Systemic antibiotics and tooth loss in periodontal disease

Systemic antibiotics have been recommended for the treatment of destructive periodontal disease. Our goal was to relate antibiotic use for medical or dental reasons to subsequent tooth loss in a cohort of 12,631 persons with destructive periodontal disease. After adjustment for age, smoking, and other confounders, the dispensing of antibiotics for 1-13 days, 14-20 days, or 21 or more days was not associated with reduced tooth loss [Adjusted rate ratio (RR) = 1.0; 95% Confidence Interval (CI) = 0.8-1.1; RR = 1.2; 95% CI = 0.9-1.4, and RR =1.2, 95% CI =1.0-1.3, respectively]. Numerous subgroup analyses were consistent with these overall null findings, with two exceptions: Longer courses of tetracyclines were associated with reduced tooth loss among persons receiving periodontal care, and penicillin was associated with reduced tooth loss among persons with more severe disease. Long-term, larger randomized trials are needed to provide evidence that antibiotics reduce tooth loss when used in the management of destructive periodontal disease.

Statin use and tooth loss in chronic periodontitis patients

BACKGROUND

Statins have anti-inflammatory and bone stimulating properties that may positively affect chronic periodontitis. Our objective in this study was to evaluate whether statin use by chronic periodontitis patients had a beneficial impact on tooth loss.

METHODS

In a retrospective cohort study (N patients = 1,021; mean follow-up = 7.1 years), dental records were merged with pharmacy data. Any statin use during 3 years, statin use during each of 3 consecutive years (regular use), and any statin use during the first 3 years after the initial periodontal exam were evaluated as predictors of tooth loss using negative binomial regression models with adjustment for potential confounding factors.

RESULTS

Any statin use during 3 years was not associated with tooth loss rate in the year subsequent to the 3-year period (rate ratio [RR] = 1.00; 95% confidence interval [CI] = 0.56 to 1.81). Regular statin use during 3 years was associated with a non-significant 37% reduced tooth loss rate in the year subsequent to the 3-year period (RR = 0.63; 95% CI = 0.32 to 1.25). Any statin use during the first 3 years after the initial periodontal exam was associated with a 48% decreased tooth loss rate in year 4 and subsequent years (RR = 0.52; 95% CI = 0.29 to 0.95).

CONCLUSIONS

Our findings were mixed for an association of statin use with reduced tooth loss in chronic periodontitis patients. Lack of control for some potential confounders, particularly smoking, and evaluation of different patterns of statin usage hamper the interpretation of the results. Exploration of these findings in additional epidemiological studies may be worthwhile.

Attitudes toward menopause and hormone therapy among women with access to health care

OBJECTIVE

To explore the relationship between women's attitudes toward menopause and hormone therapy and paradigms of menopause as a natural life event versus a biomedical phenomenon.

DESIGN

Women (N = 2092) sampled from physicians' practices in Washington state completed mailed questionnaires with a response rate of 72%.

RESULTS

Women's attitudes toward menopause were unrelated to their adoption of a biomedical versus developmental paradigm of menopause. In contrast, women's adoption of the view that menopause was an endocrine deficiency and that symptoms should be treated with hormones were correlated. Endorsement of the endocrine deficiency model of menopause was related to women's attitudes toward hormone therapy as more efficacious, less risky, and requiring daily use of a drug. Women's experiences of a hysterectomy and hormone use were associated with their attitudes.

CONCLUSIONS

Women's attitudes toward menopause are multidimensional and not influenced wholly by adoption of a biomedical or developmental paradigm. Women embraced menopause as part of life and simultaneously accepted changes in their endocrine production. Attitudes toward hormone therapy were closely aligned with adoption of a biomedical view of menopause and use of hormone therapy.

Deciding about hormone therapy: validation of a model

OBJECTIVE

The purposes of this study were to (1) validate components of a decision process regarding adoption of hormone therapy and (2) compare the decision processes women used with respect to their evaluation of decision quality.

DESIGN

A sample of women participating in a population-based study of midlife women's health participated in individual in-depth interviews.

RESULTS

Content analysis of 30 recorded interviews provided evidence that each component of the decision process (precontemplation, contemplation, commitment, critical evaluation, and continuance) was replicated. Few additional codes were identified, and these could be subsumed under the phases of the original decision model.

CONCLUSIONS

Women's self-reported statuses on a screening questionnaire corresponded to the stages of the decision model coded from their interviews. What women actually decided to do (use hormone therapy or something else) was not associated with their decision process. Satisfaction with the decision, uncertainty about the decision, and other factors related to the decision were independent of the decision phases.

Catalog card production with a programmable terminal

Application of a programmable terminal and printer to the cataloging task of a small medical library is described. The application is independent of a computer; the terminal is used in "local" mode only. Full sets of catalog cards are produced, following a single typing of descriptive cataloging data and tracings. Books can be cataloged the same day they are received. Actual cost per book is just over a dollar, for equipment rental, card stock, and the cataloger's time at the console, after call number, tracings, and main entry for the book have been determined.