Systematic Review of Evidence of Interventions Addressing Disparities in Oral Health for Adults with Intellectual Disabilities: Year 2

Preventive oral health care and treatment for individuals with an intellectual or developmental disability (I/DD) is a leading public health disparity. Evidence points to poorer oral hygiene, higher prevalence and greater severity of periodontal disease, as well as a higher incidence of untreated caries in the I/DD population. In year 1 of this systematic review, the literature was searched and screened for inclusion, developing an extensive database of interventions to increase access and behavioral oral health interventions for individuals with I/DD. The objective of year 2 of the systematic review is to examine this literature in depth. Data review and assessment will be conducted in an electronic repository. Incorporating a public health approach, including social, personal and environmental factors, the team will assess, sort and summarize the interventions, providing a better understanding of common themes. Expert clinicians and methodologists will conduct an assessment of the evidence with a consideration of the execution, design suitability, number of studies available, consistency of findings, effect size, and whether expert opinion was used. In addition, findings resulting from a lack of evidence due to poor study design, small sample size, inconsistent findings, small effect sizes, or other limitations in the study will be identified and catalogued. Reviewed findings will be synthesized to identify effective interventions to reduce oral health disparities in adults with I/DD. These findings will be presented, in addition to a catalogue of promising interventions that have yet to be demonstrated but nevertheless are viewed as promising approaches to reduce disparities

Educating Dental Health Professionals about People with Intellectual and Developmental Disabilities

Dental schools and dental hygiene programs are required to incorporate specialized training in their programs to serve people with special needs, however people with intellectual and developmental disability (I/DD) continue to experience poor oral health outcomes. Access to clinicians with the desire and skill to care for people with I/DD remains a challenge. There is a need to understand the best approaches to improve access, and to reduce disparity in oral health, for this vulnerable population representing approximately 1-3% of the general population. Researchers are systematically investigating the literature to uncover evidence of effective approaches to improve access and to support good oral health behaviors. These approaches should be integrated into educational curricula

A Systematic Review of Oral Health Interventions to Reduce Disparities in Adults with Intellectual Disability: Results of a Novel Approach

Research consistently shows that people with I/DD experience poorer oral hygiene, higher prevalence and severity of periodontal disease, and higher incidence of untreated caries when compared to the general population. In a systematic review funded by the Centers for Disease Control (NCBDD), researchers rigorously evaluated evidence for a wide range of interventions that offer the potential to reduce those disparities. More than 4,000 titles/abstracts were identified from a literature search that included peer reviewed as well as gray literature. After criteria were applied to identify the I/DD population and intervention-studies only, the number of full text reviews was reduced to 125, and intervention categories were identified as follows: 1) sedation, appropriate use in the population; 2) education and behavioral interventions for treatment and prevention directed at individuals, caregivers and providers; 3) prevention strategies such as fluoride and chlorhexidine; and 4) access issues related to financing and funding. Researchers completed data extraction using a structured on-line tool, the Systematic Review Data Repository. The broad range of topic areas required researchers to include clinical experts in the structured review providing valuable input into the interpretation of findings, providing a measure of external validity for each reported study. A research methodologist accomplished a separate review of the studies’ internal validity, including design and statistical analyses. Results of the complimentary examinations of validity were included in the overall measure of the quality of each study and used in assigning a level of evidence to each study that was included for each topic

Interventions to Improve Access and Health Behaviors in Individuals with Intellectual and Developmental Disability: A National Resource for Oral Health

The presentation will describe the process by which the systematic review, designed to uncover interventions to reduce oral health disparities in individuals with intellectual and developmental disability, was conducted, along with the search strategy, interventions and outcomes measured. The presentation will convey the evidence base and promising practices for access, behavior, and prevention to generate discussion among researchers, clinicians and policy makers, about future study topics

Uncovering the evidence: Systematic review of interventions to reduce oral health disparities between adults with Intellectual Disability and the general population

Oral health is a public health concern for people with intellectual or developmental disabilities (I/DD). Research consistently shows that the population with I/DD experiences poorer oral hygiene, higher prevalence and severity of periodontal disease, and higher incidence of untreated caries when compared to the general population. Poor oral health can cause chronic pain, affect the ability to eat and communicate, and adversely affect physical health and quality of life. Intervention strategies include enhanced prevention, increased routine care, expanded insurance coverage, and training for dentists and hygienists. Research is needed to identify the most effective interventions. A standard systematic literature review for evidence-based practices is not adequate for identifying and evaluating the evidence in areas such as health policy and individual health behaviors. This presentation describes the structured processes used in uncovering evidence where there is limited published literature that includes 1) the I/DD population and 2) traditional scientific reviews of interventions addressing their oral health. By adapting a transdisciplinary conceptual model, which could be applied to a multitude of disciplines, we identify the best available evidence as collected through a conventional systematic review, allowing for additional emphasis on the personal, social and environmental factors that affect the I/DD population. The process includes search strategies to include peer reviewed and gray literature, along with other associated programs, policies, and practices, resulting in a unique evidence base from varied sources. Additionally, we frame and refine a formal plan to review the outcomes and establish a level of evidence for the identified interventions

Magnetic frustration and spontaneous rotational symmetry breaking in PdCrO2

In the triangular layered magnet PdCrO2 the intralayer magnetic interactions are strong, however the lattice structure frustrates interlayer interactions. In spite of this, long-range, 120$^\circ$ antiferromagnetic order condenses at $T_N = 38$~K. We show here through neutron scattering measurements under in-plane uniaxial stress and in-plane magnetic field that this occurs through a spontaneous lifting of the three-fold rotational symmetry of the nonmagnetic lattice, which relieves the interlayer frustration. We also show through resistivity measurements that uniaxial stress can suppress thermal magnetic disorder within the antiferromagnetic phase.Comment: 9 pages, 9 figure

Post-transplant lymphoproliferative disorder presented as small bowel intussusception in adult liver transplant patient

Intestinal obstruction after liver transplant is a rare complication, with diverse clinical manifestations. Intestinal adhesion is the most common cause. However, internal hernia, abdominal wall hernia, and neoplasm are also reported. Intussusception is another rare cause of intestinal obstruction, which has been reported primarily in pediatric patients. Herein, we report a case of intestinal obstruction from intussusception in an adult liver transplant patient associated with post-transplant lymphoproliferative disorder

Strong peak in Tc of Sr2RuO4 under uniaxial pressure

Sr2RuO4 is an unconventional superconductor that has attracted widespread study because of its high purity and the possibility that its superconducting order parameter has odd parity. We study the dependence of its superconductivity on anisotropic strain. Applying uniaxial pressures of up to ~1 gigapascals along a 〈100〉 direction (a axis) of the crystal lattice results in the transition temperature (Tc) increasing from 1.5 kelvin in the unstrained material to 3.4 kelvin at compression by ≈0.6%, and then falling steeply. Calculations give evidence that the observed maximum Tc occurs at or near a Lifshitz transition when the Fermi level passes through a Van Hove singularity, and open the possibility that the highly strained, Tc = 3.4 K Sr2RuO4 has an even-parity, rather than an odd-parity, order parameter.PostprintPeer reviewe