A bi-level intervention to improve oral hygiene of older and disabled adults in low-income housing: results of a pilot study.

OBJECTIVE: This paper describes the results of a bi-level intervention, using a cognitive-behavioral theoretical approach, to improve the oral hygiene of older adults and the disabled in community-based low income senior housing. METHODS: The bi-level pilot intervention consisted of an on-site tailored adapted motivational interviewing (AMI) session and two oral health fairs, supported by a resident campaign committee, to change community norms. All materials were available in English and Spanish. Participants completed a survey consisting of 12 domains that provided the basis for tailoring the AMI and shaping the campaigns. The domains were activities of daily living (ADLs), access to oral health information, oral hygiene status, dental knowledge, hygiene behaviors, importance of oral hygiene, self-efficacy/locus of control, diet, intentions, self-management worries/fears, perceived risk and dry mouth. MAIN OUTCOME MEASURES: Each participant received clinical assessments consisting of full-mouth plaque score (PS) and gingival index (GI) before the intervention and at three months. RESULTS: Twenty-seven residents with at least one tooth completed all phases of the study. The mean number of domains requiring attention was 4.5 (SD 1.6) with a range of one to seven. Mean baseline PS was 83% (SD 16%) which improved significantly to 58% (SD 31%); mean baseline GI was 1.15 (SD 0.61) and improved significantly to 0.49 (SD 0.46). CONCLUSIONS: This pilot study supports the feasibility and acceptability of a tailored oral hygiene intervention among older and disabled adults living in low income senior housing. Although a small sample, the study demonstrated significant improvements in both plaque and gingival scores three months after the bi-level intervention.

Structural issues affecting creation of a community action and advocacy board.

The most effective woman-initiated method to prevent HIV/sexually transmitted infections is the female condom (FC). Yet, FCs are often difficult to find and denigrated or ignored by community health and service providers. Evidence increasingly supports the need to develop and test theoretically driven, multilevel interventions using a community-empowerment framework to promote FCs in a sustained way. We conducted a study in a midsized northeastern US city (2009-2013) designed to create, mobilize and build capacity of a community group to develop and implement multilevel interventions to increase availability, accessibility and support for FCs in their city. The Community Action and Advocacy Board (CAAB) designed and piloted interventions concurrently targeting community, organizational and individual levels. Ethnographic observation of the CAAB training and intervention planning and pilot implementation sessions documented the process, preliminary successes, challenges and limitations of this model. The CAAB demonstrated ability to conceptualize, plan and initiate multilevel community change. However, challenges in group decision-making and limitations in members' availability or personal capacity constrained CAAB processes and intervention implementation. Lessons from this experience could inform similar efforts to mobilize, engage and build capacity of community coalitions to increase access to and support for FCs and other novel effective prevention options for at-risk women.

Asymmetry in search.

Most of the work on search in artificial intelligence (AI) deals with one search direction only-mostly forward search-although it is known that a structural asymmetry of the search graph causes differences in the efficiency of searching in the forward or the backward direction, respectively. In the case of symmetrical graph structure, however, current theory would not predict such differences in efficiency. In several classes of job sequencing problems, we observed a phenomenon of asymmetry in search that relates to the distribution of the are costs in the search graph. This phenomenon can be utilized for improving the search efficiency by a new algorithm that automatically selects the search direction. We demonstrate fur a class of job sequencing problems that, through the utilization of this phenomenon, much more difficult problems can be solved-according to our best knowledge-than by the best published approach, and on the same problems, the running time is much reduced. As a consequence, we propose to check given problems for asymmetrical distribution of are costs that may cause asymmetry in search.

Changing the environment of AIDS risk: findings on syringe exchange and pharmacy sales of syringes in Hartford, CT.

This paper reports findings from a National Institute on Drug Abuse-funded study designed to test the hypothesis that environmental changes, such as the enactment of laws to increase the accessibility of sterile syringes, including syringe exchange and pharmacy sale of syringes without a prescription, will lower the frequency of HIV risk and the prevalence of HIV among street drug users. Project COPE, a study of AIDS risk and risk prevention, collected longitudinal data on drug use, HIV risk, serostatus, and source of syringes in a sample of 710 out-of-treatment injection drug users in Hartford, CT. Findings support the hypothesis and the growing research-based conclusion that syringe exchange is an effective AIDS risk reduction modality.