Follow-up with primary care providers for elevated glycated haemoglobin identified at the dental visit.

OBJECTIVES: This study examined patient experiences after receiving elevated diabetes screening values using blood collected at a dental clinic. It explores patients' reactions to screening, whether or not they sought recommended medical follow-up, and facilitating factors and barriers to obtaining follow-up care. METHODS: At the comprehensive care clinics at a large, urban College of Dentistry in the United States, haemoglobin A1C (HbA1C) values were obtained from 379 study participants who had not been previously diagnosed with diabetes. In all, 169 (44.6%) had elevated HbA1C values. We analysed quantitative and qualitative data concerning these patients' follow-up with primary care providers (PCPs). RESULTS: We were able to contact 112 (66.3%) of the 169 study participants who had an elevated HbA1C reading. Of that group, 61 (54.5%) received recommended follow-up care from a PCP within 3 months, and an additional 28 (25.0%) said they intended to seek such care. Qualitative themes included the following: the screening letter - opportunity or burden, appreciation for the 3-month follow-up call and barriers to medical follow-up that included the following: lack of knowledge about diabetes, not understanding the importance of follow-up, busyness, financial concerns, fear and denial. CONCLUSIONS: Quantitative and qualitative data demonstrate that dentists, dental hygienists and nurses are well poised to discover and translate new models of patient-centred, comprehensive care to patients with oral and systemic illness.

Interdental cleaning among persons with diabetes: relationships with individual characteristics.

OBJECTIVES: Given the existence of many potential oral health complications for adults with diabetes (especially for those who do not practise regular oral self-care), and the specific importance of regular interdental cleaning, the research determined the proportion of U.S. adults with diabetes who practise daily interdental cleaning and their socio-demographic, economic and oral health characteristics related to this practice. METHODS: Analyses were conducted using data collected from 573 dentulous adults with diabetes ≥ 30 years who participated in the U.S. 2009-2010 National Health and Nutrition Examination survey. Using complex sample survey software, findings were extrapolated to >15 million U.S. adults. Descriptive statistics were used to determine the frequency of interdental cleaning, and chi-square tests were used to identify salient individual characteristics related to this practice. RESULTS: 41.2% reported that they never used any interdental device, while 24.8% indicated that they practised interdental cleaning daily. Statistically significant relationships (P < 0.05) with daily interdental cleaning included female sex, ever having had treatment for gum disease and using mouthwash daily for a dental problem. CONCLUSIONS: Because so many adults with diabetes do not practise regular interdental cleaning, and in view of the important role that dental hygienists fulfil as oral healthcare educators, there is a great need for dental hygienists to teach and motivate adults with diabetes to practise regular interdental cleaning. This need is especially great for subgroups of these adults who are men, have not been treated for periodontitis and do not regularly use a mouthwash for dental problems.

Diabetes screening at the periodontal visit: patient and provider experiences with two screening approaches.

OBJECTIVES: This study examined patient and dental provider experiences during the periodontal visit of diabetes screening approaches involving the collection of gingival crevicular blood (GCB) and finger stick blood (FSB) for haemoglobin A1c (HbA1c) testing. METHODS: At a large, urban, US periodontics and implant clinic, FSB samples from 120 patients and GCB samples from 102 of these patients were collected on special blood collection cards and sent to a laboratory for HbA1c testing, with test results sent to the patients from the laboratory. Quantitative and qualitative data from patients and qualitative data from providers were collected and analysed. RESULTS: Quantitative and qualitative data support the feasibility and acceptability of the approaches described. Themes that arose from the interviews with providers and patients include 'a good chance to check', 'patient choice', 'FSB versus GCB testing' and 'a new way of interacting and viewing the dental visit'. CONCLUSIONS: Periodontal patients and dental providers believe that the dental visit is an opportune site for diabetes screening and generally prefer GCB to FSB collection. HbA1c testing is well tolerated, convenient and acceptable to patients, and GCB testing reduces time and liability obstacles for dental providers to conduct diabetes screening.

Patient-to-patient transmission is important in extended-spectrum beta-lactamase-producing Klebsiella pneumoniae acquisition.

We performed a prospective cohort study to quantify the number of cases of patient-to-patient transmission of extended-spectrum beta-lactamase-producing Klebsiella species on perianal surveillance culture. Among 27 patients who acquired Klebsiella pneumoniae infection, 14 had infections (52%) that were due to patient-to-patient transmission, and 6 (22%) had a subsequent positive extended-spectrum beta-lactamase clinical culture results.

HIV negative women's communication of their HIV status to their intimate partners.

This article identifies factors that differentiate HIV-negative, drug-involved women in New York City (N = 104) who communicate their HIV status to their intimate partners from those who do not. Findings indicate that HIV-negative women are more likely to reveal their status to their intimate partners if they (a) were tested more often for HIV, (b) talked with supporters about various HIV/AIDS-related issues besides their HIV status, (c) had a larger number of other supporters (in addition to intimate partners), (d) also communicated their HIV status to a larger percent of their other supporters, and (e) felt very sure they could ask their partner(s) about their partners' other sex partners. Drug treatment programs may be able to help HIV-negative women avoid contracting the virus by encouraging them to communicate with their supporters, especially their intimate partners, about their HIV status as well as HIV risk reduction practices.

The first week after drug treatment: the influence of treatment on drug use among women offenders.

Over the last decade, there has been a dramatic rise in the number of women arrested for drug offenses, and many have serious drug abuse problems. Increasingly, these women have been mandated to drug treatment, often in community-based settings. This article examines the impact of the treatment programs on the short-term posttreatment drug use of women offenders (N = 165) leaving two community-based treatment programs in Portland, Oregon. Our analyses indicate that women who abstained from drug use during the first week after treatment were more likely than those who used drugs during this time to have remained in treatment longer, received a plan to make a successful transition out of treatment, avoided associations with other drug users after leaving treatment, and obtained encouragement from individuals and groups in support of abstinence.

The relationship between the quality of drug user treatment and program completion: understanding the perceptions of women in a prison-based program.

To determine why some women offenders complete prison-based drug user treatment and others leave early, clients' (N = 101) perceptions of various aspects of the quality of the treatment experience were compared. Analyses of both quantitative and qualitative data indicate that clients who completed the program had a more favorable perception of staff and felt empowered by the experience in treatment. Most of the clients who left early did so because of conflicts or disagreements with the program's rules. We discuss how a supportive approach to personal development may enhance client perceptions of program quality and increase retention rates.

Social support systems of women offenders who use drugs: a focus on the mother-daughter relationship.

Conceptually, social support among very heavily drug-involved women is complex and multidimensional. This article examines the structure and function of the social support systems of women offenders (N = 100) who used drugs during the last 6 months before entering court-mandated drug-free treatment programs. These systems typically contain about nine supporters, almost equally divided between men and women, and about half of the women's supporters are family members. The women identify parents and partners as their major providers of practical help and advice. They look most to their partners for a sympathetic ear, and to their parents for affirmation of their self-worth. Overall, two-thirds of the women identify their mothers as among their supporters. These mothers are often anxious to do whatever they can to help their daughters stop using drugs. Paradoxically, the assistance many mothers give their daughters in providing money or basic life necessities often enables the daughter's drug use. Although many daughters appreciate their mother's help, there is an element of distrust and control in many of the mother-daughter relationships, and some daughters receive unwanted help from their mothers. Drug treatment providers can benefit from understanding their clients' social support systems, especially the dynamics of important relationships with main pretreatment supporters, such as parents. By gaining this understanding and helping their clients to effectively accept and use social support, treatment providers can assist them in maintaining their recovery when they leave treatment and return to their communities.

Modeling Relationships Between Two Categorical Variables When Data Are Missing: Examining Consequences of the Missing Data Mechanism in an HIV Data Set.

Analysts evaluating the strengths of relationships between variables in behavioral science research must often contend with the problem of missing data. Analyses are typically performed using data for cases that are either complete in all the variables, or assume that the data are missing at random. Often, these approaches yield biased results. Using empirical data, the current work explores the implications and consequences of using various statistical models to describe the association of two variables, one ordinal and one dichotomous, in which data are incomplete for the dichotomous variable. These models explicitly reflect the missing data mechanism; models that hypothesize nonignorable nonresponse are given particular attention. Both the statistical fit and substantive consequences of these models are examined. This new methodological approach to examining nonignorable nonresponse can be applied to many behavioral science data sets containing an ordinal variable.

Concurrence of drug users' self-report of current HIV status and serotest results.

This study examines the concurrence of drug users' self-reports of current HIV status with serotest results. The analyses are based on data obtained from face-to-face interviews with 7,256 out-of-treatment injection drug and/or crack users in 10 sites that participated in the Cooperative Agreement for AIDS Community-Based Outreach/Intervention Research Program (funded by the U.S. National Institute on Drug Abuse ). Although the degree of concurrence between HIV-negative individuals' self-reports of their current HIV status and their serotest results was high (specificity, 99%), this was not the situation for individuals who tested positive for HIV (sensitivity, 44%).