Patterns in Pediatric Dental Surgery under General Anesthesia across 7 State Medicaid Programs.

To two contrasting centres, to describe the provision of dental general anaesthesia (DGA) for simple non-surgical extractions in terms of the type of treatment provided, including the number of primary and permanent teeth extracted, and the characteristics of child patients attending in terms of their age group and gender. Retrospective analysis of hospital records. Data were drawn from records of services over a 12-month period in 1996/97 at: a) a London dental hospital (Centre 1), and b) in the community dental services in Rochdale, Lancashire (Centre 2). Information was collated and analysed using the SPSS statistical software package. The majority of patients at both centres were aged less than 9 years. Almost one third (31%) of those seen at Centre 1 were below 5 years of age, but fewer of this age group were treated at Centre 2. Children aged 9 years or less had an average of 5.4 (SD = 3.0) primary teeth extracted at Centre 1 and 3.0 (SD = 2.0) at Centre 2. For permanent teeth, an average of 3.2 (SD = 1.2) and 2.7 (SD = 1.4) were extracted at Centres 1 and 2 respectively. Both services were used primarily for the extraction of primary teeth although the services differed in the ages of patients who used them and in the numbers of teeth extracted. Numbers of patients attending the service at Centre 1 had declined over time but numbers of teeth extracted per child had increased.

Anesthesia for Office-Based Surgery: Are We Paying Too High a Price for Access and Convenience?

Despite early evidence touting the effectiveness of physician-provided oral health services (POHS), recent evidence suggests these services might have little impact on caries-related outcomes in children. General anesthesia (GA) is often used to treat early childhood caries and may be considered the most extreme utilization outcome. We sought to assess the impact of POHS utilization on dental GA utilization and expenditures. We used the Medicaid claims of a birth cohort of children born in 2008 in North Carolina (N = 32,558) to determine the impact of POHS on dental utilization and expenditures under GA for individual children. Children were followed until their eighth birthday. We analyzed the association of the number of prior POHS visits with visit-specific outcomes of dental treatment under GA using population-averaged models fit with generalized estimating equations with exchangeable working correlation structure. Children with 2 or more previous POHS visits had reduced odds of GA (odds ratio [OR] = 0.93; confidence interval [CI], 0.87-0.99; P = 0.029) and expenditures ($114; CI,-$152.61 to -$75.19; P < 0.001) compared to those without physician-provided oral health visits, adjusting for age, sex, race/ethnicity, and geographic residence. Dental expenditures did not differ between POHS and non-POHS subjects at non-GA visits. POHS decreased the odds of having dental GA treatment and dental expenditures at GA visits. The role of physicians in oral health care can reduce the impact on the most severe outcome-treatment under general anesthesia. The results of this study have important financial implications for state Medicaid programs and disease management programs trying to mitigate the costs of treating early childhood caries under general anesthesia. Children who receive physician oral health care are less likely to use and more likely to save money on general anesthesia to complete dental treatment.

The FDA Warning on Anesthesia Drugs.

The primary purpose of this study was to determine whether unconscious racial and ethnic bias influences nonverbal rapport-building communication during the presurgical anesthesia consult. A single academic center, observational study was conducted with enrollment of a balanced cohort of 102 White and minority group patients undergoing elective surgery in a level 1 trauma center and ambulatory surgery center between July 2021 and February 2022. This study was approved by the OHSU Institutional Review Board. Minority and White patients were matched by day of surgery and setting, trauma versus ambulatory center. Nonverbal communication (NSC) is a composite that takes into account different components of nonverbal behavior. These components are rated from 0 to 1 then added together to a final range of 0 (worst) to 4 (best). We examined (NCS) differences by minority status using a linear mixed-effects model with a random intercept to account for clustering by provider, adjusted for prespecified confounders of interest (provider minority status, sex, and experience level). Additional regression analyses assessed for post hoc confounding of NCS by patient health, surgical risk, and consult duration. NCS was not associated with American Society of Anesthesiologists physical status, surgical risk, or anesthesia consult duration. Multivariable analysis also found no significant association between patient minority status and NCS (coefficient estimate = - 0.07; 95% CI = [- 0.29,0.16]; P = 0.57). In this study, unconscious racial and ethnic bias was not associated with NCS, change in baseline anxiety, or patient management decisions among anesthesia providers. Trial Registration Time stamped publicly available protocol available on clinicaltrials.gov: https://clinicaltrials.gov/study/NCT04508543.

Today’s public health challenges are complex and link with living conditions and lifestyles of people. Our goal must be better health and well-being which is equitable and sustainable. It is clear that the disease burden affects populations unequally as a result of a complex interaction of socio-environmental determinants and the structure and function of health systems. The mechanisms are becoming better understood thanks to public health research. Oral health is a vitally important part of general health. This Conference focuses on the oral disease burden in Europe, the well-documented inequalities in the way it is experienced by different population groups and the necessary responses by health systems and by public health intervention. Thus, solutions to tackling this significant component of NCDs are greatly welcome. Overall we are doing well. Europeans continue to live longer and healthier lives than ever before; the differences in life expectancy and mortality between countries are diminishing; and premature mortality is decreasing. Meanwhile, oral diseases and related poor quality of life persist in Europe even in countries with advanced oral health care and high public expenditures for oral health. Profound challenges remain in Europe. The absolute differences in oral health status between countries are substantial, and within-country inequities remain. Unfortunately, there remain political, structural and professional obstacles in eliminating or reducing the key social determinants of oral health and in implementation of effective preventive programmes. We must absolutely rise to the challenge of unhealthy lifestyles. For example, if current rates of intake of sugars, tobacco use, and excessive alcohol consumption do not decline substantially our opportunities in preventing non- communicable diseases could be lost. This applies to oral health as well. (Eliminate) We must truly “leave no-one behind”. Policies that influence the social determinants help explain the health inequities that we see and the new forms of health vulnerability which affect particularly those whose health is already lagging. We must integrate and coordinate our responses to all of the determinants of health. Within the WHO European Region since 2012 we have established Health2020: a single health policy framework to guide our work. We have a variety of supporting strategies and action plans in place. The work carried out by our recently revitalised Oral Health Programme is consistent to the WHO Health2020 policy; this programme is part of the Division of Noncommunicable Diseases and Promoting Health through the Life-course. The concern for oral health is now incorporated into the “Action Plan for the prevention and control of noncommunicable diseases in the WHO European Region” which was just confirmed a few days ago by the Member States at the 2016 Meeting of the Regional Committee. Today the United Nations 2030 Agenda for Sustainable Development, and the Sustainable Development Goals (SDGs), together with Health 2020, give us an opportunity to establish a coalition for health to ensure that “no-one is left behind” in pursuing health and well-being for all. We need to secure good governance for health; policy coherence at regional, national and sub-national levels. and whole-of-government and whole-of-society efforts involving all stakeholders. National ownership, political commitment, the assessment of needs and robust planning combined with effective delivery are fundamental. The WHO document “Oral Health Surveys – Basic Methods” is most instrumental to the assessment of population needs, surveillance of oral health, and continuous evaluation and planning adequate delivery of services. Promoting intersectoral work amongst diverse actors is one of the key challenges. This requires the strengthening of accountability for health across the whole of government and society, as well as the implementation of Health in All Policies (HiAP). For oral health as for all health, we need strong and effective public health services to fight against health problems and to help us respond to needs. A focus on moving “upstream” towards health promotion and integrated disease prevention is most essential and we need people centred health services that work together. 11.30 – 12.15. Member’s presentations Saturday 1st October 2016.

The disease burden of Multiple Sclerosis from the individual and population perspective: Which symptoms matter most?

Introduction: The incidence of human papillomavirus-positive (HPV+) oropharyngeal cancer (OPC) has increased rapidly, and HPV early antigen serology has been proposed as a scalable and cost-effective early detection test. HPV seropositivity can precede clinical presentation of OPC by several years, so additional surveillance procedures may be necessary to optimize early cancer detection. The potential for HPV circulating tumor DNA (ctDNA) to confirm a diagnosis of OPC in seropositive individuals is poorly understood. Here, we assess the relationship between HPV serology and HPV ctDNA with disease burden in a large cohort of HPV+ OPC. Methods: We analyzed pre-treatment peripheral blood plasma from 262 patients with non-metastatic p16+ OPC treated with definitive (chemo)radiotherapy. A multiplex ELISA was used for serologic evidence of HPV proteins from 10 HPV genotypes, quantified by mean fluorescence intensity (MFI). Plasma HPV ctDNA was quantified by whole viral genome sequencing utilizing a custom HPV-targeted capture panel for 38 HPV genotypes. Gross tumor volume (GTV) was obtained from the sum of all target contours on computed tomography scans. Results: Both assays identified HPV16 as the most prevalent genotype (84%), with results indicating a total of 4 and 6 HPV genotypes for serology and HPV ctDNA, respectively. HPV ctDNA results demonstrated higher sensitivity and lower cross-reactivity between HPV types compared with HPV serology results. Furthermore, HPV ctDNA but not HPV16 E6 antibody levels were positively associated with disease burden as determined by N-category (Table 1) and tumor volume (ctDNA vs GTV, r=0.48 p=6.4e-13; E6 vs GTV, r= -0.079 p=0.26). Conclusion: This is the largest cohort to compare HPV serology and ctDNA results in OPC. These findings highlight the potential for ctDNA to augment future strategies for blood-based early detection of HPV+ OPC. Citation Format: Lucas Penny, Eric Y. Stutheit-Zhao, Birgitta E. Michels, Fabian Rosing, Jinfeng Zou, Zhen Zhao, Yangqiao Zheng, Shao Hui Huang, Johnny Carlton, Andrew McPartlin, John R. de Almeida, David Goldstein, Andrew Hope, Ali Hosni, John Kim, Fei-Fei Liu, C Jillian Tsai, John N. Waldron, Anna Spreafico, Enrique Sanz Garcia, Lillian L. Siu, Tim Waterboer, Geoffrey Liu, Scott V. Bratmn. HPV serology and circulating viral DNA for detection, genotyping, and measurement of disease burden in oropharyngeal cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 680.

STUDY AIM To bolster Crohn’s disease (CD) clinical trial and research infrastructure through the development and validation of a sensitive, multifactorial, disease-specific, patient-reported outcome measure (PRO) for patient monitoring in therapeutic trials of CD. BACKGROUND As therapeutic advancements are made in the field of CD, it is vital to have a fully validated, sensitive, and reliable, disease-specific PRO to accurately measure changes in disease burden. Importantly, the U.S. Food and Drug Administration has encouraged the use of PROs to measure therapeutic benefit of new treatments on patient populations. This research describes the creation, testing, and validation of a new, multifactorial PRO: The Crohn’s Disease-Health Index (CD-HI). METHODS Questions were selected for the CD-HI based on their importance to patients, potential to respond to therapeutic benefit, reliability, internal consistency, and generalizability (Figure 1). We beta tested the CD-HI to evaluate its clarity, ease of use, and applicability to the CD patient population. We performed test-retest reliability, known groups validity, internal consistency, and area under the curve (AUC) analyses. RESULTS The final version of the CD-HI contains 12 subscales that measure disease burden in the following areas: 1) fatigue, 2) dietary restrictions, 3) gastrointestinal health, 4) sleep and daytime sleepiness, 5) bowel and bladder function, 6) emotional wellbeing, 7) joint health, 8) pain, 9) neck and back health, 10) activity participation, 11) social wellbeing, and 12) skin health. The CD-HI also provides a composite measure of total disease burden. Fifteen participants participated in beta testing and identified the CD-HI as easy to use, clear, relevant, and comprehensive. Twenty-three individuals with CD participated in test-retest reliability testing of the CD-HI, which indicated a high reliability of the individual questions, subscales, and full instrument (intraclass correlation coefficient = 0.84 for the full instrument). The CD-HI and its subscales demonstrated a high internal consistency (Cronbach’s α = 0.98 for the full instrument). The CD-HI total and subscale scores successfully distinguished between patient cohorts with differing disease severity. AUC analysis demonstrated a high sensitivity and specificity of the CD-HI in distinguishing between those with CD on disability vs. not on disability, with an AUC value of 0.9087 (Figure 2). CONCLUSIONS The CD-HI is a fully validated, sensitive, and accurate marker of disease burden in CD. This disease-specific PRO is available for use by researchers, clinicians, patient organizations, and companies to monitor patients and measure disease burden during therapeutic trials

The effects of global change on semi-natural and agro-ecosystem functioning have been studied extensively. However, less well understood is how global change will influence fungal diseases, especially in a natural ecosystem. We use data from a 6-yr factorial experiment with warming (simulated using infrared heaters) and altered precipitation treatments in a natural Tibetan alpine meadow ecosystem, from which we tested global change effects on foliar fungal diseases at the population and community levels, and evaluated the importance of direct effects of the treatments and community-mediated (indirect) effects (through changes in plant community composition and competence) of global change on community pathogen load. At the population level, we found warming significantly increased fungal diseases for nine plant species. At the community level, we found that warming significantly increased pathogen load of entire host communities, whereas no significant effect of altered precipitation on community pathogen load was detected. We concluded that warming influences fungal disease prevalence more than precipitation does in a Tibetan alpine meadow. Moreover, our study provides new experimental evidence that increases in disease burden on some plant species and for entire host communities is primarily the direct effects of warming, rather than community-mediated (indirect) effects.

BackgroundAllocation of health research funds among diseases has never been evaluated in China. This study aimed to examine the relationship between disease-specific funding levels of National Nature Science Foundation of China (NSFC), the main governmental resource for health research in China, and burden of disease.MethodsFunding magnitudes for 53 diseases or conditions were obtained from the website of NSFC. Measures of disease burden, mortality, years of life lost (YLLs) and disability-adjusted life years (DALYs), were derived from the Global Burden of Disease Study 2010. The relationship between NSFC funding and disease burden was analyzed with univariate linear regression. For each measure associated with funding, regression-derived estimates were used to calculate the expected funds for each disease. The actual and expected funds were then compared. We also evaluated the impacts of changes of disease burden metrics since 1990, and differences from the world averages on NSFC funding.ResultsNSFC health research funding was associated with disease burden measured in mortality (R = 0.33, P = 0.02), YLLs (R = 0.39, P = 0.004), and DALYs (R = 0.40, P = 0.003). But none of the changes of mortality (R = 0.22, P = 0.12), YLLs (R = −0.04, P = 0.79) and DALYs (R = −0.003, P = 0.98) since 1990 was associated with the funding magnitudes. None of the differences of mortality (R = −0.11, P = 0.45), YLLs (R = −0.11, P = 0.43) and DALYs (R = −0.12, P = 0.38) from that of the concurrent world averages were associated with the funding magnitudes. Measured by DALY, stroke and COPD received the least funding compared to expected; while leukemia and diabetes received the most funding compared to expected.ConclusionAlthough NSFC funding were roughly associated with disease burden as measured in mortality, YLLs and DALYs. Some major diseases such as stroke were underfunded; while others such as leukaemia were overfunded. Change of disease burden during the last 20 years and country-specialized disease burden were not reflected in current allocation of NSFC funds.

In order to strengthen local health policies, a study was initiated to measure the burden of disease (BOD) at local household level in a rural population in a desert district in India. The association of selected variables with BOD at household level was investigated in an attempt to reduce BOD through easy-to-execute public health measures. Nine hundred households from 30 villages were surveyed. BOD percentages (BOD%) according to age- and sex-based distribution in households were found to be increasing with age, up to the age of 45 years, and across this age spectrum BOD%s was lower among females than males; this trend was, however, reversed in favour of males in persons older than 45 years. Among the BOD% shared by dichotomised variables determined for each household, cattle-keeping inside houses was found in 93% of the households, as opposed to keeping cattle outside houses. This significant variable was followed by water storage pattern (91%), sharing of sleeping space (76%), economic status (90%) and non-cemented houses (73%), all with high statistical significance at p .01) with a share of 62%. BOD% of electricity provision and sanitation practices did not reach statistical significance (p>.05) in this setting. Thus the first three variables with significant association with BOD listed above were identified as priority targets against which easy-to-execute measures could be instituted by health authorities.

In Japan, the burden associated with myocardial infarction (MI) and ischemic stroke as well as atherosclerotic cardiovascular disease (ASCVD) generally is high. One key element in measuring disease burden is years of life lost (YLL). The aim of this study was to understand the burden of these diseases by estimating YLL at an overall disease level and average person-YLL (PYLL), a measure of disease burden also used in prior studies. Because calculation of YLL and PYLL involves inputs such as disease prevalence, disease-related mortality by age, and general population mortality by age and sex, we searched public databases of disease surveillance to identify comprehensive Japanese-specific inputs. For our reference analysis, disease-specific prevalence and mortality were taken from the Institute for Health Metrics and Evaluation Global Disease Burden study, and background mortality data were from the Japanese life tables published by the Ministry of Health, Labour and Welfare. The average age of patients with MI or stroke was 74 and 70 years, respectively. On average, men comprised 59% and 54% of the MI and stroke population, respectively. The disease-level burden of ASCVD (inclusive of MI, stroke, and peripheral artery disease) was 2,703,711 YLL in 2017. The patient-level burden was 11.99 PYLL for MI and 9.39 PYLL for stroke. The burden of ASCVD, MI, and stroke in terms of premature mortality is substantial in Japan, both on a population disease level and an individual patient level.

The burden of oral diseases is rising in India, affecting individuals across all socioeconomic strata. Although the National Oral Health Policy and Programme aim to improve access to affordable and quality healthcare through public facilities, challenges in implementation persist. In Kerala, oral disease prevalence is high despite a dentist-to-population ratio four times higher than the WHO’s recommendation. In a context where private healthcare providers dominate service delivery and out-of-pocket expenditure remains high, it is essential to explore the perspectives of public sector dental professionals on the delivery and utilisation of existing services in government dental outpatient centres - to reinforce current capacities and develop strategies to address service gaps. A qualitative study was conducted through interviews (key informant and in-depth) with public sector dental healthcare providers. Thematic analysis was used to interpret the data. Providers identified facilitators such as affordability of services, responsive administration, outreach activities, and additional government schemes in the service of vulnerable groups. Key barriers identified were staffing shortages, infrastructural limitations, and insufficient oral health literacy. To address these gaps, providers recommended expanding the dental workforce, upgrading infrastructure with dental laboratories, and promoting oral health awareness in schools and communities. Insights from public sector dental healthcare providers highlight important systemic and policy-level factors underlying service provision and utilisation. These perspectives are vital for developing contextually responsive strategies to enhance the capacity of existing public dental services amidst growing disease burden.

The purpose of this paper is to describe the Hispanic/Latino (H/L) dentist workforce, their general practice patterns, and their contributions to oral health care for H/L and underserved patients. A national sample survey of underrepresented minority dentists was conducted in 2012 and received a 35.4 percent response rate for self-reported H/L dentists. Data were weighted for selection and response bias to be nationally representative. A workforce profile of H/L dentists was created using descriptive and multivariable statistics and published data. Among all H/L dentists (weighted n = 5,748), 31.9 percent self-identify their origin as Mexican, 13.4 percent as Puerto Rican, 13.0 percent as Cuban, and 41.7 percent as another H/L group. The largest share of H/L dentists are male, married, and have children under age 18. Fifty percent of H/L dentists are foreign-born and 25 percent are foreign-trained. H/L dentists report higher than average educational debt, with those completing International Dentist Programs reporting the highest debt load. Sixty-nine percent of clinically active H/L dentists own their own practices, and 85 percent speak Spanish in their practice. Among clinical H/L dentists, 7 percent work in safety-net settings, 40 percent primarily treat underserved populations, and, on average, 42 percent of their patient population is H/L. H/L dental providers are underrepresented in the dentist population, and those that are in practice shoulder a disproportionate share of dental care for minority and underserved communities. Improving the workforce diversity of dental providers is a critical part of strategy to address the high burden of dental disease in the H/L population.