Predicting Dental Caries in Young Children in Primary Health Care Settings.

Young children need increased access to dental prevention and care. Targeting high caries risk children first helps meet this need. The objective of this study was to develop a parent-completed, easy-to-score, short, accurate caries risk tool for screening in primary health care settings to identify children at increased risk for cavities. A longitudinal, prospective, multisite, cohort study enrolled (primarily through primary health care settings) and followed 985 (out of 1,326) 1-y-old children and their primary caregivers (PCGs) until age 4. The PCG completed a 52-item self-administered questionnaire, and children were examined using the International Caries Detection and Assessment Criteria (ICDAS) at 12 ± 3 mo (baseline), 30 ± 3 mo (80% retention), and 48 ± 3 mo of age (74% retention). Cavitated caries lesion (dmfs = decayed, missing, and filled surfaces; d = ICDAS ≥3) experience at 4 y of age was assessed and tested for associations with questionnaire items using generalized estimating equation models applied to logistic regression. Multivariable analysis used backward model selection, with a limit of 10 items. At age 4, 24% of children had cavitated-level caries experience; 49% were female; 14% were Hispanic, 41% were White, 33% were Black, 2% were other, and 10% were multiracial; 58% enrolled in Medicaid; and 95% lived in urban communities. The age 4 multivariable prediction model, using age 1 responses (area under the receiver operating characteristic curve = 0.73), included the following significant (P < 0.001) variables (odds ratios): child participating in public assistance programs such as Medicaid (1.74), being non-White (1.80-1.96), born premature (1.48), not born by caesarean section (1.28), snacking on sugary snacks (3 or more/d, 2.22; 1-2/d or weekly, 1.55), PCG cleaning the pacifier with juice/soda/honey or sweet drink (2.17), PCG daily sharing/tasting food with child using same spoon/fork/glass (1.32), PCG brushing their teeth less than daily (2.72), PCG's gums bleeding daily when brushing or PCG having no teeth (1.83-2.00), and PCG having cavities/fillings/extractions in past 2 y (1.55). A 10-item caries risk tool at age 1 shows good agreement with cavitated-level caries experience by age 4.

A systematic review of asylum-seeking women's views and experiences of UK maternity care.

OBJECTIVE: To explore and synthesise evidence of asylum-seeking women's experiences of maternity care in the UK. DESIGN: A systematic review and thematic synthesis of peer-reviewed qualitative evidence. Relevant databases were searched from 2000 until 2018. Study quality was appraised using the Critical Appraisal Skills Programme (CASP) qualitative research appraisal tool. SETTING AND PARTICIPANTS: UK-based studies which describe asylum-seeking women's views and experiences of maternity care. FINDINGS: Six studies were included for thematic synthesis. Seven common themes emerged; 'Communication challenges', 'Isolation', Mental health challenges', 'Professional attitudes', Access to healthcare', 'Effects of dispersal' and 'Housing challenges'. The review indicated that pregnant asylum seekers face significant barriers to accessing maternity care due to practical issues related to the challenges of their status and lack of knowledge of maternity services, together with professional attitudes. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Mandatory provision of interpreter services, together with training for health care professionals could address urgent issues faced by pregnant asylum seekers. Further research and population-specific guidelines are needed to improve care for these women.

Predicting Caries in Medical Settings: Risk Factors in Diverse Infant Groups.

Expanded partnership with the medical community is a promising strategy for reducing disparities in dental caries among young children. However, no validated caries risk instrument exists for use in primary health care settings. To help resolve this gap, a 52-item caries risk questionnaire was developed and targeted to primary caregivers (PCGs) to test in a 3-y prospective study. To begin to understand the validity of the questionnaire items, the purpose of this study was to compare responses to the questionnaire based on key demographic characteristics known to be associated with disparities in caries experience (e.g., race/ethnicity and insurance status). A total of 1,323 one-year-old children were recruited primarily through 3 medical research networks. Baseline questionnaire responses were analyzed via logistic regression. The sample was 49% female. Its racial/ethnic makeup was as follows: 13% Hispanic, 37% White, 37% Black, and 13% other or multiracial. Sixty-one percent were enrolled in Medicaid, and 95% resided in urban communities. Mothers represented 94% of PCGs. There were significant differences ( P < 0.05) in baseline responses based on Medicaid status and race/ethnicity. As compared with those not enrolled in Medicaid, children in the Medicaid group were significantly more likely (after adjusting for race/ethnicity) to 1) go to sleep while nursing or drinking something other than water, 2) eat sugary snacks between meals, 3) consume sugary drinks between meals, 4) receive topical fluoride from a health professional, 5) visit the dentist, and 6) not have an employed adult in the household. PCGs of children enrolled in Medicaid were significantly more likely to be the mother, have bleeding gums, eat sugary snacks between meals, consume sugary drinks between meals, eat or drink something other than water before going to bed, and not get regular dental checkups. In conclusion, there are significant differences in caries risk questionnaire responses based on Medicaid status and race/ethnicity that provide construct and criterion validity to the developed caries risk tool (ClinicalTrials.gov NCT01707797).

Subcutaneous Implants of a Cholesterol-Triglyceride-Buprenorphine Suspension in Rats.

A Target Animal Safety protocol was used to examine adverse events in male and female Fischer F344/NTac rats treated with increasing doses of a subcutaneous implant of a lipid suspension of buprenorphine. A single injection of 0.65 mg/kg afforded clinically significant blood levels of drug for 3 days. Chemistry, hematology, coagulation, and urinalysis values with 2- to 10-fold excess doses of the drug-lipid suspension were within normal limits. Histopathology findings were unremarkable. The skin and underlying tissue surrounding the drug injection were unremarkable. Approximately 25% of a cohort of rats given the excess doses of 1.3, 3.9, and 6.5 mg/kg displayed nausea-related behavior consisting of intermittent and limited excess grooming and self-gnawing. These results confirm the safety of cholesterol-triglyceride carrier systems for subcutaneous drug delivery of buprenorphine in laboratory animals and further demonstrate the utility of lipid-based carriers as scaffolds for subcutaneous, long-acting drug therapy.

Brief intervention for heavy-drinking college students: 4-year follow-up and natural history.

OBJECTIVES: This study examined long-term response to an individual preventive intervention for high-risk college drinkers relative to the natural history of college drinking. METHODS: A single-session, individualized preventive intervention was evaluated within a randomized controlled trial with college freshmen who reported drinking heavily while in high school. An additional group randomly selected from the entire screening pool provided a normative comparison. Participant self-report was assessed annually for 4 years. RESULTS: High-risk controls showed secular trends for reduced drinking quantity and negative consequences without changes in drinking frequency. Those receiving the brief preventive intervention reported significant additional reductions, particularly with respect to negative consequences. Categorical individual change analyses show that remission is normative, and they suggest that participants receiving the brief intervention are more likely to improve and less likely to worsen regarding negative drinking consequences. CONCLUSIONS: Brief individual preventive interventions for high-risk college drinkers can achieve long-term benefits even in the context of maturational trends.

Multivariate modeling of missing data within and across assessment waves.

Missing data constitute a common but widely underappreciated problem in both cross-sectional and longitudinal research. Furthermore, both the gravity of the problems associated with missing data and the availability of the applicable solutions are greatly increased by the use of multivariate analysis. The most common approaches to dealing with missing data are reviewed, such as data deletion and data imputation, and their relative merits and limitations are discussed. One particular form of data imputation based on latent variable modeling, which we call Multivariate Imputation, is highlighted as holding great promise for dealing with missing data in the context of multivariate analysis. The recent theoretical extension of latent variable modeling to growth curve analysis also permitted us to extend the same kind of solution to the problem of missing data in longitudinal studies. Data simulations are used to compare the results of multivariate imputation to other common approaches to missing data.

Calibration of measures for psychotherapy outcome studies.

Many findings in psychology, including those in psychotherapy, lack interpretability because measures are not in any meaningful metric. Measures need to be calibrated so as to endow them with inherent meaning. In particular, it is important to calibrate measures against behaviors and real events in people's lives. Approaches to calibrating measures include calibration against direct personal experience, against cross-experiential equivalents, and against cross-modal equivalents, to reflect empirically established behavioral implications as well as just noticeable differences in behavior or between people. Psychological measures may never be as closely calibrated as those for physical properties, but wider reporting of unstandardized regression equations would be of great help. Psychological measures also need to be calibrated against each other so as to permit easy transformations of values or substitutions of measures. Finally, greater standardization of measures is recommended so as to produce better bases for calibration.

Willingness for treatment as a predictor of retention and outcomes.

Retention in drug treatment is important to successful outcomes. The purpose of this study was to test assumptions made in the development and implementation of the ASSET project. The three assumptions were that living conditions of the homeless adult drug user influence willingness for treatment; willingness relates to treatment tenure; and, conditions, willingness and time in treatment influence treatment outcomes. Data on alcohol use, drug use, employment and housing as well as motivation, readiness and suitability of treatment were collected from 494 homeless adults at baseline and at follow-up. Data were subjected to multivariate causal analysis using factor analytic structural equations modeling. Practical fit indices were acceptable. The measurement model confirmed a higher order construct labelled willingness encompassing motivation, readiness and suitability. The structural model demonstrated that willingness positively related to treatment tenure; willingness positively influenced change in drug use and housing; and, tenure related positively to change in housing.

Randomized, controlled trial of compression gloves in rheumatoid arthritis.

A randomized, controlled trial was conducted to determine efficacy of the Isotoner and the Futuro compression gloves in 39 patients with hand synovitis secondary to rheumatoid arthritis. After 7 days of nighttime treatment, both brands of gloves were found to decrease subjective symptoms of pain and stiffness (p < 0.05). In addition, swelling of the proximal interphalangeal joints decreased, while range of motion, rate of finger motion, and grip strength all increased (p < 0.05). Compression gloves should be used with caution in patients with bilateral carpal tunnel syndrome, because 12 of 13 such patients experienced worsening of their symptoms following one nighttime wearing of compression gloves. While both gloves were found to be efficacious in improving the signs and symptoms of hand synovitis, neither glove was found to be superior to the other. Patient preferences related to glove composition and fit may ultimately determine which glove to prescribe.

Seizure disorders in Down syndrome.

The prevalence, onset, and type of seizure disorders, as well as seizure control, were studied in a large cohort of 405 individuals with Down syndrome (age range, 6 months to 45 years). The evaluation of a questionnaire completed by the subjects' parents and of the patients' medical records indicated that 33 (8.1%) of 405 persons with Down syndrome had seizure disorder. With regard to the onset of seizures, a bimodal distribution was noted: 40% of patients began having seizures before the age of 1 year, and another 40% started with seizure activity in the third decade of life. In the younger age group, primarily infantile spasms and tonic-clonic seizures with myoclonus were observed, and the older patients often had partial simplex or partial complex seizures as well as tonic-clonic seizures.

Management strategies to minimize nursing turnover.

The nursing shortage continues nationwide. Many factors contribute to the recurring crisis. Some realistic recommendations for short- and long-term solutions are presented here.

One more time--solutions to the nursing shortage.

The shortage of registered nurses continues nationwide. Reviewing factors that contribute to the recurring crisis, the authors recommend short- and long-term solutions, which focus on retention as more effective and less expensive than recruitment. The authors also discuss the complex issues of employing agency RNs and recruiting of foreign-educated RNs.

Air pressure splint effects on hand symptoms of patients with rheumatoid arthritis.

Thirty patients with symptomatic rheumatoid arthritis (RA) of both hands were treated with an air pressure splint. Evaluations were made by measuring ring size, hand volume, range and rate of finger motions, grip strength and degree of pain and stiffness. One hand was randomly assigned to the treatment group while the other served as a control. Patients received the air splint treatment for 5 consecutive days. Data were analyzed by a 2-factor repeated analysis of variance to determine the effectiveness of 1 treatment, the cumulative effect of 5 treatments, the effect of the 5th treatment, and whether the results after the 1st treatment lasted until the 5th treatment. All measurements except hand volume significantly improved with the 1st treatment. Furthermore, the beneficial effects persisted throughout the treatment period. These data indicate the air splint treatment is effective in reducing swelling and other symptoms of RA in the hands.

Effect of label format on information recall in patients receiving prescription medications.

Many patients receive their filled prescriptions without verbal instructions and must rely on the label as their only source of information. A two-phase study was designed to measure differences in recall information when two common variations in label format were employed. Phase I: Does the patient comprehend label directions better if numbers are typed as words or as numerals? Phase II: Does the addition of preprinted auxiliary labels affect recall of directions? In Phase I, 100 patients were asked to read a label expressing three numbers as words and an additional 100 read the same label using numerals. In Phase II, patients saw the label using numerals with either zero, one, two, or three auxiliary labels attached. Each label was seen by 50 patients. Patients were scored on a point system based on their ability to repeat label directions. There was no significant difference in information recall between label format groups (p greater than 0.05). Only 44% of the patients could remember all directions, 13% could remember no information, and 63% failed to read the auxiliary labels. These results suggest that pharmacists should place less reliance on label format and the use of auxiliary labels to communicate information and spend more time verbally counseling their patients on the proper use of their medications.