CDC COVID-19 Vaccine Pregnancy Registry: Design, data collection, response rates, and cohort description.

The U.S. Centers for Disease Control and Prevention (CDC) developed and implemented the CDC COVID-19 Vaccine Pregnancy Registry (C19VPR) to monitor vaccine safety. Potential participants who received a COVID-19 vaccine in pregnancy or up to 30 days prior to their pregnancy-associated last menstrual period were eligible to participate in the registry, which monitored health outcomes of participants and their infants through phone interviews and review of available medical records. Data for select outcomes, including birth defects, were reviewed by clinicians. In certain cases, medical records were used to confirm and add detail to participant-reported health conditions. This paper serves as a description of CDC C19VPR protocol. We describe the development and implementation for each data collection aspect of the registry (i.e., participant phone interviews, clinical review, and medical record abstraction), data management, and strengths and limitations. We also describe the demographics and vaccinations received among eligible and enrolled participants. There were 123,609 potential participants 18-54 years of age identified from January 2021 through mid-June 2021; 23,339 were eligible and enrolled into the registry. Among these, 85.3 % consented to medical record review for themselves and/or their infants. Participants were majority non-Hispanic White (79.1 %), residents of urban areas (93.3 %), and 48.3 % were between 30 and 34 years of age. Most participants completed the primary series of vaccination by the end of pregnancy (89.7 %). Many participants were healthcare personnel (44.8 %), possibly due to the phased roll-out of the vaccination program. The registry continues to provide important information about the safety of COVID-19 vaccination among pregnant people, a population with higher risk of poor outcomes from COVID-19 who were not included in pre-authorization clinical trials. Lessons learned from the registry may guide development and implementation of future vaccine safety monitoring efforts for pregnant people and their infants.

Hammersmith Infant Neurological Examination Subscores Are Predictive of Cerebral Palsy.

BACKGROUND: The Hammersmith Infant Neurological Examination (HINE) is a standardized assessment that identifies early signs of cerebral palsy (CP). In practice, the clinician performs this assessment in its entirety, yielding a global score. This study aimed to investigate the individual HINE subscores and "asymmetries" as predictive indicators of CP. METHODS: In this retrospective nested case-control study, a pediatric neurologist performed the HINE on a cohort of three- to four-month-old former neonatal intensive care unit infants. The infants' neurodevelopmental outcomes were determined by chart review when they were aged two to three years. We performed univariate and multivariable logistic regression analyses to yield the accuracy of the global HINE score, HINE subscores, and "asymmetries" in classifying infants with and without CP. RESULTS: Of the 108 infants on whom HINE was performed, 50 were either discharged due to normal developmental progress or were lost to follow-up. Of the remaining 58 subjects, 17 had CP and 41 did not. Receiver operator characteristic (ROC) curves of univariate models yielded the following area under the curve (AUC) scores: global HINE score (AUC = 0.75), "reflexes and reactions" (AUC = 0.80), "cranial nerve function" (AUC = 0.76), "asymmetries" (AUC = 0.75), and "movements" (AUC = 0.71). The ROC for our multivariable model (AUC = 0.91) surpassed the global HINE score's predictive value for CP. CONCLUSIONS: The weighted combination of HINE subscores and "asymmetries" outperforms the global HINE score in predicting CP. These findings suggest the need for revisiting HINE, but further validation with a larger dataset is required.

Utilization of social media communities for caregiver information support in stroke recovery: An analysis of content and interactions.

BACKGROUND: Caregivers often use the internet to access information related to stroke care to improve preparedness, thereby reducing uncertainty and enhancing the quality of care. METHOD: Social media communities used by caregivers of people affected by stroke were identified using popular keywords searched for using Google. Communities were filtered based on their ability to provide support to caregivers. Data from the included communities were extracted and analysed to determine the content and level of interaction. RESULTS: There was a significant rise in the use of social media by caregivers of people affected by stroke. The most popular social media communities were charitable and governmental organizations with the highest user interaction-this was for topics related to stroke prevention, signs and symptoms, and caregiver self-care delivered through video-based resources. CONCLUSION: Findings show the ability of social media to support stroke caregiver needs and practices that should be considered to increase their interaction and support.

Supine lying center of pressure movement characteristics as a predictor of normal developmental stages in early infancy.

BACKGROUND: Absent or abnormal fidgety movements in young infants are associated with subsequent diagnoses of developmental disorders such as cerebral palsy. The General Movement Assessment (GMA) is a qualitative clinical tool to visually identify infants with absent or abnormal fidgety movements associated with developmental stage, yet no quantitative measures exist to detect fidgety activity. OBJECTIVE: To determine whether a correlation exists between quantitative Center of Pressure (CoP) measurements during supine lying and age. METHODS: Twenty-four healthy full-term infants participated in the Institutional Review Board-approved study. Participants were placed supine in view of a GoPro camera on an AMTI force plate for two minutes. Spontaneous movements were evaluated by three trained raters using the GMA. Traditional CoP parameters (range, total path length, mean velocity, and mean acceleration of resultant CoP) were assessed, and complexity of each of the resultant CoP variables (location, velocity, and acceleration) was calculated by sample entropy. Linear regression with Pearson correlation was performed to assess the correlations between the CoP parameters and adjusted age. RESULTS: Nineteen infants were deemed fidgety per the GMA and were included in further analyses. All Sample entropy measures and range of resultant CoP had significant correlations with adjusted age (p< 0.05). Sample entropy of resultant CoP decreased with increasing age while range of resultant CoP increased with increasing age. CONCLUSION: The results suggest that complexity of CoP and range of CoP are good predictors of age in typical developing infants during the fidgety period. Therefore, an approach using these parameters should be explored further as a quantifiable tool to identify infants at risk for neurodevelopmental impairment.

Anxiety-Related Adverse Event Clusters After Janssen COVID-19 Vaccination - Five U.S. Mass Vaccination Sites, April 2021.

On April 7, 2021, after 5 weeks' use of the Janssen COVID-19 vaccine under the Food and Drug Administration (FDA) Emergency Use Authorization (EUA), CDC received reports of clusters of anxiety-related events after administration of Janssen COVID-19 vaccine from five mass vaccination sites, all in different states. To further investigate these cases, CDC interviewed vaccination site staff members to gather additional information about the reported events and vaccination site practices. Four of the five sites temporarily closed while an investigation took place. Overall, 64 anxiety-related events, including 17 reports of syncope (fainting), an anxiety-related event, among 8,624 Janssen COVID-19 vaccine recipients, were reported from these sites for vaccines administered during April 7-9. As a follow-up to these interviews, CDC analyzed reports of syncope shortly after receipt of Janssen COVID-19 vaccine to the Vaccine Adverse Event Reporting System (VAERS), the vaccine safety monitoring program managed by CDC and FDA. To compare the occurrence of these events with those reported after receipt of other vaccines, reports of syncopal events after influenza vaccine administered in the 2019-20 influenza season were also reviewed. Syncope after Janssen COVID-19 vaccination was reported to VAERS (8.2 episodes per 100,000 doses). By comparison, after influenza vaccination, the reporting rate of syncope was 0.05 episodes per 100,000 doses. Anxiety-related events can occur after any vaccination. It is important that vaccination providers are aware that anxiety-related adverse events might be reported more frequently after receipt of the Janssen COVID-19 vaccine than after influenza vaccination and observe all COVID-19 vaccine recipients for any adverse reactions for at least 15 minutes after vaccine administration.

Respiratory health, allergies, and the farm environment: design, methods and enrollment in the observational Wisconsin Infant Study Cohort (WISC): a research proposal.

Epidemiologic and cross-sectional studies suggest that early life farming and animal exposures are associated with major health benefits, influencing immune development and modifying the subsequent risk of allergic diseases, including asthma. The Wisconsin Infant Study Cohort (WISC) study was established in central Wisconsin to test the hypothesis that early life animal farm exposures are associated with distinct innate immune cell maturation trajectories, decreased allergen sensitization and reduced respiratory viral illness burden during the first 2 years of life. Beginning in 2013, a total of 240 families have been enrolled, 16,522 biospecimens have been collected, and 4098 questionnaires have been administered and entered into a secure database. Study endpoints include nasal respiratory virus identification and respiratory illness burden score, allergic sensitization, expression of allergic disease, and anti-viral immune response maturation and profiles. The WISC study prospective design, broad biospecimen collections, and unique US rural community will provide insights into the role of environmental exposures on early life immune maturation profiles associated with protection from allergic sensitization and significant respiratory viral disease burden. The WISC study findings will ultimately inform development of new strategies to promote resistance to severe respiratory viral illnesses and design primary prevention approaches for allergic diseases for all infants.

Aspirin Use among Adults with Cardiovascular Disease in the United States: Implications for an Intervention Approach.

Cardiovascular disease (CVD) is a major underlying cause of death, with high economic burden in most countries, including the United States. Lifestyle modifications and the use of antiplatelet therapy, such as aspirin, can contribute significantly to secondary prevention of CVD in adults. This study examined the prevalence and associated factors of aspirin use for the secondary prevention of angina pectoris, myocardial infarction (MI), and cerebrovascular disease (stroke) in a sample of American adults. The 2015 Behavioral Risk Factor Surveillance System (BRFSS) dataset was analyzed for this cross-sectional study. Almost 16% of the study population (N = 441,456) had angina, MI, or stroke. Weighted percentages of respondents with angina, MI, and stroke were 4%, 4.3%, and 3%, respectively. Overall, weighted prevalence of daily (or every other day) aspirin use was about 65%, 71%, and 57% among respondents with angina, MI, and stroke, respectively. Factors that were significantly associated with aspirin use included male sex, more than high school education, high blood pressure, diabetes, and less than excellent general health. There were existing differences among individuals with CVD based on diagnosis, demographic and socioeconomic status in the use of aspirin for secondary prevention. Resources for promoting aspirin use should be directed toward groups with lower utilization.

Selenium, Mercury, and Their Molar Ratio in Sportfish from Drinking Water Reservoirs.

Mercury (Hg) bioaccumulates in aquatic ecosystems and may pose a risk to humans who consume fish. Selenium (Se) has the ability to reduce Hg toxicity, but the current guidance for human consumption of fish is based on Hg concentration alone. The purpose of the present study was to examine the relationship between Se and Hg in freshwater sportfish, for which there is a paucity of existing data. We collected three species of fish from different trophic positions from two drinking water reservoirs in central North Carolina, USA, to assess Hg and Se concentrations in relation to fish total length and to compare two measures of the protective ability of Se, the Se:Hg molar ratio and Se health benefit value (HBVSe), to current guidance for Hg. According to the Se:Hg molar ratio, all of the low trophic position fish sampled and the middle trophic position fish sampled from one of the reservoirs were safe for consumption. The same number of fish were considered safe using the HBVSe. More fish were deemed unsafe when using the Se:Hg molar ratio and HBVSe than were considered unsafe when using the U.S. Environmental Protection Agency (USEPA) Hg threshold. These findings suggest that the measures of Se protection may be unnecessarily conservative or that the USEPA Hg threshold may not be sufficiently protective of human health, especially the health of sensitive populations like pregnant or nursing mothers and young children. Future examination of the Se:Hg molar ratio and HBVSe from a variety of fish tissue samples would help refine the accuracy of these measures so that they may be appropriately utilized in ecological and human health risk assessment.

Polypharmacy and Off-label Drug Use in Dentistry: knowledge, attitudes and practices of California dental hygienists.

Purpose: This study examined the knowledge, attitudes, and practices of dental hygienists, licensed in the state of California, regarding polypharmacy and off-label drug use for purposes in dentistry.Methods: A cross-sectional design was used to assess the knowledge, attitudes, and practices (KAP) related to off-label drug use and polypharmacy via an online survey tool. The study sample included licensed dental hygienists, who were members of the Long Beach and Tri-County Dental Hygienists' Associations located in Southern California (n=360). Descriptive statistics were used to assess the participant characteristics. ANOVA was used to assess differences in knowledge, attitudes and practices when compared to three key variables: highest academic/professional degree, experience and license type.Results: One hundred seven electronic surveys (n=107) were returned for a 34% response rate. Over half of respondents (53%) held an associates' degree for their license, most (72%) worked in a general dentistry setting and 46% had practiced 15 years or less. Regarding knowledge of polypharmacy and off-label drug use, the results demonstrated very low knowledge, with 25% of the respondents unable to answer any of the knowledge questions correctly. No significant differences in practices related to off-label drugs or polypharmacy were found based on type of licensure, highest degree achieved, or years of experience. However, participants holding a baccalaureate degree or higher were significantly more confident (p=.011) in discussing polypharmacy with patients and colleagues.Conclusion: Participants showed a general low-level of knowledge related to polypharmacy and off-label drug use in dentistry regardless of their level of education, years of experience, or type of dental hygiene licensure; indicating a need for increased pharmacology content in both entry-level dental hygiene programs and continuing education courses.

Destination memory accuracy and confidence in younger and older adults.

Background/Study Context: Nascent research on destination memory-remembering to whom we tell particular information-suggested that older adults have deficits in destination memory and are more confident on inaccurate responses than younger adults. This study assessed the effects of age, attentional resources, and mental imagery on destination memory accuracy and confidence in younger and older adults. METHODS: Using computer format, participants told facts to pictures of famous people in one of four conditions (control, self-focus, refocus, imagery). RESULTS: Older adults had lower destination memory accuracy than younger adults, driven by a higher level of false alarms. Whereas younger adults were more confident in accurate answers, older adults were more confident in inaccurate answers. Accuracy across participants was lowest when attention was directed internally but significantly improved when mental imagery was used. Importantly, the age-related differences in false alarms and high-confidence inaccurate answers disappeared when imagery was used. CONCLUSION: Older adults are more likely than younger adults to commit destination memory errors and are less accurate in related confidence judgments. Furthermore, the use of associative memory strategies may help improve destination memory across age groups, improve the accuracy of confidence judgments in older adults, and decrease age-related destination memory impairment, particularly in young-old adults.

A phase I trial of the aurora kinase inhibitor, ENMD-2076, in patients with relapsed or refractory acute myeloid leukemia or chronic myelomonocytic leukemia.

ENMD-2076 is a novel, orally-active molecule that inhibits Aurora A kinase, as well as c-Kit, FLT3 and VEGFR2. A phase I study was conducted to determine the maximum tolerated dose (MTD), recommended phase 2 dose (RP2D) and toxicities of ENMD-2076 in patients with acute myeloid leukemia (AML) and chronic myelomonocytic leukemia (CMML). Patients received escalating doses of ENMD-2076 administered orally daily [225 mg (n = 7), 375 mg (n = 6), 325 mg (n = 9), or 275 mg (n = 5)]. Twenty-seven patients were treated (26 AML; 1 CMML-2). The most common non-hematological toxicities of any grade, regardless of association with drug, were fatigue, diarrhea, dysphonia, dyspnea, hypertension, constipation, and abdominal pain. Dose-limiting toxicities (DLTs) consisted of grade 3 fatigue, grade 3 typhilitis, grade 3 syncope and grade 3 QTc prolongation). Of the 16 evaluable patients, one patient achieved a complete remission with incomplete count recovery (CRi), three experienced a morphologic leukemia-free state (MLFS) with a major hematologic improvement in platelets (HI-P), and 5 other patients had a reduction in marrow blast percentage (i.e. 11-65 %). The RP2D in this patient population is 225 mg orally once daily.

Emergency Department of a Rural Hospital in Ecuador.

INTRODUCTION: There is a paucity of data studying patients and complaints presenting to emergency departments (EDs) in low- and middle-income countries. The town of Pedro Vicente Maldonado (PVM) is located in the northwestern highlands of Ecuador. Hospital PVM (HPVM) is a rural teaching hospital providing family medicine residency training. These physicians provide around-the-clock acute medical care in HPVM's ED. This study provides a first look at a functioning ED in rural Latin America by reviewing one year of ED visits to HPVM. METHODS: All ED visits between April 14, 2013, and April 13, 2014, were included and analyzed, totaling 1,239 patient visits. Data were collected from their electronic medical record and exported into a de-identified Excel® database where it was sorted and categorized. Variables included age, gender, mode of arrival, insurance type, month and day of the week of the service, chief complaint, laboratory and imaging requests, and disposition. We performed descriptive statistics, and where possible, comparisons using Student's T or chi-square, as appropriate. RESULTS: Of the 1239 total ED visits, 48% were males and 52% females; 93% of the visits were ambulatory, and 7% came by ambulance. Sixty-three percent of the patients had social security insurance. The top three chief complaints were abdominal pain (25.5%), fever (15.1%) and trauma (10.8%). Healthcare providers requested labs on 71.3% of patients and imaging on 43.2%. The most frequently requested imaging studies were chest radiograph (14.9%), upper extremity radiograph (9.4%), and electrocardiogram (9.0%). There was no seasonal or day-of-week variability to number of ED patients. The chief complaint of human or animal bite made it more likely the patient would be admitted, and the chief complaint of traumatic injury made it more likely the patient would be transferred. CONCLUSION: Analysis of patients presenting to a rural ED in Ecuador contributes to the global study of acute care in the developing world and also provides a self-analysis identifying disease patterns of the area, training topics for residents, areas for introducing protocols, and information to help planning for rural EDs in low- and middle-income countries.

Does playing a sports active video game improve young children's ball skill competence?

OBJECTIVES: Actual and perceived object control (commonly ball) skill proficiency is associated with higher physical activity in children and adolescents. Active video games (AVGs) encourage whole body movement to control/play the electronic gaming system and therefore provide an opportunity for screen time to become more active. The purpose of this study was to determine whether playing sports AVGs has a positive influence on young children's actual and perceived object control skills. DESIGN: Two group pre/post experimental design study. METHODS: Thirty-six children aged 6-10 years old from one school were randomly allocated to a control or intervention condition. The Test of Gross Motor Development-3 assessed object control skill. The Pictorial Scale of Perceived Competence for Young Children assessed perceived object control skill. The intervention consisted of 6×50min lunchtime AVG sessions on the Xbox Kinect. Two to three sport games were chosen for participants to play each session. General linear models with either perceived object control or actual object control skill as the outcome variables were conducted. Each base model adjusted for intervention status and pre-score of the respective outcome variable. Additional models adjusted for potential confounding variables (sex of child and game at home). RESULTS: No significant differences between the control and intervention groups were observed for both outcomes. CONCLUSIONS: This study found that playing the Xbox Kinect does not significantly influence children's perceived or actual object control skills, suggesting that the utility of the Xbox Kinect for developing perceived and actual object control skill competence is questionable.

CHILDREN'S MOVEMENT SKILLS WHEN PLAYING ACTIVE VIDEO GAMES.

Active video games (AVGs) may be useful for movement skill practice. This study examined children's skill execution while playing Xbox Kinect™ and during movement skill assessment. Nineteen children (10 boys, 9 girls; M age=7.9 yr., SD=1.4) had their skills assessed before AVG play and then were observed once a week for 6 wk. while playing AVGs for 50 min. While AVG play showed evidence of correct skill performance (at least 30-50% of the time when playing table tennis, tennis, and baseball), nearly all skills were more correctly performed during skill assessment (generally more than 50% of the time). This study may help researchers to better understand the role AVGs could play in enhancing real life movement skills.

New York State Dental Hygienists' Perceptions of a Baccalaureate Degree as the Entry-Level Degree Required for Practice.

PURPOSE: Dual educational pathways exist for entry into the dental hygiene profession, namely associate and baccalaureate degrees. The purpose of this study was to examine practicing dental hygienists' perceptions, regarding the requirement of a baccalaureate degree as entry-to-practice for the profession. METHODS: A purposive sample of 800 dental hygienists licensed within New York State, both members and non-members of the Dental Hygienists' Association of the state of New York, were contacted via email and asked to participate in this Web-based survey. Survey items included both open-ended demographic and 12 Likert-type questions about perceptions of the Bachelor of Science in Dental Hygiene (BSDH) being required as entry-level into the profession. Data were analyzed using descriptive statistics, Spearman's rank correlations and the Kruskal-Wallis test. RESULTS: One hundred and seventeen surveys were returned and 107 (14%) were valid for analysis. Fifty-two percent of participants held an associate degree and 98% were members of the ADHA. Nearly a third of participants were employed in solo practice, and 43% agreed/strongly agreed the associate degree is sufficient preparation for dental hygiene practice. Still, more participants agreed/strongly agreed (50%) the BSDH should be considered entry-level for the discipline. Participants identified professional recognition by other health care practitioners and increased individual self-esteem as benefits of a BSDH. CONCLUSION: Results indicate the BSDH as entry-to-practice may be essential in elevating the status of the dental hygiene profession to that of other mid-level health care providers. Improving professional competence and credibility with colleagues and patients may be an important personal benefit of earning a baccalaureate degree.

Access to disease treatment among patients presenting to the emergency department with asthma or hypertension.

BACKGROUND: Asthma and hypertension are common among Emergency Department (ED) patients. Primary care providers are integral in managing these conditions, yet these patients are often in the ED. OBJECTIVE: To determine access to care among ED patients with asthma or hypertension and the association with sociodemographic factors and disease acuity. METHODS: This was a prospective, cross-sectional study of ED patients at an urban county hospital conducted between June 4 and August 31, 2008. Consenting patients were surveyed, and peak flow or blood pressure measured as appropriate. Access to disease treatment was defined as self-reported access to a primary care provider or current prescription for asthma or hypertension, or both. Descriptive statistics and multinomial logistic regression were used to analyze data. RESULTS: There were 2303 patients enrolled; 283 had asthma, 543 had hypertension, and 187 had both. Seventy-one patients (25.1%) with asthma, 151 patients (27.8%) with hypertension, and 19 patients (10.2%) with both had poor access to disease treatment. Seeking ED medical attention was related to having poor access to treatment for patients with both asthma and hypertension. Females with asthma had poor access to treatment. In hypertension patients, good access to treatment was associated with excellent/good health status, housing status, and decreasing age. Poor access to treatment was associated with increasing blood pressure. CONCLUSIONS: Poor access to disease treatment and aspects of socioeconomic status were associated with seeking care in the ED. Changes in access to treatment may affect the number of patients seeking ED care, but not the severity of the presenting illness.

Executive directors' perceptions of oral health care of aging adults in long-term care settings.

PURPOSE: The objective of this study was to investigate knowledge and perceptions of executive directors of long-term care facilities in a large western state regarding oral health of residents, barriers to the provision of optimal oral health care and the collaborative practice role for dental hygienists. METHODS: A descriptive, exploratory online survey research design was utilized. A purposive sample of executive directors of long-term care facilities in a large western state certified for Medicare/Medicaid reimbursement was used. An online survey was developed to investigate perceptions and knowledge regarding oral health of long-term care residents, protocol for provision of, and barriers to optimal oral health care, and support for employment of dental hygienists in long-term care facilities. Statistics used for data analysis included frequency distributions, Spearman's rho correlation coefficient and the Mann-Whitney test. RESULTS: Executive directors in long-term care facilities included in the study perceived oral health as an important aspect of general health; however, a knowledge deficit was identified related to oral disease as an exacerbating factor to systemic disease. Financial concerns and low interest among residents/families were identified as major barriers to accessing care. Executive directors supported interprofessional practice of nurses working with dental hygienists to optimize oral health care of residents. No significant associations were found between demographics and facility characteristics. CONCLUSION: Awareness of the knowledge and perceptions of executive directors providing leadership in these facilities can provide avenues to creating needed change, which can foster improvement in the oral and overall health status of long-term care residents. Support for interprofessional work of nurses and dental hygienists can open a door for innovative practice that optimizes oral health care of long-term care facility residents through the application of shared expertise.

Oral health champions in long-term care facilities-a pilot study.

This preintervention/postintervention pilot study examined impact of onsite support by a dental hygiene champion (DHC) on oral health and quality of life (QOL) of elderly residents in three long-term care facilities (LTCFs) in Arkansas. Oral health and oral health-related QOL were operationalized using the Oral Health Assessment Tool (OHAT) and Geriatric Oral Health Assessment Index (GOHAI), respectively. CNAs in Facility A received standardized oral health education/materials with onsite DHC support. Facility B received education/materials only. Facility C served as control. Data analyses included Wilcoxon-signed rank tests (OHAT) and repeated measures ANOVA (GOHAI) (p ≤ .05). OHAT postintervention data in Facility A showed significant improvements in three measured areas (tongue health, denture status, and oral cleanliness); in Facility B, one area (tongue health); and none in Facility C. No significant differences were found in GOHAI scores across facilities. Findings suggest that the presence of DHCs in LTCFs may positively impact the oral health of CNA-assisted residents.

Dental hygienists' knowledge, attitudes and practice behaviors regarding caries risk assessment and management.

PURPOSE: Lifelong control of disease processes associated with dental caries should be an essential part of the process of care for practicing dental hygienists. The purpose of this study was to identify the knowledge, attitudes and practice behaviors among dental hygienists regarding caries risk assessment (CRA) and management. METHODS: Utilizing the American Dental Hygienists' Association (ADHA) Survey/Research Center database of all registered dental hygienists in the U.S., 2,500 actively licensed dental hygienists were randomly selected and sent a web-based survey via SurveyMonkey™. The survey included items about practice characteristics and questions regarding knowledge, attitudes and practice behaviors regarding CRA and management. Second and third emails were sent to non-respondents. A 4-point Likert type scale (1=never, 2=sometimes, 3=frequently and 4=always) was used to rate the occurrence of caries management recommendations used in the practice setting. Frequencies and percentiles were used to evaluate demographic, knowledge and attitude information. RESULTS: The response rate was 9% (n=219) - 87% were ADHA members. Participants reported a high level of comfort (89%) in performing CRA, yet only 23% used an established CRA/management instrument. Over-the-counter fluoride dentifrices (70.1%), individualized oral hygiene instructions (86%) and individualized recare intervals (73.7%) were most often used as caries management recommendations, while low-dose fluoride rinses (45%) and prescription strength sodium fluoride gel or paste (42%) were used less frequently. Dental hygienists scored high on knowledge of CRA with the exception of white spot lesions as a risk factor (42%) and efficacy of chlorhexidine in caries management (61%). CONCLUSION: There is a need to improve practicing dental hygienists' knowledge and involvement in the active management of caries. Focused training in the use of established CRA/management tools should be designed to improve their knowledge and influence practice behaviors.