We visualize, for the first time, the profile of structural deficits in the human brain associated with chronic methamphetamine (MA) abuse. Studies of human subjects who have used MA chronically have revealed deficits in dopaminergic and serotonergic systems and cerebral metabolic abnormalities. Using magnetic resonance imaging (MRI) and new computational brain-mapping techniques, we determined the pattern of structural brain alterations associated with chronic MA abuse in human subjects and related these deficits to cognitive impairment. We used high-resolution MRI and surface-based computational image analyses to map regional abnormalities in the cortex, hippocampus, white matter, and ventricles in 22 human subjects who used MA and 21 age-matched, healthy controls. Cortical maps revealed severe gray-matter deficits in the cingulate, limbic, and paralimbic cortices of MA abusers (averaging 11.3% below control; p Ͻ 0.05). On average, MA abusers had 7.8% smaller hippocampal volumes than control subjects ( p Ͻ 0.01; left, p ϭ 0.01; right, p Ͻ 0.05) and significant white-matter hypertrophy (7.0%; p Ͻ 0.01). Hippocampal deficits were mapped and correlated with memory performance on a word-recall test ( p Ͻ 0.05). MRI-based maps suggest that chronic methamphetamine abuse causes a selective pattern of cerebral deterioration that contributes to impaired memory performance. MA may selectively damage the medial temporal lobe and, consistent with metabolic studies, the cingulate-limbic cortex, inducing neuroadaptation, neuropil reduction, or cell death. Prominent white-matter hypertrophy may result from altered myelination and adaptive glial changes, including gliosis secondary to neuronal damage. These brain substrates may help account for the symptoms of MA abuse, providing therapeutic targets for drug-induced brain injury.

Children with poorer oral health status were more likely to experience dental pain, miss school, and perform poorly in school. These findings suggest that improving children's oral health status may be a vehicle to enhancing their educational experience.

The new REALD-30 instrument displays good reliability but only partial validity. Results suggest that dental health literacy may be distinct from medical health literacy and may have an independent effect on dental health outcomes.

Objective-To examine the relationship of primary caregivers' literacy with children's oral health outcomes.Design-We performed a cross-sectional study of children ages six and younger who presented for an initial dental appointment in the teaching clinics at the University of North Carolina at Chapel Hill School of Dentistry. Caregiver literacy was measured using the Rapid Estimate of Adult Literacy in Dentistry (REALD-30). The outcome measures included oral health knowledge, oral health behaviors, primary caregiver's reports of their child's oral health status, and the clinical oral health status of the child as determined by a clinical exam completed by trained, calibrated examiners.Results-Among the 106 caregiver/child dyads enrolled, 59% of the children were male, 52% were white, and 86% caregivers were the biological mothers. The bivariate results showed no significant relationships between literacy and oral health knowledge (p=0.16) and behaviors (p=0.24); however, there was an association between literacy and oral health status (p<0.05). The multivariate analysis controlled for race, and income; this analysis revealed a significant relationship between caregiver literacy scores and clinical oral health status as determined using a standardized clinical exam. Caregivers of children with mild to moderate treatment needs were more likely to have higher REALD-30 scores than those with severe treatment needs (OR=1.14; 95%CI 1.05:1.25, p=0.003).Conclusions-Caregiver literacy is significantly associated with children's dental disease status.Keywords oral health; health literacy; child health outcomes BACKGROUND AND SIGNIFICANCE

ABSTRACT. Objective. To determine the effects of early preventive dental visits on subsequent utilization and costs of dental services among preschool-aged children.Design. This investigation studied North Carolina children who were enrolled continuously in Medicaid from birth for a 5-year period. Our research design was a longitudinal cohort study that relied on 4 large administrative datasets, including North Carolina composite birth records from 1992, Medicaid enrollment and claims files from 1992 to 1997, and the Area Resource File. Our outcome measures included type of use and dentally related costs.Results. Of the 53 591 Medicaid-enrolled children born in 1992, 9204 were continuously enrolled for 5 years and met our inclusion criteria. Twenty-three children had their first preventive dental visit before 1 year of age, 249 between 1 and 2 years, 465 between 2 and 3 years, 915 between 3 and 4 years, and 823 between 4 and 5 years. Children who had their first preventive dental visit by age 1 were more likely to have subsequent preventive visits but were not more likely to have subsequent restorative or emergency visits. Those who had their first preventive visit at age 2 or 3 were more likely to have subsequent preventive, restorative, and emergency visits. The age at the first preventive dental visit had a significant positive effect on dentally related expenditures, with the average dentally related costs being less for children who received earlier preventive care. The average dentally related costs per child according to age at the first preventive visit were as follows: before age 1, $262; age 1 to 2, $339; age 2 to 3, $449; age 3 to 4, $492; age 4 to 5, $546.Conclusions. Our results should be interpreted cautiously, because of the potential for selection bias; however, we concluded that preschool-aged, Medicaid-enrolled children who had an early preventive dental visit were more likely to use subsequent preventive services and experience lower dentally related costs. In addition, children from racial minority groups had significantly more difficulty in finding access to dental care, as did those in counties with fewer dentists per population. Pediatrics 2004;114:e418-e423. URL: www.pediatrics.org/ cgi/doi/10.1542/peds.2003-0469-F; early childhood caries, preventive dental visit, cost, first dental visit, Medicaid dental use.ABBREVIATIONS. ECC, early childhood caries; NC, North Carolina; DPCR, number of dentists per 10 000 population according to county of residence. E arly childhood caries (ECC) is defined as dental decay among children Յ5 years of age. 1 It is estimated that 2% of infants 12 to 23 months of age in the United States have at least 1 tooth with questionable decay, whereas 19% of children 24 to 60 months of age meet the criteria for ECC. 2 ECC is much more prevalent among children from low-income families; for example, among children 3 to 5 years of age in Head Start, the prevalence of ECC has been reported to be as high as 90%. 3,4 Untreated caries is concentrated disproportionately among...