Symptoms of Depression, Anxiety, and Post-Traumatic Stress Disorder, and Suicidal Ideation Among School Nurses in Prekindergarten through Grade 12 Schools - United States, March 2022.

School nurses are integral to creating safe environments in U.S. schools. Many experienced increased work burden and stress during the COVID-19 pandemic. CDC collaborated with the National Association of School Nurses and the National Association of State School Nurse Consultants to distribute a 121-item online, anonymous survey to school nurses nationwide during March 7-30, 2022. Among the 7,971 respondents, symptoms of depression, anxiety and PTSD, and suicidal ideation were measured, and prevalence ratios were used to identify associations with demographics, workplace characteristics, and support. Results found high levels of work-related stressors and indicated that employment characteristics, COVID-19-related job duties, and other workplace stressors and supports affected school nurse mental health. The survey findings underscore the mental health challenges many school nurses experienced during the 2021/2022 school year. The findings can inform supportive policies and practices to reduce workplace stressors and increase workplace supports for school nurses.

Utility of a Test-to-Return Strategy to Identify Individuals With Coronavirus Disease 2019 (COVID-19) in the Prekindergarten Through Grade 12 School Setting-District of Columbia, January 2022.

The highly transmissible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant led to increased hospitalizations, staffing shortages, and increased school closures. To reduce spread in school-aged children during the Omicron peak, the District of Columbia implemented a test-to-return strategy in public and public charter schools after a 2-week break from in-person learning.

Mixed-methods evaluation of mental healthcare integration into tuberculosis and maternal-child healthcare services of four South African districts.

BACKGROUND: The South African National Mental Health Policy Framework and Strategic Plan 2013-2020 was adopted to address the country's substantial burden and inadequate treatment of mental illness. It outlines measures toward the goal of full integration of mental health services into primary care by 2020. To evaluate progress and challenges in implementation, we conducted a mixed-methods assessment of mental health service provision in tuberculosis and maternal-child healthcare services of four districts in South Africa. METHODS: Forty clinics (ten per district) were purposively selected to represent both urban and rural locations. District-level program managers (DPMs) for mental health, tuberculosis, and maternal-child healthcare were qualitatively interviewed about district policy and procedures for management of mental illness and challenges in integrating mental health services into primary care. Clinic nurses and mental health practitioners (MHPs) completed a quantitative questionnaire to assess their engagement with stepped care for patients with mental illness. Qualitative and quantitative data were collected concurrently and compared to triangulate progress in implementation of integrated services. RESULTS: A total of 59 nurses and 17 MHPs completed questionnaires, and nine DPMs were interviewed (total n = 85). DPMs indicated that nurses should screen for mental illness at every patient visit, although only 43 (73%) nurses reported conducting universal screening and 26 (44%) reported using a specific screening tool. For patients who screen positive for mental illness, DPMs described a stepped-care approach in which MHPs diagnose patients and then treat or refer them to specialized care. However, only 7 (41%) MHPs indicated that they diagnose mental illness and 14 (82%) offer any treatment for mental illness. Addressing challenges to current integration efforts, DPMs highlighted 1) insufficient funding and material resources, 2) poor coordination at the district administrative level, and 3) low mental health awareness in district administration and the general population. CONCLUSIONS: Though some progress has been made toward integration of mental health services into primary care settings, there is a substantial lack of training and clarity of roles for nurses and MHPs. To enhance implementation, increased efforts must be directed toward improving district-level administrative coordination, mental health awareness, and financial and material resources.

Anterior Mandibular Lingual Defect As a Possible Cause of Near-Fatal Bleeding During Routine Dental Implant Surgery: A Retrospective Computed Tomography Study.

INTRODUCTION: The anterior mandible is generally regarded as a safe anatomical region for implant placement. However, anatomical variations may lead to severe intraoperative complications with potential fatal outcome. The objective of this study was to evaluate the anterior mandibular lingual defect (AMLD) in patients undergoing implant surgery. MATERIALS AND METHODS: The CT data of 338 consecutive dental implant patients were reformatted with appropriate software. The AMLDs were first identified using 3-D reconstruction and further evaluated in the relevant 2-D slices. RESULTS: The AMLD was present in 10.95% of patients; of these, 83.8% were present bilaterally. No significant differences were found between sex, age, or race within the investigated population with regards to the presence of the AMLD. CONCLUSIONS: The presence of an AMLD might be a possible cause of near-fatal bleeding during routine dental implant surgery. This study found the presence of the AMLD in a small (10.95%), but not negligible number of patients. To avoid possible complications, meticulous planning and the use of 3-D imaging are advisable before performing implant surgery in this anatomical region.

Buccal and palatal alveolar bone dimensions in the anterior maxilla: A micro-CT study.

OBJECTIVE: Anterior maxillary immediate implant placement has become a popular procedure. It has aesthetic and functional risks. A prerequisite for success is sufficient alveolar bone for primary stability. Many cone-beam computed tomography (CBCT) studies have assessed alveolar bone dimensions in the anterior maxilla, with varying results. More accurate information on the alveolar bone dimensions in the anterior maxilla is required. The objective of the present study was to evaluate bone dimensions in the anterior maxilla using micro-CT, a high-resolution imaging tool. MATERIALS AND METHODS: Seventy-two human skulls were scanned using micro-CT at the South African Nuclear Energy Corporation. Specialized software was used for 3-D rendering, segmentation, and visualization of the reconstructed volume data. Axial planes were created over each alveolus/tooth from canine to canine. Buccal and palatal bone dimensions were measured at crestal, 3 mm, 6 mm, and 9 mm levels. RESULTS: Buccal bone rarely exceeded 0.5 mm, consisting of bundle bone only for all investigated teeth at all levels. Up to a third of teeth showed buccal fenestrations. Alveolar bone on the palatal side was thicker than buccal and increased from <1 mm at crestal level up to 3.77 mm, 4.56 mm, and 5.43 mm for centrals, laterals, and canines at the 9 mm level, respectively. CONCLUSIONS: Immediate implants in the anterior maxillae has anatomical risks. Alveolar bone on the buccal aspect is very thin, with fenestrations in certain positions. Therefore, a thorough planning and individual approach are needed to avoid possible complications and achieve stable aesthetic and functional results in the long-term.

Understanding COVID-19 Vaccine Hesitancy Among K-12 Staff, Parents, and Students: District of Columbia, February to April, 2022.

OBJECTIVE: Despite widespread availability of COVID-19 vaccines, millions of Americans have not received the recommended vaccine doses. In the District of Columbia (DC), COVID-19 vaccination rates are lowest among residents who are Non-Hispanic (NH) Black and among school-aged children. We assessed COVID-19 vaccine hesitancy among staff and parents of students in DC K-12 public and public charter schools. METHODS: We conducted a telephone-based survey from February 6 to April 16, 2022 to staff, students, and parents of students who participated in school-based COVID-19 screening testing. COVID-19-related survey items included: vaccination status, reasons for not getting vaccinated, perceived vaccine access, and trusted COVID-19 information sources. Utilizing time-to-event analyses, we evaluated differences across demographic groups. RESULTS: The interview response rate was 25.8% (308/1193). Most unvaccinated participants were NH Black and ages 5 to 11 years. Median time from vaccine eligibility to uptake was 236 days for NH Black participants vs. 10 days for NH White participants. Vaccine safety was the top concern among unvaccinated participants. Government and healthcare providers were the most trusted COVID-19 information sources. CONCLUSIONS: Differences in timing of vaccine uptake among respondents and greater vaccine hesitancy among NH Black participants compared to other racial/ethnic groups highlight a need for continued tailored outreach and communication using trusted sources to convey the importance, benefits, and safety of COVID-19 vaccination.

Testing and Nonpharmaceutical Interventions for Prevention of SARS-CoV-2 in 20 US Overnight Camps in Summer 2021.

OBJECTIVES: Overnight camps are a setting where COVID-19 can easily spread without the diligent use of layered public health interventions. We evaluated 20 camps in the United States to examine COVID-19 transmission and mitigation strategies during summer 2021. METHODS: For this descriptive cross-sectional study, we examined self-reported information from 20 camps in 6 predominantly northeastern states on geographic information, tests and testing cadences, vaccination rates, and number of COVID-19 cases during summer 2021. Because the camps had hired public health consultants to guide them on reducing COVID-19 introduction and spread, all camps implemented similar interventions, including encouraging behaviors that lower the risk of COVID-19 transmission prior to camp arrival, use of cohorts, testing before and after arrival, and strong encouragement of vaccination among eligible campers and staff members. RESULTS: A total of 9474 attendees at the 20 camps came from geographically diverse regions. Camps generally tested before and at arrival, as well as once or twice after arrival. Rates of vaccination were high among staff members (84.6%) and campers (76.2%). Camps identified 27 COVID-19 cases, with 17 (63.0%) detected after arrival, 3 (7.4%) detected on arrival, and 8 (29.6%) detected prior to arrival. CONCLUSIONS: The spread of cases detected after arrival to overnight camps was limited by the use of 3 key interventions: (1) high vaccination rates, (2) a rigorous and responsive testing strategy, and (3) ongoing use of public health interventions. These findings have implications for successful operation of overnight camps, residential schools and colleges, and other similar settings.

Effect of a brief motivational interview and text message intervention targeting tobacco smoking, alcohol use and medication adherence to improve tuberculosis treatment outcomes in adult patients with tuberculosis: a multicentre, randomised controlled trial of the ProLife programme in South Africa.

OBJECTIVE: To investigate the effectiveness of a complex behavioural intervention, ProLife, on tuberculosis (TB) treatment success, medication adherence, alcohol use and tobacco smoking. DESIGN: Multicentre, individual, randomised controlled trial where participants were assigned (1:1) to the ProLife intervention or usual care. SETTING: 27 primary care clinics in South Africa. PARTICIPANTS: 574 adults starting treatment for drug-sensitive pulmonary TB who smoked tobacco or reported harmful/hazardous alcohol use. INTERVENTIONS: The intervention, delivered by lay health workers (LHWs), consisted of three brief motivational interviewing (MI) sessions, augmented with short message service (SMS) messages, targeting medication adherence, alcohol use and tobacco smoking. OUTCOME MEASURES: The primary outcome was successful versus unsuccessful TB treatment at 6-9 months, from TB records. Secondary outcomes were biochemically confirmed sustained smoking cessation, reduction in the Alcohol Use Disorder Identification Test (AUDIT) score, improved TB and antiretroviral therapy (ART) adherence and ART initiation, each measured at 3 and 6 months by questionnaires; and cure rates in patients who had bacteriology-confirmed TB at baseline, from TB records. RESULTS: Between 15 November 2018 and 31 August 2019, 574 participants were randomised to receive either the intervention (n=283) or usual care (n=291). TB treatment success rates did not differ significantly between intervention (67.8%) and control (70.1%; OR 0.9, 95% CI 0.64% to 1.27%). There was no evidence of an effect at 3 and 6 months, respectively, on continuous smoking abstinence (OR 0.65, 95% CI 0.37 to 1.14; OR 0.76, 95% CI 0.35 to 1.63), TB medication adherence (OR 1.22, 95% CI 0.52 to 2.87; OR 0.89, 95% CI 0.26 to 3.07), taking ART (OR 0.79, 95% CI 0.38 to 1.65; OR 2.05, 95% CI 0.80 to 5.27) or AUDIT scores (mean score difference 0.55, 95% CI -1.01 to 2.11; -0.04, 95% CI -2.0 to 1.91) and adjusting for baseline values. Cure rates were not significantly higher (OR 1.16, 95% CI 0.83 to 1.63). CONCLUSIONS: Simultaneous targeting of multiple health risk behaviours with MI and SMS using LHWs may not be an effective approach to improve TB outcomes. TRIAL REGISTRATION NUMBER: ISRCTN62728852.

Test-to-Stay Implementation in 4 Pre-K-12 School Districts.

OBJECTIVES: Globally, coronavirus disease 2019 (COVID-19) has affected how children learn. We evaluated the impact of Test to Stay (TTS) on secondary and tertiary transmission of severe acute respiratory syndrome coronavirus 2 and potential impact on in-person learning in 4 school districts in the United States from September 13 to November 19, 2021. METHODS: Implementation of TTS varied across school districts. Data on index cases, school-based close contacts, TTS participation, and testing results were obtained from 4 school districts in diverse geographic regions. Descriptive statistics, secondary and tertiary attack risk, and a theoretical estimate of impact on in-person learning were calculated. RESULTS: Fifty-one schools in 4 school districts reported 374 coronavirus disease COVID-19 index cases and 2520 school-based close contacts eligible for TTS. The proportion participating in TTS ranged from 22% to 79%. By district, the secondary attack risk and tertiary attack risk among TTS participants ranged between 2.2% to 11.1% and 0% to 17.6%, respectively. Nine clusters were identified among secondary cases and 2 among tertiary cases. The theoretical maximum number of days of in-person learning saved by using TTS was 976 to 4650 days across jurisdictions. CONCLUSIONS: TTS preserves in-person learning. Decisions to participate in TTS may have been influenced by ease of access to testing, communication between schools and families, testing logistics, and school resources. Tertiary attack risk determination became more complicated when numbers of close contacts increased. Minimizing exposure through continued layered prevention strategies is imperative. To ensure adequate resources for TTS, community transmission levels should be considered.

Amplification of 3q26.2, 5q14.3, 8q24.3, 8q22.3, and 14q32.33 Are Possible Common Genetic Alterations in Oral Cancer Patients.

The lack of clinical biomarkers for head and neck cancer subtypes limits early diagnosis and monitoring of disease progression. This study investigates genetic alterations in clinically identical tumor, tumor-adjacent dysplastic epithelium (TADE) and normal epithelium (NE) in five oral cancer patients to identify differences and commonalities between oral cancer, TADE and NE. A VELscope®Vx device was used to identify TADE and NE surrounding a clinical tumor for analysis of genetic alterations using the OncoScan® assay. One of the tumor samples examined was an "M" class tumor with a high confidence BRAF:p.G469A:c.1406G>C somatic mutation, which is the first to be reported in oral cancer. Another tumor showed mosaicism in genetic alterations, indicating the presence of multiple clones. Overall, each patient's tumor, TADE and NE showed a distinct genetic profile which indicates intertumoral clonal/genetic diversity. Interestingly, four tumors showed gain of 3q26.2, 5q14.3, 8q24.3, 8q22.3, 14q32.33 and loss/LOH in 9p21.3 while all TADE had LOH on 22q11.23. In addition, some genetic alterations progressed from NE through TADE into tumor in individual patients. Furthermore, no molecular event was identified that is common to all NE and/or TADE that progressed into tumor. This pilot study demonstrates the presence of genetic heterogeneity in oral tumorigenesis, and suggests that there might exist some common genetic alterations between tumors and TADE. However, this observation would need to be further investigated and validated in a larger cohort of oral cancer patients for its potential role in oral tumorigenesis.

A retrospective analysis of maxillary sinus septa on reformatted computerised tomography scans.

OBJECTIVES: This study analysed 200 consecutive computerised tomography (CT) scans, reformatted with specialised software for the identification of maxillary sinus septa. All patients were routine implant patients who had undergone CT scans for dental implant planning. MATERIALS AND METHODS: The data of two hundred consecutive patients (400 maxillary sinuses) who had been sent for CT scan, were reformatted with CT software. The group consisted of 115 edentulous and 85 dentate (below sinuses) patients. Septa were identified using three-dimensional (3D) reconstruction and panoramic views. No septa were included unless they were clearly visible on the 3D reconstruction. The prevalence, height and number of septa were analysed for both groups of patients. RESULTS: The prevalence of sinus septa was found to be 69% (138 patients), with a significant number of these patients showing multiple septa (89/138). The mean age of the patients was 54 (+/-14). The prevalence of edentulous patients with septa (71%) was not statistically different from the dentate patients (66%) (P=0.7). DISCUSSION: This study found a higher prevalence of patients with maxillary sinus septa than what has been reported previously. This may be due to the exact nature of the CT software and the ease of use of the 3D reconstruction for identification of septa. Another explanation could be that all septa that were visible on the 3D reconstruction were included and there was no minimum cut-off height. No significant differences were found between edentulous and dentate patients.

A micro-CT study of the greater palatine foramen in human skulls.

The greater palatine foramen (GPF) is an important anatomical landmark and has substantial clinical relevance in dental surgery. Knowledge of its precise location and dimensions is required for proper planning of surgical procedures involving the posterior maxilla. We used microfocus computed tomography to determine the location and dimensions of the GPF, and any sex and race variations in those measurements, in 77 human skulls scanned at the South African Nuclear Energy Corporation. Specialized software was used for three-dimensional rendering, segmentation, and visualization of the reconstructed volume data. GPF location ranged from adjacent to the first molar to distal of the third molar. The most common GPF location was near the third molar (66.7% of skulls), and the GPF was as close as 6.31 mm (mean distance 12.75 ± 3 mm). The mean GPF dimensions were 5.22 mm on the anterior-posterior axis and 2.81 mm on the lateral-medial axis. We noted no significant differences in relation to race, sex, or age in the sample. The GPF was adjacent or posterior to the third maxillary molar in most skulls.

Stability Development of Immediately Loaded Hybrid Self-Tapping Implants Inserted in the Posterior Maxilla: 1-Year Results of a Randomized Controlled Trial.

The objective of the present study was to elucidate stability development of immediately loaded hybrid self-tapping implants inserted in the posterior maxilla. Forty-eight hybrid self-tapping implants with a chemically modified surface (∅4.1; length: 8 mm) were inserted bilaterally in the maxillary first and second premolar and first molar sites of 8 patients. In each patient, both sides of the maxilla were assigned randomly to either immediate (IL) or early (EL) loading group. Implant stability was evaluated by means of resonance frequency analysis immediately after implant placement and after 1, 2, 3, 4, 5, 6, 12, 26, and 52 weeks. High values of primary stability were found in both groups (71.91 ± 6.52 implant stability quotient [ISQ] in IL group; 73.87 ± 6.5 ISQ in EL group), with significant differences between the groups at the different time points. Initial decrease in stability was observed between the first and fifth weeks in the IL group and between the first and third weeks for the EL group. In the IL group 1 implant was removed after 3 weeks due to lack of stability. Early results of this study showed the ability of hybrid self-tapping dental implants with a chemically modified surface to achieve sufficient primary stability and to maintain high values of secondary implant stability in bone type 3 and 4, even when loaded immediately. Minimal alterations in stability were observed for both investigated groups, but the EL group showed faster recovery after an initial drop in stability.

The midline mandibular lingual canal: importance in implant surgery.

PURPOSE: The study aims to determine if midline mandibular dental implants pose a risk for the midline lingual canal (MLC). MATERIALS AND METHODS: Cone beam computed tomography was used to scan 122 mandibles (31 black males; 28 black females; 32 white males and 31 white females). Midsagittal sections in the reconstructed images were made. A measurement of 6 mm across bucco-lingually was delineated as the minimum dimensions for implant placement. In dentate cases with a bucco-lingual distance in excess of 6 mm, the measurement was across the apex of the socket to determine the bone dimension available below the socket for implant placement. From these markers a vertical line was dropped to the MLC to measure the available bone. RESULTS: The MLC was a consistent finding. A statistical significant difference in bone availability among the sexes and dentition pattern was found, indicating that midline implants in edentulous females posed a risk of injury to the vessels of the MLC. CONCLUSION: Implants in the position of lower central incisors are regarded as a safe procedure. Clinicians should however take note of the position of the midline mandibular lingual canal and approach this area with caution, especially if the alveolar ridge is to be reduced before implant placement.

Correlation between dysplasia and ploidy status in oral leukoplakia.

Oral leukoplakia and other potentially malignant disorders (PMD) may progress to oral squamous cell carcinoma (OSCC). The gold standard for assessing the potential for malignant transformation remains histologic examination with the aim of grading the dysplastic changes. However, not all lesions with dysplasia will progress to OSCC. DNA ploidy has been suggested as a method to predict the clinical behaviour of PMD. This study reports on the use of high-resolution flow cytometry to determine the ploidy status of formalin-fixed, paraffin-embedded material from PMD compared to their dysplasia grade on histology. Aneuploidy was found in 13 % of mild, 31 % of moderate, and 54 % of severe dysplasia cases. This difference was statistically significant (p = 0.011). The differences in ploidy status were more significant when grouping the dysplasia into low-risk and high-risk categories (p = 0.008). These findings indicate that the ploidy status of PMD as determined by high-resolution flow cytometry may be of value in predicting biological behaviour in PMD such as leukoplakia.

Promoting GMP implementation: developing training materials for the international audience.

This paper outlines the development of a CD-ROM training package entitled: The WHO Basic Training Modules on GMP, intended to support the creation of training courses aimed particularly at government compliance officials who inspect pharmaceutical manufacturing facilities. The material was created over a three-year period in collaboration with a team of external experts, WHO regional and local offices, and Drug Regulatory Authorities of participating countries. The nine training workshops and courses that contributed to the development and evaluation processes were attended by approximately 240 participants from 47 countries. To date over 5,800 copies of the CD-ROM have been distributed.