A Community-Based Dental Program for Older Adults

The planning and implementation of a community-based outreach program for older adults is described. Objectives of the program were to provide dental health education to older persons at their place of residence, to improve access to dental care for that population, and to increase the number of older adults treated at a dental facility administered by the Department of Community Dentistry, University of Michigan. Data collected during encounters with participants are reported to supplement the description of the program. In the first year, 98 older adults (mean age 71.3 years)participated in the outreach program which was directed by a dental hygienist. Of those persons whose initial encounter was with the outreach program, 47 percent eventually contacted the dental care facility and 36 percent completed treatment. Persons who elected to seek treatment averaged 3.9 encounters with the hygienist during the program; persons who did not seek treatment averaged 2.2 encounters. Strengths and weaknesses of the program are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66221/1/j.1752-7325.1984.tb03075.x.pd

Synaptic Defects in the Spinal and Neuromuscular Circuitry in a Mouse Model of Spinal Muscular Atrophy

Spinal muscular atrophy (SMA) is a major genetic cause of death in childhood characterized by marked muscle weakness. To investigate mechanisms underlying motor impairment in SMA, we examined the spinal and neuromuscular circuitry governing hindlimb ambulatory behavior in SMA model mice (SMNΔ7). In the neuromuscular circuitry, we found that nearly all neuromuscular junctions (NMJs) in hindlimb muscles of SMNΔ7 mice remained fully innervated at the disease end stage and were capable of eliciting muscle contraction, despite a modest reduction in quantal content. In the spinal circuitry, we observed a ∼28% loss of synapses onto spinal motoneurons in the lateral column of lumbar segments 3–5, and a significant reduction in proprioceptive sensory neurons, which may contribute to the 50% reduction in vesicular glutamate transporter 1(VGLUT1)-positive synapses onto SMNΔ7 motoneurons. In addition, there was an increase in the association of activated microglia with SMNΔ7 motoneurons. Together, our results present a novel concept that synaptic defects occur at multiple levels of the spinal and neuromuscular circuitry in SMNΔ7 mice, and that proprioceptive spinal synapses could be a potential target for SMA therapy

Reported Pain and Fatigue Behaviors Mediate the Relationship Between Catastrophizing and Perceptions of Solicitousness in Patients With Chronic Fatigue

Catastrophizing is associated with negative outcomes in chronic pain and illness. The communal coping model (CCM) and cognitive behavioral (CB) formulations provide differing accounts of the function of catastrophizing in these contexts. In the present study we examined predictions from CCM and CB theoretical models in a sample of 116 patients with chronic fatigue to test 1) whether patient-reported solicitous responses from significant others mediate the relationship of catastrophizing with patient-reported pain and fatigue behaviors, as predicted by the CCM; and 2) whether pain and fatigue behaviors mediate the relationship of catastrophizing with solicitous responses, consistent with a CB model. This work is a secondary data analysis in which the strength of the indirect (ie, mediating) effects among study variables was examined. Consistent with CB models, pain and fatigue behaviors were associated with catastrophizing and solicitous responses, and there was a significant indirect effect of catastrophizing on solicitous responses through pain and fatigue behaviors. Results were inconsistent with the CCM; catastrophizing was not significantly associated with solicitous responses, nor did solicitous responses mediate the relationship between catastrophizing and pain or fatigue behaviors. These findings highlight the importance of behavioral expressions of pain and fatigue in understanding the relationship of catastrophizing to solicitous responses in chronic fatigue. This study of chronic fatigue patients tested CB and CCMs of catastrophizing, pain, and fatigue behaviors, and solicitous responses by significant others. Results were more consistent with CB formulations, which highlighted the importance of behavioral expressions of pain and fatigue in understanding the relationship of catastrophizing to solicitous responses. •Communal coping and behavioral models of catastrophizing make different predictions.•In this study we tested mediational paths from these models in chronic fatigue patients.•Catastrophizing's effects on solicitousness occurred through pain/fatigue behavior.•Solicitousness did not mediate the path of catastrophizing to pain/fatigue behavior.•Results were more consistent with a cognitive behavioral than communal coping model

Stakeholder Engagement in Pragmatic Clinical Trials: Emphasizing Relationships to Improve Pain Management Delivery and Outcomes

BackgroundThe NIH-DOD-VA Pain Management Collaboratory (PMC) supports 11 pragmatic clinical trials (PCTs) on nonpharmacological approaches to management of pain and co-occurring conditions in U.S. military and veteran health organizations. The Stakeholder Engagement Work Group is supported by a separately funded Coordinating Center and was formed with the goal of developing respectful and productive partnerships that will maximize the ability to generate trustworthy, internally valid findings directly relevant to veterans and military service members with pain, front-line primary care clinicians and health care teams, and health system leaders. The Stakeholder Engagement Work Group provides a forum to promote success of the PCTs in which principal investigators and/or their designees discuss various stakeholder engagement strategies, address challenges, and share experiences. Herein, we communicate features of meaningful stakeholder engagement in the design and implementation of pain management pragmatic trials, across the PMC.DesignOur collective experiences suggest that an optimal stakeholder-engaged research project involves understanding the following: i) Who are research stakeholders in PMC trials? ii) How do investigators ensure that stakeholders represent the interests of a study's target treatment population, including individuals from underrepresented groups?, and iii) How can sustained stakeholder relationships help overcome implementation challenges over the course of a PCT?SummaryOur experiences outline the role of stakeholders in pain research and may inform future pragmatic trial researchers regarding methods to engage stakeholders effectively

Radiogenomics: radiobiology enters the era of big data and team science.

Radiogenomics is the study of the link between germ line genotypic variations and the large clinical variability observed in response to radiation therapy. The radiogenomics hypothesis is that a proportion of the variance in the phenotype of interest – radiation toxicity - is explained by genotypic variation. Thus, the aim of radiogenomics is to identify the alleles that underlie the inherited dissimilarities in phenotype. However, this hypothesis does not assume that all of the phenotypic differences are due to germ line genetic alterations, but acknowledges that epigenetic changes (inherited and acquired) and other factors could also be important.In order to foster collaborative research, the Radiogenomics Consortium (RGC) was established in 2009 (1). The RGC currently has 174 members from 90 institutions in 20 countries and is an NCI supported cancer epidemiology consortium (2). The goal of the RGC is to facilitate large-scale collaborative research assessing gene-radiation effect relationships, including genome wide association studies (GWAS). The aim of this research is to produce assays for use in the clinic to predict risk of toxicities following radiotherapy, given alone or in multi-modality treatments. The results of this research could also lead to the identification of novel strategies for prevention or mitigation of toxicities. Currently, the radiogenomics landscape is rapidly changing. This is partly a result of research advances within the field of radiogenomics itself and partly due to progress in biotechnology and medical informatics that facilitate the pursuit of novel discovery strategies. Radiogenomics is now rapidly advancing from an effort to screen a limited number of candidate genes towards an open discovery approach. Or, from relatively small studies conducted by a few scientists to the potentially powerful, but challenging, era of Big Data and Team Science.However, the substantial progress in radiogenomics may be largely unnoticed by the broader radiotherapy community leading to underestimation of its potential for improving patient outcomes. Therefore, it is critical to address the following questions at this stage in the development of research in radiogenomics