Diabetes and Tooth Loss in a National Sample of Dentate Adults Reporting Annual Dental Visits

IntroductionPeriodontal disease has been associated with tooth loss and reported as more prevalent among people with diabetes than among those without diabetes. Having an annual dental examination is a national goal of Healthy People 2010. Our objective was to examine whether an association exists between diabetes and tooth loss among a population reporting an annual dental visit.MethodsWe used data from the 2004 Behavioral Risk Factor Surveillance System to examine the association between self-reported diabetes and tooth removal due to decay or periodontal disease among 155,280 respondents reporting a dental visit within the past year. We calculated prevalence estimates, odds ratios, and 95% confidence intervals. Multiple logistic regression allowed for adjustment.ResultsThe overall prevalence of tooth removal among the people in the study was 38.3%. People with diabetes had a significantly higher prevalence of tooth removal. In a multivariable model adjusting for selected covariates, respondents with diabetes were 1.46 times as likely (95% CI, 1.30–1.64) to have at least one tooth removed than respondents without diabetes. A stronger association between diabetes and tooth loss was observed among people in the younger age groups than among those in the older age groups.ConclusionEven among people reporting a recent dental visit, diabetes was independently associated with tooth loss. Multidisciplinary efforts are needed to raise awareness of the risk of tooth loss among younger people with diabetes. Good oral hygiene as well as annual dental examinations are important for preventing tooth loss

Collective impact : operationalizing a framework to coordinate community services

The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program provides comprehensive early childhood services. Federal agencies emphasize coordination of stakeholders for systems-building. Designing a well-coordinated system is complex. We reviewed MIECHV’s literature and program documents to identify community-coordination infrastructure elements. We designed visual frameworks for each model to display infrastructure, components, and connections. In the independent point of entry model, families access services directly. In the coordinated point of entry model, a centralized intake and referral structure supports system coordination. In the collective impact model, relevant community stakeholders actively and collaboratively participate in service coordination. Visual frameworks allow stakeholders to align on process and infrastructure of their programs to facilitate planning activities, use these frameworks to identify whether the model under which they operate is ideal, and then evolve their infrastructure.Includes bibliographical references (page 8-9)

Using Process Mining to Assess the Fidelity of a Home Visiting Program

Background: The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program is a federal public health initiative which supports at-risk families through evidence-based programs and promising approaches for pregnant women, and childhood development for children aged 0 to 5. These public health program funding mechanisms commonly include process evaluation mandates. Purpose: The use of process mining was explored as a methodology to assess the fidelity of the MIECHV programs’ actual workflow to that of their intended models. Methods: Research Electronic Data Capture (REDCap) data files that were populated with program process data elements from the local implementing agencies were mined. The focus was on three main variables: participant identification, activity labels, and timestamps. These variables were imported into the Disco process-mining software. Disco was used to develop process maps to track process pathways and compare the actual workflow against the intended model. Results: Using process mining as a diagnostic tool, fidelity to the MIECHV process model was assessed, identifying a total of 262 different process variations. The 15 most frequent variations represent 60.7% of the total pool of process variations, 13 of which were deemed to have fidelity to the intended model. Analysis of the variations indicated that many activities in the intended process were skipped or implemented out of sequence. Implications: Process mining is a useful tool for organizations to visually display, track, understand, compare, and improve their workflow processes. This method should be considered by programs as complex as MIECHV to improve the data reporting and the identification of opportunities to strengthen programs

Visualizing Complex Adaptive Systems: A Case Study of the Missouri Maternal, Infant, and Early Childhood Home Visiting Program

Background: The Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program was created by the 2010 Patient Protection and Affordable Care Act. MIECHV provides comprehensive services to at-risk families through evidence-based home visiting programs. Purpose: The following question is addressed: Does the Missouri MIECHV system meet the definition of a complex adaptive system (CAS)? Methods: A systematic review was conducted of documents related to MIECHV programs (federal, state, and local levels), and to affiliated programs with a home visiting and early childhood (aged birth to 5 years) scope. The organizations’ fit was identified for the scope of early childhood home visiting programs, and then its relationship extracted to MIECHV and its affiliates. Results: MIECHV meets the definition of a CAS, being dynamic, massively entangled, scale independent, transformative, and emergent. Over 250 organizations were identified; 19 federal and 79 state organizations; 24 nonprofits at the federal level, 31 at the state; over 150 community-level agencies; and 13 home visiting models implemented in Missouri. Implications: A considerable amount of organizational complexity exists within the MIECHV system and among its affiliates with a home visiting and early childhood scope. The complexity of the system challenges its potential for effective and efficient implementation, coordination, sustainability, and evaluation, and increases the potential for redundancy, overlap, and fragmentation. Evaluating a CAS requires acknowledgement of its complexity, beyond traditional approaches to evaluation. Creating visualization tools of federal, state, and local stakeholders and their relationships is a practical approach for aligning, organizing, and communicating the work flow

Missouri Research-Extension (MO-RE) protocol to accelerate the translation of science to communities

This project is designed to strengthen the bridge between research and practice through which leading science developed throughout the University of Missouri system (UM) is delivered to its communities, particularly in rural areas. MU Extension’s delivery systems offer immense potential for knowledge translation given they reach every community in the state, but there are infrastructure barriers connecting research to practice that require intentionality before these systems can realize their potential. A focus area of the work is closing the health and health care equity gap with high-touch community health approaches delivered through Extension educational programs that link Missouri communities with university research. The protocol’s creation represents the confluence of research and scholarship, clinical training and practice, and public and community health needs. [Excerpted paragraph from p. 6]This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $12,095,043 with 10 percent financed with nongovernmental sources (Grant # 6 T99HP33557-03-02) to Dr. Quinn. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government

A Prospective Assessment of Racial/Ethnic Differences in Future Mammography Behavior among Women Who had Early Mammography

29% of women aged 30-39 report having had a mammogram though sensitivity and specificity are low. We investigate racial/ethnic differences in future mammography behavior among women who had a baseline screening mammogram prior to age 40

Are there racial/ethnic disparities among women younger than 40 undergoing mammography?

While the probability of a woman developing invasive breast cancer at age <40 is low (<1%), mammography use reported among younger women (age <40) is substantial, and varies by race/ethnicity. Little detail is known about mammography use among women aged <40, particularly by race/ethnicity. We describe racial/ethnic differences in: (1) mammography indication after considering underlying risk factors (breast symptoms and family history); (2) follow-up recommendations, and (3) mammography outcomes for first mammograms in women aged <40. These 1996–2005 Breast Cancer Surveillance Consortium data are prospectively pooled from seven U.S. mammography registries. Our community-based sample included 99,615 women aged 18–39 who self-reported race/ethnicity and presented for a first mammogram (screening or diagnostic) with no history of breast cancer. Multivariable analyses controlled for registry site, age, family history of breast cancer, symptoms, and exam year. Overall, 73.6% of the women in our sample were seen for a screening mammogram. Following screening mammography, African American (AA) women were more likely than white women to be recommended for additional workup [relative risk (RR): 1.15 (95% CI: 1.07–1.23)]. Following diagnostic mammography, AA [RR: 1.30 (95% CI: 1.17–1.44)] and Asian [RR: 1.44 (95% CI: 1.26–1.64)] women were more likely to be recommended for biopsy, fine-needle aspiration, or surgical consultation. Depending on race/ethnicity, and considering the rate of true positive to total first screening mammograms of younger women, a women has a likelihood of a true positive of 1 in 363–1,122; she has a likelihood of a false positive of 1 in 7–10. This study of community-based practice found racial/ethnic variability in mammography indication, recommendations, and outcomes among women undergoing first mammography before 40. These findings highlight important areas for future research to understand the motivating factors for these practice patterns and the implications of early mammography use

Wrong schools or wrong students? The potential role of medical education in regional imbalances of the health workforce in the United Republic of Tanzania

<p>Abstract</p> <p>Background</p> <p>The United Republic of Tanzania, like many other countries in sub-Saharan Africa, faces a human resources crisis in its health sector, with a small and inequitably distributed health workforce. Rural areas and other poor regions are characterised by a high burden of disease compared to other regions of the country. At the same time, these areas are poorly supplied with human resources compared to urban areas, a reflection of the situation in the whole of Sub-Saharan Africa, where 1.3% of the world's health workforce shoulders 25% of the world's burden of disease. Medical schools select candidates for training and form these candidates' professional morale. It is therefore likely that medical schools can play an important role in the problem of geographical imbalance of doctors in the United Republic of Tanzania.</p> <p>Methods</p> <p>This paper reviews available research evidence that links medical students' characteristics with human resource imbalances and the contribution of medical schools in perpetuating an inequitable distribution of the health workforce.</p> <p>Existing literature on the determinants of the geographical imbalance of clinicians, with a special focus on the role of medical schools, is reviewed. In addition, structured questionnaires collecting data on demographics, rural experience, working preferences and motivational aspects were administered to 130 fifth-year medical students at the medical faculties of MUCHS (University of Dar es Salaam), HKMU (Dar es Salaam) and KCMC (Tumaini University, Moshi campus) in the United Republic of Tanzania. The 130 students represented 95.6% of the Tanzanian finalists in 2005. Finally, we apply probit regressions in STATA to analyse the cross-sectional data coming from the aforementioned survey.</p> <p>Results</p> <p>The lack of a primary interest in medicine among medical school entrants, biases in recruitment, the absence of rural related clinical curricula in medical schools, and a preference for specialisation not available in rural areas are among the main obstacles for building a motivated health workforce which can help correct the inequitable distribution of doctors in the United Republic of Tanzania.</p> <p>Conclusion</p> <p>This study suggests that there is a need to re-examine medical school admission policies and practices.</p

Revival of the magnetar PSR J1622-4950: observations with MeerKAT, Parkes, XMM-Newton, Swift, Chandra, and NuSTAR

New radio (MeerKAT and Parkes) and X-ray (XMM-Newton, Swift, Chandra, and NuSTAR) observations of PSR J1622-4950 indicate that the magnetar, in a quiescent state since at least early 2015, reactivated between 2017 March 19 and April 5. The radio flux density, while variable, is approximately 100x larger than during its dormant state. The X-ray flux one month after reactivation was at least 800x larger than during quiescence, and has been decaying exponentially on a 111+/-19 day timescale. This high-flux state, together with a radio-derived rotational ephemeris, enabled for the first time the detection of X-ray pulsations for this magnetar. At 5%, the 0.3-6 keV pulsed fraction is comparable to the smallest observed for magnetars. The overall pulsar geometry inferred from polarized radio emission appears to be broadly consistent with that determined 6-8 years earlier. However, rotating vector model fits suggest that we are now seeing radio emission from a different location in the magnetosphere than previously. This indicates a novel way in which radio emission from magnetars can differ from that of ordinary pulsars. The torque on the neutron star is varying rapidly and unsteadily, as is common for magnetars following outburst, having changed by a factor of 7 within six months of reactivation.Comment: Published in ApJ (2018 April 5); 13 pages, 4 figure