Oral Health Status of Independent Older Adults in Texas: An observational study comparing urban and rural areas.

Purpose: The purpose of this study was to assess the oral health needs of community-dwelling older adults participating in congregate meal centers and to determine whether differences exist in the oral health needs of older adult populations residing in urban versus rural communities in the state of Texas.Methods: Study participants were recruited at 6 congregate meal centers located in identified rural and urban communities in the greater metropolitan area of Austin, Texas. (N=78) Participants completed a validated, modified questionnaire containing 20 items on the following topics: self-reported oral health, tooth loss, dental insurance, frequency of dental visits, time since last dental visit, access to dental care, dry mouth, and oral cancer screening. Each participant received an oral health screening based on the Association of State and Territorial Dental Directors Basic Screening Survey for Older Adults. The examiners received hands-on training prior to the study to ensure the validity of their findings and to test for inter-examiner reliability.The chi-square test of independence was performed to analyze the participants' responses on the Basic Screening Survey to identify any relationships between the variables.Results: There were no significant differences in oral health conditions of older adults residing in urban versus rural communities. Over 50% of the participants (64.9% urban; 56.1% rural) reported incomes below $15,000 and lacked dental insurance to cover all or a portion of their oral health care needs. Eighty-seven percent of the participants reported tooth loss due to dental caries, 35% required periodontal care, and 37% reported occasional and 43% reported frequent oral pain over the last 12 months.Conclusions: Oral health promotion and disease prevention is an emergent need for older adult populations residing in urban and rural communities of the state of Texas. Analysis revealed that the majority of the older adult populations in both settings to have financial and socioeconomic barriers to access preventative and restorative dental care services.

Changes in metabolic parameters in patients with severe mental illness over a 10-year period: A retrospective cohort study.

BACKGROUND: Diabetes, obesity and metabolic syndrome are highly prevalent in patients with severe mental illness and can impose a major physical health burden. OBJECTIVE: To determine how anthropometric and metabolic features changed over time in a retrospective cohort of people with Severe Mental Illness living in Cheshire, UK. METHODS: In all, 1307 individuals on the severe mental illness Register were followed up between 2002 and 2012 in UK general practice. Subjects were identified through a pseudanonymised search of general practice registers. RESULTS: Baseline body mass index was 28.6 kg/m2 increasing to 31.0 at 10-year follow-up ( r2 = 0.84; p = 0.0002). There was a significant increase in fasting blood glucose from 5.72 to 6.79 mmol/L ( r2 = 0.48; p = 0.026). Correspondingly, there was a strong positive univariate relation between increase in body mass index and fasting blood glucose ( r2 = 0.54; p < 0.0001) taking into account all measurements. Fasting blood glucose also increased slightly with age ( p = 0.028). With increasing use of statins, total cholesterol fell from 4.5 to 3.9 mmol/L ( r2 = 0.88; p = 0.0001), as did low-density lipoprotein cholesterol from 3.43 to 2.35 mmol/L ( r2 = 0.94; p = 0.0001). In multivariate models, adjusting for age, gender, smoking and blood pressure, each unit increase in body mass index (odds ratio = 1.07 [1.01, 1.13]; p = 0.031) and triglycerides (odds ratio = 1.28 (1.06, 1.55); p = 0.009) was independently associated with an increased risk of having type 2 diabetes. CONCLUSION: Increasing body mass index relates to increasing rates of dysglycaemia over time. Measures to encourage weight reduction should be key strategies to reduce dysglycaemia rates in severe mental illness. Prescribing statins may have been effective in improving the lipid profile in this group.

Heteronormativity and practitioner-patient interaction.

Heteronormativity is the presumption of heterosexuality as the default sexual orientation and can result in discrimination against the lesbian, gay, and bisexual (LGB) population. This study serves as one of the first experimental studies to examine heteronormative perceptions in communication and their effects on practitioner-patient relationships. LGB participants were randomly assigned to read either heteronormative or non-heteronormative vignettes of a doctor-patient interaction. They then indicated how much health-relevant information they would disclose to the doctor in the vignette and their level of trust in the doctor. In the heteronormative condition, participants were less likely to disclose health-relevant information to the doctor in the vignette and were less trustful of the doctor as compared to those in the non-heteronormative condition. These results have important health implications, as lack of disclosure and trust may prevent people from getting needed care and prevent doctors from giving the best health advice possible. The results of this study provide further evidence that there is a need for more education for all health care professionals to feel comfortable while respectfully communicating with and treating patients who do not identify as heterosexual in order to ensure the best health care experience.

Intraoperative transesophageal echocardiography after aortic valve replacement does not predict subsequent transvalvular gradients.

BACKGROUND AND AIM OF THE STUDY: Intraoperative transesophageal echocardiography (TEE) can be used to assess gradients after aortic valve replacement (AVR). However, altered cardiac output after weaning from cardiopulmonary bypass, dynamic changes in valve function early after surgery, and limitations in transducer alignment may compromise the ability to predict valve hemodynamics on follow up. The study aim was to compare gradients on intraoperative TEE immediately after AVR with gradients on transthoracic echocardiography (TTE) after two to four months. METHODS: Among 90 patients who underwent AVR between September 2002 and April 2003, 31 had both intraoperative 'post-pump' TEE, including transaortic gradients, and TTE at two to four months after surgery. Mean and peak transvalvular gradients were compared between time periods, and a receiver operator curve (ROC) was constructed to test the ability to predict a mean gradient >15 mmHg (upper quartile of patients) on follow up. RESULTS: There was no discernable correlation between mean gradient on intraoperative imaging and at follow up (R2 = 0.09; p = 0.11); for peak gradient there was a statistically significant but extremely weak correlation between time points (R2 = 0.17; p = 0.02). A ROC revealed very poor prediction of high mean gradient on follow up based on mean gradient on intraoperative TEE (area under curve 0.63). CONCLUSION: Gradients on intraoperative TEE immediately after AVR do not correlate with later gradients on TTE. The mean gradient on intraoperative TEE holds no useful predictive value for a high mean gradient at follow up.