Temporal Characterization of Prion Shedding in Secreta of White-Tailed Deer in Longitudinal Study of Chronic Wasting Disease, United States.

Chronic wasting disease (CWD) affects cervids in North America, Asia, and Scandinavia. CWD is unique in its efficient spread, partially because of contact with infectious prions shed in secreta. To assess temporal profiles of CWD prion shedding, we collected saliva, urine, and feces from white-tailed deer for 66 months after exposure to low oral doses of CWD-positive brain tissue or saliva. We analyzed prion seeding activity by using modified amyloid amplification assays incorporating iron oxide bead extraction, which improved CWD detection and reduced false positives. CWD prions were detected in feces, urine, and saliva as early as 6 months postinfection. More frequent and consistent shedding was observed in deer homozygous for glycine at prion protein gene codon 96 than in deer expressing alternate genotypes. Our findings demonstrate that improved amplification methods can be used to identify early antemortem CWD prion shedding, which might aid in disease surveillance of cervids.

Food insecurity and periodontitis in US adults.

OBJECTIVES: To determine the relationship between food insecurity and periodontitis among adults in the United States (US). METHODS: Secondary analysis of the 2009-2014 National Health and Nutrition Examination Survey data. The sample included 6,108 US participants aged ≥ 30 years in a probability weighted sample. Periodontitis status was measured in full-month oral examinations at 6 sites per tooth for clinical attachment loss and periodontal probing depth. Food insecurity was assessed by the 18-item US Food Security Survey Module. RESULTS: Controlling for covariates, multiple logistic regression showed that periodontitis was associated with low food security (adjusted odds ratio (aOR)=1.30, 95% CI: 1.08-1.57). Risk factors for periodontitis included HbA1c ≥ 7% (aOR=1.74, 95% CI: 1.26-2.40), seeking emergency dental care (aOR=1.36, 95% CI:1.19-1.55), smoking status, racial minorities, low income, and older age. Protective factors for periodontitis were annual dental visit (aOR=0.52, 95% CI: 0.43-0.64), health insurance (aOR=0.66, 95% CI: 0.54-0.80), female gender, and college education. CONCLUSIONS: Food insecurity was associated with a higher risk of periodontitis among US adults. Having enough food to eat is a basic human right and would improve well-being.

Vanadium: A U.S. Perspective on an Understudied Metal.

Vanadium is an element that is little known except to those who manufacture high-performance iron alloys and other widely used metal products that are indispensable for creating improved product performance across a variety of final-use sectors. We report here on deriving a detailed material flow cycle for vanadium in the United States for 1992-2021, the most recent year for which detailed data are available. The steels [tool steel, alloy steels, and high-strength low-alloy (HSLA) steels] are responsible for about half of the cumulative vanadium demand (167 Gg), with significantly smaller fractions being used to create catalysts, titanium-vanadium alloys, and several smaller product groups. These products flow to five end-use sectors, transport (61 Gg) and industrial machinery (62 Gg) being the largest. At end of product life, the vanadium-containing tool steels and catalysts are largely recycled, while most of the vanadium in carbon steels, alloy steels, HSLA steels, and other vanadium use sectors is functionally lost.

Diabetes and dental caries in US adults: an analysis of data from the National Health and Nutrition Examination Survey, 2011-2018.

OBJECTIVES: To determine the relationship between diabetes and dental caries among US adults participating in the 2011-2018 National Health and Nutrition Examination Survey (NHANES). BASIC RESEARCH DESIGN: The NHANES was a cross-sectional study including clinical assessments, laboratory analysis, and interviews. The sample included 16,635 participants aged 20 years and older that represent 187,596,215 individuals in the US in a probability weighted sample. Outcome variables included overall total caries score (or number of decayed, missing, filled permanent teeth - DMFT index) and the presence of caries. Bivariate analysis, Poisson regression for total caries score, logistic regression for the presence of caries were used for analysis. RESULTS: Controlling for covariates, multiple Poisson regression revealed that total DMFT scores were associated with diabetes status (adjusted relative risk ratio (RR)controlled diabetes = 1.13, RRuncontrolled diabetes = 1.18; p⟨0.001), no college education, female sex, white race, elderly (≥ 65 years), cigarette smoking, obesity, yearly dental visits, seeing a dentist only for treatment. Similarly, multiple logistic regression shows that the odds of adults with diabetes having dental caries were higher than among those without diabetes (adjusted risk ratio (OR)controlled diabetes = 1.84, ORuncontrolled diabetes = 1.87; p⟨0.05). CONCLUSIONS: Diabetes was associated with a higher caries score and a greater risk for dental caries among US adults.

Environmental Persistence of Monkeypox Virus on Surfaces in Household of Person with Travel-Associated Infection, Dallas, Texas, USA, 2021.

In July 2021, we conducted environmental sampling at the residence of a person in Dallas, Texas, USA, who had travel-associated human West African monkeypox virus (MPXV-WA). Targeted environmental swab sampling was conducted 15 days after the person who had monkeypox left the household. Results indicate extensive MPXV-WA DNA contamination, and viable virus from 7 samples was successfully isolated in cell culture. There was no statistical difference (p = 0.94) between MPXV-WA PCR positivity of porous (9/10, 90%) vs. nonporous (19/21, 90.5%) surfaces, but there was a significant difference (p<0.01) between viable virus detected in cultures of porous (6/10, 60%) vs. nonporous (1/21, 5%) surfaces. These findings indicate that porous surfaces (e.g., bedding, clothing) may pose more of a MPXV exposure risk than nonporous surfaces (e.g., metal, plastic). Viable MPXV was detected on household surfaces after at least 15 days. However, low titers (<102 PFU) indicate a limited potential for indirect transmission.

Links between oral health-related quality of life in US adults and type 2 diabetes: structural equation modeling analysis.

OBJECTIVES: To analyze the effects of type 2 diabetes mellitus (T2DM), need for dental care, personal health practices and use of services on oral health-related quality of life (OHRQoL) in US adults. BASIC RESEARCH DESIGN: The sample included 2,945 participants (aged ≥ 20) selected from the National Health and Nutrition Examination Survey (NHANES) 2003-2004 stratified probability sample that represented 124,525,899 individuals in the weighted sample. Two-stage structural equation modelling (SEM) assessed interrelationships between T2DM regressions on factors associated with OHRQoL in a simplified three-factor Andersen Behavioral Model (ABM). RESULTS: SEM supported the hypotheses that T2DM directly predicted need (perceived need, evaluated need, general health condition) with a significant path coefficient of 0.49 (ß=0.49, p⟨0.05). Need had direct (77%) and indirect (23%) effects on OHRQoL (ßdirect=0.30, ßindirect=0.09, p⟨ 0.001). Need predicted personal health practices including use of services (reason for dental visit, frequency of dental visits, smoking status) (ß=0.46, p⟨0.001). Need, in turn, predicted OHRQoL (ß=0.19, p⟨0.001). In the model, 23.8%, 59.7%, and 18.1% of the variance was explained by need, personal health practices including use of services, and OHRQoL, respectively. CONCLUSIONS: The results confirmed T2DM predicted need, which in sequence had direct and indirect effects on OHRQoL.

Poor mental health days is associated with higher odds of poor oral health outcomes in the BRFSS 2020.

BACKGROUND: To test the hypothesis that among individuals in the 2020 Behavioral Risk Factor Surveillance System (BRFSS) cross-sectional anonymous health survey in the United States (US), after controlling for confounding, an increasing number of poor mental health (MH) days in the past month is associated with increasing odds of delayed oral health (OH) care utilization and poorer OH outcomes. METHODS: Adjusted logistic regression models were developed with poor MH days as the exposure to examine the association with two dependent variables (DVs): Most recent dental visit longer than one year ago (yes/no), and having lost 6 or more teeth (yes/no). RESULTS: Approximately one third (32%) reported most recent dental visit more than one year ago, and 17% had lost 6 or more teeth. Those in the second quartile of poor MH days had 11% higher odds of delayed dental visit, and those in the highest quartile had 26% higher odds, compared to the reference group. For having lost 6 or more teeth, compared to the reference group, those in the third quartile had 8% higher odds and those in the fourth quartile had 18% higher odds. CONCLUSIONS: Poor MH days is independently associated with odds of poor OH utilization and OH in the US above and beyond diagnosed mental and physical conditions. Policymakers in the US should expand health insurance plans to include dental insurance, and should increase access to MH care, especially for the aging population, and those with chronic conditions.

Malpractice allegations among US dentists: association of malpractice allegation with the severity of the alleged malpractice injury.

The objective of this study was to explore associations between allegations of malpractice and the severity of the alleged malpractice injury. The public-use data file of the National Practitioner Data Bank was used to identify 34,042 dentist malpractice reports from January 1, 2010, through December 31, 2020. Univariate descriptive analysis was conducted to identify frequencies of malpractice allegations when classified by the severity of the alleged malpractice injury, practitioner graduation year, and year of original report processing. Ordinal logistic regression analyses were conducted to explore associations between the malpractice allegation type and the severity of the alleged malpractice injury. A total of 15,183 valid reports were used in the analysis. Compared with treatment-related allegations, a surgery related allegation proved 5.3 times more likely to result in minor permanent injury; a diagnosis-related allegation was 6.5 times more likely to result in significant permanent injury and 10.4 times more likely to result in major permanent injury; and an anesthesia-related allegation was 6.2 times more likely to result in major permanent injury. The confounding variable of graduation year proved significant with respect to major temporary and minor permanent injury. As the allegation group advanced from diagnosis-related to anesthesia-, treatment-, and surgery-related allegations, the odds of a higher severity of injury did not increase. Establishing a proper diagnosis and developing a treatment plan to manage the anticipated complications of the procedure to be performed are critical to a successful outcome.

Trends in the prevalence of dental caries in the US pediatric population 2011-2020.

OBJECTIVE: The aim of this study was to provide statistics on the trends and changes in the distribution of dental caries in the United States (US) pediatric population for the 10-year period 2011 through 2020. STUDY DESIGN: Using data from the 2011 to 2020 National Health and Nutrition Examination Surveys, estimates were derived for the prevalence of decayed and filled teeth in the US population aged between 2 to 11 years. Analyses were stratified by primary and permanent dentition, and prevalence was assessed amongst the various sociodemographic and body mass index (BMI) subgroups. RESULTS: Over the 10-year period, the following changes were observed: the prevalence of decayed primary teeth has decreased from 14.1% to 12.2%, the prevalence of filled primary teeth has decreased from 29.8% to 26.1%, the prevalence of decayed permanent teeth has decreased from 5.2% to 2.7%, and the prevalence of filled permanent teeth has decreased from 16.1% to 12.3%. Despite these decreases in prevalence, there remains substantial inequality in how the disease is distributed, with those from ethnic minorities, poorer households, and with a non-normal BMI carrying the majority of disease burden. CONCLUSIONS: The prevalence of dental caries has decreased over the past 10 years, but there is still inequality in disease distribution.

Effects of Patient Characteristics on Diagnostic Performance of Self-Collected Samples for SARS-CoV-2 Testing.

We evaluated the performance of self-collected anterior nasal swab (ANS) and saliva samples compared with healthcare worker-collected nasopharyngeal swab specimens used to test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We used the same PCR diagnostic panel to test all self-collected and healthcare worker-collected samples from participants at a public hospital in Atlanta, Georgia, USA. Among 1,076 participants, 51.9% were men, 57.1% were >50 years of age, 81.2% were Black (non-Hispanic), and 74.9% reported >1 chronic medical condition. In total, 8.0% tested positive for SARS-CoV-2. Compared with nasopharyngeal swab samples, ANS samples had a sensitivity of 59% and saliva samples a sensitivity of 68%. Among participants tested 3-7 days after symptom onset, ANS samples had a sensitivity of 80% and saliva samples a sensitivity of 85%. Sensitivity varied by specimen type and patient characteristics. These findings can help physicians interpret PCR results for SARS-CoV-2.

Increased dental fluctuating asymmetry is associated with active skeletal lesions, but not mortality hazards in the precontact Southwest United States.

OBJECTIVE: This study examines whether individuals with higher dental fluctuating asymmetry (DFA) are frailer than those with lower DFA, by examining whether increased DFA is associated with skeletal lesion formation. SUBJECTS AND METHODS: 150 individuals with permanent teeth and 64 individuals with deciduous teeth. All individuals are Ancestral Puebloans from archaeological sites in modern-day New Mexico. We estimate DFA in three ways: (a) deciduous DFA only, (b) permanent DFA only, and (c) a composite of permanent and deciduous DFA. We analyzed DFA alongside lesion status for cribra orbitalia (CO) and porotic hyperostosis (PH), as well as the presence/absence of enamel hypoplasia (EH). All stress indicators were further analyzed for their impact on mortality hazards. RESULTS: We find that individuals with active CO and PH lesions have increased DFA, while those with healed lesions have lower DFA. We found no relationship between EH and DFA. Further, DFA alone does not predict individual mortality but CO does. CONCLUSIONS: Individuals with increased DFA are frailer and therefore, less capable of buffering themselves against perturbations to their health than those with lower DFA. All results indicate that individuals in this study with lower DFA were more successful in buffering themselves against random environmental impacts during childhood. While DFA alone does not predict mortality hazard, its relationship to lesion status (lower DFA in individuals with healed lesions) indicates that it would be a valuable addition to studies of health and stress.

Occupational burnout and depression among paediatric dentists in the United States.

BACKGROUND: Paediatric dentists in the United States may be at greater risk for occupational burnout and/or depression because of chronic stress associated with provision of paediatric dental care and increasing prevalence of females in the workforce. AIMS: To determine the prevalence of occupational burnout and/or depression among US paediatric dentists. DESIGN: A self-administered online anonymous survey was sent to members of the American Academy of Pediatric Dentistry (n = 4735). The questionnaire consisted of seven demographic items, 22 items of Maslach Burnout Inventory (Three subscales: Emotional exhaustion, Depersonalization, and Personal accomplishment), and eight items of Patient Health Questionnaire-8. RESULTS: The survey had a response rate of 11.4% (females = 53%). Twenty-three per cent of respondents had high emotional exhaustion while fewer respondents had high depersonalization (12%) or low personal accomplishment (10%). Nine per cent fulfilled the study's definition of occupational burnout (high emotional exhaustion + high depersonalization). Seven per cent of respondents had moderate-to-severe depression and showed significant correlations (P < .05) with high emotional exhaustion, high depersonalization and low personal accomplishment. Two out of five respondents with occupational burnout also had moderate-to-severe depression. There were no gender differences in prevalence of burnout or depression. CONCLUSIONS: Few paediatric dentists had occupational burnout and/or depression.

Assessing Child Health and Health Care in the U.S. Virgin Islands Using the National Survey of Children's Health.

OBJECTIVES: To characterize the health and health care experiences of children in the U.S. Virgin Islands (USVI), assess differences by household poverty status, and provide comparisons to the general U.S. child population. METHODS: Data are from the 2011-2012 National Survey of Children's Health, which included 2342 USVI children, aged 0-17 years. Parent-reported measures of health status and health conditions, behavioral characteristics, and health care access and utilization were assessed. Weighted prevalence estimates were calculated and compared by household poverty status using Chi square tests. RESULTS: Overall, 31.3% of USVI children lived in households below 100% of the federal poverty level (FPL). Children in these low-income households were more likely to have public insurance (33.0% vs. 8.4%) and unmet health needs (11.6% vs. 6.3%) as compared to those in households with incomes ≥ 100% FPL (all p < 0.01). They were also less likely to have a medical home (22.5% vs. 42.2%), including a usual source of sick care (p < 0.01). Compared with U.S. children in general, USVI children had lower rates of preventive medical visits, preventive dental visits, and care received in a medical home. CONCLUSIONS: USVI children experience challenges in accessing and utilizing health care services, particularly those in low-income households, and fare worse than U.S. children on many of these measures. These findings will serve as a baseline comparison for an upcoming survey of maternal and child health to be conducted in eight U.S. territories including the USVI.

Community Water Fluoridation Benefits US Children From Poor Families More Than Those From More Affluent Families.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Association Between Water Fluoridation and Income-Related Dental Caries of US Children and Adolescents. Sanders AE, Grider WB, Maas WR, Curiel JA, Slade GD. JAMA Pediatr 2019;173(3):288-90. SOURCE OF FUNDING: National Institute of Dental and Craniofacial Research of the National Institutes of Health under award number UH2DE025494. TYPE OF STUDY/DESIGN: Cross-sectional study.

Children Who Live in Mainly Fluoridated us Counties Have Less Tooth Decay.

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION: Water Fluoridation and Dental Caries in U.S. Children and Adolescents. Slade GD, Grider WB, Maas WR, Sanders AE. J Dent Res 2018;97(10):1122-8. SOURCE OF FUNDING: National Institute of Dental and Craniofacial Research of the National Institutes of Health under award number UH2DE025494. TYPE OF STUDY/DESIGN: Cross-sectional study.

Depressive symptoms and untreated coronal dental caries among adults ages 21-64 years, NHANES 2013-2014.

BACKGROUND: Depression has been linked to poor oral health among patients seeking dental care. However, systematic research on the relationship between depressive symptoms and oral health is limited. OBJECTIVE: To examine the association of depressive symptoms with untreated dental caries among adults aged 21-64 years. BASIC RESEARCH DESIGN: Cross-sectional secondary analysis. SETTING: The data were extracted national data collected in the United States (2013-2014 National Health Nutrition and Examination Survey). PARTICIPANTS: The sample consisted of 3,127 non-institutionalized civilians. MAIN OUTCOME MEASURE: Untreated coronal dental caries (yes, no) was the key outcome variable. Depressive symptom categories (none, moderate, and severe) were derived from the Patient Health Questionnaire-9 Depression Scale. RESULTS: In the study sample, 33.4% of adults had untreated coronal dental caries. Most participants (77.9%) did not report depressive symptoms; 13.9% had mild and 8.2% had moderate or severe depressive symptoms. In unadjusted analyses, individuals with mild (Odds Ratio = 1.62 [95% CI: 1.26, 2.08] and moderate/severe depressive symptoms (Odds Ratio = 2.70 [95% CI: 1.81, 4.02]) were more likely to have untreated coronal caries as compared with individuals without depressive symptoms. When sex, race, age, education, family income-to-poverty ratio, dental visits, history of previous dental restorations, health insurance, and smoking were included into the model, the associations were no longer statistically significant (1.27 [95% CI: 0.96, 1.69] and 1.61 [95% CI: 0.95, 2.73], respectively). CONCLUSION: The relationship between depressive symptoms and untreated coronal dental caries failed to remain significant after the addition of tobacco usage in the analysis.

Prolonged Detection of Zika Virus in Vaginal Secretions and Whole Blood.

Infection with Zika virus is an emerging public health crisis. We observed prolonged detection of virus RNA in vaginal mucosal swab specimens and whole blood for a US traveler with acute Zika virus infection who had visited Honduras. These findings advance understanding of Zika virus infection and provide data for additional testing strategies.

Care delivery and compensation system changes: a case study of organizational readiness within a large dental care practice organization in the United States.

BACKGROUND: Dental care delivery systems in the United States are consolidating and large practice organizations are becoming more common. At the same time, greater accountability for addressing disparities in access to care is being demanded when public funds are used to pay for care. As change occurs within these new practice structures, attempts to implement change in the delivery system may be hampered by failure to understand the organizational climate or fail to prepare employees to accommodate new goals or processes. Studies of organizational behavior within oral health care are sparse and have not addressed consolidation of current delivery systems. The objective of this case study was to assess organizational readiness for implementing change in a large dental care organization consisting of staff model clinics and affiliated dental practices and test associations of readiness with workforce characteristics and work environment. METHODS: A dental care organization implemented a multifaceted quality improvement program, called PREDICT, in which community-based mobile and clinic-based dental services were integrated and the team compensated based in part on meeting performance targets. Dental care providers and supporting staff members (N = 181) were surveyed before program implementation and organizational readiness for implementing change (ORIC) was assessed by two 5-point scales: change commitment and efficacy. RESULTS: Providers and staff demonstrated high organizational readiness for change. Median change commitment was 3.8 (Interquartile range [IQR]: 3.3-4.3) and change efficacy was 3.8 (IQR: 3.0-4.2). In the adjusted regression model, change commitment was associated with organizational climate, support for methods to arrest tooth decay and was inversely related to office chaos. Change efficacy was associated with organizational climate, support for the company's mission and was inversely related to burnout. Each unit increase in the organizational climate scale predicted 0.45 and 0.8-unit increases in change commitment and change efficacy. CONCLUSIONS: The survey identified positive readiness for change and highlighted weaknesses that are important cautions for this organization and others initiating change. Future studies will examine how organizational readiness to change, workforce characteristics and work environment influenced successful implementation within this organization.

Health-care access among adults with epilepsy: The U.S. National Health Interview Survey, 2010 and 2013.

INTRODUCTION: Community-based and other epidemiologic studies within the United States have identified substantial disparities in health care among adults with epilepsy. However, few data analyses addressing their health-care access are representative of the entire United States. This study aimed to examine national survey data about adults with epilepsy and to identify barriers to their health care. MATERIALS AND METHODS: We analyzed data from U.S. adults in the 2010 and the 2013 National Health Interview Surveys, multistage probability samples with supplemental questions on epilepsy. We defined active epilepsy as a history of physician-diagnosed epilepsy either currently under treatment or accompanied by seizures during the preceding year. We employed SAS-callable SUDAAN software to obtain weighted estimates of population proportions and rate ratios (RRs) adjusted for sex, age, and race/ethnicity. RESULTS: Compared to adults reporting no history of epilepsy, adults reporting active epilepsy were significantly more likely to be insured under Medicaid (RR=3.58) and less likely to have private health insurance (RR=0.58). Adults with active epilepsy were also less likely to be employed (RR=0.53) and much more likely to report being disabled (RR=6.14). They experience greater barriers to health-care access including an inability to afford medication (RR=2.40), mental health care (RR=3.23), eyeglasses (RR=2.36), or dental care (RR=1.98) and are more likely to report transportation as a barrier to health care (RR=5.28). CONCLUSIONS: These reported substantial disparities in, and barriers to, access to health care for adults with active epilepsy are amenable to intervention.

Comparison of systemic health conditions between African American and Caucasian complete denture patients.

PURPOSE: To compare prevalence of systemic health conditions (SHC) between African American and Caucasian edentulous patients presenting for complete dentures (CD) at an urban dental school. METHODS: The study included patients presenting for CD 1/1-12/31/2010, ages 20 to 64 years, and either African American or Caucasian. Covariates included: age group, gender, employment status, Medicaid status, smoking history, and alcohol consumption. SHC included at least one of the following: arthritis, asthma, cancer, diabetes, emphysema, heart attack, heart murmur, heart surgery, hypertension, or stroke. RESULTS: The group (n = 88) was 44.3% African American, 65.9% ≥50, 45.5% male, 22.7% employed, and 67.0% with at least one SHC. African Americans were older (p = 0.001) and more likely to have one or more SHC (p = 0.011). Patients with at least one SHC were older (p = 0.018) and more likely female (p = 0.012). The total sample logistic regression model assessing SHC yielded only gender as statistically significant (males < OR 0.32, 95% CI 0.11 to 0.92). Caucasian males were less likely to have SHC (OR 0.17, 95% CI 0.04 to 0.77), and Caucasians ≥50 were more likely (OR 5.36, 95% CI 1.19 to 24.08). African Americans yielded no significant associations. CONCLUSIONS: Among selected completely edentulous denture patients at an urban dental school, two out of three patients had at least one SHC. This exploratory study suggests there may be health status differences between African American and Caucasian patients in this setting, calling for further study.