The role of dental insurance in mitigating mortality among working-age U.S. adults with periodontitis.

AIM: To assess the relationship of dental insurance with all-cause mortality and mortality due to cardiovascular diseases (CVD), diabetes mellitus (DM), and cerebrovascular diseases (CBD) among those with periodontitis. MATERIALS AND METHODS: NHANES III and its associated mortality data set were used in this study. The outcome variables were "all-cause mortality" and "combined mortality" due to CVD, DM, and CBD. The independent variable was dental insurance stratified over periodontitis status. Unweighted frequencies with weighted column percentages were used for descriptive statistics, and chi-square test was applied for significance. Cox proportional hazard models were used for stratified multivariable analyses. All analyses were performed in SAS v9.4 accounting for survey data complexities. Significance level was kept at 5%. RESULTS: The mortality was 14.58% for all-cause mortality and 4.06% for combined mortality among those with periodontitis in this study. Dental insurance significantly reduced the hazard of all-cause mortality among those with periodontitis (HR: 0.75; 95% CI: 0.61 - 0.93), adjusted for covariates. However, no association of dental insurance with combined mortality was observed among periodontitis group. CONCLUSIONS: Dental insurance reduces hazard of all-cause mortality among those with periodontitis. Dental insurance ensures access to dentists and improves oral and dental health. Longitudinal study is needed to establish causality.

Public health education and health system needs in Pakistan: a mixed methods study.

BACKGROUND: Pakistan has recently observed a significant growth in public health education programmes. Little is known about the structure of these programmes nor whether they are adequately responsive to national health system needs. AIMS: We reviewed existing public health degree programmes in Pakistan along with an exploration of the national public health market and health system needs. METHODS: A mixed-methods study was conducted between January 2015 and March 2016. Seventeen public health degree programmes were reviewed for programmatic and instructional attributes. Thirteen key-informant interviews were conducted to explore health system needs and challenges related to public health workforce. RESULTS: We found substantial variation in public health academic programmes in terms of offered courses, credit hours, number of faculty and tuition costs. About 70% of public health degree programmes were generic (i.e. with no specific concentration track) and only 18% offered practicums. Overall median tuition cost in 2016 was US$ 10 350. During key-informant interviews, emerged themes for challenges included lack of practical public health skills, limited knowledge of latest theoretical principles, poor communication skills and insufficient IT orientation. Identified themes about knowledge and skills areas to address future public health challenges of Pakistan included system thinking mind set, healthcare IT skills, and leadership and management skills. CONCLUSIONS: Public health education in Pakistan falls short of meeting current national challenges. Pakistan needs a national public health accreditation body for regulating education, harmonizing global standards to local context and developing relevant career pathways.

The importance of human factors in therapeutic dietary errors of a hospital: A mixed-methods study.

An accurate therapeutic diet can help people improve their medical condition. Any discrepancy in this regard could jeopardize a patient's clinical condition. This study was aimed to determine prevalence of dietary errors among in-patients at an international private hospital's food department, and to explore causes of error to suggest strategies to reduce such errors in the future. Thus, a sequential explanatory mixed-methods study was carried out. For the quantitative part, secondary data were collected on a daily basis over one-month. For qualitative data, errors arising during the meal flow process were traced to the source on the same day of error followed by qualitative interviews with person responsible. Quantitative data were analyzed in SPSS v.25 as percentages. Qualitative data were analyzed by deductive-inductive thematic analysis. Out of a total of 7041 diets, we found that only 17 had errors. Of these, almost two-thirds were critical. Majority of these errors took place during diet card preparation (52.94%), by dietitians (70.59%), during weekdays (82.35%), breakfasts (47.06%), and in the cardiac care ward (47.06%). The causes identified through interviews were lack of backup or accessory food staff, and employee's personal and domestic issues. It was concluded that even though the prevalence of dietary errors was low in this study, critical errors formed majority of these errors. Adopting organizational behavior strategies in the hospital may not only reduce dietary errors, but improve patients' well-being, and employee satisfaction in a long run.

Predictive value of tissue p53 protein expression and serum p53 antibodies in oral potentially malignant disorders: Relative to oral squamous cell carcinoma.

Objective: This study aims to assess and report the predictive value of tissue p53 protein expression and serum p53 antibodies as a screening tool for oral potentially malignant disorders (OPMDs) cases with risk of malignant transformation. Methods: A case-control study was jointly conducted at the Department of Pathology and Oral and Maxillofacial Surgery in several dental institutes in the country from April 2016 to March 2017. A total of 180 eligible subjects (60 cases of OPMDs, 60 cases of oral squamous cell carcinoma, and 60 controls) were included in the study. Tissue p53 immunoreactivity was determined by immunohistochemistry, and serum concentrations of p53 antibodies were determined by enzyme-linked immunosorbent assay. Specimens were collected for laboratory investigations after obtaining written consent from both patients and controls. Results: Among the study participants, the recorded male to female ratio was close to 2:1, and most participants fell in the age range of 41-60 years and above. Of the 60 cases of OPMDs, the observed tissue p53 immunopositivity was 73.3% (n = 44) while for the p53 antibody, the seropositivity was 96.7% (n = 58). The sensitivity for p53 immunoreactivity was 73%, and specificity was 98.3% between OPMDs and healthy individuals. Conclusion: The present study provides evidence (for OPMDs) that serum p53 antibodies and p53 immunoreactivity could be used as a sensitivity test and a specific test, respectively, and may contribute to determining the potential of OPMD for malignant transformation risk.

Consumer choice of health facility among the lowest socioeconomic group in newly established demand-side health-financing scheme in Pakistan.

BACKGROUND: The Social Health Protection Initiative (SHPI) was introduced initially in Pakistan in Khyber Pakhtunkhwa Province. The initiative aimed to provide the lowest socioeconomic group of the population with in-patient healthcare services, which otherwise would be financially hard to obtain. It is one of the flagship projects of the Provincial Government to contribute towards the United Nations Sustainable Development Goals and universal health coverage. AIMS: To assess consumer choice of health facility and its determinants for public versus private sector health facilities by people enrolled in SHPI. METHODS: We used secondary data of availed health services from February 2016 to September 2017 under SHPI. A proxy outcome variable, visit to health facility, was used to determine consumer choice between public and private sector health facilities. The treatment group (health services received by beneficiaries) was used as an independent variable controlled for age groups, cost groups, and geographic location of health facilities. All statistical analyses were performed by SPSS version 20. RESULTS: Most beneficiaries chose private over public health facilities (90.25%). The adjusted odds of visiting a public sector health facility for surgical and obstetrics/gynaecological services were 0.12 [95% confidence interval (CI): 0.10-0.16] and 0.11 (95% CI: 0.09-0.14) respectively, when compared to medical services. CONCLUSION: SHPI beneficiaries have lesser odds of visiting a public hospital over a private one. The choice may be affected by factors such as age of the beneficiary, cost of health services, and geographic location of health facilities.

Assessing the knowledge and skill of vaccination staff at Adult Vaccination Counters for COVID-19 vaccines: Simulated client method.

The Government of Pakistan has established Adult Vaccination Counters (AVCs) to immunize general population with COVID-19 vaccine. Different brands of COVID-19 vaccines have different protocols. It is important that the knowledge and skills of the vaccination staff at AVCs should be accurate. To assess this, a cross-sectional study was conducted in all 15 AVCs at Khyber Pakhtunkhwa's provincial capital in May 2021, using the simulated client approach. Structured open-ended and simulated scenario-based questions were used to collect data from the vaccination staff of AVCs. This study showed that 53.3% of the AVCs had at most three out of four brands of COVID-19 vaccines. 60% of the AVCs did not have the mechanism to track client's vaccine first dose, date, and brand. Only 66.7% of the AVCs had a complete knowledge of all the available vaccines. 86.7% and 80% of the AVCs knew the correct duration and administration of the same brand of COVID-19 vaccine's second dose respectively. At the client's end, 6.7% were aware about the brand of administered COVID-19 vaccine. 46.7% were advised about the date of the second shot of vaccination. Only 13.3% of the clients were informed about the procedure of getting an official vaccination certificate. It was concluded that the knowledge and skill of the vaccination staff at AVCs is inadequate. Every vaccine has a different protocol in terms of number of doses and duration. AVCs must have a tracking system to inoculate the second dose with the same brand as the first dose. There is a need for rigorous monitoring and training of the COVID-19 vaccination staff on various protocols of vaccine to prevent losing public's trust.

Untreated Dental Caries May be Associated with Subsequent Mortality among Working-Age Adults: Evidence from NHANES III.

OBJECTIVES: Poor oral health has been shown to be associated with selected adverse health outcomes. This study assessed the association between untreated dental caries and mortality and examined whether having dental insurance mitigates the risk of mortality among working-age US adults with dental caries. METHODS: Analysis used the publicly available linked mortality file for NHANES III, an observational study conducted in 1988-1994, with follow-up through December 2015. Propensity score matching was conducted to create similar populations of insured and uninsured adults, resulting in a sample of 4420 matched observations. The Cox proportional hazard model was used to investigate the effect of untreated dental caries and that of dental insurance on risk of all-cause mortality. The descriptive and final outcome statistical analyses were adjusted for complex sampling technique using weights, strata and cluster variables. RESULTS: Adults with untreated dental caries had a higher risk of mortality (HR: 1.33; 95% CI: 1.06-1.68) than those with no dental caries. Having dental insurance was associated with a lower risk of mortality (HR: 0.73; 95% CI: 0.59-0.92). An interaction between caries treatment status and dental insurance was not statistically significant. CONCLUSIONS: Adults with untreated dental caries have a higher risk of mortality, even in the presence of dental insurance. Untreated caries may be an indicator for multiple risk factors, including personal attitudes regarding health and healthcare-seeking behaviour.