Biomedical subjects

P Weinstein

Publications and source records attributed to P Weinstein.

At least 19 recordsLinked to original sources

PubMed2006

Pilot clinical trial of gabapentin to decrease postoperative delirium in older patients.

In this randomized pilot clinical trial, the authors tested the hypothesis that using gabapentin as an add-on agent in the treatment of postoperative pain reduces the occurrence of postoperative delirium. Postoperative delirium occurred in 5/12 patients (42%) who received placebo vs 0/9 patients who received gabapentin, p = 0.045. The reduction in delirium appears to be secondary to the opioid-sparing effect of gabapentin.

Amines↗

PubMed2006

A qualitative look at parents' experience of their child's dental general anaesthesia.

OBJECTIVES: Caries relapse after treatment of early childhood caries (ECC) under general anaesthesia (GA) has been frequently reported. This research used a qualitative method of inquiry to explore parents' experience of their child's treatment under GA, and their perception of the impact of this treatment on their child. METHODS: The participants were parents whose children had recently undergone dental rehabilitation under GA. Data was collected by semistructured, open-ended interviews scheduled at the postoperative appointment. Interviews were audio-taped, transcribed, checked and coded into a qualitative computer software program for analysis. Data collection and analysis were done simultaneously, and the interview guide was modified based on responses. RESULTS: Parents were troubled that their child needed a GA and appeared aware of the complications. While some parents felt 'guilty' and struggled to accept this mode of treatment for their child, others felt 'blameless', and were convinced that the GA was 'preferable' for their child and superior to conventional treatment. Nonetheless, all parents reported some levels of anxiety during the GA; they expressed their emotions with 'fear', 'worry' and 'concern'. After the GA, improvement was reported by most parents in their child's amount of dental pain, sleeping pattern, eating habits and acceptance of parental toothbrushing. The most common changes in their child's behaviour mentioned by parents were increased toothbrushing and decreased consumption of sugary foods. Several children who had had primary teeth extracted were distressed as a result of this 'loss'. CONCLUSION: The general anaesthetic experience was troubling in a variety of ways for both parents and children. However, an 'early' and positive outcome of the GA was a reported improvement in dental health practices. Parents were more positive about maintaining the health of primary teeth and now knew how to take care of their child's teeth. Future exploration is required to reveal if and how the GA experience will affect long-term preventive behaviours.

Adult↗

PubMed2006

Comparison of Campylobacter jejuni PFGE and Penner subtypes in human infections and in water samples from the Taieri River catchment of New Zealand.

AIMS: To determine the degree of overlap in strain types of Campylobacter jejuni isolated from clinical cases and water samples from the Taieri catchment in the South Island of New Zealand. METHODS AND RESULTS: Thermophilic Campylobacter were collected from human cases of infection, the main stem of the Taieri River and streams within distinct land-use types over a 1-year period. Campylobacter jejuni (187 isolates) and Campylobacter lari (four isolates) were identified using a multiplex polymerase chain reaction protocol. Isolates were typed by the Penner method and pulsed-field gel electrophoresis (PFGE) utilizing two restriction endonucleases. Several serotypes and PFGE types occurred in both water samples and clinical cases when the restriction profiles for each enzyme were considered separately. However, when PFGE profiles and serotyping were combined, there was no overlap between Camp. jejuni types from water and clinical cases. CONCLUSIONS: The results of this study indicate that recreational water in the Taieri catchment is not a major source of campylobacteriosis in the Dunedin area. SIGNIFICANCE AND IMPACT OF THE STUDY: This study suggests the risk of acquiring campylobacteriosis from surface waters in the Taieri catchment is considerably lower than previously predicted and highlights the necessity of using two endonucleases in PFGE typing.

Bacterial Typing Techniques↗

PubMed2005

Health effects of natural dust: role of trace elements and compounds.

This article reviews the health effects of trace elements carried in natural dusts of geologic or geochemical origin. The sources of these dusts are diverse, including volcanoes, dust storms, long-range transport of desert dust, and displacement through natural processes such as landslides and earthquakes. The primary focus is dust exposures affecting communities rather than occupational groups (which have been comprehensively explored in other publications). The principal elements and compounds reviewed are trace metals (including As, Hg, Cd, and Fe), radioactive elements, fluoride, silicates, natural asbestiform compounds, and alkali salts. The pathways by which such agents affect human populations are explored, including carriage through water, air, soil, and the food chain. The mechanisms of biotoxicity and the acute and chronic consequences on health associated with these elements are described. The discussion explores problems inferring risk and disease causation from natural dust exposures using standard epidemiological indicators, particularly for chronic outcomes, and will argue for the importance of the ecological perspective in assessing pathogenesis. The authors stress the global scale of the problem, which remains underevaluated and underreported in terms of health implications.

Animals↗

PubMed2005

The Child Dental Control Assessment (CDCA) in youth: reliability, validity and cross-cultural differences.

AIM: The Child Dental Control Assessment (CDCA) measures children's preferred control strategies in the dental situation. Three studies are reported, assessing aspects of this instrument in youths from the USA, Japan and Australia. In particular, measurements were made as to the reliability and validity of this instrument in this age group in the three cultures, as well as comparing some results across cultures. STUDY DESIGN: These studies used a questionnaire design. METHODS: Questionnaires (including the CDCA and other measures) were given to youths aged 11-15 in the three cultures. In one culture, youths received the questionnaire twice, to compute test-retest reliability. RESULTS: The measure's reliability and validity were similar to those of other measures. The CDCA behaves similarly to the Revised Iowa Dental Control Index (R-IDCI). Youths in all three cultures showed similar responses, although the Japanese were less likely to endorse items. STATISTICS: Internal reliability of the scale ranged from 0.74 to 0.85. Test- retest reliability was 0.74. Participants in the High Desire/Low Predicted classification on the R-IDCI scored higher on the CDCA (t (73) = 2.9, p < .01). In the Japanese and Australian samples the correlation between CDCA and dental fear was 0.29-0.33 (p < .001). The Australian and USA samples scored significantly higher than the Japanese sample (overall F(2,1544) = 383.98, p < .001, followed by Tukey's HSD, p < .001). CONCLUSIONS: These results provide evidence for the reliability and validity of the CDCA in youth. It appears to measure the discrepancy between Desired and Predicted Control identified in the Revised Iowa Dental Control Index (R-IDCI). Responses of the youth in all three cultures were similar, indicating common dental control preferences for individuals of this age. However, consistent with cultural values, Japanese youth were less likely to endorse the control strategies. These results underline the need to develop culturally-specific, as well as situationally-specific control measures.

Adolescent↗

PubMed2004

Factors related to severe untreated tooth decay in rural adolescents: a case-control study for public health planning.

OBJECTIVES: In this case-control study of rural adolescents we identified factors to discriminate those who have high levels of tooth decay and receive treatment from those with similar levels who receive no treatment. METHODS: The sample was drawn from all 12-20-year-olds (n = 439) in a rural high school in Washington State, U.S. The criterion for being included was 5 or more decayed, missing or filled teeth. The questionnaire included structure, history, cognition and expectation variables based on a model by Grembowski, Andersen and Chen. RESULTS: No structural variable was related to the dependent variable. Two of 10 history variables were related: perceived poor own dental health and perceived poor mother's dental health. Four of eight cognition variables were also predictive: negative beliefs about the dentist, not planning to go to a dentist even if having severe problems, not being in any club or playing on a sports team and not having a best friend. No relationship was found for the expectation variable 'usual source of care'. CONCLUSIONS: These data are consistent with the hypothesis that untreated tooth decay is associated with avoidance of care and point to the importance of history and cognition variables in planning efforts to improve oral health of rural adolescents.

Adolescent↗

PubMed2004

Clinical outcomes for Early Childhood Caries (ECC): the influence of health locus of control.

AIM: To assess the relationship between clinical outcomes for children treated for ECC and health locus of control. STUDY DESIGN AND METHODS: The study cohort consisted of 79 children (42 males, 37 females) treated for ECC; age range was 2.3-7.3 years (mean 4.2 years) at the time of entry into the study. A questionnaire [developed by DeVellis et al., 1993] was administered to each child's parent(s) on the day of dental surgery. This questionnaire examined the expectation that healthcare outcomes in children are influenced by one of the following loci of control: Professional, Parent, Child, Media, Fate and Divine. The cohort was evaluated for new caries lesions at 6 months post dental surgery. Relapse was defined as the presence of new smooth surface caries lesions. STATISTICS: For each locus, the scores for the Relapse versus Non-relapse groups (returning patients) and the scores for the returning versus non-returning patients were compared using t-tests. RESULTS: 57 children (72%) returned for follow-up and 21 of these 57 (37%) relapsed. No statistically significant difference for Relapse versus Non-relapse groups was indicated with respect to the scores for any locus parameter (p values ranged from 0.35 to 0.95). Returning parents (N=57) versus non- returning parents (N=22) exhibited statistically significant differences with respect to the Parent, Divine and Fate loci. Returning parents exhibited higher scores on the Parent locus (p=0.0392) and lower scores on the Fate (p=0.0024) and Divine (p=0.0031) loci. CONCLUSION: 1). The relapse rate (37%) was high and rapid for children treated for ECC; 2). no meaningful difference existed between the Relapse versus Non-relapse groups with respect to each health locus of control parameter; 3). parents who returned for follow-up care appeared to have an internal health locus of control while those who did not return had an external locus.

Child↗

PubMed2004

Clinical outcomes for Early Childhood Caries (ECC): the influence of salivary mutans streptococci levels.

AIM: To assess the relationship between clinical outcomes for children treated for Early Childhood Caries (ECC) and salivary mutans streptococci (MS) levels. STUDY DESIGN AND METHODS: The study cohort consisted of 79 children (42 males, 37 females) treated for ECC, aged from 2.3 to 7.3 years at time of entry. Whole non-stimulated saliva samples were obtained from each subject prior to dental surgery and at 6 mths post dental surgery, by saturating a cotton swab in the saliva pooled in the floor of the mouth. Samples were placed into PBS on ice and processed within 2 hours. Samples were sonicated, serially diluted and plated onto MSB and SBA agar plates, then incubated 48 hours anaerobically; SBA plates were incubated an additional 24 hours aerobically. The MS level in each sample was expressed as a percentage of the total cultivable flora. The cohort was evaluated for new caries lesions at 6 months post dental surgery. Relapse was defined as the presence of new smooth surface caries lesions. STATISTICS: Comparisons between Relapse (R) and Non-Relapse (NR) groups with respect to mutans streptococci levels were performed using Wilcoxon tests. Within group comparisons were performed using Wilcoxon signed-rank tests. RESULTS: 57 children (72%) returned for the 6 months examination and 21 of these subjects (37%) relapsed. No statistically significant difference in median salivary MS levels existed between the R (0.20%) and NR (0.033%) groups at baseline (p=0.647) or at 6 months post dental surgery (R=0.03%; NR=0.01%; p=0.273). A statistically significant difference between baseline and 6 months post dental surgery was noted in the median salivary MS level within the R group (p=0.0007) and within the NR group (P<0.0001). CONCLUSIONS: The relapse rate (37%) was high and rapid for children treated for ECC. Dental surgery resulted in a statistically significant reduction in salivary MS reservoirs for children treated for ECC. However, this did not translate into acceptable clinical outcomes.

Child↗

PubMed2003

Social deprivation and the public health risks of community drinking water supplies in New Zealand.

STUDY OBJECTIVE: Quantitative evidence linking environmental exposures and social status at sub-national scales is surprisingly limited. This study investigated the public health risks associated with community water supplies in relation to social status in New Zealand. DESIGN: An ecological study using a Geographic Information System (GIS) to compare the grade of community water supplies with an index of social deprivation for small areas. SETTING: New Zealand. PARTICIPANTS: The New Zealand population usually resident in meshblocks (census areas) with a community water supply (70% of the 1996 population of 3.6 million people). MAIN RESULTS: People living in deprived areas are exposed to greater public health risks from community water supplies. In urban areas, the odds of water supplies being high risk were 3.76 times greater for the most deprived decile compared with the least deprived decile (95% CI: 2.95 to 4.78). CONCLUSIONS: It is probable that deprived communities in New Zealand are experiencing a disproportionate burden of adverse health effects as a result of poor water quality.

Adolescent↗

PubMed2003

A videotaped intervention to enhance child control and reduce anxiety of the pain of dental injections.

AIM: While the psychological literature shows that perceptions of uncontrollability contribute to anxiety and other pathologies, interventions that enhance perceived control have been shown to reduce anxiety. This study attempted to assess a brief videotape to enhance child perceived control in a dental setting. METHODS: 101 children aged 7-9 years completed warm-up procedures and viewed either: a) the experimental intervention, a 2 minutes video of a dentist explaining what an injection will feel like and proposing hand raising as a signal mechanism; or b) the control condition, a 2 minutes video of Disneyland. Fear of dental injections was assessed on a 10 cm visual analogue scale before and after the intervention. RESULTS: In the experimental group there was a significant fear reduction from pre- to post-intervention, while this was not the case in the control group. Children with higher pre-existing levels of fear benefited more from the intervention than children with lower levels of fear. CONCLUSION: The results of this pilot study suggest that intervention packages that impact child control have promise in lowering anxiety.

Analysis of Variance↗

PubMed2003

An intervention program to reduce dental avoidance behaviour among adolescents: a pilot study.

AIM: To develop and test the methodology of an intervention to reduce avoidance of dental care among adolescents, and to measure the respondents' beliefs regarding the intervention (credibility and cognitions). METHODS: Based on a group comparison design a sample of 18 year olds (n=50) with dental non-attendance behaviour was randomly selected to three experimental and one control group. Subjects were surveyed with one baseline questionnaire and one post-intervention questionnaire, to evaluate their beliefs regarding the program. Two different instruments were tested: 1) cards representing different statements related to previous dental experiences, possible reasons for attending (pros) and not attending (cons) dental appointments, and preferences for future treatment. Cards were selected based on individual priority; 2) a brief, structured telephone interview based on Motivational Interviewing. The instruments were tested separately (groups I and II) and in combination (group III). Subjects in the control group (group IV) were given conventional health education. RESULTS: Subjects in the experimental groups had significantly higher credibility scores to the statement "How much easier do you perceive dental treatment to be for you, based on this program", compared with the control group (p<0.05). They had also more positive beliefs to the statement "I think the interviewer liked to talk to me" (p<0.05) than controls. CONCLUSION: A questionnaire sent to non-attending adolescents followed by a brief telephone call based on Motivational Interviewing appears to be a credible intervention for adolescents avoiding dental care.

Adolescent↗

PubMed2002

Changing epidemiology of human leptospirosis in New Zealand.

The objective was to describe the current epidemiology and trends in New Zealand human leptospirosis, using descriptive epidemiology of laboratory surveillance and disease notification data, 1990-8. The annual incidence of human leptospirosis in New Zealand 1990-8 was 44 per 100,000. Incidence was highest among meat processing workers (163.5/100,000), livestock farm workers (91.7), and forestry-related workers (24.1). The most commonly detected serovars were Leptospira borgpetersenii serovar (sv.) hardjo (hardjobovis) (46.1%), L. interrogans sv. pomona (24.4%) and L. borgpetersenii sv. ballum (11.9%). The annual incidence of leptospirosis declined from 5.7/100,000 in 1990-2 to 2.9/100,000 in 1996-8. Incidence of L. borgpetersenii sv. hardjo and L. interrogans sv. pomona infection declined, while incidence of L. borgpetersenii sv. ballum infection increased. The incidence of human leptospirosis in New Zealand remains high for a temperate developed country. Increasing L. borgpetersenii sv. ballum case numbers suggest changing transmission patterns via direct or indirect exposure to contaminated surface water. Targeted and evaluated disease control programmes should be renewed.

Adolescent↗

PubMed2002

The microbiota of young children from tooth and tongue samples.

This study determined the frequency with which 38 microbial species were detected in 171 randomly selected children from 6 to 36 months of age. Children were sampled and dental caries measured. Oral samples were assayed by means of a checkerboard DNA probe assay. The detection frequencies from tongue samples in children under 18 mos were: S. mutans 70%, S. sobrinus 72%, P. gingivalis 23%, B. forsythus 11%, and A. actinomycetemcomitans 30%, with similar detection frequencies in children over 18 mos. Thus, S. mutans and the periodontal pathogens, P. gingivalis and B. forsythus, were detected even in the youngest subjects. Species associated with caries included S. mutans (children ages 18-36 mos) and A. israelii (children ages < 18 mos), the latter species possibly reflecting increased plaque in children with caries. Species detection from tooth and tongue samples was highly associated, with most species detected more frequently from tongue than from tooth samples in children under 18 mos, suggesting that the tongue was a potential microbial reservoir.

Aggregatibacter actinomycetemcomitans↗

PubMed2001

Use of a computer model to identify potential hotspots for dengue fever in New Zealand.

AIMS: To describe the areas of potential dengue fever risk in New Zealand for present climatic conditions and projected scenarios of climate change. METHODS: A computer model, the HOTSPOTS System, was developed. This allowed the integration of climatic, topographical, entomological, demographic, trade and travel data to generate spatial information describing vector introduction risk, potential vector distribution and dengue fever risk. RESULTS: Under present climatic conditions, Auckland and Northland, and some coastal areas of other northern parts of the North Island, have a potential risk for dengue outbreaks supported by the vector Aedes albopictus. Greenhouse gas induced climate change could make these areas also receptive to Aedes aegypti--the more efficient tropical dengue vector--and increase the potential distribution of A. albopictus to much of the South Island. CONCLUSIONS: Given the introduction of a competent vector, there is an appreciable risk of dengue fever occurring in New Zealand under present climatic conditions. Greenhouse gas induced climate change would substantially increase the magnitude and spatial extent of this risk.

Climate↗

PubMed2001

A serological survey of antibodies to rabbit haemorrhagic disease virus (rabbit calicivirus disease) in two rural Central Otago communities.

AIMS: To determine whether individuals from two rural communities with heavy exposure to the Rabbit Haemorrhagic Disease Virus (RHDV) developed antibodies to this virus. METHODS: Sera were assayed using competition ELISA (cELISA) and solid phase ELISA (spELISA). Exposure estimates were based on answers to an interviewer administered questionnaire. RESULTS: Of the 104 participants, 79 were considered to have experienced high or medium exposure, many of whom described specific exposures. There were 58 people who reported contact with RHDV infected bait, organ homogenate mixtures or rabbit body fluids. A one-way analysis of variance (Kruskal Wallis) found that human cELISA results were differently distributed from both strongly RHDV positive rabbits (chi2(1) = 27.37, p < 0.001) and weakly RHDV positive rabbits (chi2(1) = 27.35, p < 0.001). The distribution of assay results in each exposure group did not differ in either cELISA (chi2(2) = 2.49, p = 0.29) or spELISA (chi2(2) = 1.70, p = 0.43). Relatively fewer results were categorised as reactive (two 'barely' positive and two doubtful) than in a previous survey of 493 unexposed people. None of the five positive results categorised by the less specific spELISA occurred in people described as 'barely' positive or doubtful by cELISA. CONCLUSIONS. No serological evidence of infection with RHDV was found in a cohort including many heavily exposed individuals.

Adult↗

PubMed2001

An ethnographic study for understanding children's oral health in a multicultural community.

OBJECTIVE: To provide guidance for a public health intervention in a high caries rate multicultural population by understanding cultural issues surrounding children's oral health. METHOD: Seven community focus groups were conducted with five ethnic populations (Chamorro, Filipino, Carolinian, Pohnpean, and Chuukese) living on the island of Saipan, Commonwealth of the Northern Mariana Islands, USA. Participants were asked questions about their beliefs, attitudes, knowledge, and care practices regarding issues around children's oral health. RESULTS: Analysis consisted of a content review of participants' responses within two targeted areas: past and current attitudes and health beliefs, and behaviours impacting risk of developing disease. Both the lack of value of baby teeth and negative parental experiences are factors underlying health beliefs and behaviours. Although some differences in beliefs and practices existed across cultural groups, most women were interested in learning about new preventive strategies to reduce dental disease. Several new mothers reported that they actively sought out parenting information during their initial pregnancy. CONCLUSIONS: Aversive parental experience and disregard for primary dentition were identified as serious obstacles to be addressed in order for any new programme to be effective. Despite these obstacles, new mothers were open to information and strategies to reduce the prevalence of early childhood caries.

Adolescent↗

PubMed2001

The influence of climate variation and change on diarrheal disease in the Pacific Islands.

Freshwater resources are a high-priority issue in the Pacific region. Water shortage is a serious problem in many small island states, and many depend heavily on rainwater as the source of their water. Lack of safe water supplies is an important factor in diarrheal illness. There have been no previous studies looking specifically at the relationship between climate variability and diarrhea in the Pacific region. We carried out two related studies to explore the potential relationship between climate variability and the incidence of diarrhea in the Pacific Islands. In the first study, we examined the average annual rates of diarrhea in adults, as well as temperature and water availability from 1986 to 1994 for 18 Pacific Island countries. There was a positive association between annual average temperature and the rate of diarrhea reports, and a negative association between water availability and diarrhea rates. In the second study, we examined diarrhea notifications in Fiji in relation to estimates of temperature and rainfall, using Poisson regression analysis of monthly data for 1978-1998. There were positive associations between diarrhea reports and temperature and between diarrhea reports and extremes of rainfall. These results are consistent with previous research and suggest that global climate change is likely to exacerbate diarrheal illness in many Pacific Island countries.

Child, Preschool↗

PubMed2000

An investigation into the incidence of toxoplasmosis in pregnancy in New Zealand.

AIM: To estimate the incidence of toxoplasmosis in pregnancy in New Zealand and consider whether there is a case for screening women in pregnancy. METHODS: The risk of maternal and fetal infection with toxoplasmosis was derived by first determining the rate of maternal seroconversion based on seroprevalence studies. The age-specific number of seroconversions in pregnancy was then estimated from the birth rate. Using reported fetal infection rates after primary maternal infection, the expected number of congenitally infected infants in one year was estimated. These incidences were compared with the number of recognised cases of toxoplasmosis infection in pregnancy and the actual number of positive IgM results at the Wellington Hospital laboratory. Using national births data, this incidence was extrapolated to estimate the number of expected cases in New Zealand. RESULTS: The annual seroconversion rate was 0.62% (95% confidence interval 0.39-0.86). On this basis, 164 primary maternal infections are expected annually with 66 fetuses being infected. Ten patients tested positive for IgM in Wellington, which averaged only one case per year being identified over the time examined in this study. CONCLUSIONS: Very few of the expected cases in pregnancy are diagnosed. Reporting rates were low when toxoplasmosis was a notifiable disease. Other means of improving detection, reporting and the avoidance of infection are discussed. More information is required before screening can be recommended in New Zealand.

Adolescent↗