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Utilization of Dental Care and Dentate Status in Diabetic and Nondiabetic Patients Across US States: An Analysis Using the 2020 Behavioral Risk Factor Surveillance System
No full textObjective: This study examines the differences, by state, in dental care utilization and tooth retention between adults with and without diabetes mellitus (DM).
Methods: We conducted a secondary analysis of data from the 2020 Behavioral Risk Factor Surveillance System, an annual, state-based, random telephone survey of noninstitutionalized US civilian adults. The predictor variable was DM status. The outcome variables were time since the last dental appointment and tooth loss. We utilized multiple multinomial logistic regression models followed by postestimation procedures to determine state-level adjusted proportions for dental visits within the last year and complete teeth retention among DM and non-DM adults.
Results: Among adults with DM, 60.0% reported dentist visits within a year of survey participation, while 53.6% had complete tooth retention. As education and income levels increased, dental attendance and tooth retention increased among adults with DM. Most Southern states had a higher prevalence of DM, a lower proportion of dentist visits, and worse tooth retention among DM adults. Nationally, DM individuals were 4.3 percentage points less likely to visit a dentist and were 7 percent less likely to have complete teeth retention than non-DM adults. Compared with the national average, 25/50 states had greater disparities in dental visits between DM and non-DM adults, and 27/50 states had greater disparities in tooth loss between DM and non-DM adults.
Conclusion: State-level variations indicate geographical and dental coverage influences on DM and dental outcomes. There is a need for state-specific interventions to improve dental access and outcomes for adults with DM
The Role of County-Level Persistent Poverty in Stroke Mortality in the USA
No full textStroke is a major health concern in the USA, disproportionately affecting socioeconomically disadvantaged groups. This study investigates the link between persistent poverty and stroke mortality rates in residents aged 65 and above, positing that sustained economic challenges at the county level correlate with an increase in stroke-related deaths. Persistent poverty refers to a long-term state where a significant portion of a population lives below the poverty threshold for an extended period, typically measured over several decades. It captures the chronic nature of economic hardship faced by a community across multiple generations. Utilizing data from the CDC Wonder database and the American Community Survey, we conducted a comprehensive analysis across US counties, differentiating them by persistent poverty status. Our results indicate a statistically significant link between persistent poverty and increased mortality from ischemic and hemorrhagic strokes; counties afflicted by long-standing poverty were associated with an additional 33.49 ischemic and 8.16 hemorrhagic stroke deaths per 100,000 residents annually compared to their wealthier counterparts. These disparities persisted when controlling for known stroke risk factors and other socioeconomic variables. These results highlight the need for targeted public health strategies and interventions to address the disparities in stroke mortality rates and the broader implications for healthcare equity. The study underscores the vital role of socioeconomic context in health outcomes and the urgency of addressing long-term poverty as a key determinant of public health
Use of Ultrasound in the Evaluation of Cryptorchidism: A Single-Institution Analysis
No full textIntroduction: The American Urological Association guidelines recommend against the performance of ultrasound and other imaging modalities in the evaluation of patients with cryptorchidism before expert consultation. We aimed to examine our institutional experience with cryptorchidism and measure adherence to currently available guidelines.
Methods: An institutional review board-approved retrospective review of ultrasound utilization in the evaluation of patients with cryptorchidism was performed from June 1, 2016, to June 30, 2019, at a single tertiary level pediatric hospital.
Results: We identified 1796 patients evaluated in surgical clinics for cryptorchidism. Surgical intervention was performed in 75.2% (n = 1351) of the entire cohort. Ultrasound was performed in 42% (n = 754), most of which were ordered by referring physicians (91% n = 686). Of those who received an ultrasound, surgical intervention was performed in 78% (n = 588). Those 166 patients (22%) who did not undergo surgical intervention were referred with ultrasounds suggesting inguinal testes; however, all had normal physical examinations or mildly retractile testes at the time of consultation and were discharged from the outpatient clinic. There were 597 patients referred without an ultrasound, 81% (n = 483) were confirmed to have cryptorchidism at the time of specialist physical examination and underwent definitive surgical intervention, the remainder (19%, n = 114) were discharged from the outpatient clinics.
Conclusions: Ultrasound evaluation of cryptorchidism continues despite high-quality evidence-based guidelines that recommend otherwise, as they should have little to no bearing on the surgeon\u27s decision to operate or the type of operation. Instead, physical examination findings should guide surgical planning
Factors That Influence Depression Categorization in Christian Clergy Members From the United States
No full textIn the United States, clergy members are at higher risk for mental health distress than the general population. To support early intervention, understanding factors associated with depression status is vital. This study seeks to examine factors associated with mild and moderate depression using the patient health questionnaire depression scale (PHQ) in Christian clergy members from the United States (N = 186). Using logistic regression procedures and Ferguson’s (Professional Psychology: Research and Practice, 40(5), 532–538, 2009) criteria for practical significance, younger age (Exp(B) = 0.956, 95% C·I = 0.072–0.016, p = 0.002), history of family therapy (Exp(B) = 0.119, 95% C·I = 0.986–0.008, p = 0.049), and psychiatric medications (Exp(B) = 3.050, 95% C·I = 1.407–6.611, p = 0.005) increased the odds of clergy members being classified in the mild depression group. Additionally, logistic regression procedures indicated that younger age (B = −0.045, Exp(B) = 0.96, 95% C·I = 0.92–0.97, p = 0.03), previous individual therapy (B = 1.66, Exp(B) = 5.28, 95% C·I = 1.36–20.44, p = 0.02), suburban (B = 1.66, Exp(B) = 5.28, 95% C·I = 1.36–20.44, p = 0.02), and rural status (B = 2.36, Exp(B) = 10.63, 95% C·I = 1.99–56.92, p = 0.006) increased the odds of being classified in the moderate depression group. Implications are discussed for researchers, clergy members, and faith tradition leaders
Emerging Trends in the Prevalence of Military Medicine Interest Groups and Specialty Tracks at U.S. Medical Schools
No full textIntroduction: A challenge confronting health care is the national physician shortage, notably impacting the DoD\u27s recruitment of military physicians. To address this, the Health Professions Scholarship Program is annually awarded to medical students to facilitate their transition into the U.S. Armed Forces. There is a glaring absence of military medical education in civilian schools to accommodate the unique interests of these students. While medical schools have adapted with interest groups and specialty tracks, the current presence of military medicine interest groups (MMIGs) and military medicine specialty tracks (MMSTs) remains under-explored. This study aimed to (1) update the prevalence of MMIGs in U.S. medical institutions, (2) identify the presence of MMSTs, and (3) compare military medicine involvement between allopathic and osteopathic programs.
Methods: The study was approved for exempt status from the Kansas City University Institutional Review Board (study number 20,211,568-1). In a cross-sectional analysis, surveys were sent to 208 U.S. medical schools, with responses from student services or available public data from 200 institutions included in the final analysis. A secondary survey was sent to respondents who provided MMIG or MMST contacts.
Results: Results indicated that 62% (n = 124/200) of schools currently have an established MMIG, a modest growth from 56% (n = 70/125) in 2015 (p = .14). MMST prevalence, however, is minimal at 2.5% (5/200). Osteopathic institutions demonstrated a significantly greater engagement in military medicine education (88.7%) compared to allopathic schools (52.4%) (p \u3c .001).
Conclusion: This research underscores the need for comprehensive military medical training in medical schools to meet the interests and career aspirations of their students. Future studies should also evaluate the efficacy of MMIGs and MMSTs in preparing students for military medical roles
Drug-induced Acute Lung Injury: A Comprehensive Radiologic Review
No full textDrug-induced acute lung injury is a significant yet often underrecognized clinical challenge, associated with a wide range of therapeutic agents, including chemotherapy drugs, antibiotics, anti-inflammatory drugs, and immunotherapies. This comprehensive review examines the pathophysiology, clinical manifestations, and radiologic findings of drug-induced acute lung injury across different drug categories. Common imaging findings are highlighted to aid radiologists and clinicians in early recognition and diagnosis. The review emphasizes the importance of immediate cessation of the offending drug and supportive care, which may include corticosteroids. Understanding these patterns is crucial for prompt diagnosis and management, potentially improving patient outcomes
Translating Theory to Treatment: A Conceptual and Empirical Comparison between Cognitive Remediation Therapy and Family-Based Therapy Regarding the Treatment of Eating Disorders
No full textEating Disorders (EDs) such as anorexia nervosa and bulimia nervosa are complex disorders that are difficult to conceptualize and treat. Currently, two main models are used to conceptualize and treat the disorders. The Neurobiological model asserts that EDs are a result of a brain-based endophenotype which requires treatment that targets faulty cognitive processes such as cognitive remediation therapy (Mishra et al., 2017). The second major model, the Open Family Systems Model, was developed by Salvador Minuchin (1975) and asserts EDs are a product of pathological processes within the family that are best treated with family-based therapy. Family-based therapy has historically been the go-to treatment for EDs and has shown to be relatively effective at attaining partial or full remission (Gerstein & Pollack, 2016). Currently, most of the research and funding is being directed toward Neurobiological models of EDs, but it is unclear whether or not the Neurobiological model informs better treatment for EDs (Graham & Kunn, 2013). This literature review aimed to review the Neurobiological and Family Systems model of EDs, the treatment they each inform, and discuss which model informs more effective treatment
Evaluating Stigmatization Toward Mental Illnesses Among Resident Physicians
Get PDFBackground
Individuals with mental illness are stigmatized by peers in societal, workplace, and healthcare settings. The stigmatization individuals experience from healthcare providers is well documented and pervasive, often being a detriment to the quality of healthcare these individuals receive.
Objective
Recognizing and addressing stigmatization toward individuals with mental illnesses is imperative during residency training in Graduate Medical Education (GME) programs and throughout professional practice. We hope that this cross-sectional study will cultivate mindfulness and improve the healthcare outcomes of stigmatized individuals.
Methodology
A cross-sectional study using a web-based Attitude to Mental Illness Questionnaire (AMIQ) with additional scenarios was utilized to assess stigma among resident physicians in differing specialties in a hospital training system. The research investigators collected anonymous data on demographics, characteristics, specialties, and the AMIQ. In eight vignettes, participants responded to five items using a five-point Likert scale assessing attitudes toward individuals.
Results
Of the 104 resident physicians enrolled in the hospital training system where the study was conducted, 58 (56%) volunteered to participate. The participating residents markedly exhibited negative attitudes toward the individual in the vignette with multiple inpatient psychiatric admissions. Residents also exhibited more negative attitudes toward individuals with schizophrenia, self-harm by way of overdose, psychedelic users, cannabis users, and alcohol problems compared to diabetic and Christian individuals.
Conclusions
Residents exhibited negative attitudes toward individuals with mental illness. Additional research would further our understanding of the reasons for physician bias. Moreover, GME programs and medical educators can play a crucial role in mitigating stigma among future physicians, thereby enhancing care for individuals with mental illness
A Retrospective Analysis of Mortality Due to Pneumonia and Renal Disease in a Midwestern Patient Population
Get PDFBackground: The impact of pneumonia (PNA) with concomitant renal disease (RD) has not been fully investigated in a United States Midwestern patient population, despite the morbidity and mortality associated with such diseases.
Materials and methods: A retrospective cohort study was performed on International Classification of Diseases, 10th Revision (ICD-10) data from a hospital system located in Southwest Missouri. Data was acquired from patients admitted between January 2019 and December 2021. Patients were separated into five groups (disease categories): acute kidney injury (AKI), chronic kidney disease (CKD), PNA, AKI with PNA, and CKD with PNA. The data were analyzed, and subset analysis was performed utilizing two-sample proportion tests (Wald test) to compare mortality rates. Informed consent was not needed due to the retrospective nature of the study.
Results: The mortality rate of patients with PNA with AKI and PNA with CKD was 36.08% (32.87% to 39.28%, 95% CI) and 24.97% (21.93% to 28.00%, 95% CI), respectively, revealing a significant increase in mortality for those diagnosed with PNA and AKI - higher than any other disease category. For reference, PNA without (w/o) RD, CKD w/o PNA, and AKI w/o PNA had much lower mortality rates at 9.45%, 7.87% and 12.19%, respectively, with AKI w/o PNA having a 2.63% to 6.00% higher (p\u3c0.0001) and 0.99% to 4.49% higher (p=0.0020), mortality alone than CKD w/o PNA or PNA w/o RD, respectively.
Discussion and conclusion: Mortality associated with RD and PNA was examined in a predominantly rural, relatively poor, Midwestern patient population presenting to a tertiary center with the key finding that the presence of AKI correlates with a much greater mortality rate in both patients with and without PNA. Looking forward, future studies may include a broader population base (including urban, suburban, and rural areas), allowing not only for more statistical power but also a broader assessment of the population. Such knowledge is invaluable as we continue to prioritize healthcare resources for critically ill patients suffering from RD and PNA in different settings