Effects of a Brief Case Management Intervention Linking People With HIV to Oral Health Care: Project SMILE.

Objectives. Although people with HIV experience significant oral health problems, many consistently identify oral health as an unmet health care need. We conducted a randomized controlled trial to evaluate the impact of a dental case management intervention on dental care use. Methods. We evaluated the intervention according to self-reported dental care use at 6-, 12-, and 18-month follow-ups. Multivariable logistic models with generalized estimating equations were used to assess the effects of the intervention over time. Results. The odds of having a dental care visit were about twice as high in the intervention group as in the standard care group at 6 months (adjusted odds ratio [OR] = 2.52; 95% confidence interval [CI] = 1.58, 4.08) and 12 months (adjusted OR = 1.98; 95% CI = 1.17, 3.35), but the odds were comparable in the 2 groups by 18 months (adjusted OR = 1.07; 95% CI = 0.62, 1.86). Factors significantly associated with having a dental care visit included frequent physician visits and dental care referrals. Conclusions. We demonstrated that a dental case management intervention targeting people with HIV was efficacious but not sustainable over time. Barriers not addressed in the intervention must be considered to sustain its use over time.

Utilization of dental care services among low-income HIV-positive persons receiving primary care in South Florida.

We investigated the use of dental care services among a population of low-income persons living with HIV/AIDS who had not seen a dental care provider during the 12 months prior to study enrollment. A total of 593 participants were recruited from five HIV primary care clinics in two South Florida counties and interviewed regarding past utilization of dental care services, HIV primary care service utilization, and barriers to care. Multivariate logistic regression analysis was used to determine correlates of oral care utilization within the preceding two years. One-third of respondents reported seeing a dentist in the preceding two years. The odds of having seen a dentist were greater for respondents with stable housing, more than a high school education, and who had received help in getting dental care; black respondents (compared to Hispanics and non-Hispanic whites) were less likely to have seen a dentist in the preceding two years. Despite the availability of dental services for low-income HIV-positive persons, utilization of dental care remains low. This study reinforces the need to provide assistance to HIV-positive persons in obtaining dental care. In particular, it indicates that such assistance should be targeted toward Black Americans, persons with low income and unstable housing situations, and those with limited help to navigate the health care system.

Behavioral and clinical characteristics of persons receiving medical care for HIV infection - Medical Monitoring Project, United States, 2009.

PROBLEM: As of December 31, 2009, an estimated 864,748 persons were living with human immunodeficiency virus (HIV) infection in the 50 U.S. states, the District of Columbia, and six U.S.-dependent areas. Whereas HIV surveillance programs in the United States collect information about persons with a diagnosis of HIV infection, supplemental surveillance systems collect in-depth information about the behavioral and clinical characteristics of persons receiving outpatient medical care for HIV infection. These data are needed to reduce HIV-related morbidity and mortality and HIV transmission. REPORTING PERIOD COVERED: Data were collected during June 2009-May 2010 for patients receiving medical care at least once during January-April 2009. DESCRIPTION OF THE SYSTEM: The Medical Monitoring Project (MMP) is an ongoing surveillance system that assesses behaviors and clinical characteristics of HIV-infected persons who have received outpatient medical care. For the 2009 data collection cycle, participants must have been aged ≥18 years and have received medical care during January-April 2009 at sampled facilities that provide HIV medical care within participating MMP project areas. Behavioral and selected clinical data were collected using an in-person interview, and most clinical data were collected using medical record abstraction. A total of 23 project areas in 16 states and Puerto Rico were funded to collect data during the 2009 data collection cycle. The data were weighted for probability of selection and nonresponse to be representative of adults receiving outpatient medical care for HIV infection in the United States and Puerto Rico. Prevalence estimates are presented as weighted percentages. The period of reference is the 12 months before the patient interview unless otherwise noted. RESULTS: The patients in MMP represent 421,186 adults who received outpatient medical care for HIV infection in the United States and Puerto Rico during January-April 2009. Of adults who received medical care for HIV infection, an estimated 71.2% were male, 27.2% were female, and 1.6% were transgender. An estimated 41.4% were black or African American, 34.6% were white, and 19.1% were Hispanic or Latino. The largest proportion (23.1%) were aged 45-49 years. Most patients (81.1%) had medical coverage; 40.3% had Medicaid, 30.6% had private health insurance, and 25.7% had Medicare. An estimated 69.6% of patients had three or more documented CD4+ T-lymphocyte cell (CD4+) or HIV viral load tests. Most patients (88.7%) were prescribed antiretroviral therapy (ART), and 71.6% had a documented viral load that was undetectable or ≤200 copies/mL at their most recent test. Among sexually active patients, 55.0% had documentation in the medical record of being tested for syphilis, 23.2% for gonorrhea, and 23.9% for chlamydia. Noninjection drugs were used for nonmedical purposes by an estimated 27.1% of patients, whereas injection drugs were used for nonmedical purposes by 2.1% of patients. Overall, 12.9% of patients engaged in unprotected sex with a partner of negative or unknown HIV status. Unmet supportive service needs were prevalent, with an estimated 22.8% in need of dental care and 12.0% in need of public benefits, including Social Security Income or Social Security Disability Insurance. Fewer than half of patients (44.8%) reported receiving HIV and sexually transmitted disease prevention counseling from a health-care provider. INTERPRETATION: The findings in this report indicate that most adults living with HIV who received medical care in 2009 were taking ART, had CD4+ and HIV viral load testing at regular intervals, and had health insurance or other coverage. However, some patients did not receive clinical services and treatment in accordance with guidelines. Some patients engaged in behaviors, such as unprotected sex, that increase the risk for transmitting HIV to sex partners, and some used noninjection or injection drugs or both. PUBLIC HEALTH ACTIONS: Local and state health departments and federal agencies can use MMP data for program planning to determine allocation of services and resources, guide prevention planning, assess unmet medical and supportive service needs, inform health-care providers, and help focus intervention programs and health policies at the local, state, and national levels.

Características esqueléticas evaluadas por los análisis cefalométricos de Jaraback, McNamara y DiPaolo en niños peruanos de 5 a 12 años de edad / Characteristic skeletal in children who went to the Pediatric Dentistry Postgraduate Service from Cayetano Heredia Peruvian University on 2005 year. McNamara, Jarabak and DiPaolo cephalometric analysis were used

El objetivo del estudio fue determinar las características esqueléticas en niños que acudieron al Servicio de Post-grado de Odontología Pediátrica de la Universidad Peruana Cayetano Herediaen el año 2005. Se utilizó los análisis cefalométricos de McNamara, Jarabak y Di Paolo. La muestra estuvo conformada por 73 radiografías cefalométricas, siendo el sexo femeninoel más predominante (72.6 por ciento). La edad del grupo poblacional se encontró dentro de los 5 a 12 años de edad, teniendo un promedio de 8.5 años. La muestra fue dividida en dos grupos, niños mayores de 9 años y menores de 9 años. Los parámetros de inclusión de muestra consideraron: simetría facial, perfil facial aceptable, oclusión clínicamente aceptable, relación molar clase I, relación canina I y overbite yoverjet aceptables. Según el análisis de varianzas la mayoría de valores de las medidas cefalométricas encontradosen los niños de 9 a 12 años de edad, para los análisis de McNamara y Jarabak son estadísticamente diferentes (p < 0.05). De acuerdo a la distribución de datos se empleó la prueba de T-pareada y ôUõ Mann Whitney para evaluar la significancia entre sexos, no encontrando diferencias estadísticamente significativas en el grupo de 9 a 12 años. Según grupo de edad se encontraron diferencias estadísticamente significativas, siendo mayores los valores en niños y niñas mayores de 9 años cuando se aplicó la prueba de Kruskal Wallis (p < 0.05). Según el análisis de Di Paolo, los niños del estudio tuvieron un patrón facial balanceado, y el tipo facial predominante fue el normodivergente.

The aim of the study was a determinate characteristic skeletal in children who went to the pediatric Dentistry Postgraduate Service from Cayetano Heredia Peruvian University on 2005 year. McNamara, Jarabak and Di Paolo cephalometric analysis were used. The sample was conformed by 73 cephalometric x-rays, being the most predominant the feminine sex (72.6 per cent). The population group age was within 5 to 12 years old. The average was 8.5 the sample was divided in two groups; children that were more than 9 years and less than 9 years old. The sample inclusion parameters considered: symmetry, acceptable face profile, clinically acceptable occlusion, Molar Relation Class I, Canine Relation Class I and acceptable overbite and overjet. According to variables analysis, most of the cephalometric measures values found in the study of children within 9 to 12 years old, to McNamara, Jarabak analyses are statistically different (p less than 0.05). According to data distribution, T-paired test and U Mann Whitney test were used to access significance between sexes, no differences statistically significant were found. According to age group statistically significant differences were found, being higher the values in children more than 9 years old when Kruskal Wallis test was applied (p less than 0.05). According to Di Paolo analysis, these children had a balanced face pattern, and predominate face type was norm divergent.