Food insecurity is associated with lower diet quality among dental students

PURPOSE

Food insecurity is associated with lower diet quality, adverse health outcomes, and academic difficulty among undergraduate students. The objective was to identify the relationship between food security status and diet quality in dental students.

METHODS

All dental students attending Howard University (n = 286) or the University of Iowa (n = 326) during the fall 2021 semester were invited to complete a cross-sectional survey designed to query demographics, food security status (i.e., United States Department of Agriculture's ten item Adult Food Security Module), and diet quality (i.e., short Healthy Eating Index). The survey was administered using the Qualtrics platform.

RESULTS

Response rates were similar for Howard (32.5%) and Iowa (29.4%). Students with food insecurity (46.0%) were slightly older and more likely to be Black or other, first generation professional/graduate students, and receive financial aid than peers with food security (p < 0.050). Food insecurity was associated with lower intakes of fruits and vegetables (p ≤ 0.005), higher intakes of added sugars (p < 0.001), and lower diet quality (p = 0.003). In linear regression analyses that controlled for other variables, food insecurity (p = 0.012), school site (p = 0.027), and gender (p = 0.039) were predictive of lower diet quality.

CONCLUSIONS

The inability to procure adequate and appropriate foods was associated with marginal dietary habits (i.e., less than ideal food choices and eating behaviors) and lower diet quality in dental students. Both marginal dietary habits and lower diet quality increase chronic disease risk and may present a barrier to academic success. Addressing food insecurity among dental students is necessary to ensure equitable opportunities for a healthy workforce in the future.

Fear of COVID-19 among dental students at a Historically Black College and University (HBCU)

OBJECTIVE

To examine fear levels of COVID-19 among dental students at a Historically Black College and University (HBCU). Participants-162 first through fourth year dental students who were enrolled at the HBCU dental school between January 27, 2021 and May 3, 2021.

METHODS

Students completed an online survey that included the Fear of COVID-19 Scale (FCV-19S) and information on demographic variables.

RESULTS

Associations were observed between the fear of COVID-19 and the dental student's gender, ethnicity, marital status and self-rated health. Those in the highest quartile for the fear scale were less likely to be African American and more likely to be Asian or Pacific Islander, Hispanic or of Middle Eastern descent as compared to those in the lowest quartile.

CONCLUSION

Dental students at an HBCU are a population particularly vulnerable to fear of COVID-19 possibly due to the high demands and mental stress of dental school.

Sugar-Sweetened Beverage Consumption and Caries Prevalence in Underserved Black Adolescents

Purpose: The purpose of this study was to examine the association between sugar-sweetened beverage (SSB) consumption and dental caries prevalence among underserved Black adolescents. Methods: This was a cross-sectional study of 545 Black adolescents, ages 12 to 17 years, who participated in the Howard Meharry Adolescent Caries Study (HMACS). The outcome was dental caries prevalence, measured using the decayed, missing, and filled permanent tooth surfaces (DMFS) index. Participants were recruited from middle and high schools in Washington, D.C., USA, and Nashville, Tenn., USA. Questionnaires were used to assess beverage intake, demographic, and health-related behavioral characteristics. The multivariable analysis used marginalized zero-inflated Poisson regression (MZIP) stratified by toothbrushing frequency to estimate adjusted mean caries ratios (MRs), adjusted odds ratios (ORs), and 95 percent confidence intervals (95 percent CIs). Results: The mean age of the participants was 14.1 years. Participants in the highest quartile for SSB consumption had a higher caries ratio than those in the lowest quartile [MR equals (=) 1.59, 95 percent CI equals 1.15 to 2.20] and a lower odds of not being at risk for caries (OR = 0.24, 95 percent CI = 0.09 to 0.61). These findings were only observed among those brushing once a day or less (n =202). Conclusions: Among Black adolescents in this study who brushed once a day or less, high levels of sugar-sweetened beverage consumption were associated with greater caries prevalence and a reduced likelihood of remaining caries-free than those with lower levels of SSB consumption. Future studies will focus on interventions to reduce SSB consumption.

Food Insecurity, Meal Behaviors, Beverage Intake, and Body Mass Index in Underserved Adolescents

OBJECTIVE

Associations between food insecurity, meal patterns, beverage intake, and body mass index (BMI) were investigated using data from the Howard Meharry Adolescent Caries Study.

METHODS

Secondary analyses of food security status used the Wilcoxon rank sum, chi-square, and Fisher's exact tests.

RESULTS

The group of adolescents (n=627) was 42.1% male, 14.2±1.9 years, 86.9% African American, and 19.9% food-insecure. Meal frequency, meal structure, most beverage intake, and BMI did not differ by food-security status. Adolescents from Washington, DC were more likely to be food insecure than adolescents from Nashville, TN (P=0.003). Most had unstructured meal patterns and irregular breakfast intake. Median milk intake was below and sugar-sweetened beverage intake above dietary recommendations.

CONCLUSIONS

This study extends our knowledge concerning food insecurity in urban African American adolescents and suggests public health initiatives designed to encourage meal structure, increase milk intake, and reduce sugar-sweetened beverage intake can improve diet quality of underserved youth.

The contrasting short-term effects of COVID-19 on dental care practices in the United States

OBJECTIVES

The study utilized a cross-sectional survey to determine the short-term effects of the COVID-19 pandemic on dental care practices. The authors hypothesized that the effects of the pandemic would indicate differences based on the ethnicity of the participating dentist.

MATERIALS AND METHODS

The survey was available online between June 1, 2020 and July 10, 2020, a period when many dental offices remained closed, and for the most part, unable to provide non-emergency dental care. The link to the survey was made available to dentists through outreach to several national dental organizations. Descriptive statistics summarized the characteristics of the entire sample and Fisher's exact test was used to examine respondents' answers stratified by ethnicity using frequencies and percentages.

RESULTS

All ethnic groups reported decreased revenue and African American dentists were the least likely to report a decrease in revenue compared to White and Other ethnic groups (84.2%, 87.2% and 92.9%). African American dentists were the most likely to report willingness to contribute to a task force to address the new challenges resulting from COVID-19 when compared to White and Other ethnic groups (46.4%, 18.8%, and 29.6%, respectively). African American dentists were more likely to indicate a need for a stronger connection to academic programs as compared to White or Other dentists in order to address current and future challenges (12.3%, 0.0%, and 9.1%).

CONCLUSION

The COVID-19 pandemic has affected dental practices differently, highlighting racial disparities, and strategies that factor in the race or ethnicity of the dentist and the communities in which they practice need to be considered to ensure that underserved communities receive needed resources.

An Approach to Engaging Schools In Oral Health Initiatives: The Howard Meharry Adolescent Caries Study (HMACS)

Use of community-based participatory research (CBPR) principles can help identify strategies for development and implementation of studies that can address oral health disparities disfavoring African American youth. This paper summarizes approaches of the Howard Meharry Adolescent Caries Study (HMACS) to provide sustained oral health services beyond the life of a research study.

Depression and the Likelihood of Hospital Admission from the Emergency Department among Older Patients with HIV

OBJECTIVE

The objective was to determine if depression was associated with an increased likelihood of hospital admission following an emergency department (ED) visit among older patients diagnosed with HIV.

METHODS

We performed secondary analysis of data from the Nationwide Emergency Department Sample (NEDS) in the United States using multivariable Poisson regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). We included adults aged 50 years and older, diagnosed with HIV using International Classification of Diseases, 9th revision (ICD-9-CM) codes. We controlled for demographic characteristics, hospital characteristics, and comorbid conditions in the analysis.

RESULTS

In the final multivariable model, there was a 45% increase in the likelihood of hospital admission following an ED visit among older patients with HIV diagnosed with depression compared with those not diagnosed with depression (PR = 1.45, 95% CI = 1.39-1.52).

CONCLUSIONS

Depression was associated with hospital admission among adults aged 50 and over.

Reducing Dental Plaque Scores in Long-term Care Facilities Using a Checklist and Random Inspections: A Pilot Study

The development and use of tailored interventions in overcoming barriers to optimum health in long-term care facility residents is of the highest importance. One successful approach to improving health outcomes is the use of a checklist by health care providers. Despite the evidence of the success of such checklists in nursing and medicine, there is little evidence on their use in improving dental outcomes. This study investigated whether an intervention comprising the daily use of a checklist for oral care by nursing staff supplemented by random inspections by a charge nurse resulted in lower dental plaque scores in patient participants at a long-term care facility (n=19) as compared with in those at another long-term care facility that did not receive the intervention (n=13). All participants received a dental cleaning at baseline. At a follow-up examination at 6 to 8 weeks post-baseline, significant differences were observed in the plaque scores between the participants at each location, with the median plaque scores in those undergoing the intervention being less than half of those in the patients that did not (20.8% vs. 52.8%, p<0.001). After adjusting for age in a linear regression model, this difference remained significant. The use of a daily checklist for oral care supplemented by random inspections by a charge nurse was associated with lower plaque scores (p<0.001). These results warrant further research, including prospective studies aimed at establishing how use of both clinical supervision and a checklist for oral health may influence plaque scores in geriatric patients in long-term care facilities over time.

Hospital admissions for pneumonia more likely with concomitant dental infections

OBJECTIVE

The objective of this study is to determine if the presence of dental infection is associated with an increased likelihood of hospital admission following an emergency department (ED) visit among patients diagnosed with pneumonia. We hypothesized that the presence of a dental infection may worsen the clinical symptoms in ED patients diagnosed with pneumonia and are using hospital admission as a marker of worsening clinical severity.

MATERIALS AND METHODS

We analyzed the data from the 2008 Nationwide Emergency Department Sample and used Poisson regression with robust estimates of variance to obtain prevalence ratios (PRs) with the appropriate adjustments for complex survey sampling.

RESULTS

In the final multivariable model, there was a 19% increase in the likelihood of hospital admission following an ED visit among pneumonia patients diagnosed with dental infection compared to those without dental infection (PR = 1.19, 95% CI = 1.11-1.27). In an exploratory multivariable analysis, pneumonia patients diagnosed with dental caries had a 29% increase in the likelihood of admission compared to those not having dental caries (PR = 1.29, 95% CI = 1.23-1.34). These findings remained consistent in a subgroup analysis among patients with less clinically severe forms of pneumonia.

CONCLUSIONS

Dental infections may worsen the clinical symptoms in ED patients with pneumonia increasing their likelihood for hospital admission. Dental caries may be a marker for poor oral hygiene and increased dental plaque rather than serve directly as a source of respiratory pathogens.

CLINICAL RELEVANCE

The findings suggest that an increased focus on preventive oral health may reduce the need for admission following an ED visit for patients diagnosed with pneumonia.

Dental infections increase the likelihood of hospital admissions among adult patients with sickle cell disease

THE OBJECTIVE

To determine if dental infections increase the likelihood of hospital admission among adult patients with sickle cell disease (SCD).

BASIC RESEARCH DESIGN

Cross-sectional analysis of data from the Nationwide Emergency Department Sample (NEDS) pooled for the years 2006 through 2008. Prevalence ratios (PR) for the effects of interest were estimated using Poisson regression with robust estimates of the variance.

PARTICIPANTS

Adults, aged 18 and over, diagnosed with SCD using ICD-9-CM codes excluding participants discharged with a code for sickle cell trait.

MAIN OUTCOME MEASURE

Emergency department (ED) visit disposition, dichotomised to represent whether or not the ED visit ended in admission versus being treated and released.

RESULTS

Among patients having a sickle cell crisis, those with dental infections were 72% more likely to be admitted compared to those not having dental infections (PR = 1.72, 95% CI 1.58-1.87). No association was observed among adult SCD patients not having a sickle crisis event. Based on preliminary data from this analysis, prevention of dental infection among patients with SCD could result in an estimated cost saving of $2.5 million dollars per year.

CONCLUSIONS

Having a dental infection complicated by a sickle cell crisis significantly increases the likelihood of hospital admission among adult SCD patients presenting to the ED.

Dentists consider medical screening important and are willing to incorporate screening procedures into dental practice

SUBJECTS

Subjects were 1945 respondents from a survey sent out to 7400 general dentists practicing in the United States (26% response rate). The 7400 dentists were from a random sample generated from the American Dental Association (ADA) master file, which included ADA members and nonmembers. Among respondents, 82.3% were male, 85.7% were white, and 84.8% were 40 years of age or older. The study sample was different from the total sampling frame of US practicing dentists in that the respondents in this sample included older individuals, fewer women, and fewer Asian Americans and African Americans.

KEY RISK/STUDY FACTOR

No one independent variable was identified, as the study was exploratory and not driven by a specific hypothesis. Demographic information was obtained about each respondent's sex, age, race/ethnicity, location of practice, and years in practice.

MAIN OUTCOME MEASURE

No one outcome was identified, as the purpose of the study was to obtain information about dentists' attitudes, acceptance of, and perceived barriers to performing medical screening in a dental setting. The questionnaire included 5 Likert scale questions that used a 5-point response scale as follows: 1 = very important/very willing, 2 = somewhat important/somewhat willing, 3 = not sure, 4 = somewhat unimportant/somewhat unwilling, and 5 = very unimportant/very unwilling. A Friedman 2-way nonparametric analysis of variance (ANOVA) was used for the analyses with Wilcoxon-Mann-Whitney mean rank sum value provided when the ANOVA test yielded a significant difference.

MAIN RESULTS

The authors combined the first 2 responses "very important" and "somewhat important" to create one variable "important" to score Questions 1 and 2. As a result, most thought it was important to conduct screening for hypertension (85.8%), cardiovascular disease (76.8%), diabetes mellitus (76.6%), hepatitis (71.5%), and human immunodeficiency virus (68.8%). The authors combined the responses "very willing" and "somewhat willing" to create one variable "willing" to score Question 3. The result was that most were willing to conduct screening that yielded immediate results (83.4%), to discuss results immediately with the patient during the dental visit (76.0%), or refer a patient for a medical consultation (96.4%). Only 45.9% were willing to send samples to a laboratory for testing. Using the same coding scheme for Question 4 as was used for Question 3, the authors found that most respondents (87.7%) were willing to collect oral fluids and blood pressure measurements (90.8%). Respondents were less willing to collect blood via finger stick (55.9%) or measure height and weight (57.4%). For Question 5, 54.7% thought that having insurance coverage was "very important" in deciding whether to incorporate medical screening into dental practice, compared with 75.4% for the variable categorized as time, 76.1% for the variable costs, 82.4% for the variable liability, and 83.5% for the variable described as patient willingness. According to the authors, the results suggest that having insurance is the least important barrier to incorporating screening into the dental practice. The authors also performed subgroup analysis according to sex and years of practice, observing some differences with the former but none with the latter. Women were more willing to test for hypertension, cardiovascular disease, and diabetes mellitus and thought that having insurance coverage was more important compared with men when considering whether to incorporate medical screening into dental practice. No mention was made of subgroup analysis according to locale (urban, suburban, and rural). Comparing the mean rank sums, insurance was significantly less important than time, cost, liability, or a patient's willingness when deciding whether or not to incorporate screening (P < .001).

CONCLUSIONS

Most respondents thought that chairside screening for medical conditions was important and were willing to conduct screening for specified medical conditions in a dental setting.

Adaptation of the Communication Skills Attitude Scale (CSAS) to dental students

The purpose of this study was to adapt the twenty-six-item Communication Skills Attitude Scale (CSAS) developed for medical students for use among dental students and to test the psychometric properties of the modified instrument. The sample consisted of 250 students (an 80.1 percent response rate) in years D1 to D4 at a dental school in Washington, DC. The mean age of participants was 26.6 years with a range from twenty-one to forty-two years. Slightly more than half of the participants were female (52.4 percent) and were African American or of African descent (51.7 percent). Principal components analysis was used to test the psychometric properties of the instrument. The index that resulted measured both positive and negative attitudes toward learning communications skills. The final twenty-four-item scale had good internal consistency (Cronbach's alpha=0.87), and the study obtained four important factors-Learning, Importance, Quality, and Success-that explained a significant portion of the variance (49.1 percent). Stratified analysis by demographic variables suggested that there may be gender and ethnic differences in the students' attitudes towards learning communication skills. The authors conclude that the CSAS modified for dental students, or DCSAS, is a useful tool to assess attitudes towards learning communication skills among dental students.

Planning and tracking chemotherapy production for cancer treatment: a performing and integrated solution

PURPOSE

Chemotherapy drugs are intended for the treatment of cancer. The production of such drugs and their administration to the patient is a delicate and expensive operation. The study deals with the acquisition and processing of data regarding the production of intravenous chemotherapy, from the production request (the medical prescription), the production itself (pharmaceutical process), to the delivery in the health care unit, for the administration of the chemotherapy. The goal of this study is to develop a system that can schedule, control and track the chemotherapy preparations and satisfy a certification process of quality management ("ISO 9001 version 2000" standard).

METHODS

The solution proposed in this paper was developed within the framework of a common certification process at the Biopharmaceutical Unit of the Oncology Clinic (UBCO) of the Bretonneau hospital in Tours (France). The system consists of two software programs: a software to insure traceability and a decision making software to plan the production. To simplify the data entry process, some mobile entry points with bar code reader have been deployed. These tools enable an accurate tracking of the production, a security and control for the schedule production phases, and a full traceability of each operation leading to the administration of the chemotherapy drug.

RESULTS

The first result is a software that creates the production schedule, allows a real time control of the production process and a full traceability of each step. Computational experiments are based on real data sets, with a comparison of a time period before and after the implementation of this solution. The results show the positive impacts of this software, like the reduction of delayed deliveries, real time generation of production indicators, optimization of the production and a saving of staff time.

CONCLUSIONS

This intuitive system guarantees a traceability in connection with a high quality system certified ISO 9001-v2000 (with a rapid data entry), an assistant to schedule the production of preparations in a better way, a permanent follow-up and analysis of operations. This project proves the benefits of implementing computer solutions for the traceability and assistance in decision making in the hospital systems.

Depressive symptoms, stress, and social support among dental students at a historically black college and university

OBJECTIVE

The authors measured the prevalence of depressive symptoms among dental students at a historically black college in the United States to determine how depressive symptoms, stress, and social support influence each other within this student population.

PARTICIPANTS

Dental students (n = 143) completed a self-administered survey to assess depressive symptoms, stress, and social support, using validated and reliable instruments. Participants also reported demographic variables.

METHODS

The authors used multivariable linear regression controlling for potential confounding.

RESULTS

The prevalence of depressive symptoms was 16.7%. There were significantly higher levels of stress for students with depressive symptoms compared with those without such symptoms (p < .01), and students with depressive symptoms had significantly lower levels of social support (p < .01). Results show higher levels of depressive symptomatology to be related to decreased social support at both high and low stress levels (p < .01).

CONCLUSIONS

Stress and social support are associated with depressive symptoms among dental students.

Clinical, cytogenetic and molecular characteristics of 14 T-ALL patients carrying the TCRβ-HOXA rearrangement: a study of the Groupe Francophone de Cytogénétique Hématologique

Recently, we and others described a new chromosomal rearrangement, that is, inv(7)(p15q34) and t(7;7)(p15;q34) involving the T-cell receptor beta (TCRbeta) (7q34) and the HOXA gene locus (7p15) in 5% of T-cell acute lymphoblastic leukemia (T-ALL) patients leading to transcriptional activation of especially HOXA10. To further address the clinical, immunophenotypical and molecular genetic findings of this chromosomal aberration, we studied 330 additional T-ALLs. This revealed TCRbeta-HOXA rearrangements in five additional patients, which brings the total to 14 cases in 424 patients (3.3%). Real-time quantitative PCR analysis for HOXA10 gene expression was performed in 170 T-ALL patients and detected HOXA10 overexpression in 25.2% of cases including all the cases with a TCRbeta-HOXA rearrangement (8.2%). In contrast, expression of the short HOXA10 transcript, HOXA10b, was almost exclusively found in the TCRbeta-HOXA rearranged cases, suggesting a specific role for the HOXA10b short transcript in TCRbeta-HOXA-mediated oncogenesis. Other molecular and/or cytogenetic aberrations frequently found in subtypes of T-ALL (SIL-TAL1, CALM-AF10, HOX11, HOX11L2) were not detected in the TCRbeta-HOXA rearranged cases except for deletion 9p21 and NOTCH1 activating mutations, which were present in 64 and 67%, respectively. In conclusion, this study defines TCRbeta-HOXA rearranged T-ALLs as a distinct cytogenetic subgroup by clinical, immunophenotypical and molecular genetic characteristics.

The association between sickle cell disease and dental caries in African Americans

This study sought to determine whether there was an association between sickle cell disease (SCD) and dental caries in African-American adults. A sample of 102 African-American adult patients with SCD from Washington, D.C., and Baltimore, Maryland, were matched to 103 African-American adult subjects, who did not have SCD. The match was by age, gender and recruitment location. Each subject underwent a standardized oral examination as well as an interview to ascertain risk factors for dental caries. For individuals with incomes of less than dollars 15,000, subjects with SCD had more decayed (10.36 versus 1.58) and fewer filled (2.86 versus 8.45) surfaces compared to subjects without SCD with both differences being statistically significant (p<0.05) after adjusting for age and gender. The results suggest that low-income African Americans with SCD may be at increased risk for dental caries and are less likely to receive treatment with a restoration.

Association between elevated depressive symptoms and clinical disease severity in African-American adults with sickle cell disease

OBJECTIVE

The purpose of this cross-sectional study was to examine the association between elevated depressive symptoms and the clinical severity of sickle cell disease (SCD) using African-American adults with and without SCD.

STUDY DESIGN

The population consisted of 102 African-American adults with SCD, diagnosed using hemoglobin electrophoresis, individually matched on age (+/-5 years), gender and recruitment location to 103 African-American adults without SCD (mean age of all subjects was 35.4 years, 55.6% female). Logistic regression was used to examine the association between SCD clinical severity and elevated depressive symptoms in bivariate and multivariable analyses.

RESULTS

The prevalence of elevated depressive symptoms as measured using the 10-item Center for Epidemiological Studies Depression Scale (CES-D) was 38.6% in those with SCD, compared to 27.5% in those without SCD; however, this difference was not statistically significant (p>0.05). Compared to African Americans without SCD, African Americans with SCD were less educated, had lower incomes, and were more likely to be unemployed or disabled (p<0.01). The odds of having elevated depressive symptoms were 1.78 (CI: 0.94, 3.38) for those with high clinical SCD severity compared to those without SCD in bivariate analysis and 1.37 (CI: 0.62, 3.02) in multivariable analysis after adjusting for socioeconomic factors.

CONCLUSIONS

The reported relationship between elevated depressive symptoms and SCD may be a result of the adverse economic conditions associated with SCD.

Self-perceived Loss of Control and Untreated Dental Decay in African American Adults With and Without Sickle Cell Disease

The aim of this cross-sectional study was to investigate the association between self-perceived loss of control as measured by dental external locus of control summary scores, with the amount of untreated dental decay in African American adults with sickle cell disease (SCD) and African Americans adults without SCD. The sample included 102 subjects with SCD and 103 subjects without SCD matched on age, sex, and recruitment location (mean age of all subjects 35.4 years, 55.6% female). Subjects with SCD in the highest quartile for dental external locus of control summary scores had 2.58-fold (CI 1.05, 6.34) as much untreated decay as those in the lowest quartile (p<.05) in multivariable analysis using the negative binomial regression model. For subjects without SCD, those in the highest quartile for dental external locus of control summary scores had 3.00-fold (CI 1.38, 6.49) as much untreated decay as those in the lowest quartile (p<.05) using similar analysis. This study showed that higher dental external locus of control is associated with increased untreated tooth decay, both for African Americans with and without SCD and that the magnitude of the association did not differ across groups.

Argon plasma coagulation for treatment of watermelon stomach

BACKGROUND AND STUDY AIMS

Watermelon stomach or gastric antral vascular ectasia (GAVE) is a rare but well-recognized cause of gastrointestinal blood loss, which typically affects elderly women. Historically patients were treated with antrectomy but this has been largely replaced by endoscopic therapy such as Nd:YAG laser. Argon plasma coagulation (APC) is a new noncontact electocoagulation technique which has several theoretical advantages over laser. The objective of this study was to assess the efficacy of APC in treating GAVE.

PATIENTS AND METHODS

We retrospectively reviewed the case-records of five patients (four women, one man) with iron deficiency anaemia or gastrointestinal blood loss due to GAVE who were treated with APC and for whom a follow-up of more than 12 months was available. Four patients were transfusion-dependent. Their mean age was 71 years (range 58 - 83). The mode of presentation, number of treatment sessions, response to therapy and recurrence (if any) were recorded.

RESULTS

A mean of 2.6 treatment sessions per patient were required. All patients had an endoscopically observed response to therapy and all patients had a sustained rise in hemoglobin level after treatment. Transfusion dependence ceased in all patients. After a mean follow-up of 20 months GAVE recurred in two patients (40 %). Both patients responded to further APC treatment. No major complications were recorded.

CONCLUSION

APC is a safe and effective short-term treatment for GAVE. The natural history of the condition is uncertain, and at medium-term follow-up GAVE is found to recur in a substantial number of patients treated with APC. Re-treatment with APC is an option in these patients.

Sickle cell anemia and dental caries: a literature review and pilot study

The purpose of this cohort study was to determine whether individuals with sickle cell anemia (SCA) were more susceptible to dental caries than non-sickle-cell control subjects. A review of the literature suggests several reasons why individuals with SCA may be at increased risk. Thirty-five cases of SCA aged 6 years and older were identified from a screening of 15,900 current patient files at the Howard University College of Dentistry Dental Clinic. A total of 140 non-SCA control subjects (four per case), frequency-matched on enrollment period (+/- 5 yrs) and age (+/- 2 yrs if under age 21, or +/- 5 yrs if 21 or over), was selected by a nonbiased method from the same dental clinic files. SCA cases and controls were identical on mean age (30.4 +/- 19 yrs, ranging from 5 to 92 yrs) and were similar in sex distribution (males: 34% of SCA cases, 40% of controls). The mean number of permanent teeth present was very similar for SCA cases and controls (23.4 +/- 6.4 vs. 24.2 +/- 6.4). The mean DMFT was 21% higher in the SCA cases (12.0 +/- 8.4 vs. 9.9 +/- 6.9), and the mean DMFS was 26% higher in the SCA cases (33.0 +/- 32.3 vs. 26.2 +/- 27.7). While there was virtually no difference in DMFS between SCA cases and controls for 6- to 19-year-olds, for subjects aged 20 and older, the DMFS was 30.4% higher in the SCD cases. For all ages, the M component for SCA cases was 40.7% higher, and the D component was 20.0% higher, while the F component was only 3.5% higher than for controls. Untreated decay (the D/D+F surfaces ratio) was 24.4% higher in the SCA cases. The findings from this pilot study suggest that SCA cases have a higher susceptibility to dental caries and/or that SCA patients may have different treatment pathways once caries is detected. While none of the observed differences was statistically significant, these findings were of clinical interest and should be pursued in future large-scale studies.

Jaundice: a clinical perspective

The correct diagnosis in a jaundiced adult suggests itself clinically. A logical approach will avoid inappropriate tests, delays in diagnosis and unnecessary hospitalisation.

Laser photocoagulation in obstructing malignant tumours of the respiratory and gastrointestinal tracts

The palliation of obstructing malignant tumours of the respiratory tract and the gut is often inadequate. We report the endoscopic use of Nd-YAG laser photocoagulation for the rapid and safe relief of malignant obstruction in airways, colon and oesophagus in three patients.