Prevalence and treatment of necrotizing ulcerative gingivitis (NUG) in the British Armed Forces: a case-control study.

OBJECTIVES: Necrotizing ulcerative gingivitis (NUG) has been seen in military populations throughout history. This study aims to determine the prevalence, treatment modality and risk factors associated with NUG in the British Armed Forces. MATERIALS AND METHODS: A whole population dataset of the British Armed Forces was searched to determine cases of NUG during the period 1 January to 31 December 2012. Individual case records were identified, and a case-control study undertaken with data gathered and analysed against a randomised control group, matched for age, sex and service. RESULTS: A prevalence rate for NUG of 0.11 % was determined against the whole military population. The majority of cases received (alone or in combination) the following: oral hygiene instruction (66.5 %), antibiotics (64.4 %) and a mouthwash (58.1 %). Of the cases, 48.7 % received debridement. Analgesics were only prescribed in 8.4 % of the cases, and smoking cessation advice was only given in 10.7 % of the cases. Analysis of risk factors against the control group showed an increase in odds ratios for diagnosis of NUG of 3.4 (95 % CI 2.0-5.7) for current smokers and 7.3 (95 % CI 1.9-28.0) for individuals with an overall Basic Periodontal Examination (BPE) score of 3. CONCLUSIONS: Whilst NUG is a rare disease, it is evident from this study that it still occurs within the British Armed Forces. A strong association was shown between NUG and current smokers and those cases with an overall BPE score of 3. CLINICAL RELEVANCE: This study provides prevalence data for NUG in the British Armed Forces and description of its treatment and associated risk factors. Oral hygiene and smoking must be addressed in patients with NUG and prescribing protocols should be carefully followed.

Effectiveness of community health workers in providing outreach and education for colorectal cancer screening in Appalachian Kentucky.

The purpose of this study was to examine the effectiveness of a community health worker (CHW)-delivered cancer education program designed to increase knowledge and awareness of colorectal cancer screening options. The study population was an extremely vulnerable and medically underserved geographic region in Appalachian Kentucky. CHWs enrolled participants in face-to-face visits, obtained informed consent, and administered a baseline assessment of knowledge of colorectal cancer risks and the benefits of screening and screening history. An educational intervention was then provided and participants were re-contacted 6 months later when a posttest was administered. The mean score of the 637 participants increased from 4.27 at baseline to 4.57 at follow-up (p < .001). Participants who reported asking their health care provider about colorectal cancer screening increased from 27.6% at baseline to 34.1% at follow-up (p = .013). Results suggest that CHWs were very effective at maintaining the study population; no loss to follow-up occurred. The results also showed increased knowledge and awareness about colorectal cancer screening education. Implications for social work practice, policy and research are discussed.

Increasing the medical school applicant pool: a key to training more rural physicians.

CONTEXT: Workforce studies show shortages of physicians in many areas of the United States. These shortages are especially severe in states such as Kentucky with many rural counties and are predicted to worsen in the future unless there are changes throughout our educational system to build aspirations and prepare students for medical school education. PURPOSE: To examine rural-urban differences and community characteristics of applicants and matriculants to Kentucky's two allopathic medical schools and influences on the educational aspirations of young students who wish to become physicians. METHODS: The number of Kentucky applicants and matriculants to allopathic medical schools was obtained from the Association of American Medical College's data warehouse for the period from 2002-2006. A continuous, multidimensional measure was used to classify counties by degree of rurality. Socio-demographic variables were selected for the counties of residence for applicants and matriculants. Model variables were tested in a least squares multiple regression model for their ability to explain patterns among Kentucky's 120 counties in the number of both resident applicants and matriculants to medical school. Data from a survey of middle school participants in summer health camps were analyzed to help identify important influences on young students aspiring to a career as a health professional, especially becoming a physician, and how these might be supported to increase the supply of rural medical school applicants. FINDINGS: The low number of rural applicants to medical school was highly correlated with the relative rurality of their county of residence, a low physician-to-population ratio and a low number of total primary care physicians. The percentage of county residents having a bachelor's degree level of education or higher had a positive impact on the application rate. Respondents became interested in health careers at age 15 or younger, and parents and grandparents, teachers, and close associates stimulated their aspirations, with teachers being the most influential. CONCLUSIONS: Prospective students respond to their perception of need for physicians. Rural students are influenced by those who are more highly educated. To overcome the shortage of physicians in rural communities efforts must be made to increase the aspirations for medical education of prospective students from rural counties.

Influenza syndromic surveillance and vaccine efficacy in the UK Armed Forces, 2017-2018.

INTRODUCTION: This paper describes the first ever analysis of health data to report influenza vaccine uptake and the effectiveness of the vaccine in preventing general practice presentations for influenza-like illness (ILI) in the UK Armed Forces (UK AF). This was undertaken during the 2017-2018 influenza season. METHODS: Clinical Read codes for ILI and influenza vaccinations were used to generate reports for the period from September 2017 to April 2018. Using a methodology adapted from Public Health England's (PHE) in hours syndromic surveillance, the ILI rate for the UK AF was calculated. Subsequent analysis explored vaccination uptake in target groups and compared the relative risk (RR) of ILI in vaccinated versus unvaccinated Service Personnel (SP). RESULTS: 4234 SPs had a record of ILI between September 2017 and April 2018, with a peak rate of 216 cases per 100 000 PAR. The absolute risk reduction for reporting ILI in vaccinated versus unvaccinated SP was 0.4% (p=0.0031), and the RR was statistically significant at 15% (95% CI 5% to 23 %) lower than in the non-vaccinated PAR. The number needed to vaccinate (NNV) to prevent one presentation of ILI was 241 (95% CI 145 to 714). The 8153 vaccinations recorded for the untrained strength equate to approximately 38% of overall training throughput and 65% of all Army SP recorded as being in phase 1 training at some point during this period. CONCLUSIONS: The relative risk reduction (RRR) for vaccinated personnel was modest and lower than reported elsewhere, but closely compares with ILI rates included in a 2018 Cochrane review. The small RRR and large NNV do not support widening the population of UK AF eligible to receive influenza vaccine. Regimental Medical Officers (RMOs) seeking advice on whether to vaccinate other groups of SP should be aware that this approach offers questionable clinical benefit. The ILI surveillance methodology used in this work could be adapted for syndromic surveillance of other infectious diseases.

Hepatitis B in a vaccinated soldier: a case report.

Assessing for an adequate immunological response to a pre-exposure course of hepatitis B vaccine is not routinely recommended in all vaccinated individuals. Current UK guidelines advise checking hepatitis B surface antibody titres only in those considered at high occupational risk such as healthcare and laboratory workers. We present a case of an infantry soldier who developed acute hepatitis B despite having a complete course of hepatitis B vaccinations. This case emphasises that hepatitis B is still an important differential diagnosis for all returning military personnel who present with compatible symptoms despite being vaccinated.

Kentucky Homeplace Defeat Diabetes Screening Test: an analysis of rural Kentucky's challenge to overcome the growing diabetes epidemic.

The University of Kentucky Center for Rural Health original research note, "Kentucky Homeplace Defeat Diabetes Screening Test: An Analysis of Rural Kentucky's Challenge to Overcome the Growing Diabetes Epidemic," provides the results of a yearlong diabetes risk survey that included more than 3,000 participants in rural Kentucky. It is well known that diabetes poses serious health threats across our country. For various reasons, that is especially true in Kentucky, with rural Kentucky having the highest prevalence for the disease. From September 2002 through August 2003, lay health workers with the nationally recognized Kentucky Homeplace program distributed and processed 3,092 diabetes self-test surveys to their clients across five regions of the state to get a better picture of the diabetes epidemic. The screening test was developed as an educational and public awareness tool by the Defeat Diabetes Foundation Inc, a nonprofit organization based in Madeira Beach, FL. It was distributed to various health agencies across the country. Each survey contained 16 questions, ranging from determining participants' urinary frequency and family medical history to their age and weight. Zero, five, or 10 points were allotted depending on respondents' degree of incidence for each question. A score of 0-15 points suggested a low risk for having diabetes, 20-25 points suggested that a respondent was at medium risk and should be tested for the disease, and a score of 30 points or higher suggested that he/she was at very high risk and "should seek (a) medical evaluation right away." Several months of analysis of the data collected indicated that 74.6% of the Kentucky Homeplace clients who participated in the survey were at moderate to significant risk of having or developing diabetes, a much higher rate than the approximately 50% of Kentucky adults in the general population that previous studies indicated were at risk. While findings from the survey of more than 3,000 Kentucky Homeplace clients cannot be generalized to Kentucky's population as a whole, they further confirm other evidence indicating that diabetes will continue to be one of the most serious health threats facing the state's rural populations. The research note further offered some recommendations for curbing rural Kentucky's diabetes epidemic, including increasing the number of certified diabetes educators serving rural Kentucky, expanding lay health worker programs within the rural portions of the Commonwealth, and studying the method and effectiveness of diabetes education between physicians and patients.

Discerning applicants' interests in rural medicine: a textual analysis of admission essays.

BACKGROUND: Despite efforts to construct targeted medical school admission processes using applicant-level correlates of future practice location, accurately gauging applicants' interests in rural medicine remains an imperfect science. This study explores the usefulness of textual analysis to identify rural-oriented themes and values underlying applicants' open-ended responses to admission essays. METHODS: The study population consisted of 75 applicants to the Rural Physician Leadership Program (RPLP) at the University of Kentucky College of Medicine. Using WordStat, a proprietary text analysis program, applicants' American Medical College Application Service personal statement and an admission essay written at the time of interview were searched for predefined keywords and phrases reflecting rural medical values. From these text searches, derived scores were then examined relative to interviewers' subjective ratings of applicants' overall acceptability for admission to the RPLP program and likelihood of practicing in a rural area. RESULTS: The two interviewer-assigned ratings of likelihood of rural practice and overall acceptability were significantly related. A statistically significant relationship was also found between the rural medical values scores and estimated likelihood of rural practice. However, there was no association between rural medical values scores and subjective ratings of applicant acceptability. CONCLUSIONS: That applicants' rural values in admission essays were not related to interviewers' overall acceptability ratings indicates that other factors played a role in the interviewers' assessments of applicants' acceptability for admission.

Double vision in a child.

A 10-year-old boy presented with a complete left oculomotor cranial nerve palsy. Diagnostic evaluation, including neuroimaging and cerebral angiography revealed a small intracranial aneurysm compressing the third nerve. Neurosurgical clipping of the aneurysm produced resolution of the third nerve palsy. The rarity of this presentation in a young patient is discussed, along with the importance of rapid diagnosis and treatment.

An alternative marker for the effectiveness of water fluoridation: hospital extraction rates for dental decay, a two-region study.

BACKGROUND: Contemporary evidence for the effectiveness of water fluoridation schemes in the U.K. is sparse. The utility of routinely collected data in providing evidence warrants further research. OBJECTIVES: To examine inpatient hospital episodes statistics for dental extractions as an alternative population marker for the effectiveness of water fluoridation by comparing hospital admissions between two major strategic health authority (SHA) areas, the West Midlands SHA-largely fluoridated--and the North West SHA--largely unfluoridated. METHOD: Hospital episodes statistics (HES) were interrogated to provide data on admissions for simple and surgical dental extractions, which had a primary diagnostic code of either dental caries or diseases of pulp and periapical tissues for financial years 2006/7, 2007/8 and 2008/9. Data was aggregated by SHA area and quinary age group. Directly standardised rates (DSR) of admissions purchased for each primary care trust (PCT) were calculated and ranked by index of multiple deprivation (IMD). RESULTS: A significant difference in DSRs of admission between PCTs in the West Midlands and North West was observed (Mann-Whitney U test [p <0.0001]) irrespective of IMD ranking. The difference in rates between the two most deprived PCTs was 27-fold. CONCLUSIONS: After ranking by IMD, DSRs of hospital admissions for the extraction of decayed or pulpally/periapically involved teeth is lower in areas with a fluoridated water supply. The analysis of routinely collected HES data may help identify the impact of water fluoridation schemes.

Is there a differential in the dental health of new recruits to the British Armed Forces? A pilot study.

BACKGROUND AND AIM: Figures from the British Defence Dental Services reveal that serving personnel in the British Army have a persistently lower level of dental fitness than those in the Royal Navy or the Royal Air Force. No research had been undertaken to ascertain if this reflects the oral health of recruits joining each Service. This study aimed to pilot a process for collecting dental and sociodemographic data from new recruits to each Service and examine the null hypothesis that no differences in dental health existed. METHOD: Diagnostic criteria were developed, a sample size calculated and data collected at the initial training establishments of each Service. RESULTS: Data for 432 participants were entered into the analysis. Recruits in the Army sample had a significantly greater prevalence of dental decay and greater treatment resource need than either of the other two Services. Army recruits had a mean number of 2.59 (2.08, 3.09) decayed teeth per recruit, compared to 1.93 (1.49, 2.39 p <0.01) in Royal Navy recruits and 1.26 (0.98, 1.53 p <0.001) in Royal Air Force recruits. Among Army recruits 62.7% were from the two most deprived quintiles of the Index of Multiple Deprivation compared to 42.5% of Royal Naval recruits and 36.6% of Royal Air Force recruits. CONCLUSION: A significant difference in dental health between recruits to each Service does exist and is a likely to be a reflection of the sociodemographic background from which they are drawn.

Rural-urban differences in health insurance coverage and patterns among working-age adults in Kentucky.

CONTEXT: Past studies show that rural populations are less likely than urban populations to have health insurance coverage, which may severely limit their access to needed health services. PURPOSE: To examine rural-urban differences in various aspects of health insurance coverage among working-age adults in Kentucky. METHODS: Data are from a household survey conducted in Kentucky in 2005. The respondents include 2,036 individuals ages 18-64. Bivariate analyses were used to compare the rural-urban differences in health insurance coverage by individual characteristics. Logistic regression analyses were used to examine the independent impact of rural-urban residence on the various aspects of health insurance coverage, while controlling for the individuals' health status and sociodemographic characteristics. FINDINGS: The overall rate of working-age adults with health insurance did not differ significantly between the rural and urban areas of Kentucky. However, there were significant rural-urban differences in insurance for specific types of health care and in patterns of insurance coverage. Rural adults were less likely than urban adults to have coverage for vision care, dental care, mental health care, and drug abuse treatment. Rural adults were also less likely to obtain insurance through employment, and their current insurance coverage was, on average, of shorter duration than that of urban adults. CONCLUSIONS: In Kentucky, the overall health insurance rate of working-age adults is influenced more by employment status and income than by whether these individuals reside in rural or urban areas. However, coverage for specific types of care, and coverage patterns, differ significantly by place of residence.

Reliability of anal pressure measurements.

This study investigates whether measurements of anal sphincter pressure and length are reproducible and whether visual analyses of manometric tracings are reliable. Manometric studies were performed on three different days in 10 male and 10 female healthy subjects with the use of a pneumohydraulic capillary perfusion system. There was complete agreement between both observers in the analysis of anal resting and squeeze pressure as well as sphincter length. The pressure profiles from different days correlated significantly (P less than 0.01) with each other regardless of whether the studies were performed in the prepared or unprepared bowel. However, anal sphincter length and the quality of the anorectal inhibitory reflex varied greatly on different days. Male and female subjects showed major differences in the capacity of the anal sphincter to contract voluntarily (P less than 0.01), but resting tone and sphincter length were comparable in the two groups. It is concluded that pressure determinations in the anal canal are reliable and reproducible, but that alterations in the quality of the anorectal reflex need to be confirmed by repeated measurements before pathology is diagnosed.