Oral Health in Communities and Neighborhoods (OHICAN) Pilot Project: The Burden of Poor Oral Health

Poor oral health afflicts many low-income and other vulnerable populations. Lack of access to oral health can lead to unnecessary tooth decay, periodontal disease, pain, and the advancement of oral cancer. The absence of preventive care often leads to unnecessary and expensive visits to hospital-based emergency departments to address the pain of dental disease but not the causal conditions. The consequences on inequitable access to dental care are significant for individuals, families and communities. The OHICAN pilot project looked to address the lack of equitable access to care by creating new points of access, training medical providers to perform oral exams and apply fluoride when indicated, thus increasing the oral health workforce, utilizing technology to bridge clinical practice, education, training and research, educating stakeholders to allow dental hygienists to provide preventive care under general supervision, and creating business models that will assist others who seek to create a dental home for those they serve. Social, political and economic forces all contribute to varying degrees in terms of equity in healthcare. The work of OHICAN was designed to create a blueprint for potential solutions to these issues in order to foster oral health equity. Changes to improve access to dental care can take place in a relatively short period of time when all who care and are impacted by this continued unmet oral health need work together

Cognitive Behavioral Group Treatment for Social Phobia: Comparison with a Credible Placebo Control

Forty-nine patients participated in a study comparing cognitive-behavioral group treatment (CBGT) for social phobia with a credible placebo control. CBGT consisted of exposure to simulated phobic events, cognitive restructuring of maladaptive thoughts, and homework for self-directed exposure and cognitive restructuring between sessions. Control patients received a treatment package consisting of lecture-discussion and group support that was comparable to CBGT on measures of treatment credibility and outcome expectations. At pretest, posttest, and 3- and 6-month follow-ups, patients completed assessments that included clinician ratings, self-report measures, and behavioral physiological and cognitive-subjective measures derived from a behavioral simulation of a personally relevant phobic event. Both groups improved on most measures, but, at both posttest and follow-up, CBGT patients were rated as more improved than controls and reported less anxiety before and during the behavioral test. At follow-up, CBGT patients also reported significantly fewer negative and more positive self-statements than controls on a thought-listing task following the behavioral test. Regardless of treatment condition, follow-up changes in clinician-rated phobic severity were significantly related to changes on the thought-listing measure

Community-based field implementation scenarios of a short message service reporting tool for lymphatic filariasis case estimates in Africa and Asia

BACKGROUND: Lymphatic filariasis (LF) is a neglected tropical disease (NTD) targeted for global elimination by 2020. Currently there is considerable international effort to scale-up morbidity management activities in endemic countries, however there remains a need for rapid, cost-effective methods and adaptable tools for obtaining estimates of people presenting with clinical manifestations of LF, namely lymphoedema and hydrocele. The mHealth tool 'MeasureSMS-Morbidity' allows health workers in endemic areas to use their own mobile phones to send clinical information in a simple format using short message service (SMS). The experience gained through programmatic use of the tool in five endemic countries across a diversity of settings in Africa and Asia is used here to present implementation scenarios that are suitable for adapting the tool for use in a range of different programmatic, endemic, demographic and health system settings. METHODS: A checklist of five key factors and sub-questions was used to determine and define specific community-based field implementation scenarios for using the MeasureSMS-Morbidity tool in a range of settings. These factors included: (I) tool feasibility (acceptability; community access and ownership); (II) LF endemicity (high; low prevalence); (III) population demography (urban; rural); (IV) health system structure (human resources; community access); and (V) integration with other diseases (co-endemicity). RESULTS: Based on experiences in Bangladesh, Ethiopia, Malawi, Nepal and Tanzania, four implementation scenarios were identified as suitable for using the MeasureSMS-Morbidity tool for searching and reporting LF clinical case data across a range of programmatic, endemic, demographic and health system settings. These include: (I) urban, high endemic setting with two-tier reporting; (II) rural, high endemic setting with one-tier reporting; (III) rural, high endemic setting with two-tier reporting; and (IV) low-endemic, urban and rural setting with one-tier reporting. CONCLUSIONS: A decision-making framework built from the key factors and questions, and the resulting four implementation scenarios is proposed as a means of using the MeasureSMS-Morbidity tool. This framework will help national LF programmes consider appropriate methods to implement a survey using this tool to improve estimates of the clinical burden of LF. Obtaining LF case estimates is a vital step towards the elimination of LF as a public health problem in endemic countries

Cancer negatively impacts on sexual function in adolescents and young adults: The AYA HOPE study

ObjectiveThis cohort study examined the impact of cancer on sexual function and intimate relationships in adolescents and young adults (AYAs). We also explored factors predicting an increased likelihood that cancer had negatively affected these outcomes.MethodsParticipants (nâ =â 465, ages 15â 39) in the Adolescent and Young Adult Health Outcomes and Patient Experience (AYA HOPE) study completed two surveys approximately 1 and 2 years postâ cancer diagnosis. We used multivariable logistic regression to determine factors negatively affected by perceptions of sexual function at 2 years postâ diagnosis.ResultsFortyâ nine percent of AYAs reported negative effects on sexual function at 1 year postâ cancer diagnosis and 70% of those persisted in their negative perceptions 2 years after diagnosis. Those reporting a negative impact at 2 years were more likely to be 25 years or older (OR, 2.53; 95% CI, 1.44â 4.42), currently not raising children (OR, 1.81; 95% CI, 1.06â 3.08), experiencing fatigue (OR, 0.99; 95% CI, 0.975â 0.998) and more likely to report that their diagnosis has had a negative effect on physical appearance (OR, 3.08; 95% CI, 1.97â 4.81). Clinical factors and mental health were not significant predictors of negative effects on sexual function.ConclusionsMany AYAs diagnosed with cancer experience a persistent negative impact on sexual life up to 2 years following diagnosis. The findings underscore the need to develop routine protocols to assess sexual function in AYAs with cancer and to provide comprehensive management in the clinical setting. Copyright © 2016 John Wiley & Sons, Ltd.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138867/1/pon4181_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138867/2/pon4181.pd

[Review] Cian Duffy (2014) My purpose was humbler, but also higher: Thomas De Quincey’s 'System of the heavens’, popular science and the sublime

Review of article: Duffy Cian, Romanticism, Volume 20 Issue 1, Page 1-14, ISSN 1354-991x Available Online Mar 201

How to design a study to evaluate therapeutic drug monitoring in infectious diseases?

Background: Therapeutic drug monitoring (TDM) is a tool to personalize and optimize dosing by measuring the drug concentration and subsequently adjusting the dose to reach a target concentration or exposure. The evidence to support TDM is however often ranked as expert opinion. Limitations in study design and sample size have hampered definitive conclusions of the potential added value of TDM. Objectives: We aim to give expert opinion and discuss the main points and limitations of available data from antibiotic TDM trials and emphasize key elements for consideration in design of future clinical studies to quantify the benefits of TDM. Sources: The sources were peer-reviewed publications, guidelines and expert opinions from the field of TDM. Content: This review focuses on key aspects of antimicrobial TDM study design: describing the rationale for a TDM study, assessing the exposure of a drug, assessing susceptibility of pathogens and selecting appropriate clinical endpoints. Moreover we provide guidance on appropriate study design. Implications: This is an overview of different aspects relevant for the conduct of a TDM study. We believe that this paper will help researchers and clinicians to design and conduct high-quality TDM studies

Significant improvement in quality of life following surgery for hydrocoele caused by lymphatic filariasis in Malawi: A prospective cohort study

Lymphatic filariasis (LF) is a mosquito-borne parasitic infection that causes significant disabling and disfiguring clinical manifestations. Hydrocoele (scrotal swelling) is the most common clinical condition, which affects an estimated 25 million men globally. The recommended strategy is surgical intervention, yet little is known about the impact of hydrocoele on men’s lives, and how it may change if they have access to surger

Social class origin and assortative mating in Britain, 1949-2010

This article examines trends in assortative mating in Britain over the last 60 years. Assortative mating is the tendency for like to form a conjugal partnership with like. Our focus is on the association between the social class origins of the partners. The propensity towards assortative mating is taken as an index of the openness of society which we regard as a macro level aspect of social inequality. There is some evidence that the propensity for partners to come from similar class backgrounds declined during the 1960s. Thereafter, there was a period of 40 years of remarkable stability during which the propensity towards assortative mating fluctuated trendlessly within quite narrow limits. This picture of stability over time in social openness parallels the well-established facts about intergenerational social class mobility in Britain