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When a volcano erupts, it is often associated with destruction, particularly damage to infrastructure and loss of life. But these natural events also offer unexpected research opportunities, leading to serendipitous discoveries. This was the case for the volcanic events that made the headlines during 19 September to 25 December 2021, on the Canarian Island of La Palma. Rather than viewing the voluminous ash that erupted as a waste material needing to be removed as soon as possible, we saw the many possibilities that this remarkable material could offer science and engineering. Sustainability is a word that is commonly used in connection with geology these days. Here we present some possibilities of how the La Palma ash can be re‐purposed for use on this planet but also help us to develop new ideas for the future living on the Moon. [ABSTRACT FROM AUTHOR]

Background: This study came to determine the prevalence of Early Childhood Carries (ECC) among preschoolers in a marginalized population and describe the influence of behavioral and social determinants on the development of ECC. Methods: This is a cross-sectional study that was carried out in four random preschools in the Jerusalem Governorate of the Occupied Palestinian Territories. All children aged 3–5 years old in the selected schools were screened for ECC using the decayed, missing, and filled teeth index (dmft). Data on children’s socio-economic, feeding habits, hygiene habits, access to care, parental level of stress, social support, and locus of control were collected by a validated questionnaire sent to the children’s main caregivers. Descriptive statistics were generated and bivariable and multivariable analyses were used to explain the influence of different behavioral and social determinants on ECC levels. Results: Four hundred and fifty-seven preschoolers completed the questionnaire and the clinical screening. Ninety-seven percent (n = 447) had experienced dental decay, with an average dmft score of 6.6 ± 4.3. After accounting for potential confounding, parents’ internal locus of control was associated with lower dental caries among children (IRR = 0.97, 95% CI = 0.97, 0.98). Having routine, preventive visits versus never seeing a dentist were associated with lower dmft scores (IRR = 0.42, 95% CI = 0.33, 0.52). Night feeding habits (putting things other than water in the baby bottle at night, having children sleep while being breastfed at night) were positively associated with children’s dental caries (IRR = 1.06, 95% CI = 1.04, 1.09: IRR = 1.15, 95% CI = 1.03, 1.29, respectively). Not adding sugar to the bottle was negatively associated with children’s dental caries (IRR = 0.86, 95% CI = 0.74, 1.00). Conclusions: Preschoolers in this study suffered from high dental caries experience. Although infant feeding habits were key factors in explaining the elevated level of the disease, system and socio-psychological factors were also detrimental to ECC prevalence. Policies and interventions to alleviate the burden of ECC need to address socioeconomic determinants of health in addition to feeding and hygiene practices. [ABSTRACT FROM AUTHOR]

Background and aims: Opioid overdose is a leading cause of death during the immediate time after release from jail or prison. Most jails in the United States do not provide methadone and buprenorphine treatment for opioid use disorder (MOUD), and research in estimating its impact in jail settings is limited. We aimed to test the hypothesis that in‐jail MOUD is associated with lower overdose mortality risk post‐release. Design, setting and participants: Retrospective, observational cohort study of 15 797 adults with opioid use disorder who were released from New York City jails to the community in 2011–2017. They experienced 31 382 incarcerations and were followed up to 1 year. Measurements: The primary outcomes were death caused by accidental drug poisoning and all‐cause death. The exposure was receipt of MOUD (17 119 events) versus out‐of‐treatment (14 263 events) during the last 3 days before community re‐entry. Covariates included demographic, clinical, behavioral, housing, health‐care utilization and legal characteristics variables. We performed a multivariable, mixed‐effect Cox regression analysis to test association between in‐jail MOUD and deaths. Findings The majority were male (82%) and their average age was 42 years. Receiving MOUD was associated with misdemeanor charges, being female, injection drug use and homelessness. During 1 year post‐release, 111 overdose deaths occurred and crude death rates were 0.49 and 0.83 per 100 person‐years for in‐jail MOUD and out‐of‐treatment groups, respectively. Accounting for confounding and random effects, in‐jail MOUD was associated with lower overdose mortality risk [adjusted hazard ratio (aHR) = 0.20, 95% confidence interval (CI) = 0.08–0.46] and all‐cause mortality risk (aHR = 0.22, 95% CI = 0.11–0.42) for the first month post‐release. Conclusions: Methadone and buprenorphine treatment for opioid use disorder during incarceration was associated with an 80% reduction in overdose mortality risk for the first month post‐release. [ABSTRACT FROM AUTHOR]

Background Evidence is accumulating of coronavirus disease 2019 (COVID-19) vaccine effectiveness among persons with prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Methods We evaluated the effect against incident SARS-CoV-2 infection of (1) prior infection without vaccination, (2) vaccination (2 doses of Pfizer-BioNTech COVID-19 vaccine) without prior infection, and (3) vaccination after prior infection, all compared with unvaccinated persons without prior infection. We included long-term care facility staff in New York City aged <65 years with weekly SARS-CoV-2 testing from 21 January to 5 June 2021. Test results were obtained from state-mandated laboratory reporting. Vaccination status was obtained from the Citywide Immunization Registry. Cox proportional hazards models adjusted for confounding with inverse probability of treatment weights. Results Compared with unvaccinated persons without prior infection, incident SARS-CoV-2 infection risk was lower in all groups: 54.6% (95% confidence interval, 38.0%–66.8%) lower among unvaccinated, previously infected persons; 80.0% (67.6%–87.7%) lower among fully vaccinated persons without prior infection; and 82.4% (70.8%–89.3%) lower among persons fully vaccinated after prior infection. Conclusions Two doses of Pfizer-BioNTech COVID-19 vaccine reduced SARS-CoV-2 infection risk by ≥80% and, for those with prior infection, increased protection from prior infection alone. These findings support recommendations that all eligible persons, regardless of prior infection, be vaccinated against COVID-19. [ABSTRACT FROM AUTHOR]

Background Belief that vaccination is not needed for individuals with prior infection contributes to coronavirus disease 2019 (COVID-19) vaccine hesitancy. Among individuals infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) before vaccines became available, we determined whether vaccinated individuals had reduced odds of reinfection. Methods We conducted a case-control study among adult New York City residents who tested positive for SARS-CoV-2 infection in 2020 and had not died or tested positive again >90 days after an initial positive test as of 1 July 2021. Case patients with reinfection during July 2021–November 2021 and controls with no reinfection were matched (1:3) on age, sex, timing of initial positive test in 2020, and neighborhood poverty level. Matched odds ratios (mORs) and 95% confidence intervals (CIs) were calculated using conditional logistic regression. Results Of 349 827 eligible adults, 2583 were reinfected during July 2021–November 2021. Of 2401 with complete matching criteria data, 1102 (45.9%) were known to be symptomatic for COVID-19-like illness, and 96 (4.0%) were hospitalized. Unvaccinated individuals, compared with individuals fully vaccinated within the prior 90 days, had elevated odds of reinfection (mOR, 3.21; 95% CI, 2.70 to 3.82), of symptomatic reinfection (mOR, 2.97; 95% CI, 2.31 to 3.83), and of reinfection with hospitalization (mOR, 2.09; 95% CI,.91 to 4.79). Conclusions Vaccination reduced odds of reinfections when the Delta variant predominated. Further studies should assess risk of severe outcomes among reinfected persons as new variants emerge, infection- and vaccine-induced immunity wanes, and booster doses are administered. [ABSTRACT FROM AUTHOR]

To achieve a sustainable human presence on the Moon, it is critical to develop technologies utilising the local resources (a.k.a. in-situ resource utilisation or ISRU) for construction and resource extraction. In this study, we investigate the viability of microwave heating of two lunar soil simulants (JSC-1A and OPRH3N) under vacuum conditions, to simulate a lunar surface environment compared to previous studies performed at atmospheric pressure. All simulants are thermally treated in a bespoke 2.45 GHz microwave apparatus using three input powers: 1000 W, 600 W and 250 W. The microstructures and mechanical properties of the microwaved samples are analysed to identify their potential applications. Our key findings are: (i) higher input powers generate materials in shorter fabrication times with higher mechanical strengths and higher yields despite the same total energy input; (ii) the microstructures of the microwaved samples under vacuum are very different from those under atmospheric conditions due to the widespread vesicles/bubbles; and (iii) different heating rates caused by different input powers can be utilised for specific ISRU purposes: higher input powers for extra-terrestrial construction and lower input powers for resource extraction. Findings from this study have significant implications for developing a microwave-heating payload for lunar ISRU demonstration missions. [ABSTRACT FROM AUTHOR]

Background: Compliance with the requirements of the Individuals with Disabilities Education Act (IDEA) in the United States is monitored through review of cross‐sectional reports from three discrete, age‐defined programmes (early intervention [EI], early childhood special education [ECSE)] and school‐age special education [SE]) to promote the timely, efficient and effective delivery of appropriate services to all eligible children. Analysis of longitudinal data is required to discern how children use services across programmes to provide the necessary context for IDEA oversight and to identify areas for programme or policy interventions to reduce barriers to service use and promote equity. Methods: We applied sequence analysis to a data linkage across five public record systems among 15 626 New York City children born in 1998 who had records from birth through third grade. Results: Five predominant patterns of service use were identified: (1) multiple therapies across EI/ECSE/SE (13%), (2) EI without transition to Department of Education schools or services (24%), (3) EI and intermittent ECSE/SE (16%), (4) older entry into EI and both speech and occupational therapy throughout ECSE/SE (9%) and (5) limited EI use and mostly speech therapy in ECSE/SE (38%). Each pattern had distinct demographics (e.g., pattern 2 was disproportionately White and from low poverty neighbourhoods; pattern 4 was disproportionately male and Black; pattern 5 was disproportionately Latino) and academic outcomes (e.g., pattern 1 had largest proportion in a SE school and not tested in third grade; pattern 3 had third grade tests scores that were similar to overall citywide mean scores). Conclusions: The differences in demographic profiles across the five patterns of service use illustrate the systemic inequities in the delivery of these important services. Delayed entry and limited use of EI services among children of colour underscore the need for equity goals to increase early referral and optimize service use. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C virus (HCV) infection disproportionately impacts people experiencing homelessness. Hepatitis C virus can lead to negative health outcomes, including mortality. We evaluated the impact of a permanent supportive housing (PSH) program (ie, "treatment") on liver-related morbidity and mortality among persons with chronic homelessness and HCV infection.Methods: We matched records for persons eligible for a New York City PSH program (2007-2014) with Heath Department HCV and Vital Statistics registries and Medicaid claims. Among persons diagnosed with HCV before or 2 years posteligibility, we added stabilized inverse probability of treatment weights to negative binomial regression models to compare rates for liver disease-related emergency department visits and hospitalizations, and hazard ratios for mortality, by program placement 2 and 5 years posteligibility.Results: We identified 1158 of 8783 placed and 1952 of 19 019 unplaced persons with laboratory-confirmed HCV infection. Permanent supportive housing placement was associated with significantly reduced liver-related emergency department visits (adjusted rate ratio [aRR] = 0.76, 95% confidence interval [CI] = .61-.95), hospitalizations (aRR = 0.62, 95% CI = .54-.71), and all-cause (adjusted hazard ratio [aHR] = 0.65, 95% CI = .46-.92) and liver-related mortality (aHR = 0.72, 95% CI = .09-.83) within 2 years. The reduction remained significant for hospitalizations after 5 years.Conclusions: Placement into PSH was associated with reduced liver-related morbidity and mortality among persons with HCV infection and chronic homelessness. [ABSTRACT FROM AUTHOR]

Purpose: Residential instability is associated with poor mental health, but its causal inference is challenging due to time-varying exposure and confounding, and the role of changing social environments. We tested the association between frequent residential moving and depression risk among adults exposed to the 9/11 disaster. Methods: We used four waves of survey data from the World Trade Center Health Registry. We measured residential movement and depression using geocoded annual address records and the Personal Health Questionnaire Depression Scale, respectively, for a prospective cohort of 38,495 adults. We used the longitudinal Targeted Maximum Likelihood Method to estimate depression risk by frequent residential moving and conducted causal mediation analysis to evaluate a mediating role of social environments. Results: Most enrollees (68%) did not move in 2007–2014, and 6% moved at least once every 4 years. The remaining 26% moved less frequently (e.g., only moving in 2007–2010). Frequent moving versus no moving was associated with risk of depression in 2015–16 (RR = 1.20, 95% CI = 1.06, 1.37). Frequent residential moving—depression pathway was mediated by high social integration (OR = 0.93, 95% CI = 0.90, 0.97). Conclusion: These findings demonstrate the importance of social networks in understanding increased risk of depression associated with housing instability. [ABSTRACT FROM AUTHOR]

The relationship between HIV patient caseload and a clinic's ability to achieve viral load suppression (VLS) in their HIV patient population is not understood. The New York City Department of Health and Mental Hygiene (NYCDOHMH) administered a survey to clinics providing HIV care to people living with HIV (PLWH) in NYC in 2016. Clinics were stratified by quartiles of HIV patient caseload and dichotomized by whether ≥85% (n = 36) or <85% (n = 74) of their patients achieved VLS. Multivariable logistic regression adjusted for confounders of age, sex, ethnicity, and race. Provider to patient ratios (PPR) were calculated for each clinic as staffing full time equivalents per 100 HIV patients. [ABSTRACT FROM AUTHOR]

Introduction: State cancer prevention and control programs rely on public health surveillance data to set objectives to improve cancer prevention and control, plan interventions, and evaluate state-level progress towards achieving those objectives. The goal of this project was to evaluate the validity of using electronic health records (EHRs) based on common data model variables to generate indicators for surveillance of cancer prevention and control for these public health programs.Methods: Following the methodological guidance from the PRISMA Extension for Scoping Reviews, we conducted a literature scoping review to assess how EHRs are used to inform cancer surveillance. We then developed 26 indicators along the continuum of the cascade of care, including cancer risk factors, immunizations to prevent cancer, cancer screenings, quality of initial care after abnormal screening results, and cancer burden. Indicators were calculated within a sample of patients from the New York City (NYC) INSIGHT Clinical Research Network using common data model EHR data and were weighted to the NYC population using post-stratification. We used prevalence ratios to compare these estimates to estimates from the raw EHR of NYU Langone Health to assess quality of information within INSIGHT, and we compared estimates to results from existing surveillance sources to assess validity.Results: Of the 401 identified articles, 15% had a study purpose related to surveillance. Our indicator comparisons found that INSIGHT EHR-based measures for risk factor indicators were similar to estimates from external sources. In contrast, cancer screening and vaccination indicators were substantially underestimated as compared to estimates from external sources. Cancer screenings and vaccinations were often recorded in sections of the EHR that were not captured by the common data model. INSIGHT estimates for many quality-of-care indicators were higher than those calculated using a raw EHR.Conclusion: Common data model EHR data can provide rich information for certain indicators related to the cascade of care but may have substantial biases for others that limit their use in informing surveillance efforts for cancer prevention and control programs. [ABSTRACT FROM AUTHOR]

Objectives: To examine racial and ethnic disparities in COVID-19-like illness (CLI) during March - August 2020 in New York City, and to test effect modification by age, nativity, and working from home vs outside the home, and mediation via social distancing behavior.Design: Analysis of the monthly Community Health Survey datasets.Setting: New York City.Participants: 5,305 adults living in New York City.Main Outcome Measures: A binary indicator of having new onset of CLI in the past 30 days.Methods: Prevalence of having CLI was compared among racial and ethnic groups using multivariable log-linear regression. Stratified and causal mediation analyses were conducted to test effect modification and mediation, respectively.Results: Overall percentage of CLI decreased from 25% during March-May to 14% during June-August. In both periods, there was no increased prevalence of CLI among Black or Latino New Yorkers compared with White New Yorkers. However, in stratified analyses, Latino vs White New Yorkers had 2.05 times (95%CI=1.09, 3.83) higher prevalence of CLI among adults working outside the home. Mediation via social distancing was not statistically significant.Conclusions: Excess burden of CLI among Latino adults working outside the home underscores inequitable impacts of COVID-19 in New York City. [ABSTRACT FROM AUTHOR]

Using a population-based, representative telephone survey, ~930 000 New York City residents had COVID-19 illness beginning 20 March–30 April 2020, a period with limited testing. For every 1000 persons estimated with COVID-19 illness, 141.8 were tested and reported as cases, 36.8 were hospitalized, and 12.8 died, varying by demographic characteristics. [ABSTRACT FROM AUTHOR]

Background: In New York City (NYC), pneumonia is a leading cause of death and most pneumonia deaths occur in hospitals. Whether the pneumonia death rate in NYC reflects reporting artifact or is associated with factors during pneumonia-associated hospitalization (PAH) is unknown. We aimed to identify hospital-level factors associated with higher than expected in-hospital pneumonia death rates among adults in NYC. Methods: Data from January 1, 2010–December 31, 2014 were obtained from the New York Statewide Planning and Research Cooperative System and the American Hospital Association Database. In-hospital pneumonia standardized mortality ratio (SMR) was calculated for each hospital as observed PAH death rate divided by expected PAH death rate. To determine hospital-level factors associated with higher in-hospital pneumonia SMR, we fit a hospital-level multivariable negative binomial regression model. Results: Of 148,172 PAH among adult NYC residents in 39 hospitals during 2010–2014, 20,820 (14.06%) resulted in in-hospital death. In-hospital pneumonia SMRs varied across NYC hospitals (0.77–1.23) after controlling for patient-level factors. An increase in average daily occupancy and membership in the Council of Teaching Hospitals were associated with increased in-hospital pneumonia SMR. Conclusions: Differences in in-hospital pneumonia SMRs between hospitals might reflect differences in disease severity, quality of care, or coding practices. More research is needed to understand the association between average daily occupancy and in-hospital pneumonia SMR. Additional pneumonia-specific training at teaching hospitals can be considered to address higher in-hospital pneumonia SMR in teaching hospitals. [ABSTRACT FROM AUTHOR]

Objective: To examine the effect of Medicaid managed care (MMC) versus Medicaid fee-for-service (FFS) on emergency department (ED) use and hospitalization during the first 6 and 12 months of life among low-birth-weight (LBW) infants. Methods: We used the New York City Office of Vital Statistics—Statewide Planning and Research Cooperative System (OVS-SPARCS) dataset to identify 9135 LBW infants born to female Medicaid beneficiaries in New York City from January 2008–March 2012. We applied a robust regression discontinuity framework using a New York State Medicaid policy in effect at that time. This policy automatically enrolled infants born to female Medicaid beneficiaries to Medicaid managed care (MMC) or Medicaid fee-for-service (FFS) based on their birth weight (less than 1200 g vs. 1200–2500 g) during the first 6 months of their lives. Results: LBW infants in MMC had an average 0.16% points higher probability of being hospitalized within the first year of their lives than those in Medicaid FFS (p-value = 0.04). Conclusions for Practice: More research is necessary to understand possible differences in healthcare utilization between MMC and FFS participants with high health risks. [ABSTRACT FROM AUTHOR]

Purpose: The transition from a paper‐based to an all‐electronic patient health record took a major step forward in 2018, with the implementation of an electronic health record that supports the School's patient‐centered comprehensive care model and facilitates outcomes assessment. The Patient Wellness Report (PWR) summarizes findings of the patient assessment, and it does so automatically by locating data already entered in axiUm forms. This study aimed to describe the PWR implementation procedures and to examine outcomes and characteristics among patients with completed treatment plans during an 18‐month period. Methods: Outcome data were extracted from axiUm for patients aged ≥16 years who completed comprehensive care treatment plans. Each PWR contained 14 metrics related to "dimensions" of wellness (quality of life, general health factors, oral hygiene, caries risk, and degree of periodontal inflammation and pocketing), each of which is rated on a 3‐point scale based on best available scientific evidence. Results: A total of 2074 patients completed planned procedures between July 2018 and January 2020, and met the study eligibility criteria. Improvement of several conditions was observed between baseline and follow‐up in caries lesions (21%), blood pressure (9%), and periodontal pocket (3.2%). A majority of patients rated in good condition at baseline had their scores unchanged at follow‐up in the following areas: dental anxiety (92%), speaking (88%), smoking (87%), and alcohol consumption (79%). Conclusion: Improvements in dental caries and blood pressure metrics were easily monitored using the PWR. In addition, disparities exist in improvement of patient outcomes by race/ethnicity. [ABSTRACT FROM AUTHOR]

Objective: Homeless persons are at high risk for poor oral health. Supportive housing can improve housing stability for persons with behavioural health conditions, but its impact on dental service use has been little studied. Methods: Data for this evaluation come from matched public service records for eligible applicants to a New York City supportive housing program (NY III) targeting chronic homelessness. NY III tenants (N = 5678) were compared with applicants not placed in housing (N = 6536) and applicants placed in other supportive housing programmes (N = 4823). Regression analysis was used to assess the association between supportive housing, primary care use, clinical severity and the likelihood of dental visits. Results: Over four observation years, 71% of applicants had at least one dental visit for any cause and 57% for preventive dental care. Incidence of dental visits was lower for persons with physical disability (IRR = 0.91; 95% CI = 0.85, 0.97, P =.003), psychiatric hospital stays (IRR = 0.78; 95% CI = 0.68, 0.88, P <.001) and age over 54. Persons engaged in primary care (IRR = 1.26; 95% CI = 1.21, 1.31, P <.001) and outpatient mental health care (IRR = 1.16; 95% CI = 1.12, 1.21, P <.001) had greater incidence of dental visits. Conclusions: Supportive housing was associated with greater dental service use. The positive association between primary care, mental health care and dental care suggests important points of entry for dental care. Oral health education and service referrals in supportive housing and primary care settings may improve oral health service delivery to persons experiencing social exclusion due to homelessness, mental illness and poor oral health. [ABSTRACT FROM AUTHOR]

Background: New York City (NYC) reported a higher pneumonia and influenza death rate than the rest of New York State during 2010–2014. Most NYC pneumonia and influenza deaths are attributed to pneumonia caused by infection acquired in the community, and these deaths typically occur in hospitals. Methods: We identified hospitalizations of New York State residents aged ≥20 years discharged from New York State hospitals during 2010–2014 with a principal diagnosis of community-setting pneumonia or a secondary diagnosis of community-setting pneumonia if the principal diagnosis was respiratory failure or sepsis. We examined mean annual age-adjusted community-setting pneumonia-associated hospitalization (CSPAH) rates and proportion of CSPAH with in-hospital death, overall and by sociodemographic group, and produced a multivariable negative binomial model to assess hospitalization rate ratios. Results: Compared with non-NYC urban, suburban, and rural areas of New York State, NYC had the highest mean annual age-adjusted CSPAH rate at 475.3 per 100,000 population and the highest percentage of CSPAH with in-hospital death at 13.7%. NYC also had the highest proportion of CSPAH patients residing in higher-poverty-level areas. Adjusting for age, sex, and area-based poverty, NYC residents experienced 1.3 (95% confidence interval [CI], 1.2–1.4), non-NYC urban residents 1.4 (95% CI, 1.3–1.6), and suburban residents 1.2 (95% CI, 1.1–1.3) times the rate of CSPAH than rural residents. Conclusions: In New York State, NYC as well as other urban areas and suburban areas had higher rates of CSPAH than rural areas. Further research is needed into drivers of CSPAH deaths, which may be associated with poverty. [ABSTRACT FROM AUTHOR]

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Mental health hospitalization rates among U.S. children have been increasing locally and nationally in recent decades. Children in New York State (NYS) have also witnessed several collective traumatic events during the last two decades including the September 11, 2001, terrorist attacks (9/11), the Great Recession, and Hurricane Sandy (2012) and its aftermath. Decomposition of these rates into age, period, and cohort effects may help elucidate how large-scale collective traumatic events may be driving time trends. This study examined age-period-cohort effects in children and youth mental health hospitalizations in NYS from 1999-2013. Age effects followed a linear trend from age 5 years, B = -2.76, 95% CI [-3.48, -2.03)] up to age 15 years, B = 1.62, 95% CI [1.52, 1.73]. The largest period effects were noted in 2004, B = 0.36, 95% CI [0.28, 0.45], and in 2013, B = 0.31, 95% CI [0.15, 0.47], approximately 3 years after 9/11 and the Great Recession, respectively. The largest birth cohort effect was noted for children born in 1992-1995 (range: 0.29 for children born in 1992-0.27 for children born in 1995), suggesting that the birth cohorts who experienced the 9/11 attacks during middle childhood and the Great Recession during puberty are at increased risk of mental health hospitalizations compared to other birth cohorts. [ABSTRACT FROM AUTHOR]

Objectives: We conducted a trial to assess the treatment fidelity of an individual-based oral health education intervention utilising motivational interviewing (MI) techniques and its efficacy when compared to a group-based traditional oral health education intervention (TOHE) and a standard of care group (SC) in a sample from Philadelphia during a 12-month follow-up.Background: There is lack of information on how different types of oral health educational interventions affect older adults on non-clinical outcomes including changes in oral health-related quality of life (OHRQoL), oral health self-efficacy (SE) and oral health knowledge (OHK).Materials and Methods: One hundred and eighty patients were randomly allocated to TOHE, MI and SC groups. Treatment fidelity was measured in 16 non-study patients. The MI intervention was administered by a public health dental hygienist (PHDH). All interviews were audio-recorded and coded by an expert using the Motivational Interviewing Treatment Integrity (MITI) Code. Multivariable longitudinal regression analyses accounting for baseline demographics and correlated errors due to repeated measures via generalised estimating equation were conducted following an intention to treat approach.Results: Over the 1-year follow-up, SE and OHRQoL scores significantly improved amongst the MI group whereas both outcomes worsened amongst the SC group. During the same period, SE and OHRQoL did not change in the TOHE group.Conclusion: Findings from the study support the fidelity of this intervention and the improvement of all non-clinical outcomes after 12 months amongst the MI group. [ABSTRACT FROM AUTHOR]

Objective: Infants born to women with hepatitis B virus (HBV) infection are at high risk for chronic HBV infection and premature death. We examined epidemiologic trends among women with HBV infection who gave birth in New York City (NYC) to inform public health prevention activities. Methods: We obtained data on HBV-infected women residing and giving birth in NYC during 1998-2015 from the NYC Perinatal HBV Prevention Program. We obtained citywide birth data from the NYC Office of Vital Statistics. We calculated the incidence of births to HBV-infected women per 100 000 live births and stratified by maternal race, birthplace, and age. We calculated annual percentage change (APC) in incidence of births to HBV-infected women by using joinpoint regression. Results: Of 29 896 HBV-infected women included in the study, 28 195 (94.3%) were non–US-born, of whom 16 600 (58.9%) were born in China. Overall incidence of births to HBV-infected women per 100 000 live births increased from 1156 in 1998 to 1573 in 2006 (APC = 3.1%; P <.001) but declined to 1329 in 2015 (APC = –1.4%; P =.02). Incidence among US-born women declined from 1998 to 2015 (330 to 84; APC = –7.3%; P <.001) and among non–US-born women increased from 1998 to 2007 (1877 to 2864; APC = 3.6%; P <.001) but not thereafter. Incidence among women born in China increased from 1998 to 2006 (13 275 to 16 480; APC = 1.8%; P =.02) but decreased to 12 631 through 2015 (APC = –3.3%; P <.001). Conclusions: The incidence of births to HBV-infected women in NYC declined significantly among US-born women but not among non–US-born women, highlighting the need for successful vaccination programs worldwide. [ABSTRACT FROM AUTHOR]

Objective: Hospital discharge data are a means of monitoring infectious diseases in a population. We investigated rates of infectious disease hospitalizations in New York City. Methods: We analyzed data for residents discharged from New York State hospitals with a principal diagnosis of an infectious disease during 2001-2014 by using the Statewide Planning and Research Cooperative System. We calculated annual age-adjusted hospitalization rates and the percentage of hospitalizations in which in-hospital death occurred. We examined diagnoses by site of infection or sepsis and by pathogen type. Results: During 2001-2014, the mean annual age-adjusted rate of infectious disease hospitalizations in New York City was 1661.6 (95% CI, 1659.2-1663.9) per 100 000 population; the mean annual age-adjusted hospitalization rate decreased from 2001-2003 to 2012-2014 (rate ratio = 0.9; 95% CI, 0.9-0.9). The percentage of in-hospital death during 2001-2014 was 5.9%. The diagnoses with the highest mean annual age-adjusted hospitalization rates among all sites of infection and sepsis diagnoses were the lower respiratory tract, followed by sepsis. From 2001-2003 to 2012-2014, the mean annual age-adjusted hospitalization rate per 100 000 population for HIV decreased from 123.1 (95% CI, 121.7-124.5) to 40.0 (95% CI, 39.2-40.7) and for tuberculosis decreased from 10.2 (95% CI, 9.8-10.6) to 4.6 (95% CI, 4.4-4.9). Conclusions: Although hospital discharge data are subject to limitations, particularly for tracking sepsis, lower respiratory tract infections and sepsis are important causes of infectious disease hospitalizations in New York City. Hospitalizations for HIV infection and tuberculosis appear to be declining. [ABSTRACT FROM AUTHOR]

Objective: To propose an individual-level indicator of caries severity based on the maximum score generated using the international caries detection and assessment system (ICDAS) and test validity of this individual-level indicator by assessing differences between this proposed indicator and the traditional decayed, missing, and filled surfaces (DMFS or dmfs for primary teeth) index.Methods: Data on caries severity were collected using a representative sample of children from Detroit, Michigan, aged less than 6 years (N = 749) examined in 2002-2003 (W1) and 2004-2005 (W2). For each wave, each child was assigned to six caries severity groups based on the maximum ICDAS scores. This individual-level indicator was then compared with the surface-level dental caries measure (dmfs + DMFS). In addition, caries progression between W1 and W2 were assessed using individual-level and tooth surface-level indicators.Results: Both measures were linearly related, and the relationship was statistically significant (P < 0.001).Conclusion: An individual-level caries progression indicator can be developed that is simple and has the ability to communicate with policymakers and the public the severity and impact of dental caries and it can add value to the conventional presentation of DMF/dmf data. [ABSTRACT FROM AUTHOR]

An effect of soda intake on dental caries in young children (birth to 5 years) may vary over time. Estimating a dynamic effect may be challenging due to time-varying confounding and loss to follow-up. The purpose of this paper is to demonstrate utility of targeted maximum likelihood estimation (TMLE) method in addressing longitudinal data analysis challenges and estimating a dynamic effect of soda intake on pediatric caries. Data came from the Detroit Dental Health Project, a 4-year cohort study of low-income -African-American children and caregivers. The sample included 995 child-caregiver pairs who participated in 2002-03 (W1) and were followed up in 2004-05 (W2) and 2007 (W3). The outcome was counts of caries surfaces at W3, and the exposure was child's soda intake at W1 and W2. Time-varying covariates included caregiver's smoking status, oral health fatalism, and social support. Forty-three percent of children consistently consumed soda at W1 and W2, whereas 21% were nonconsumers throughout 2 surveys. The remaining 35% switched intake status between W1 and W2. Association between soda intake patterns and caries was tested using TMLE. Children with a consistent soda intake had 1.03 more caries lesions at W3 than those with consistently no soda intake (95% CI 0.09-1.97) on average. If soda was consumed only at W1 or W2, an estimated effect of soda on caries development at W3 was no longer statistically significant. In conclusion, consistent soda intake during the early childhood led to one additional caries tooth surface. The study highlights utility of TMLE in pediatric caries research as it can handle modeling challenges associated with longitudinal data. [ABSTRACT FROM AUTHOR]

Supportive housing addresses a fundamental survival need among homeless persons, which can lead to reduced risk of diabetes mellitus and improved diabetes care. We tested the association between supportive housing and diabetes outcomes among homeless adults who were eligible for New York City's supportive housing program in 2007–2012. We used multiple administrative data sources, identifying 7,525 Medicaid-eligible adults. The outcomes included receiving medical evaluation and management services, hemoglobin A1C and lipid testing (n = 1,489 persons with baseline diabetes), and incidence of new diabetes diagnoses (n = 6,036 persons without baseline diabetes) in the 2 years postbaseline. Differences in these outcomes by placement were estimated using inverse-probability-of-treatment weighting. Placed persons were more likely to receive evaluation and management services (relative risk (RR) = 1.03, 95% confidence interval (CI): 1.01, 1.04) than unplaced persons. For those with baseline diabetes, placed persons were more likely to receive hemoglobin A1C tests (RR = 1.10, 95% CI: 1.02, 1.19) and lipid tests (RR = 1.09, 95% CI: 1.02, 1.17). For those without baseline diabetes, placement was also associated with lower risk of new diabetes diagnoses (RR = 0.87, 95% CI: 0.76, 0.99). These findings show that benefits of supportive housing may be extended to diabetes care and prevention. [ABSTRACT FROM AUTHOR]

Objective: To assess the impact of a New York City supportive housing program on housing stability and preventable emergency department (ED) visits/hospitalizations among heads of homeless families with mental and physical health conditions or substance use disorders.Data Sources: Multiple administrative data from New York City and New York State for 966 heads of families eligible for the program during 2007-12.Study Design: We captured housing events and health care service utilization during 2 years prior to the first program eligibility date (baseline) and 2 years postbaseline. We performed sequence analysis to measure housing stability and compared housing stability and preventable ED visits and hospitalizations between program participants (treatment group) and eligible applicants not placed in the program (comparison group) via marginal structural modeling.Data Collection/extraction Methods: We matched electronically collected data.Principal Findings: Eighty-seven percent of supportive housing tenants experienced housing stability in 2 years postbaseline. Compared with unstably housed heads of families in the comparison group, those in the treatment group were 0.60 times as likely to make preventable ED visits postbaseline (95% CI = 0.38, 0.96).Conclusions: Supportive housing placement was associated with improved housing stability and reduced preventable health care visits among homeless families. [ABSTRACT FROM AUTHOR]

It is unknown whether providing housing to persons experiencing homelessness decreases HIV risk. Housing, including access to preventive services and counseling, might provide a period of transition for persons with HIV risk factors. We assessed whether the new HIV diagnosis rate was associated with duration of supportive housing. We linked data from a cohort of 21,689 persons without a previous HIV diagnosis who applied to a supportive housing program in New York City (NYC) during 2007-2013 to the NYC HIV surveillance registry. We used time-dependent Cox modeling to compare new HIV diagnoses among recipients of supportive housing (defined a priori, for program evaluation purposes, as persons who spent > 7 days in supportive housing; n = 6447) and unplaced applicants (remainder of cohort), after balancing the groups on baseline characteristics with propensity score weights. Compared with unplaced applicants, persons who received ≥ 3 continuous years of supportive housing had decreased risk for new HIV diagnosis (HR 0.10; CI 0.01-0.99). Risk of new HIV diagnosis decreased with longer duration placement in supportive housing. Supportive housing might aid in primary HIV prevention. [ABSTRACT FROM AUTHOR]

This study examined factors associated with being paid for sick leave after implementation of the New York City (NYC) paid sick leave law. A random sample of NYC residents was surveyed by telephone multiple times over a 2-year period. Participants (n = 1195) reported socio-demographics, awareness of the law, income, work hours per week, and payment for sick time off work. In the year after implementation of the law, part-time workers were significantly more likely to attend work while sick than full-time workers (relative risk = 1.25, 95% CI = 1.1, 1.4). Seventy percent of workers who missed work due to illness (n = 249) were paid for sick leave. Part-time workers, respondents not aware of the benefit (30% of workers), and workers without a college degree were the least likely to be paid for sick days. More than one third (37%) of persons not paid for sick leave worked in retail, food service, or health care. Although 70% of respondents were paid for sick leave after implementation of the law, part-time workers and workers with low education were least likely to access the benefit and more likely to work while sick. The disparity in paid sick leave may have public health consequences as many persons not paid for sick leave had occupations that carry a high risk of disease transmission to others. [ABSTRACT FROM AUTHOR]

Background: A rapid increase of Medicaid expenditures has been a serious concern, and housing stability has been discussed as a means to reduce Medicaid costs. A program evaluation of a New York City supportive housing program has assessed the association between supportive housing tenancy and Medicaid savings among New York City housing program applicants with serious mental illness and chronic homelessness or dual diagnoses of mental illness and substance use disorder, stratified by distinctive Medicaid expenditure patterns.Methods: The evaluation used matched data from administrative records for 2827 people. Sequence analysis identified 6 Medicaid expenditure patterns during 2 years prior to baseline among people placed in the program (n = 737) and people eligible but not placed (n = 2090), including very low Medicaid coverage, increasing Medicaid expenditure, low, middle, high, and very high Medicaid expenditure patterns. We assessed the impact of the program on Medicaid costs for 2 years post-baseline via propensity score matching and bootstrapping.Results: The housing program was associated with Medicaid savings during 2 years post-baseline (-$9526, 95% CI = -$19,038 to -$2003). Stratified by Medicaid expenditure patterns, Medicaid savings were found among those with very low Medicaid coverage (-$15,694, 95% CI = -$35,926 to -$7983), increasing Medicaid expenditures (-$9020, 95% CI = -$26,753 to -$1705), and high Medicaid expenditure patterns (-$14,450, 95% CI = -$38,232 to -$4454). Savings were largely driven by shorter psychiatric hospitalizations in the post-baseline period among those placed.Conclusions: The supportive housing program was associated with Medicaid savings, particularly for individuals with very low Medicaid coverage, increasing Medicaid expenditures, and high Medicaid expenditures pre-baseline. [ABSTRACT FROM AUTHOR]

Objectives: As gentrification continues in New York City as well as other urban areas, residents of lower socioeconomic status maybe at higher risk for residential displacement. Yet, there have been few quantitative assessments of the health impacts of displacement. The objective of this paper is to assess the association between displacement and healthcare access and mental health among the original residents of gentrifying neighborhoods in New York City. Methods: We used 2 data sources: 1) 2005–2014 American Community Surveys to identify gentrifying neighborhoods in New York City, and 2) 2006–2014 Statewide Planning and Research Cooperative System. Our cohort included 12,882 residents of gentrifying neighborhoods in 2006 who had records of emergency department visits or hospitalization at least once every 2 years in 2006–2014. Rates of emergency department visits and hospitalizations post-baseline were compared between residents who were displaced and those who remained. Results: During 2006–2014, 23% were displaced. Compared with those who remained, displaced residents were more likely to make emergency department visits and experience hospitalizations, mainly due to mental health (Rate Ratio = 1.8, 95% confidence interval = 1.5, 2.2), after controlling for baseline demographics, health status, healthcare utilization, residential movement, and the neighborhood of residence in 2006. Conclusions: These findings suggest negative impacts of displacement on healthcare access and mental health, particularly among adults living in urban areas and with a history of frequent emergency department visits or hospitalizations. [ABSTRACT FROM AUTHOR]

Objective: Neighborhood-level factors such as ethnic densities and social cohesion have been negatively associated with psychological distress among Latino Americans. Yet, existing evidence is based on either specific neighborhood factors or particular Latino subgroups. The objective of the study was to assess difference in psychological distress between each of four Latino subgroups (Puerto Ricans, Dominicans, Mexicans, other Latinos) and non-Latino white adults in New York City, and quantify total neighborhood-level influence on these differences. Design: We used the combined Community Health Survey data from 2009, 2010, and 2012 surveys. We estimated the odds ratios (ORs) for self-reported non-specific psychological distress (Kessler-6 questions scale ≥ 13) by race/ethnicity using logistic regression models. We further adjusted these estimates for both observed and unobserved neighborhood-level confounding using the conditional pseudolikelihood method for complex survey data. Results: Puerto Ricans were more likely to be psychologically distressed (OR = 1.58, 95% CI = 1.18, 2.12) compared with non-Latino whites, whereas the opposite was seen in other Latino subgroups. Accounting for full neighborhood-level confounding increased the disparity for Puerto Ricans (OR = 1.79, 95% CI = 1.26-2.54). For the other subgroups, lower odds of psychological distress were no longer observed or attenuated after accounting for neighborhood-level confounding. Overall neighborhood-level factors were associated with lower psychological distress at greater extent among all Latinos subgroups versus non-Latino whites in New York City. Conclusion: Despite substantial variations of psychological distress across Latino subgroups, the study shows evidence that neighborhood-level factors might play a protective role in all Latino subgroups. [ABSTRACT FROM AUTHOR]

The health of people ever incarcerated in New York City (NYC) jails during 2001 to 2005 was characterized by matching jail, shelter, mortality, sexually transmitted infection, HIV, and tuberculosis (TB) data from the NYC Departments of Health and Mental Hygiene, Correction, and Homeless Services. Compared with nonincarcerated people and those living in the lowest income NYC neighborhoods, those ever incarcerated had higher HIV prevalence and HIV case rates. Ever-incarcerated females also had higher rates of gonorrhea and syphilis than nonincarcerated females. Ever-incarcerated people who used the single adult homeless shelter system had higher HIV, gonorrhea, and TB case rates and all-cause mortality rates than ever-incarcerated people without shelter use, when adjusting for other variables. People ever incarcerated in NYC jails are at risk for conditions of public health importance. Sex-specific jail- and community-based interventions are needed. [ABSTRACT FROM AUTHOR]

Objective: This article presents data on the burden of periodontal diseases in Turkish adults aged 35 years or older.Methods: Within each region of Turkey, a rural and an urban area or city were selected in 2009-10 using a probability proportional to size method. In the selected towns, local officials who were familiar with their communities assisted in recruiting subjects. Loss of Attachment (LOA) was measured at six sites around each tooth present in the mouth, excluding third molars. Additionally, the Community Periodontal Index was used to assess the severity of periodontal diseases around 12 index teeth. Self-reported data on key risk factors were also collected. Weights were computed using a raking ratio adjustment procedure and used in all analyses.Results: Almost all examined adults had some loss of periodontal attachment. The proportion of those with more than 3 mm LOA ranged from 43 percent in 35-44 year olds to 91 percent in those aged 65+ years. Among females, older age, low education status, smoking 11-40+ cigarettes a day, being employed, and presence of high number of missing tooth surfaces were associated with LOA > 3 mm. Among males LOA >3 mm was associated with older age, use of alcohol, and unemployment. The CPI data did not yield the same associations with periodontal diseases and risk factors.Conclusions: Periodontal diseases in Turkish adults are highly prevalent. A tailored common risk factor health promotion program is recommended to reduce the burden of periodontal infection in Turkey. [ABSTRACT FROM AUTHOR]

Evidence on ethnic enclave-health associations for Asian Americans is limited due to an inconsistent definition of ethnic enclave. The authors aimed to establish a robust criterion for defining Asian enclaves in New York City (NYC) and assessed the association between enclave residence and health outcomes among Asian American adults. Data came from 2009-2012 NYC Community Health Surveys and 2008-2012 American Community Survey. Asian enclave was defined as an area with high dissimilarity and isolation scores as well as high concentration of Asians. Five of 55 NYC community districts were identified as Asian enclaves. After controlling for confounding, enclave residence was associated with positive perception of general health with borderline significance (prevalence ratio = 1.06, 95 % CI 0.98, 1.15), but not with current smoking, hypertension, and diabetes. Ethnic enclave residence in urban areas may not produce a substantial impact on chronic health outcomes for Asian Americans beyond individual-level factors. [ABSTRACT FROM AUTHOR]

The period immediately after release from prison or jail carries increased mortality risk. This study sought to better understand postrelease death by matching electronic health records from those incarcerated in New York City jails between 2011 and 2012 with vital statistics records. The in-jail and 6-week postrelease mortality rates were estimated to be 1.39 and 5.89 per 1,000 person-years, respectively. Of 59 deaths occurring within 6 weeks of release from jail, the causes included opioid overdose (37.3%), other drugs (8.5%), chronic disease (25.4%), assaultive trauma (20.3%), and other trauma (8.5%). These data confirm that overdose death accounts for the most frequent cause of postrelease death. Matching between correctional health systems and vital statistics can inform quality improvement efforts in jail health care delivery. [ABSTRACT FROM AUTHOR]

Background: Limited information is available on the oral health status of upper income Americans (>400 percent of the FPL). They constitute 33 percent of the population and account for 53 percent of dental expenditures.Methods: Using 1999-2004 NHANES data, we examined differences in the mean number and percentage of decayed and filled permanent surfaces and missing teeth among age and family income groups.Results: For upper income Americans, across age groups, the mean number of untreated decayed surfaces and missing teeth ranged from 0.2 to 0.5 and 2.6 to 3.3, respectively. The mean number of restored surfaces was low in children but extensive in adults. Income disparities increased with increasing age.Discussion: Overall, upper income Americans have good oral health. Relatively few have untreated decayed surfaces or missing teeth. The reasons for the large number of restored surfaces in upper income adults require further research.Conclusion: Most upper income Americans are in good oral health, especially the 12-18 year cohort. As this group ages, the oral health of upper income adults is expected to improve. [ABSTRACT FROM AUTHOR]

Self-reported hypertension has not been validated in specific Hispanic subgroups (Puerto Ricans, Dominicans) and in Asian Americans. The objectives were to assess validity of self-reported hypertension in Hispanic and Asian American adults, and to recalibrate self-reported hypertension with measured values. Data were from the New York City Community Health Survey 2005-2008 and the Heart Follow-Up Study (HFUS) 2010 (included measured hypertension). Sensitivity and specificity were calculated in the HFUS data; recalibration was conducted using a previously described method by Mentz et al. Sensitivity was similar in Puerto Ricans and Dominicans versus whites. The differences in hypertension prevalence after recalibration were largest in Hispanics. No substantial differences occurred among Asian Americans. Factors such as low health literacy or insurance status are potential explanations for bias in self-reported hypertension among Hispanic subgroups. Surveillance systems may consider recalibration, potentially in areas with a high percentage of Hispanics or uninsured. [ABSTRACT FROM AUTHOR]

Objectives: Both homelessness and incarceration are associated with housing instability, which in turn can disrupt continuity of HIV medical care. Yet, their impacts have not been systematically assessed among people living with HIV/AIDS (PLWHA). Methods: We studied a retrospective cohort of 1,698 New York City PLWHA with both jail incarceration and homelessness during 2001–05 to evaluate whether frequent transitions between jail incarceration and homelessness were associated with a lower likelihood of continuity of HIV care during a subsequent one-year follow-up period. Using matched jail, single-adult homeless shelter, and HIV registry data, we performed sequence analysis to identify trajectories of these events and assessed their influence on engagement in HIV care and HIV viral suppression via marginal structural modeling. Results: Sequence analysis identified four trajectories; 72% of the cohort had sporadic experiences of both brief incarceration and homelessness, whereas others experienced more consistent incarceration or homelessness during early or late months. Trajectories were not associated with differential engagement in HIV care during follow-up. However, compared with PLWHA experiencing early bouts of homelessness and later minimal incarceration/homelessness events, we observed a lower prevalence of viral suppression among PLWHA with two other trajectories: those with sporadic, brief occurrences of incarceration/homelessness (0.67, 95% CI = 0.50,0.90) and those with extensive incarceration experiences (0.62, 95% CI = 0.43,0.88). Conclusions: Housing instability due to frequent jail incarceration and homelessness or extensive incarceration may exert negative influences on viral suppression. Policies and services that support housing stability should be strengthened among incarcerated and sheltered PLWHA to reduce risk of adverse health conditions. [ABSTRACT FROM AUTHOR]

The federal Housing Opportunities for Persons with AIDS (HOPWA) program addresses housing needs of low-income persons living with HIV/AIDS (PLWHA). The New York City (NYC) Department of Health and Mental Hygiene oversees 22 HOPWA contracts for over 2,400 clients, and manages the NYC HIV Registry. HOPWA clients ( N = 1,357) were matched to a random 20 % sample of other PLWHA ( N = 13,489). Groups were compared on HIV care retention, viral suppression, and rebound. HOPWA clients were, on average, 3 years younger and more likely to be concurrently diagnosed with HIV and AIDS. While HOPWA clients were more likely to be retained in care (94 vs. 82 %; mOR = 2.97, 95 % CI 2.35-3.74), they were no more likely to achieve suppression (84 vs. 86 %; mOR = 0.85, 95 % 0.70-1.03) and were more likely to rebound (11 vs. 7 %; mOR = 1.45; 95 % CI 1.10-1.91). HIV care retention does not fully translate to virologic suppression in this low-income service population. [ABSTRACT FROM AUTHOR]

The objective of this paper is to describe primary tooth surface level caries progression, over 2 years, based on the severity of the caries lesions. Data were collected from 790 low-income African-American preschool children in Detroit, Mich., USA. The caregivers of the children (aged 0-5 years) completed interviews and the dyad of child-caregiver completed dental examinations in 2002-2004 (baseline) and in 2004-2005 (follow-up). Caries were measured using the International Caries Detection and Assessment System (ICDAS). The caries status of tooth surfaces was classified into initial (ICDAS 1-2), moderate (ICDAS 3-4) and extensive (ICDAS 5-6) stages. Counts of tooth surfaces with progression, by baseline caries severity level, were used to compute rate ratios (RRs) relative to sound stages. RRs were also computed for type of tooth surfaces and frequency of intake of soda consumption at baseline. After adjusting for confounders, caries progression was more likely to occur in tooth surfaces with any baseline caries relative to sound surfaces. For surfaces with initial caries, the rate of progression to moderate caries was 9.6 times higher than that of sound surfaces. Surfaces with initial and moderate caries progressed to extensive caries 6.1 and 20.6 times, respectively, relative to sound surfaces. Baseline soda consumption was not associated with the RR of caries progression. In conclusion, the staging of caries identifies different progression risks and significant emphasis should be placed on secondary prevention of initial lesions as well as on primary prevention. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective To examine dental caries development and caries risk factors among preschool African American children from low-income families in Detroit, Michigan, over a 4-year window. Methods Data came from a representative sample of 1021 children (0-5 years) and their caregivers in Detroit. The baseline participants in 2002-2003 (W1) were re-examined in 2004-2005 (W2) and 2007 (W3). Caries was measured using the International Caries Detection and Assessment System. Bivariate and multivariate analyses for repeated data were conducted to explore associations between caries increment outcomes and demographics, access to dental care, oral health-related behaviours, and social and physical environments. Results The mean number of new noncavitated caries lesions ( NCCL) was 2.8 between W1 and W2 and 2.6 between W2 and W3, while the mean number of new cavitated caries lesions ( CCL) was 2.0 and 2.0, respectively, during the same time periods. In younger children (<3 years old in W1), higher number of new NCCL than new CCL was observed in both W1-W2 and W2-W3. The risk of new NCCL was associated with child's soda intake and caregiver's age. For the risk of new CCL, significant risk factors included baseline NCCL, baseline CCL, as well as child's age. Baseline caries and child's soda intake were also associated with the risk of developing new decayed, missing and filled tooth surfaces. Conclusions Higher number of new NCCL relative to CCL was developed among low-income African American children during early childhood. New caries development was associated with baseline caries and child's soda intake. [ABSTRACT FROM AUTHOR]

Objectives To examine the prevalence of dental anxiety and its associations with pain and other psychological variables among patients seeking dental treatment and develop a directed acyclical graph of these relationships. Methods One hundred and twenty patients who sought regular or emergency dental care completed a semi-structured interview assessing DSM-IV specific phobia of dental procedures and questionnaires assessing dental anxiety, pain at last dental visit, blood-injection-injury ( BII) phobia, social appearance anxiety, and other psychological constructs. Differences between regular and emergency patients were explored using t-tests. Potential excess risk of dental anxiety due to interactions between pain and psychological processes was explored. Finally, multivariate linear regression was conducted. Results Thirty-five percent of participants came for emergency care. Almost half (49.2%) reported moderate or high anxiety, and 20% met criteria for specific phobia. The relationship between pain at the last dental visit and dental anxiety scores was confounded by social appearance anxiety and BII phobia. Conclusion The dental anxiety-pain response may be affected by psychological processes such as social appearance anxiety and BII phobia. Targeting these related psychological constructs may improve the management of anxiety treatment among adult patients seeking dental care. [ABSTRACT FROM AUTHOR]