Educating long-term care staff on older adult oral health: Maine's oral team-based initiative vital access to education (MOTIVATE) program.

INTRODUCTION: The oral health status of older adults in the United States is a public health crisis and a silent epidemic. Maine's Oral Team-Based Initiative Vital Access to Education (MOTIVATE) Program is an innovative interprofessional oral health program aimed at enhancing oral health education and practice of interprofessional health care teams in nursing homes. Using a blended learning model, a combination of in-person and online learning, this program provides a foundation from which to implement evidenced based oral care in nursing homes. METHODS: Learning outcomes were assessed via a three-part timed series survey. A set of self-report assessment items measured skills implemented at baseline and post-training. RESULTS: Learning domain scores increased over time from baseline to post-training. Confidence in providing oral healthcare and role clarity in providing oral health care improved over time. Staff identified using new skills in daily oral care and communication across the interprofessional team. DISCUSSION: The MOTIVATE program is an effective collaborative-based model for developing oral health competencies and promoting evidence-based oral health care in nursing homes.

Human immunodeficiency virus receptor and coreceptor expression on human uterine epithelial cells: regulation of expression during the menstrual cycle and implications for human immunodeficiency virus infection.

Human immunodeficiency virus-1 (HIV-1) is primarily a sexually transmitted disease. Identification of cell populations within the female reproductive tract that are initially infected, and the events involved in transmission of infection to other cells, remain to be established. In this report, we evaluated expression of HIV receptors and coreceptors on epithelial cells in the uterus and found they express several receptors critical for HIV infection including CD4, CXCR4, CCR5 and galactosylceramide (GalC). Moreover, expression of these receptors varied during the menstrual cycle. Expression of CD4 and CCR5 on uterine epithelial cells is high throughout the proliferative phase of the menstrual cycle when blood levels of oestradiol are high. In contrast, CXCR4 expression increased gradually throughout the proliferative phase. During the secretory phase of the cycle when both oestradiol and progesterone are elevated, CD4 and CCR5 expression decreased whereas CXCR4 expression remained elevated. Expression of GalC on endometrial glands is higher during the secretory phase than during the proliferative phase of the menstrual cycle. Because epithelial cells line the female reproductive tract and express HIV receptors and coreceptors, it is likely that they are one of the first cell types to become infected. The hormonal regulation of HIV receptor expression may affect a woman's susceptibility to HIV infection during her menstrual cycle. Moreover, selective coreceptor expression could account for the preferential transmission of R5-HIV-1 strains to women. In addition, these studies provide evidence that the uterus, and potentially the entire upper reproductive tract, are important sites for the initial events involved in HIV infection.