[Show abstract][Hide abstract] ABSTRACT: This is a systematic review of the scientific literature with regard to normal sleep patterns in infants and children (0-12 years). The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Mean and variability data for sleep duration, number of night wakings, sleep latency, longest sleep period overnight, and number of daytime naps were extracted from questionnaire or diary data from 34 eligible studies. Meta-analysis was conducted within age-bands and categories. In addition, fractional polynomial regression models were used to estimate best-fit equations for the sleep variables in relation to age. Reference values (means) and ranges (±1.96 SD) for sleep duration (hours) were: infant, 12.8 (9.7-15.9); toddler/preschool, 11.9 (9.9-13.8); and child, 9.2 (7.6-10.8). The best-fit (R(2)=0.89) equation for hours over the 0-12 year age range was 10.49-5.56×[(age/10)^0.5-0.71]. Meta-regression showed predominantly Asian countries had significantly shorter sleep (1h less over the 0-12 year range) compared to studies from Caucasian/non-Asian countries. Night waking data provided 4 age-bands up to 2 years ranging from 0 to 3.4 wakes per night for infants (0-2 months), to 0-2.5 per night (1-2 year-olds). Sleep latency data were sparse but estimated to be stable across 0-6 years. Because the main data analysis combined data from different countries and cultures, the reference values should be considered as global norms.
Sleep Medicine Reviews 07/2011; 16(3):213-22. DOI:10.1016/j.smrv.2011.06.001 · 8.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the long-term outcomes of primary trabeculectomies and primary Molteno implants performed in cases of primary open-angle glaucoma at Dunedin Hospital.
Prospective comparative case series of 718 eyes (500 patients) and 260 eyes (195 patients) that had trabeculectomy and Molteno implants, respectively, at Dunedin Hospital as the first drainage operation for primary open-angle glaucoma between 1976 and 2007, and followed up for a mean of 7.7 (range, 0.0-28.0) and 5.0 (range, 0.0-27.4) years, respectively.
The probability of intraocular pressure (IOP) control at 21 mm Hg or less following trabeculectomy at 1, 2, 5, 10, 15, and 20 years was 0.95 (95% confidence interval [CI], 0.94-0.97), 0.93 (95% CI, 0.91-0.96), 0.89 (95% CI, 0.86-0.92), 0.82 (95% CI, 0.78-0.86), 0.74 (95% CI, 0.68-0.80), and 0.68 (95% CI, 0.59-0.77), respectively. There were 96 (13%) failures (using the >21-mm Hg definition of failure) in the trabeculectomy group by the final follow-up. The probability of IOP control at 21 mm Hg or less following Molteno implant insertion at 1, 2, 5, 10, 15, and 20 years was 0.98 (95% CI, 0.97-1.0), 0.97 (95% CI, 0.96-1.0), 0.96 (95% CI, 0.92-0.99), 0.96 (95% CI, 0.92-0.99), 0.91 (95% CI, 0.81-1.00), and 0.91 (95% CI, 0.81-1.00), respectively. In the Molteno implant group, there were 8 (3%) failures (using the >21-mm Hg definition of failure) by the final follow-up.
Insertion of a Molteno implant provided superior IOP control to trabeculectomy when carried out as a first operation in cases of primary glaucoma.
Archives of ophthalmology 07/2011; 129(11):1444-50. DOI:10.1001/archophthalmol.2011.221 · 4.40 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Age estimation of young victims of natural and un-natural disasters remains a crucial and challenging task during the process of Disaster Victim Identification (DVI). The purpose of this study was to compare dental maturity using the Demirjian and Cameriere methods and to explore the relationship between dental age and cervical vertebral maturity (CVM) using the Hassel and Farman method for a group of New Zealand children. The study used lateral cephalometric and panoramic radiographs of 200 orthodontic patients aged 7-17 years. Dental age was calculated from mandibular tooth formation stages using the Demirjian and Cameriere methods by calculating the ratio of tooth length to apex width for these teeth. CVM was assessed using stages from Hassel and Farman. Reliability of maturity from reassessment of 20 radiographs showed good agreement for the three methods. Chronological and dental ages were compared using a mixed model. Descriptive statistics of dental ages by CVM stage were calculated. The results show that both dental methods were similar in assessing maturity. A disadvantage of using the Cameriere method was that all seven teeth reached maturity at 13.69 and 14.06 years in females and males respectively, compared to age 16 using the Dermijian method. Females reached CVM stages at earlier chronological and dental ages than males. Mean chronological age for CVM stages 2-5 is about 1 year earlier in females than males. The Demirjian and Cameriere methods of dental maturity and CVM are reliable and useful in assessing dental and skeletal maturity. Ideally in a DVI situation, both the methods of Demirjian and Cameriere, together with CVM, should be employed in the ageing of individuals suspected of being between 7 and 16 years.
Forensic Science Medicine and Pathology 06/2011; 8(2):101-8. DOI:10.1007/s12024-011-9251-8 · 1.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Nocturnal enuresis has been reported in patients taking clozapine, but the incidence has not been accurately established. The incidence of enuresis in patients taking risperidone, olanzapine or quetiapine is unknown. Aims To compare nocturnal enuresis in patients taking clozapine with that in patients taking risperidone, olanzapine or quetiapine.
Observational cohort study using prescription event monitoring methods. Patients prescribed atypical antipsychotic medicines were followed up by questionnaires that were sent to their medical practitioner. Practitioners were asked to directly ask their patients about bed-wetting.
Nocturnal enuresis was reported by 17 of 82 (20.7%) patients taking clozapine, 11 of 115 (9.6%) taking olanzapine, 7 of 105 (6.7%) taking quetiapine and 12 of 195 (6.2%) taking risperidone. Compared with clozapine, the risk of nocturnal enuresis was significantly lower in patients taking olanzapine (odds ratio, OR = 0.43, 95% CI 0.19-0.96), quetiapine (OR = 0.33, 95% CI 0.13-0.59) or risperidone (OR = 0.27, 0.12-0.59), with odds ratios adjusted for age, gender and duration of treatment.
Approximately one in five patients prescribed clozapine experienced bed-wetting. This was significantly higher than the rate of nocturnal enuresis in patients taking olanzapine, quetiapine or risperidone.
The British journal of psychiatry: the journal of mental science 06/2011; 199(2):140-4. DOI:10.1192/bjp.bp.110.087478 · 7.99 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Little is known about the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in most Pacific Island nations. Relatively high rates of MRSA have been reported in Polynesian people living outside the Pacific Islands. To determine the prevalence and characteristics of MRSA, we assessed wound swabs from 399 persons with skin and soft tissue infection living in Samoa. MRSA was isolated from 9% of study participants; 34 of the 196 S. aureus isolates were MRSA. Five MRSA genotypes were identified; the 3 most common were USA300, the Queensland clone, and a sequence type 1 MRSA strain that shares <85% homology with the sequence type 1 MRSA strain common in the region (WA MRSA-1). The Southwest Pacific MRSA clone was identified but accounted for only 12% of MRSA isolates. The high prevalence of MRSA in Samoa provides impetus for initiatives to improve antimicrobial drug resistance surveillance, infection control, and antimicrobial drug use in Pacific Island nations.
[Show abstract][Hide abstract] ABSTRACT: Midwives providing care as lead maternity caregivers in New Zealand provide continuity of care to women who may give birth in a variety of settings, including home, primary units, and secondary and tertiary level hospitals. The purpose of this study was to compare mode of birth and intrapartum intervention rates for low-risk women planning to give birth in these settings under the care of midwives.
Data for a cohort of low-risk women giving birth in 2006 and 2007 were extracted from the Midwifery Maternity Provider Organisation database. Mode of birth, intrapartum interventions, and neonatal outcomes were compared with results adjusted for age, parity, ethnicity, and smoking.
Women planning to give birth in secondary and tertiary hospitals had a higher risk of cesarean section, assisted modes of birth, and intrapartum interventions than similar women planning to give birth at home and in primary units. The risk of emergency cesarean section for women planning to give birth in a tertiary unit was 4.62 (95% CI: 3.66-5.84) times that of a woman planning to give birth in a primary unit. Newborns of women planning to give birth in secondary and tertiary hospitals also had a higher risk of admission to a neonatal intensive care unit (RR: 1.40, 95% CI: 1.05-1.87; RR: 1.78, 95% CI: 1.31-2.42) than women planning to give birth in a primary unit.
Planned place of birth has a significant influence on mode of birth and rates of intrapartum intervention in childbirth.
[Show abstract][Hide abstract] ABSTRACT: Although antibiotic use in the community is a significant contributor to resistance, little is known about social patterns of use. This study aimed to explore the use of antibiotics by age, gender, ethnicity, socio-economic status and rurality.
Data were obtained on all medicines dispensed to ambulatory patients in one isolated town for a year, and data on antibiotics are presented in this paper. Demographic details were obtained from pharmacy records or by matching to a national patient dataset.
During the study year, 51% of the population received a prescription for one or more antibiotics, and on average people in the region received 10.15 defined daily doses (DDDs). Prevalence of use was higher for females (ratio, 1.18), and for young people (under 25) and the elderly (75 and over), and the amount in DDDs/person/year broadly followed this pattern. Māori (indigenous New Zealanders) were less likely to receive a prescription (48% of the population) than non-Māori (55%) and received smaller quantities on average. Rural Māori, including rural Māori children, received few prescriptions and low quantities of antibiotics compared with other population groups.
The level of antibiotic use in the general population is high, despite campaigns to try to reduce unnecessary use. The prevalence of acute rheumatic fever is high amongst rural Māori, and consequently treatment guidelines recommend prophylactic use of antibiotics for sore throat in this population. This makes the comparatively very low level of use of antibiotics amongst rural Māori children very concerning.
[Show abstract][Hide abstract] ABSTRACT: Graduates from a new, 3-year Bachelor of Midwifery program joined those educated through the 1 year, postgraduate route (for those already qualified as nurses) for the first time in New South Wales (NSW) Australia in 2007. Many hospitals offer transition support programs for new graduates during their first year of practice though there is little evidence available to inform these programs.
To establish the new midwife's confidence in working to the 14 "National Competency Standards for the Midwife"(1) and the International Confederation of Midwives (ICM) Definition of a Midwife and to explore whether the new midwife's confidence changed over the new graduate year. In particular the study set out to determine whether there were any differences in the confidence of new graduates from undergraduate or postgraduate programs.
Pre and post survey with comparisons longitudinally and within undergraduate and postgraduate cohorts.
Three Area Health Services in Sydney and surrounding areas, Australia.
A convenience sample of all new graduate midwives employed in the three Area Health Services in the early months of 2008.
New graduate midwives rated their level of confidence (1-10) in working to the 14 National Competency Standards for the Midwife and the ICM Definition of a Midwife during their first weeks of employment and after the completion of their first year of practice.
Midwives prepared through the undergraduate and postgraduate routes commenced their first year of practice with similar levels of confidence. The confidence of these midwives increased modestly over the first year of practice. Those from postgraduate programs were significantly more confident than those from undergraduate programs on four competencies after the first year of practice. Participant's self reported confidence in working to the ICM Definition of a Midwife was low.
Our profession and community need strong, confident midwives and it is in all our interests to look to ways we can best achieve this. While the findings of this study should be treated with caution, this study suggests that there is room for improvement in the way we support newly graduated midwives to build their confidence over their first year of practice. Further research is needed to identify the needs of newly graduated midwives and how best we can support them to develop as strong and confident practitioners through their first year of practice.
Women and Birth 04/2011; 25(3):e1-10. DOI:10.1016/j.wombi.2011.03.005 · 1.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Insecure hiding of the treatment allocation in randomized trials is associated with bias. It is less certain how much bias is associated with different methods of treatment allocation.
Meta-epidemiological study of 389 randomized trials from 19 systematic reviews and 65 meta-analyses with differing methods of treatment allocation. Pooled ratios of odds ratios (RORs) and 95% confidence intervals (95% CI) were calculated from trials with different methods of treatment allocation. An ROR less than one shows exaggeration of treatment effect.
There is no evidence that the use of sealed envelopes with enhancement was different from central randomization (ROR 1.02, 95% CI: 0.85-1.23). Sealed envelopes without enhancement were associated with an exaggeration of the estimate of effect (ROR 0.87, 95% CI: 0.76-1.00). Where allocation concealment for double-blind trials was unclear, the ROR is 0.86 (95% CI: 0.78-0.96) and if not hidden, the ROR is 0.89 (95% CI: 0.70-1.15).
Sealed envelopes with some form of enhancement (opaque, sequentially numbered, and so forth) may give adequate concealment. Description of a study as "double blind" does not imply a lack of bias when concealment of allocation is unclear.
[Show abstract][Hide abstract] ABSTRACT: To obtain pharmacists' views on proposals for electronic transmission of dispensing data to the New Zealand Intensive Medicines Monitoring Programme (IMMP).
Consultation with a randomly selected group of 100 community pharmacists and all 28 hospital pharmacies in New Zealand was conducted by postal survey. A specific questionnaire was designed to obtain pharmacists' views on several aspects of electronic data transmission including willingness to co-operate with a new system, awareness of other electronic systems and views on security.
Survey response rates were 95% for community pharmacists and 73% for hospital pharmacists. Ninety (95%) of the community pharmacists and 18 (95%) of the hospital pharmacists who responded stated they would use the IMMP proposed method of electronic data transmission. Some 91% of community pharmacists and 100% of hospital pharmacists considered the proposed new method would be equally or more secure than the present hard-copy system of posting dispensing records.
There is a high level of support from New Zealand pharmacists for electronic capture of prescription dispensing data for medicines monitored by the IMMP. This electronic method will now be implemented. Development of such systems is important for enhancing patient safety and pharmacovigilance programmes worldwide.
International Journal of Pharmacy Practice 04/2011; 19(2):136-9. DOI:10.1111/j.2042-7174.2010.00082.x
[Show abstract][Hide abstract] ABSTRACT: The objective of this systematic review was to identify trial design and patient characteristics associated with symptom improvement in acute mania clinical trials.
Drug trials in acute mania that used the Young Mania Rating Scale (YMRS) score as the primary endpoint were identified using a systematic search strategy. Details of the trial, patient population, and treatment assignment were recorded. Covariates associated with change in YMRS were analyzed using a multiple regression model.
A total of 41 studies, comprising 89 treatment arms and 10,471 patients, were selected for this analysis. Three variables were statistically significantly associated with change in YMRS score: treatment assignment, baseline mania score, and study location. Compared with placebo, greater mean (95% confidence interval) reductions in YMRS score were noted for all three active treatment arms [-4.7 (-6.4 to -3.0) for mood stabilizers; -5.9 (-7.6 to -4.2) for antipsychotics; and -8.3 (-10.2 to -6.4) for combined mood stabilizer/antipsychotics; all comparisons p < 0.0001]. Greater changes in YMRS score were associated with higher baseline YMRS scores (p = 0.002) and with studies performed outside of the USA (p= 0.02). Year of study publication was not associated with YMRS score change. Study size, number of study sites, YMRS score required for study entry, inclusion of patients with mixed mania or treatment resistance, and enrollment of inpatients versus outpatients had no significant influence on change in YMRS score.
These findings may assist in the design of future drug trials for acute mania.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to conduct a prospective randomized controlled clinical trial to evaluate the rate of space closure and tooth angulation during maxillary canine retraction using preactivated T-loops made from titanium-molybdenum alloy (TMA) and nickel-titanium (NiTi). Twelve patients (six males and six females) aged between 13 and 20 years who had upper premolar extractions were included, and each acted as their own control, with a NiTi T-loop allocated to one quadrant and TMA to the other using a split mouth block randomization design. The loops were activated 3 mm at each visit to deliver a load of approximately 150 g to the upper canine teeth. Maxillary dental casts, taken at the first and each subsequent monthly visit, were used to evaluate changes in extraction space and canine angulation. All used T-loops were compared with unused loops in order to assess distortion. Mixed model statistical analysis was used to adjust for confounding variables. The mean rate of canine retraction using preactivated NiTi and TMA T-loops was 0.91 mm/month (±0.46) and 0.87 mm/month (±0.34), respectively. The canine tipping rates were 0.71 degrees/month (±2.34) for NiTi and 1.15 degrees/month (±2.86) for TMA. Both the rate of space closure and the tipping were not significantly different between the two wire types. The average percentage distortion of the TMA T-loop was 10 times greater than that of the NiTi loops when all other variables were matched. There was no difference in the rate of space closure or tooth angulation between preactivated TMA or NiTi T-loops when used to retract upper canines. The NiTi loops possessed a greater ability to retain and return to their original shapes following cyclical activation.
The European Journal of Orthodontics 03/2011; 34(1):33-8. DOI:10.1093/ejo/cjq156 · 1.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Knowledge regarding the possible health benefits of probiotic preparations has been increasing, but clinical trials have largely produced non-significant results. In contrast, the open market for probiotics is expanding worldwide despite little research of consumer characteristics.
We aimed to survey the availability of probiotic preparations, the recommendation patterns of general practitioners (GP) and the characteristics of consumers.
Pharmacies were visited and the types of probiotic supplements were reviewed. A telephone survey was conducted to identify and characterise users and non-users. A questionnaire was sent to GPs.
We found 31 probiotic products containing 16 different strains of bacteria. The majority of GPs were unable to clearly define a probiotic. Of 1512 random phone numbers called, 873 were answered. The prevalence of probiotic use was 25.4% of respondents. More females than males had ever used probiotics (30.6% vs 17.2%; p<0.0001). The highest rate of use was found in those with tertiary qualifications (34.2%; p<0.001). Of users, 75.2% said they had used probiotics on a recommendation, 80.5% of non-users said they would consider taking a probiotic if it was recommended by the GP. Probiotics were mainly used alongside antibiotic treatment (23%) and gastrointestinal disorders (27.5%). Significantly more users than non-users believed in the benefits of probiotic without concern for possible side effects.
The majority of participants would consider taking a probiotic if it was recommended by their GP, but GPs exhibited a lack of knowledge in the use and indications for probiotic therapy. There was a general lack of concern regarding potential side-effects.
The New Zealand medical journal 02/2011; 124(1329):36-43.
[Show abstract][Hide abstract] ABSTRACT: Background Knowledge regarding the possible health benefits of probiotic preparations has been increasing, but clinical trials have largely produced non-significant results. In contrast, the open market for probiotics is expanding worldwide despite little research of consumer characteristics.
[Show abstract][Hide abstract] ABSTRACT: Many systematic reviews include only a few studies. It is unclear whether recommendations based on these will be correct in the longer term; hence, this article explores whether meta-analyses give reliable results after only a few studies.
Cumulative meta-analysis of data from 65 meta-analyses from 18 Cochrane systematic reviews was carried out. Various measures of closeness to the pooled estimate from all trials after three and five trials were included. Changes during the accumulation of evidence were noted.
The 95% confidence interval included the final estimate in 72% of meta-analyses after three studies and in 83% after five studies. It took a median of four (interquartile range: 1.25-6) studies to get within 10% of the final point estimate. Agreement between the results at three and five studies and the final estimate was not predicted by the number of participants, the number of events, τ(2), or I(2). Estimates could still change substantially after many trials were included.
Many of the conclusions drawn from systematic reviews with small numbers of included studies will be correct in the long run, but it is not possible to predict which ones.
[Show abstract][Hide abstract] ABSTRACT: Randomised controlled trials have investigated aspects of postal survey design yet cannot elaborate on reasons behind participants' decision making and survey behaviour. This paper reports participants' perspectives of the design of, and participation in, a longitudinal postal cohort survey. It describes strengths and weaknesses in study design from the perspectives of study participants and aims to contribute to the: 1) design of future cohort surveys and questionnaires generally and, 2) design of cohort surveys for people with musculoskeletal disorders (MSDs) specifically.
In-depth interviews explored the design of postal surveys previously completed by participants. Interviews used open ended questioning with a topic guide for prompts if areas of interest were not covered spontaneously. Thematic data analysis was undertaken based on the framework method. A second researcher verified all coding.
Data from fourteen interviews were analysed within three main themes; participation, survey design and survey content. One of the main findings was the importance of clear communication aimed at the correct audience both when inviting potential participants to take part and within the survey itself. Providing enough information about the study, having a topic of interest and an explanation of likely benefits of the study were important when inviting people to participate. The neutrality of the survey and origination from a reputable source were both important; as was an explanation about why information was being collected within the survey itself. Study findings included participants' impressions when invited to take part, why they participated, the acceptability of follow-up of non-responders and why participants completed the follow-up postal survey. Also discussed were participants' first impression of the survey, its length, presentation and participants' views about specific questions within the survey.
Ideas generated in this study provide an insight into participants' decision making and survey behaviour and may enhance the acceptability of future surveys to potential participants. As well as clear communication, participants valued incentives and survey questions that were relevant to them. However, opinions varied as to the preferred format for responses with some advising more opportunity for open-ended feedback. We also found that some standard format questions can raise quandaries for individual participants.
BMC Medical Research Methodology 01/2011; 11(1):8. DOI:10.1186/1471-2288-11-8 · 2.27 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: All treatment guidelines for acute mania recommend monotherapy with either mood stabilizers (MS) or antipsychotics. The objective of this analysis was to compare the efficacy and acceptability of both drug classes in an expanded set of clinical trials in acute mania.
Randomized double-blind trials comparing MS vs second generation antipsychotics (SGA) in acute mania were identified in a systematic literature search. Change in mania rating scale, responder rates and dropout rates were compared by treatment assignment using Review Manager version 5.0.
Nine studies totaling 1631 patients that compared the MS lithium or valproate against a number of SGAs, and which reported one or more analysis endpoints were identified. Statistically significant advantages were noted in favour of SGA over MS for standardized mean difference (SMD) for change in mania scores (-0.22 [95% CI -0.33 to -0.11]; p < 0.0001), responder rate risk difference (7% [95% CI 1% to 13%]; p = 0.02), and dropout risk difference (-5% [95% CI -10% to -1%]; p = 0.02). This change in SMD for mania scores is equivalent to a 2.5-3 point difference in Young Mania Rating Scale score. Similar trends for SMD were noted when comparing subgroups of lithium and valproate studies against SGAs.
Over half the included studies included olanzapine, and the applicability of these findings, especially to first generation antipsychotic drugs, requires confirmation. This analysis could not assess the relative efficacy of combined MS/SGA vs individual monotherapies.
In acute mania, monotherapy with SGAs demonstrates statistically significant advantages over MS in terms of both efficacy and acceptability, and may be preferable for initial choice of treatment.
[Show abstract][Hide abstract] ABSTRACT: Pharmacy dispensing databases provide a comprehensive source of data on medicines use free from many of the biases inherent in administrative databases. There are challenges associated with using pharmacy databases however. This paper describes the methods we used, and their performance, so that other researchers considering using pharmacy databases may benefit from our experiences.
Data were collected from all nine pharmacy dispensing databases in an isolated New Zealand town for the period October 2005-September 2006. Probabilistic record matching was used to link individuals across pharmacies. Patient addresses from the pharmacy data were geo-located to small areas so an area measure of socioeconomic deprivation could be assigned. Medicines were coded according to the ATC-DDD drug classification system.
Data on 619,264 dispensings were collected. Record matching reduced an initial pool of individuals from 54,484 to 38,027. Socioeconomic deprivation ranks were assigned for 30,972 (93%) of the 33,375 unique addresses identified, or 36,048 (95%) of individuals. ATC codes were assigned to 613,490 (99%) of the dispensings, with DDDs assigned to 561,223 (91%). Overall, 93% of dispensing records had complete demographic and drug information.
The methods described in this paper generated a rich dataset for medicines use research. These methods, while initially resource-intensive, can to a great extent be automated and applied to other locations, and will hopefully prove useful to other researchers facing similar challenges with using pharmacy databases. However, it is difficult to envisage these methods being viable on a long-term or national scale.
[Show abstract][Hide abstract] ABSTRACT: To investigate mandibular motion in six degrees of freedom before, during and after twin block treatment in one individual.
The appliance was worn for eight months, and motion recordings, using a 12-camera opto-electric system, were captured prior to placement of a twin block appliance and 2, 4, 14 and 52 weeks after insertion.
The wide variations in mandibular motion that accompany twin block wear disappeared post-treatment, except for an increase in anteroposterior movement of the mandible.
Twin block therapy appears to affect mandibular motion temporarily.
Australian orthodontic journal 11/2010; 26(2):189-94. · 0.43 Impact Factor