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Purpose: Outcome research has become an increasingly important form of clinical evidence for making health care decisions, including oral health considerations in the field of dentistry. In oral reconstruction involving dental implants, the risk of implant failure may be influenced by a patient's underlying medical condition. To identify associations, implant failure and systemic conditions or diseases were studied in a consecutive series of patients who received dental implants from October 1, 1983, to December 31, 2014, in the Department of Dental Specialties at Mayo Clinic in Rochester, Minnesota. Materials and Methods: Data were abstracted from a prospective clinical database and electronic health records for patients' demographic, implant-specific, and medical profiles to determine time to first implant failure. Survival free of implant failure at the patient level was estimated by using the Kaplan-Meier method. Associations of demographic and systemic characteristics with implant failure were evaluated by using Cox proportional hazards regression models and summarized with hazard ratios and 95% confidence intervals. Results: The patient cohort consisted of 6,358 patients with a median age of 53 years at placement of the first implant. A total of 713 patients experienced implant failure at a median of 0.6 years. Among the 5,645 patients who did not experience implant failure, the median duration of follow-up was 5.8 years. More than 20 systemic diseases or conditions were identified for assessment, of which 15 comprised more than 50 patients and five comprised more than 500 patients. All associations were adjusted for age, sex, and era of implant, given the strong influence of these features on implant failure. After adjustment, no systemic disease or condition was shown to increase the risk for implant failure in the population and setting studied. Conclusion: Patients considering oral reconstruction involving implants in the medical setting studied do not appear to risk implant loss because of systemic conditions or diseases. [ABSTRACT FROM AUTHOR]

Background: Hallux valgus and lesser toe deformities are common foot disorders with substantial functional consequences. While the exact etiologies are multi-factorial, it is unknown if certain endocrine abnormalities, such as thyroid dysfunction, may be associated with these pathologies. The current study sought to investigate the prevalence of thyroid disease in patients with hallux valgus or lesser toe deformities.Methods: Every new patient who presented to our institution's foot and ankle clinic during a three-month time period was given a survey to determine the presence of a known thyroid disorder. The diagnosis for each visit was then recorded. Additionally, a national, publicly available database was queried for patients diagnosed with thyroid disease and concomitant hallux valgus or specific forefoot pathology. Odds ratios for the presence of thyroid dysfunction were then calculated for each patient group.Results: Three-hundred and fifty initial visit patient surveys were collected, and 74 (21.1%) patients had a known diagnosis of thyroid disease. The most common diagnoses were primary hypothyroidism (n = 61, 17.4%), secondary hypothyroidism (n = 6, 1.7%), thyroiditis (n = 4, 1.1%), and hyperthyroidism (n = 3, 0.9%). Thyroid disease was present in 16 of 26 patients (61.5%) with a diagnosis of hallux valgus (OR 7.3, CI[3.16-16.99], p < 0.0001). Lesser toe deformities, including hammertoes, mallet toes, bunionettes and crossover toes, were also significantly associated with thyroid disease (OR 5.45, CI[1.83-16.26], p < 0.002). The national database revealed 905,924 patients with a diagnosis of a specific forefoot deformity, and 321,656 of these patients (35.5%) had a concomitant diagnosis of a thyroid condition (OR 2.11, CI[2.10-2.12], p < 0.0001).Conclusions: The current study suggests a significant association between forefoot pathology and thyroid dysfunction, especially hallux valgus and lesser toe deformities. Increased understanding of these correlations may offer an important opportunity in population health management, both in diagnosis and treatment. While further studies with long-term outcomes are necessary, the early diagnosis of thyroid disease may provide an opportunity to predict and potentially alter the course of forefoot pathology. [ABSTRACT FROM AUTHOR]

The concept of ecological integrity has been applied widely to management of aquatic systems, but still is considered by many to be too vague and difficult to quantify to be useful for managing terrestrial systems, particularly across broad areas. Extensive public lands in the western United States are managed for diverse uses such as timber harvest, livestock grazing, energy development, and wildlife conservation, some of which may degrade ecological integrity. We propose a method for assessing ecological integrity on multiple-use lands that identifies the components of integrity and levels in the ecological hierarchy where the assessment will focus, and considers existing policies and management objectives. Both natural reference and societally desired environmental conditions are relevant comparison points. We applied the method to evaluate the ecological integrity of shrublands in Nevada, yielding an assessment based on six indicators of ecosystem structure, function, and composition, including resource- and stressor-based indicators measured at multiple scales. Results varied spatially and among indicators. Invasive plant cover and surface development were highest in shrublands in northwest and southeast Nevada. Departure from reference conditions of shrubland area, composition, patch size, and connectivity was highest in central and northern Nevada. Results may inform efforts to control invasive species and restore shrublands on federal lands in Nevada. We suggest that ecological integrity assessments for multiple-use lands be grounded in existing policies and monitoring programs, incorporate resource- and stressor-based metrics, rely on publicly available data collected at multiple spatial scales, and quantify both natural reference and societally desired resource conditions. [ABSTRACT FROM AUTHOR]

Background. "The ongoing opioid crisis lies at the intersection of two substantial public health challenges- reducing the burden of suffering from pain and containing the rising toll of the harms that can result from the use of opioid medications" [1]. Improved pain education for health care providers is an essential component of the multidimensional response to both still-unmet challenges [2,3]. Despite the importance of licensing examinations in assuring competency in health care providers, there has been no prior appraisal of pain and related content within the United States Medical Licensing Examination (USMLE). Methods. An expert panel developed a novel methodology for characterizing USMLE questions based on pain core competencies and topical and public health relevance. Results. Under secure conditions, raters used this methodology to score 1,506 questions, with 28.7% (432) identified as including the word "pain." Of these, 232 questions (15.4% of the 1,506 USMLE questions reviewed) were assessed as being fully or partially related to pain, rather than just mentioning pain but not testing knowledge of its mechanisms and their implications for treatment. The large majority of questions related to pain (88%) focused on assessment rather than safe and effective pain management, or the context of pain. Conclusions. This emphasis on assessment misses other important aspects of safe and effective pain management, including those specific to opioid safety. Our findings inform ways to improve the long-term education of our medical and other graduates, thereby improving the health care of the populations they serve. [ABSTRACT FROM AUTHOR]

In 2011, the USA had the second highest teen birth rate of any developed nation, according to the World Bank, . In an effort to lower teen pregnancy rates, several states have enacted policies requiring abstinence-based sex education. In this study, we utilize a difference-in-differences research design to analyze the causal effects of state-level sex education policies from 2000-2011 on various teen sexual health outcomes. We find that state-level abstinence education mandates have no effect on teen birth rates or abortion rates, although we find that state-level policies may affect teen sexually transmitted disease rates in some states. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective. Inventory one medical school's first- and second-year pain-related curriculum in order to explore opportunities to teach about pain both as a social, population-based process and as a neuroncentered phenomenon. Design. Deconstruction of pain-related curricular content through a detailed content inventory and analysis by students and faculty. Setting and Subjects. University-affiliated US medical school. Methods. Detailed inventory and content analysis of first- and second-year curricular materials. Results. The inventory of pain content showed fragmentation, mostly presenting it as a symptom without an underlying framework. Conclusion. Analysis of one medical school's painrelated curricular materials reveals opportunities for a more unified perspective that includes pain as a widespread disease state (not merely a symptom) and to provide an emphasis in the curriculum consistent with pain's public health burden. [ABSTRACT FROM AUTHOR]

Objectives. A recent US federal review and clinical guideline on opioids for chronic pain asserted that the literature contributes no evidence on efficacy because all trials had "inadequate duration." To explore the evidence, we examined durations of studies on opioid, nonopioid drug, and behavioral therapies for chronic pain. Methods. We retrieved Cochrane reviews of anticonvulsants, antidepressants, NSAIDs, opioids, or behavioral interventions for chronic pain. We also examined all opioid treatment studies retrieved for the federal evidence report but excluded due to "inadequate duration.". Results. Of 378 Cochrane reviews retrieved, 72 evaluated one of the five therapies. Six of these 72 were excluded because they were proposals without data or investigated acute pain. Fourteen addressed multiple interventions, leaving 52 for analysis. We graphed numbers of trials vs duration for the five treatments reviewed in the Cochrane Library, compared with durations of opioid trials dropped from the federal evidence report. Most graphs were overdispersed Poisson distributions. Nearly all trials had active treatment durations of 12 weeks or less. Conclusions. No common nonopioid treatment for chronic pain has been studied in aggregate over longer intervals of active treatment than opioids. To dismiss trials as "inadequate" if their observation period is a year or less is inconsistent with current regulatory standards. The literature on major drug and nondrug treatments for chronic pain reveals similarly shaped distributions across modalities. Considering only duration of active treatment in efficacy or effectiveness trials, published evidence is no stronger for any major drug category or behavioral therapy than for opioids. [ABSTRACT FROM AUTHOR]

Background Consensus indicates that a comprehensive, multimodal, holistic approach is foundational to the practice of acute pain medicine (APM), but lack of uniform, evidence-based clinical pathways leads to undesirable variability throughout U. S. healthcare systems. Acute pain studies are inconsistently synthesized to guide educational programs. Advanced practice techniques involving regional anesthesia assume the presence of a physician-led, multidisciplinary acute pain service, which is often unavailable or inconsistently applied. This heterogeneity of educational and organizational standards may result in unnecessary patient pain and escalation of healthcare costs. Methods A multidisciplinary panel was nominated through the APM Shared Interest Group of the American Academy of Pain Medicine. The panel met in Chicago, IL, in July 2014, to identify gaps and set priorities in APM research and education. Results The panel identified three areas of critical need: 1) an open-source acute pain data registry and clinical support tool to inform clinical decision making and resource allocation and to enhance research efforts; 2) a strong professional APM identity as an accredited subspecialty; and 3) educational goals targeted toward third-party payers, hospital administrators, and other key stakeholders to convey the importance of APM. Conclusion This report is the first step in a 3-year initiative aimed at creating conditions and incentives for the optimal provision of APM services to facilitate and enhance the quality of patient recovery after surgery, illness, or trauma. The ultimate goal is to reduce the conversion of acute pain to the debilitating disease of chronic pain. [ABSTRACT FROM AUTHOR]

Service collaborations often must confront risks arising from problems of coordination, division, and defection. U.S. scholars have focused on understanding the efficacy of three general strategies to reducing these risks. First, the use of adaptive and restrictive contracts to reduce the risks from service characteristics has received a lot of attention. Second, scholars have studied how the use of different institutional arrangements reduces the risks of collaborative service provision. Third, attention has been devoted to understanding how the social networks of administrators and elected officials mitigate risk in sharing services. This article concludes with suggestions for future research on this topic. [ABSTRACT FROM PUBLISHER]

This research examines the joint effects of the tax and expenditure limits states impose on municipal and county governments on the structure of local government in 500 randomly selected U.S. counties. Understanding the contingent effects of these limitations is critical to assessing the consequences of TELs on the structure of local government in communities and the “circumvention” arguments common in this literature. We find evidence of a circumvention effect for restrictive limits on county governments, but not for the limits states place on municipal governments. Also, our findings indicate that the effect of increasing the limits on either government is to mitigate any circumvention effects created by limitations on the other. Our findings indicate that the circumvention question is more complex than previous works suggest. [ABSTRACT FROM PUBLISHER]

Analyses of local government contracting increasingly focus on understanding how the transaction costs created by service attributes limit opportunities for external service production. However, the institutional collective action framework suggests that networks among local government actors help to offset these costs for intergovernmental contracting decisions. We use data describing service production arrangements of cities in Michigan to examine the proposition that service production decisions are conditioned by the communication networks created through institutional linkages in addition to the transaction characteristics of services. We examine three different production options: (1) internal production, (2) joint or complete contracting with another government, and (3) production by a private or nonprofit organization, and find strong support for the expected role of transaction costs in these production choices. We also find that some types of networks created by institutions increase the likelihood that local governments will rely on intergovernmental service arrangements. [ABSTRACT FROM AUTHOR]

Objectives. 1) To investigate health status of older (≥60 years) and younger adults (<60 years) with chronic pain and to separately compare that with existing normative data; and 2) to examine more fully differences in health status between younger and older adults with chronic pain and explore their geographic variation across three multidisciplinary pain programs in the Pacific, Mountain, and New England regions of the United States. Design. We performed a cross-sectional analysis. Patients. Initial assessments of 6,147 patients dating from January 1998 to January 2003 were used. Outcomes Measures. We used the Treatment Outcomes of Pain Survey (TOPS), a disease-specific instrument that includes the Short Form-36. Results. The health status of the older pain patients in terms of their actual scores was comparable with that of younger pain patients across the three sites. Health status is impaired to a lesser degree in older than in younger adults with chronic pain as compared with normative adults. Statistically significant differences were found in a number of domains of the TOPS. Older adults with chronic pain present with pain intensity similar to that of younger patients with chronic pain, but report better mental health ( P < 0.002), less fear-avoidance ( P < 0.05), less passive coping ( P < 0.0001), more life control ( P < 0.05), and more lower body physical limitations ( P < 0.005) than younger patients with chronic pain. Conclusions. Older adults with chronic pain differ in a number of important domains from younger adults with chronic pain: overall the former present with greater physical, and less psychosocial impairment. [ABSTRACT FROM AUTHOR]

We identified 28 epidemiological surveys by applying a sensitive search in Medline and CancerLit databases, supplemented by hand searches. Only two surveys enrolled more than 10,000 patients with cancer. The remaining were hospital or clinic-based surveys of at most a few hundred patients. Fourteen surveys were conducted in the United States. The majority of the remaining studies were conducted in Europe (Finland, France, Germany, UK/Ireland). No single survey identified a prevalence of any type of pain below 14%. The prevalence of pain reported in these surveys varies with the specific type of pain (e.g., breakthrough pain) and/or population studied. Based on these surveys an aggregate statement could not be deduced regarding the correlation between the occurrence of pain and patient factors, disease characteristics, the setting in which care is provided (e.g., primary care or specialized oncology or pain treatment clinics), or specific treatments directed towards the underlying disease and its associated pain. However, these surveys suggest that a significant number of patients with cancer worldwide will, during the course of their disease, experience pain that requires medical and/or other treatment. [ABSTRACT FROM AUTHOR]

Lifestyle modification reduces the risk of developing type 2 diabetes and may have its effect through improving insulin sensitivity, β-cell function, or both. To determine whether diet and exercise improve insulin sensitivity and/or β-cell function and to evaluate these effects over time, we quantified insulin sensitivity and the acute insulin response to glucose (AIRg) in 62 Japanese Americans (age 56.5 ± 1.3 years; mean ± SE) with impaired glucose tolerance (IGT) who were randomized to the American Heart Association (AHA) Step 2 diet plus endurance exercise (n = 30) versus the AHA Step I diet plus stretching (n = 32) for 24 months. β-Cell function (disposition index [DI]) was calculated as Si x AIRg, where S[sub i] is the insulin sensitivity index. The incremental area under the curve for glucose (incAUCg) was calculated from a 75-g oral glucose tolerance test. Intra-abdominal fat (IAF) and subcutaneous fat (SCF) areas were measured by computed tomography. At 24 months, the Step 2/endurance group had lower weight (63.1 ± 2.4 vs. 71.3 ± 2.9 kg; P = 0.004) and IAF (75.0 ± 7.9 vs. 112.7 ± 10.4 cm² P = 0.03) and SCF (196.5 ± 18.0 vs. 227.7 ± 19.9 cm² P < 0.001) areas, greater Si (4.7 ± 0.5 vs. 3.3 ± 0.3 x 10-5 min ⋅ pmol[sup -1] ⋅ l[sup -1]; P = 0.01), and a trend toward lower AIRg (294.9 ± 50.0 vs. 305.4 ± 30.0 pmol/l; P = 0.06) and incAUCg (8,217.3 ± 350.7 vs. 8,902.0 ± 367.2 mg ⋅ dl-1 ⋅ 2 h-1]; P = 0.08) compared with the Step 1/stretching group after adjusting for baseline values. There was no difference in the DI (P = 0.7) between the groups. Si was associated with changes in weight (r = -0.426, P = 0.001) and IAF (r = -0.395, P = 0.003) and SCF (r = -0.341, P = 0.01) areas. Thus, the lifestyle modifications decreased weight and central adiposity and improved insulin sensitivity in Japanese Americans with IGT. However, such changes did not improve β-cell function, suggesting that this degree of lifestyle modifications may be limited in preventing type 2 diabetes over the long term. Diabetes 54:340-347, 2005 [ABSTRACT FROM AUTHOR]

Older driver safety is a growing public health concern for which interventions are currently being sought. Statistics show that older drivers suffer a disproportionately high rate of motor vehicle fatalities compared with other adult drivers. This disproportion is due to two factors: an increased crash rate per vehicle mile driven and an increased risk of fatality in the event of a crash. Traditionally, traffic safety efforts for the older population have focused on methods to identify unsafe drivers to enforce driving cessation, but driving cessation deprives the majority of older Americans of their primary form of transportation and has been associated with an increase in depressive symptoms. In response to these concerns, the Older Drivers Project, created by the American Medical Association in partnership with the National Highway Traffic Safety Administration, describes and advocates a more acceptable approach to traffic safety. The primary objective of this approach involves helping older drivers stay on the road safely to preserve their mobility and independence. This can be accomplished through three methods: (1) optimizing the driver, (2) optimizing the driving environment, and (3) optimizing the vehicle. In this approach, driving cessation is recommended only after the safety of the driver cannot be secured through any other means. [ABSTRACT FROM AUTHOR]

Examines whether state laws influence municipal annexations of unincorporated areas in the United States. Option by local governments to expand their boundaries; Range of powers available to local governments; Incentives to pursue this option; Impact of state rules on local boundary expansions; Findings which indicate that state rules designed to constrain annexation influence local boundary patterns.

Focuses on the age and health concerns in older adults who are driving in the United States. Things considered in driving assessment; Injury prevention measures; Referral sources and rehabilitation; Recommendations on discontinuing driving.

Assesses the development impacts of city-county consolidation by examining the attraction of manufacturing and retail/service firms for nine consolidated governments from 1950-1993. Regionalism through city-county consolidation; Research design and data description; Analysis.

The emerging North American trade bloc presents both challenges and opportunities for Mexico, Canada, and the United States. Free trade among disparate partners is a complex undertaking. The North American Free Trade Agreement (NAFTA) will bring important benefits to all three countries, but it will also raise many important issues. The sharp differences in wage rates, worker productivity, and education levels among the partners has fueled fears of job losses on both sides of the border. Disparity among NAFTA nations on labor practices, health and occupational safety laws and regulations are also sources of conflict. Effective dispute resolution mechanisms must exist for both the trade and non-trade issues. Practical guidance, in this regard, can come from the experience of the Canadian Free Trade Agreement(CFTA) and the European Economic Community (ECC; European Union since 1993). New political and administration mechanisms will be required to deal with each of these challenging issues. [ABSTRACT FROM AUTHOR]

The article offers insight on the consideration of pain as a public health issue. Topics discussed include an outline the development of strategies catering pain management, the National Pain Strategy with specific plans for pain management, the public health problem of chronic pain, and the overlap of the issues between public health and pain medicine.

In this article the author relates the optimization of coaching education in physical education teacher education (PETE) programs, in response to the lack of coaches in U.S. schools. The author mentions that PETE programs often lack of approach that would emphasize the coaching interests of its students, where he suggests "Quality Coaches, Quality Sports: National Standards for Sport Coaches (NSSC)." He also proposes coaching courses in preparation for a student's introduction to PETE programs.

An introduction to the journal is presented which features topics related to urban politics and U.S. housing policy.

The article looks at the findings of a U.S. study about the association of polymorphisms in genes encoding the transcription factor 7-like 2 (TCF7L2) and the pancreatic β-cell adenosine triphosphate (ATP)-sensitive potassium channel subunit Kirb6.2 (KCNJ11) with diabetes mellitus (DM) in Japanese Americans. The study found that only 2.4% of the subjects had the at risk T allele at rs12255372 which was not associated with DM. There was no association found between DM and the KCNJ11 variant.

Abstract: This article details a systematic review of medical evaluation forms in support of licensing decisions for medically at-risk drivers. Comparisons were made between all-inclusive forms utilized by 52 State and Provincial Departments of Motor Vehicles (DMVs) in the US and Canada. Comparisons focused on length, format, content, instructional quality, medical coverage, ease of use, and other qualitative characteristics. Median page length was 2 (range 1–10), and mean word count was 1083 (494–3884). Common response options included open-ended (98%), forced choice (87%), and check box (81%). While the majority of forms (77%) required driver consent, only 24% requested information from the driver. Less than half (46%) included text on confidentiality protection. While all forms requested general medical information, just over half included specific sections for vision (54%) and cognitive/neurological conditions (56%). Most forms (81%) required that a judgment be made concerning driver safety, and half prompted for possible license restrictions. Criterion-based quality ratings were assigned on a five-point Likert scale by group consensus. One third of forms were rated as marginal or poor in comprehensiveness and utility, and just two garnered an excellent overall rating. Findings are discussed relative to current research on driver fitness and elements of a proposed model form. Best practice recommendations include a page length limitation, emphasis on in-person evaluation (i.e., as opposed to a records-only review), prompts to collect crash and other driving history information, clear instructions and stepwise format, content prompts across relevant medical categories, documentation of functional status and impairment levels, options for driving with restrictions in lieu of de-licensing, and emphasis on relative (vs. absolute) clinical judgments of overall driver safety. [Copyright &y& Elsevier]