Oral Health: Successes and Opportunities for Children's Health Initiatives

Examines the relationship between dental insurance and oral health improvement, including access to oral health care. Looks at utilization of dental services by children in the Children's Health Initiatives as well as other programs

Paradox in Paradise: Hidden Health Inequities on California's Central Coast

Examines the health of people living in the Central Coast region of California, and provides data about the area's increasingly diversified population and challenged health delivery system

Adult Dental Medi-Cal Cuts: Costs & Consequences

Outlines the expected impact of the proposal to eliminate California's Medi-Cal dental benefits for adults not in nursing facilities, including loss of federal matching funds, reduced access to dental care, and effects on concomitant health conditions

Maternal factors shaping the fetal environment and the occurrence of autism spectrum disorders

Thesis (Ph.D.)--Boston UniversityMaternal stress response, micronutrient deficiency and maternal immune activation have all been implicated in the etiology of autism spectrum disorders (ASD). We evaluated several maternal factors that might act through one or more of these mechanisms. Specifically, we assessed the independent effects of maternal illness before and during pregnancy (Study 1) and maternal pre-pregnancy obesity (Study 2) on the risk of ASD using a case-control design among patients born into the General Practice Research Database from 1993-2008. We also assessed the effects of short interpregnancy interval and maternal history of pregnancy loss (Study 3) on the risk of ASD through age 3 years using a cohort design among individuals born to multigravida in Massachusetts from 2000-2010. Conditional logistic regression (Studies 1 and 2) or log-binomial regression models (Study 3) were used to analyze the data. In study 1, we found modest associations with maternal bacterial infection (aOR: 1.5, 95% CI: 1.1, 2.0) and asthma (aOR: 1.3, 95% CI: 1.1, 1.5), which were consistent across the ASD subtypes. No association was found between maternal autoimmune disease and ASDs. In study 2, we observed a nonlinear association between maternal BMI and ASD that suggested extremes in maternal BMI (underweight and obesity) are associated with modest increases in the risk for ASD among offspring. In study 3, we found a non-linear association with IPI, where IPI lengths less than 18 months and longer than 60 months were associated with an increased risk for ASD. This association was restricted to consecutive live births and stronger for younger mothers than older mothers. A history of pregnancy loss among multigravida was also associated with a modest increase in ASD risk. Together these findings contribute important information about the etiology of autism spectrum disorders and provide additional support for the maternal immune activation and nutritional depletion hypotheses

The Evolution of Multilateral Regimes: Implications for Climate Change

Examines why multilateral regimes deepen, broaden, and integrate; analyzes the evolution of the United Nations Framework Convention on Climate Change into a more incremental approach to reaching a legally binding agreement; and explores implications

Evaluation of Durability of Nonwoven Polypropylene Grocery Bags Under Routine Use

Recently, the thin plastic-film bags distributed at thousands of checkouts across the United States have been targeted by environmental advocacy groups as wasteful nuisance packaging, and many places have passed legislation to ban or restrict their distribution. The resulting demand for a more durable grocery bag able to withstand reuse has led to a rise in popularity for bags made from fabric, and the relative durability and low cost of nonwoven polypropylene fabric has made it a popular choice of material. However, studies have shown that these bags come with their own set of issues: their reusability makes them a vector for cross-contamination, and many consumers do not reuse their bags enough to recoup the additional cost of materials and energy needed to create the thicker material. Many of the bag laws offer guidelines for determining if a given bag officially qualifies as “reusable,” but at this time, virtually no data exists regarding the real-world durability of nonwoven polypropylene bags. To test whether they could handle the real-world wear-and-tear, 40 nonwoven polypropylene bags were loaded with grocery items and carried by hand for 125 repetitions of 175 feet, with half of the samples undergoing machine-washing every 25 repetitions to determine if washing would affect the durability of the bag. Additionally, 80 bags were tested with the mechanically-assisted ATP-001 testing protocol suggested by the Los Angeles County Department of Public Works, to see if it could serve as an acceptable alternative to the physically-intensive walk test. Half of this sample was also washed, to see if this had an effect on lifespan. All 20 of the unwashed, hand-carried bags withstood at least 50 reuses, and 12 out of 20 of them withstood the required 125 reuses necessary to meet the most strenuous definition of reusable bag required by various municipal laws. Washing did appear to result in a lower lifespan, with only 7 of the 20 bags able to withstand both 125 reuses and 5 machine-wash cycles. The ATP-001 tests, conducted with slightly different criteria for failure, resulted in similar rates of success, with 23 out of 40 unwashed bags and 14 out of 40 washed bags able to withstand testing

Year in review 2011: Critical Care – neurocritical care

Contributions from the neurosciences to Critical Care in 2011 covered an array of topics. We learned about potential biomarkers for, and the effect of cerebral oxygen metabolism on, delirium, in addition to treatment of the latter. A group of investigators studied surface cooling in healthy awake volunteers, and incidence of infection associated with therapeutic hypothermia. The effects of statin and erythropoietin on stroke were revisited, and the role of adhesion molecule in the inflammatory reaction accompanying intracerebral hemorrhage was scrutinized. Biomarkers in subarachnoid hemorrhage and their relationship to vasospasm and outcome, and effect of daylight on outcome in this patient population, as well as a new meta-analysis of statin therapy were among the research in subarachnoid hemorrhage. Moreover, 2011 witnessed the publication of a multidisciplinary consensus conference's recommendations on the critical care management of subarachnoid hemorrhage. Results of studies regarding the diagnosis and vascular complications of meningitis were reported. Traumatic brain injury received its share of articles addressing therapy with hypertonic saline and surgical decompression, the development of coagulopathy, and biomarkers to help with prognostication. Finally, research on the treatment of Guillain-Barre syndrome in children, prediction of long-term need of ventilatory support, and pathophysiology of critical illness polyneuropathy and myopathy were reported

Clinical review: Prevention and therapy of vasospasm in subarachnoid hemorrhage

Vasospasm is one of the leading causes of morbidity and mortality following aneurysmal subarachnoid hemorrhage (SAH). Radiographic vasospasm usually develops between 5 and 15 days after the initial hemorrhage, and is associated with clinically apparent delayed ischemic neurological deficits (DID) in one-third of patients. The pathophysiology of this reversible vasculopathy is not fully understood but appears to involve structural changes and biochemical alterations at the levels of the vascular endothelium and smooth muscle cells. Blood in the subarachnoid space is believed to trigger these changes. In addition, cerebral perfusion may be concurrently impaired by hypovolemia and impaired cerebral autoregulatory function. The combined effects of these processes can lead to reduction in cerebral blood flow so severe as to cause ischemia leading to infarction. Diagnosis is made by some combination of clinical, cerebral angiographic, and transcranial doppler ultrasonographic factors. Nimodipine, a calcium channel antagonist, is so far the only available therapy with proven benefit for reducing the impact of DID. Aggressive therapy combining hemodynamic augmentation, transluminal balloon angioplasty, and intra-arterial infusion of vasodilator drugs is, to varying degrees, usually implemented. A panoply of drugs, with different mechanisms of action, has been studied in SAH related vasospasm. Currently, the most promising are magnesium sulfate, 3-hydroxy-3-methylglutaryl-CoA reductase inhibitors, nitric oxide donors and endothelin-1 antagonists. This paper reviews established and emerging therapies for vasospasm

Year in review 2010: Critical Care- neurocritical care

In 2010 Critical Care published a large number of articles on critical care aspects of neurologic and neurosurgical conditions. These aspects included investigation of diagnostic criteria for bacterial meningitis, critical illness myopathy and their relationship to systemic inflammation. A number of studies investigated the biology of sepsis-related delirium, its biomarkers, its relationship to inflammation and its impact on outcome. Other teams reported on the use of magnetic resonance imaging, biomarkers and electroencephalogram to predict outcome in patients who were comatose following cardiac arrest. Our understanding of the pathophysiology as well as management of subarachnoid hemorrhage was addressed in several papers. Topics included the effect of hemodynamic treatment of delayed cerebral ischemia, pulmonary edema and the impact of subarachnoid hemorrhage on endocrine function. Finally, outcome from neurocritical care and patients' retrospective willingness to consent to the treatment they received were reported