ingesting baked milk was included. Serum samples were collected for measurement of IgE and IgG4 antibodies to milk, casein, and beta-lactoglobulin. All food challenges were performed openly.Challenges were conducted over a median of 37 months (range: 8–75 months). In the group of 65 subjects initially tolerant to baked milk, 39 (60%) now tolerated unheated milk. Over the same time period, 2 (9%) of the 23 subjects who were originally reactive to baked milk tolerated unheated milk. Subjects who were initially tolerant to baked milk were 28 times more likely to become unheated milk tolerant compared with baked milk–reactive subjects (P < .001). Subjects who introduced dietary baked milk were 16 times more likely than comparison group subjects to become unheated milk tolerant (P < .001). Median casein IgG4 levels in baked milk–tolerant group increased significantly (P < .001), but median milk IgE values did not change significantly.Tolerance of baked milk suggests a transient IgE-mediated cow’s milk allergy. The addition of baked milk to the diet in children tolerating such foods appears to accelerate the development of unheated milk tolerance compared with strict avoidance.This and other supportive studies now suggest a change to the mantra of strict avoidance of known food allergens for a subset of foods. For milk-allergic patients, allergists can now offer baked milk oral food challenges with the hope of accelerating clearance of their food allergy. Additional studies directed at determining which patients would be at increased risk for reacting to a baked milk challenge would be helpful because those reacting sometimes experience anaphylaxis.

New Study Answers Questions About Cardiac Risk of ADHD Drugs

New Study Answers Questions About Cardiac Risk of ADHD Drugs

Cryotherapy and Topical Minocycline as Adjunctive Measures to Control Pain After Third Molar Surgery: An Exploratory Study

To assess the impact of cryotherapy or topical minocycline on patients' perceptions of recovery from pain after third molar surgery in an exploratory comparative-effectiveness study. Subjects aged at least 14 years who were having all 4 third molars removed were enrolled in 3 separate institutional review board-approved studies. Study groups included subjects treated with a passively applied cold wrap for 24 hours postoperatively, subjects treated with topical minocycline during surgery, and subjects enrolled in a nonconcurrent comparison group who had received neither topical minocycline nor directed cryotherapy. Third molar surgery was performed in all cases by trained surgeons using the same protocol. An exact Kruskal-Wallis test was used to compare the distributions of the worst and average pain scores and a Fisher exact test to compare verbal responses from Gracely pain scales among the 3 groups for postsurgical days (PSDs) 1 to 3. This study comprised 51 cryotherapy subjects (2005-2009), 63 minocycline subjects (2003-2004), and 92 comparison-group subjects (2002-2006) who were treated at academic centers and in community practices across the United States (N = 206). Demographic descriptors were similar among all groups. For PSDs 1 through 3 (unadjusted), the highest scores for worst pain (6-7 [out of 7] on Likert-type scale) were reported less frequently in each of the study groups than in subjects in the comparison group, although the numbers of subjects reporting the highest scores were few. The distribution of pain outcomes was significantly different among the 3 groups for worst pain and affective words on PSD 1 (P = .04 for both). However, the small number of subjects who reported the highest pain scores precluded adequate multivariate statistical analyses for all outcomes on PSD 1 to 3. Data from this exploratory study suggest that adjunctive therapy to decrease postoperative pain-cryotherapy or topical minocycline-might be effective at moderating the patient's highest pain levels after third molar surgery. The topic should be studied further in a multicenter, prospective, randomized trial.

Gravidade do transtorno fonológico, consciência fonológica e praxia articulatória em pré-escolares

OBJETIVO: Caracterizar o transtorno fonológico quanto à gravidade, consciência fonológica e praxia articulatória e investigar a existência de correlações entre essas variáveis, em um grupo de pré-escolares. MÉTODOS: Participaram 56 pré-escolares entre 4 anos e 6 anos e 11 meses, meninos e meninas, separados em Grupo Pesquisa (GP) e Grupo de Comparação (GC), respectivamente à presença ou ausência de alterações de fala. Foram aplicados: Teste de Linguagem Infantil ABFW: Fonologia; Consciência Fonológica: Instrumento de Avaliação Sequencial - CONFIAS; e o Protocolo de Avaliação das Praxias Articulatórias e Buco-faciais. Realizou-se o cálculo da Porcentagem de Consoantes Corretas - PCC para classificar a gravidade do transtorno fonológico. Os dados receberam análise estatística. RESULTADOS: Os pré-escolares com transtorno apresentaram desempenho inferior em tarefas de consciência fonológica e praxia articulatória quando comparados aos do GC. A gravidade correlacionou-se com consciência fonológica e praxia articulatória e esta com consciência fonológica nesses pré-escolares. Ambos os grupos mostraram correlação entre consciência fonológica total, consciência fonológica de sílaba e de fonema. CONCLUSÃO: O GP caracterizou-se pelo pior desempenho em consciência fonológica e praxia articulatória e pela presença de correlação entre a gravidade do transtorno, a consciência fonológica e a praxia articulatória.

All-Cause Health Care Charges among Managed Care Patients with Constipation and Comorbid Irritable Bowel Syndrome

Objective: Chronic idiopathic constipation and irritable bowel syndrome (IBS) are common gastrointestinal conditions with potentially significant burden on managed care systems. Our objective was to examine all-cause resource utilization and charges associated with constipation alone (C-only) and with IBS with comorbid constipation (IBS+C). Methods: Administrative claims from a US health plan between January 1, 2003 and December 31, 2005 were analyzed. Patients with C-only (n = 48 585) and IBS+C (n = 10 952) were identified using International Classification of Diseases, 9th Revision, Clinical Modification diagnosis codes. Outcomes were compared with demographically matched controls and with a benchmark group of patients with migraine (N = 48 759). An index date was defined as the date 3 months prior to first observed diagnosis of the condition of interest. Outcomes were evaluated over a 12-month period before and after the index date. Results: The pre-to-post increase in total charges for subjects with C-only was substantially higher than that for the comparison group ($8837 vs $1717; P < 0.001) or the migraine group ($8837 vs $ 4804; P < 0.001). Subjects with IBS+C also had a greater pre-to-post increase in total charges than did comparison group members ($6192 vs $1319; P < 0.001) and subjects with migraine ($6192 vs $4804; P = 0.0120). Conclusions: Both C-only and IBS+C impose substantial economic burden on third-party payers.

A Comparison of Treatment Outcomes Among Chronically Homelessness Adults Receiving Comprehensive Housing and Health Care Services Versus Usual Local Care

Service use and 2-year treatment outcomes were compared between chronically homelessness clients receiving comprehensive housing and healthcare services through the federal Collaborative Initiative on Chronic Homelessness (CICH) program (n=281) a sample of similarly chronically homeless individuals receiving usual care (n=104) in the same 5 communities. CICH clients were housed an average of 23 of 90days (52%) more than comparison group subjects averaging over all assessments over a 2-year follow-up period. CICH clients were significantly more likely to report having a usual mental health/substance abuse treater (55% vs. 23%) or a primary case manager (26% vs. 9%) and to receive community case management visits (64% vs. 14%). They reported receiving more outpatient visits for medical (2.3 vs. 1.7), mental health (2.8 vs. 1.0), substance abuse treatment (6.4 vs. 3.6), and all healthcare services (11.6 vs. 6.1) than comparison subjects. Total quarterly healthcare costs were significantly higher for CICH clients than comparison subjects ($4,544 vs. $3,326) due to increased use of outpatient mental health and substance abuse services. Although CICH clients were also more likely to receive public assistance income (80% vs. 75%), and to have a mental health/substance provider at all, they expressed slightly less satisfaction with their primary mental health/substance abuse provider (satisfaction score of 5.0 vs. 5.4). No significant differences were found between the groups on measures of substance use, community adjustment, or health status. These findings suggest that access to a well funded, comprehensive array of permanent housing, intensive case management, and healthcare services is associated with improved housing outcomes, but not substance use, health status or community adjustment outcomes, among chronically homeless adults.