Mind the gaps: identifying opportunities in mental health assessment and mental health certificate completion in rural and remote NSW, Australia.

OBJECTIVE: This study aimed to examine the quality of mental health certificate (MHC) completion in rural and remote New South Wales, to include the determination of those identified as mentally ill or mentally disordered, and subsequent processes thereafter. METHODS: MHCs were collected from April 2016 to March 2017. A de-identified review was undertaken and audited for completion of mandatory criteria. Data were separated by three groups of completing health practitioners, and descriptive and inferential statistics calculated to assess for differences between groups. RESULTS: A total of 277 MHCs were included. Local medical officers were significantly more likely to: have longer assessment periods, indicate mentally disordered rather than mentally ill, and to have the mental health certificate revoked upon reassessment at a declared mental health facility, than their psychiatry or accredited person peers. They were also significantly less likely to complete documentation relating to behaviour personally assessed or observed by others. CONCLUSION: This study identified inconsistencies in documentation completion between groups, highlighting training opportunities for non-mental health specialists, particularly mental health assessment and lawful detention requirements. Attention to this is warranted within medical training syllabuses, post-graduate training and support programs.

Issues in access to oral health care for special care patients.

Access to oral health care for persons with special health care needs is quite limited. Psychologic, economic, and physical barriers exist that prevent these patients, who may have complex medical histories and physical or psychologic disabilities, from accessing appropriate continuing dental care. There are ways to surmount each of these barriers, typically with both positive and negative aspects that must be considered. Education of the health care professionals, the patients, government officials, third-party payers, and colleagues in all aspects of health care, is needed. The ultimate answer is education of and cooperation by all concerned, including the patients and caretakers.

Promoting physical activity for low-income minority women in primary care.

OBJECTIVE: To examine the effects of a primary-care weight management intervention on physical activity (PA) among overweight/obese women. METHODS: This randomized controlled trial included 139 women (92% African American). The effects of a physician-delivered tailored intervention were compared with standard care. Repeated measures analyses of variance (ANOVA) were used to examine changes in PA (measured by a 7-day physical activity recall) and physical fitness (measured by heart rate recovery following exercise). RESULTS: Although the intervention group demonstrated an increase in PA, this did not differ significantly from standard care. A significantly greater proportion of intervention participants (90%) achieved current PA recommendations compared with standard care (77%), P<.03. CONCLUSION: These results provide novel information suggesting that a physician-delivered intervention may have limited effectiveness for increasing PA among this at-risk population.

The relationship between social deprivation, disease outcome measures, and response to treatment in patients with stable, long-standing rheumatoid arthritis.

OBJECTIVE: Patients with rheumatoid arthritis (RA) with lower socioeconomic status (SES) are known to have more severe disease, more comorbidity, and higher mortality. It is not known whether SES influences response to treatment in RA. We examined the relationship between area of residence (as a surrogate for SES) and baseline outcome measures and response to treatment, using data from the British Rheumatoid Outcome Study Group randomized controlled trial of aggressive versus symptomatic treatment of long-standing, stable RA. METHODS: A total of 466 patients from 5 centers were recruited to the trial. Baseline data included age, sex, smoking status, and comorbidity. Patients were assigned a Townsend score (a measure of social deprivation) according to their area of residence. Outcome measures including the Disease Activity Score (DAS28), Health Assessment Questionnaire, Medical Outcomes Study Short Form-36, and EuroQol (EQ5D) were recorded at the beginning and end of the 3 year trial. The baseline, 3 year values, and change data were examined by Townsend quintile adjusting for each treatment arm. RESULTS: Significant relationships between increasing social deprivation by area of residence and higher disease activity, higher pain, poorer physical function, poorer emotional aspects of mental health, and lower quality of life were found at baseline (adjusted for age, sex, disease duration, current smoking, treatment center, and treatment group). During the 3 year trial period, patients from the most deprived areas showed greater improvement, with statistically significant greater improvement on DAS28 (p = 0.041) and 28 tender joint count (p = 0.015). CONCLUSION: Area of residence is related to the severity of RA at recruitment and is a predictor of response in a clinical trial situation. The results suggest that measures of SES should be recorded for patients enrolled in clinical trials, longitudinal observational studies, and in the clinical setting.

Creating an environment for diversity in dental schools: one school's approach.

Recent reports have indicated the need to improve the diversity in the dental profession's workforce. The enrollment of underrepresented minority students in the nation's dental schools must increase to accomplish this goal. A complex change process within the dental schools is required to prepare schools to enroll a more diverse student body. While each dental school in the United States is unique, a product of its history and institutional culture, and will, therefore, create an environment for diversity in different ways, it is appropriate to describe lessons learned in individual schools as they strive for diversity. The purpose of this paper is to describe how one dental school, the Columbia University School of Dental and Oral Surgery, approached diversity, so that appropriate strategies can be shared among schools.

The dental educator. An endangered species.

The dental educator is increasingly an endangered species. Part of the problem rests with the failure of dental educators themselves to convey to new graduates and to seasoned colleagues the variety, excitement and realities of reasonable income and fringe benefits associated with an academic career. Each of us in dental education must make a daily effort to convey this information through personal experience to our potential junior and new senior colleagues. Loan forgiveness protocols and unique training programs for those who choose to pursue full-time academic careers require collaborative financing from all of us in the profession, from our state and federal governments, and, ideally, from private industrial resources as well. The use of new educational technologies to relieve some of the more repetitive and burdensome aspects of education and to free the time of dental educators for more discussion in small groups, for problem-solving discussions, and for one-on-one interaction is imperative. If the current, clear and frightening decrease in the number of dental educators is ignored or even inadvertently fostered through ignorance or inaction, the entire profession will suffer directly. Practitioners, educators, industry and our government must cooperate in an intense and immediate effort to reverse this trend.