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Baseline assessment of oral health needs among underserved populations in the United States
No full textIntroduction:
There are numerous inequities in access to oral healthcare in the United States (US). Lower utilization of oral healthcare services, a higher burden of dental diseases, and poorer dental outcomes are more prevalent among US immigrants compared to US-born populations. Study Sample:
A sizable population of people in Iowa are immigrants. These immigrants are from democratic republic of congo (DRC), Eritrea, Burma, Bhutan, Burundi, Ethiopia, and Afghanistan. Iowa Refugee Assessment Report of 2018 shows that dental ailment is the second most prevalent condition among new entrant refugees. As a result, the Oral Health Programs targeted an oral health intervention at US immigrant populations. Objectives:
This report aims to highlight significant findings from the baseline survey to further understand the needs for oral healthcare amongst immigrant and underserved populations in Iowa. This intervention utilized community peer educators to sensitize and mobilize immigrants to better access dental services. Training modules were developed for the volunteer peer educators and educational materials were translated into the native languages of the most populous refugees (French, Swahili, and Arabic). The Oral Health Program implemented a community health campaign, developing a questionnaire to capture demographic information, knowledge, awareness, barriers to uptake of dental check-ups/oral assessment,s and preferred sources of information. Preliminary findings indicated the need for increased awareness about oral health. Findings:
There is a need to leverage existing social safety net programs to deliver oral health information and foster connections between dental service providers and their target populations. This study has shown the need for continued efforts towards increasing oral healthcare among underserved ethnic/minority and immigrant populations in Iowa. Future interventions need to focus on improving access and removing structural and social barriers to dental/oral care
Demise of the USMLE Step-2 CS exam: rationalizing a way forward
No full textThe COVID-19 pandemic has compelled rethinking and changes in medical education, the most controversial perhaps being the cancelation of USMLE Step-2 Clinical Skills exam (Step-2 CS). What started in March of 2020 as suspension of this professional licensure exam, because of concerns about infection risk for examinees, standardized patients (SPs), and administrators, soon became permanent cancelation in January 2021. Expectedly, it triggered debate in medical education circles. Positively, however, the USMLE regulatory agencies (NBME and FSMB) saw an opportunity to innovate an exam tainted with perceptions of validity deficits, cost, examinee inconvenience, and worries about future pandemics; they therefore called for a public debate to fashion a way forward. We have approached the issue by defining Clinical Skills (CS), exploring its epistemology and historic evolution, including assessment modalities from Hippocratic times to the modern era. We defined CS as the art of medicine manifest in the physician-patient encounter as history taking (driven by communication skills and cultural competence) and physical examination. We classified CS components into knowledge and psychomotor skill domains, established their relative importance in the physician process (clinical reasoning) of diagnosis, thus establishing a theoretical framework for developing valid, reliable, feasible, fair, and verifiable CS assessment. Given the concerns for COVID-19 and future pandemics, we established that CS can largely be assessed remotely, and what could not, can be assessed locally (school/regional consortia level) as part of a USMLE-regulated/supervised assessment regimen with established national standards, thus maintaining USMLE\u27s fiduciary responsibilities. We have suggested a national/regional program for faculty development in CS curriculum development, and assessment, including standard setting skills. This pool of expert faculty will form the nucleus of our proposed USMLE-regulated External Peer Review Initiative (EPRI). Finally, we suggest that CS evolves into an academic discipline/department of its own, rooted in scholarship
Auditory discrimination in aging bilinguals vs. monolinguals with and without hearing loss
No full textDemands for effective assessments of speech perception specific to the aging brain are increasing, as the impacts of hearing loss on an individual’s functional health, socialization, and cognition have become more widely recognized. Understanding the mechanisms behind the optimal function of the aging brain in relation to speech and language is challenging, especially in the bilingual population where the language learning and language interference processes could be mistaken for perceptual difficulty. Age-related presbycusis is unavoidable, and the contributions of this sensorineural hearing loss (SNHL) process on impaired speech recognition are not completely understood. This lack of understanding of the effects of aging and bilingual language competency on speech perception can act as a barrier to successful auditory rehabilitation. The present study investigated the effects of aging on vowel sound discrimination in adult listeners (age 50+) with the following characteristics: American English (AE) monolinguals with normal hearing, simultaneous or early sequential Spanish-English (SE) bilinguals with normal hearing, and AE monolinguals with SNHL (AE-SNHL). The goal was to identify the differences in vowel sound discrimination performance between the monolingual and bilingual aging populations to guide future language assessments and intervention processes. English vowel discrimination was assessed using an AXB discrimination task in quiet and using the Quick Speech in Noise (QuickSIN) test. SE bilinguals were outperformed by AE and AE-SNHL monolinguals, suggesting SE bilinguals primarily use their L1 acoustic properties to discriminate speech segments. No significant difference was found in QuickSIN performance between the bilingual and the monolingual groups, but there was a significant difference between AE and AE-SNHL. In conclusion, vowel discrimination was affected by interference with the native language, while performance in the noise condition was affected by hearing loss. The results of this study contribute to our understanding of the age-related speech processing deficits from three different aging groups regarding the cognitive control system
3D-Printed Overlay Template for Diagnosis and Planning Complete Arch Implant Prostheses
No full textDental implants are a reliable alternative to treating edentulism. In clinical situations where the dentition has been severely affected by partial edentulism, advanced wear, or periodontal disease, establishing important occlusal elements such as the occlusal plane, incisal guidance, and esthetics can be hard to visualize at the diagnostic stage. Contemporary data-acquisition technologies such as 3D scanners and CAD/CAM systems permit the precise manufacture of highly complex devices applicable to any stage of restorative treatment. The present clinical report presents an alternative technique for evaluating the projected artificial tooth relationships, vertical dimension, and occlusal plane in patients with severely weakened dentition by using a 3D-printed overlay template
Clinical and histomorphometric soft tissue assessment comparing free gingival graft and a collagen matrix as alveolar-sealer materials: a randomized controlled pilot clinical trial
No full textAbstract
Objective: This study aimed to compare the alveolar sealing performance between free gingival graft (FGG) and porcine collagen membrane (MS) and qualitatively assess patient-centered outcomes via a visual analog scale.
Method and materials: Eighteen patients were randomly divided into control (FGG) and test (MS) groups. After extraction, all the alveoli were filled with bovine bone grafts (small granules) and sealed. Follow-up was during the immediate postoperative period and after 3, 7, 15, 30, 60, 90, and 120 days. After 180 days, before implant placement, tissue samples were obtained for histologic analysis. The epithelial tissues were morphometrically measured for each sample. Qualitative information on the patient\u27s perception of the treatment was collected after 7 days.
Results: A faster healing was observed for the MS group. After 60 days, all the sites from the MS were partially healed, in contrast with only five from the FGG. The histologic results after 120 days showed for the FGG group a predominant acute inflammatory process, whereas chronic processes were observed for the MS group. The mean epithelial heights found for the FGG and MS were 535.69 µm and 495.33 µm, respectively (P = .54). The intragroup analysis showed significant variance among the data (P \u3c .001) for both groups. The qualitative result showed statistically more significative comfort for the MS group (P \u3c .05).
Conclusion: Within the limitations of the study, both techniques effectively promote alveolar sealing. However, the visual analog scale result was superior and more significant for the MS group, with faster wound healing and lower discomfort
Alligator ascension: climbing performance of Alligator mississippiensis
No full textIn tetrapedal locomotion, whether horizontal or during climbing, interactions between the foot and the contact surface or substrate influence the locomotor performance. Multiple previous studies of tetrapedal squamates (lizards) have reported that the animals used the same locomotor velocity, regardless of the angle of ascension. The present study was performed to determine if the American alligator (Alligator mississippiensis) would exhibit a stable climbing velocity and to determine to what degree, if any, this climbing velocity could be modified by substrate differences. Sub-adult Alligator mississippiensis, with body lengths around 170 cm, used the same stride velocity when moving at angles of 0°, 30°, and 55°. During these trials, both the sub-adult and juvenile alligators used a “low walk” gait, rather than a distinctive climbing gait. When the alligators traversed an open grate, their stride duration increased (and stride velocity decreased) presumably due to the insertion (and retraction) of their claws and digits into the grate. When climbing at 55° the juvenile and sub-adult alligators used the same stride duration; the sub-adults used a stride length that was significantly larger in absolute terms, but significantly shorter in relative terms. Despite their large size, and their more caudal center of mass, the climbing performance of Alligator mississippiensis is similar to what has been described in the previously-studied tetrapedal squamates
Audiology, an Important Contributor to Interprofessional Holistic Care: An Interprofessional Collaborative Case Example
No full textPurpose: Interprofessional collaboration improves health outcomes, enhances health care satisfaction, and facilitates more effective use of resources. Interprofessional collaborators increasinJ]Ngly understand and value other professions. A.T. Still University provides students from multiple programs with opportunities to develop interprofessional collaboration skills. This research note presents details of one such interprofessional education (IPE) opportunity, a collaborative case. Audiology was part of this case in two ways: Audiologic details of the simulated patient were provided to all students, and audiology students participated in the experience. The results of this involvement are reported. This research note is primarily descriptive in nature; however, the question of whether students viewed their interprofessional competencies as improving following the IPE experience was explored using a validated self-report tool, the Interprofessional Collaborative Competency Attainment Survey (ICCAS). Method: A total of 23 students completed the ICCAS. Additionally, student case presentations were reviewed and audiology-based recommendations were tallied. Results: Highly significant differences (p ≤ .01) for all 20 items on the ICCAS were observed for differences in self-assessed interprofessional skills knowledge. All but one of the 12 teams made specific recommendations regarding the communication needs of the patient. Conclusions: Students viewed their own competencies related to interprofessional collaboration as improved following the collaborative case experience. Overall, the collaborative case experience was effective in providing students with the opportunity to develop a breadth of skills needed for interprofessional collaboration. Providing audiologic information in the case history prompted all but one team to consider patient communication needs
Patient-reported outcome measures as an outcome variable in sports medicine research
No full textInjury prevention and rehabilitation research often address variables that would be considered clinician-oriented outcomes, such as strength, range of motion, laxity, and return-to-sport. While clinician-oriented variables are helpful in describing the physiological recovery from injury, they neglect the patient perspective and aspects of patient-centered care. Variables that capture patient perspective are essential when considering the impact of injury and recovery on the lives of patients. The inclusion of patient-reported outcome measures (PROMs) as dependent variables in sports medicine research, including injury prevention and rehabilitation research, provides a unique perspective regarding the patient\u27s perception of their health status, the effectiveness of treatments, and other information that the patient deems important to their care. Over the last 20 years, there has been a significant increase in the use of PROMs in sports medicine research. The growing body of work gives opportunity to reflect on what has been done and to provide some ideas of how to strengthen the evidence moving forward. This mini-review will discuss ideas for the inclusion of PROMs in sports medicine research, with a focus on critical factors, gaps, and future directions in this area of research. Important elements of research with PROMs, including instrument selection, administration, and interpretation, will be discussed and areas for improvement, consideration, and standardization will be provided
An Examination of Perceived Pressure from Stakeholders on Concussion Reporting Intentions and Behavior in Ice Hockey Athletes
No full textObjective: We aimed to assess whether perceived pressure predicts concussion reporting intentions and behavior in youth, high school, and collegiate ice hockey athletes, and, secondarily, whether perceived pressure from stakeholders differed between sex or level of play. Setting: Online survey. Participants: One hundred fifty-two ice hockey athletes (males: n = 96, 63.2%; females: n = 55, 36.2%; missing: n = 1, 0.7%; age = 14.04 ± 3.6 years). Design: Cross-sectional. Main Measures: Respondents answered a survey that elicited information about demography, perceived pressure from 6 stakeholders, and concussion reporting intentions and behavior. For the first aim, we used a generalized linear model to determine whether perceived pressure from any stakeholder predicted intention (symptom reporting, concussion reporting, and intention beliefs) or behavior ( all concussions, not obvious concussions ; α \u3c.05) while controlling for level of play. To determine whether pressure from any stakeholder predicted symptom reporting behavior, we used logistic regression while controlling for level of play. For the second aim, to examine sex differences in perceived pressure from each stakeholder, we employed Mann-Whitney tests and to examine level of play differences, we used Kruskal-Wallis tests. Results: Controlling for level of play, a 1-point increase in perceived pressure from parents and athletic administrators decreased concussion reporting intentions by 0.92 (P =.004) and 1.09 (P =.005) points, respectively. Perceived pressure from a sports medicine professional decreased intention beliefs by 0.17 (P =.029) points. Perceived pressure from stakeholders did not predict symptom reporting (P =.440) or not obvious concussion reporting (P =.655) behavior. We observed no difference in perceived pressure across stakeholders (all P values \u3e.05); however, collegiate ice hockey respondents perceived greater pressure from coaches than youth or high school athletes (P \u3c.001). We noted no other differences in perceived pressure across levels of play (all P values \u3e.05). Conclusions: Concussion reporting intentions were negatively influenced by perceived pressure from parents, athletic administrators, and sports medicine professionals, but these findings did not translate to reporting behavior