Opioid prescribing and misuse among dental patients in the US: a literature-based review.

OBJECTIVES: Although health care practitioners have become more cognizant of the hazards of opioid use, opioid misuse has emerged as a leading public health problem in the United States, accounting for 20% of all deaths among older adolescents and young adults. Opioid analgesics are an important component of dental pain management following dental procedures. The aim of this study was to assess the status of literature on dental opioid prescriptions, their misuse, and relevant prevention strategies in the US. DATA SOURCES: A keyword search of MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL (EBSCO), and Web of Science was conducted in July 2018. The search criteria were carefully selected to include all practitioners treating patients presenting with dental issues and was not restricted to dentists. All peer-reviewed publications in the US written in English about patients with dental problems were included. RESULTS: The initial search led to 267 publications; after removing duplicates, the set consolidated to 196. After an appraisal of the title and abstract for relatedness, 82 publications were selected. Three major themes were identified: epidemiology of dental opioid prescriptions; recognition of the dental providers' contribution to opioid prescription practice; pain management protocols and guidelines in dentistry. CONCLUSIONS: There is moderate recognition of the contribution of dental prescriptions to the opioid epidemic. Several tools are available to increase patient education and practitioner knowledge about the safe use of opioids with a focus on patients at greatest risk.

Attitudes Toward Obese People: A Comparative Study of Nursing, Education, and Social Work Students.

BACKGROUND: Stigmatization and bias toward the obese population has been studied globally in a variety of professional groups, supporting the existence of negative attitudes and weight bias against this population. Attitudes fostering the prevalence of stigmatization undermine the effectiveness and quality of health care. Studies have not compared attitudes and beliefs of graduate and undergraduate students from professional schools within the same university. As an exemplar, this study compared nursing students' attitudes and beliefs toward obese individuals with students' attitudes in other professional schools. METHODS: The Attitudes Toward Obese Persons and Beliefs About Obese Persons scales were administered to undergraduate and graduate nursing students and graduate education and social work students at a US northeastern university. RESULTS: Analyses indicated students who were younger; in nursing programs; and reported not having a friend or family member who is overweight had significantly worse attitudes than others. Gender, location of residence, perceptions of own body weight, and participating in an exercise regimen were not significant. CONCLUSION: Understanding attitudes toward obese people may guide educators as they train nursing, education, and social work students. Reducing negative attitudes, beliefs, and stigmatization is an important starting point in the battle against this growing public health concern.

Measuring birth outcomes in New York State using a multidimensional approach.

OBJECTIVE: Poorer birth outcomes in the United States and New York State (NYS) remain a significant public health concern. The objectives of this study were to assess the effect of common and unique demographic, socioeconomic, and health services predictors on low birth weight (LBW), moderately LBW, very low birth weight (VLBW), and extremely low birth weight (ELBW) in NYS counties and to recommend policies that address unique differences at the county level. METHODS: Secondary data were collected for each of the 62 counties in NYS. Using a multidimensional approach, common and unique factors for LBW, moderately LBW, VLBW, and ELBW among NYS counties were evaluated. Correlations and multiple regression analyses were conducted for each of the outcome variables. RESULTS: Late prenatal care was the only significant predictor across all measures of poorer birth outcomes in NYS counties. Out-of-wedlock births, Medicaid Obstetrical Maternal Service providers, rural location, early prenatal care, advanced maternal age, and teen pregnancy rate were significant predictors, but not for all measures. CONCLUSIONS: Findings highlight the need to move beyond the number of providers when analyzing birth outcomes at the county level. Programs that support teens and women of all ages and marital status need to be expanded to curb poorer birth outcomes that take a heavy human and financial toll in NYS.

Turkish and American Undergraduate Students' Attitudes Toward HIV/AIDS Patients: A Comparative Study.

BACKGROUND: Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a complex healthcare problem. Research has demonstrated that negative attitudes affect healthcare provision. AIMS: The purpose of this study was to compare nursing students' attitudes using the AIDS Attitude Scale (AAS). SETTINGS: A descriptive, cross-sectional study was conducted in nursing schools in Istanbul, Turkey, and in Upstate New York (NY). PARTICIPANTS: Baccalaureate nursing students (n = 613) from both countries completed the questionnaire. METHODS: Demographic data, overall AAS attitudes, and attitudes within each subscale were compared. Analyses included frequency and percentages of the grouped variables, arithmetic means and standard deviations, t-test for independent samples, and multiple analysis of variance. RESULTS: Upstate NY students' mean total AAS scores were significantly more positive toward HIV+ patients than Turkish students'. Scores for Professional Resistance and Emotions subscales were significantly more positive for the Upstate NY students, but Fear of Contagion was not. Upstate NY students had more negative attitudes in the contexts of job risk and eating in a restaurant where the chef has AIDS; more professional resistance to referring patients and training specialists for HIV/AIDS patients; and lower tender feelings for people with HIV/AIDS (p < .01 for each). CONCLUSIONS: Improvement in students' attitudes is beneficial for promoting nonjudgmental, compassionate care for the HIV+ population.

Attitudes towards HIV/AIDS patients and empathic tendencies: a study of Turkish undergraduate nursing students.

BACKGROUND: Studies indicate that the attitudes of nurses, nursing students, and other health care professionals towards Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS) patients are affected by cultural differences and the fear of HIV/AIDS infection, resulting in both negative attitudes and reluctance to care for these patients. Empathy is critical for all health professionals in the delivery of effective care. Research indicates that as empathic tendencies develop, so do better communication skills, better attitudes, and better quality of care. OBJECTIVES: The purpose of this study was to examine the relationships among demographic factors, familiarity with HIV/AIDS, attitudes towards HIV/AIDS, and empathic tendencies in a Turkish sample of nursing students. DESIGN AND METHODS: Using a non-experimental, correlational design, data on demographics, HIV/AIDS Attitude Scale (AAS) and the Scale of Empathic Tendency (SET) were collected. PARTICIPANTS: The study sample consisted of 614 undergraduate nursing students in two universities located in different geographic regions of Turkey. RESULTS: The results of this study indicated that attitudes and empathic tendencies are related to knowledge and exposure to patients. As well, those students with more positive attitudes had higher empathic tendencies towards HIV/AIDS patients. CONCLUSIONS: It is important to adopt strategies to improve the empathic tendencies and attitudes of nursing students. These strategic changes would increase the quality of care provided to all patients.

Risk factors for low birth weight in New York state counties.

The rate of low birth weight (LBW) is a national concern. In New York counties in 2009, the LBW rate was 8.2%. Reducing LBW has significant humanitarian and economic implications. At an average cost of $51,600 per infant, care for infants weighing less than 2,500 grams at birth is substantial. The purpose of this study was to identify demographic, socioeconomic, and health service factors that contribute to LBW among counties in New York. Analyses of data indicated that the number of MOMs providers and teen pregnancy rate were the strongest predictors for LBW. These findings reinforce the fact that LBW is a correctable phenomenon that can be addressed through public policy. With increasing budget cuts, provision of health services and implementation of programs that address teen pregnancy have become challenging. Public policy decisions and stewardship that support programs that increase the number of providers for the uninsured, underinsured, and economic underclass and maintain programs for the pregnant adolescent will help New York counties in their fight against LBW.

The relationship between glomerular filtration rate and survival in patients treated with an implantable cardioverter defibrillator.

OBJECTIVES: We explored the association between renal insufficiency (RI) and mortality among patients treated with an implantable cardioverter defibrillator (ICD). BACKGROUND: Randomized trials have shown improvements in survival among select patients treated with an ICD. Renal insufficiency patients have a high risk of cardiac death; however, it is not clear whether the ICD has a positive effect on survival in this group of patients. METHODS: This was a retrospective review of a single-center experience of 346 patients treated with an ICD. Patients were stratified into 4 groups according to their glomerular filtration rate (eGFR; expressed as mL/min/ -1.73 m(2)) at implantation: group I, > 75.0; group II, - 60.0 to 74.9; group III, - 45.0 to 59.9; and group IV, - < or = 45.0. All-cause mortality was the primary end point, with differences in survival times among the 4 groups of patients expressed in Kaplan-Meier curves. RESULTS: Mean follow-up was 3.5 y (range 0.1 to 12.9 y), during which 67 patients died (19%). Mortality in each eGFR group was: I - 6.8%, II - 13.8%, III - 11.5%, IV - 45.8% (p < 0.001). Survival times (mean, y) were I, 3.74; II, 3.66; III, 3.38, and IV, 2.82. The presence of diabetes was not a factor in the outcomes. CONCLUSIONS: Patients treated with an ICD with an eGFR of < or = 45.0 mL/min/1.73 m(2) have a significantly shorter survival time than those patients with an eGFR > 45.0 mL/min/1.73 m(2). Patients with an eGFR > 45.0 mL/min/1.73 m(2) appear to have equally good outcomes when treated with an ICD. This may have implications for patient selection for ICD therapy.

Adjustment of hemodialysis dose for residual renal urea clearance: a two year study of impact on dialysis time.

Urea kinetic modeling suggests that significant time reductions may be realized in hemodialysis patients with residual renal urea clearance (K(r)t/V urea). However, the actual impact of a strategy that integrates such function into the dialysis prescription is not clear, because of both uncertainty regarding the rate of decay of K(r)t/V urea, as well as potential clinical constraints upon dose reduction. To examine this issue, we retrospectively reviewed data from 51 patients with K(r)t/N urea after initiation of maintenance hemodialysis. In 31 cases, there were no clinical barriers to adjustment of the dialysis prescriptions. Regression analysis revealed that each 0.10 increment in K(r)t/V urea yielded an actual dialysis time reduction of 12 minutes per week with average cumulative reduction of 80 minutes per week per patient. At approximately 1 year after initiation of dialysis, there were still 10 patients whose dialysis prescriptions were being adjusted on the basis of K(r)t/V urea. In conclusion, our results suggest that the incorporation of K(r)t/V urea in the hemodialysis prescription allows for substantial and enduring reductions in dialysis time in a significant minority of patients. Larger prospective studies are needed to evaluate the long-term safety of this strategy in modifying the dose of hemodialysis.