Evaluating The Effectiveness of the Texas Medicaid First Dental Home Program Regarding Parental Knowledge and Practice of Oral Health Care for Children

Early childhood caries (ECC) is a problematic disease that has been on the rise in young pre-school age children within the last decade. Children who have untreated dental disease early in life, are at increased risk of having poor oral health throughout their lifetimes. Approximately 70% of dental disease is found in only 20% of the nation’s high-risk children. Professional organizations and governing bodies have formed several initiatives in order to help lower the prevalence of ECC in children. One such initiative, early preventive dental visits, i.e. dental home, has proven to be successful; yet, the evidence is limited in documenting its effectiveness. First Dental Home (FDH) is the state of Texas Medicaid initiative to improve access to care for children. FDH was initiated to improve oral healthcare for children aged 6 months to 35 months of age by providing simple, consistent messages regarding proper oral healthcare to the parents/caregivers of the children. Despite the large fiscal budget allocated towards the success of FDH, no studies regarding the program’s effectiveness have been published to date. This study aimed to evaluate the effectiveness of the FDH by comparing the knowledge, practice and opinions of participating vs. non-participating parents regarding their young children. A 29-question survey was given to mostly low-income parents who visited qualifying Medicaid clinics in North Texas (Dallas/Fort Worth) and South Texas (Harlingen). A total of 165 parents completed the survey. Several significant results emerged between the knowledge and practices responses of the parents sampled. On the knowledge section, FDH parents responded correctly more often than the non-FDH parents when asked about the recommended amount of toothpaste recommended for toddlers (p=0.023). In addition, 79.6% of FDH parents vs. 21.1% of non-FDH parents knew that tap water is a potential source of fluoride (p< 0.001). Regarding oral health practices, 80 % of FDH parents did not let their child go to sleep with anything such as a bottle, sippy cup or pacifier (p=0.01). Furthermore, FDH parents scored higher on the overall knowledge score (p<0.001) and practice score (p<0.001). Based on our preliminary findings, FDH visits are having a positive impact on parents by not only increasing their oral healthcare knowledge, but also helping them implement what they have learned

Investigating the relationships between unfavourable habitual sleep and metabolomic traits:evidence from multi-cohort multivariable regression and Mendelian randomization analyses

BACKGROUND: Sleep traits are associated with cardiometabolic disease risk, with evidence from Mendelian randomization (MR) suggesting that insomnia symptoms and shorter sleep duration increase coronary artery disease risk. We combined adjusted multivariable regression (AMV) and MR analyses of phenotypes of unfavourable sleep on 113 metabolomic traits to investigate possible biochemical mechanisms linking sleep to cardiovascular disease.METHODS: We used AMV (N = 17,368) combined with two-sample MR (N = 38,618) to examine effects of self-reported insomnia symptoms, total habitual sleep duration, and chronotype on 113 metabolomic traits. The AMV analyses were conducted on data from 10 cohorts of mostly Europeans, adjusted for age, sex, and body mass index. For the MR analyses, we used summary results from published European-ancestry genome-wide association studies of self-reported sleep traits and of nuclear magnetic resonance (NMR) serum metabolites. We used the inverse-variance weighted (IVW) method and complemented this with sensitivity analyses to assess MR assumptions.RESULTS: We found consistent evidence from AMV and MR analyses for associations of usual vs. sometimes/rare/never insomnia symptoms with lower citrate (- 0.08 standard deviation (SD)[95% confidence interval (CI) - 0.12, - 0.03] in AMV and - 0.03SD [- 0.07, - 0.003] in MR), higher glycoprotein acetyls (0.08SD [95% CI 0.03, 0.12] in AMV and 0.06SD [0.03, 0.10) in MR]), lower total very large HDL particles (- 0.04SD [- 0.08, 0.00] in AMV and - 0.05SD [- 0.09, - 0.02] in MR), and lower phospholipids in very large HDL particles (- 0.04SD [- 0.08, 0.002] in AMV and - 0.05SD [- 0.08, - 0.02] in MR). Longer total sleep duration associated with higher creatinine concentrations using both methods (0.02SD per 1 h [0.01, 0.03] in AMV and 0.15SD [0.02, 0.29] in MR) and with isoleucine in MR analyses (0.22SD [0.08, 0.35]). No consistent evidence was observed for effects of chronotype on metabolomic measures.CONCLUSIONS: Whilst our results suggested that unfavourable sleep traits may not cause widespread metabolic disruption, some notable effects were observed. The evidence for possible effects of insomnia symptoms on glycoprotein acetyls and citrate and longer total sleep duration on creatinine and isoleucine might explain some of the effects, found in MR analyses of these sleep traits on coronary heart disease, which warrant further investigation.</p

Identification of genetic variants associated with Huntington's disease progression: a genome-wide association study

Background Huntington's disease is caused by a CAG repeat expansion in the huntingtin gene, HTT. Age at onset has been used as a quantitative phenotype in genetic analysis looking for Huntington's disease modifiers, but is hard to define and not always available. Therefore, we aimed to generate a novel measure of disease progression and to identify genetic markers associated with this progression measure. Methods We generated a progression score on the basis of principal component analysis of prospectively acquired longitudinal changes in motor, cognitive, and imaging measures in the 218 indivduals in the TRACK-HD cohort of Huntington's disease gene mutation carriers (data collected 2008–11). We generated a parallel progression score using data from 1773 previously genotyped participants from the European Huntington's Disease Network REGISTRY study of Huntington's disease mutation carriers (data collected 2003–13). We did a genome-wide association analyses in terms of progression for 216 TRACK-HD participants and 1773 REGISTRY participants, then a meta-analysis of these results was undertaken. Findings Longitudinal motor, cognitive, and imaging scores were correlated with each other in TRACK-HD participants, justifying use of a single, cross-domain measure of disease progression in both studies. The TRACK-HD and REGISTRY progression measures were correlated with each other (r=0·674), and with age at onset (TRACK-HD, r=0·315; REGISTRY, r=0·234). The meta-analysis of progression in TRACK-HD and REGISTRY gave a genome-wide significant signal (p=1·12 × 10−10) on chromosome 5 spanning three genes: MSH3, DHFR, and MTRNR2L2. The genes in this locus were associated with progression in TRACK-HD (MSH3 p=2·94 × 10−8 DHFR p=8·37 × 10−7 MTRNR2L2 p=2·15 × 10−9) and to a lesser extent in REGISTRY (MSH3 p=9·36 × 10−4 DHFR p=8·45 × 10−4 MTRNR2L2 p=1·20 × 10−3). The lead single nucleotide polymorphism (SNP) in TRACK-HD (rs557874766) was genome-wide significant in the meta-analysis (p=1·58 × 10−8), and encodes an aminoacid change (Pro67Ala) in MSH3. In TRACK-HD, each copy of the minor allele at this SNP was associated with a 0·4 units per year (95% CI 0·16–0·66) reduction in the rate of change of the Unified Huntington's Disease Rating Scale (UHDRS) Total Motor Score, and a reduction of 0·12 units per year (95% CI 0·06–0·18) in the rate of change of UHDRS Total Functional Capacity score. These associations remained significant after adjusting for age of onset. Interpretation The multidomain progression measure in TRACK-HD was associated with a functional variant that was genome-wide significant in our meta-analysis. The association in only 216 participants implies that the progression measure is a sensitive reflection of disease burden, that the effect size at this locus is large, or both. Knockout of Msh3 reduces somatic expansion in Huntington's disease mouse models, suggesting this mechanism as an area for future therapeutic investigation

Size Does Matter: Implied Object Size is Mentally Simulated During Language Comprehension

Embodied theories of language comprehension propose that readers construct a mental simulation of described objects that contains perceptual characteristics of their real-world referents. The present study is the first to investigate directly whether implied object size is mentally simulated during sentence comprehension and to study the potential influence of developmental factors on mental simulation by comparing adults' and children's mental simulation processing. Participants performed a sentence-picture verification task in which they read a sentence that implied a large or a small size for an object and then saw a picture of the object that matched or mismatched the implied size. Responses to pictures were faster when implied size and pictured size matched, suggesting that readers activated perceptual information on object size during sentence comprehension. The magnitude of the match effect was equal across age groups. The results contribute to refining and advancing knowledge with respect to the nature of mental simulations

Mental simulation of four visual object properties: similarities and differences as assessed by the sentence-picture verification task

In the sentence–picture verification (SPV) task, people read sentences implying the shape/size/colour/orientation of objects. They then verify whether pictured objects, which either match or mismatch the implied visual information mentioned in the sentence. Faster verification times on matching trials (match advantage) are considered supportive to the notion that readers perform mental simulations during sentence comprehension. This study advances this work by applying a within-subjects design to the SPV-task, enabling us to directly address the strength of and correlation between the match advantages for the properties shape, size, colour, and orientation. Results showed varying match advantages with colour showing the strongest effect, and no match advantage for orientation. Shape, size, and colour were significantly correlated, whereas there were no significant correlations with orientation. These findings suggest that interpretations of match advantages could benefit from a re-evaluation of mental simulation accountsby distinguishing between intrinsic (shape, size, and colour) and extrinsic (orientation) object properties

Inspecting a picture before reading affects attentional processing but not comprehension

This study investigated whether presenting a picture before reading can encourage situation-model construction. We compared two conditions (n = 30) which differed in whether a picture of the initial situation described in a narrative text was presented before reading (i.e. pictorial-support condition) or not (i.e. no-picture condition). Situation-model construction was measured using both process- and product-oriented measures. Eye-tracking data indicated online resource allocation to the different levels of text representation: surface, textbase, and situation model. Literal text questions and inference questions were used as an offline indication of textbase and situation-model processing, respectively. The results showed that a picture presented before reading led to a redistribution of processing resources during reading, evidenced by a shift from textbase to situation-model processing. This attentional shift did not translate into higher comprehension scores. The results were interpreted in line with multimedia learning theories suggesting pictures can serve as a mental scaffold for situation-model construction

What can measures of text comprehension tell us about creative text production?

Evidence is accumulating that the level of text comprehension is dependent on the situatedness and sensory richness of a child's mental representation formed during reading. This study investigated whether these factors involved in text comprehension also serve a functional role in writing a narrative. Direct influences of situatedness and sensory richness as well as indirect influences via the number of sensory and situational words on the creativity (i.e., originality/novelty) of a written narrative were examined in 165 primary school children through path analyses. Results showed that sensory richness and situatedness explained 35 % of the variance in creativity scores. Sensory richness influenced the originality/novelty of children's narrative writing directly, whereas situatedness had an indirect influence, through the number of sensory words, but both pathways influenced the outcomes to a comparable extent. Findings suggest that creative writing requires similar representational processes as reading comprehension, which may contribute to the development of instructional methods to help children in creative writing assignments

What can measures of text comprehension tell us about creative text production?

Evidence is accumulating that the level of text comprehension is dependent on the situatedness and sensory richness of a child's mental representation formed during reading. This study investigated whether these factors involved in text comprehension also serve a functional role in writing a narrative. Direct influences of situatedness and sensory richness as well as indirect influences via the number of sensory and situational words on the creativity (i.e., originality/novelty) of a written narrative were examined in 165 primary school children through path analyses. Results showed that sensory richness and situatedness explained 35 % of the variance in creativity scores. Sensory richness influenced the originality/novelty of children's narrative writing directly, whereas situatedness had an indirect influence, through the number of sensory words, but both pathways influenced the outcomes to a comparable extent. Findings suggest that creative writing requires similar representational processes as reading comprehension, which may contribute to the development of instructional methods to help children in creative writing assignments