Biomedical subjects
Publications and source records attributed to M Mullin.
Retention is normally required after active orthodontic tooth movement to hold the teeth in their new positions. This article reviews the principles of orthodontic retention and describes common retention regimes and appliances.
Studies have suggested that occupational disease and injury are under-recognized by clinicians. To estimate the frequency of occupational factors in disease and injury, 108 patients in a general (not occupational) health care facility were interviewed about the frequency and types of workplace-health interactions. Thirty-nine percent reported possible causation by work, and 66% reported a possible increase in symptoms by work, even if not caused by work. Twenty-seven percent reported changing jobs and/or tasks because of work-health interactions. The majority of men and women reported that worksite changes could improve their functional ability at work. This study therefore indicates that (1) occupational health concerns are common in primary care clinics, even if not addressed by clinicians; (2) the definition of occupational health concerns should be broadened to include disease caused by work, disease symptoms worsened by work, and the need for occupational accommodation even if the disease itself is not caused by work; and (3) inquiring about patient concerns about workplace-health interactions can provide clinicians with significant opportunities for primary, secondary, and tertiary prevention.
OBJECTIVE: To use an extremity magnetic resonance system to perform kinematic magnetic resonance imaging (MRI) of the patellofemoral joint to qualitatively assess the effect of bracing on patellar position. DESIGN AND SETTING: Subjects underwent kinematic MRI of the symptomatic extremity with a 0.2-Tesla extremity magnetic resonance system. Images were obtained using a knee coil and a T1-weighted, spin echo pulse sequence. SUBJECTS: Seven female patients with patellofemoral joint symptoms. MEASUREMENTS: FOUR DIFFERENT AXIAL SECTIONS WERE OBTAINED FOR EACH POSITION: extension and 3 positions of flexion up to 36 degrees . An appropriate-sized patellofemoral brace was applied, and the kinematic MRI procedure was repeated. RESULTS: Six patients had lateral displacement of the patella, and 1 patient had medial displacement of the patella. After application of the brace, 6 patients (5 with lateral displacement and 1 with medial displacement, 86%) exhibited correction (5) or improvement (1 with lateral displacement) in the abnormal patellar positions, and 1 patient had worsening of the abnormal position of the patella. CONCLUSIONS: We used kinematic MRI to determine the presence of abnormal patellar positioning. Application of the brace counteracted the abnormal patellar positions in most of the patients studied.
Two procedures (laser bullectomy and lung reduction surgery with staples) are currently available for the surgical treatment of patients with diffuse emphysema. We compared the efficacy of these two surgical approaches in 72 patients, aged 67 +/- 7 years (mean +/- standard deviation), who had diffuse emphysema scored as severe on computed tomography and severe fixed expiratory airflow obstruction. The patients were prospectively randomized to undergo either neodymium:yttrium aluminum garnet contact laser surgery (n = 33) or stapled lung reduction surgery (n = 39) by unilateral thoracoscopy. The operative mortalities were 0% and 2.5%, respectively. No significant differences were noted between the groups (p < 0.05) with respect to operating time, hospital days, or air leakage for more than 7 days. However, a delayed pneumothorax developed in six patients (18%) who had laser treatment (p = 0.005). The operations eliminated dependency on supplemental oxygen in 52% of the laser group and 87.5% of the stapled lung reduction group (p = 0.02). The mean postoperative improvement in the forced expiratory volume in 1 second at 6 months was significantly greater for the patients undergoing the staple technique (32.9% vs 13.4%, p = 0.01) than for the laser treatment group.
OBJECTIVE: To examine positive and negative social support and other selected social context variables (age, education, marital status, gender, and exposure to other smokers inside and outside the home) as predictors of smoking cessation in non-hospitalised adults with diagnosed cardiovascular disease at follow up after one, six, and 12 months. DESIGN: Discriminant function analyses (DFA) and longitudinal "lag" analyses. SUBJECTS: 137 Non-hospitalised adults with diagnosed cardiovascular health problems. RESULTS: Examination of the concurrent DFAs revealed significant univariate F ratios for the predictor variables of gender and marital status at one year and low negative support at all three follow ups. Quitters reported significantly lower levels of negative support than non-quitters over the course of the year and tended to be male and married. Longitudinal "lag" analyses, however, revealed that higher positive social support at one month and higher negative support at six months were both predictive of smoking cessation at one year. At one year more men than women and more married than not married smokers were successful in quitting. No effects for age, education, or exposure to others smoking inside or outside the home were found on any of the concurrent DFAs or longitudinal analyses. CONCLUSION: A series of concurrent DFAs revealed that positive support was a significant predictor of quitting at one year and negative support was predictive of not quitting at all three follow ups. Longitudinal "lag" analyses showed that positive support at one month and negative support at six months both predicted quitting at one year. Being male and married were found to contribute to quitting on both sets of analyses. The effects for positive and negative support on the smoking behaviour of adults with cardiovascular disease tended to change over the course of a year. These findings suggest that positive and negative social support may have differential effects over time. As the smoker moves along the "quitting trajectory" it may be that more "nagging" or negative interactions are needed at some point to get smokers to quit, if positive support has not worked or is not working. Progression of disease also may have served as a stimulus for family members and friends to become more insistent and negative about the person's continued smoking. More research is needed to examine the quitting process to determine which and how social context variables contribute.
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Despite growing interest in social support as a moderator of stress, few studies have attempted to demonstrate the effects of a psychological intervention in this domain. Hairdressers are an acknowledged source of social support and a randomly selected group (n = 8) were given structured training in the provision of social support to their customers. In comparison with a group of their untrained colleagues (n = 7), repeated measures indicated a significant training effect in terms of the hairdressers' understanding and proficiency in providing social support, while a generalization effect was suggested by customers' ratings of their perceived 'helpfulness'.
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Adolescent pregnancy has long been considered high risk perinatally. It is also a symptom of social disorder. Older studies provided ominous portents of increased risk of toxemia, prematurity, anemia, cephalopelvic disproportion, and perinatal wastage. Studies during the past decade have shown more encouraging data, especially when representing a concerted effort toward this age group. The first 2 years of an intensive and individual approach to gravidas under age 17 are discussed. A total of 135 young women were studied and compared with 100 controls of similar age, treated routinely, and with 100 women of more nearly ideal childbearing age. Perinatal and social data are shown. The implications of the data are discussed in light of other studies. Few, if any, medical differences between the two groups of adolescents and the older women are noted. More important are the social and emotional factors in determining future difficulties.
Experiences with primary closure of the pericardium in a series of 100 patients undergoing open-heart operations are described. The pericardium was kept under tension during the operation to minimize shrinkage and permit closure at the end of the procedure. In 28 patients one pleural space was opened for drainage, whereas in 72 patients intra- and extrapericardial sumps alone were used for drainage. Measurements of sump drainage revealed that most postoperative bleeding originates from outside the pericardium. There were no instances of cardiac tamponade although 19 patients lost more than 1 L. of blood after operation and 5 required reoperation for hemorrhage. Transpleural drainage tubes were shown to be ineffective and in addition were associated with a fourfold increase in postcardiotomy syndrome and a significantly greater frequency of pleural effusion and atelectasis when compared to the use of mediastinal sump drainage alone. We have concluded that closing the pericardium and using mediastinal sump drainage minimizes the risk of cardiac tamponade and allows early localization of the site of postoperative bledding. Another advantage of pericardial closure and drainage is that postoperative adhesions and postcardiotomy syndrome will be less significant. As a consequence the danger of injuring the heart in a subsequent operation is lessened.
The synthesis of all possible Isomeric nona- and octachlorobiphenyls has been accomplished by the Cadogan coupling of commercially available or synthetic chlorinated anilines in the presence of excess chlorinated benzenes and isoamyl nitrite. 2, 3, 4, 6-Tetrachloraniline was prepared by the chlorination of 2, 4, 5-trichloroaniline. The synthetic polychlorinated biphenyls (PCBs) were characterized by their proton magnetic resonance and mass spectra and their purities determined by gas chromatographic analyses. The PCB standards were used to unambiguously identify the deca-, nona-, and octachlorobiphenyls present in human breast milk and in the commercial PCB preparations Arociors 1268, 1262, 1260, 1254, 1248, 1242, 1016, 1232 and 1221 utilizing high resolution glass capillary gas chromatography.
OBJECTIVE: To examine the relative effectiveness of three different presentations of a smoking cessation program on the smoking behavior of adults with cardiovascular health problems. DESIGN: A 2 x 2 x 2 x 4 experimental design with stratification by sex, smoking history, and a cardiovascular event, and randomization to Individual, Group, Written, or No Intervention groups. SETTING: Six community hospital classrooms. SUBJECTS: 255 nonhospitalized adults. THEORETIC FRAMEWORK: Interaction Model of Client Health Behavior. MEASUREMENTS: Study Intake: Professional referral form, demographic questionnaire, smoking habits questionnaire, health history, perceived threat survey, perceived health status. Follow up: smoking cessation and health questionnaire, saliva thiocyanate testing. RESULTS: At 12-month follow-up, a nurse-client interaction was more effective than written self-help materials; however, smoking cessation rates were highest in the No Intervention control group, possibly related to having had coronary artery bypass graft surgery. Variables positively related to quitting were being male and married and having a higher income. With baseline factors considered, a quitter was most likely to be male and less than 48 years of age, have a high degree of perceived threat relative to medical diagnosis, and be in the individual intervention group. Only partial support for the study hypotheses was found.