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IntroductionSurgical interventions such as tooth extraction increase the chances of developing osteonecrosis of the jaw in patients receiving bisphosphonates (BPs) for the treatment of bone-related diseases. Tooth extraction is often performed to eliminate preexisting pathological inflammatory conditions that make the tooth unsalvageable; however, the role of such conditions on bisphosphonate-related osteonecrosis of the jaw (BRONJ) development after tooth extraction is not clearly defined. Here, we examined the effects of periapical periodontitis on tooth extraction-induced BRONJ development in mice.MethodsPeriapical periodontitis was induced by exposing the pulp of the maxillary first molar for 3 weeks in C57/BL6 mice that were intravenously administered with BPs. The same tooth was extracted, and after an 3 additional weeks, the mice were harvested for histologic, histomorphometric, and histochemical staining analyses.ResultsPulp exposure induced periapical radiolucency as shown by increased inflammatory cells, tartrate-resistant acid phosphatase-positive osteoclasts, and bone resorption. When BPs were administered, pulp exposure did not induce apical bone resorption despite the presence of inflammatory cells and tartrate-resistant acid phosphatase-positive osteoclasts. Although tooth extraction alone induced BRONJ lesions, pulp exposure further increased tooth extraction-induced BRONJ development as shown by the presence of more bone necrosis.ConclusionsOur study demonstrates that a preexisting pathological inflammatory condition such as periapical periodontitis is a predisposing factor that may exacerbate BRONJ development after tooth extraction. Our study further provides a clinical implication wherein periapical periodontitis should be controlled before performing tooth extraction in BP users in order to reduce the risk of developing BRONJ.

A significant number of children in the United States have developmental disabilities. Historically, many children with developmental disabilities were institutionalized and rarely seen in public. Currently, children with developmental disabilities are entitled to education and health-related support services that permit them access to public education and community services. To understand current laws related to children with developmental disabilities, it is important to consider past legislation and landmark court cases that have significantly affected the lives of children with disabilities and school nursing practice. This article presents an overview of historical legislation and court cases as they pertain to children and individuals with developmental disabilities and of current issues that require further attention and inquiry. (Contains 1 table.)

Background: This study assessed the co-occurrence of cognitive problems and difficult temperament characteristics in children aged 3 to 5 years exhibiting aggressive behavior. Methods: Thirty-one children with high ratings on the Aggressive Behavior subscale of the Achenbach Child Behavior Checklist or Teacher Report Form were recruited from a school district-based clinic. Cognitive ability and temperament were assessed with the Differential Ability Scales and the Carey Temperament Scales Behavioral Styles Questionnaire, respectively. Cluster analysis was applied to these variables. Results: Three prominent groups of children sharing cognitive and temperament characteristics emerged. The first, comprising 41.9% of the sample, demonstrated low adaptability, low persistence, high activity, negative mood, and low rhythmicity, along with borderline-deficient cognitive scores. The second (38.7%) demonstrated low adaptability, low persistence, high activity, and negative mood, along with average cognitive scores. The third (19.4%) demonstrated essentially midrange temperament characteristics and average cognitive scores. All 3 groups shared temperamental tendencies toward a higher threshold of response. Most children in the sample also had significant sleep disturbances (54.5%), other health problems (63.6%), and/or suspected developmental problems (54.5%). Conclusions: The widespread presence of sleep, health, cognitive, temperament, and developmental problems in this sample supports the involvement of medical and developmental health experts in teams evaluating young children who present with high levels of aggressive behavior. The diverse nature of cognitive-temperament profiles in this sample also suggests a need to assess cognitive ability and temperament in young, aggressive children to provide individualized interventions. (Contains 6 tables.)

Attention-deficit/hyperactivity disorder (ADHD) is one of the most challenging chronic conditions for children, families, schools, and physicians. Because symptoms of ADHD can be mistaken for other health conditions and misdiagnosis can occur, accurate diagnosis and treatment require comprehensive evaluation. This article introduces a school-based framework--ADHD Identification and Management in Schools (AIMS)--developed by a multidisciplinary team composed of a pediatrician, school nurses, and school psychologists that sought to improve communication between school personnel and physicians, standardize practice, and improve the quality of care for children with ADHD. The framework provides school nurses with an evidence-based, systematic method for early identification and management of children with ADHD. (Contains 4 figures.)

Objectives. We explored factors associated with perception of barriers to immunization among parents of Hmong origin in California, whose children experience persistent immunization inequities even with health insurance. Methods. A partnership of academic researchers and members of the Hmong community conducted a community-based participatory research project. We collected data in naturalistic settings with a standardized instrument. We analyzed responses from 417 parents and caregivers and created a structural equation model to determine factors that contributed to perceived barriers. Results. Of 3 potential contributing factors to perceived barriers--nativity, socioeconomic position, and use of traditional Hmong health care (i.e., consulting shamans and herbalists)--the latter 2 significantly predicted higher perceived barriers to immunization. Nativity, indicated by years in the United States, age of arrival in the United States, and English language fluency, did not predict perceived barriers. Conclusions. Interventions aimed at reducing immunization inequities should consider distinct sociocultural factors that affect immunization rates among different refugee and immigrant groups. (Am J Public Health. 2010;100:839-845. doi: 10.2105/AJPH.2009.175935)

BACKGROUND: This study assessed the co-occurrence of cognitive problems and difficult temperament characteristics in children aged 3 to 5 years exhibiting aggressive behavior. METHODS: Thirty-one children with high ratings on the Aggressive Behavior subscale of the Achenbach Child Behavior Checklist or Teacher Report Form were recruited from a school district-based clinic. Cognitive ability and temperament were assessed with the Differential Ability Scales and the Carey Temperament Scales Behavioral Styles Questionnaire, respectively. Cluster analysis was applied to these variables. RESULTS: Three prominent groups of children sharing cognitive and temperament characteristics emerged. The first, comprising 41.9% of the sample, demonstrated low adaptability, low persistence, high activity, negative mood, and low rhythmicity, along with borderline-deficient cognitive scores. The second (38.7%) demonstrated low adaptability, low persistence, high activity, and negative mood, along with average cognitive scores. The third (19.4%) demonstrated essentially midrange temperament characteristics and average cognitive scores. All 3 groups shared temperamental tendencies toward a higher threshold of response. Most children in the sample also had significant sleep disturbances (54-5%), other health problems (63.6%), and/or suspected developmental problems (54-5%). CONCLUSIONS: The widespread presence of sleep, health, cognitive, temperament, and developmental problems in this sample supports the involvement of medical and developmental health experts in teams evaluating young children who present with high levels of aggressive behavior. The diverse nature of cognitive-temperament profiles in this sample also suggests a need to assess cognitive ability and temperament in young, aggressive children to provide individualized interventions. Keywords: aggressive behavior; preschool; cognitive ability; temperament., LITERATURE REVIEW As many as 15% of young children attending public school programs such as Head Start exhibit high levels of aggressive or other externalizing behavior. (1) Children with early-onset [...]

Author(s): Steven E. Scherer (corresponding author) [1]; Donna M. Muzny [1]; Christian J. Buhay [1]; Rui Chen [1]; Andrew Cree [1]; Yan Ding [1]; Shannon Dugan-Rocha [1]; Rachel Gill [1]; [...]