BACKGROUND: Caries (dental decay) is a disease of the hard tissues of the teeth caused by an imbalance, over time, in the interactions between cariogenic bacteria in dental plaque and fermentable carbohydrates (mainly sugars). The use of fluoride toothpaste is the primary intervention for the prevention of caries. OBJECTIVES: To determine the relative effectiveness of fluoride toothpastes of different concentrations in preventing dental caries in children and adolescents, and to examine the potentially modifying effects of baseline caries level and supervised toothbrushing. SEARCH STRATEGY: A search was undertaken on Cochrane Oral Health Group`s Trials Register, CENTRAL, MEDLINE and several other databases. Reference lists of articles were also searched. Date of the most recent searches: 8 June 2009. SELECTION CRITERIA: Randomised controlled trials and cluster-randomised controlled trials comparing fluoride toothpaste with placebo or fluoride toothpaste of a different concentration in children up to 16 years of age with a follow-up period of at least 1 year. The primary outcome was caries increment in the permanent or deciduous dentition as measured by the change in decayed, (missing), filled tooth surfaces (D(M)FS/d(m)fs) from baseline. DATA COLLECTION AND ANALYSIS: Inclusion of studies, data extraction and quality assessment were undertaken independently and in duplicate by two members of the review team. Disagreements were resolved by discussion and consensus or by a third party. The primary effect measure was the prevented fraction (PF), the caries increment of the control group minus the caries increment of the treatment group, expressed as a proportion of the caries increment in the control group. Where it was appropriate to pool data, network meta-analysis, network meta-regression or meta-analysis models were used. Potential sources of heterogeneity were specified a priori and examined through random-effects meta-regression analysis where appropriate. MAIN RESULTS: 75 studies were included, of which 71 studies comprising 79 trials contributed data to the network meta-analysis, network meta-regression or meta-analysis.For the 66 studies (74 trials) that contributed to the network meta-analysis of D(M)FS in the mixed or permanent dentition, the caries preventive effect of fluoride toothpaste increased significantly with higher fluoride concentrations (D(M)FS PF compared to placebo was 23% (95% credible interval (CrI) 19% to 27%) for 1000/1055/1100/1250 parts per million (ppm) concentrations rising to 36% (95% CrI 27% to 44%) for toothpastes with a concentration of 2400/2500/2800 ppm), but concentrations of 440/500/550 ppm and below showed no statistically significant effect when compared to placebo. There is some evidence of a dose response relationship in that the PF increased as the fluoride concentration increased from the baseline although this was not always statistically significant. The effect of fluoride toothpaste also increased with baseline level of D(M)FS and supervised brushing, though this did not reach statistical significance. Six studies assessed the effects of fluoride concentrations on the deciduous dentition with equivocal results dependent upon the fluoride concentrations compared and the outcome measure. Compliance with treatment regimen and unwanted effects was assessed in only a minority of studies. When reported, no differential compliance was observed and unwanted effects such as soft tissue damage and tooth staining were minimal. AUTHORS` CONCLUSIONS: This review confirms the benefits of using fluoride toothpaste in preventing caries in children and adolescents when compared to placebo, but only significantly for fluoride concentrations of 1000 ppm and above. The relative caries preventive effects of fluoride toothpastes of different concentrations increase with higher fluoride concentration. The decision of what fluoride levels to use for children under 6 years should be balanced with the risk of fluorosis.
 
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BACKGROUND: Binge drinking is a common pattern of alcohol use in the US. However, no studies have evaluated the effectiveness of brief interventions targeting only binge drinkers. METHODS: Randomized controlled clinical trial with a 12-month follow-up period conducted from March 1, 2003 to March 1, 2006 in Spain. Of a screened population of 15,325 patients seeking routine medical care from their primary care providers, patients who met inclusion criteria were randomized into an experimental group (n=371) or a control group (n=381). The primary outcome measures were the frequency of binge drinking episodes and weekly alcohol intake. RESULTS: There were no significant differences at baseline between groups in alcohol use and demographic variables. At the end of the 12-month follow-up period, there were significant reductions in binge-drinking status (52.2% vs 67.2%, P <.001), number of episodes of binge drinking (1.14 vs 1.56, P <.001), number of drinks weekly (19.2 vs 22.4, P <.001), and frequency of excessive alcohol intake in 7 days (47.9% vs 66.6%, P >.001). CONCLUSIONS: This study provided evidence that screening and brief counseling delivered by a primary care physician as part of regular health care significantly reduced binge drinking episodes in binge drinkers.
 
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BACKGROUND: The prevalence of chronic kidney disease is growing most rapidly among older adults; however, determinants of impaired kidney function in this population are not well understood. Obesity assessed in midlife has been associated with chronic kidney disease. STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: 4,295 participants in the community-based Cardiovascular Health Study, aged >or= 65 years. PREDICTORS: Body mass index, waist circumference, and fat mass measured using bioelectrical impedance. OUTCOME: Change in glomerular filtration rate (GFR) during 7 years of follow-up. MEASUREMENTS: Longitudinal estimates of GFR calculated using the 4-variable Modification of Diet in Renal Disease (MDRD) Study equation. RESULTS: Estimated GFR decreased by an average of 0.4 +/- 3.6 mL/min/1.73 m(2)/y, and rapid GFR loss (>3 mL/min/1.73 m(2)/y) occurred in 693 participants (16%). Baseline body mass index, waist circumference, and fat mass were each associated with increased risk of rapid GFR loss: ORs, 1.19 (95% CI, 1.09-1.30) per 5 kg/m(2), 1.25 (95% CI, 1.16-1.36) per 12 cm, and 1.14 (95% CI, 1.05-1.24) per 10 kg after adjustment for age, sex, race, and smoking. The magnitude of increased risk was larger for participants with estimated GFR < 60 mL/min/1.73 m(2) at baseline (P for interaction < 0.05). Associations were substantially attenuated by further adjustment for diabetes, hypertension, and C-reactive protein level. Obesity measurements were not associated with change in GFR estimated using serum cystatin C level. LIMITATIONS: Few participants with advanced chronic kidney disease at baseline, no direct GFR measurements. CONCLUSION: Obesity may be a modifiable risk factor for the development and progression of kidney disease in older adults.
 
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BACKGROUND: Aversion therapy pairs the pleasurable stimulus of smoking a cigarette with some unpleasant stimulus. The objective is to extinguish the urge to smoke. OBJECTIVES: This review has two aims: First, to determine the efficacy of rapid smoking and other aversive methods in helping smokers to stop smoking; Second, to determine whether there is a dose-response effect on smoking cessation at different levels of aversive stimulation. SEARCH STRATEGY: We searched the Cochrane Tobacco Addiction Group trials register for studies which evaluated any technique of aversive smoking. SELECTION CRITERIA: Randomized trials which compared aversion treatments with `inactive` procedures or which compared aversion treatments of different intensity for smoking cessation. Trials must have reported follow up of least six months from beginning of treatment. DATA COLLECTION AND ANALYSIS: We extracted data in duplicate on the study population, the type of aversion treatment, the outcome measure, method of randomization and completeness of follow up. The outcome measure was abstinence from smoking at maximum follow up, using the strictest measure reported by the authors. Subjects lost to follow up were regarded as smokers. Where appropriate, we performed meta-analysis using a fixed effect model. MAIN RESULTS: Twenty-five trials met the inclusion criteria. Twelve included rapid smoking and nine used other aversion methods. Ten trials included two or more conditions allowing assessment of a dose-response to aversive stimulation. The odds ratio (OR) for abstinence following rapid smoking compared to control was 1.98 (95% confidence intervals (CI): 1.36 to 2.90). Several factors suggest that this finding should be interpreted cautiously. A funnel plot of included studies was asymmetric, due to the relative absence of small studies with negative results. Most trials had a number of serious methodological problems likely to lead to spurious positive results. The only trial using biochemical validation of all self reported cessation gave a non-significant result. Other aversion methods were not shown to be effective (odds ratio 1.15, 95% confidence interval 0.73 to 1.82). There was a borderline dose-response to the level of aversive stimulation (OR 1.66, 95% CI: 1.00 to 2.78). REVIEWERS` CONCLUSIONS: The existing studies provide insufficient evidence to determine the efficacy of rapid smoking, or whether there is a dose-response to aversive stimulation. Milder versions of aversive smoking seem to lack specific efficacy. Rapid smoking is an unproven method with sufficient indications of promise to warrant evaluation using modern rigorous methodology.
 
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OBJECTIVES: To examine the association between body mass index (BMI) and mortality in older people. DESIGN: A longitudinal cohort study of an age-homogenous, representative sample born in 1920/21. SETTING: Community-based home assessments. PARTICIPANTS: West Jerusalem residents born in 1920/21 examined at baseline in 1990 (n=447), with additional recruitment waves in 1998 (n=870) and 2005 (n=1,086). MEASUREMENTS: Comprehensive assessment of health variables including BMI (m/kg(2)) at ages 70, 78, and 85. The primary outcome of mortality was collected from age 70 to 88 (1990-2008). Adjusted Cox proportional hazards analysis was used to calculate hazard ratios (HRs) for mortality according to unit increase in BMI. RESULTS: A unit increase in BMI in women resulted in HRs of 0.94, (95% confidence interval (CI)=0.89-0.99) at age 70, 0.95 (95% CI=0.91-0.98) at age 78, and 0.91 (95% CI=0.86-0.98) at age 85. Similarly, in men, HRs were 0.99 (95% CI=0.95-1.05) at age 70, 0.94 (95% CI=0.91-0.98) at age 78, and 0.91 (95% CI=0.86-0.98) at age 85. A time-dependent analysis of 450 subjects followed for 18 years confirmed the above findings; a unit increase in BMI resulted in HRs of 0.93 (95% CI=0.87-0.99) in women and 0.93(95% CI=0.88-0.98) in men. Eliminating the first third of follow-up mortality to account for possibility of reverse causality did not change the results. CONCLUSION: Higher BMI was associated with lower mortality from age 70 to 88.
 
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Rapid infant weight gain is associated with increased abdominal adiposity, but there is no published report of the relationship of early infant growth to differences in specific adipose tissue depots in the abdomen, including visceral adipose tissue (VAT). In this study, we tested the associations of birth weight, infant weight gain, and other early life traits with VAT, abdominal subcutaneous adipose tissue (ASAT), and other body composition measures using magnetic resonance imaging (MRI) and dual-energy X-ray absorptiometry in middle adulthood (mean age = 46.5 years). The sample included 233 appropriate for gestational age singleton white children (114 males) enrolled in the Fels Longitudinal Study. Multivariate-adjusted general linear models were used to test the association of infant weight gain (from 0 to 2 years), maternal BMI, gestational age, parity, maternal age, and other covariates with adulthood body composition. Compared to infants with slow weight gain, rapid weight gain was associated with elevated risk of obesity (adjusted odds ratio = 4.1, 95% confidence interval = 1.4, 11.1), higher total body fat (+7 kg, P = 0.0002), percent body fat (+5%, P = 0.0006), logVAT mass (+0.43 kg, P = 0.02), logASAT mass (+0.47 kg, P = 0.001), and percent abdominal fat (+5%, P = 0.03). There was no evidence that the increased abdominal adipose tissue was due to a preferential deposition of VAT. In conclusion, rapid infant weight gain is associated with increases in both VAT and ASAT, as well as total adiposity and the risk of obesity in middle adulthood.
 
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Among the explanations proposed for the weak and inconsistent association between BMI and mortality in the elderly are the lack of adjustment for waist circumference (WC) and that the association varies with health status. This work examines the independent association of BMI and WC with mortality in older adults, and the influence of health status on this association. A cohort of 3,536 persons representative of the Spanish population aged >or=60 years was selected in 2000 and 2001, and followed prospectively until 2007. The analyses were performed with Cox models and adjusted for the main confounders. During follow-up, 659 persons died (18.6% of the cohort). Before adjusting for WC, mortality in the upper quartile of BMI was 15% lower than in the lower quartile (hazard ratio (HR): 0.85; 95% confidence interval (CI): 0.66-1.08; P for linear trend = 0.076). After adjusting for WC, the association was even stronger, so that mortality in the upper quartile of BMI was 37% lower than in the lower quartile (HR: 0.63; 95% CI: 0.45-0.88; P for linear trend < 0.003). Before adjusting for BMI, no association was observed between WC and mortality. After adjusting for BMI, WC was positively associated with mortality (HR for upper vs. lower quartile of WC: 1.48; 95% CI: 1.07-2.05; P for linear trend = 0.008). These associations were mainly observed in those with limitations in mobility and agility. BMI has an inverse, and WC has a direct, independent association with mortality in older adults, particularly in those with worse health status.
 
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The aim of this study was to evaluate the efficacy of an Internet-based weight-loss program for men in an assessor blinded randomized controlled trial. In total, 65 overweight/obese male staff and students at the University of Newcastle (mean (s.d.) age = 35.9 (11.1) years; BMI = 30.6 (2.8)) were randomly assigned to either (i) Internet group (n = 34) or (ii) control group (information only) (n = 31). Both groups received one face-to-face information session and a program booklet. Internet group participants used the study website to self-monitor diet and activity with feedback provided based on participants` online entries on seven occasions over 3 months. Participants were assessed at baseline, 3-, and 6-month follow-up for weight, waist circumference, BMI, blood pressure, resting heart rate, objectively measured physical activity, and self-reported total daily kilojoules. Intention-to-treat analysis revealed significant weight loss of 5.3 kg (95% confidence interval (CI): -7.3, -3.3) at 6 months for the Internet group and 3.5 kg (95% CI: -5.5, -1.4) for the control group. A significant time effect was found for all outcomes but no between-group differences. Per-protocol analysis revealed a significant group-by-time interaction (P < 0.001), with compliers losing more weight at 6 months (-9.1 kg; 95% CI -11.8, -6.5) than noncompliers (-2.7 kg; 95% CI -5.3, -0.01) and the control group (-4.2 kg; 95% CI -6.2, -2.2). Simple weight-loss interventions can be effective in achieving statistically and clinically significant weight loss in men. The Internet is a feasible and effective medium for weight loss in men but strategies need to be explored to improve engagement in online programs.
 
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Health utilities are measures of health-related quality of life (HRQL) used in cost-effectiveness research. We evaluated whether changes in body weight were associated with changes in health utilities in the Diabetes Prevention Program (DPP) and whether associations differed by treatment assignment (lifestyle intervention, metformin, placebo) or baseline obesity severity. We constructed physical (PCS-36) and mental component summary (MCS-36) subscales and short-form-6D (SF-6D) health utility index for all DPP participants completing a baseline 36-item short form (SF-36) HRQL assessment (N = 3,064). We used linear regression to test associations between changes in body weight and changes in HRQL indicators, while adjusting for other demographic and behavioral variables. Overall differences in HRQL between treatment groups were highly statistically significant but clinically small after 1 year. In multivariable models, weight change was independently associated with change in SF-6D score (increase of 0.007 for every 5 kg weight loss; P < 0.001), but treatment effects independent of weight loss were not. We found no significant interaction between baseline obesity severity and changes in SF-6D with changes in body weight. However, increases in physical function (PCS-36) with weight loss were greater in persons with higher baseline obesity severity. In summary, improvements in HRQL are associated with weight loss but not with other effects of obesity treatments that are unrelated to weight loss. Although improvements in the SF-6D did not exceed commonly reported thresholds for a minimally important difference (0.04), these changes, if causal, could still have a significant impact on clinical cost-effectiveness estimates if sustained over multiple years.
 
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BACKGROUND: Mortality from trauma in rural areas is increased compared with the urban environment. We aimed to describe the relationship between trauma deaths and various categories of remoteness in rural areas, in Western Australia (WA). METHODS: We used Death Registry data from July 1, 1997 to June 30, 2006. Deaths were allocated to one of the five Remoteness Areas classified by the Accessibility/ Remoteness Index of Australia: Major Cities, Inner Regional, Outer Regional, Remote, and Very Remote. Population data were obtained from the Australian Bureau of Statistics 2001 census. RESULTS: There were 4,937 deaths (3,543, 71.8% men; mean age 43.4 years +/- 24.3 years). The least number of deaths occurred in Remote WA, and the age at which death occurred decreased as remoteness increased. Falls occur predominantly in the elderly in the major city. Transport injuries are the leading cause of death (43.3%) outside the major city, where self harm is the leading cause of death (31.2%). The relative risk for death in very remote WA compared with the major city is 4.28 (95% CI 3.93-4.68). The standardized age-specific death rates ranged from 24.09 per 100,000 person-years in the major city, to 103.30 per 100,000 person-years in very remote WA. CONCLUSIONS: We have quantified the direct relationship between remoteness and trauma deaths. In particular, the death rate in very remote areas is over four times the rate in major cities. Such data should be useful for the planning of trauma systems in these areas.
 
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