The Health Status of Dentists Exposed to Mercury from Silver Amalgam Tooth Restorations

The authors employed pharmacy utilization data to evaluate the health status of a representative sample of 600 dentists, matched to control subjects, for gender, age, geographical area, and insurance plan structure. Dentists demonstrated significantly more prescription utilization of specific illness medications than did Controls, for the following disease categories: Neuropsychological, Neurological, Respiratory, and Cardiovascular. The greater majority of pediatric and general practice dentists still use mercury amalgam restorations. This places them at greater risk than the general population for those disorders, as well as threatening the future health of America's children and adults who continue to receive silver amalgam restorations.

Establishing Reliability When Multiple Examiners Evaluate a Single Case-Part II: Applications to Symptoms of Post-Traumatic Stress Disorder (PTSD)

In an earlier article, the authors assessed the clinical significance of each of 19 Clinician Administered PTSD Scale items and composite scores (CAPS-1) [1] when 12 clinicians evaluated a Vietnam era veteran. A second patient was also evaluated by the same 12 clinicians and used for cross-validation purposes [2]. The objectives of this follow-up research are: (1) to describe and apply novel bio-statistical methods for establishing the statistical significance of these reliability estimates when the same 12 examiners evaluated each of the two Vietnam era patients. This approach is also utilized within the broader contexts of the ideographic and nomothetic conceptualizations to science, and the interplay between statistical and clinical or practical significance; (2) to detail the steps for applying the new methodology; and (3) to investigate whether the quality of the symptoms (frequency, intensity); item content; or specific clinician affect the levels of rater reliability. The more typical (nomothetic) reliability research design focuses on group averages and broader principles related to biomedical issues, rather than the focus on the individual case (ideographic approach). Both research designs (ideographic and nomothetic) have been incorporated in this follow-up research endeavor

Adaptive Behavior in Autism and Pervasive Developmental Disorder-Not Otherwise Specified: Microanalysis of Scores on the Vineland Adaptive Behavior Scales

The purpose of this study is to provide a microanalysis of differences in adaptive functioning seen between well-matched groups of school-aged children with autism and those diagnosed as having Pervasive Developmental Disorder-Not Otherwise Specified, all of whom functioned in the mild to moderate range of intellectual impairment. Findings indicate that the major area of difference between children with autism and those with Pervasive Developmental Disorder-Not Otherwise Specified, was expressive communication; specifically, the use of elaborations in syntax and morphology and in pragmatic use of language to convey and to seek information in discourse. Linear discriminant function analysis revealed that scores on just three of these expressive communication item sets correctly identified subjects in the two diagnostic categories with 80% overall accuracy. Implications of these findings for both diagnosis and intervention with children with Autism Spectrum Disorders will be discussed

Group Intervention to Promote Social Skills in School-age Children with Pervasive Developmental Disorders: Reconsidering Efficacy

A consistent result in the evaluation of group-delivered intervention to promote social reciprocity in children with PDDs is that outcome data are inconclusive. Lack of robust evidence of efficacy confounds understanding of these interventions and their value to the field. It is conceivable that the construct of impaired social reciprocity in PDD presents unique circumstances that require special consideration when evaluating the evidence base. Social reciprocity and impairment in social functioning are complex constructs, which require a multi-dimensional, multi-method approach to intervention and measurement of gains. The existing paradigm for evaluating the evidence base of intervention may need modification to permit a more intricate analysis of the extant research, and increase the sophistication of future research

Enhancing the Understanding of Clinically Meaningful Results: A Clinical Research Perspective

Published research often address aspects related to “statistical significance” but fail to address the clinical and practical importance and meaning of results. Our main objectives in this article are to investigate the merit of common measures of Effect Size in statistical research and to highlight the importance of the simple Relative Risk ratio. In this article we present data where we consider two widely utilized effect size measures (Cohen's d and Pearson's r) in relations to relative risk. We conclude that probability analyses of risk surpass the most commonly used statistical approach used in clinical trials today and should thus be the preferred compared to the misuse and misunderstanding of reporting for instance p-values alone.publishedVersio

Clinical Features of Children With Autism Who Passed 18-Month Screening

OBJECTIVES: We compared sex-stratified developmental and temperamental profiles at 18 months in children screening negative for autism spectrum disorder (ASD) on the Modified Checklist for Autism in Toddlers (M-CHAT) but later receiving diagnoses of ASD (false-negative group) versus those without later ASD diagnoses (true-negative group). METHODS: We included 68 197 screen-negative cases from the Norwegian Mother and Child Cohort Study (49.1% girls). Children were screened by using the 6 critical items of the M-CHAT at 18 months. Groups were compared on domains of the Ages and Stages Questionnaire and the Emotionality Activity Sociability Temperament Survey. RESULTS: Despite passing M-CHAT screening at 18 months, children in the false-negative group exhibited delays in social, communication, and motor skills compared with the true-negative group. Differences were more pronounced in girls. However, with regard to shyness, boys in the false-negative group were rated as more shy than their true-negative counterparts, but girls in the false-negative group were rated as less shy than their counterparts in the true-negative group. CONCLUSIONS: This is the first study to reveal that children who pass M-CHAT screening at 18 months and are later diagnosed with ASD exhibit delays in core social and communication areas as well as fine motor skills at 18 months. Differences appeared to be more pronounced in girls. With these findings, we underscore the need to enhance the understanding of early markers of ASD in boys and girls, as well as factors affecting parental report on early delays and abnormalities, to improve the sensitivity of screening instruments. </jats:sec

Clinical Features of Children With Autism Who Passed 18-Month Screening

We examine birth-cohort trends behind recent changes in the prevalence of functional disability in the older population living in private households in the United Kingdom (UK). By using three different socio-economic indicators available in the nationally representative cross-sectional data on older individuals interviewed between 2002 and 2012 in the Family Resource Survey (FRS) (96,733 respondents), we investigate the extent to which the overall trends have been more favourable among more advantaged than disadvantaged socioeconomic groups. Compared to the cohort of people born in 1924, successive cohorts of older men have lower odds of having at least one functional difficulty (FD), whereas no significant trend was found for women. Among people with at least one FD, however, the number of disabilities increases for each successive cohort of older women (incidence rate ratio 1.027, 95% confidence interval 1.023 to 1.031, P<0.001) and men (incidence rate ratio 1.028, 95% confidence interval 1.024 to 1.033, P<0.001). By allowing interactions between birth cohort and SES indicators, a significant increasing cohort trend in the number of reported FDs was found among older men and women at lower SES, whereas an almost stable pattern was observed at high SES. Our results suggest that the overall slightly increasing birth-cohort trend in functional difficulties observed among current cohorts of older people in the UK hides underlying increases among low SES individuals and a relative small reduction among high SES individuals. Further studies are needed to understand the causes of such trends and to propose appropriate interventions. However, if the SES differentials in trends in FDs observed in the past continue, this could have important implications for the future costs of the public system of care and support for people with care needs