Management and treatment of HIV: are primary care clinicians prepared for their new role?

BACKGROUND: Current literature suggests the number of HIV clinicians in the United States is diminishing. There are 294,834 primary care providers (PCP) in the United States, and, of these, 3101 provide care to HIV-positive patients. More PCPs to treat and manage HIV patients may be the solution to alleviate the HIV provider shortage. However, PCPs also face challenges, including workforce shortages. We surveyed PCPs to determine perceived barriers, beliefs, and attitudes about their readiness to manage and treat HIV patients. METHODS: Following a quantitative, descriptive, cross-sectional survey design, currently practicing clinicians in primary care (physicians, residents, physician assistants, family nurse practitioners) were emailed a link to the study survey. Three hundred forty-seven family medicine clinicians from 47 states met the study inclusion criteria. RESULTS: Most (245/347, 70.6%) of the PCPs agreed that PCPs should take care of HIV patients. PCPs practicing HIV medicine (n = 171) were more likely than those not practicing HIV medicine (n = 176) to agree that PCPs should help with the HIV provider shortage (U = 10,384, p < 0.001) and that PCPs are the best solution to the HIV provider shortage (U = 10,294, p < 0.001). The majority (206, 59.4%) believed PCPs are the best solution for the HIV provider shortage. Of 133 physician assistants (PAs) and family nurse practitioners (NPs), seventy (52.6%) believed they could be ready to manage HIV patients with some training. CONCLUSION: The HIV provider shortage in the United States is likely to continue. To alleviate the provider shortage, PCPs should be offered additional training, decreased workload, and increased compensation when treating and managing HIV patients. Also, encouraging PAs and family NPs to be involved with HIV medicine may be a solution.

Job Satisfaction Among Physician Assistants Practicing Cardiovascular Medicine in the United States.

We assessed overall job satisfaction and factors of job satisfaction among physician assistants (PAs) practicing cardiovascular medicine in the United States. Job satisfaction among health care providers is associated with provider satisfaction and retention, reduced health care costs, increased patient satisfaction, and improved health care. Research regarding job satisfaction among physicians and nurse practitioners has been conducted, but knowledge of job satisfaction among PAs is limited, dated, and inadequate. Job satisfaction among PAs in cardiology, a specialty with a disparity between provider supply and demand, has not been investigated. A quantitative, correlational, descriptive study was conducted using participants from the Association of Physician Assistants in Cardiology database. Overall job satisfaction, 45 factors of job satisfaction, and 6 composite factors were calculated. Correlational analysis was performed for factors most associated with overall job satisfaction. Overall job satisfaction was high. Most PAs (87.3%) were satisfied or very satisfied. Physician assistants were most satisfied with job factors related to challenge and autonomy, and these factors had the greatest correlation to overall job satisfaction. Findings can guide employers, health care administrators, and policy makers to promote job satisfaction among PAs in cardiology and provide insights into job satisfaction among PAs in general.

Effect of a Matter of Balance programme on avoidance behaviour due to fear of falling in older adults.

BACKGROUND: Fear of falling (FOF) is associated with restricted activities, increased risk of falling, and decreased quality of life. A Matter of Balance (AMOB) is an evidence-based programme designed to decrease FOF. The current study investigated the influence of the AMOB on activity avoidance caused by FOF in older adults using the Fear of Falling Avoidance Behavior Questionnaire (FFABQ), health-related quality of life, and a question regarding concerns about falling. METHODS: Participants of this quasi-experimental, one-group, pretest-post-test study design were older adults from community sites in the Phoenix, Arizona, metropolitan area. Participants attended the AMOB programme, which consisted of one weekly 2-h session for 8 weeks. At the beginning and end of the programme, participants completed the standard AMOB assessments, the FFABQ, the Centers for Disease Control Core Healthy Days Measure (CDC HRQOL-4), and a question regarding concerns about falling. RESULTS: Sixty-three participants completed the study; their mean ± SD age was 75.3 ± 7.1 years (range: 60.0-90.0 years), and 84.1% were women. The FFABQ scores decreased from baseline (24.4 ± 12.7 points) to post-AMOB (20.1 ± 11.9 points; t = 2.62, P = 0.01). No changes in any of the CDC HRQOL-4 questions were noted (CDC HRQOL-4 question (Q)1 (z = -1.41, P = 0.16), CDC HRQOL-4 Q2 and Q3 summary index (z = -1.60, P = 0.11), and CDC HRQOL-4 Q4 (z = -0.97, P = 0.33)). Concerns about falling decreased from baseline (3.4 ± 0.9 points) to post-AMOB (2.8 ± 0.8 points; z = -4.09, P < 0.001). CONCLUSION: Avoidance behaviour caused by FOF, as measured by the FFABQ, and concerns about falling decreased in community-dwelling older adults who participated in the AMOB. Findings support the efficacy of the AMOB for reducing both avoidance behaviour caused by FOF and concerns about falling through an approach that combines education and exercise.

Urinary Incontinence and Quality of Life: A Cross-Sectional Study.

Over half of women in the United States report urinary incontinence (UI). This condition can be treated conservatively, but many people do not seek treatment. The current correlational study assessed women's knowledge of UI. Specifically, we investigated the relationships between knowledge level about UI and quality of life (QoL), and between severity level of UI and QoL. A convenience cross-sectional sample of 39 older women was obtained from two YMCA locations. Data were analyzed using the Spearman rank-order correlation coefficient. A significant relationship was found between severity of UI and QoL, rs = -.73, p < .001; no relationship was found between knowledge level of UI and QoL, rs = .24, p = .13. Results suggested women's knowledge about the causes of UI and conservative therapy is limited. Occupational therapists need to address UI with their patients and educate them about treatment options and availability.

Urinary Incontinence and Quality of Life: A Cross-Sectional StudyThis research article describes a study assessing the knowledge of women about urinary incontinence (UI), if they are experiencing UI, and their level of quality of life (QoL) as it pertains to UI. The authors explored the relationship between knowledge of UI and the QoL of the study participants and the relationship between their current symptom level of UI and their QoL. Results showed a significant relationship between increased severity of UI symptoms and decreased QoL. Although the results did not show a link between the level of knowledge about UI and QoL of the participants, the authors found that knowledge about the causes and possible treatments of UI by the study participants was limited. The study results indicate the need for community education on occupational therapy treatment options. Occupational therapy practitioners can expand their practice areas to address the needs of women experiencing a reduction in occupational engagement due to UI.

Infection control professionals' information-seeking preferences.

OBJECTIVES: The aims of this study were to: 1) establish whether infection control professionals (ICPs) who had access to and utilised medical librarian services for evidence-based medicine (EBM) research perceived this assistance to be useful and 2) to establish whether ICPs who used electronic or hard copy resources for EBM research perceived that those resources had a significant impact on their work. METHODS: Convenience sampling was used to collect quantitative data via a questionnaire. Study participants were members of South-west and Western chapters of the Association for Professionals in Infection Control and Epidemiology. There were 264 questionnaires distributed in this study; 179 participants completed the questionnaire. The response rate for eligible respondents was 59.5% (157). RESULTS: Results indicated 56.7% (51) of the ICPs with librarian access reported requesting assistance from their work facility librarian. In reference to locating infection control information, 77.9% (95), 87.3% (124) and 93.3% (138) of ICPs found textbooks, journals and the Internet 'very useful' or 'useful', respectively. CONCLUSION: Study results indicated ICPs who used the assistance of medical librarians and/or hard copy or electronic resources for EBM research perceived such sources to be valuable for obtaining infection control information.

Physician Assistant Students' Perception of Online Didactic Education: A Cross-Sectional Study.

PURPOSE: This study describes physician assistant students' perception toward online didactic education and highlights relationships between student characteristics and their preference for online learning. METHODS: A previously validated survey questionnaire was administered online to physician assistant students enrolled in traditional, in-person training programs across the United States. The survey consisted of five Likert-scale statements measuring perceptions of online learning and was rated on a seven-point Likert scale. Students also reported their age, gender, history of taking an online course, and preferred learning style. Mean scores were reported for agreement with each Likert-scale statement; Pearson correlation coefficients, one-way ANOVA with post hoc Tukey tests, and independent samples t-tests were used to determine relationships between student characteristics and their preference for online learning. RESULTS: A total of 391 completed surveys met the inclusion criteria for the study and were used in data analysis. The average age of respondents was 25.98 years, 81.1% (n = 317) were female, 96.2%, (n = 376) reported taking an online course previously, and preferred learning styles were reported as 36.1% (n = 141) visual, 7.7% (n = 30) auditory, 15.6% (n = 61) reading/writing, and 40.7% (n = 159) kinesthetic. Nearly a quarter of respondents indicated they preferred online courses, particularly students with a preferred learning style of reading/writing. No relationships were observed between age, gender, or history of taking an online course and preference for online education. CONCLUSION: Most physician assistant students prefer in-person learning. However, a substantial number prefer online learning, and a significant number of these students reported a preferred learning style of reading/writing. More research is necessary to give educational institutions the ability to make data-driven, student-centered program development decisions. However, data in this study indicate a need for continued development of online/hybrid physician assistant programs to better align with current student preferences.

Is harmonica playing an effective adjunct therapy to pulmonary rehabilitation?

PURPOSE: This randomized controlled trial examined the effect harmonica playing has on various clinical, psychosocial, and functional outcomes among chronic obstructive pulmonary disease (COPD) patients in pulmonary rehabilitation (PR). METHOD: Twenty-eight participants (Age 69.9 ± 1.8; FEV1 Predicted 41.9 ± 2.0%) were recruited from an outpatient PR program. Participants were randomly assigned to one of two groups, traditional PR (C; n = 16) or traditional PR plus harmonica playing (HT; n = 9). The HT group was provided a harmonica and one-on-one instruction by PR staff. Patients were given practice exercises to perform for at least 5 minutes, but not exceeding 20 minutes twice/day, 5 days/week. RESULTS: No significant differences were found between groups. The combined sample improved significantly in their perception of shortness of breath, quality of life, and distance walked in 6 minutes. CONCLUSION: Harmonica playing does not significantly affect the clinical, psychosocial, or functional status of COPD patients enrolled in PR.

Isolated and combined effects of aerobic and strength exercise on post-exercise blood pressure and cardiac vagal reactivation in normotensive men.

The purpose of this study was to examine blood pressure (BP), heart rate (HR), and cardiac vagal reactivation (VR) after an aerobic training session (ATS), a strength training session (STS), and a combined aerobic and strength training session (ASTS) in normotensive men. Eleven healthy men (age 26.8 ± 2.9 years, body mass index 24.3 ± 1.6 kg·m) with at least 6 months of strength and aerobic training experience performed an STS, an ATS, and an ASTS in a counterbalanced crossover design. Blood pressure and HR were measured at rest and at 15-minute intervals post-training for 1 hour. Vagal reactivation was measured during the first minute immediately post-exercise. After STS and ASTS, systolic BP (SBP) and mean arterial BP (MAP) remained significantly lower than at rest at all time intervals (p < 0.05). After ATS, SBP was significantly lower than at rest at 30 minutes and beyond (p < 0.01); however, no significant differences were observed for MAP. Post-training HR remained high after STS and ASTS at all intervals (p < 0.01). However, after ATS, the HR remained high only at the 15-minute post-exercise interval (p < 0.01). Vagal reactivation was significantly less pronounced after the first 30 seconds post-exercise (p < 0.01) in ASTS (531.3 ± 329.6 seconds) than in ATS (220.7 ± 88.5 seconds) and in STS (317.6 ± 158.5 seconds). The delta of the HR decrease at 60 seconds post-exercise was greater (p < 0.00) in ATS (33.4 ± 12.7 b·min) than in STS (14.1 ± 7.2 b·min) and in ASTS (11.4 ± 7.1 b·min). In conclusion, post-exercise BP reduction was independent of the type of exercise; however, HR remained significantly greater after combination of strength and aerobic exercise, implying a reduction in cardiac VR after this type of training. Therefore, strength and conditioning professionals may prescribe aerobic, strength, or a combination of aerobic and strength exercise to assist individuals concerned with BP control, thus allowing for variety in training while similarly impacting post-exercise SBP regardless of desired exercise modality.

Acute cardiovascular response in anabolic androgenic steroid users performing maximal treadmill exercise testing.

The purpose of this study was to investigate the cardiovascular effects of anabolic androgenic steroid (AAS) use, specifically the hemodynamic response, during maximal treadmill exercise testing by comparing the exercise response between users of AAS (U-AAS) and non-AAS users (N-AAS). Twenty-four men (n=12; 29+/-3.4 years and n=12; 29.5+/-8.2 years for the U-AAS and N-AAS groups, respectively) with regular participation in both resistance (mean=6 d.wk) and aerobic exercise (mean=2 d.wk) volunteered for the study. Both groups of subjects completed a ramp-protocol maximal treadmill exercise test to volitional fatigue. Several hemodynamic and metabolic measures were obtained before, during, and after testing. The results demonstrate for the first time that chronic administration of high doses of AAS (355.4+/-59.47 mg.wk) lead to hemodynamic and metabolic response impairment. In conclusion, the chronotropic significant incompetence in the current study was reflected by an exaggerated hemodynamic response to exercise. Furthermore, the findings suggest that nonusers of AAS showed increases in VO2max when compared to the AAS group. Therefore, this study provides a contraindication to AAS use, especially in those at increased risk of cardiovascular events.

Patient Attitudes Toward Telemedicine-Delivered Cardiac Rehabilitation.

BACKGROUND: Telemedicine-delivered cardiac rehabilitation (telemedicine-CR) provides an alternative pathway for patients who are unable to participate in conventional CR. Little is known regarding the relationships among potential participants' perceptions of barriers to CR participation, interest in telemedicine-CR, and self-efficacy beliefs toward the use of telemedicine. The purpose of this study was to identify if associations exist between these variables. METHODS: A quantitative, correlational survey study was conducted using the Cardiac Rehabilitation Barriers Scale and a survey examining interest in and self-efficacy for telemedicine technologies. Eighty-three patients were invited to participate. RESULTS: Twenty surveys (24%) were returned. Significant correlations were identified between interest in telemedicine-CR and self-efficacy beliefs for the use of live video links, rs(14) = .510, p = .044, and the Cardiac Rehabilitation Barriers Scale Comorbidity subscale, rs(18) = -.469, p = .037. CONCLUSIONS: Higher self-efficacy for the use of video chat and fewer perceived comorbidity barriers were associated with greater interest in telemedicine-CR.

The effect of strength training on functional fitness in older patients with chronic lung disease enrolled in pulmonary rehabilitation.

The purpose of this study was to compare the effects of a strength training-enhanced program and a traditional pulmonary rehabilitation (PR) program on functional fitness (FF) in older patients with chronic obstructive pulmonary disease (COPD), using the Senior Fitness Test. Twenty patients were recruited from an outpatient PR program. After completing baseline measures, including muscular strength and the Senior Fitness Test, patients were randomly assigned to the strength training program (TR+ST, n = 10) or traditional PR program (TR, n = 10). Patients completed 16 exercise sessions that were conducted twice a week for 8-10 weeks, after which patients repeated outcome measurements. Independent t tests were conducted to determine whether groups differed between measures. Both the TR+ST and TR groups improved on all FF measures. Moderate effect sizes were found for two of the FF measures when the groups were compared. The addition of strength training to PR may have a favorable impact on FF in older patients with COPD.

Progression of Resistance Training Intensity among Older COPD Patients: A Comparison of 2 Resistance Training Studies.

OBJECTIVE: This comparison study examined strength and functional fitness (FF) outcomes between 2 single-set resistance training (SSRT) studies of differing intensity progressions (rapid progression [RP] versus delayed progression [DP]) among elderly pulmonary rehabilitation (PR) patients to determine if there is a threshold effect for training intensity. METHODS: Twenty PR patients participating in identical hospital-based PR programs, which met twice a week for 8 weeks, were randomly assigned to SSRT programs, which differed in intensity progression (RP: n = 10, mean age = 71.0 +/- 3.7 years; DP: n = 10, mean age = 65.4 +/- 7.8 years). The SSRT consisted of 1 set of 8 to 15 repetitions of 5 exercises. For both studies, training loads were determined equally. Load increases in the RP study consisted of 5% to 10% immediately following a session where 10 repetitions were completed. Load increases for the DP study consisted of 3 to 5 lbs following 2 consecutive sessions wherein 12 repetitions were completed. RESULTS of the primary outcomes data from both SSRT studies were compared to determine the presence of a threshold effect for intensity progression. The outcomes evaluated in both studies were upper and lower body strength and various FF measures. Repeated measures controlling for age, pulmonary function, and body mass index (BMI) were used to assess the presence of significant differences. To determine statistical significance, alpha was set at P < 0.05. RESULTS: Rapid progression resulted in greater increases in upper body strength (chest press; P = 0.021) and FF (arm curl test, P = 0.001; lift and reach test, P = 0.003) than DP. CONCLUSIONS: Rapid progression of training intensity in a SSRT involving elderly PR patients appears superior to delayed progression. KEYWORDS: strength training; weight lifting; older adults; exercise intensity; pulmonary rehabilitation; COPD.

Clinical Research Nursing: Awareness and Understanding Among Baccalaureate Nursing Students.

BACKGROUND: The American Nurses Association recognizes the specialty practice of Clinical Research Nursing, but many new nurses are unaware of the specialty and lack knowledge to effectively interact with research teams. METHOD: Participants completed a novel online survey to describe the level of awareness and understanding of the clinical research nursing specialty and the effect of clinical studies on nursing practice in fourth-year baccalaureate nursing program students. RESULTS: Ninety-three participants completed the survey. Most were aware that some nurses specialize in the care of clinical study participants, and most did not know how to effectively support research teams. Years of nursing experience was associated with an understanding of how to effectively collaborate with clinical research nurses and an interest in a career as a clinical research nurse. CONCLUSION: Entry-level nursing programs should expose students to the clinical research nurse role and provide the knowledge needed to collaborate with researchers when caring for patients in clinical studies. [J Nurs Educ. 2018;57(10):598-603.].

How cardiac rehabilitation relates to quality of life.

The purpose of this study is to determine the relationship between adherence to cardiac rehabilitation (CR) and improvements in health-related quality of life (HRQL) with a 12-week, Phase-II CR program. Previously collected data from 153 CR patients (114 males, 39 females; 69.1 years of age +/- 11.5) were utilized to complete this retrospective study. Patients completed the Medical Outcomes Survey Short Form-36 to assess HRQL at the beginning of CR (N = 153), at 3 months (N = 152), and at 1 year (N = 94). Pearson correlation coefficients were generated to assess the relationship between CR attendance and HRQL. Paired sample t-tests helped determine the effect of CR on HRQL at 3 months and 1 year. No relationship was found between CR adherence and improvements in HRQL. Significant improvements in HRQL were found among all patients from baseline to 3 months and 1 year. Study findings demonstrate the effectiveness of CR in improving patient short- and long-term HRQL regardless of patient adherence rate.

Laboratory Animal Workers' Attitudes and Perceptions Concerning Occupational Risk and Injury.

Little is known regarding the risk perceptions and attitudes of laboratory animal care workers toward biologic safety. The purpose of this descriptive study was to assess the attitudes and perceptions of laboratory animal workers toward occupational and injury risk. Subscribers to the CompMed and TechLink listservs (n = 4808) were surveyed electronically, and 5.3% responded; data from 215 respondents were included in the final analysis. Primary variables of interest included AALAS certifications status, level of education, and responses to Likert-scale questions related to attitudes and perceptions of occupational risk and injury. Nonparametric (χ(2)) testing and measures of central tendency and dispersion were used to analyze and describe the data. According to 88.6% of respondents, biologic safety training is provided with information about zoonotic diseases of laboratory animals. Level of education was significantly related to perception of importance regarding wearing personal protective equipment. Participants indicated that appropriate support from coworkers and management staff is received, especially when performance and perception are hindered due to stress and fatigue. Laboratory animal staff are susceptible to injury and exposure to dangerous organisms and toxic substances. For this reason, to maximize safety, yearly biologic safety training should be provided, the importance of protective equipment adherence strengthened, and the culture of safety made a priority within the institution.

Cardiac rehabilitation patient versus proxy quality-of-life perceptions.

Spousal perceptions and/or attitudes to their patient partners' capabilities have been shown to affect the effectiveness of the cardiac rehabilitation (CR) process. The purpose of this study was (a) to assess differences between patient and proxy responses to the Medical Outcomes Survey-Short Form 36 (SF36)and (b) suggest how such information may contribute to enhancing rehabitation outcomes. Fifty-eight patients completed the SF36 prior to entering Phase II CR. Patient spouses completed a proxy version of the same questionnaire. The authors found that spouses' perceptions of their patient partners physical functioning (PF) was approximately 10% lower than patients' perceptions of their own PF (p < .04). Implications for the appropriate application of such data are discussed.

Relationship between strength, function, and quality of life in older adults with chronic lung disease: is there an influence of gender?

PURPOSE: Chronic lung disease results in impaired quality of life (QOL) linked to loss of muscular strength and functional ability. Inequalities in strength and function may place women at greater risk than men. This study evaluated the influence of gender on the relationship between muscular strength, functional ability, and QOL. METHODS: Older adults (N = 40) referred to a pulmonary rehabilitation program completed assessment of upper body and lower body strength, functional ability, and QOL. To compensate for gender differences, strength was normalized for body mass. RESULTS: Strength was greater in men than in women (P < .001). No gender differences were observed for function. Men perceived better QOL related to physical function (score: 39.3 ± 3.3 vs 27.1 ± 2.1, P < .01) and social function (score: 58.0 ± 5.8 vs 41.6 ± 4.0, P < .05). In men, strength was related directly to QOL through physical function (r = 0.53, P < .05) and social function (r = 0.52, P < .05), and functional ability had no relationship to QOL. In women, strength was related to functional ability (r = 0.57, P < .05), and functional ability was directly related to QOL through physical function (r = 0.46, P < .05), and social function (r = 0.59, P < .01). CONCLUSIONS: Functional ability mediates the relationship between strength and QOL in women, while in men strength is directly related to QOL. These gender-specific pathways to QOL may be of importance to clinicians planning interventions for older adults with chronic lung disease.

Physician assistant program directors' attitudes, practices, and plans regarding financial compensation to clinical sites.

PURPOSE: Some physician assistant (PA) program directors believe paying clinicians and administrators for clinical sites is fair and necessary, while others regard such practices as undermining traditional altruistic motivations for precepting. The purpose of this study was to assess PA program directors' attitudes on this topic and describe current practices and future plans regarding compensation to clinical sites. METHODS: A cross-sectional descriptive survey was sent to directors of PA programs with continuing and provisional accreditation status in 2012. RESULTS: Seventy-eight (48%) of the 163 program directors surveyed participated in the study. Although most respondents indicated that paying for clinical sites was not an acceptable practice, almost half believed it would. be acceptable if there were standards and definitions for equitable and fair payments. Despite the finding that most respondents' programs do not pay for clinical sites, nearly half anticipate their programs will be paying for clinical sites in three years, and the cost of such payments will be passed on to students in the form of increased tuition or separate fees. Many indicated a concern that paying for clinical sites may result in monopolies and bidding wars. CONCLUSION: While paying clinical sites may be effective for recruitment and retention of clinical sites, most program directors are concerned about the expanded role economics will have for their program. Agreed-upon standards and definitions for fair and equitable payment practices may alleviate some of these concerns. However, the potential effects on students and programs identified in this study necessitate additional research to fully assess what implications this may have on PA education and the profession.

Femoral neck stress fracture in Air Force basic trainees.

Stress fractures are a common overuse problem among military trainees resulting in preventable morbidity, prolonged training, and long-term disability following military service. Femoral neck stress fractures (FNSFs) account for 2% of all stress fractures but result in disproportionate burden in terms of cost and convalescence. The purpose of this study was to describe and investigate FNSF in U.S. Air Force basic trainees and to present new data on risks factors for developing FNSF. We examined 47 cases of FNSF occurring in Air Force basic trainees between 2008 and 2011 and 94 controls using a matched case-control model. Analysis with t tests and conditional logistic regression found the risk of FNSF was not associated with body mass index or abdominal circumference. Female gender (p < 0.001) and slower run time significantly increased risk of FNSF (1.49 OR, p < 0.001; 95% CI 1.19-1.86). A greater number of push-up and sit-up repetitions significantly reduced risk of FNSF (0.55 OR, p = 0.03; 95% CI 0.32-0.93; 0.62 OR, p = 0.04; 95% CI 0.4-0.98) for females. In this study body mass index was not correlated with FNSF risk; however, physical fitness level on arrival to training and female gender were significantly associated with risk of FNSF.

Perceived influence of community oral health curriculum on graduates' dental practice choice and volunteerism.

The purpose of this study was to determine if A.T. Still University Arizona School of Dentistry and Oral Health (ASDOH) curricular content regarding community oral health has influenced graduates' dental practice choice and volunteering activities in their communities. At ASDOH, the community oral health curriculum consists of three components: 1) coursework in public health resulting in a certificate or master's degree in public health; 2) service-learning activities in the Dentistry in the Community series of course modules, wherein students plan and implement community projects; and 3) community-based clinical rotations of approximately ninety-five days during the fourth year. To accomplish the purposes of the study, a survey was sent to ASDOH alumni who graduated between 2007 and 2010. Of the 208 graduates contacted, ninety-four responded (45.2 percent). Of those who responded, 85 percent reported that the community oral health curriculum influenced their practice choice, and 76 percent reported that they volunteer. Additionally, 58 percent of the respondents reported that the amount of dental school debt they had incurred affected their career plans and professional decision making.