By Word of Mouth: A Qualitative Approach to Understanding the Integration of Preventive Dental Health in Primary Care Settings

Childhood and adolescence are sensitive periods in the lifespan when oral and craniofacial appearances can help determine social interactions and lifetime outcomes. In this respect, oral health can be viewed as more than just brushing or flossing for healthy teeth; children’s oral health can influence their social development and behaviors, impact their academic growth, affect their guardian’s responsibility for healthcare cost and create a potential pathway for negative impacts on quality of life. Access to quality oral healthcare is vital for the prevention of unwanted diseases and to avoid the burden of oral health complications. Oral health disparities may not be the consequence of negligence, but rather, the result of unmet needs and limited access to quality oral health care. Collaborations within systems of care that include medical and dental health professionals may lead to opportunities for improvements in oral health and overall health among children and adolescents. This research study was focused on medical-dental collaboration model and its potential to provide an opportunity to meet the oral health needs of children and adolescents. Therefore, the overall goal of this study was to understand how preventive dental health was integrated in the pediatric primary care settings that participated in the Quality through Technology & Innovation in Pediatrics (QTIP) demonstration project. Data were collected from August 2014 – January 2015 and analyzed in two stages. First, we conducted a directed content analysis using data provided by the QTIP project director. Second, twenty-two QTIP participants were interviewed using qualitative methods. Overall, the process evaluation data suggested that the principles of preventive dental health integration were successfully implemented as result of the QTIP demonstration project. Through examination of the process evaluation domains of fidelity, dose delivered, reach and dose received, we were able to determine to what extent primary care pediatric practices engaged with materials and trainings of the QTIP demonstration project and how primary care pediatric practices integrated preventive dental health in their medical settings. Through the qualitative interviews we identified seven key themes related to the feasibility of integrating preventive dental health: 1) communication between staff members; 2) role delineation; 3) preventive dental health education and training; 4) sustaining improvement; 5) willingness to engage in QTIP recommendations for preventive dental health; 6) parent behaviors and 7) practice-based recommendations for preventive dental health integration. We also categorized each practice as having a strong, moderate, or weak preventive dental health implementation based on their perceived achievement of preventive dental health integration in their medical setting. Overall, the findings of this dissertation revealed that preventive dental health integration has the potential to be a feasible and effective strategy to improving the oral health outcomes for children and adolescents in South Carolina (SC)

Distributional reinforcement learning in prefrontal cortex

The prefrontal cortex is crucial for learning and decision-making. Classic reinforcement learning (RL) theories center on learning the expectation of potential rewarding outcomes and explain a wealth of neural data in the prefrontal cortex. Distributional RL, on the other hand, learns the full distribution of rewarding outcomes and better explains dopamine responses. In the present study, we show that distributional RL also better explains macaque anterior cingulate cortex neuronal responses, suggesting that it is a common mechanism for reward-guided learning

Safe, Supportive Neighborhoods: Are They Associated With Childhood Oral Health?

Objective There has been limited examination of how community-level supports may influence oral health metrics among children. The purpose of our study is to examine the association between two types of community-level positive childhood experiences and oral healthcare and oral health outcomes among children ages 6 to 17 years of age. Methods This study uses a cross-sectional data set from the 2018–2019 National Survey of Children\u27s Health. Two oral health metrics were used: preventive dental care, measured as one or more preventive dental visits in the past 12 months, and tooth decay, measured as tooth decay or cavities in the last 12 months. To quantify living in safe, stable, equitable environments, questions on residing in a safe and supportive neighborhood were used. Descriptive statistics and bivariate analyses were used to calculate frequencies, proportions, and unadjusted associations for each variable (n = 40,290). Multivariable logistic regression models were used. Results In an adjusted analysis, children who lived in a supportive neighborhood had a higher likelihood of receiving a preventive dental visit than children who did not live in a supportive neighborhood (aOR 1.41; 95% CI 1.21–1.65). Children who lived in a safe neighborhood were less likely to have tooth decay than children who did not live in a safe neighborhood (aOR 0.75; 95% CI 0.65–0.86). Conclusions The findings from this study highlight the role of social structures in tightening the safety net for oral healthcare in children

Efficacy of a meal replacement diet plan compared to a food-based diet plan after a period of weight loss and weight maintenance: a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Obesity has reached epidemic proportions in the United States. It is implicated in the development of a variety of chronic disease states and is associated with increased levels of inflammation and oxidative stress. The objective of this study is to examine the effect of Medifast's meal replacement program (MD) on body weight, body composition, and biomarkers of inflammation and oxidative stress among obese individuals following a period of weight loss and weight maintenance compared to a an isocaloric, food-based diet (FB).</p> <p>Methods</p> <p>This 40-week randomized, controlled clinical trial included 90 obese adults with a body mass index (BMI) between 30 and 50 kg/m², randomly assigned to one of two weight loss programs for 16 weeks and then followed for a 24-week period of weight maintenance. The dietary interventions consisted of Medifast's meal replacement program for weight loss and weight maintenance, or a self-selected, isocaloric, food-based meal plan.</p> <p>Results</p> <p>Weight loss at 16 weeks was significantly better in the Medifast group (MD) versus the food-based group (FB) (12.3% vs. 6.9%), and while significantly more weight was regained during weight maintenance on MD versus FB, overall greater weight loss was achieved on MD versus FB. Significantly more of the MD participants lost ≥ 5% of their initial weight at week 16 (93% vs. 55%) and week 40 (62% vs. 30%). There was no difference in satiety observed between the two groups during the weight loss phase. Significant improvements in body composition were also observed in MD participants compared to FB at week 16 and week 40. At week 40, both groups experienced improvements in biochemical outcomes and other clinical indicators.</p> <p>Conclusions</p> <p>Our data suggest that the meal replacement diet plan evaluated was an effective strategy for producing robust initial weight loss and for achieving improvements in a number of health-related parameters during weight maintenance, including inflammation and oxidative stress, two key factors more recently shown to underlie our most common chronic diseases.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov NCT01011491</p

Chronic disease self‐management programs for Aboriginal and Torres Strait Islander people: Factors influencing participation in an urban setting

Issue addressed Evidence suggests that participation in a Chronic Disease Self-Management (CDSM) program improves the health of clients. Many factors are known to influence participation in these programs for the broader Australian population. However, less is known about why Aboriginal and Torres Strait Islanders choose to participate. This study identifies key factors that support or enable Aboriginal and Torres Strait Islanders to participate in a CDSM program in an urban setting. Methods Twelve focus groups were undertaken with a total of 102 participants who were diagnosed with or at risk of chronic disease. These participants were recruited from the Work It Out program, a CDSM program comprising exercise and health education. The Work It Out program is specifically designed for Aboriginal and Torres Strait Islanders and delivered by an Aboriginal led and community-controlled organisation in South-East and Central Queensland. The study received ethical clearance through the Behavioural and Social Sciences Ethical Review Committee at The University of Queensland (Approval Number 2011001283). Results Findings indicate that key features of program design based on a culturally responsive approach influences participation. The main features are as follows: providing easy access to the program; permitting flexibility in attendance; a group environment; the approach of program staff that prioritises relationship building; personalised and integrated care; communicating result regularly; and ensuring community ownership of the program. Conclusion These findings are useful to consider when designing a health program for Aboriginal and Torres Strait Islanders. Programs which are culturally responsive and include the design features identified in this study are more likely to increase participation amongst Aboriginal and Torres Strait Islanders. So What? Increasing participation of Aboriginal and Torres Strait Islanders in CDSM programs using the design features identified in the paper may contribute significantly in closing the health disparity gap

Formative research to promote lupus awareness and early screening at Historically Black College and University (HBCU) communities in South Carolina

Abstract Background Systemic lupus erythematosus or lupus is a severe chronic autoimmune disorder that disproportionately impacts young African Americans. Increasing lupus awareness in this high-risk group may be an effective approach to ultimately improving lupus outcomes. To begin to address this disparity, this report describes qualitative data to be utilized in the development of a campaign to enhance awareness of lupus on Historically Black Colleges and University (HBCU) campuses. Methods Two focus groups (N = 14) were held with African American students in the network of HBCU’s in South Carolina to examine perspectives of focus group participants on knowledge, awareness, and experiences with lupus. Results Five key emergent themes included: (1) Lupus Knowledge and Awareness, (2) Barriers for Not Seeking Healthcare, (3) Fatalism for Disease Burden, (4) Lifestyle Debilitation, and (5) Elevation of Education and Advocacy for Lupus. Additionally, five key recommendations emerged to improve lupus awareness and support, including: (1) remaining positive, (2) developing a supportive network, (3) the importance of increasing advocacy efficacy, and (4) messaging strategies around lupus, and (5) providing education to foster knowledge around the clinical impacts of lupus. Conclusion Participants in our study stressed the necessity of lupus education and awareness among African American youth and expressed the desire for resources that would enable them to advocate for themselves and their families. Given the early age of onset for lupus, it is therefore vital to include African American youth in increasing education and awareness about lupus

PERAN SOCIAL SUPPORT TERHADAP WORK CONFLICT, KEPUASAN DAN KINERJA

Penelitian ini bertujuan untuk mengukur pengaruh konflik kerja-keluarga terhadap kepuasan kerja dan kinerja karyawan wanita dari industri pengemasan di Tangerang yang dimoderasi oleh dukungan sosial. Pengumpulan data dilakukan dengan simple random sampling untuk 171 populasi karyawan wanita. Hasil kuesioner yang dikembalikan dan valid adalah 134 sampel. Pemrosesan data menggunakan metode SEM dengan perangkat lunak SmartPLS 3.0. Hasil penelitian ini menyimpulkan bahwa konflik kerja-keluarga memiliki pengaruh negatif dan signifikan terhadap kepuasan kerja. Sementara itu, konflik kerja-keluarga tidak berpengaruh signifikan terhadap kinerja karyawan

Projected climate change impacts on tropical life zones in Costa Rica. Progress in Physical Geography: Earth and Environment

Efforts to protect tropical ecosystems aim at implementing biological corridors across the national territory of Costa Rica. However, potential near-future climate change challenges the effectiveness of such conservation measures. For this purpose, we developed near-future climate change scenarios at high spatial resolution using open-access global data from the Copernicus Climate Data Store (CDS). These projections resulted from downscaling (to a 1km2 national grid) and quantile-mapping bias-correction of the Essential Climate Variables Global Circulation Model (ECV_GCM) ensemble mean from the CDS using a moderate Representative Concentration Pathway 4.5 (RCP4.5). Projections were evaluated with limited local station data and applied to generate future ecosystem indicators (Holdridge Life Zones, HLZs). We show significantly increasing temperatures of 2.6°C with a spatial variability of ± 0.4°C for Costa Rica until 2040 with local differences (higher temperatures projected for the southern Costa Rican Caribbean). The future mean annual precipitation showed slightly wetter conditions (120 ± 43 mm/year) and most prominently in the Costa Rican Caribbean and south Pacific, but no significant drying in the north of Costa Rica by 2040. The bias-corrected climate data were aggregated to decadal and 30-year average (1971–2040) life zone ecosystem indicators that could potentially show ecosystem shifts. Changes in the life zones are most likely due to warmer temperatures and to a lesser extent caused by projected wetter conditions. Shifts are more likely to occur at higher elevations with a potential loss of the sub-tropical rainforest ecosystem. The projections support diminishing tropical dry forests and slightly increasing tropical rain and wet forests in the biological corridors of the driest and wettest regions, respectively. A countrywide spatial uniformity of dominating tropical moist forests (increase from 24% to 49%) at the expense of other HLZs was projected by 2040.Universidad de Costa Rica/[217-B8-276]/UCR/Costa RicaUniversidad de Costa Rica/[ED-3319]/UCR/Costa RicaUniversidad de Costa Rica/[217-C0-603]/UCR/Costa RicaUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Básicas::Centro de Investigaciones Geofísicas (CIGEFI)UCR::Vicerrectoría de Docencia::Ciencias Sociales::Facultad de Ciencias Sociales::Escuela de Geografí