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Background Periodontitis has been shown to be associated with allostatic load, a measure of physiological instability across biological systems from cumulative or repeated adaptation to stressors. Minority racial/ethnic and low socioeconomic groups tend to have higher prevalence of periodontitis and are more likely to be exposed to stress. The association between periodontitis and allostatic load and whether this association differed by race/ethnicity, education, income and age among US adults were examined. Methods Using data from the National Health and Nutrition Examination Survey 1999–2004, prevalence ratios were calculated using logistic regression to estimate the strength of the association between allostatic load and the prevalence of periodontitis before and after adjusting for selected characteristics. Results After adjustment for selected characteristics, including race/ethnicity, income and education, US adults with a high allostatic load were 55% (95% CI 1.05 to 2.29) more likely to have periodontitis than their counterparts with low allostatic load. This association varied by race/ethnicity where Mexican Americans with a high allostatic load were almost five (PR 4.62; 95% CI 2.52 to 8.50) times more likely to have periodontitis than their counterparts with low allostatic load. Conclusions These data suggest that stress may be associated with periodontitis in the USA, with Mexican Americans exhibiting the strongest association. Furthermore, this group may lack appropriate coping responses to process chronic stressors that other groups may have historically been conditioned to handle. More research is needed to understand allostatic load in Mexican Americans and its influence on periodontitis. [ABSTRACT FROM PUBLISHER]

Background and Objectives: The Vaccines for Children Program (VFC) provides vaccines for children who may not otherwise be vaccinated because of financial barriers. Pediatrician participation is crucial to the VFC's ongoing success. Our objectives were to assess, among a national sample of pediatricians, (1) VFC program participation, (2) perceived burden versus benefit of participation, and (3) knowledge and perception of a time-limited increased payment for VFC vaccine administration under the Patient Protection and Affordable Care Act., Methods: An electronic and mail survey was conducted from June 2017 to September 2017., Results: Response rate was 79% (372 of 471); 86% of pediatricians reported currently participating in the VFC; among those, 85% reported never having considered stopping, 10% considered it but not seriously, and 5% seriously considered it. Among those who had considered no longer participating ( n = 47), the most commonly reported reasons included difficulty meeting VFC record-keeping requirements (74%), concern about action by the VFC for noncompliance (61%), and unpredictable VFC vaccine supplies (59%). Participating pediatricians rated, on a scale from -5 (high burden) to +5 (high benefit), their overall perception of the VFC: 63% reported +4 or +5, 23% reported +1 to +3, 5% reported 0, and 9% reported -1 to -5. Of pediatricians, 39% reported awareness of temporary increased payment for VFC vaccine administration. Among those, 10% reported that their practice increased the proportion of Medicaid and/or VFC-eligible patients served on the basis of this change., Conclusions: For most pediatricians, perceived benefits of VFC participation far outweigh perceived burdens. To ensure the program's ongoing success, it will be important to monitor factors influencing provider participation., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)

Robotic systems in surgery have developed rapidly. Installations of the da Vinci Surgical System® (Intuitive Surgical, Sunnyvale, CA, USA), widely used in urological and gynecological procedures, have nearly doubled in the United States from 2010 to 2017. Robotics systems in spine surgery have been adopted more slowly; however, users are enthusiastic about their applications in this subspecialty. Spinal surgery often requires fine manipulation of vital structures that must be accessed via limited surgical corridors and can require repetitive tasks over lengthy periods of time - issues for which robotic assistance is well-positioned to complement human ability. To date, the United States Food and Drug Administration (FDA) has approved 7 robotic systems across 4 companies for use in spinal surgery. The available clinical data evaluating their efficacy have generally demonstrated these systems to be accurate and safe. A critical next step in the broader adoption of surgical robotics in spine surgery is the design and implementation of rigorous comparative studies to interrogate the utility of robotic assistance. Here we discuss current applications of robotics in spine surgery, review robotic systems FDA-approved for use in spine surgery, summarize randomized controlled trials involving robotics in spine surgery, and comment on prospects of robotic-assisted spine surgery.

Objective: To examine linkages between mitochondrial genetics and preterm birth by assessing the risk for preterm birth associated with the inheritance of nuclear haplotypes that are ancestrally distinct from mitochondrial haplogroup., Study Design: Genome-wide genotyping studies of cohorts of preterm and term individuals were evaluated. We determined the mitochondrial haplogroup and nuclear ancestry for individuals and developed a scoring for the degree to which mitochondrial ancestry is divergent from nuclear ancestry., Results: Infants with higher degrees of divergent mitochondrial ancestry were at increased risk for preterm birth (0.124 for preterm vs 0.105 for term infants; P< .05). This finding was validated in 1 of 2 replication cohorts. We also observed that greater degrees of divergent ancestry correlated with earlier delivery within the primary study population, but this finding was not replicated in secondary cohorts born preterm., Conclusions: Individuals with divergent patterns of mitochondrial and nuclear ancestry are at increased risk for preterm birth. These findings may in part explain the higher rates of preterm birth in African Americans and in individuals with a matrilineal family history of preterm birth., (Copyright © 2017 Elsevier Inc. All rights reserved.)