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Purpose Non-surgical periodontal therapy (NSPT) is considered to be fundamental in the treatment of periodontal disease. Advanced area specific instruments were designed to increase the clinician's ability to effectively access root furcation areas during NSPT. The purpose of this study was to explore clinical dental hygienists' familiarity, utilization, and perceived efficacy of advanced instruments in root furcation areas during NSPT. Methods A randomized sample (n=3,500) of licensed dental hygienists in Michigan was invited to participate in a paper-based, mail survey. The 10-item instrument consisted of demographic, multiple choice, Likert scale, and open-ended questions. Descriptive and inferential statistics were used to analyze the data. Results A total of 1,156 surveys were returned; 858 met the inclusion criteria for a response rate of 24.5%. Respondents who graduated between 2010-2020 than those who graduated between 1990-1999 were more likely to utilize advanced instruments and those who graduated in 1989 or earlier (16.0% and 19.9% respectively). Respondents familiar with advanced instruments were more likely to use them in furcation areas during NSPT than those less familiar with the instruments (95% CI [18.1, 29.6], p<0.001). Respondents who perceived advanced instruments to be effective in furcation areas were more likely to utilize them (95% CI [1.0, 8.0], p<0.05) during NSPT. Most respondents indicated that they became familiar with advanced instruments during their dental hygiene education or through continuing education courses. Conclusion Familiarity with advanced instruments and perceived efficacy of these instruments for accessing root furcations increased the likelihood of clinical dental hygienists utilizing them during NSPT. Dental hygiene education and continuing education programs should continue to provide opportunities for students and practicing clinicians to learn NSPT instrumentation techniques utilizing advanced instruments designed for furcation access. [ABSTRACT FROM AUTHOR]

Purpose With the growing preference of the generation of ageing baby boomers to age in place, mobility has played an increasingly important role in their continued physical and mental well-being. As older adults drive less, their ability to travel freely where and when they desire becomes increasingly limited. Consequences of this include the cessation of various activities and services that are necessary for daily living. Transportation immobility is known to negatively impact the quality of life through physical, mental, and social isolation. For any initiative or policy to be put in place, an assessment of the current state of transportation services, specifically for older adults, needs to be carried out. The purpose of this paper is to assess the access to public transit in the Greater Lansing, Michigan region, which has a population density of about 2,042 people per square kilometre, available to ageing adults, especially when they have to stop driving.Design/methodology/approach The study uses a spatial approach through the use of geographical information systems to assess the transit infrastructure available for use by older adults in the Greater Lansing region.Findings This paper finds a considerable gap in available options and that some of these can be addressed by quite simple actions and initiatives.Research limitations/implications Because the data were drawn from the US Census, the spatial analysis is limited to block-level data. The US Census (2011) defines blocks as “statistical areas bounded by visible features such as roads, streams, and railroad tracks, and by nonvisible boundaries such as property lines, city, township, school district, county limits and short line-of-sight extensions of roads”. More detailed geographical data would have enabled a more comprehensive analysis.Practical implications This study area is typical of many small towns in the USA and underlines the need for more policy- and community-led transit initiatives to address this critical barrier to optimal ageing.Originality/value This paper fulfils an identified need to study the transit infrastructure of a range of urban areas and ascertain whether it currently fulfils mobility needs of older adults who do not drive. [ABSTRACT FROM AUTHOR]

The alveolar bone crest level is essential in determining the need for bone removal in subjects with altered passive eruption (APE). This study assessed the validity of CBCT and transgingival probing in determining the alveolar bone crest level. Patients presenting with APE were assessed. Transgingival probing was performed to clinically assess the distance between the cementoenamel junction (CEJ) and the bone crest at the midpoint of the maxillary anterior teeth. CBCT was used to assess this distance at the same point. Upon reflection of a full mucoperiosteal flap, the actual distance was measured. Similar actual and CBCT measurements of the distance between the CEJ and bone crest at teeth 13, 22, and 23 (FDI numbering system) were recorded (P > .05). However, in teeth 11, 12, and 21, the distance was significantly greater on CBCT scans (P < .05). No significant difference was detected between transgingival probing and the actual distance at all teeth assessed. Careful transgingival probing provides an accurate measure of the distance between the CEJ and bone crest. CBCT gives an accurate estimate, though it may not be justified for each patient in the presence of safer methods. [ABSTRACT FROM AUTHOR]

Using multiple pharmacies has been linked to negative outcomes including increased inappropriate drug use, toxicity, and mortality, yet up to half of all patients in the US use multiple pharmacies. A pilot survey was administered to measure pharmacy use in people living with HIV (PWH) and examine the associated attitudes and outcomes. In a midwestern HIV clinic, a convenience sample was surveyed based on using single (SPU) versus multiple pharmacies (MPU). One hundred forty-two subjects participated (69 SPU; 73 MPU): 75% male, 59% white, and > 70% being ≥ 40 years old. There was a trend towards increased recall of self-reported CD4 and viral load status for SPUs vs MPUs [OR 2.26 (95%, 0.91–5.64)]. SPU participants indicated acquiring all meds in one place [Likert Scale weighted average (LS WA) = 4.45], proximity (LS WA = 3.64), the identification of adverse effects (LS WA = 4.17), and concerns about missing potential drug-drug interactions (LS WA = 4.06) as reasons for preferring a single pharmacy. The desire to keep HIV status private (LS WA = 3.65) was noted as a significant reason for using a separate pharmacy specifically for acquiring antiretrovirals in MPU participants. Results indicate patients often have justifiable reasons for using single versus multiple pharmacies. [ABSTRACT FROM AUTHOR]

Introduction: Finite resources limit the amount of time EMS agencies can dedicate to continuing education in pediatric emergencies. EMS instructors need effective, efficient, and affordable educational strategies for these high-risk, low frequency events. Objective: To compare the effectiveness of four training methods in management of pediatric emergencies for paramedics. Methods: A validated, performance-based, simulated clinical assessment module was used to provide a baseline measurement of paramedics' resuscitation skills during three simulated pediatric emergencies. Educational modules were developed that targeted deficiencies identified by the baseline assessment, including advanced pediatric life support skills, airway management, use of the Broselow-Luten Tape®, pediatric drug dose calculations and drug delivery, seizure management, and trauma assessment. Paramedics from five EMS agencies in Michigan were randomized to four education intervention groups. The control group used an existing, online, continuing education course. Three experimental groups were exposed to the same content during five, one-hour sessions conducted over 2.5 years. Instruction was delivered using high-fidelity, simulated case-based training, low-fidelity simulation training, or lecture with procedural skills lab, based on group assignment. After the training, all groups were tested within 4–6 months using methods identical to baseline testing. Results: One hundred forty-seven subjects completed the study. There were no differences in baseline skill levels among the four groups. Only the low fidelity simulation training group demonstrated improvement of combined scenario scores (p = 0.0008). Scores for targeted skills improved in one scenario in the high-fidelity group, two in the low-fidelity group, one in the lecture/lab group, and none in the control group. Conclusions: Although improvements in those skills included in the training were found in three groups, two hours of training in pediatric emergencies per year was insufficient to produce a substantial improvement overall. Expensive, high-fidelity simulators were not necessary for teaching pediatric resuscitation skills to paramedics; instructive scenarios using low-fidelity manikins and debriefings appear to be adequate. The content delivered by an online refresher course did not provide any improvement in performance as measured by simulated, case-based assessments. [ABSTRACT FROM AUTHOR]

Purpose: Mood and anxiety disorders affect 20–30 percent of school-age children, contributing to academic failure, substance abuse, and adult psychopathology, with immense social and economic impact. These disorders are treatable, but only a fraction of students in need have access to evidence-based treatment practices (EBPs). Access could be substantially increased if school professionals were trained to identify students at risk and deliver EBPs in the context of school-based support services. However, current training for school professionals is largely ineffective because it lacks follow-up supported practice, an essential element for producing lasting behavioral change. The paper aims to discuss these issues. Design/methodology/approach: In this pilot feasibility study, the authors explored whether a coaching-based implementation strategy could be used to integrate common elements of evidence-based cognitive behavioral therapy (CBT) into schools. The strategy incorporated didactic training in CBT for school professionals followed by coaching from an expert during co-facilitation of CBT groups offered to students. Findings: In total, 17 school professionals in nine high schools with significant cultural and socioe-conomic diversity participated, serving 105 students. School professionals were assessed for changes in confidence in CBT delivery, frequency of generalized use of CBT skills and attitudes about the utility of CBT for the school setting. Students were assessed for symptom improvement. The school professionals showed increased confidence in, utilization of, and attitudes toward CBT. Student participants showed significant reductions in depression and anxiety symptoms pre- to post-group. Originality/value: These findings support the feasibility and potential impact of a coaching-based implementation strategy for school settings, as well as student symptom improvement associated with receipt of school-delivered CBT. [ABSTRACT FROM AUTHOR]

Development and implementation of policy, systems, and environmental (PSE) change is a commonly used public health approach to reduce disease burden. The Centers for Disease Control and Prevention's National Comprehensive Cancer Control Program conducted a demonstration with 13 programs to determine whether and to what extent dedicated resources would enhance the adoption of PSE strategies. This paper describes results of the qualitative portion of a longitudinal, mixed-methods evaluation of this demonstration. Case studies were conducted with a diverse subset of the 13 programs, and 106 in-depth interviews were completed with state/tribal program staff, community partners, and decision makers. Interviews addressed PSE change planning and capacity building, partnerships, local context, and how programs achieved PSE change. Dedicated PSE resources, including a policy analyst, helped increase PSE change capacity, intensify focus on PSE change overall, and accomplish specific PSE changes within individual jurisdictions. Stakeholders described PSE change as a gradual process requiring preparation and prioritization, strategic collaboration, and navigation of local context. Findings suggest that the demonstration program, including PSE-dedicated funds and a policy analyst, was successful in both increasing PSE change capacity and achieving PSE change itself. These results may be useful to other state, tribal, territorial, and public health organizations planning or implementing PSE change strategies. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Many psychiatric inpatients use tobacco, but most psychiatric hospital units prohibit tobacco use. Psychiatric nurses do not receive adequate education about how to teach patients to best manage tobacco withdrawal symptoms. What does this paper add to existing knowledge?: Psychiatric nurses who receive a brief educational intervention about tobacco withdrawal symptoms and best practices for using nicotine gum may be more prepared to teach patients about these topics. In turn, patients may use nicotine gum more often during their hospitalization, leading to improved outcomes for them as well as for staff. What are the implications for practice?: A simple educational intervention aimed at psychiatric nurses can result in positive outcomes for psychiatric inpatients who use tobacco. Patients who have a positive experience with stopping tobacco use while hospitalized may be more likely to commit to lifelong tobacco cessation afterwards. The results of this feasibility study demonstrate that additional research that builds on the work presented here is warranted. Introduction: Tobacco use is prohibited in most psychiatric facilities in the United States, yet many psychiatric inpatients are tobacco users. Psychiatric nurses have reported inadequate education about best practices for managing tobacco dependence. Aim: To explore the feasibility of an educational intervention for psychiatric nurses designed to improve their ability to educate patients about best practices for managing tobacco dependence, as well as effective use of nicotine gum. Method: Fourteen nurses on a psychiatric inpatient unit at a community hospital were educated about the targeted topics. Chart reviews of nonequivalent pre‐intervention and post‐intervention patient groups were conducted to explore the outcomes of the intervention. Results: Patients received more teaching, and used nicotine gum more often, following the intervention. However, no statistically significant differences between the pre‐intervention and post‐intervention patient groups were found. Discussion: Educating nurses about best practices for managing tobacco withdrawal symptoms may have positive outcomes. Existing research suggests that such interventions may be most effective when support and structure are provided to ensure long‐term practice changes. Implications for practice: This feasibility study demonstrates that a brief nurse education intervention has the potential to improve the experience of tobacco withdrawal for psychiatric inpatients. Future research that expands upon the current project is warranted. [ABSTRACT FROM AUTHOR]

The goal of this paper was to investigate the possible trade-off between peak hand acceleration and accuracy and consistency of hand strikes performed by martial artists of different training experiences. Ten male martial artists with training experience ranging from one to nine years volunteered to participate in the experiment. Each participant performed 12 maximum effort goal-directed strikes. Hand acceleration during the strikes was obtained using a tri-axial accelerometer block. A pressure sensor matrix was used to determine the accuracy and consistency of the strikes. Accuracy was estimated by the radial distance between the centroid of each subject's 12 strikes and the target, whereas consistency was estimated by the square root of the 12 strikes mean squared distance from their centroid. We found that training experience was significantly correlated to hand peak acceleration prior to impact (r2=0.456,p =0.032) and accuracy (r2=0. 621,p=0.012). These correlations suggest that more experienced participants exhibited higher hand peak accelerations and at the same time were more accurate. Training experience, however, was not correlated to consistency (r2=0.085,p=0.413). Overall, our results suggest that martial arts training may lead practitioners to achieve higher striking hand accelerations with better accuracy and no change in striking consistency. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject: Person‐centered care, as compared to standard approaches, is a widely accepted, evidence‐based approach for managing aggressive behaviour in persons with dementia. The attitudes, beliefs and values of long‐term care and mental health nursing employees are important prerequisites to implementing person‐centered practices. Research shows that nursing employees typically support person‐centered approaches; however, less is known about the attitudes of non‐nursing employee groups. What this paper adds to existing knowledge: Nurse managers and administrators tended to agree with person‐centered approaches for managing aggression in dementia, suggesting some prerequisites are in place to support wider adoption of person‐centered frameworks. Employees with more resident contact tended to support person‐centered approaches the least, suggesting discipline‐specific trainings may not be adequate for preparing frontline staff to use person‐centered techniques. Attitudes towards aggressive behaviour may be especially varied and contradictory within certain employee groups, providing implications for facility‐wide initiatives. Implications for practice: Person‐centered values and practices should be monitored and reinforced across the organization. Person‐centered trainings should be interdisciplinary in nature and focused on care areas, such as mealtime or bathing. Long‐term care facilities should consider allowing nurse management and registered nurses to share the burden of direct resident care with frontline employees on a more regular basis. Abstract: Introduction: Implementing person‐centered care requires shared attitudes, beliefs and values among all care employees. Existing research has failed to examine the attitudes of non‐nursing employees. Aim: This study examined attitudes towards aggression among nursing and non‐nursing employees to address gaps in existing research and assess readiness for wider adoption of person‐centered frameworks. Method: The Management of Aggression in People with Dementia Attitude Questionnaire was used to survey attitudes of employees in Michigan‐based nursing homes. Results: Overall, employees preferred person‐centered over standard approaches. Job title was a significant predictor of paradigm support. Frontline employees were found to support person‐centered attitudes the least. Wide‐ranging responses were noted within employee groups. Discussion: Job title may influence the degree to which an employee supports and utilizes person‐centered approaches. Employees with the most contact with persons with dementia may be the least likely to implement person‐centered approaches. In contrast to prior studies, years of experience was not a significant predictor of attitude towards aggressive behaviour. Wide‐ranging responses indicate that employee attitudes are varied and complex. Implications: Person‐centered approaches should be trained within care areas rather than individual employee groups. Programs should be interdisciplinary and seek to establish a shared understanding of person‐centered beliefs and values. [ABSTRACT FROM AUTHOR]

The Kick and Cook-a-Palooza program was an interprofessional partnership between the Grand Valley State University Public Health Department and the therapeutic recreation (TR) program to provide a physical activity and nutrition program at three after-school sites in Grand Rapids, Michigan. Working with children classified as youth at risk, the purpose of the program was to teach children healthy habits related to nutrition and physical activity that they can continue and share with their families. In addition, interprofessional education occurred among university students as they experienced interprofessional collaboration between two health professions and a community agency. This paper presents a practice perspective on developing, implementing, and evaluating the results of the physical activity component of a program with youth at risk in an interprofessional collaborative environment. The program was funded by grants from the General Mills Foundation and the Academy of Nutrition and Dietetics Foundation and the Recreational Therapy Foundation. [ABSTRACT FROM AUTHOR]

States are struggling to assure an adequate number of registered nurses are active in the clinical workforce to serve patients and communities. Nurse compact legislation—enacted in 39 states—facilitates interstate recognition of nurse licensure. We used a cross-sectional email survey of registered nurses in Michigan to measure their opinions on compact licensure legislation and examined differences in compact licensure opinions by nurses' personal characteristics. Primary analyses reported herein are from 7,098 Michigan nurses with complete data. Most respondents felt that the compact would make it easier to redeploy nurses in an emergency (76.6%), improve access to nursing care (66.6%), and boost their personal career options (55.1%). Most nurses disagreed that compact legislation would weaken patient protections (60.7%). The majority expressed neutral feelings on whether compact licensure would make disciplinary actions more difficult to enforce (50.9%) and a plurality that current licensure policies were satisfactory (44.0%). The majority were supportive of Michigan joining the compact (72.3%). In multivariable analysis, stronger support for joining the compact was associated with advanced degrees, male sex, and younger age. Less support was associated with membership in a collective bargaining unit. Policymakers who wish to ease acute nurse vacancies should consider enacting nurse licensure compact legislation. Careful attention to patient protections and disciplinary review would address potential safety concerns. [ABSTRACT FROM AUTHOR]

High poverty urban areas in the U.S. are over-burdened by early adult death and disability, yet there has been little documentation of how early parental death impacts youth residing in these communities. We conducted qualitative, community-based research on the health and well-being of 20 residentially unstable young women ages 18-24 in Detroit during 2011-2012. Participants were selected through their association with a local social service organization. We found that nine of these 20 young women had experienced the loss of a parent or primary caretaker during childhood or adolescence. Using data from in-depth, semi-structured interviews, this paper explores the role of parental loss as a precipitating event for residential instability and episodic homelessness. For these young women, parental loss was a catalyst for subsequent periods of intermittent homelessness and persistent mobility between the households of extended family and friends. These narratives provide unique testimony to the impact of early parental loss on young women from low-income households in an economically-stressed urban context in the U.S. Their stories highlight the dynamic associations between periods of housing insecurity and vulnerability to numerous social risks, including sexual commerce, acute stress, and alienation from social support networks. In this context, parental loss reflects a broader social inequality of early adult mortality in high poverty areas, and the health and social gains to be realized through targeted policies to support areas of urban economic crisis. [ABSTRACT FROM AUTHOR]

Objetives: The major objective of our paper was to test and validate the nutritional literacy scale (NLS) in a pre-dominantly African-American geriatric population. Design: Completion of the 2 literacy scales Short Test of Functional Health Literacy in Adults (STOHFLA) and nutritional literacy scale (NLS) during a 5-month period from September 2008 to January 2009. Setting: The Rosa Parks Geriatric Center at Detroit Medical Center/Wayne State University. Participants: The study cohort consisted of elderly (>65years old) 150 patients that had presented to the geriatric clinic. Measurements: NLS and STOHFLA were simultaneously given to the patients. The NLS consists of 28 questions regarding organic foods; calorie intake etc. and questions in each section were arranged from easier to more difficult ones. The baseline characteristics were stratified according to the NLS (< 25 and ≥ 25) and STOHFLA (< 35 and ≥ 35) scores. Additionally we also collected data on demographic information, educational experience, blood pressure recordings from 3 consecutive clinic visits. Results: The patients with a higher NLS score were younger (72 ± 9) as compared to those with lower NLS score (76 ± 9) (p = 0.005), and also had more years of education (16 ± 3 years v/s 13 ± 3 years; p <0.001). A higher proportion of patients with lower score on NLS had hypertension (95.10 % for NLS < 25 v/s 77.08 % for NLS > 25; p =0.001). Conclusion: We validated a potentially useful nutritional literacy tool that might prove to be useful intervention aimed at identifying individuals with lower levels of education and insight regarding their nutritional behaviors. [ABSTRACT FROM AUTHOR]

Background: It is generally accepted that obesity and depression are positively related in women. Very little prior research, however, has examined potential variation in this relationship across different racial/ethnic groups. This paper examines the association between obesity and depression in non-Hispanic White, non-Hispanic Black, and Mexican American women. Methods: The sample included women aged 20 years and older in the 2005-2008 National Health and Nutrition Examination Surveys ( n=3666). Logistic regression was used to assess the relationship between obesity and depression syndrome (assessed using the Patient Health Questionnaire-9), after adjusting for covariates. We then investigated whether this association varied by race/ethnicity. Results: Overall, obese women showed a 73% greater odds of depression (odds ratio [OR]=1.73; 95% confidence interval [CI]=1.19, 2.53) compared with normal weight women. This association varied significantly, however, by race/ethnicity. The obesity-depression associations for both Black and Mexican American women were different from the positive association found for White women (ORBlack*obese=0.24; 95% CI=0.10,0.54; ORMexican American*obese=0.42; 95% CI=1.04). Among White women, obesity was associated with significantly greater likelihood of depression (OR=2.37; 95% CI=1.41, 4.00) compared to normal weight. Among Black women, although not statistically significant, results are suggestive that obesity was inversely associated with depression (OR=0.56; 95% CI=0.28, 1.12) relative to normal weight. Among Mexican American women, obesity was not associated with depression (OR=1.01; 95% CI=0.59, 1.72). Conclusions: The results reveal that the association between obesity and depression varies by racial/ethnic categorization. White, but not Black or Mexican American women showed a positive association. Next research steps could include examination of factors that vary by race/ethnicity that may link obesity to depression. [ABSTRACT FROM AUTHOR]

The Building Healthy Communities (BHC) initiative addresses inadequate physical activity in Michigan using a population-based approach to prevent chronic disease. Eighteen local health departments through 2010 received $1,505,179 to plan and implement community-based interventions to increase physical activity among low-income and minority populations. This paper examines park user demographics, compares park user demographics to the demographic characteristics and examines physical activity behaviors of park users in these parks. BHC Park usage was examined from 2008 to 2010 using the System for Observing Play and Recreation in Communities (SOPARC). One sample binomial tests were used to examine if the proportion of male and female park users was different than the proportion of males and females in Michigan and to examine if the proportion of white and other park users was different than the proportion of whites and others in Michigan. A chi-square goodness-of-fit test was used to examine whether the observed proportions for age groups observed using the park differed from the actual proportions for age groups in Michigan. The majority of BHC park users were white. More children were observed than other age groups. Park users were most often observed engaging in walking or vigorous activity rather than sedentary activities. When comparing the proportion of whites (54.7%) and others (42.8%) observed using the parks to the proportion of whites (79%) and others (21%) residing in Michigan, there was a significant difference ( P < 0.001) with a greater proportion of whites and smaller proportion of persons of other ethnicities expected to be observed using the parks. This chi square goodness of fit test showed a significant difference in the observed and expected number of persons observed using the trail in each age group (χ = 4,897.707, df = 3, P < 0.001) with a greater number of children (n = 1,939) and teens (n = 1,116) observed than the number of children (n = 828) and teens (n = 305) expected based on 2010 Michigan census data. A greater proportion of non-whites (compared to whites) were observed using the park than would be expected. In Michigan, 60% of blacks, 37% of Hispanics, and 53% of other minority groups do not meet national physical activity recommendations. Perhaps developing additional parks in Michigan can increase physical activity behaviors among minorities. [ABSTRACT FROM AUTHOR]

Background: Despite high levels of clinically significant persistent cancer related fatigue in breast cancer survivors few treatments are currently available and most pose a significant burden on the part of the woman. Acupressure, a component of Traditional Chinese Medicine, has been shown to decrease fatigue levels by as much as 70% in cancer survivors while being inexpensive, non-toxic and an easy to use intervention. The primary aim of this study was to determine the efficacy of two types of self-administered acupressure (relaxation acupressure and stimulating acupressure), compared to standard of care on fatigue severity. Secondary aims were to evaluate the efficacy of two types of acupressure on sleep and kinetic parameters required for implementation of acupressure in a clinical setting; The purpose of this paper is to share the methodology used including challenges and insights. Methods/design: This study is a three group, randomized clinical trial. 375 breast cancer survivors at least 12 months after completion of cancer treatments, with moderate to severe persistent fatigue, are being randomized to one of 3 groups: self-administered relaxation acupressure; self-administered stimulating acupressure; or standard of care. Participants are assessed at baseline, 3 weeks, and 6 weeks followed by a 4-week follow-up period. The primary aim is to examine the effect of 6-weeks of relaxation acupressure compared to stimulatory acupressure or standard of care on fatigue as assessed by: weekly self-report using the Brief Fatigue Inventory; objective daytime physical activity on actigraph; or fatigue patterns assessed 4-times daily using a visual analog scale. Secondary endpoints include depression, anxiety, self-efficacy, and sleep quality. Discussion: This study has the potential to develop a low-cost, self-care intervention for the most troubling of late-term effects in breast cancer populations, fatigue. The methods used may lend constructive ideas to other investigators working with this population and/or intervention. Trial registration: ClinicalTrial.Gov Trials Register NCT01281904 [ABSTRACT FROM AUTHOR]

Purpose: Strict eligibility criteria exclude a majority of the veteran population from receiving oral healthcare benefits through the Veterans' Administration Dental Care program (VADC). The purpose of this study was to examine perceptions of oral health status, and access/barriers to dental care of veterans who are ineligible for VADC benefits. Methods: This cross-sectional study was conducted using a 24-item paper survey, disseminated in person to 227 veterans across the state of Michigan over a period of two months. Items included socio-demographic information, questions regarding perceptions of oral health, access to dental care, and perceived barriers. Descriptive statistics were collected to provide an overview of the data. Results: A response rate of 80% (n=182) was achieved. Veterans who perceived themselves as having a poor oral health status were less likely to have a dental home (p=.000) or receive dental care (p=.001). Respondents were more likely to report cost as a barrier (p=.000), and to report having had a toothache during the past 12-months (p=.000). Conclusion: Results from this study indicate that while veterans in general value the importance of oral healthcare, cost and time are significant barriers to accessing dental care for individual's ineligible for VADC benefits. Veterans who perceive themselves as having poor oral health are more likely to report oral health disparities. Further research is needed to impact Veterans Administration policy and decrease oral health disparities. [ABSTRACT FROM AUTHOR]

Ismail AI, Ondersma S, Willem Jedele JM, Little RJ, Lepkowski JM. Evaluation of a brief tailored motivational intervention to prevent early childhood caries. Community Dent Oral Epidemiol 2011; 39: 433-448. © 2011 John Wiley & Sons A/S Abstract - Objectives: This pragmatic randomized trial evaluated the effectiveness of a tailored educational intervention on oral health behaviors and new untreated carious lesions in low-income African-American children in Detroit, Michigan. Methods: Participating families were recruited in a longitudinal study of the determinants of dental caries in 1021 randomly selected children (0-5 years) and their caregivers. The families were examined at baseline in 2002-2004 (Wave I), 2004-2005 (Wave II) and 2007 (Wave III). Prior to Wave II, the families were randomized into two educational groups. An interviewer trained in applying motivational interviewing principles (MI) reviewed the dental examination findings with caregivers assigned to the intervention group (MI + DVD) and engaged the caregiver in a dialogue on the importance of and potential actions for improving the child's oral health. The interviewer and caregiver watched a special 15-minute DVD developed specifically for this project based on data collected at Wave I and focused on how the caregivers can 'keep their children free from tooth decay'. After the MI session, the caregivers developed their own preventive goals. Some families in this group chose not to develop goals and were offered the project-developed goals. The goals, if defined, were printed on glossy paper that included the child's photograph. Families in the second group (DVD-only) were met by an interviewer, shown the DVD, and provided with the project's recommended goals. Both groups of families received a copy of the DVD. Families in the MI + DVD group received booster calls within 6 months of the intervention. Both caregivers and the children were interviewed and examined after approximately 2 years (Wave III: 2007). Results: After 6-month of follow-up, caregivers receiving MI + DVD were more likely to report checking the child for 'precavities' and making sure the child brushes at bedtime. Evaluation of the final outcomes approximately 2 years later found that caregivers receiving the MI + DVD were still more likely to report making sure the child brushed at bedtime, yet were no more likely to make sure the child brushed twice per day. Despite differences in one of the reported behaviors, children whose caregivers received the motivational intervention did not have fewer new untreated lesions at the final evaluation. Conclusions: This study found that a single motivational interviewing intervention may change some reported oral health behaviors, it failed to reduce the number of new untreated carious lesions. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to assess dentists' and dental hygienists' current motivation, attitudes, and knowledge regarding volunteering in a non-profit dental setting and the opportunity for earning continuing education (CE) credits. Methods: This cross-sectional study surveyed a convenience sample of dental and dental hygiene professionals from the state of Michigan. A 20-question paper survey was developed and pilot tested. The survey was disseminated to attendees at various component meetings of the dental and dental hygienists' associations in southeastern Michigan. Results: Out of the 274 surveys that were distributed, 182 (n=182) were completed, yielding a 66% response rate. Eighty percent of the participants were unaware of the opportunity for earning CE by volunteering and 79% were unaware of the volunteering site approval requirement by the Michigan Board of Dentistry. Thirty percent of participants were unable to determine how many unpaid days per year they were willing to volunteer and a similar percentage, (28%), were unable to determine how many paid days. The most common motivating factor to volunteer was to give back to the community (60%) while the greatest barrier was lack of time (62%). Conclusion: The opportunity to earn CE credit for volunteerism is seen as a benefit, however, it needs to be better promoted to potential volunteers, through dissemination of information by professional associations and in educational settings. Community-based clinics also need to be made aware of how to become a CE provider. Further research on the longitudinal impact of CE for volunteerism in community-based clinics is warranted. [ABSTRACT FROM AUTHOR]

This study characterizes the impact of the COVID-19 pandemic on the mental and physical health of nurses. Qualitative data (collected using semi-structured interviews) were integrated with quantitative data (collected concurrently using the SF-12 Health Survey). Nurses (N = 30) compared their health prior to and during the first pandemic wave (March–May 2020). Interviews were analyzed thematically; descriptive statistics and t -tests compared pre-pandemic to current SF-12 scores. Qualitative findings demonstrated an impact on nurses' mental health expressed as isolation, loss, intense emotions, and feelings of being expendable. Impact on nurses' physical health included exhaustion, personal protective equipment skin breakdown, limited breaks from work, and virus exposure. Quantitative results show nurses' experienced declines in overall mental health (p <.001), and multiple physical health domains: role limitations due to physical problems (p <.0001), bodily pain (p <.0001), and general health (p <.0001). Promotion of nurses' well-being and safety, as well as education in emergency preparedness, must be given precedence to protect nurses' health. [ABSTRACT FROM AUTHOR]

Anti-immigrant rhetoric and immigration policy enforcement in the United States over the last 2 decades has increased attention to fear of deportation as a determinant of poor health. We describe its association with mental health outcomes among Middle East and North African (MENA) residents of Michigan. Using a convenience sample of MENA residents in Michigan (n = 397), we conducted bivariate and multiple variable regression to describe the prevalence of deportation worry and examine the relationship between deportation worry and depressive symptoms (PHQ-4 scores). We found that 33% of our sample worried a loved one will be deported. Deportation worry was associated with worse mental health (p < 0.01). Immigration policies are health policies and deportation worry impacts mental and behavioral health. [ABSTRACT FROM AUTHOR]

The use of numerous social media formats (SMFs) has grown exponentially over the past several years. In many cases it has become the sole source of communication, the sole source of entertainment, and, unfortunately in many instances it exhibits the characteristics of a disruptive behavior. As a result, it has interfered with fundamental relationships. The following research sought to examine if there is a negative correlation between the disruptive use of SMFs and an individual's early life attachments to parents and/or other adults. In order to determine if a correlation existed, the research participants completed 4 standardized questionnaires of which 3 measured early life attachments to mothers, fathers, and/or other adults and a single questionnaire that measured their later life disruptive use of a variety of SMFs. This research did identitfy a significant negative correlation does exist between the positive protective factor of early childhood attachments when measured against the risk factor of later life disruptive use of SMFs. This finding was true for research participants who identified only parental attachment figures but the strength of the correlation was enhanced when a research participant also identified an other adult as an early attachment figure. The research further identified that certain of the 9 subcategories of the Disruptive Use Scale were more significant for female research participants while other subcategories were more significant for male research participants. This research clearly establisheda robust negative correlation between research participants' early childhood attachment experiences and their later life disruptive use of SMFs. However, to generalize the above findings, additional research needs to be conducted that is more inclusive of a variety of research participants. [ABSTRACT FROM AUTHOR]

Parent-to-parent mental health treatment approaches demonstrate a solid evidence base, though a tool to measure changes associated with this innovative service delivery approach has yet to appear in the literature. The Parent Support Partner (PSP) Outcome Tool was developed to evaluate a statewide parent-to-parent service for families of children presenting severe emotional and behavioral challenges. This study explored the factor structure and reliability of the PSP Outcome Tool. Participants were 1,502 Medicaid-eligible parents of children between the ages of 5–19 with SED (82%), I/DD (12%), or both SED and I/DD (5%) who enrolled in and participated in PSP Services across the state of Michigan from 2017 to 2020. Exploratory factor analysis revealed a three-factor solution (Bridging Collaborative Relationships, Empowerment, Navigating Resources). Cronbach's alpha was high (0.95) for the resulting 23-item outcome tool, and the three factors (i.e. Bridging Collaborative Relationships = 0.91, Empowerment = 0.90, Navigating Resources = 0.84). The factor structure of the scale and the need to establish additional validity support (i.e. predictive, convergent, divergent validity) for its use with diverse groups of parents are discussed. [ABSTRACT FROM AUTHOR]

Identifying the consumption patterns of toddlers and preschool children is critical to evaluating their potential for healthy development and future heath trajectories. The purpose of this longitudinal cohort study was to describe breastfeeding, nutritional trends, and dietary diversity in 12-to-36-month-old children in a Michigan cohort. Mothers completed surveys when their children were 12 (n = 44), 24 (n = 46) and 36 months old (n = 32). Mothers reported their child's dietary intake in the past 24 h and intake of specific foods in the past year. About 95% of 12-to-24-month-old children in the study population were ever breastfed, with 70% consuming human milk at 6 months and just over 40% at 12 months. Over 90% of participants gave their child a bottle since birth, with 75% providing human milk and 69% giving formula. Consumption of juice significantly increased with age and ~55% of the 36-month-old children consumed juice. A larger proportion of children consumed soda, chocolate, and candy as they aged. Though dietary diversity numerically increased with child age, this did not reach significance. Gut microbiota composition and structure was not associated with diet diversity. This research lays the foundation for future work to determine which nutritional interventions may be most effective in this population. [ABSTRACT FROM AUTHOR]

Economically disadvantaged communities experience disproportionate health and social challenges relative to more affluent areas. This study describes ways women support and give back to their community in a minority-majority community experiencing social, economic and health challenges. We conducted qualitative interviews with 100 women and human service providers serving women in Flint, Genesee County, Michigan. Using methods aligned with community-based participatory research, a group of community and academic partners analyzed the data. Participants noted several personal characteristics of women they identified as assets including resilience, strength, resourcefulness, creativity, determination, tenacity, wisdom and the ability to nurture others. We think these personal characteristics represent individual assets that help women in Flint survive and build social capital. Women reported developing their social capital through giving, collaborating and sharing their skills with people in their personal networks. Significant personal assets in the form of individual characteristics already exist within Flint. Even in an area characterized as having health and economic challenges, women in this study were able to leverage their personal assets to build social capital and to mobilize resources for their benefit and the benefit of the community. [ABSTRACT FROM AUTHOR]

Few studies describe how community disadvantage impacts intergenerational relationships. Using interviews with women and service providers (n = 100), we explored benefits and challenges of intergenerational relationships in Flint, Michigan, an economically vulnerable community. Women valued relationships that increased social connections and generativity; however, few community resources promoted such relationships. Intergenerational relationships were important for leaving a social legacy in lieu of a meaningful economic legacy. Some middle-aged women are overwhelmed by caregiving, balancing employment while caring for multiple generations. Women desired intergenerational activities that include children and younger adult women. Further, caregiving programs should attend to the needs of middle-aged caregivers. [ABSTRACT FROM AUTHOR]

By enacting administrative rule 325.176 (12), Michigan added a vaccine education component as a precondition to granting vaccine waivers to vaccine-hesitant parents wishing to file a nonmedical vaccine exemption for their school-aged child. The purpose of the study was to identify best practices for reaching vaccine-hesitant parents during face-to-face vaccine education sessions conducted by vaccine waiver educators in Michigan. This study utilized qualitative descriptive content analysis of semi-structured phone interviews with vaccine waiver educators from local health departments (LHDs) in Michigan. Participants were vaccine waiver educators who were employed by a local health department in Michigan and had conducted at least 30 vaccine waiver education sessions. Strategies, resources, and techniques identified by educators as beneficial included using and providing information from a variety of sources, compiling their own educational materials, creating a positive experience, holding personalized sessions, and streamlining exemption and vaccination sessions. However, unexpected themes that emerged from the interviews revealed that vaccine waiver educators need additional training in discussing vaccine ingredients with parents, handling religious vaccine exemption requests, and assessing the role of schools. Implementing successful vaccine education interventions targeting vaccine-hesitancy is crucial to public health. Charging LHDs with overseeing vaccine education via a face-to-face discussion is a novel intervention strategy, the effective implementation of which may inform vaccine education intervention nationwide and may even be translated into international contexts and prove useful to current COVID-19 vaccination efforts. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is a significant public health problem among college students and many students have difficulty identifying unhealthy and abusive behaviors. The aims of this mixed methods study are to: (a) create an inclusive tool that illustrates the power and control experiences of a diverse group of young adult college students, (b) ensure a broad scope of tactics are illustrated (related to technology and different types of relationships), and (c) measure the experience of these tactics, including how IPV knowledge, attitudes, and self-efficacy are influenced by a more inclusive tool. In Phase I, semi-structured interviews were conducted with students (n = 33) and staff (n = 10) at campus sexual assault centers at the three University of Michigan (UM) campuses to explore power and control tactics utilized by perpetrators on college campuses. Content analysis revealed 13 categories of tactics in college relationships. A draft tool was created and assessed for accuracy using cognitive interviews with students (n = 20) from all three campuses in Phase II. Cognitive interviews resulted in the following changes to the final tool: (a) new presentation of the Socioecological Model, (b) identification of substance use as a facilitator for multiple forms of violence, and (c) edits to tactic descriptions. In Phase III, 250 students at UM–Ann Arbor participated in a quasi-experimental evaluation in which 133 interacted with the tool and 117 received access to usual care (campus sexual misconduct policy). Both groups answered survey questions about IPV knowledge, attitudes, self-efficacy, and experiences at baseline, and after one month and five months. Among all college participants in Phase III, 33.5% had experienced lifetime IPV and 25.2% had experienced IPV in the past year. There were no significant differences among IPV knowledge, attitudes, or self-efficacy by group. The Dynamics of Interpersonal Coercion Among College Students tool was created by incorporating current tactics utilized among a diverse college population. [ABSTRACT FROM AUTHOR]

Few studies explore how intimate partner violence (IPV) affects Arab Americans. Through focus groups with stakeholders from an Arab-centered health organization and semistructured interviews with Arab-American female clients (18–65 years), we explore how IPV affects Arab-American women and factors that impede and facilitate their access to support services. We find that IPV is a critical concern among Arab Americans and that generational status, educational attainment, and support from family, friends, or religious leaders were perceived to influence access to IPV support services. This study has implications for developing culturally sensitive IPV interventions for Arab-American women. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite great progress in reducing environmental lead (Pb) levels, many children in the United States are still being exposed. OBJECTIVE: Our aim was to develop a generalizable approach for systematically identifying, verifying, and analyzing locations with high prevalence of children’s elevated blood Pb levels (EBLLs) and to assess available Pb models/indices as surrogates, using a Michigan case study. METHODS: We obtained ~1:9 million BLL test results of children <6 years of age in Michigan from 2006–2016; we then evaluated them for data representativeness by comparing two percentage EBLL (%EBLL) rates (number of children tested with EBLL divided by both number of children tested and total population). We analyzed %EBLLs across census tracts over three time periods and between two EBLL reference values (=5 vs. =10 µg/dL) to evaluate consistency. Locations with high %EBLLs were identified by a top 20 percentile method and a Getis-Ord Gi* geospatial cluster “hotspot” analysis. For the locations identified, we analyzed convergences with three available Pb exposure models/indices based on old housing and sociodemographics. RESULTS: Analyses of 2014–2016 %EBLL data identified 11 Michigan locations via cluster analysis and 80 additional locations via the top 20 percentile method and their associated census tracts. Data representativeness and consistency were supported by a 0.93 correlation coefficient between the two EBLL rates over 11 y, and a Kappa score of ~0:8 of %EBLL hotspots across the time periods (2014–2016) and reference values. Many EBLL hotspot locations converge with current Pb exposure models/indices; others diverge, suggesting additional Pb sources for targeted interventions. DISCUSSION: This analysis confirmed known Pb hotspot locations and revealed new ones at a finer geographic resolution than previously available, using advanced geospatial statistical methods and mapping/visualization. It also assessed the utility of surrogates in the absence of blood Pb data. This approach could be applied to other states to inform Pb mitigation and prevention efforts. [ABSTRACT FROM AUTHOR]

The main purposes of this study are to determine the extent to which the James White Library at Andrews University serves the information needs of graduate students enrolled in distance learning programs and to examine their information-seeking behavior to ascertain how they access material for their online courses. A 14-part questionnaire was developed to collect information for this quantitative, nonexperimental design research. The data showed that although some off-campus students were satisfied with the services and resources delivered, the library might realign its offerings to better meet students' academic needs and devise promotional strategies to increase their awareness of the services it provides. [ABSTRACT FROM AUTHOR]

Prior studies of neighborhood racial segregation and intrauterine growth have not accounted for confounding factors in early life. We used the Life-Course Influences on Fetal Environment Study of births to Black women in metropolitan Detroit, 2009–2011, (N = 1,408) to examine whether health and social conditions in childhood and adulthood confound or modify the association of neighborhood segregation (addresses during pregnancy geocoded to census tract racial composition) and gestational age-adjusted birthweight. Before adjusting for covariates, women living in a predominantly (≥75%) Black neighborhood gave birth to 47.3 grams (95% CI: –99.0, 4.4) lighter infants, on average, compared with women living in <75% Black neighborhoods. This association was confounded by adulthood (age at delivery, parity, neighborhood deprivation) and childhood (parental education, neighborhood racial composition) factors and modified by adulthood socioeconomic position. These findings underscore the complex relationship between neighborhood racial segregation and birth outcomes, which would be enhanced through a life course framework. [ABSTRACT FROM AUTHOR]

Background: The United States physician shortages affect rural health care access, including maternity care. Project aims were to identify and characterize prenatal and delivery care in Michigan's rural counties and to explore access to trial of labor after cesarean (TOLAC) services for women in rural Michigan. Methods: Descriptive, cross‐sectional design used 2015 Medicaid claims data and public health plan information to identify maternity care services provided within Michigan's rural counties. Publicly available health plan information was used to identify rural maternity hospitals and prenatal care practitioners; findings were verified by Internet searches and telephone interviews. Medicaid claims data were used to determine services provided. High‐risk geographic areas were defined as those where women needed to travel >30 miles for maternity‐related care. Expected TOLAC rate was determined based on published national birth data; rural hospitals were stratified based on whether they met the expected TOLAC rate, delivered 20%‐60% of expected rate, or billed ≤1 TOLAC birth to Medicaid in 2015. Results: In Michigan's 57 rural counties, only 29 hospitals provide maternity care. Geographic high‐risk areas were identified in the Upper Peninsula and northeast Lower Peninsula of Michigan. Only two rural hospitals billed for the expected rate of TOLAC births; six delivered at a lower rate, and the remaining 21 hospitals provided no TOLAC services, resulting in large areas of the state where women were not offered this option locally. Conclusions: Maternity care services are limited for many rural Michigan women. Findings can be used to target specific strategies to improve access to care for these women. Similar analyses, exploring patterns of maternity care delivery in other rural regions worldwide, may uncover similar or additional inequities. [ABSTRACT FROM AUTHOR]

Aim: College students are presumed to be exposed to a vast amount of sexual health information and may participate in various sexual behaviors. Without appropriate sources of sexual health information, the sexual health of college students could be severely affected. The purpose of this study was to identify the sources of sexual information and determine the relationship between socio-demographic factors and discussing sexual matters with father, mother, brother, and/or sister. Subject and method: A school-based cross-sectional study design was conducted in the spring of 2018 (January to May). A simple random sampling was used to select a total of 808 students attending Central Michigan University. Participants answered a questionnaire from the World Health Organization administrated through Qualtrics software. The data was extracted from Qualtrics, and further analysis was done using SPSS software. The outcome of interest was discussing sexual matters with father, mother, brother, and/or sister. Descriptive statistics and bivariate and logistic regression analyses were performed, and all associations were set by p-values less than 0.05 and reported by unadjusted and adjusted odds ratios with 95% CI. Results: Nearly 80% of the study participants were females. Most of the respondents (39.7%) were first- and second-year university students, followed by third- to fifth-year students (38.4%). Approximately 59% of the study sample fell into the group 21 years of age and below. The majority (70.1%) of the study participants identified mothers (rather than fathers, brothers, or sisters) as a source of sexual health information. The majority of participants (39.4%) were non-religious, followed by Christians (35.6%). Most of the study participants (69.9%) earned less than $1000 per year. In a multivariate analysis, this study revealed that there was no statistically significant association between socio-demographic factors and obtaining sexually related information from mothers or sisters. Males also were three times more likely to discuss sexual matters with their fathers when compared to females [AOR: 3.09; 95% CI: 1.92–4.97]. Again, males were 96% more likely to discuss sexual matters with their brothers compared to females [AOR: 1.96; 95% CI:1.11–3.46]. In terms of education, first- and second-year students, and third- to fifth-year students were three times more likely to discuss sexual matters with their fathers compared to graduates [AOR: 3.41; 95% CI: 1.53–7.57, AOR: 3.02; 95% CI:1.53–6.02 respectively]. Conclusion: The majority of participants (70.1%) identified mothers as a source of sexual health matters. Therefore, mothers should be encouraged to be trained for effective communication regarding sexual health issues. Gender showed a significant association with discussing sex matters with fathers and brothers. The year of education also showed a significant association with discussing sexual matters with fathers. All findings suggest that family members need to be informed with correct sexuality information to better inform children/siblings. [ABSTRACT FROM AUTHOR]

The surge of coronavirus disease 2019 (COVID-19) hospitalizations at our 877-bed quaternary care hospital in Detroit led to an emergent demand for Infectious Diseases (ID) consultations. The traditional 1-on-1 consultation model was untenable. Therefore, we rapidly restructured our ID division to provide effective consultative services. We implemented a novel unit-based group rounds model that focused on delivering key updates to teams and providing unit-wide consultations simultaneously to all team members. Effectiveness of the program was studied using Likert-scale survey data. The survey captured data from the first month of the Detroit COVID-19 pandemic. During this period there were approximately 950 patients hospitalized for treatment of COVID-19. The survey of trainees and faculty reported an overall 95% positive response to delivery of information, new knowledge acquisition, and provider confidence in the care of COVID-19 patients. This showed that the unit-based consult model is a sustainable effort to provide care during epidemics. [ABSTRACT FROM AUTHOR]

Breast cancer is a common cancer among women in the US and cultural barriers and medical mistrust have been associated with breast cancer screening (BCS) rates among minority populations. A heterogeneous sample of Arab women (N = 196) were recruited from across the Detroit metropolitan area and administered a questionnaire. Multiple regression analyses revealed an association between Arab Cultural Specific Barriers (ACSB) to BCS and Group-Based Medical Mistrust Scale. The environmental ACSB to BCS was associated with the medical mistrust—suspicion of HC providers (β = 0.363, p = 0.01), lack of HC provider support (β = 0.396, p = 0.001), and Arab inequities (β = 0.250, p = 0.05). Findings suggest that ACSB to BCS are predictive of medical mistrust for Arab American women. This study illuminates the need to emphasize strategies that will target the medical care system and the cultural barriers to BCS that Arab American women face in the health care system. [ABSTRACT FROM AUTHOR]

In 2016, Detroiters passed a community benefits ordinance with the main goal of having their voices heard in the process of development negotiating a set of benefits that will be delivered at the cost of the developer. To evaluate how effectively this new approach has incorporated the voices of Detroiters into developments, we conducted a qualitative analysis of interviews with residents, developers and planners, and policy documents. We propose several amendments to the Ordinance like more inclusionary selection of residents for negotiations, lengthening the timeline, and removing interference from overlapping agreements that may prevent local communities from winning certain benefits. [ABSTRACT FROM AUTHOR]

Purpose: Literature on the relationship between hair cortisol concentration (HCC) and body mass index (BMI) is scarce and inconsistent in both preschoolers and parents. Thus, the study aimed to examine the relationships among HCC, perceived distress, coping, and BMI among low-income Head Start preschoolers and mothers. Methods: A cross-sectional, correlational study was conducted with a non-random sample of 35 mother-preschooler dyads. Height and weight were measured using a ShorrBoard Stadiometer and a Seca portable electronic scale, respectively. HCC was extracted using the enzyme immunoassay approach. Mothers' perceived distress and coping were assessed by Cohen's Perceived Stress Scale. Results: Mothers' mean age was 29.74 years, and preschoolers' mean age was 4.69 years. The sample included 17% Hispanic, 54% Black, and 60% single mothers; and 23% Hispanic and 60% Black preschoolers. Compared to mothers in low HCC group (< 4.1 pg/mg), mothers in high HCC group (≥ 4.1 pg/mg) had lower BMI (B = − 4.62, p =.049). The indirect effects of mothers' HCC on BMI via perceived distress and coping was 15% of the total effects. Preschoolers with mothers in high HCC group had significantly lower BMI z-score than those with mothers in low HCC group (B = − 0.94, p =.043). Preschoolers' HCC had a small positive correlation with their BMI z-score (B = 0.01, p =.112). Conclusions: Relationships between HCC and BMI varied between low-income mothers and preschoolers. A stress management component may need to be integrated into future obesity interventions. Given the limitation of small sample size and cross-sectional study design, the findings need to be interpreted with caution, and further investigation is warranted. [ABSTRACT FROM AUTHOR]

Purpose: This study discusses the ways in which the presence of background noise may adversely affect bilingual students' ability to repeat speech, specifically, whether the presence of background noise increases lexical, grammatical, omission, and other errors on the AzBio Sentence Test. Method: Participants consisted of 15 monolingual English (first language) speakers and 41 bilingual (second language [L2]) speakers from Spanish, Portuguese, and Korean language groups, ranging from students who learned English after the age of 4 years to adulthood. Participants completed the AzBio Sentence Test in both quiet and background noise environments. A language analysis was conducted, and errors were classified under categories of lexical, grammatical, omissions, and other. Results: The results of this study show that L2 speakers made more lexical, grammatical, omissions, and other errors than first language speakers on the AzBio Sentence Test. In background noise, all bilingual language groups made more errors than monolinguals. Portuguese speakers notably made more omissions than other language groups. This study also shows that participants who were introduced to English at a younger age made fewer errors. Conclusions: In conclusion, our results corroborate previous research, indicating that bilingual speakers have more difficulty accurately interpreting speech in the presence of background noise. These findings have implications for classroom instruction considering the statistically higher percentage of omissions made by L2 speakers. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this cone beam computed tomography (CBCT) study was to investigate the incidence of fenestration and associated risk factors with virtual placement of an implant in the maxillary incisor region. Materials and Methods: Edentulous ridges missing a maxillary central or lateral incisor and amenable for single implant placement were included. Root-form implants (4 × 12 mm and 3.5 × 12 mm for the central and lateral incisors, respectively) were placed virtually in the edentulous space following the axis of the ipsilateral crown. Buccolingually, the implants were placed in the ideal prosthetic cingulum position. The angles of the ridge (RA) and implants (IA) in relation to the hard palate and the incidence of fenestration were recorded. Results: A total of 48 CBCT scans were analyzed. The mean RA and IA were 124.32 degrees and 110.91 degrees, respectively. Nine cases resulted in fenestration, equivalent to 18.75% of the total cases. The discrepancy between the RA and IA was statistically significantly larger in the fenestration sites (19.93 degrees) than in the nonfenestration sites (13.05 degrees). The concavity depth of the alveolar ridge was statistically significantly higher in the fenestration sites (4.79 mm) than in the nonfenestration sites (3.40 mm). Conclusion: Within the limitations of this study, it can be concluded that the occurrence of fenestration is common (approximately 20%) if an implant is placed in the cingulum position with the axis following that of its restoration. [ABSTRACT FROM AUTHOR]

Problem: The adverse effects of bullying victimization among adolescents have been examined extensively. However, few studies have examined how bullying perpetration affects health. Moreover, ethnic or religious minorities are particularly at risk for bullying involvement, but little is known about bullying among Arab Americans. The purpose of this study is to examine how bullying perpetration and victimization are related—independently and concurrently—to physical and psychological problems among Arab American adolescents. Method: Arab American adolescents (N = 150), ages 12–16, were recruited from a community center and a mosque located in Southeast Michigan. Participants completed the Adolescent Peer Relations Instrument, the Children's Somatization Inventory, the Kessler Psychological Distress Scale, and the Perceived Stress Scale. Findings: Both bullying perpetration and victimization correlated positively with physical and psychological symptoms. Hierarchical regressions indicated that both perpetration and victimization simultaneously and significantly predicted physical and psychological symptoms, and these relationships were independent of the demographic factors and general life stress. Conclusions: Bullying perpetration and victimization are associated with adverse health outcomes in Arab American adolescents, independent of life stress. These findings are among the first ones in this population and pave the way for future research and intervention programs. [ABSTRACT FROM AUTHOR]

Rising hostility towards immigrants characterised the 2016 Presidential election in the United States (US) and subsequent policy priorities by the new presidential administration. The political shift towards aggressive policies targeting undocumented immigrants is far‐reaching and extends into other communities that convive con—or coexist with—immigrant communities. Our study aims to examine the rippling effects of these anti‐immigrant policies and rhetoric on health and social service providers in Southeast Michigan who predominantly serve Latino immigrants. Between April and August 2018, we conducted in‐depth individual interviews in two Federally Qualified Health Centers and a non‐profit social service agency at a county health department. We interviewed 28 frontline health and social service providers. After coding and thematic analyses, we found that staff members' experiences in supporting immigrant clients was congruent with definitions of secondary trauma stress and compassion fatigue, whereby exposure to clients' trauma combined with job burden subsequently impacted the mental health of providers. Major themes included: (a) frontline staff experienced a mental and emotional burden in providing services to immigrant clients given the restrictive anti‐immigrant context; and (b) this burden was exacerbated by the increased difficulties in providing these services to their clients. Staff described psychological and emotional distress stemming from exposure to clients' immigration‐related trauma and increased mental health needs. This distress was exacerbated by an increased demand to meet clients' needs, which involved explaining or translating documents into English, assisting with legal paperwork, referring clients to mental health resources, addressing increased transportation barriers, and reestablishing trust with the community. Our findings add qualitative data on the mental health implications for frontline providers who support Latino immigrant clients impacted by immigration and highlights the need for further research and resources that address the workplace‐related stress generated by heightened immigration enforcement. [ABSTRACT FROM AUTHOR]

Purpose: The present study examined the feasibility of internet-based cognitive behavioral therapy (iCBT) for home care older adults. Method: A feasibility open trial was conducted with 26 recipients of nonmedical home care with depressive symptoms. When possible, home care workers (HCWs) of older adults (n = 13) were recruited to provide external support for iCBT usage. Results: The mean therapy sessions completed was 4.7 out of 8, and 86% would recommend the program to others with depressed mood. Participants' depressive symptoms and anxiety symptoms decreased, whereas their quality of life ratings improved. Discussion: iCBT is a feasible and acceptable treatment modality for home care older adults with depressive symptoms and is potentially effective. Future studies are warranted to refine the existing treatment platform to achieve a better fit between the demands of the program and the needs and capabilities of homebound older adults and to examine treatment effectiveness as a function of HCW support. [ABSTRACT FROM AUTHOR]

Introduction: Research shows that mainstream parenting and repeat pregnancy prevention programs generally do not effectively engage with fathers and that young men's levels of participation in such services are low. To support practitioners in overcoming the barriers to recruiting and retaining young fathers, the current study aimed to gather lessons learned from one program's state administrators, case managers, and young fathers about the most effective strategies for engaging this population in intensive case management. Methods: Three focus groups were conducted. One focus group was held with the creators and managers of the Michigan Adolescent Pregnancy and Parenting Program MI-APPP at the state Department of Health and Human Services (n = 3). The other two groups were designed to jointly engage young fathers currently involved in intensive case management (n = 11) and their case managers (n = 5). A qualitative analysis of the focus group transcripts was conducted using a coding scheme developed from emerging themes in the transcripts and related literature. Results: The findings highlight a selection of those strategies that focus group participants perceived to be most successful in improving male recruitment and retention in intensive ongoing case management. Among these strategies were centralizing feedback from young fathers in program decision making, offering opportunities for young fathers to connect, and challenging staff's negative stereotypes about young fathers. Discussion: Despite the small sample size, the results of this study nevertheless contribute to debates in the field regarding appropriate strategies for engaging young fathers by informing professional practice. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament (ACL) tears are common knee injuries. Despite undergoing extensive rehabilitation after ACL reconstruction (ACLR), many patients have persistent quadriceps muscle weakness that limits their successful return to play and are also at an increased risk of developing knee osteoarthritis (OA). Human growth hormone (HGH) has been shown to prevent muscle atrophy and weakness in various models of disuse and disease but has not been evaluated in patients undergoing ACLR. Hypothesis: Compared with placebo treatment, a 6-week perioperative treatment course of HGH would protect against muscle atrophy and weakness in patients undergoing ACLR. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: A total of 19 male patients (aged 18-35 years) scheduled to undergo ACLR were randomly assigned to the placebo (n = 9) or HGH (n = 10) group. Patients began placebo or HGH treatment twice daily 1 week before surgery and continued through 5 weeks after surgery. Knee muscle strength and volume, patient-reported outcome scores, and circulating biomarkers were measured at several time points through 6 months after surgery. Mixed-effects models were used to evaluate differences between treatment groups and time points, and as this was a pilot study, significance was set at P <.10. The Cohen d was calculated to determine the effect size. Results: HGH was well-tolerated, and no differences in adverse events between the groups were observed. The HGH group had a 2.1-fold increase in circulating insulin-like growth factor 1 over the course of the treatment period (P <.05; d = 2.93). The primary outcome measure was knee extension strength, and HGH treatment increased normalized peak isokinetic knee extension torque by 29% compared with the placebo group (P =.05; d = 0.80). Matrix metalloproteinase–3 (MMP3), which was used as an indirect biomarker of cartilage degradation, was 36% lower in the HGH group (P =.05; d = –1.34). HGH did not appear to be associated with changes in muscle volume or patient-reported outcome scores. Conclusion: HGH improved quadriceps strength and reduced MMP3 levels in patients undergoing ACLR. On the basis of this pilot study, further trials to more comprehensively evaluate the ability of HGH to improve muscle function and potentially protect against OA in patients undergoing ACLR are warranted. Registration: NCT02420353 (ClinicalTrials.gov identifier) [ABSTRACT FROM AUTHOR]

BACKGROUND: For pandemic preparedness, researchers used online systematic searches to track unplanned school closures (USCs). We determine if Twitter provides complementary data. METHODS: Twitter handles of Michigan public schools and school districts were identified. All tweets associated with these handles were downloaded. USC‐related tweets were identified using 5 keywords. Descriptive statistics and multivariable logistic regression were performed in R. RESULTS: Among 3469 Michigan public schools, 2003 maintained their own active Twitter accounts or belonged to school districts with active Twitter accounts. Of these 2003 schools, in 2015‐2016 school year, at least 1 USC announcement was identified for 349 schools via the current method only, 678 schools via Twitter only, and 562 schools via both methods. No USC announcements were identified for 414 schools. Rural schools were less likely than city schools to have active Twitter coverage (adjusted relative risk [adjRR] = 0.3956, 95% confidence interval [CI] 0.3312‐0.4671), and to announce USCs on Twitter (adjRR = 0.5692, 95% CI 0.4645‐0.6823), but more likely to have USCs identified by the current method (adjRR = 1.4545, 95% CI 1.3545‐1.5490). CONCLUSIONS: Each method identified USCs that were missed by the other. Our results suggested that identifying USCs on Twitter is complementary to the current method. [ABSTRACT FROM AUTHOR]

Muslims in the U.S. have a long history of being active in their communities, but September 11th marked a turning point for involvement due to backlash against Islam. While we know that Muslim civic engagement increased after the tragedy, we know little about why it increased or why some Muslims avoid civic activities altogether. Using a case study on Detroit area Muslims, I find four factors that drive civic engagement as well as three factors that hinder engagement. Findings suggest that social work practitioners and educators can act to support civic engagement and address the challenges that hinder community involvement. [ABSTRACT FROM AUTHOR]

This study tested whether the cortisol awakening response is dependent on the transition from sleep to awakening, or alternatively, a circadian-driven process that is independent of awakening. A total of 40 participants were randomly assigned to either a total sleep deprivation or a sleep condition. Salivary cortisol was also assessed. Participants in the sleep condition demonstrated a traditional cortisol awakening response, whereas participants in the total sleep deprivation condition showed no increases in morning cortisol. These results are consistent with the notion that if circadian-driven processes are related to the cortisol awakening response, they may only be activated when awakening occurs or is anticipated. [ABSTRACT FROM AUTHOR]

This mixed-method study explored how early childhood clinicians integrate play therapy into early childhood mental health treatment services with high-risk preschool children (ages 3 to 6 years) and their families, and its influence on parent involvement and the clinician–parent relationship. Interviews with parents and clinicians identified a parallel process with five distinctive phases of the integrative treatment process, all of which heightened parental involvement during home visits. Central to this integrative process was a supportive clinician–parent relationship that influenced parental confidence, empowerment, and ability to advocate for their child to friends and family, which led to improved familial understanding of child emotions and behaviors, natural supports and fewer feelings of social isolation. Interview data were triangulated and results identified specific play therapy interventions and significant relationships between play and other early childhood mental health interventions, which represent a possible need for specialized techniques and clinical trainings specific to this population. Further discussion of the integrative process along with clinical and research implications and needs are examined. [ABSTRACT FROM AUTHOR]