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Biomedical subjects

Ruth Freeman

Publications and source records attributed to Ruth Freeman.

18 recordsLinked to original sources
PubMed2006

HIV infection and bone mineral density in middle-aged women.

BACKGROUND: Osteopenia is prevalent in persons with human immunodeficiency virus (HIV) infection and is part of a normal sequence of aging in women. Most studies of bone mineral density (BMD) and HIV infection have focused on men or have lacked a comparison group of individuals without HIV infection with similar behavioral risk factors. METHODS: We analyzed BMD in 495 middle-aged women (defined as women > or =40 years of age); 263 women had HIV infection, and 232 women were HIV-negative with behavioral risk factors similar to those of the HIV-positive group. RESULTS: The median age of the women in the study was 44 years, 54% were black, and 92% had used illicit drugs. Femoral neck BMD and lumbar spine BMD were reduced in women with HIV infection, compared with women without HIV infection (femoral neck BMD, 1.01+/-0.13 g/cm2 vs. 1.05+/-0.13 g/cm2; P=.001; lumbar spine BMD, 1.21+/-0.17 g/cm2 vs. 1.24+/-0.17 g/cm2; P=.04). In addition to HIV infection, other factors independently associated with lower BMD in both sites were being older, not being black, and having a low body weight. In race-stratified multivariate analyses, HIV infection was associated with BMD only in non-black women. Among HIV-positive women, 84% had taken antiretrovirals, and 62% had taken protease inhibitors, but their use was not associated with BMD. Methadone treatment was also independently associated with reduced lumbar spine BMD. CONCLUSION: Middle-aged women with HIV infection have reduced BMD, compared with women at similar risk for HIV infection, independent of antiretroviral use. Among HIV-positive women, those who are not black, who are underweight, and who use opiates may be at particular risk. Although the prevalence of reduced BMD in this cohort was higher among women with HIV infection than among those without (27% vs. 19%), the overall prevalence of reduced BMD was low, compared with national estimates and with previous studies involving HIV-positive women and men.

Adult↗
PubMed2005

Fat distribution in HIV-infected women in the United States: DEXA substudy in the Women's Interagency HIV Study.

Surveys in HIV-infected men on antiretroviral therapy (ART) consistently demonstrate decreased levels of peripheral fat, with variable effects on central fat. This substudy of the Women's Interagency HIV Study was undertaken to examine fat distribution in a well-characterized cohort of HIV-positive and HIV-negative women in the United States. Whole-body dual-energy x-ray absorptiometry scanning with standardized regional analysis was performed in 271 nonpregnant women. Results were compared in the following groups: HIV negative (n = 88); and HIV positive on no ART (n = 70), highly active ART with a protease inhibitor (HAART/PI) (n = 48), or non-PI-containing HAART (n = 53). The groups were well matched with respect to race, with the majority of women coming from racial/ethnic minorities. The majority of both HIV-positive and HIV-negative women were overweight (body mass index [BMI] >/=25 kg/m), and many were obese (BMI >30 kg/m). Leg fat in both groups on HAART was significantly lower than in HIV-negative women (P = 0.01 and <0.0001 vs. HIV-negative for HAART/PI and HAART/no PI, respectively), whereas trunk fat was lower only in HAART/no PI (P = 0.0004 vs. HIV-negative). Thus, consistent with reports in men, lower levels of peripheral (leg) fat are seen in HIV-infected women on HAART, despite the high prevalence of obesity in this population.

Absorptiometry, Photon↗
PubMed2005

Vulnerability and presenting symptoms in burning mouth syndrome.

OBJECTIVES: To investigate if burning mouth syndrome (BMS) patients have differing health perceptions, medication, and life experiences compared with controls and to examine the role of vulnerability factors and differentiate them from the presenting symptomology in patients with BMS. STUDY DESIGN: A nonprobability convenience sample of patients presenting with BMS and age- and sex-matched controls were recruited from Queen's University, Belfast, King's College London, and Baylor College of Dentistry, Dallas. Participants completed a questionnaire to assess 9 aspects of their medical and social history, including early and past life experiences. The subjects completed the Hospital Anxiety and Depression Scale to assess current distress. RESULTS: Participants with BMS had significantly higher experiences of adverse early life experiences compared with controls. They had statistically significantly higher mean scores for anxiety and depression compared with controls. A hierarchical multiple logistic regression analysis showed that the characteristics of BMS included cancer phobia, gastro-intestinal problems, and chronic fatigue. CONCLUSION: BMS is a complex disorder. People who experience adverse life experiences may become vulnerable to developing BMS in later life.

Adult↗
PubMed2005

Dentist-assistant communication style: perceived gender differences in The Netherlands and Northern Ireland.

OBJECTIVES: To assess communication style differences with the (female) dental assistant, as perceived by male and female dentists. METHODS: Data were collected from 216 Dutch (male: 99; female: 117) and 261 Northern Irish (male: 135; female: 126) dentists (overall response rate: 60%). Respondents filled in a self-report questionnaire (one follow-up mailing), with 22 items on staff communication style. Using principal component analysis, four distinguishable factors could be extracted: businesslike leadership style (seven items, Cronbach's alpha = 0.87), friendly leadership style (seven items, alpha = 0.87), professional interacting style (four items, alpha = 0.83) and gender interacting style (four items, alpha = 0.83). RESULTS: manova indicated a main effect for gender [F(8,946) = 10.905, P < 0.001] and for country [F(4,474) =4.197, P = 0.002] on the communication style scales. Male dentists, compared with female colleagues, showed higher mean scores on businesslike leadership style and gender interacting style, whereas female dentists showed higher mean scores on friendly leadership style and professional interacting style. Dutch dentists showed higher mean scores on friendly leadership style and professional interacting style than their Northern Irish colleagues. No interaction effect between gender and country was found. Dentist's age and length of assistant's employment (in years) partly explained differences in means. CONCLUSION: Male and female dentists perceive their communication with the assistant differently; male dentists tend to be influenced by the gender differences, female dentists by striving for friendliness. Some country differences were found. Increasing influx of young female dentists underlines the relevance of this topic in dental education and for future research.

Adult↗
PubMed2005

Oral health-related quality of life for 8-10-year-old children: an assessment of a new measure.

OBJECTIVES: The aim of the study was to assess the reliability and construct validity of the Child Oral Health-Related Quality of Life for 8-10-year-olds (COHRQoL [8-10]) using confirmatory factor analysis (CFA) and to test the measurement properties of latent variables believed to define the multidimensional construct of OHRQoL. METHODS: A convenience sample of 270, year 4 children from six schools was obtained. The administered questionnaire included the 25-item COHRQoL [8-10] and the Coopersmith Self-Esteem Inventory-School Form. The analytical method was based upon CFA using maximum likelihood estimation. A second-order factoring approach was applied to determine the extent that the latent variables tapped a single over-arching domain of quality of life. RESULTS: Seven items were withdrawn for low endorsement and poor association with resultant factors. The COHRQoL [8-10] was confirmed to measure a single construct of three latent variables invariant to gender. Internal consistency of the three scales derived comprising a total of 18 retained items was acceptable. Associations with self-esteem and with a single question on the extent that the mouth was a problem were confirmed and strengthened the construct validity of the COHRQoL [8-10] measure. CONCLUSIONS: Reliability and construct validity were demonstrated for COHRQoL [8-10] and supported the scale for adoption as an epidemiological and scientific tool for group comparisons. CFA showed that the three constructs or latent variables underlying the overall COHRQoL ratings were discrete measures that can be reliably assessed in children. Further model testing with additional data will increase generalization of these findings.

Age Factors↗
PubMed2005

Patient-active prevention in primary dental care: a characterisation of general practices in Northern Ireland.

AIM: To investigate the preventive orientation of general dental practices by examining their patient-active prevention activities, practice policies for prevention and employment strategies. METHOD: All general dental practices located within the region of the Eastern Health and Social Services Board (EHSSB) in Northern Ireland were contacted and invited to participate. A questionnaire assessed practice characteristics, patient-active prevention, practice policies and employment strategies. The principal general dental practitioner (GDP) was invited to complete the questionnaire. RESULTS: Seventy-seven per cent of practices participated. Nearly all the practices provided patient-active prevention; however, lower proportions of dentists provided advice on diet for dental caries (3%), oral hygiene instruction, fluoride toothpaste use and interdental cleaning (7%) with each new course of dental treatment. 'Patient-active' prevention practices were 5.8 times more likely to employ a hygienist and 5.3 times more likely to have a practice policy to screen for oral cancer. CONCLUSIONS: These findings suggest that the employment of a hygienist is central to the reorientation of primary dental care. The Government must be encouraged to provide the financial means to allow primary care to shift from being disease-centred to health-focused.

Dental Hygienists↗
PubMed2005

Making equity a reality: oral health promotion in a psychiatric setting.

The aim of the study addresses the inequity in oral health status of long stay psychiatric patients, by promoting an inter-disciplinary team approach to oral health promotion. A cross sectional study using a modified version of the oral health assessment guide (OHAG) (Eilers et al 1988, Sjorgen & Nordstrom 2000) was used by a nurse who received training and calibration at the School of Dentistry, Queen's University, Belfast, to assess the oral health status of long stay psychiatric patients. The paper provides an overview of the literature relating to oral health within the context of holistic health. It highlights the non-random distribution of oral health problems amongst psychiatric patients and the potential contribution of health needs assessment to the realization of equity. The study focused on 65 long stay patients in a psychiatric hospital, mean length of time patients had been in the hospital was 25.6 years; nine patients had been living in the hospital between 40 and 65 years. The study achieved a response rate of 82% and identified that oral health of the psychiatric patients was generally very poor, compared to the general population. Only one patient did not have calculus, decayed or fractured teeth and 12 of the patients were endentate and there was a conspicuous absence of health promoting behaviours amongst the patient group. A case study is used to highlight the lived reality of the patients and the need for a holistic and an inter-disciplinary approach to oral health promotion, for patients residing in a psychiatric setting. This preliminary investigation highlights the benefits of systematic assessment of need: in this instance the use of the OHAG as a tool, for promoting equity based care by making visible the non random distribution of oral health problems amongst the patients.

Adult↗
PubMed2004

Conjugated equine estrogens and global cognitive function in postmenopausal women: Women's Health Initiative Memory Study.

CONTEXT: The Women's Health Initiative Memory Study (WHIMS) previously reported that estrogen plus progestin therapy does not protect cognition among women aged 65 years or older. The effect of estrogen-alone therapy, also evaluated in WHIMS, on cognition has not been established for this population. OBJECTIVES: To determine whether conjugated equine estrogen (CEE) alters global cognitive function in older women and to compare its effect with CEE plus medroxyprogesterone acetate (CEE plus MPA). DESIGN, SETTING, AND PARTICIPANTS: A randomized, double-blind, placebo-controlled ancillary study of the Women's Health Initiative (WHI), WHIMS evaluated the effect of CEE on incidence of probable dementia among community-dwelling women aged 65 to 79 years with prior hysterectomy from 39 US academic centers that started in June 1995. Of 3200 eligible women free of probable dementia enrolled in the WHI, 2947 (92.1%) were enrolled in WHIMS. Analyses were conducted on the 2808 women (95.3%) with a baseline and at least 1 follow-up measure of global cognitive function before the trial's termination on February 29, 2004. INTERVENTIONS: Participants received 1 daily tablet containing either 0.625 mg of CEE (n = 1387) or matching placebo (n = 1421). MAIN OUTCOME MEASURE: Global cognitive function measured annually with the Modified Mini-Mental State Examination (3MSE). RESULTS: During a mean follow-up of 5.4 years, mean (SE) 3MSE scores were 0.26 (0.13) units lower than among women assigned to CEE compared with placebo (P =.04). For pooled hormone therapy (CEE combined with CEE plus MPA), the mean (SE) decrease was 0.21 (0.08; P =.006). Removing women with dementia, mild cognitive impairment, or stroke from the analyses lessened these differences. The adverse effect of hormone therapy was more pronounced among women with lower cognitive function at baseline (all P<.01). For women assigned to CEE compared with placebo, the relative risk of having a 10-unit decrease in 3MSE scores (>2 SDs) was estimated to be 1.47 (95% confidence interval, 1.04-2.07). CONCLUSION: For women aged 65 years or older, hormone therapy had an adverse effect on cognition, which was greater among women with lower cognitive function at initiation of treatment.

Aged↗
PubMed2004

The therapeutic role of estrogens in postmenopausal women.

This article reviews the history and present use of estrogens for the treatment of menopausal symptoms. It includes management of several different cases, including a review of all estrogens and estrogen/progestin preparations available in the United States.

Administration, Intravaginal↗
PubMed2004

Critical health promotion and education--a new research challenge.

In relation to health promotion and education, the use of post-positivist and constructivist approaches has been gathering strength in recent years. Despite this emerging tradition, little has been done to explore what this sort of approach actually represents, particularly in terms of health promotion in schools, professional organizations and wider society. Acknowledging this, it is suggested that more researchers in this area should be adopting qualitative approaches-including semi-structured interviews, focus groups, story/dialogue workshops and developmental schemes of health education-in order to uncover the hidden meaning of 'health promotion', particularly in the school context. This paper therefore attempts to challenge the idea that traditionalist paradigms of positivist research are capable of appropriately representing the nature and complexity of the health promotion issues. In this paper, methodological and theoretical frameworks that can enable researchers to understand health promotion from the perspective of students, teachers and school 'stakeholders' are suggested. Particular attention is given to a discussion of the potential value of designing and implementing programmes of health education or promotion using a critical pedagogical approach within schools in the UK. It is argued that programmes using a critical pedagogical and reflective approach, and which are aimed at social transformation, would be of enormous benefit to both researchers and educational/health professionals who are seeking to understand the complexity of health promotion issues from the perspective of children and adolescents.

Health Education↗
PubMed2004

Reflective practice and experiential learning: tools for continuing professional development.

The models of reflective practice and experiential learning, described within this article, provide the dental practitioner and his/her team with realistic methods by which they can improve their skills and working atmosphere, and also reduce occupational stress. The reflective dentist is one who engages his/her team in a process of discussion regarding a variety of clinical situations, and who learns from both positive and negative clinical experience. This article offers a detailed analysis of reflective practice and experiential learning, and the ways in which application of these procedures can contribute significantly to the continuing professional development of dentists and dental teams.

Education, Dental, Continuing↗
PubMed2004

Developing explanatory models of health inequalities in childhood dental caries.

OBJECTIVE: Long-term aim is to determine optimum interventions to reduce dental caries in children in disadvantaged communities and minimise the effects of exclusion from health care systems, of ethnic diversity, and health inequalities. DESIGN: Generation of initial explanatory models, study protocol and development of two standardised measures. First, to investigate how parental attitudes may impact on their children's oral health-related behaviours and second, to assess how dentists' attitudes may impact on the provision of dental care. SUBJECTS: Core research team, lead methodologists, 44 consortium members from 18 countries. To complete the development of the questionnaire, the initial set of items was administered to parents (n = 23) with children in nursery schools in Dundee, Scotland and sent to the same parents one week later. A standardised measure examining barriers to providing dental care for children aged 3 to 6 years was developed. 20 dentists working in primary dental care in Scotland completed the measure on two different occasions separated by one week. RESULTS: Explanatory models were developed. Family questionnaire: test-retest reliability excellent (r = 0.93 p < or = 0.001) with very good internal reliability (alpha = 0.89). Dentists questionnaire: excellent test-re-test reliability r = 0.88, (alpha = 0.90). CONCLUSIONS: Interaction between consortium members enhanced the validity of the questionnaires and protocols for different cultural locations. There were challenges in developing and delivering this multi-centre study. Experience gained will support the development of substantive trials and longitudinal studies to address the considerable international health disparity of childhood dental caries.

Attitude of Health Personnel↗
PubMed2004

Familial and cultural perceptions and beliefs of oral hygiene and dietary practices among ethnically and socio-economicall diverse groups.

UNLABELLED: OBJECTIVE; The aim of this international study was to develop a valid and reliable psychometric measure to examine the extent to which parents' attitudes about engaging in twice-daily tooth brushing and controlling sugar snacking predict these respective behaviours in their children. A supplementary objective was to assess whether ethnic group, culture, level of deprivation or children's caries experience impact upon the relationships between oral health related behaviours, attitudes to these respective behaviours and to dental caries. CLINICAL SETTING: Nurseries, health centres and dental clinics in 17 countries. PARTICIPANTS: 2822 children aged 3 to 4 years and their parents. MAIN OUTCOME MEASURES: Dental examination of children and questionnaire to parents. RESULTS: Factor analysis identified 8 coherent attitudes towards toothbrushing, sugar snacking and childhood caries. Attitudes were significantly different in families from deprived and non-deprived backgrounds and in families of children with and without caries. Parents perception of their ability to control their children's toothbrushing and sugar snacking habits were the most significant predictor of whether or not favourable habits were reported. Some differences were found by site and ethnic group. CONCLUSIONS: This study supports the hypothesis that parental attitudes significantly impact on the establishment of habits favourable to oral health. An appreciation of the impact of cultural and ethnic diversity is important in understanding how parental attitudes to oral health vary. Further research should examine in a prospective intervention whether enhancing parenting skills is an effective route to preventing childhood caries.

Adult↗
PubMed2004

International comparisons of health inequalities in childhood dental caries.

OBJECTIVE: To undertake formative studies investigating how the experience of dental caries in young children living in diverse settings relates to familial and cultural perceptions and beliefs, oral health-related behaviour and oral microflora. PARTICIPANTS: The scientific consortium came from 27 sites in 17 countries, each site followed a common protocol. Each aimed to recruit 100 families with children aged 3 or 4 years, half from deprived backgrounds, and within deprived and non-deprived groups, half to be "caries-free" and half to have at least 3 decayed teeth. OUTCOME MEASURES: Parents completed a questionnaire, developed using psychological models, on their beliefs, attitudes and behaviours related to their child's oral health. 10% of children had plaque sampled. RESULTS: 2,822 children and families were recruited. In multivariate analyses, reported toothbrushing behaviours that doubled the odds of being caries-free were a combination of brushing before age 1, brushing twice a day and adult involvement in brushing. Analyses combining beliefs, attitudes and behaviours found that parents' perceived ability to implement regular toothbrushing into their child's daily routine was the most important predictor of whether children had caries and this factor persisted in children from disadvantaged communities. 90% of children with lactobacillus had caries. CONCLUSIONS: Parental beliefs and attitudes play a key role in moderating oral health related behaviour in young children and in determining whether they develop caries. Further research is indicated to determine whether supporting the development of parenting skills would reduce dental caries in children from disadvantaged communities independent of ethnic origin.

Adult↗
PubMed2004

Variations in hip fracture hospitalization rates among different race/ethnicity groups in New York City.

Hip fractures are a major cause of death and disability among the elderly. Although previous studies have shown hip fracture rates to be highest among Whites, and lowest among Blacks, less is known about how these differences are affected by gender and age. We determined the hip fracture hospitalization rates for non-Hispanic Whites, Blacks, Hispanics, and Asians in New York City from 1988 to 2002 using Statewide Planning and Resource Cooperative System data from the New York state Department of Health. We found that hip fracture hospitalization rates for those aged 50 and older were higher for women than men, with a risk ratio of 1.75 (95% confidence interval [CI] 1.73-1.77). Annual age-adjusted hip fracture hospitalization rates among White, Black, Hispanic, and Asian women were 459, 137, 143, and 174 per 100,000, respectively. The corresponding rates for men were 230, 109, 87, and 104, respectively. For both genders, and all race/ethnicity groups, the rates increased sharply with age. Although overall, women had higher rates compared to men, these differences varied by race and age. For Whites and Asians, women had higher rates for all age groups older than 50 years. For Hispanics aged 50-59, men had a higher rate than did women, but this gender relationship reversed after age 60. For Blacks, however, men had higher rates than women until age 70, after which women had higher rates. These results demonstrate that race/ethnicity, as well as age and gender, influence the incidence of hip fractures. Moreover, Asians, with their low bone mass, showed no increased hip fractures, compared to non-Hispanic Blacks and Hispanics. Further study is needed to explain this paradox.

Black or African American↗
PubMed2002

Elevated levels of Factor XI are associated with cardiovascular disease in women.

Coronary artery disease (CAD) continues to be the most frequent cause of death among women in the United States. Although elevated levels of clotting factors have been associated with CAD, few of these studies have been performed in women. Elevated levels of Factor XI have previously been associated with venous thrombosis, but little is known about its effect on arterial thrombosis. We selected women referred for cardiac catheterization who were found to have either normal coronaries or evidence of severe CAD and compared levels of homocysteine, anticardiolipin IgG/IgM antibodies, fibrinogen, platelet count, Factor VII, Factor VIII and Factor XI. Women with severe CAD had significantly higher levels of Factor XI than those without CAD (128% vs. 82%, p<0.04). Statistical adjustment for age, diabetes, hypertension, total cholesterol (TC), current smoking, or BMI had no effect on the independent association between CAD status and Factor XI. Factor XI was higher in women with total cholesterol levels >6.18 mmol/l (>239 mg/dl) compared with normocholesteremic women and was also higher in the upper tertile of age, but even when adjusted for these, the association remained significant. This initial study suggests that Factor XI may be an important parameter in arterial as well as venous thrombosis.

Age Factors↗
PubMed2002

Psychological stress in undergraduate dental students: baseline results from seven European dental schools.

OBJECTIVES: To determine the degree of psychological distress, the experience of emotional exhaustion, and the extent of stress associated with course work in dental students and to compare these measurements among seven European dental schools. DESIGN: Multi-centred survey. SETTING: Dental Schools at Amsterdam, Belfast, Cork, Greifswald, Helsinki, Liverpool and Manchester. PARTICIPANTS: 333 undergraduate first-year dental students. MEASURES: General Health Questionnaire (GHQ12), Maslach Burnout Inventory (MBI), Dental Environment Stress Questionnaire (DES), demographic variables. PROCEDURE: Questionnaire administered to all students attending first year course. Completed questionnaires sent to central office for processing. RESULTS: Seventy-nine percent of the sampled students responded. Over a third of the students (36%) reported significant psychological distress (morbidity) at the recommended cut-off point (>3 on GHQ). These scores were similar to those reported for medical undergraduates. Twenty-two percent recorded comparatively high scores on emotional exhaustion. A wide variation in these 2 measurements was found across schools (p's<0.001). Stress levels indicated by the DES were less variable (p>0.5). Some evidence showed that contact with patients and the level of support afforded by living at home may be protective. CONCLUSION: Higher than expected levels of emotional exhaustion were found in a large sample of first-year undergraduate dental students in Europe.

Adolescent↗