Call for algorithmic fairness to mitigate amplification of racial biases in artificial intelligence models used in orthodontics and craniofacial health.

Machine Learning (ML), a subfield of Artificial Intelligence (AI), is being increasingly used in Orthodontics and craniofacial health for predicting clinical outcomes. Current ML/AI models are prone to accentuate racial disparities. The objective of this narrative review is to provide an overview of how AI/ML models perpetuate racial biases and how we can mitigate this situation. A narrative review of articles published in the medical literature on racial biases and the use of AI/ML models was undertaken. Current AI/ML models are built on homogenous clinical datasets that have a gross underrepresentation of historically disadvantages demographic groups, especially the ethno-racial minorities. The consequence of such AI/ML models is that they perform poorly when deployed on ethno-racial minorities thus further amplifying racial biases. Healthcare providers, policymakers, AI developers and all stakeholders should pay close attention to various steps in the pipeline of building AI/ML models and every effort must be made to establish algorithmic fairness to redress inequities.

Blockchain technology and federated machine learning for collaborative initiatives in orthodontics and craniofacial health.

There is a paucity of largescale collaborative initiatives in orthodontics and craniofacial health. Such nationally representative projects would yield findings that are generalizable. The lack of large-scale collaborative initiatives in the field of orthodontics creates a deficiency in study outcomes that can be applied to the population at large. The objective of this study is to provide a narrative review of potential applications of blockchain technology and federated machine learning to improve collaborative care. We conducted a narrative review of articles published from 2018 to 2023 to provide a high level overview of blockchain technology, federated machine learning, remote monitoring, and genomics and how they can be leveraged together to establish a patient centered model of care. To strengthen the empirical framework for clinical decision making in healthcare, we suggest use of blockchain technology and integrating it with federated machine learning. There are several challenges to adoption of these technologies in the current healthcare ecosystem. Nevertheless, this may be an ideal time to explore how best we can integrate these technologies to deliver high quality personalized care. This article provides an overview of blockchain technology and federated machine learning and how they can be leveraged to initiate collaborative projects that will have the patient at the center of care.

Trends in Head Computed Tomography Utilization in Children Presenting to Emergency Departments After Traumatic Head Injury.

OBJECTIVES: Although closed head injuries occur commonly in children, most do not have a clinically important traumatic brain injury (ciTBI) and do not require neuroimaging. We sought to determine whether the utilization of computed tomography of the head (CT-H) in children presenting to an emergency department (ED) with a closed head injury changed after publication of validated clinical prediction rules to identify children at risk of ciTBI by the Pediatric Emergency Care Applied Research Network (PECARN). METHODS: We used the nationwide ED sample (2008-2013) to examine children visiting an ED after a mild closed head injury. Multiple patient and hospital characteristics were assessed. RESULTS: Of the 4,552,071 children presenting to an ED with a mild closed head injury, 1,181,659 (26.0%) underwent CT-H. Care was most commonly received at metropolitan teaching hospitals (43.5%) and varied markedly by geographic region. Overall, there were no significant changes in the nationwide rates of CT-H utilization in the period immediately after publication of the PECARN prediction rules. However, compared with metropolitan teaching hospitals, CT-H utilization increased significantly for patients treated at nonteaching hospitals and at nonmetropolitan hospitals. CONCLUSIONS: There was no overall reduction in CT-H utilization after publication of the 2009 PECARN prediction rules. However, patients treated at metropolitan teaching hospitals were significantly less likely to undergo CT-H after 2009, suggesting some penetration of the PECARN tool in that setting. Further research should study patterns of CT-H utilization in nonteaching hospitals and nonmetropolitan hospitals to assess challenges for adoption of validated pediatric ciTBI prediction rules.

Assessing health professionals' perception of health literacy in Rhode Island community health centers: a qualitative study.

BACKGROUND: Limited health literacy is linked with poor health behaviors, limited health care access, and poor health outcomes. Improving individual and population health outcomes requires understanding and addressing barriers to promoting health literacy. METHODS: Using the socio-ecological model as a guiding framework, this qualitative study (Phase 1 of a larger ongoing project) explored the interpersonal and organizational levels that may impact the health literacy levels of patients seeking care at federally qualified community health centers (FQCHCs) in Rhode Island. Focus groups were conducted with FQCHC employees (n = 37) to explore their perceptions of the health literacy skills of their patients, health literacy barriers patients encounter, and possible strategies to increase health literacy. The focus groups were audio-recorded and transcribed, and transcripts were coded using a process of open, axial, and selective coding. Codes were grouped into categories, and the constant comparative approach was used to identify themes. RESULTS: Eight unique themes centered on health literacy, sources of health information, organizational culture's impact, challenges from limited health literacy, and suggestions to ameliorate the impact of limited health literacy. All focus group participants were versed in health literacy and viewed health literacy as impacting patients' health status. Participants perceived that some patients at their FQCHC have limited health literacy. Participants spoke of themselves and of their FQCHC addressing health literacy through organizational- and provider-level strategies. They also identified additional strategies (e.g., training staff and providers on health literacy, providing patients with information that includes graphics) that could be adopted or expanded upon to address and promote health literacy. CONCLUSIONS: Study findings suggest that strategies may need to be implemented at the organizational-, provider-, and patient- level to advance health literacy. The intervention phase of this project will explore intervention strategies informed by study results, and could include offering health literacy training to providers and staff to increase their understanding of health literacy to include motivation to make and act on healthy decisions and strategies to address health literacy, including the use of visual aids.

Hospital-Based Emergency Department Visits With Pediatric Burns: Characteristics and Outcomes.

OBJECTIVE: The objective of this study was to examine the characteristics and outcomes in children presenting to emergency departments (EDs) with burn injuries. METHODS: The Nationwide Emergency Department Sample (NEDS) for the years 2008 to 2013 was used. All patients younger than 18 years who visited a hospital-based ED with a burn injury were selected. The study focused on (1) demographics (age, sex, insurance status), (2) characteristics of burns (types, causes), (3) disposition status after ED/hospitalization, (4) charges (ED and hospital), and (5) patient outcomes. Inclusion criteria were a visit to ED in the United States with a burn. Descriptive statistics were used to summarize the findings. RESULTS: During the study period, there were 746,593 ED visits due to burn injuries. Majority were insured by Medicaid (52.8%). Most frequent injuries were burns of wrists/hands (39.5%), lower limbs (24.1%), and upper limb-except wrist/hand (20.1%). The most common causes of burns were heat from electric appliances (37.1%) or hot liquids and vapors (24.8%). Following the ED visit, 89.1% were discharged routinely, and 4.3% were admitted. Mean charge per patient per ED visit was $1117. Total ED charges across the United States was $708.7 million. When admitted, mean length of stay was 5.7 days. Total hospitalization charge across the United States was $1.7 billion. CONCLUSIONS: Pediatric burn injuries require significant resources for stabilization and treatment by EDs. The present study highlights the burden and impact of pediatric burn injuries in the United States.

Patient Characteristics and Causes of Facial Fractures in the State of California.

PURPOSE: Each year, more than 400,000 emergency department (ED) visits in the United States are due to facial fractures. To inform targeted interventions to prevent facial fractures, the purpose of this study was to identify patient characteristics associated with causes of facial fractures in California. MATERIALS AND METHODS: The 2005 to 2011 California State Emergency Department Database was used for this cross-sectional study. The study population was composed of all ED visits for facial fractures. The primary outcome was cause of injury: fall, firearm injury, motor vehicle traffic accident, pedal cycle accident, pedestrian accident, transport accident, and assault. Predictor variables included patient characteristics, such as age, gender, insurance type, and race and ethnicity. Multivariable logistic regression models were used. RESULTS: There were 198,870 ED visits for facial fractures from 2005 to 2011. The patients' average age was 35.7 years. Most ED visits were by male patients (71%), privately insured patients (35%), and white patients (52%). Approximately 65% of visits were on weekdays and 93% were routinely discharged. Closed fractures of nasal bones, other facial bones, orbital floor, malar and maxillary bones, and mandible were the most prevalent (91%) facial fractures. Assaults (44%), falls (24%), and motor vehicle traffic crashes (6%) were the top 3 causes of facial fractures. Elderly patients (odds ratio [OR] = 6.17), female patients (OR = 2.25), and Medicare enrollees (OR = 1.51) were statistically more likely to have fall-related fractures than patients 45 to 64 years old, male patients, and privately insured patients. Blacks (OR = 0.46) and micropolitan residents (OR = 0.76) were statistically less likely to have fall-related fractures than whites and metropolitan residents. CONCLUSIONS: Violence among youth and falls among the elderly are predominant causes of facial fractures. The uninsured contribute to more than one fourth of ED visits for facial fractures. Interventions targeted at these population groups can curb the prevalence of these fractures.

Opioid Abuse and Dependence in Those Hospitalized Due to Head and Neck Cancer.

PURPOSE: In the United States, 2.1 million people develop substance abuse disorders that are associated with prescribed opioids. The objective of the present study was to identify the factors associated with opioid abuse and dependence (OAD) in those hospitalized for head and neck cancer (HNC). Although measures are being implementing to reduce opioid prescribing, the use of these drugs in individuals with HNC can be valuable. However, little is known about OAD among this cohort of individuals. MATERIALS AND METHODS: The present study was a retrospective analysis of the Nationwide Inpatient Sample for 2012 to 2014. All patients hospitalized because of any HNC were selected. The OAD prevalence was identified. The patient demographic, hospital, and geographic factors were considered independent variables and OAD was the outcome. Multivariable logistic regression model was used to identify the factors associated with OAD. RESULTS: A total of 92,055 patients were hospitalized because of HNCs. OAD was prevalent in 0.8% of the patients. The OAD rates were greatest in patients with a malignant neoplasm of ill-defined sites within the lip, oral cavity, and pharynx (1.6%). Age 30 to 44 years (odds ratio [OR] 5.19, 95% confidence interval [CI] 2.23 to 12.06; P < .01) and age 45 to 64 years (OR 4.05, 95% CI 2.15 to 7.61; P < .01) were associated with greater odds for OAD compared with age older than 64 years. Black (OR 1.76, 95% CI 1.12 to 2.78; P = .01) and Hispanic (OR 2.20, 95% CI 1.27 to 3.79; P < .01) race/ethnicity were associated with greater odds for OAD compared with white race/ethnicity. Individuals covered by Medicaid (OR 2.08, 95% CI 1.26 to 3.43; P < .01), and those who were uninsured (OR 2.27, 95% CI 1.05 to 4.89; P = .04) were associated with greater odds for OAD compared with those covered by private insurance. An increase in the comorbid burden was associated with increased odds of OAD (OR 1.57, 95% CI 1.47 to 1.68; P < .001). CONCLUSIONS: The present study identified specific anatomic sites where malignant neoplasm was associated with greater odds of OAD. Additionally, the study found that coverage by Medicaid, black and/or Hispanic race/ethnicity, lowest income households, and a greater comorbid burden were associated with greater odds of OAD.

Hospital-Based Emergency Department Visits With Dental Conditions: Impact of the Medicaid Reimbursement Fee for Dental Services in New York State, 2009-2013.

OBJECTIVES: Hospital-based emergency department (ED) visits for dental problems have been on the rise. The objectives of this study are to provide estimates of hospital-based ED visits with dental conditions in New York State and to examine the impact of Medicaid reimbursement fee for dental services on the utilization of EDs with dental conditions. METHODS: New York State Emergency Department Database for the year 2009-2013 and Health Resources and Services Administration's Area Health Resource File were used. All ED visits with diagnosis for dental conditions were selected for analysis. RESULTS: The present study found a total of 325,354 ED visits with dental conditions. The mean age of patient was 32.4 years. A majority of ED visits were made by those aged 25-44 years (49%). Whites comprised 52.1% of ED visits. Proportion of Medicaid increased from 22% (in 2009) to 41.3% (in 2013). For Medicaid patients, the mean ED charges and aggregated ED charges were $811.4 and $88.1 million, respectively. Eleven counties had fewer than 4 dentists per 10,000 population in New York State. CONCLUSION: High-risk groups identified from the study are those aged 25-44 years, uninsured, covered by Medicaid and private insurance, and residing in low-income areas. The study highlights the need for increased Medicaid reimbursement for dentists and improves access to preventive dental care especially for the vulnerable groups.

The Burden of Facial Cellulitis Leading to Inpatient Hospitalization.

PURPOSE: The purpose of the present study was to present nationally representative estimates of hospitalizations primarily attributed to facial cellulitis and to conduct an exploratory analysis on identifying factors associated with outcomes, such as hospital charges, length of stay (LOS), disposition status, and occurrence of infectious complications. MATERIALS AND METHODS: The present study is a retrospective analysis of the Nationwide Inpatient Sample (NIS) for 2012 and 2013. The International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of "682.0" in the primary diagnosis field of NIS (reason for hospitalization) was used to identify cases with facial cellulitis. All patients at least 18 years old who were hospitalized for facial cellulitis were included. Outcome variables examined in the present study were hospital charges, LOS, disposition status, and occurrence of infectious complications. Descriptive statistics and a multivariable linear regression model were used to examine association between independent variables and patient disposition and infectious complications. RESULTS: In 2012 and 2013, 74,480 hospitalizations involved facial cellulitis in adults at least 18 years old in the United States. Most were women (mean age, 47.5 yr). Most patients were routinely discharged home. Age was associated with an increase in odds of discharge to another facility. Variables associated with decreased odds of bacterial infections were age and black or Hispanic race. Women with at least 1 comorbidity had higher odds of mycoses. Statistically relevant predictors of longer than average LOS were age, race, insurance, presence of sepsis, and location. CONCLUSIONS: This study presented nationally representative estimates of hospitalizations attributed primarily to facial cellulitis in the adult population in the United States in 2012 and 2013. The presence of a comorbid condition predicted worse outcomes. Public health efforts should focus on targeting high-risk patients and providing monitoring or early treatment of face cellulitis.

Facial Fractures in Patients With Firearm Injuries: Profile and Outcomes.

PURPOSE: Firearm injuries (FAIs) are a major public health issue in the United States. The objective of this study was to examine characteristics and outcomes of patients presenting to emergency departments (EDs) with facial fractures attributed to FAIs. MATERIALS AND METHODS: The Nationwide Emergency Department Sample for the years 2008 to 2013 was used. All patients who visited EDs with FAIs and facial fractures were selected. The study focused on the following variables: 1) demographic characteristics, 2) types of facial fractures, 3) disposition status after ED visit or subsequent hospitalization, 4) charges (ED and hospitalization), and 5) patient outcomes. The inclusion criteria were a visit to a hospital-based ED with facial fractures and an external cause of FAI. Descriptive statistics were used to summarize findings. Multivariate logistic regression analysis was used to examine the simultaneous effects of patient-related factors on ED death. RESULTS: During the study period, a total of 15,469 patients (mean age, 34 years) visited hospital-based EDs with facial fractures attributed to FAIs. Most were uninsured male patients. The most common etiology of FAIs was assault. The most common facial fractures were open mandibular fractures and open maxillary and/or malar bone fractures. Approximately 27% of patients had a concomitant intracranial injury. After the ED visit, 74% were admitted. The mean ED charge per patient was $6,403, and the total ED charge across the United States was $76.48 million. The mean hospitalization charge per patient was $167,203. The total hospitalization charge across the United States was $1.9 billion. Patients with intracranial injuries (odds ratio [OR], 21.21; 95% confidence interval [CI], 7.16 to 62.85; P < .01), uninsured patients (OR, 4.24; 95% CI, 1.44 to 12.51; P < .01), and patients residing in areas with high household incomes (OR, 5.60; 95% CI, 2.51 to 12.46; P < .01) were high-risk groups for ED death. CONCLUSIONS: FAIs require substantial resources for stabilization and treatment by EDs. This study highlights the burden and impact of facial fractures in patients with FAIs in the United States.

Legal Mapping Analysis of State Telehealth Reimbursement Policies.

BACKGROUND: There exists rapid growth and inconsistency in the telehealth policy environment, which makes it difficult to quantitatively evaluate the impact of telehealth reimbursement and other policies without the availability of a legal mapping database. INTRODUCTION: We describe the creation of a legal mapping database of state-level policies related to telehealth reimbursement of healthcare services. Trends and characteristics of these policies are presented. MATERIALS AND METHODS: Information provided by the Center for Connected Health Policy was used to identify statewide laws and regulations regarding telehealth reimbursement. Other information was retrieved by using: (1) LexisNexis database, (2) Westlaw database, and (3) retrieval from legislative Web sites, historical documents, and contacting state officials. We examined policies for live video, store-and-forward, and remote patient monitoring (RPM). RESULTS: In the United States, there are 24 states with policies regarding reimbursement for live video transmission. Fourteen states have store-and-forward policies, and six states have RPM-related policies. Mississippi is the only state that requires reimbursement for all three types of telehealth transmission modes. Most states (47 states) have Medicaid policies regarding live video transmission, followed by 37 states for store-and-forward and 20 states for RPM. Only 13 states require that live video will be reimbursed "consistent with" or at the "same rate" as in-person services in their Medicaid program. DISCUSSION: There are no widely accepted telehealth reimbursement policies across states. They contain diverse restrictions and requirements that present complexities in policy evaluation and in determining policy effectiveness across states.

Adverse clinical events reported during Invisalign treatment: Analysis of the MAUDE database.

INTRODUCTION: The objectives of this study were to examine adverse clinical events after the use of the Invisalign system and to provide an overview of the actions taken by the manufacturer to address these events. METHODS: A retrospective analysis of the Manufacturer and User Facility Device Experience database of the United States Food and Drug Administration was used. All medical device reports reported to the United States Food and Drug Administration pertaining to products of Align Technology from November 1, 2006, to November 30, 2016, were analyzed. Qualitative content analysis was conducted of event descriptions and manufacturer narrative reports. RESULTS: A total of 173 medical device reports were reported in the Manufacturer and User Facility Device Experience database: 169 (97.7%) were designated as adverse event reports, and 45 (26%) were deemed by the treating doctor to be serious or life threatening. The most medical device reports that reported a serious or life-threatening event were in 2014 (50%). The most frequently reported adverse event was difficulty breathing (56 events) followed by sore throat (35 events), swollen throat (34 events), swollen tongue (31 events), hives and itchiness (31 events), anaphylaxis (30 events), swollen lips (27 events), and feeling of throat closing/tight airway/airway obstruction/laryngospasm (24 events). CONCLUSIONS: Serious or life-threatening events could be associated with use of Invisalign systems. Health care providers should be aware of these events and know how to handle them if they arise in their practices.

Emergency Department Utilization related to dental conditions and distribution of Dentists, Nebraska 2011-2013.

PURPOSE: This study aims to provide estimates of hospital-based emergency department (ED) visits due to dental conditions in Nebraska and to examine patient-related characteristics associated with ED charges. In addition, this study provides dental-related ED visits and distribution of dentists by county. METHODS: For the study, we used the State Emergency Department Database for Nebraska for the years 2011 through 2013 and the Health Resources and Services Administration's Area Health Resource File. All ED visits with dental conditions in Nebraska were selected. The primary outcome variable was hospital-based ED charges. Multivariable linear regression model was used to examine the effects of patient-related factors on ED charges. RESULTS: During the study period, a total of 9943 dental-related ED visits occurred. Of these, 55.5% patients aged between 25 and 44 years. Thirty-nine percent of all dental ED visits had patients who were self-financed or uninsured. Twenty counties in Nebraska do not have a dentist, and nine counties had more than 50 ED visits per 10,000 population. Patients residing in urban areas paid significantly higher charges than those living in rural towns, small rural towns, or isolated rural areas. The mean and total ED charges attributed to dental conditions for the entire study period were $934 and $9.3 million, respectively. CONCLUSION: Patients who are uninsured, aged 25-44 years, covered by private insurance, and residing in urban areas are identified to be at high risk. There is a need to develop health policies and programs to improve access to dental care in rural states.

Impact of Periapical Abscess on Infectious Complications in Patients Undergoing Extracorporeal Circulation Auxiliary to Open-Heart Surgical Procedures.

OBJECTIVE: Extracorporeal circulation auxiliary to open-heart surgeries (ECAOHS) may exert nonphysiological stresses on periapical abscessed tissues leading to hematogenous spread of microbes. The aim of this report was to estimate risk of postoperative infectious complications in patients with periapical abscesses and undergoing ECAOHS. METHODS: A retrospective analysis of Nationwide Inpatient Sample (years 2009 and 2010) was conducted. All patients (aged 19 to 65 years) who underwent ECAOHS were selected. International Classification of Diseases-9-Clinical Modification codes were used to identify the presence of periapical abscess and infectious complications. Multivariable logistic regression models were used to examine the associations between the presence of periapical abscess and occurrence of infectious complications. RESULTS: A total of 265,235 patients underwent an ECAOH procedure. Of these, 431 patients had a periapical abscess. Septicemia developed in 16% of those with periapical abscess (compared with 4.2% in those without periapical abscess). Those with periapical abscess had higher rates of any of the infectious complications when compared with those without periapical abscess (30.2% vs 11.6%, respectively). After adjustment for multiple confounders, those with periapical abscess were associated with higher odds for developing septicemia (odds ratio = 2.51, 95% confidence interval = 1.06-5.91, P = .04) and any of the infectious complications (odds ratio = 2.23, 95% confidence interval = 1.08-4.59, P = .03) when compared with those who did not have periapical abscess. CONCLUSIONS: Those with periapical abscess are associated with higher odds for infectious complications when compared with those without periapical abscess.

Outcomes of invasive mechanical ventilation in children and adolescents hospitalized due to status asthmaticus in United States: a population based study.

OBJECTIVE: Current national estimates of and outcomes of Invasive Mechanical Ventilation (MV) in status asthmaticus (SA) are unclear. The objective of this study is to estimate the incidence and outcomes of MV in hospitalized SA children and adolescents. METHODS: We used the Nationwide Inpatient Sample (NIS, 2009-2010), the largest all-payer hospital discharge database in United States. All hospitalizations (age ≤21 years) with a primary diagnosis of SA were selected. MV was identified using ICD-9-CM procedure codes. Multivariable regression analyses were used to examine the association between MV and outcomes (Length of Stay (LOS) and Hospital Charges (HC)). RESULTS: Over the study period, of the 250 718 SA hospitalizations, MV was needed for <96 h in 0.37% hospitalizations and 0.18% had MV for ≥96 h. Complications occurred in 12.4% (30 991) of all hospitalizations with pneumonia (10.8%) being the most common. A total of 65 patients died in hospitals (the overall in-hospital mortality [IHM] rate was 0.03%). About 55 of these deaths occurred among those who had MV (4% IHM rate for those receiving MV). The mean LOS and hospital HC included without MV (2.1 d, $11 921) MV < 96 h (4.8 d, $52 201); MV > 96 h (15.6 d, $200 336). After adjustment for patient/hospital level factors, the need for MV was associated with significantly higher LOS and HC (p < 0.0001). Those who had MV<96 h (OR = 2.58, 95% CI = 1.77-3.77) or MV ≥ 96 h (OR = 6.23, 95% CI = 3.87-10.03) had higher risk of developing pneumonia. CONCLUSIONS: Although MV is infrequently needed in children and adolescents hospitalized for SA (0.55% incidence rate), it is associated with higher IHM rate and significant hospital resource utilization.

Presence of gingivitis and periodontitis significantly increases hospital charges in patients undergoing heart valve surgery.

OBJECTIVE: To examine the prevalence and impact of gingivitis and periodontitis in patients having heart valve surgical procedures. METHODS: Nationwide Inpatient Sample for the years 2004-2010 was used. All patients who had heart valve surgical procedures were selected. Prevalence of gingivitis/periodontitis was examined in these patients. Impact of gingivitis/periodontitis on hospital charges, length of stay, and infectious complications was examined. RESULTS: 596,190 patients had heart valve surgical procedures. Gingivitis/periodontitis was present in 0.2 percent. Outcomes included: median hospital charges ($175,418 with gingivitis/ periodontitis versus $149,353 without gingivitis/periodontitis) and median length of stay (14 days with gingivitis/periodontitis versus 8 days without gingivitis/periodontitis). After adjusting for the effects of patient- and hospital-level confounding factors, hospital charges and length of stay were significantly higher (p < 0.001) in those with gingivitis/periodontitis compared to their counterparts. Further, patients with gingivitis/periodontitis had significantly higher odds for having bacterial infections (OR = 3.41, 95% CI = 2.33-4.98, p < 0.0001) when compared to those without gingivitis/periodontitis. CONCLUSION: Presence of gingivitis and periodontitis is associated with higher risk for bacterial infections and significant hospital resource utilization.

Poor Oral Health Linked with Increased Risk of Infectious Complications in Adults with Leukemia.

OBJECTIVE: The objective of this study is to examine the impact of the presence of gingivitis/periodontitis on the occurrence of infectious complications (including septicemia, bacterial infections, and mycoses) in hospitalized leukemic adults in the United States. METHODS: A retrospective analysis of the Nationwide Inpatient Sample (NIS) for the years 2004-2010 was performed. All hospitalized leukemic patients aged 18 to 65 years were selected. The association between occurrence of gingivitis/periodontitis and infectious complications was examined by multivariable logistic regression models. A total of 135,692 hospitalizations were due to leukemias during the study period. Among these, gingivitis/periodontitis was present in 0.6%. Septicemia occurred in 27.8% of those who had gingivitis/periodontitis (compared to 19.6% in those without gingivitis/periodontitis), bacterial infections occurred in 19.5% of those who had gingivitis/periodontitis (compared to 10.1% in those without gingivitis/periodontitis), and mycoses occurred in 20.7% of those who had gingivitis/periodontitis (compared to 10.7% in those without gingivitis/periodontitis). Patients who had gingivitis/periodontitis were associated with significantly higher odds for septicemia (OR = 1.58, 95% CI = 1.14-2.19, p = 0.01), bacterial infections (OR = 2.15, 95% CI = 1.51-3.07, p<0.01), mycoses (OR = 2.16, 95% CI = 1.43-3.28, p<0.01), or any infectious complication (OR = 2.15, 95% CI = 1.63-2.84, p<0.01) when compared to their counterparts following adjustment for multiple patient and hospital-level confounding factors. CONCLUSIONS: Poor oral health (as defined by the presence of gingivitis/periodontitis) is an independent predictor of increased risk of infectious complications in hospitalized leukemic adults in the United States.

Global Dental Research Productivity and Its Association With Human Development, Gross National Income, and Political Stability.

OBJECTIVE: The objective of this study is to examine the associations between country level factors (such as human development, economic productivity, and political stability) and their dental research productivity. METHODS: This study is a cross-sectional analysis of bibliometric data from Scopus search engine. Human Development Index (HDI), Gross National Income per capita (GNI), and Failed State Index measures were the independent variables. Outcomes were "Total number of publications (articles or articles in press) in the field of dentistry" and "Total number of publications in the field of dentistry per million population." Non-parametric tests were used to examine the association between the independent and outcome variables. RESULTS: During the year 2013, a total of 11,952 dental research articles were published across the world. The top 5 publishing countries were United States, Brazil, India, Japan, and United Kingdom. "Very High" HDI countries had significantly higher number of total dental research articles and dental research articles per million population when compared to the "High HDI," "Medium HDI," and "Low HDI" countries (p < 0.0001). There was a significant linear relationship between the GNI quartile income levels and outcome metrics (p ≤ 0.007). Countries which were highly politically stable were associated with significantly higher dental research productivity (p < 0.0001). CONCLUSIONS: There appears to be a regional concentration of articles with just five countries contributing to over 50% of all articles. The human development and economic development of a country are linearly correlated with dental research productivity. Dental research productivity also increases with increasing political stability of a country.

Emergency department visits with facial fractures among children and adolescents: an analysis of profile and predictors of causes of injuries.

PURPOSE: The objectives of this study were to provide nationally representative estimates of hospital-based emergency department (ED) visits for facial fractures in children and adolescents, examine the burden associated with such visits, identify common types of facial fracture, and examine the role of patient-related demographic factors on the causes of facial fractures. MATERIALS AND METHODS: The Nationwide Emergency Department Sample for 2008 to 2010 was used. All ED visits with a diagnosis of facial fractures in those no older than 21 years were selected. Demographic characteristics, types of facial fracture, causes of injuries, and hospital charges were examined. RESULTS: During the study period, 336,124 ED visits were for facial fractures in those no older than 21 years. Late adolescents (18 to 21 yr old) and middle adolescents (15 to 17 yr old) comprised 45.6% and 26.6% of all ED visits, respectively. Male patients comprised 74.7% of ED visits. The most common facial fractures were those of the nasal bones and mandible. Younger children were more likely to have falls, pedal cycle accidents, pedestrian accidents, and transport accidents, whereas older groups were more likely to have firearm injuries, motor vehicle traffic accidents, and assaults (P < .05). Female patients were more likely to have falls, motor vehicle traffic accidents, and transport accidents, whereas male patients were more likely to have firearm injuries, pedal cycle accidents, and assaults (P < .05). Those residing at low annual income household levels were at a high risk for having firearm injuries, motor vehicle traffic accidents, and transport accidents (P < .05). CONCLUSIONS: Late adolescents, middle adolescents, and male patients comprise a significant proportion of these ED visits. Age, gender, and household income levels are significantly associated with the causes of facial fracture injuries.

Children in the United States make close to 200,000 emergency department visits due to poisoning each year.

OBJECTIVE: The aim of this study was to provide nationally representative hospital-based emergency department (ED) estimate visits in children (aged ≤ 18 y) attributed to poisoning in the United States in 2008. METHODS: Nationwide Emergency Department Sample for the year 2008 was used. All ED visits among children (aged ≤ 18 y) with an external cause of injury for "poisoning" were selected for analysis. Demographic characteristics of the ED visits and outcomes examined included ED charges (EDCs), hospitalization charges (HCs), length of stay in hospital, and disposition after ED visit. RESULTS: During the year 2008, a total of 191,197 ED visits were attributed to poisoning with close to 56% of all ED visits occurring among those aged younger than 4 years. Boys comprised approximately 54% of all ED visits. After an ED visit, 87% were routinely discharged, and 7.3% were admitted into the same hospital. Forty-eight children died in the ED. The frequently reported poisonings included accidental poisoning by other drugs (44,219 ED visits); accidental poisoning by other gases and vapors (27,035 ED visits); and accidental poisoning by analgesics, antipyretics, and antirheumatics (22,334 ED visits). The mean EDC per visit was $1077. The total EDC across the entire United States was $171.8 million. Mean length of stay was 1.9 days. Among those who were hospitalized, the mean HC was $11,792. The total HC across the entire United States was $162.3 million. CONCLUSIONS: The current study provides nationally representative estimates of ED visits attributed to poisoning among children in the United States. High-risk groups and economics associated with treating these injuries are estimated.